Guest Blog: More Lies About The NHS
Posted by Merk
December 7th, 2009
The following is a copy of a post made by Dr. Alienfromzog (an NHS Doctor) debunking Richard Littlejohn’s recent misinformed and frankly pathetic swipe at the NHS. The orignial article can be found at Angry Mob. We republish with kind permission.
There must be something wrong with me. I read Richard Littlejohn’s column from 30th November (Thank heavens my sick mum wasn’t at the mercy of the NHS) and I didn’t get angry.
Was this because I agreed with what RLJ had to say?
No.
Was this because RLJ extensive research had led to a well thought-out argument that I found interesting?
No.
Was it because his column contained some facts for a change?
No.
So why wasn’t I angry?
Simply because it was RLJ being RLJ and I’m told you shouldn’t shoot a duck for quaking.
Normally this kind of thing makes me really very very angry. I have a small confession to make at this point. I am an unrepentant apologist for the NHS. I work in it, I am aware of its limitations and issues and I could write long articles on what’s wrong with it. I don’t for three reasons. Firstly, the NHS is much – and unfairly – maligned. Two, the problems of it are almost always different to the issues raised in the press. And thirdly, and much more importantly, the NHS is an amazing thing and whilst it does have issues they are, in the real world, a price well worth paying for comprehensive healthcare. I am proud of the healthcare the vast majority of patients receive and the work we do in the NHS. It is hugely frustrating to see this constant abuse in the press. And it’s not just about the shear insult of this but every week I have to deal with the anxiety created in patients before they even make it to the hospital door. Of course, it is not surprising that anyone who reads our papers is scared of being admitted to hospital.
So, let’s summarise RLJ argument;
1.His mother was involved in a traffic accident and was well looked after in a hospital in the states.
2. The NHS might have killed her because all British hospitals are dirty and you will pick up a deadly disease in you are unfortunate enough to be admitted one.
3. American Healthcare is great and insurance works while the billions we spend on the NHS are a waste as there’s no good outcomes or accountability.
If I only I knew where to begin with this. I must warn any brave readers that in order to write this I have done some actual research and have provided references at the bottom so that all the facts can be checked. That’s right – this article ought to come with a health warning to anyone who reads RLJ regularly; WARNING, the following contains actual facts and not RLJ delusions.
MRSA
I think I want to begin by talking about MRSA. To be fair to Littlejohn, almost no one in the press gets this right. My own personal rant is that MRSA is NOT a superbug. (E.coli 0157 now that’s another matter…. sorry, getting of the point). MRSA stands for Methicillin resistant Staphlococcus aureus. Staph. auerus is an extremely common bacteria, it is on the skin of at least a third of the people who read this article. It can be treated with various antibiotics including penicillins. Methicillin is not used in the UK – it is most closely related to Flucloxicillin (a type of penicillin). MRSA is Staph aureus that is resistant to flucloxcillin. This is not a major problem, as the vast majority of strains of MRSA are fairly weedy and are sensitive to multiple antibiotics and are fairly easy to treat. It is quite misleading to say that someone died of MRSA – they died of Staph. aureus infection and the MR bit or otherwise is usually irrelevant. Hospital-acquired infections are common and in general have nothing to do with hospital cleanliness. I know, what a ridiculous thing to say! Well, firstly the majority of infections that patients get come from their own skin. The main reason why people get infections in hospital is not because they’re in hospital but because they’re ill. By definition the people in hospitals are those that will be most vulnerable to picking up infections. This is why hospital cleanliness matters because it is about minimising the risk to vulnerable people. However, and this is the key, even if the hospital walls, floors, ceilings and beds were entirely sterile it would not stop people getting infections.
So what’s all this fuss about MRSA? The answer to that is multifactorial. I think there are two important reasons. Staphlococcus aureus is a very clever bug and can infect multiple sites in the body; it can cause skin infections, urinary infections, pneumonia, septicaemia (blood infection) to name but a few. The other reason is that the methicillin-resistant strains of Staph aureus are only found in hospitals or other institutions. Places where antibiotics have been used. And hence there is an assumption that MRSA has been acquired in hospital. MRSA infection can certainly be reduced by increasing cleanliness but to some extent that’s irrelevant, remember that most infections come from skin (and it’s impossible to ever fully sterilize a patient’s own skin). Do you really care whether you have a MRSA or an MSSA (common-or-garden Staph. auerus) infection, if I can treat it for you either way? There is no evidence that MRSA strains are more deadly that non-resistant strains.
Here’s some facts you’ll never hear in the press:
1. MRSA is a worldwide problem. (Probably the greatest problem is in Japan for various historic reasons).
2. MRSA became endemic in UK hospitals in the early 1990s.
3. MRSA-related deaths are falling.(1)
4. MRSA is a major problem in the USA. This is a quote from a CDC report. (The CDC is the Centre for Disease Control and Prevention – one of the world’s leading authorities on infectious diseases).(2)
“Hospital-acquired infections from all causes are estimated to cause >90,000 deaths per year in the United States and are the sixth leading cause of death nationally. Nosocomial infections increase patient illness and the length of hospital stays. The direct cost has been estimated to be >$6 billion (inflation adjusted) costs of longer inpatient visits are shared by hospitals.”
So, please, can we move on from the myth that NHS hospitals are uniquely dangerous because only we have MRSA and it’s a superbug?
The US Healthcare system and its costs
So let us look at the US healthcare system. The top hospitals in the USA are amazing and provide amazing healthcare, many of them are world centres. However there are a few minor points worth noting. Healthcare in the US is astoundingly expensive.
Here are some interesting statistics;
46.3 million(3) – that’s the number of Americans with NO healthcare coverage. (15% of the population). In the event of an emergency they do indeed get treatment – but it is strictly emergency only. So cancer surgery is not covered, on-going asthma care is not covered. People with bad asthma need on-going treatment to control their disease. Without this hospital admissions are common. Emergency cover will patch them up (usually) and chuck them out to come straight back in again the next time. The frequency and severity (i.e. whether it is life-threatening or not) of attacks can be reduced with good on-going treatment. Not available to 46.3 million Americans unless of course they pay for it themselves.
The leading cause of bankruptcy is the US is healthcare costs(4) – even people with healthcare insurance struggle – limitations on cover, the deductible (i.e. how much you have to pay yourself). Imagine recovering from a serious illness to then lose your home.
£92.5bn – the cost of the entire NHS for the financial year 2008-9(5)
$596.6bn – the combined cost of the US Medicare and Medicaid programs(6). That’s £360bn. Medicare provides healthcare coverage for the elderly and Medicaid for the poorest. The majority of uninsured people are too well off for Medicaid but can’t afford insurance or their employer doesn’t provide it. Both of these programs still involve premiums and co-payments in addition to the government £360bn. Medicare has about 45 million people enrolled and Medicaid 50 million. So, in summary; the inefficient, expensive NHS covers 60 million people entirely for £92.5bn, whilst Medicare/Medicaid provides basic coverage (but not without co-payments) for 95 million people for £360bn. In fact, the US spends more per population on a basic healthcare system that only covers the oldest and poorest than the UK government spends on a healthcare system that looks after everyone. In UK terms that would equate to the government spending around £120bn for basic (so-called safety-net) coverage of less than 20 million of the UK population.
And here’s the real shock; for all the money they spend, the US life-expectancy is less than that of the UK.(7)
I am seriously impressed by anyone who’s still reading at this point. And this is part of the problem, the sort of trash that the Daily Mail puts out is much easier to read than the complex facts that actually reflect the truth of healthcare. There is so much more I can write – about unnecessary and invasive tests, about the benefits of preventative medicine but I think I should stop now.
The NHS is far from perfect but it is very very good. It is also unbelievably cheap for what we get for our money – worryingly to those who work in it, it is the most efficient healthcare system in the world. The problem is that for ideological reasons (i.e. Government=bad) The Daily Mail and those like it want to force us to take on a US-like model of healthcare. They’ll get their 5* hotel room hospital beds and everyone else will suffer. We will see the poor and the elderly left to die quietly or to live with their debilitating disease as the insurance companies make a fortune. And if the American example is anything to go by, ultimately we all end up paying more for sub-standard healthcare coverage for the most vulnerable.
I want to apologise for the length of this article but someone has to stand up to the constant lies of the Daily Mail. The NHS is an amazing thing and whilst it does have issues they are, in the real world, a price well worth paying for comprehensive healthcare. I am proud of the healthcare the vast majority of patients receive.
Dr alienfromzog BSc(Hons) MBChB MRCS(Ed)
References:
1. Department of Health: http://tinyurl.com/6kjbue
2. Centre for Disease Control and Prevention paper: http://tinyurl.com/ybvp2p3
3. US Census: http://tinyurl.com/ln5a2q
4. Baltimore newspaper article: http://tinyurl.com/ylg2fet
5. HM Treasury corrected figures: http://tinyurl.com/yzme4ng
6. Official financial report of Medicare and Medicaid; http://tinyurl.com/yguq2wn
7. World Health Organisation figures: http://tinyurl.com/yguq2wn
Categories: Guest Blog, Healthcare |
What a fantastic post. Thanks to the author and to mailwatch for republishing it here. A real eye-opener.
Please, don’t appologise for the detail.
excellent post. Do disagree with one point though:
‘the sort of trash that the Daily Mail puts out is much easier to read’
no it isn’t
[...] This post was mentioned on Twitter by Tim Ireland, mailwatch. mailwatch said: New Post: Guest Blog: More Lies About The NHS – http://www.mailwatch.co.uk/2009/12/07/guest-blog-more-lies-about-the-nhs/ [...]
One of the most fabulous posts I’ve read in a long time. I wish the Daily Mail and Paul Dacre would just die and go away.
Great piece, should be a cut-out-and-keep to use against morons. Well done.
i feel like i’ve just learnt more about MRSA in the past few minutes than i have in the past few years! i’m still a little bit confused about superbugs tho – does the word “superbug” have a specific medical definition or was it just invented by the media?
“The NHS is far from perfect but it is very very good.”
Read the Healthcare Commission report on Stafford Hospital Dr Foster says 23 Health Trusts have abnormal death rates
Read Coroners reports about negligence
As one who lost his wife thru an INFECTED BEDSORE caused by lack of basic nursing care (and I think Littlejohn is an asshole) the NHS is crap and the sooner we admit it the better it can be revived
Hel, as far as I am aware the superbug term is not a scientific term. It’s a simplistic catch-all term used to describe several different bacterial infections.
Christian: sorry to hear about your wife. But bedsores can happen to anyone anywhere in the world; and while there are some cases of NHS failure many more people’s lives are improved by it.
Three or (even four!) cheers for this article. I am a UK citizen who lives in the US, and can attest to the differences between the systems…though I have medical insurance through my work, there are still mind-boggling bureaucratic barriers put in place by insurance companies to prevent people from getting the care I need. On those occasions when I have returned to the UK and needed medical care, I have always been impressed by the service I get from the NHS.
And by ‘I’, I meant they. Whoops.
Not true James M, 40 years ago bedsores in the NHS were unheard of ,as a retired matron told me. Now people leave care homes for hospital and return with pressure sores. I have been a cheerleader for the NHS all my life but what I saw in my late wifes ward appalled me. She was a diabetic and was not fed for 5 days “because she was not hungry” So they used a drip…no
I am getting tired of “mistakes will happen” because they are becoming all too common .Yes there are good hospitals the one 30 miles form me has had no MRSA infections, Tunbridge Wells killed 300 patients. We will not improve the NHS by being in denial.
RLJ shredded.
Nice work.
Christiananarchist
“We will not improve the NHS by being in denial”
Quite so, but neither will we improve the NHS when the ‘air-time’ taken up by the exaggerated & invented ideologically hostile garbage from the likes of RLJ crowds out the legitimate criticism.
Thing is, so many people see or experience the worst and assume it’s the norm. You know, like someone interviewing a teenager from Grub Street Academy who can’t read or write and then assumes that all school leavers from Grub Street are illiterate (not that this kid might be dyslexic or something). So a work colleague said she ‘hated hospitals’ because her dad died in one, apparently he had a brain abscess which wasn’t diagnosed in time. However, when a patient dies in a private hospital (it does happen) it’s not the whole of the private health system that’s to blame, just that one hospital, or maybe just the health care staff involved. Doesn’t work like that for the NHS though.
Good to hear Littlejohn’s mum made a good recovery though! Isn’t she lucky having adequate health insurance?
Wouldn’t it be good if journalists had to give a list of references for their stories:
1. Man in pub.
2. Last week’s Daily Mail.
3. PR handout.
4. Opinion of hate mob.
Good point Mail Man.
I’d like 2 big up da NHS. They on da front line and they need support. lots of people think they deserve repect 4 nothin, but da NHS are there 24/7, rain or shine, working like dogz doin hours most would find hard 2 cope with, with one objective to protect life. and they do al this for peanuts, People need to know da truth and it is good to see someone stand up and start tellin it how it is!
Christiananarchist: look at how the author of this article referenced. Then look at how you referenced. “A retired matron” does not count as a legitimate source. And that is total bullshit pressure sores will develop within about 15minutes in an elderly patient, to say they were unheard of is just factually wrong.
“In fact, the US spends more per population on a basic healthcare system that only covers the oldest and poorest than the UK government spends on a healthcare system that looks after everyone.”
This isn’t wrong, but it tells you nothing useful. So the per-capita costs of treating the old and poor are higher than the per-capita costs of treating an entire country. You could rewrite that as: the costs of treating the expensive cases are higher than the costs of treating the average cases.
You can’t use the costs of Medicare+Medicaid as a proxy for the entire costs of the US healthcare system because they cover such a skewed sample of the population. If you’re trying to make the point that the US healthcare system costs more per-capita than the UK healthcare system (which actually I believe it does), you can’t make it these statistics.
Colin, your point is valid, but I think the NHS still comes out better than the US state system even after the figures are corrected for total population.
Here’s a few crude, first approximation calculations, based on the figures quoted in the article and one or two from a quick web search:
US population ~300E6
US state medical coverage 92E6, 92E6/300E6 = ~30% coverage
US state medical cost = £360E9, £360E9/300E6 = £1.2K per citizen, assuming uniform taxation of all citizens, to give state health coverage to 30% of those citizens.
UK population ~61M
UK health coverage allegedly ~100%
UK state medical cost £92.5E9, £92.5E9/61M = £1.5K per citizen, assuming uniform taxation, for state coverage of ~100% of those citizens.
£1.2K per capita tax for 30% state coverage in the US, vs £1.5K per capita tax for 100% state coverage in the UK. Make of that what you will. (assuming I’ve not messed up any of the figures or calculations)
I think that makes the NHS about 2.6 times as efficient, in terms of population coverage vs taxpayer cost, as the US equivalent, based on my admittedly quite many assumptions. If anyone can improve or correct this, please do.
OK, two mistakes in my post. One, for 92E6 coverage, read 95E6, which brings the fractional coverage up to about 31% from 30%. Second, for “efficiency” read “effective”, since the figures I got were, I think, effectiveness indices and not true efficiencies.
Actually, scrub the last paragraph on effectiveness; it’s not the right word either, and you’d need to do more calculations for that.
Going into more detail:
31% coverage at £1.2K per capita tax in the US means that, at worst case maximum load (i.e. every last one of the 31% covered is in hospital simultaneously), each patient gets £3.9K worth of treatment, but two thirds of that is at the expense of the other 69%. Expanding to 100% coverage, each patient of course gets a minimum of £1.2K at full load. In the UK, by comparison, maximum load gives a minimum of £1.5K per patient. In other words, as long as the US system continues to provide for only 31% of the population, the quality of care each of those patients gets will exceed that of a UK patient by a wide margin, but the average care provided to the total US population is still actually less than that of the UK. Thus, though those US patients lucky enough to be covered by the state are individually better off than those in the UK, the average US citizen gets less medical support from the government than the UK citizen does – and because the UK coverage is 100%, everyone can at least expect something close to the average, rather than a 31% chance of getting much better than average coverage vs a 69% chance of not getting anything at all.