The first is that the reduction in the number of beds would happen regardless of financial ideology. It seems to be quite a firmly held assumption both in primary care and hospitals that patients are better off at home, either self-caring, or having regular visits from nurses and home helps.
The second is that the way to cut hospital infections would be to get rid of open wards. The introduction of one or two bed rooms for all patients would allow a better level of control over infected areas, and more opportunity to 'deep clean' when necessary.
They would also allow a greater dignity to patients, and for departments to ensure their patients are kept together on the same ward. Currently, open wards mean that sex separation can sometimes trump the medical need to group by speciality. Of course, that would require a lot of investment, so I guess it won't happen. Member of the Anti-Fabulousness League since 1987.
Fortunately I'm now in France where small rooms are much more the norm in hospitals.
There's a very negative account of one journalist's bad experience in France in the Times - but some very positive comments which match my experience so far, e.g.:
I am a young mum living in france and had my second child here in niort deux sevre. the care was excellent, my husband was allowed to stay for the full time i was in. we pay our top up insurance at the lowest rate. the care my child got was also very good and the experiance was better than that of the one i had when i gave birth to my first child 3 years ago in uk.in uk i could get no care from over run maternity wards, here in france when i needed a midwife she was there quicker than i could press the button.. my father had a stroke after we had been here a year and again the care he has recieved is amazing, he has ongoing problems with dizzness and everytime he has a bad spll they do brain scans, heart scans, blood tests ect, it is so detailed even when they find nothing wrong. on a few occasions i have taken a trip to a&e at night with the children there is no waiting room of such, seen straight away in a big private cubicle. for me 100 times better than uk even with the language. http://www.timesonline.co.uk/tol/news/uk/health/article1751520.ece
I am a young mum living in france and had my second child here in niort deux sevre. the care was excellent, my husband was allowed to stay for the full time i was in. we pay our top up insurance at the lowest rate. the care my child got was also very good and the experiance was better than that of the one i had when i gave birth to my first child 3 years ago in uk.in uk i could get no care from over run maternity wards, here in france when i needed a midwife she was there quicker than i could press the button.. my father had a stroke after we had been here a year and again the care he has recieved is amazing, he has ongoing problems with dizzness and everytime he has a bad spll they do brain scans, heart scans, blood tests ect, it is so detailed even when they find nothing wrong.
on a few occasions i have taken a trip to a&e at night with the children there is no waiting room of such, seen straight away in a big private cubicle. for me 100 times better than uk even with the language.
http://www.timesonline.co.uk/tol/news/uk/health/article1751520.ece
I have to admit, the only place I have ever been hospitalised was in the United States. Though the hospital was nothing special, and the rate per night was really quite low, it fulfilled basic decent standards. Having had that experience, I really fear ever being hospitalised in the United Kingdom, where I know it won't even match up to that.
The hospital I was in was a charity foundation hospital, which was run entirely not-for-profit. I sometimes wonder if healthcare provision by such hospitals and paid for by the state wouldn't be better than the current setup. I don't know if others would count that as privatisation, as though there is no introduction of profit motive, it still puts provision at one remove from the state, which also is relegated to the 'enabler' role defined in most instances of privatisation.
It is sad that my only experiences of health services are the UK and the US, as I know which one comes out on top for me, even though the other is ideologically closer to what I desire. Member of the Anti-Fabulousness League since 1987.
... Let's start with the uninsured, those people who do not have any form of health benefits coverage. There were 21 million uninsured people in the U.S. in 1972. By 2006, that number had more than doubled to 47 million. And this increase has been independent of economic cycles. The number of uninsured grew by 3.4 million from 2004 to 2006, even as a resurgent economy raised incomes and lowered poverty rates. ... Despite the huge amount of money spent on medical care, the situation of the U.S. medical care sector is a disgrace. Even Richard Nixon, in an unguarded moment, defined it as a mess. And as noted above, it has gotten much worse since Nixon was president: in 2006, 47 million Americans did not have any form of health benefits coverage, and 108 million had insufficient coverage. And people die because of this. Estimates of the number of preventable deaths vary, from 18,000 per year (estimated by the conservative Institute of Medicine) to a more realistic level of more than 100,000 (calculated by Professor David Himmelstein of Harvard University). The number depends on how one defines "preventable deaths." But even the conservative figure of 18,000 deaths per year is six times the number of people killed in the World Trade Center on 9/11. That event outraged people (as it should), but the deaths resulting from lack of health care seem to go unnoticed; these deaths are not reported on the front pages, or even on the back pages, of the New York Times, Washington Post, Los Angeles Times, or any other U.S. newspaper. These deaths are so much a part of our reality that they are not news. How can this be tolerated in a country that claims to be a civilized nation? ... Most people believe that because they have health insurance, they will never face the problem of being unable to pay their medical bills. They eventually find out the truth -- that their insurance is dramatically insufficient. Even for families with the best health benefits coverage available, the benefits are much less comprehensive than those provided as entitlements in Canada and in most E.U. countries. And paying medical bills in the U.S. is a serious difficulty for many people. In fact, inability to pay medical bills is the primary cause of family bankruptcy, and most of these families have insurance. Furthermore, 20 percent of families spend more than 10 percent of their disposable income on insurance and medical bills (the percentage is even higher for those with individual insurance: 53 percent). In 2006, one of every four Americans lived in families that had problems in paying medical bills. And most of them had health insurance. The inhumanity of this situation is made evident by the fact that nearly 40 percent of people in the U.S. who are dying because of terminal illness are worrying about paying for care -- how their families are going to pay the medical bills, now and after they die. No other developed country comes close to these levels of insensitivity and inhumanity. Meanwhile, the federal government parades around the world as the great defender of human rights, ignoring the fact that among the developed democratic nations, the U.S. is the most deficient in human rights. The basic right of access to health care in time of need does not exist in the U.S. ... http://www.alternet.org/healthwellness/79281/?page=entire
... Let's start with the uninsured, those people who do not have any form of health benefits coverage. There were 21 million uninsured people in the U.S. in 1972. By 2006, that number had more than doubled to 47 million. And this increase has been independent of economic cycles. The number of uninsured grew by 3.4 million from 2004 to 2006, even as a resurgent economy raised incomes and lowered poverty rates.
... Despite the huge amount of money spent on medical care, the situation of the U.S. medical care sector is a disgrace. Even Richard Nixon, in an unguarded moment, defined it as a mess. And as noted above, it has gotten much worse since Nixon was president: in 2006, 47 million Americans did not have any form of health benefits coverage, and 108 million had insufficient coverage. And people die because of this. Estimates of the number of preventable deaths vary, from 18,000 per year (estimated by the conservative Institute of Medicine) to a more realistic level of more than 100,000 (calculated by Professor David Himmelstein of Harvard University). The number depends on how one defines "preventable deaths." But even the conservative figure of 18,000 deaths per year is six times the number of people killed in the World Trade Center on 9/11. That event outraged people (as it should), but the deaths resulting from lack of health care seem to go unnoticed; these deaths are not reported on the front pages, or even on the back pages, of the New York Times, Washington Post, Los Angeles Times, or any other U.S. newspaper. These deaths are so much a part of our reality that they are not news. How can this be tolerated in a country that claims to be a civilized nation?
... Most people believe that because they have health insurance, they will never face the problem of being unable to pay their medical bills. They eventually find out the truth -- that their insurance is dramatically insufficient. Even for families with the best health benefits coverage available, the benefits are much less comprehensive than those provided as entitlements in Canada and in most E.U. countries. And paying medical bills in the U.S. is a serious difficulty for many people. In fact, inability to pay medical bills is the primary cause of family bankruptcy, and most of these families have insurance. Furthermore, 20 percent of families spend more than 10 percent of their disposable income on insurance and medical bills (the percentage is even higher for those with individual insurance: 53 percent). In 2006, one of every four Americans lived in families that had problems in paying medical bills. And most of them had health insurance.
The inhumanity of this situation is made evident by the fact that nearly 40 percent of people in the U.S. who are dying because of terminal illness are worrying about paying for care -- how their families are going to pay the medical bills, now and after they die. No other developed country comes close to these levels of insensitivity and inhumanity. Meanwhile, the federal government parades around the world as the great defender of human rights, ignoring the fact that among the developed democratic nations, the U.S. is the most deficient in human rights. The basic right of access to health care in time of need does not exist in the U.S. ...
http://www.alternet.org/healthwellness/79281/?page=entire
I go to my GP, because they cover my postcode. I go to my hospital, because that's where I am referred to. I'm happy that they're paying, but it's not really my health care: it's their health care, as experienced by me. Member of the Anti-Fabulousness League since 1987.
Most people don't want to have to wade through data to try to choose a hospital, they want the system to ensure that their local one (and access is important for most people, for patients and visitors) is good, i.e. that THEIR hospital is good. It's OUR system, not that of greedy corporations offering some choice, IF you can afford it, and if they can't find an excuse for refusing payment. Maybe it's because I'm a Londoner - that I moved to Nice.
For example, you say:
It's OUR system, not that of greedy corporations offering some choice, IF you can afford it, and if they can't find an excuse for refusing payment.
But I wouldn't let businesses anywhere near the funding or the provision of services. Ever. I have no desire to see the introduction of the profit motive, or necessarily business practices, into health care. I want free access to doctors and to treatment.
Most people don't want to have to wade through data to try to choose a hospital, they want the system to ensure that their local one (and access is important for most people, for patients and visitors) is good, i.e. that THEIR hospital is good.
I would like that my local GP and my local hospital, and every person I have ever been referred to is a good doctor, but they haven't been. I have never had the chance to choose a doctor or a treatment.
I once visited my doctor concerning a relatively simply issue, and was referred to a doctor in a city I had trouble travelling to, simply because that's who they referred to, no other reason. I managed to attend the consultation, but I neither trusted the doctor to treat me, nor was I given the opportunity to make an appointment for treatment. I received a letter a couple of days beforehand telling me my treatment had been scheduled for that Sunday, in the morning! Public transport doesn't run on a Sunday morning, and despite my best efforts to hitch-hike there (I'm not kidding), I never made it. I rang the hospital to say I wouldn't be there, and asked whether they could rearrange, but they simply said that I had forfeited(!!!) my treatment, and that I had to go back to my GP and ask to be referred again. Considering that the initial referral took a year, I never bothered.
So yeah, I would love to be able to choose where I was treated, and the time of my appointment, because I might actually get treated in the future, plus I would be able to meet doctors and refuse them if I didn't trust them. I would feel empowered about health care if I could discuss with others their experiences of a doctor or a treatment and choose for myself. For me, that would be the kind of system that ensured every doctor was good. You don't have to be a market ideologue to believe that, or maybe you do, I don't care. Member of the Anti-Fabulousness League since 1987.
If the government's current policies are allowed to succeed, by the end of this decade the NHS will effectively have disappeared as a national institution providing the most economical high-quality health services in the world, freely and equally to all. The 'NHS' will still exist, but increasingly just as a logo attached to the provision of healthcare by private hospitals and GP surgeries. The services available to patients will have become more and more uneven. People will look back nostalgically to the days of 'postcode rationing' - drugs available to patients in one area being denied to those next door. At least that was in the open, and could be changed by democratic pressure. Soon entire clinical services - for example, mental health or paediatrics - will become unavailable locally, as hospitals drop unprofitable activities in order to survive in the market, and without any opportunity for the public to prevent it. This unevenness will be offset by new opportunities to buy 'superior' or 'enhanced' services through 'co- payments'. Those who can afford it will buy the kind of services that the NHS was created to provide free to everyone, regardless of ability to pay. Everyone else will get a 'basic' service, which will decline steadily as the middle class loses interest in it, and good staff flee to better-resourced and less stressful work. If this picture seems far-fetched, it is because government spin and media bias have prevented a clear picture emerging. Most of it has already occurred, or is explicitly planned. Privatisation so far NHS premises are increasingly owned and operated by private corporations. In the case of hospitals this is occurring through the private finance initiative (PH). Of the 100 hospitals promised in the 2000 NHS Plan virtually all will have been procured via the PH ... http://www.health.ed.ac.uk/CIPHP//publications/red_pepper_2006_not_safe__leys.pdf
If the government's current policies are allowed to succeed, by the end of this decade the NHS will effectively have disappeared as a national institution providing the most economical high-quality health services in the world, freely and equally to all.
The 'NHS' will still exist, but increasingly just as a logo attached to the provision of healthcare by private hospitals and GP surgeries. The services available to patients will have become more and more uneven. People will look back nostalgically to the days of 'postcode rationing' - drugs available to patients in one area being denied to those next door. At least that was in the open, and could be changed by democratic pressure. Soon entire clinical services - for example, mental health or paediatrics - will become unavailable locally, as hospitals drop unprofitable activities in order to survive in the market, and without any opportunity for the public to prevent it.
This unevenness will be offset by new opportunities to buy 'superior' or 'enhanced' services through 'co- payments'. Those who can afford it will buy the kind of services that the NHS was created to provide free to everyone, regardless of ability to pay. Everyone else will get a 'basic' service, which will decline steadily as the middle class loses interest in it, and good staff flee to better-resourced and less stressful work.
If this picture seems far-fetched, it is because government spin and media bias have prevented a clear picture emerging. Most of it has already occurred, or is explicitly planned.
Privatisation so far NHS premises are increasingly owned and operated by private corporations. In the case of hospitals this is occurring through the private finance initiative (PH). Of the 100 hospitals promised in the 2000 NHS Plan virtually all will have been procured via the PH ...
http://www.health.ed.ac.uk/CIPHP//publications/red_pepper_2006_not_safe__leys.pdf
Cf Pemberton in the diary. Maybe it's because I'm a Londoner - that I moved to Nice.
