Wednesday, February 07, 2007

Taking care of its citizens

Two friends of mine in the UK recently had run-ins with the National Health Service.

One suddenly started being sick a lot, obviously not eating and as a result rapidly losing weight. That was in November/December and he was admitted to hospital where tests proved inconclusive, and he was due to go for further tests. These took place yesterday - a gastroscopy presumably - and he has a stomach ulcer. What does it take for them to do such a test when someone is in hospital already, instead of making them wait for two months? A lot of unnecessary worry could have been saved. The former Scottish Health Minister, Sam Galbraith, who knows a thing or two about worrying (he had a heart-lung transplant in 1990 and then went on to become minister) always said that that was the worst thing about ill-health - not knowing what the diagnosis might be. Nothing much has changed.

Which in passing reminds me of the gastroscopy I had in Lithuania about a year ago what with having a sensitive stomach often reacting badly to food and water from less than perfect sources. Having read on the web that you should bring a friend because you get a bit of sedation and can't drive home, you should wear clothes that are easy to change out of, and that the procedure takes about 10 minutes, I was all prepared for losing that day - I have learnt never to do any writing during/after sedation or drink! In the public hospital I was taken aback a bit when I popped my head in the door, was told to hop on the table, unchanged, no sedation other than some throat spray, and it was all over in about 2.5 minutes - and out of the hospital. Apparently you would have got that sedation in the fancy private clinic up the road. It's survivable even without sedation.

And ... my doctor made the appointment on a Friday and I had the test on the following Monday; it might have been private, but it was cheap - and I was able to skip out and do what I had meant to do that day anyway. In the UK I think such procedures are classified as 'day surgery' with time to come in, undress, get the sedation, have it done, recover afterwards, get dressed.... needing a seat and using up space. No wonder they have a waiting list.

Another friend was due to have a joint replacement operation on 30 January, was all ready for it, maybe even in hospital for it, when she was told there would be no bed for her after her operation. Which was then postponed to late March. Pardon me, but on what level of bed occupancy does the Health Service run? It was January, when hospitals are often busy with respiratory illnesses, but January comes around every 12 months, and hospitals plan for these things. I know because I worked in the Health Ministry, and we spent much time planning for the winter so that the Minister would not be hit by negative headlines. I have seen no headlines in the UK papers about excessively busy hospitals or flu epidemics (other than those poor turkeys). In some parts of the country hospitals are few and far between, and what would they do if a coach crash were to happen on their doorstep? It would be interesting to know how many operations and procedures are cancelled because there are no beds - maybe 1000 per hospital per year?

A headline in BBC Scotland said that in 2006 1900 cases of malnutrition were discovered in hospital, almost all amongst adults. Some of these will have been malnourished before they went into hospital, given that people are only admitted if it is really urgent, but a considerable number will have become malnourished in their extended hospital stays, eg following a broken neck of femur or so. It's because no-one has time to feed them properly, and if they do not eat by themselves their food will just be removed by the ward orderly instead of nurses checking that enough food has been taken. Happy UK.