NHS: get help or die trying

Four months after the diagnostic procedure and, at last, the time for a long-awaited appointment with the specialist, who will explain to me its results, has come. No matter what is it: Gastroscopy, ECG or X-ray, — it is a normal routine for the NHS, that one doctor orders the procedure, the other executes it and the third one explains the results to the patient. The time-gap between the order, execution and explanation varies from three to eight months.

A young doctor who had burst into the room just 5 minutes ago tells me without even catching his breath that my test results are OK, apart from insignificant gastritis that will, in time, go away all by itself which is, apparently, also OK. Further, he advised, that I stop taking medication I have been prescribed for some time. If the symptoms persist I would need to start the whole process of having it prescribed again. The appointment took 5 minutes. The doctor was not the same one, who talked to me about my condition and who ordered the procedure 8 months ago. So, this one, having learned about my existence just 5 minutes ago, in the next five minutes understood my diagnosis, evaluated my medical history, cancelled therapy that brought me much relief, waved adieu — I’ll never see him again.

Not that I am complaining: who knows, maybe he is right, everything is OK with me, and I have just witnessed how superbly efficient this system is. I have witnessed such happy occasions during my time here in England. Unfortunately, they are very rare when it comes to the NHS.

For instance, my son has been waiting for the minor but extremely important, in the long run, surgical procedure for two years. During this time the system managed to forget about the procedure, although already scheduled, after that we have to go along the whole “chain of command” again: GP referral (week-long waiting time), appointment with the specialist doctor (three to six months waiting time), the procedure itself (three to six months waiting time). Then my son reached the age and automatically was transferred from “a child” category to “an adult” category, which brought us to the square one. Again. As a result — two years and a very unpleasant, on the edge of being dangerous, level of his condition.

The Ilizarov frame, stuck out from the foot of my friend after two not quite successful surgeries, five hours of waiting in the A&E reception room with the kid with the injured head and even the case of death of the patient, while waiting to be attended — I am sure, almost every one of us, living in Britain, has a story to tell about the NHS.

As many others, whose stories ended very well, who praise the NHS. That is also the truth. The system is good at saving lives as well as treating severe conditions.

For Britain and the British, the NHS is the philosophy, the way of living, talk of the town, the holy cow and the monster, all in one, a whipping boy and the Agnus Dei.

For the newcomers, those who just arrived at the UK to live, especially from Russia or former Soviet republics, the first encounter with the NHS can be overwhelming. To see the GP on the day of asking — you have to have a really serious reason. If your condition isn't alarming, you could wait up to the week to see the doctor. In case of the severeness of your condition, and if your GP does not have a time slot, you have to go to A&E. On weekends you will have to go to A&E.

There are walk-in centres in some areas, where you could walk in without an appointment and be served on the “first come first served” basis. Unfortunately, it is not always the case, that you have both, GP surgery and walk-ins in your area.

The principle of GP routine is one appointment — one problem. If you have another problem, then you have to make another appointment. You also won’t get antibiotics straight away. The system normally starts with the “wait and see, maybe it will go by itself” routine. Only if your body refuses to meet the expectations, the system gives up and prescribes you heavy artillery such as antibiotics.

For those, who come from Russia or similar countries, it may be hard to accept the fact, that there is no such service as doctor home visits. Neither GP nor ambulance will come to those who have flu or even appendicitis. Almost in all cases, you will have to go there by itself.

But all this aside, when it comes to the real thing, like a serious surgery, the system will take you on board and do the business at the highest standard it can provide: with full care and devotion, with the highest technology at hand, and absolutely free of charge. You will not have to pay anything to the nursing personnel or bring your own bed-linen. Anaesthesia, medication, technology as well as skills of super-surgeons, everything will be “on the house”, or, to be precise, on the tax-payers.

After almost fifteen years in England, I have learned to treat my health the British way: it is bad taste to bother the doctors with nickel-and-diming, but if I die — they will take me from the grave. Well, let’s say, I try to believe it.

Most sparkles on the NHS’ topic, however, are flying on the political grounds. In fact, it is the NHS, together with the immigration issue, that has been most frequently mentioned as the main reason for the Brexit.

On her page on Facebook my British friend wrote recently, complaining, that the UK has the biggest number of immigrants per the square meter, than any other European country. Although those numbers were inaccurate, the problem was not only this. Her opponents reminded her, how grateful she was, after undergoing long-term treatment for cancer, for African nurses, Pakistani oncologists, Polish anaesthesiologists and so on around the globe. My friend argued that she is more than happy to see immigrants if they are highly skilled professionals, but those who come to occupy hospitals’ beds are not welcomed. In her opinion, Brexit will not prevent the former from coming but will stop the torrent of the later.

As if the things were that easy.

It is true that the NHS’ capacities have lately been pushed to the limits, dealing with the stream of patients from, literally, all over the world. In countries like Germany (mostly), France (to a lesser degree, which is surprising, considering relatively low costs for the medical services there), medical tourism leads to quite hefty profit for all participants. While in the UK, a lot of medical services were, and some still are, free of charge, for everyone, not only for British nationals.

According to the “Duty of Care” principle, members of the NHS’ medical staff are obliged to render required medical assistance, free at the point of need or contact, to everyone, who comes at the A&E door, without any kind of discrimination on the religious, national, social or, if to be specific, immigration grounds.

Until recently, this has been going far beyond that point of need or contact. Once the patient has fallen in the hands of the system through the A&E service, he would have received full treatment, until his condition is sustainable, or even, which was frequently the case, to the full recovery, which could include expensive surgeries or other therapies. People from Africa, Asia and the Middle East come here with the whole bouquet of diseases for the free treatment. At least, that was the story until very recently.

I do not know, whether it was a coincidence or not, but almost at the same time with the Brexit/Remain referendum, the NHS  introduced measures to limit this free access to the all-you-can-eat medical buffet. Now, at least on paper, the non-British patients, albeit still receiving an emergency care when needed, for the further actions, if required, will be asked to cover the costs.

Fortunately or unfortunately, this is the two-way street, as there aren’t only non-British patients we are talking about, but non-British personnel as well. 12,5% of total NHS staff are foreigners. A little shy of the half of this figure came from EU countries, the rest is from Asia and Africa. And this stats are for the NHS staff as a whole. The picture is a bit more interesting if we talk about the proportion of foreign doctors in the NHS, as about 26% of the total number of doctors are foreigners. 12% of doctors are from Asia (India and Pakistan mostly), 10% came from EU countries and 3% are of African nationalities. As they say, the NHS relies heavily on its foreign staff.

We can’t say for sure how Britain will treat the high skill professionals’ issue after the Brexit is final. There is alarming news, coming from some media, that only at the beginning of this year a substantial number of applications for visas from foreign doctors was declined.

To add insult to injury, serious concerns have been voiced regarding the British universities and their quite alarming policy of preferring foreign students to their own straight A-s applicants. Major concerns were raised about the Medical degrees, where, one year, 700 bright British boys and girls were turned down in favour of applicants from abroad. The main reason for such policy, as suggested, is the fact, that the foreigners are paying more than three times bigger fees, in cash (for instance, British and EU students’ fees, the same for any degree, are £9,250, a foreign student will pay £35,000 for the Medical degree). British students are forced to apply to the universities in Eastern Europe (where, by the way, they did not hesitate to catch the wave, opening English-speaking courses on their campuses) in order to get the Medical degrees. This option also could be put at risk in light of the forthcoming Brexit.

All of the above, of course, are the assumptions mostly, however not unfounded, so very distressing all the same. And if, just if, those assumptions become a reality, then two years waiting time for the surgery, eight months for diagnosing a minor and obvious condition, half a day waiting for help at the A&E, would seem like highly efficient service for us.

As for now, this whole HNS experience looks more like a bloody lottery: get help or die trying. Yet, if people will make a habit of dying in the NHS’ waiting rooms, who knows, maybe British universities will start favouring its own Medical students again. Otherwise, what use is of this stupid Brexit issue?



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