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Ethics, health insurance

An American doctor experiences the NHS. Again.

WIth my cousin

WIth my cousin

Two years ago I wrote about my experience in a London emergency department with my son, Victor. That post has since been viewed > 450,000 times. There are over 800 comments with no trolls (a feat unto itself) and almost all of them express love for the NHS.

I was in England again this week. And yes, I was back in an emergency department, but this time with my cousin (who is English).

This is what happened.

My cousin loves high heels. As a former model she makes walking in the highest of heels look easy. However, cobblestone streets have challenges not found on catwalks and so she twisted her ankle very badly. Despite ice and elevation there was significant swelling and bruising and she couldn’t put any weight on her foot. I suggested we call her doctor and explain the situation. I was worried about a fracture. I hoped to arrange an x-ray. If it was broken we would arrange the needed care and if it wasn’t broken I could bandage it just as well at home.

“No,” she said. She’d have to ring for an appointment. It was Friday around 11 a.m. The chance of getting into her GP by the end of the day was apparently non-existent.  She would have to wait until Monday. Even is she were lucky enough to be seen that day there was no x-ray in his office so it would be a trip to see him and then a trip to the hospital. She was shocked when I suggested she call and just ask if he could order the x-ray. Apparently, that’s not how it’s done. In person or nothing.

As a gynecologist I will admit feet are not my strong suit, but no medical degree was needed to say she needed an x-ray. She also has some health issues that could impact healing from a break or the timing of surgery (hopefully that wouldn’t be needed, but you never know), so a timely diagnosis was more important for her than it would be in the situation were reversed and it was my ankle.

“We’re going to the emergency department I said,” and off we went to Sunderland Hospital.

Getting to the actual emergency room (ER) from the parking area required a background in orienteering. There was loads ofhelen3 construction and we had to go down hallway after hallway with Hogwarts’ worthy twists and turns. I managed to find a wheelchair, a unwieldily apparatus that only works in reverse. On purpose. This is to stop wheelchair theft, which is apparently a serious problem at Sunderland Hospital.

My cousin was triaged immediately. Within two minutes a nurse checked her ankle, gave her codeine, and then sent her off to an urgent care clinic. She wasn’t even registered in the ER. A porter wheeled her to the urgent care clinic in another building some distance away, which required a trip outside.

“What if it rains?” I asked the porter.

“We get wet. This is the North,” he said. “Of course it rains. Almost every day.”

Apparently no one complains.

The urgent care clinic had a few people ahead of us. It took about 10 minutes to check in and then no more than 15 minutes to be seen. A lovely nurse named Leslie triaged my cousin and agreed an x-ray was in order and made the arrangements. My cousin did not need to see a doctor or a nurse practitioner to get an x-ray. I’m not sure I’ve ever seen that happen in the U.S.

The x-ray and radiology report took 10 minutes. Then a nurse practitioner (also very nice) did an appropriate history and exam. The diagnosis was a torn ligament (sprain) and possibly a small fracture of the lateral malleolus (outside ankle bone). A orthopedics consult was needed. She could have a bit of a wait and be squeezed into fracture clinic that afternoon or she could have a cast and come back to Saturday fracture clinic. The clinic didn’t start until 2 p.m. and we were done in urgent care by 1 p.m. so she opted to wait. She was seen around 2:15 pm. An orthopedic consultant did an exam and recommended a tight support bandage and gave her exercises and guidelines about how to follow-up if she wasn’t meeting milestones.

My cousin was at the hospital for four hours, but over an hour was an unavoidable wait for fracture clinic and about 30 minutes of transport back and forth between the ER, urgent care, and fracture clinic. To receive this care all my cousin had to do was provide her name and birthdate. No copayments, no preauthorizations, no concerns about the radiologist or orthopedic surgeon being out of network. The nursing triage was wonderful and actually doing nursing (I hate seeing nurses relegated to charting). The nurse practitioner clearly knew what she was talking about and had reviewed the films with the radiologist. The surgeon only did the part of my cousin’s care that needed a specialist. It was a great use of resources.

Everyone I spoke with at the hospital loved the NHS, and honestly it showed. While the hospital was a veritable maze and in need of the updating that they appeared to be doing, the equipment was all fine and the people, i.e. the things that really matter, were great. Everyone from the porter to the orthopedic consultant was hard-working, knowledgeable, and friendly. What more could you ask for? I asked a few people what they would like to see changed? The only real issue was people who show up for care that is clearly not even semi urgent never mind emergent. Might a tiny user fee change that? Did we have user fees in the U.S.? Did they work?

Non-emergent care provided in the ER is obviously not the best use of health care funds, but in reality it’s a tiny drop in the health care bucket. Extra emergency room doctors and nurses and the not needed CT scans and other testing that may be generated are nothing in comparison to things like chemotherapy, or HIV medications, or bone marrow transplants. We do have user fees in the U.S. in the form of copayments. Even low copayments can cause some people to delay necessary care. They also don’t seem to deter people who don’t need the emergency room but want to go. I’ve sat in the ER with Oliver waiting for a bed while he struggled with pneumonia and overheard many examples. A man bragging that he tells the ER staff he has chest pain so he gets seen first. He was happy to pay his $100 copayment to be seen promptly at his convenience. He had nothing even remotely urgent. I’ve listened to a mother who waited hours for a diaper rash. Not a bleeding diaper rash, just a rash. Her physician had a free 24/7 pediatrics advice nurse that went unused (we had the same pediatrician, so I knew). She could have saved $40 and most of her Saturday, never mind the exposure to Oliver’s influenza, with a phone call. If you want to change ER utilization, and yes it’s a worthy goal even though it’s not the major cost driver, it’s education and outreach that are needed not penalties.

When I think of copayments I think of a 60-year-old woman with breast cancer three years post surgery and chemotherapy now in remission. She developed a cough and a fever so received a chest x-ray to look for pneumonia. The radiologist found something not quite right, a spot that was especially concerning given her breast cancer history. She needed a CT scan to see if this is a bit of scaring or if her cancer has metastasized to her lungs. When I asked her why she hasn’t yet had the CT scan she told me she couldn’t afford her $100 copayment. It will take her two months to save the $100 so she can get the CT scan to find out if her cancer has returned. She looked at me in the eyes for just a moment and then a mixture of embarrassment and fear that my eyes might tell her what she doesn’t want to know caused her to look away. And what if her CT scan is equivocal and she needs $100 (or more) for the copayment for a lung biopsy? If that’s not a circle of Hell I don’t know what it. You want to know what’s worse? I’ve heard a variation of this story more than once.

Dear U.K., the NHS is awesome. Try to treat it a little better. Maybe teach kids in school how to use the health care system (hey, why not NHS ed alongside drivers ed or sex ed?). Have safe sex. Stop smoking. Try to lose weight if you need to (obesity causes 30% of cancers). Wear lower heels for dancing. And for crying out loud stop stealing wheelchairs. The next time anyone mentions privatization or user fees tell them in America there are people trying to save enough money for the copayment for the CT scan that will tell them if their cancer has returned or not.

Thank you NHS for taking fantastic care of my cousin, of my son two years ago, and of everyone else.

To the British government, stop trying to mess it up.

Discussion

328 thoughts on “An American doctor experiences the NHS. Again.

  1. My problem with the NHS is that I put a lot of hard work into keeping healthy, and yet when I need to see a doctor I am at the back of the queue because “i’m not dying”. I understand a huge amount of NHS funds go on (a) Fixing lots of age-related issues due to our increasing aging population and (b) Fixing problems with smoking, obesity, general bad diet, lack of exercise…

    Last year I had stomach pain that wouldnt go away and it took nearly a YEAR to see a specialist (My appointment got repeatedly cancelled and that was only after an ultrasound, CT scan and gastroscopy (each with several months wait between). During this year I had to stop playing sport because it was too painful, and I lost sleep due to pain, I was on pain medication.. my work performance also suffered. I am otherwise perfectly healthy. It was a pretty bad year because the NHS failed to help me. Yes – I wasn’t dying, it wasn’t cancer, but seeing a specialist fixed the issue within weeks. It feels a bit unfair that I put in the effort and am at the back of the queue.

    Posted by mikeparker | August 23, 2016, 3:21 pm
    • Which is exactly the problem with systems like the NHS. The emergency stuff normally is done well. The urgent stuff tends to be done well once it has been determined to be urgent. The routine stuff is done well. Anything that doesn’t fall into those categories, however, gets whatever’s left and it’s never enough.

      Posted by Loren Pechtel | August 23, 2016, 5:29 pm
  2. Wow! Again!

    Posted by Am Ang Zhang | August 23, 2016, 4:50 pm
  3. My daughter just finished her undergraduate course in the UK. For three years she received excellent healthcare through the NHS–as an American student on a visa. i am grateful for the care she was provided there. Even though we have an excellent insurance plan in the US (we are fortunate), the system is much more complicated here–and expensive. No system is perfect, but the NHS is doggone good.

    Posted by Sharron Blezard | August 23, 2016, 5:46 pm
  4. I would suggest your limited experience with the NHS may not make you an expert. I lived in the UK for years and was repeatedly appalled at the flaws in their health care system, which is far from free when you consider the tremendous tax burden applied to residents of all socioeconomic classes to fund it. Also, I have never experienced emergency care in the US the way it is characterized in this post. My children have had extensive emergency care and never have we been asked for a co-pay or preauthorization at the point of service.

    Posted by Amanda | August 24, 2016, 8:14 am
    • I guess in the USA it varies from hospital to hospital. I was on vacation in LA many years ago and had to be rushed to ER by a friend. I was charged for everything: exam by a doctor (pay); injection of needed meds (pay); writing prescription (pay); the meds themselves (pay) ; pharmacy fee for dispensing (pay). I left with my wallet empty. The NHS doesn’t do that to USA visitors to A&E. There are failings in all healthcare systems but I don’t think ours are due to the fact that it’s free at point of use. Of course we pay in tax, but most people use the system. Better off folk can go private if they wish. I don’t see the system as some kind of creeping communism as some in America do.

      Posted by Sandy Robertson | August 24, 2016, 1:19 pm
      • PS: at one point it was thought on my USA visit that I’d have to be kept in hospital overnight. My buddy had to ring a very wealthy guy we both did work for and get him to agree to pay my potential bill before they’d consider it.

        Posted by Sandy Robertson | August 24, 2016, 1:23 pm
    • Amanda, The tax burden is by no means ‘tremendous’. The part of my tax contribution that goes to the NHS is much, much smaller than the private insurance premiums paid by every (insured) American I know. My parents (now dead) and siblings live in the USA. 25 years ago I watched my semi-conscious mother denied entry into a hospital because she was in no condition to tell them who she was insured with and I, visiting from the UK, had no idea. Had my sister not come dashing across the parking lot with her papers I guess they would have let her stop breathing. I relive that episode all the time. Also,, when my dual national daughter was living and working in the USA for 9 months she fell ill with a kidney infection. She was not registered with a doctor as she was travelling around and would have had to cough up over $2000 on the spot for emergency room care, which she did not have. If my sister had not found a small charity that treated her on the basis of a day of her paltry pay, I do not know what would have happened.
      I grew up in the USA, but have lived in the UK for 43 years. At least here you do not have to panic when you fall ill unexpectedly, as I did a couple of weeks ago (detached retina). I just went and got treated.

      Posted by Lisa Brown | January 18, 2017, 1:50 am
      • It is outrageous, I pay 4K, it’s an awful service with rude arrogant staff.

        Posted by Partridge | January 18, 2017, 3:27 pm
  5. I’m from Newcastle and work near Seattle as a private practice PT . My Dad has Stage IV prostate cancer and his care has been jaw droppingly amazing. I always tell my British friends and rellies how lucky they are not to be in our system.

    Posted by Mikki Townshend | August 24, 2016, 10:32 pm
  6. BULLSHIT. The English take home a mere fraction of what they earn to pay for this.

    Posted by Cynic | August 25, 2016, 10:12 pm
    • TROLL alert!

      Posted by Jeanne Jackson | August 26, 2016, 11:19 am
      • You can’t say troll alert whenever someone writes something you don’t like or in this case gives a view of the NHS you don’t like. I’d actually say you are more of a troll as you continually try to discredit people who say it as they see it (and probably have a more balanced view than yourself).

        Posted by Chris | January 2, 2017, 2:34 pm
    • Bullshit yourself. Up to about $100,000 there’s no significant difference. In US states with a high income tax rate like New York an American can actually pay higher taxes than a Brit.

      Posted by rskurat | August 26, 2016, 11:31 am
  7. As an American living in Northern Ireland for 11 years, I have not found the NHS to be efficient in any way. A&E wait times are uncivilised. I’ve had two visits to A&E before being diagnosed with gallstones. In severe pain and throwing up, I waited 5 and 7 hours to see a Dr. Then, 4 weeks wait for an ultrasound to confirm the gallstones. I’m now on a waiting list for gallbladder removal surgery…the wait? 12-18 months. I’ve lost 25 pounds and I’m skin and bones due to fear of eating anything that might cause another attack. The NHS is not working for me. The surgeon who discussed my scan results, in an NHS hospital, told me the wait to remove my gallbladder would be 12-18 months and actually said he could do the surgery in two weeks for £4600 if I went to a private clinic he worked in.

    Posted by Phillip | August 26, 2016, 4:01 am
    • You seem to be really unlucky, mine was dealt with in a week. I would fire off a missive to your local health authorities. Might not work but its worth a try.

      Posted by Jeanne Jackson | August 26, 2016, 11:15 am
    • Since the 1990’s the 4 countries of the U.K. Have developed in a more semi-independant way and the Healthcare is one of the major areas of difference.

      England made much more effort in driving long waits out of the system,
      Maximum 4 hour wait to admission or discharge in A&E. 95% target
      Maximum 18 week wait for non-emergency surgery
      Maximum 2 week wait for diagnostics for possible cancer diagnosis

      After the extra investment 2000-2010 these targets were all being met in England every month, with less money since then they are being missed consistently, but not by much e.g. 90-92% of patients being seen in 4 hours.

      Scotland, Wales and NI prioritised things differently, England kept co-pay for prescription charges and eye tests, the other 3 abolished them, Northern Ireland has more integration between Health and social care than the other 3 countries.

      Posted by dansmith17 | August 28, 2016, 6:09 am
    • The truth no one wants to hear. The facts are that the NHS is terribly inefficient and it is the staff who are behind it. Refusing to modernise and refusing to support the population over their salaries. be sure though, the government are not trying to close the NHS, most of us
      Wish they would. Or at least give the working man of the the U.K. The option to opt out and take our 4K a year elsewhere.

      Posted by Chris | December 29, 2016, 5:40 am
      • Oh, Chris, take your 4k elsewhere? Our family insurance in the US comes from my wife’s employer. Last year their share of the medical insurance bill for our family was $ 17,700. In addition to that, my wife also pays $ 400 per month. For that we have insurance that we can’t afford to use as we have to pay out $ 4,000 per family member before the insurance pays a penny.
        You say that the NHS workers don’t care as they choose their salaries over the patients. Compared to countries that have exclusively private medical systems, NHS salaries are ridiculously low.
        Have you considered buying private top-up insurance? It is not expensive in the UK, as any catastrophic or emergency treatment is covered under the NHS.

        Posted by David ashford | January 1, 2017, 9:02 pm
      • Thanks for that David. I suggest Chris watch Michael’s Moore’s ‘SICKO’ on YouTube. Its shocking.

        Posted by Jeanne Jackson | January 2, 2017, 12:09 pm
      • “watch Michael’s Moore’s ‘SICKO’ on YouTube. Its shocking”

        … just as it was intended. But appreciate the honesty in not calling the work a “documentary”.

        Posted by Frank Ch. Eigler | January 2, 2017, 12:23 pm
      • Sicko? A propaganda piece with little regard for the truth. Think Cubans can get to those clinics he was showing?

        Posted by Loren Pechtel | January 2, 2017, 12:51 pm
  8. I love the NHS I just hate our local A&E. I waited 6 hours to be seen after having fallen very heavily on my knee, bruising appeared within minutes and I was sat crying the whole 6 hours even though I was in high painkillers. I also have many ither problems that they were aware of.
    My 80 year old mother sat for 13 hours with a suspected DVT!! Was not offered food or drink, the machine didn’t work in a&e reception, and was finally seen at 1am yes 1 am after waiting for 13 hours 12 of them alone as she didn’t tell us she was there, trying to be independent!!

    It’s days like this that the system makes you rant and rave and swear. Not at the staff isn’t their fault but the hospital not spending enough on staff.

    Posted by Trish | August 26, 2016, 6:44 am
  9. Great article (read it in The Independent). My only struggle was your use of USofA terms and jargon that is different to the UK’s. e.g. exam vs examination, ER (Emergency Room) vs Accident & Emergency Department, co-payments vs (I’ve no idea at all!), user fees vs (again, no idea), charting nurse vs (I think) Chartered Nurse (it’s a qualification, granted under a Charter from the Queen). Otherwise, wonderful.

    Posted by Richard | August 26, 2016, 7:03 am
  10. Fully, wholeheartedly agree about people abusing the NHS.

    The downside of a free health service is people know it’s there and can be a little reckless about health choices safe in the knowledge they won’t have to pick up the bill.

    And yes, a fair number of our hospitals are old, even ancient by American standards, added to and extended over decades and areas repurposed so the hospital ends up with an illogical layout, porters probably walk miles whilst using navigation skills second only to London famous black cab drivers.

    That said, I recently had to use the NHS, more so in the last few months than in all my life prior to developing a health issue. Just shy of four months from being taken to a+e, through several appointments, tests, then a little op. I don’t know if four months would be excessive in the states but knowing how stretched the NHS is, I’m not complaining, especially when I know the operation alone would cost me (or my insurance) tens of thousands in America. Cost to me? Not a penny.

    Yes, the NHS is overstretched and seriously underfunded, and I’ll even go so far as to say it’s far from perfect, but I wouldn’t want to go without it.

    Posted by Andy B | August 26, 2016, 9:52 am
  11. The NHS is wonderful but it also has it’s down points, there are waiting lists in the UK to see specialists, some 6 months upwards to see the specialist needed, granted we don’t pay for this but waiting times do exist. Some people do take the NHS for granted, I for one are extremely grateful and especially from a financial point of view that we don’t have to pay hundreds and thousands of pounds for out health treatment. That being said there is also the other half, the background of the NHS or behind closed doors that people don’t see…the primary care side, GP, dentists, ophthalmics etc. Dentists and ophthalmics are business’ who provide the services for the NHS and then have to claim the money back from the NHS. In some areas there are people can’t get an appointment with a GP for 3 weeks upwards, if that’s an urgent appointment you have no choice but to go to a&e. Back to the dentists and ophthalmics side of the NHS, the NHS use a third party company who manages and pays the dentists and opticians however due to the amount of job losses since this company took on the contract the businesses such as the opticians are being paid late or aren’t being paid at all as there isn’t enough staff to cope with the work demand in the third party company and many more issues… that is the side of the NHS that isn’t seen and it’s a sure fine way to begin privatising the NHS which will happen sooner rather then later. I would recommend anyone in the UK to get healthcare insurance.

    Posted by Bethany | August 26, 2016, 12:29 pm
  12. May I reply as a Brit who blacked out in the bathroom of a Florida bar and had to experience your ‘paid for’ services in the US?

    I had fantastic travel insurance but spent more time with the lovely lady from the ‘getting paid’ department than I did with a nurse or doctor.

    The difference in medical care was marginal at best. I waited four hours in Miami’s eye emergency room. The food in Lower Keys medical centre, was inedible. Given this was being charged to an insurance co.pany why wasn’t it outstanding?

    As you rightly say, NHS hospitals are rarely refurbished but the quality of the staff is second to none.

    I have once had surgery in 24 hours and yesterday had surgery in a matter of hours. I have not had to pay anything beyond my taxes.

    The lovely person at my Florida hospital was shocked when I said I had full cover (well $10M). Jx

    Posted by Julian | August 26, 2016, 1:42 pm
  13. I’m probably a bit late reading this. I’m a retired public health doctor in the UK, just for background. What you say is all true. Another side of the US / UK health care equation comes up in the movies. There are a load of US movies where the plot simply could not work in the UK, because they hinge on the unafordability of US health care. As Good As It Gets, the Jack Nicholsen film is a good example, there are two people who’se life is turned upside down by the costs of health care.
    Maybe you’d already spotted that, but if not you might find a use for it some day.

    Posted by Prof. Rod Griffiths [CBE BSc Mb ChB MA FRCP FFPH all that just so you know.] | August 27, 2016, 7:14 am
  14. My NHS story is a short one. I was an American with permanent residency (with husband, a UK citizen) in England from 1974 to 1989). We, of course, used the NHS for many minor and one major incident – with positive outcomes. We did pay for “pop-up” insurance which, when wanting to see a consultant (specialist) and felt the need to “jump the queue”, knowing that while inequitable, the NHS depends on this to lighten the load of resources.
    In 2015 after becoming non-resident for the past 25 years, we were visiting the UK when I got an injured foot (lots of walking with grandchildren!) and our son took me to his local hospital in Kent (County). Directed to the non-urgent department, I stepped up to the desk and said I’d been living overseas for the past 25 years. No problem,said the cheerful clerk. Just give me your name and birthday. A moment later she said had found me in the system.
    I got the appropriate treatment a few minutes later and went on my way.
    Now I ask you, American Taxpayer, why can’t the US come up with a system for healthcare that the United Kingdom has had since 1948? Yes, 1948.

    Posted by Esther Graham-Yooll | August 27, 2016, 9:10 am
  15. It is so lovely to hear someone praise our hospital service. Thankyou! We are extremely privileged to have the NHS in this country. It saddens and frightens me with what is happening to it. Without it I dread to think what would have happened with my premature twins. I have experienced first hand a hospital in Mali, West Africa and for all the complaints we may have against the NHS experiencing something like that truly makes you appreciate what we have. Unfortunately our NHS is under threat and this is seen throughout the country with cuts everywhere including my local hospital the Horton General where they wish to downsize the maternity unit to a midwife led only, with no consultants or theatre staff, and thus also losing the scubu dept. There are contingency plans for other cuts to the other acute services in a town who’s population is growing vastly. If by any means people could help support us and raise awareness of this it would be greatly appreciated. http://www.keepthehortongeneral.org (please delete if not allowed).It makes me very frightened for the future that we may have a private healthcare system such as the US. Hearing stories such as that of the lady who couldn’t afford the $100 makes me very upset. I too would gladly give it to her. Once again thankyou for writing such a fantastic positive article on our NHS.

    Posted by laura jones | August 27, 2016, 2:57 pm
    • I’m based in Blackheath, SE London and have joined the SAVE OUR HORTON F/B page. Also I tried to donate to your Crowdfunding page but was unable to do so. I am such a passionate supporter of the NHS. Jeremy Hunt and his team (some of who have an ‘interest’ in private health care) are having secret meetings re our NHS. Did you happen see a TV crew discover a secret meeting with US Health Insurance providers and Health companies. They were royally disrupted and looked rather sheepish as they left the building… Its disgusting what our government is doing by stealth.

      In psychology its called the ‘drip drip’ method as used in advertising.

      If you can, watch on You Tube Michael Moore’s ‘SICKO’ about European Healthcare, you will be amazed what other countries offer although I would draw the line at having my washing done as in France!!

      Good Luck with your campaign.

      Posted by Jeanne Jackson | August 28, 2016, 3:58 am
  16. I live in the USA and I’m a Britt let’s compare eggs with eggs here … NHS is free healthcare for all USA health care is for those with insurance or money

    – how I long for the NHS it is so simple and if I want speed I use my UK medical care

    In the USA insurance / cost of medication – form after form after form -and drugs for everything ( I’m not even sure I need)! private healthcare in the UK is fantastic as was that in Singapore

    Care wise has been pretty equal

    Posted by Louise | August 29, 2016, 9:13 am
    • Agreed and, even with insurance, you sometimes have to make medical decisions based purely on finances. Should you get the CAT scan or pay the mortgage? It should be drummed in to the heads of the Brits that a major cause of personal bankruptcy in the US is medical debt.

      Posted by David ashford | January 2, 2017, 3:40 pm
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  18. The NHS has its good points and its bad points as anyone living in the UK will tell you. One of the biggest problems the NHS has is a lack of funding for people with mental health and crisis care in places like A&E is failing more and more, which often results in people taking their own life because they cannot get the help (despite asking) what they need.

    Mental health wards are getting shut because of a lack of funding, Crisis phone lines closing down and the removal of home based support for people with diagnosed mental health conditions.

    I’ve had both good experiences and bad. Bad being sent home aged 13 with a broken leg, because there was a lack of swelling after a fall on my way to school there was no need for an x-ray, despite the fact I couldn’t put weight on it. 4 days later and having hardly moved off the sofa I was taken back to A&E, where an x-ray was performed and I was told I had broken my Tibia, and a plaster cast was put on.

    Good experiences, I’ve seen my mum who died from renal failure be treated with respect and dignity in hospital, especially A&E, but I also watched her die in pain because of staff shortages after 4 months on a renal ward when she developed the rare complication calciphylaxis.

    I’ve personally been so desperate for mental health support I have opted to go private to The Priory, because the NHS has let me down again and again.

    If you can try and watch the London Ambulance Service documentary which started last week, it can be found on BBC iPlayer, it will give you an insight into how pushed our NHS is.

    Posted by Ally | October 6, 2016, 1:36 am
    • And this is down to DELIBERATE lack of funding on behalf of Jeremy Hunt, Health Minister and the Conservative government backing it. They and opposition MP’s have interest in American pharmaceutical co. An arm of Pfizer just got fined £84,000 for grossly overcharging the NHS for epilepsy tablets by 2006% yes 2006% !! thats how lucrative the americans see us! !

      Posted by Jeanne Jackson | December 12, 2016, 11:45 pm
      • I waited years for hep c treatment (thankfully now had it and cured) because rationed due to big pharma charging £858 per pill for Harvoni, and it required 56 pills to cure me.Nearly £900 a day for two months. Obscene. I know development costs a lot but that is an unjustified gouge.

        Posted by Sandy Robertson | December 13, 2016, 12:02 am
      • Jeremy Hunt was the author of a book, published about 10 years ago in which he advocated privatisation of the NHS. No surprise as to what he and the government are now doing—cuts to a level that make things unsustainable, then bingo! the case for privatisation is made.

        And it wasn’t 2006%, it was 2600%.

        Posted by korhomme | December 13, 2016, 12:28 am
      • Can you please explain why 110 billion pounds is underfunding ? I think waste is the issue and that is driven by poor management and that is at a local level.

        Posted by Chris | January 2, 2017, 2:38 pm
      • You fix waste by cutting waste. if you try to fix it by cutting funding you almost always cut meat rather than fat.

        Posted by Loren Pechtel | January 2, 2017, 3:32 pm
    • UK health care spend per capita is on the low end for western countries, and is less than half of what the US spends.
      http://www.pgpf.org/chart-archive/0006_health-care-oecd.
      https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

      For me, a large part of the problem has been the enormous increase in the number of managers & administrative personnel, at the expense of front line clinicians, doctors & nursing staff. This is to be expected due to the disastrous PPI adventure under Blair, and the continued outsourcing of NHS functions to for-profit companies under the Tories.

      Posted by David ashford | January 2, 2017, 3:36 pm
    • The real funding is 4.5 billion Chris spread over 2016/2017.

      Posted by Jeanne Jackson | January 4, 2017, 3:20 am
      • No it’s 110 billion a year. The NHS has never had so much money or staff or staff pay. Seriously, I have to believe it would be better run if it was run by McDonald’s. The decision to stop Services is a local one and mostly underpinned by the decisions of local staff. The only thing I do have an issue with the government on is devolved trusts, clearly you get no economies of scale – the most basic silly example of NHS waste is the local branding, as I put it, I don’t pay money to Poxy Lawn medical centre, I pay it to the NHS, now run it like a company, that way you wouldn’t waste money on branding for something that clearly doesn’t need branding and stop wasting millions on the design and print of local branding.

        Posted by Chris | January 8, 2017, 11:30 am
  19. I’ve posted before but just wanted to mention what happened today and tell you how it shocked me. The NHS finally gave me Hsrvoni which cured my hep c. Today was my day for a final blood test that will certify me as cured. I have been repeatedly assured I do not hsve cirrhosis. Today a student was sitting in so my results were pulled up to explain stuff to her. In the midst of showing why I was not cirrhotic the hepatology team person suddenly announced I’d been misdiagnosed and that I WAS cirrhotic and must be monitored for evermore!

    There was no real explanation, just numbers and so on which a layman like myself cannot understand, and little sympathy for how shocked I was. I’m baffled because the person who did my last ultrasound elastography only months ago said there was no cirrhosis just fibrosis.

    I’m extremely worried and disappointed as presumably if the student hadn’t been present my tests wouldn’t have been examined again and I’d have been discharged and none the wiser.

    Posted by Sandy Robertson | December 14, 2016, 3:25 pm
  20. My wife suffers from kidney reflux and on dialysis since October 2016. Soon she will be on home dialysis using the newest technology on dialysis, the NXstage portable hemodialysis dialysis. Next week both of us will go on training for a week on how to use the NXstage portable hemodialysis machine. Hopefully next month my wife will be using the NXstage machine independently at home. Thank you NHS for free healthcare! (btw, NXstage machine is new to the NHS so not all hospitals in the UK are using it at the minute)

    Posted by mike | January 7, 2017, 11:10 am
  21. Don’t wear high heels. …… that’s not what the NHS is for

    Posted by Sue | January 7, 2017, 2:31 pm
  22. I personally love the NHS but it is under staffed and underpaid. They draft a lot of foreign nurses in from places like Spain and the Phillippeanes because we do not have enough nurses in the U.K.
    GP surgeries in my opinion are not open long enough hours for patients to try and get to them and they also have appointment waiting lists as long as a month into the future as well as only being available Monday to Friday.
    Despite these GP surgeries being over subscribed and causing issues that lead patients to attend the ER for non emergency issues we also have a free helpline for people to call if they cannot get to see the GP but are sensible enough to not crowd the ER. This is called NHS 111 and they will ask you a series of questions about your general health and then some more specialist questions about the problem you are calling about. If it appears that you need to be seen urgently they will arrange for a local on call doctor to call you back and they usually then offer you to come down to the local hospital or specialist emergency clinic that are available on some parts of the country.
    There should be no excuse for people wasting the time of the doctors and nurses in the ER when we have had these options put in place for many years now.

    Posted by Kerry | January 8, 2017, 2:57 am
  23. My experience with the NHS has been quite extreme: In 2 occasions I went to see my GP for severe pain in the abdomen and colic episodes, he said he had no idea what was going on, that it was probably something from “digestion issues” to “bowl cancer” (I’m quoting) and sent me back home with painkillers until new tests could be arranged (never happened). The colics kept on happening, the days the pain was too much to handle my flatmates had to call an ambulance (twice), which never came, so, covered in sweat and feverish I had to crawl to Whitechapel hospital feeling like dying, to wait in a room with dry blood stains on the walls. After waiting for my turn I got my belly explored, no doctor asked me any question regarding my health, no X-Ray, no CAT scan, no ecography, nothing at all. Just painkillers and a “good luck”, this while routine happened twice. Something was going terribly wrong, the pain of these episodes were rising dramatically, so I had to do something. The day I had enough I filled a suitcase, told my boss I was out, called the landlord to say my goodbyes and took a flight to Madrid, Spain (my hometown) where I was rushed to ER, diagnosed Gangrenose chronic appendicits through a CAT scan in just a couple hours, went through surgery on the spot (4 hours cleaning the mess), got a good 15 cm of my intestine removed, got a remarkable amount of stitches in my body, spent 14 days at the Ramón y Cajal Hospital recovering, lost 9 kg (I’m pretty skinny by nature) and saved my life, because I was very close to sepsis according to chief surgeon. So, my thoughts on NHS? It doesn’t treat immigrants or lower classes as well as natives or the wealthy ones, and I’d rather have a Spanish butcher than an English doctor to treat me (I mean…come on, appendicitis…a VET could see that coming!), which is surprising considering Spain is a way poorer country than the U.K.

    I considered suing the NHS, but I felt sorry for them. I hope someday the Government will take it seriously so everybody in the UK could benefit from a real health care system, whatever class, race, age or economic situation they live through.

    Posted by theswampman | January 8, 2017, 5:23 am
  24. My experience with the NHS has been quite extreme: In 2 occasions I went to see my GP for severe pain in the abdomen and colic episodes, he said he had no idea what was going on, that it was probably something from “digestion issues” to “bowl cancer” (I’m quoting) and sent me back home with painkillers until new tests could be arranged (never happened). The colics kept on happening, the days the pain was too much to handle my flatmates had to call an ambulance (twice), which never came, so, covered in sweat and feverish I had to crawl to Whitechapel hospital feeling like dying, to wait in a room with dry blood stains on the walls. After waiting for my turn I got my belly explored, no doctor asked me any question regarding my health, no X-Ray, no CAT scan, no ecography, nothing at all. Just painkillers and a “good luck”, this while routine happened twice. Something was going terribly wrong, the pain of these episodes were rising dramatically, so I had to do something. The day I had enough I filled a suitcase, told my boss I was out, called the landlord to say my goodbyes and took a flight to Madrid, Spain (my hometown) where I was rushed to ER, diagnosed Gangrenose chronic appendicits through a CAT scan in just a couple hours, went through surgery on the spot (4 hours cleaning the mess), got a good 15 cm of my intestine removed, got a remarkable amount of stitches in my body, spent 14 days at the Ramón y Cajal Hospital recovering, lost 9 kg (I’m pretty skinny by nature) and saved my life, because I was very close to sepsis according to chief surgeon. So, my thoughts on NHS? It doesn’t treat immigrants or lower classes as well as natives or the wealthy ones, and I’d rather have a Spanish butcher than an English doctor to treat me (I mean…come on, appendicitis…a VET could see that coming!), which is surprising considering Spain is a way poorer country than the U.K.

    I considered suing the NHS, but I felt sorry for them. I hope someday the Government will take it seriously so everybody in the UK could benefit from a real health care system, whatever class, race, age or economic situation they live through

    Posted by theswampman | January 8, 2017, 5:24 am
  25. I’m proud of our NHS. It is the best in the world. People complain about it because they have never experienced other countries health care systems. Where else in the world can you be seen for just about any ailment in a single day. Then treat accordingly no matter what the cost and for free! Some of us here in the UK are complacent about the health care we receive. Often these are the ones that abuse it and take it for granted.

    I live up the road from sunderland in newcastle. Here we have the RVI. One the the best hospitals in the world. Alone with the research labs, Newcastle is pioneering some of the most significant medical advancements in history. Recent cures for some cancers and also the most important developmemt in the cure for HIV to name a few. Im certainly proud and thankful for what we have in the UK. Thank you for a great post. A superb reminder of how luck we are here. And next time you are over, come to Newcastle. Far better than Sunderland lol
    Love & Peace xx

    Posted by gedstar75 | January 8, 2017, 5:24 am
  26. Our NHS isn’t free as we pay for it in our wages that’s what our national insurence is.. so it may seem free to people who live abroad but it’s not. Each country has differnt ways of paying for their hospitals. Our government are cutting back on this service which is wrong as we still pay never the less its as important as education.

    Posted by Amie | January 8, 2017, 5:56 am
  27. Yes people like most of us here who are earning pays taxes and NI contributions. However, people who are unemployed never paid taxes and contributed to the NI still receives treatment from the NHS for free. Unlike in America, those who have no medical insurance won’t get the treatment they needed.

    All my children grew up under the care of orthodontics through NHS. Dental braces were fitted on them and i never paid anything. My wife goes on dialysis 3x a week she is being picked up by ambulance at home and returned on ambulance every session again I paid nothing. My daughter has special needs but I never paid anything for the medical investigations done on her. Her educational needs are provided for free by the government. She gets school transport for free also. That is why my family and I are very grateful to our NHS and to our Government. For me, NHS is perfect healthcare. We love NHS!!

    Posted by mike | January 8, 2017, 7:53 am
    • So you love the NHS because the UK government made.someone else pay for your expensive family needs. Well yes, there are always some “winners” who are net beneficiaries of the subsidies. By definition though most are not like that. They pay more than they receive in service.

      Posted by Frank Ch. Eigler | January 8, 2017, 11:12 am
      • Frank it’s medical needs of my family not our personal needs. Regardless of the economic status and race of the patient the NHS treat patients accordingly and equally. FYI, my wife and I works for the NHS. We pay taxes and contributes to the NI but we never complain about NHS treating patient who never paid taxes and contributed to the NI. All I say is we love NHS because it is perfect!!

        Posted by mike | January 8, 2017, 12:34 pm
      • @Mike, “my wife and I works for the NHS […] it is perfect”

        Please forgive me for taking your assessment with boulder of salt or two then.

        Posted by Frank Ch. Eigler | January 8, 2017, 1:19 pm
  28. Why burden Sunderland ER with a minor injury such as this, there are four Walk in centres around Sunderland where she could have received the exact same care. Why not educate yourself before lecturing British people how to appreciate our NHS, we already know dude.

    Posted by Tom Collier | January 8, 2017, 9:15 am
  29. I just wanted to say I loved reading this. And i will be looking at your previous/future posts as well.

    Posted by Mike | January 8, 2017, 11:06 am
  30. Couldn’t agree more, we hear all the bad sides of the NHS but non of the good sides. I got diagnosed with cancer at aged 30 and was treated immediately. I could not fault any one I was in contact with. After reading a simular article as I was in the middle of treatment the thought of going through all of the treatment and then being left with a bill to worry about, (if yoy had no unsurance or the fees to pay,) while trying to recover would have been agony. The only thing I can think of that would be good to be changed is more help for NHS staff aso they work such long hours while doing an amazing job!

    Posted by soph | January 8, 2017, 3:25 pm
    • My daughter has a mental illness: can you imagine needing treatment for such a condition and having to worry every time a new bill comes through the letter box?

      Posted by David ashford | January 8, 2017, 7:40 pm
  31. There is a system in place that we use called Nhs 111 you call them they triage you over the phone and tell you how you should proceed with care it ranges from take over the counter medicine to them sending out an ambulance. That is the perfect system to avoid wasted trips and resources

    Posted by Lost in the 90's | January 8, 2017, 11:36 pm
  32. It takes an outsider to make us realise what we have!

    Posted by Pete | January 9, 2017, 12:33 am
  33. NHS is unfortunately hanging on by just a thread :/ Pity really !
    I’m a med student. This is an ophthalmology series I just started. Feel free to share and follow to stay updated 🙂 https://paulchronicles.wordpress.com/2017/01/09/ophthalmology-series-case-4/

    Posted by paulchronicles | January 9, 2017, 2:55 am
  34. The NHS is not a free service, we all pay for it via NHS contributions. It’s amazing how many people think the NHS is great, ‘considering its free’.
    If you stop to think that you’re actually paying for that service, is it still so great?
    This article only tells us that they received the right kind of care for their circumstances – I wouldn’t expect anything less!
    Myself and my family have experienced some awful care in A&E departments since moving to the North East of England from Scotland. There clearly is a problem with NHS England, I’ve never seen anything like it. On one visit, we waited 10 hours to be seen with our 4 year old and it was a further 2 hours before we left the hospital.

    Posted by Sarah | January 10, 2017, 4:16 am
  35. Nice article, thank you.

    Posted by Tom Connor | January 10, 2017, 7:23 am
  36. Thank you for the insight on healthcare that is so different than what we have in the U.S. I’m glad its not my decision to determine how care should be delivered. As a nurse I recognize that there are advantages and disadvantages. I am thankful that I have reasonably good health insurance with reasonably low co pays. I am thankful that I have never had to push off treatment due to cost concern. I am thankful that I live near quality hospitals. I am thankful that my family is usually healthy and do not need specialists. Thank you for the hard work that you do for your patients.

    Posted by Nurse Laura | January 14, 2017, 5:37 pm

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