Masha Slonim: Why do we berate and yet love the NHS

In England, it’s a custom to complain about the National Health Service, NHS.

In England, it’s a custom to love the National Health Service, because we can’t live without her, our old lady.

Yes, she’s old, has recently celebrated her seventieth anniversary. Yes, she’s grown flabby, but we don’t have another service.

I understand why the NHS gets berated and I’ll tell you about it. But first, I want to begin with explaining why I love it.

During the last year or so I had a chance to get to know the NHS better. Previously, I would talk to my GP from time to time on minor occasions, and it had always been pleasant, as pleasant as a conversation with your doctor can be. Fast, professional, sympathetic. It’s said that the situation is worse in London, my sister’s experience, who lives in the capital, isn’t as happy as mine, who lives in the country. I’m registered with three clinics in three different villages. It doesn’t matter much to me as a driver where to go as long as a doctor agrees to see me, but such an abundance of clinics is for those who can’t drive as freely and choose one closer to home. Unlike me, my sister is registered with one clinic that has one GP in attendance. One can imagine how long a person sometimes has to wait to have an appointment! Sometimes for weeks. But that’s one of the reasons why people complain about the NHS. And I continue to explain why I love it.

Those two times when I needed an ambulance (after a car accident in Moscow region and a broken sternum I had a series of lung swellings and as a result almost died from the bronchospasm), I was treated with care, tenderness and professionalism. The ambulance came instantly; I was resuscitated, and they got me back on my feet. And after I had been brought back to life at the Royal Devon and Exeter hospital a miracle happened that can be explained only by the healing qualities of the NHS – I suddenly gave up a 50-year-old smoking habit. But this is only between me and the NHS; it’s personal and cannot be generalized.

After the hip replacement surgery at our Royal Devon and Exeter hospital, I’ve completely fallen in love with the NHS! And it’s not just about this surgery being performed for free – as any other surgeries in the NHS, planned or unplanned. NHS services for all citizens and residents lawfully residing in the UK are always free, we pay the National Insurance levy for good reason. No, it’s about how good these services were and how quickly I recovered. In 10 day I could walk without a stick, let alone crutches that I didn’t need on the fifth day. Yes, I had to wait about a year, there were many emergency hospitalizations, and there aren’t enough beds in the hospitals… The winter was hard, the outbreak of flu and other diseases… I waited patiently and it was worth it.

When I was in a hospital last time, doctors and nurses were amazingly affectionate and caring. And, as we know, they have to work very hard; hospitals are in dire need of workers. So let’s get to the shortcomings of the NHS.

Why we don’t like the NHS: long A&E waiting times.

A&E is a hospital department where you can obtain the urgent medical treatment going there yourself or being brought by your family members. NHS established the maximum waiting time – a patient shouldn’t wait in such a queue for more than 4 hours.  Don’t get me wrong, if you’re dying, you’ll get treatment earlier than that. There’s a nurse who examines you, measures blood pressure, etc. and decides how urgently you need to get help. When I brought my sister who was bitten by a dog and had a serious infection, she immediately got sent to a surgeon and was hospitalized and put on a drip for a week. But those who’re in need of less urgent treatment have to wait for 4 hours and more. The NHS is short of staff! Hospitals are well-equipped, but some still have large patient wards with lots of beds, remnants of the Victorian times. I was lucky to get single rooms during my stay. And I also was lucky (if it might be called luck) to get screened because people taken to a hospital by an ambulance immediately get an X-Ray or even an MRI scan. Under normal circumstances, one can wait for an MRI screening for months. The NHS is short of staff!

Why? Why does the NHS always struggle despite the regular infusion of money? The answer – there’s too many of us and we live too long! Current life expectancy is 13 years higher than 70 years ago when the NHS was created. Of course, it’s good that cancers and heart attacks are not murderers anymore, but a population gets older and requires increasingly more medical care. The average 65-year-old costs the NHS 2, 5 times more than the average 30-year-old, 85-year- old costs more than 5 times as much. By the way, all pensioners registered with a clinic get their medicines for free. Naturally, it’s a major item of expenditure. The older the person, the more medicines he needs.

We became more numerous because of the immigrants. I mean legal immigrants who are entitled to the free NHS services. I used to be an immigrant myself and also enjoyed all these advantages, paying, of course, both taxes and the National Insurance levy. But this money apparently isn’t enough. During 2016-2017 the government spent 10 times more than 60 years ago, taking into account inflation. 30 % of all budget funds reserved for the service sector are spent on health. Theresa May promised to deliver a bigger cash injection to the NHS in the next budget – at the cost of higher taxes for us of course.

Another problem is that the system is large, unwieldy and too full of red tape like all large organizations. And the NHS is truly gigantic. It receives one million patients a day, it has a staff of almost 2 million people. The NHS ranks in fifth place among the largest employers in the world. Every year there’s talk of reforming the health service, but not much progress has been made. And this time the Prime Minister talked of more money for the NHS, provided that the reforms of the service are carried out.  

In the 70 years of the NHS’s existence, the NHS spending has been increasing by 4 % every year on average, mostly thanks to the higher taxes and cuts in defence spending. But it isn’t enough as well. Recently Theresa May announced that the NHS would get «a birthday gift» of 20 billion pounds in the next five years. But even with a bigger cash injection, the problem can’t be solved instantly. The service has many vacancies for doctors and nurses, but it’ll take time for the new doctors and nurses to complete their training and fill these vacancies. The problem is there aren’t many people in Britain who want to be nurses.  

«In order to carry out surgeries and take care of patients, we need not only doctors but nurses, health care assistants, radiography assistants, imaging support workers, porters, cleaners and secretaries. A government can’t raise their salaries to a good level, and we have the chronic shortage of them. They’re the main targets of cost reduction. You can’t save money on doctors,» tells me Andrey Varvinsky, a consultant and an anesthesiologist of the Torbay Hospital. «That’s why there’s such a large amount of all these people from different EU countries in our hospitals». But even now, he says, they’re understaffed. «I want to transfer a patient to an intensive care after surgery, come there and see empty beds. So we have places! BUT! There’s nobody to serve them!».

And here we’re getting closer to what can await hospitals in the near future – namely, a problem starting with a letter «B». «After Brexit, it’ll become even worse,» Varvinsky says. «There will be even fewer people without whom hospital can’t function. Our nurses are still in training, and not many people are rushing to work for such low wages, and those who came from the EU are already leaving us. More than that, many of my colleagues are also leaving the country and move to other English-speaking countries – Canada, New Zealand, Australia. I can get a job anywhere tomorrow. Everything is hard, but I don’t want to go away yet. And that is to say nothing of what’s going to happen to the medical supplies and equipment if we leave the customs union without a deal. It’s a catastrophe.»

Still, we love our NHS. Here is an example of people’s attitude towards it. I saw that at Royal Devon and Exeter hospital, but it exists in all British hospitals. I talk about the services provided by volunteers. When you come to a hospital, you see a prim 80-86-year-old lady at the reception. She’d point you in the right direction, can show you to the place or write instructions on a piece of paper. Such old ladies can be found not only in the main hall but in offices of all hospital departments. And all of them work for free.

Andrey Varvinsky tells me: «We have lots of volunteers. By the way, there’s a small stall of «the League of Friends of the hospital» where pensioners work as well. They make sandwiches and salads at home and sell them cheaper than in any other food establishment at the hospital. They’re especially helpful to me because they bring a food trolley to the A&E every morning so that I didn’t have to get distracted by going to our hospital restaurant and could eat at a coffee room of the A&E, buying a tasty home-cooked food from them! And again, for a smaller price. They take money only to cover the costs of the ingredients. All profits are used to buy things that our hospital needs most and the government can’t afford to provide. This way our «League» bought us a CT scan and the da Vinci Surgical System. I think it’s clear what price bracket we’re talking about – it’s a six zero figure».

I would love to end on this really optimistic note. But it isn’t clear what will happen in the future to our beloved/hated NHS without which we can’t live (literally). In any case, £350 million a week for the NHS if Britain leaves the EU promised by the proponents of Brexit before Referendum turned out to be a fairytale, unlike Brexit that is real and will come soon. Is our 70-year-old lady strong enough to handle it?