These chains not only bind us to all sorts of duties — including the duty to feed one's family — but it also binds us to all sort of personal and family ailments. Yes, both the acute and chronic illnesses bring in the tragedies to the person or his/her family but being sudden the former one that embraces accidents and attacks, gives us more distress. It just doesn't give any time to prepare.
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| The NHS |
Illness requires therapy but that does not come cheap - as it is given by the professionals, who have worked hard to reach that stage. Globally speaking, the link between the treatment and payment isn't quite linear, though. In fact, depending on where you live, either you, your insurance company or your government foots the bill.
Types of health care:
1. The self pay:
This is practically the rule of thumb in poorer countries, where it runs parallel to the poor health facilities. Not being prepared at all for both the cost and the sudden sadness, the acute ones like fractures and the freshly diagnosed cancer add shock to the cost, the chronic ones bring in continuous pain. The unplanned sudden need not only compels one to sell ones property or take a loan with exuberant interest, but it also brings in discord and resentment in the cash dependent family. It's a disaster for the poor, who barely manage an income to eat and educate kids. The only positive thing one can write about this system is that with sheer luck, if one dies of sudden illness at 90 he/she doesn't lose any money in any insurance or tax payments - all his life.
2. The insurance company:
Still based on the thinking, 'you got to pay for your own health' that reminds one of the poor countries as aired above, each individual in this system is expected to pay the insurance company for his/her medical care. The joyful company, in turn, makes the hospital happy. Yes, this system takes one's money away but it obviously takes away the sudden and chronic financial stress too. And the capitalists in the US seem to love it.
It's not all honky-dory, though.
In fact, however much the capitalists may love it as a product of a great civilization, not all the people are intelligent, successful, employed, rich or even composed. There are many people, who are poor, in jail or have addiction problems. These hapless ones may get some help from the charities; if not, they either don't get treatment in the hospitals or get a huge bill after the treatment. Despite being the citizens of a rich country, these troubled beings face the same disaster faced by the poor of the much poorer countries. Yes, many take comfort in, 'that's life', but not all see it that way. The denial of treatment, despite all the facilities available and the consequence there of, does hit the conscience of upright thinkers.
Moreover, when the money makers — the insurance companies — get tied up with the hospitals, money really matters. That slimy thing enters medicine in a big way. When money is to be made, the genes of even ordinary souls are not recessive. Litigation culture had no choice but to emerge.
'Facing that onslaught, the medical profession's defensive Great Wall of China would be to investigate the patient left right and centre. This over investigation alm
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| The patient ward |
3. The Government:
Prevalent in Denmark, Australia and the UK; in this system the government raises taxes and through that, it pays for the health care of all.
The NHS:
We all know that the capitalist system focuses on the rich and the socialist/communist system guards the workers. Almost as a product of perfect merging of ideals of both the capitalist and the socialist philosophies, the labour government started NHS in the UK after the Second World War. That merger formed this beautiful system. Although this system
Although this system does not pay for cosmetic surgery and one has to pay a small charge for outside prescriptions, the system is otherwise free for all.
The following factors form the allure of this system:
1. For all people:
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| Care of the elderly |
Not only that of the very poor, the NHS takes out the stress of the ailments of people, who have failed in their first responsibility i.e. getting a job. It helps the people, who don't earn enough for a day to day living - for whom illness would bring major adversities in life. Furthermore, it doesn't leave the misguided ones like the drug addicts or the alcoholics either.
In addition, they may not get so much of sympathy but it does not leave out the ones, whose rights have been withheld i.e. the convicts. Even the surprised immigrant isn't left out.
2. For all ailments:
Far from being only for the ordinary illnesses, being for all flesh and for all diseases, this health care follows all or none principle. Yes, it doesn't shy away from organ transplants or major metastatic cancer surgery. It may not reach the stage of cosmetic care, as ugliness is not defined as illness, but when it adds the word 'morbid', it makes obesity a disease. It then offers treatment for morbid obesity.
3. Help for the infirm:
With rights overtaking duties in the fast moving selfish modern world, elderly do feel uncared for even by their families. No wonder, the evolved loneliness grabs alcohol as a buddy. Yes NHS treats that illness, but aiding even infirmity it offers free prescription at 60! And hospital admissions do not exclude social admissions. Even carers are provided for them when living gets tuff.
4. Free of money:
Money is neither an anxiety issue during illness, nor is it thought of during consultations. And for that matter, to the pleasant surprise of the consulting migrants, their innocently offered payments are politely declined by the staff! Thus, while the proliferation of altruistic doctor-patient bond is clear in this, the clearer is the freedom from the hassle of finding, contacting and organising an insurance company pay! It is not even thought of. Yes, money always talks, but when its exchange is less, research and publications can themselves speak louder.
5. The philosophy offered:
There has always been a clash of ideas between the communists/socialists, who focus on the working class and the capitalist thinkers, who focus on the rich and the successful. Each philosophy tracer argues his is the best. In trying to prove that, almost like Christian evangelists killing millions to spread the love of Jesus, while the communists have killed millions including their own lot, capitalists have not left many communists alive either.
And for that matter, to the pleasant surprise of the consulting migrants, their innocently offered payments are politely declined by the staff! Thus, while the proliferation of the altruistic doctor - patient bond is clear in this, clearer is the freedom from the hassle of finding, contacting and organising an insurance company pay! It is not even thought of. Yes, money always talks, but when its exchange is less, research and publications can themselves speak louder.
The beauty here, however, is that there is a merger between the two killer philosophies, in which both rich and the poor are taken into consideration. The high tax paying capitalist, for example, who may even go private, knowingly or unknowingly pays for the poor people. Unlike in the US, here both the government and the rich look caring. The poor themselves are able to live blissfully with dignity and free of healthcare pain that too without sloganeering, 'workers of the world unite'. Giving a philosophy that is good for all of mankind, the NHS gives a very important message to the political philosophers of the world.
Present state of the NHS:
Sadly, today, this institution is helping all, like an ambulance that needs a push to start, is itself sick. It itself is getting poorer, and the professionals themselves are not happy.
The phases:
The NHS has had two phases:
A. The expansion phase:
This saw the expansion of NHS with new hospitals emerging in many places. Each hospital had a relatively small medical staffing department, and clinicians had their say on the running of the department. Doctors had to be brought in from different parts of the world to run the hospitals. They were specially treated.
B. The contraction phase:
This phase in which we are now, began with the beginning of the merger of hospitals, the formation of trusts and the establishment of the managerial system.
This phase in which we are now, began with the beginning of the merger of hospitals, the formation of trusts and the establishment of the managerial system.
1. The organization:
Almost like a big fish or a company engulfing a small fish/company bigger hospitals engulf smaller ones - in this phase. If not, then hospitals are usually brought together under a single trust. No wonder, the term contracting phase for it, is so apt.
NHS may be out of money but it is not quite out of politics - on many occasions that is. This is so because trust managers could be easily headed by a political appointee. Also, optimal performance of the hospital would demand a clinician-manager coordination. That, however, is not the usual case scenario as narrated below.
2. The manager-clinician clash:
In this, a clash between ones with more brains and less power, and ones with more power and less brains is clearly seen. In this clash between the clinicians and the management, while bringing in new and more colleagues the hospital mergers also brought in disorganisation and disunity for clinicians, it also offered management the power to organise clinician's rota. With this victory in that clash - apart from others - also increasing the list of suspended consultants, a loss in the clash reluctantly became the clinician's desire. And when dictated, the clinician just became a pair of hands. With gravity thus gone down, they remain an unconsulted group in the running of the department or when constructing a new hospital.
3. The population growth:
While the mismatch of population growth and the hospital mergers or bed reduction in the environment of mismanagement itself produces cancellation of the scheduled operations, an addition of seasonal peak almost brings in a crisis. The waiting list rises, as does patient discontent.
4. The use of money:
All trusts receive the government allocated money. But almost like a vicious cycle, neither the allocated amount is optimal nor the utilization of that money is. For example, all hospitals don't have their own buildings, so renting one becomes a must. Here lies the biggest expense. When the capitalist and the politician merge, the rent of the building climbs up so high that it alone can take half the allocated money - as some hospitals are sadly paying. Apart from the day to day cost, higher managerial expenses in terms of salary, number of staff and furniture that is well known, also drains money. Locum staff don't come cheap either.
5. The saving of money:
It's not that managers don't think about saving money. They merge hospitals. Unlike company mergers, however, capital does not grow through mergers. In the hospital, they buy less gadgets for the wards, clinics and theatres, and don't increase bed numbers. In addition, replacing costlier qualified nurses, they flood the clinics and the wards with cheaper auxiliary nurses.
6. Litigation culture:
Although money isn't an issue in the NHS, money does talk. With the litigation culture raging like a bull in the US, along with globalization it gets visa to the UK too. Needing more of accusations and less of proof, the out of court settlement chosen to save the NHS from defamation through the newsflash and the legal costs, adds a fair share to the spend.
7. The discontent:
To start with, it may not be like the 'builder's blunders' as seen in the Net, but the not consulted clinicians at places, do find even a new hospital uncomfortable to work in. While the paucity of beds, makes the clinicians and the nurses helpless with the demand, in the dearth of the needed gadgets, an occasional new gadget's arrival forms an exciting bonus. The pay the GP per anatomy referred system, at times, brings awkwardness to the clinician, who faces a request to examine an un-referred anatomy.
The salary of the medic that was a pride once has lacked growth hormone since. No wonder even a manager, at times, is seen taunting clinicians with, 'I earn more than you'. Future isn't 'orange' either,
for rumour goes; 'With hospitals being run by immigrants, it isn't going to rise in par with the other fields of knowledge'.
Thus, with the dignity assigned to being a pair of hands, work becoming harder due to paucity of facilities, litigation culture putting the medico in the line of fire and job being guaranteed for 3 months alone if 'enlisted', honour isn't quite as desired. Thus, the aspiration of honour, comfort and a good salary that takes the medicos through the uni and the hard work of hospital training does not quite come true.
Nurses are not faring any better either. With a few trained nurses having to look after a big ward and training focused on record keeping rather than interaction, Florence Nightingale's care looks distant; a Harry Potter like write up looks closer. Yes patient contact isn't less in the clinics, but placement outside consultation rooms lessens clinical touch. When low salary is added, incentive amongst nurses sees blue too.
8. The work ethics:
It's clear from the above deliberation that enthusiasm and pride are replaced by lethargy and discontent. It can even descend to, 'you get paid with or without work' that failed communism in Russia. A positive work culture thus doesn't get enough nutrition. Education institutes cannot remain immune but rather contagious to this lack of enthusiasm. Hospitals, thus, have to rely on expats or locum doctors and nurses. The later ones don't come cheap.
Patient satisfaction:
While closure of the local A & E or a merger that compels them to travel further itself generates dismay among patients, the long wait in the clinic doesn't lessen it. Similarly, while long waiting lists for operations do prolong pain and even become news, the cancellation of scheduled operations due to emergency cases add resentment. In addition, while the wait for a bed in the A & E makes patients feel bad, an overcrowded 3rd world hospital like scene during seasons dismays even the doctors.
Thus the vicious cycle continues and the NHS itself looks ill.
Will privatisation help?
NHS is a massive organization with plethora of intricacies. Unlike the railways, it does not run on management alone. Its ways are constantly changing according to the available new knowledge. In addition, while making patients 'commodities' is not quite a good idea, the merging of academia and money isn't decent either.
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