It’s not a church.
Healthcare in the UK can be an emotive subject. After all, a significant proportion of the UK population seem to believe the NHS is some kind of religious institution.
I am going to start with a big statement. If I didn’t have access to private healthcare, I might be dead. Or, at the very least – terminally ill. Then again, if I didn’t have the NHS available when I got sepsis, I’d probably be dead too.
This isn’t a party political broadcast. In England we widely accept that the NHS is a good idea, and the system works for us. Four of my closest family members are NHS lifers, and it’s been a huge part of my own life.
We all have NHS stories
Like most people, I was born in a NHS hospital. I used to jump over the school fence to have my lunch with my mum in the hospital canteen. Both of my children were born in our local NHS hospitals, although we had a bit of expertise from the Portland too.
When my daughter was born, I walked the long hospital corridors to the special care baby unit in the middle of the night. They have cared for all my grandparents in their final moments too. The NHS looks after my father three days a week and their wages have put food in our family’s mouths since the 1960’s. Honestly, I don’t have an axe to grind here.
I have had access to a private GP for almost 20 years, probably since I first started working in the city. But I very rarely (if ever) use them, and our local NHS surgery takes care of the whole family. It’s a pretty typical set-up in the UK. Ours is a really busy surgery, it’s well regarded in our community and in the main, they do a pretty decent job.
The NHS is absolutely world class at emergency medicine. It’s a leader in research and innovation, in training and the really big complicated stuff. When it comes to surgery and recovery, you are in incredibly safe hands.
But, when it came to spotting penile cancer, they came up short. It wasn’t just my GP surgery either, even the busy NHS sexual health clinic didn’t have a clue. That place must see more penises locally than just about anything else. I don’t actually blame the health service for this failure though.
Clinical practices are very heavily regulated, and guidelines and processes seem to be blindly followed. Other conditions are eliminated first, and this, unfortunately leads to delays.
Could some initiative have been used by the doctor when the problem slipped between the cracks of their processes? Sure.
Should I have been referred on to a urologist if they were not sure I had something else? Yes, definitely. This is where we are though, and I’m not dead.
It’s probably not that hard to fix
I’m convinced that lessons can be learned, and it’s only really a question of awareness.
Despite the political hyperbole, there is no penny pinching in the NHS. It’s just about the most expensive health service provision on earth, costing us 2.65 billion pounds a week. The real issue that I regularly encounter, is bureaucracy.
You can read more about my ridiculous journey to finally get to see a urologist in my journals. But long story short, it’s an incredibly slow, inefficient, monolithic beast.
Everything is done to a set formula. If your condition is not typical, there’s a good chance that you’ll slip through the cracks, which is why it’s really important to ask lots of questions of your GP. If you’ve got a lump on the head of your penis, or trapped under your foreskin, it could have sharp pain, smelly discharge, a lump in the groin perhaps – just ask the question, could it be cancer?
What’s the difference?
Anyway, enough of my venting – this is about the difference between the NHS and private health care providers. It’s about what I’ve found, what’s brilliant about both, what could be better and what you can expect.
The first thing to remember about private healthcare is that it’s all about health insurance. Everything is signed off step by step, with cover limits, exclusions and levels of cover. You can choose bronze, silver, gold, platinum, probably black.
Every time you see someone new or find something new – they need to approve it. I must say though, my health insurers were brilliant at every step, nothing was too much trouble, and they made everything stress free.
With the NHS, there’s none of that approval nonsense, it’s just covered. Whatever it is, it’s sorted for you, cradle to grave. It’s a gift from the British taxpayer. From each, according to their means, to each, according to their needs. (Whether you want it or not)
The doctors in the UK are pretty much always the same. Whether they wear a NHS badge or a Bupa/Spire one, it’s all the same pool of doctors. Private surgeons are just NHS surgeons on their days off.
The level of expertise is the same, but instead of a broom cupboard with a couple of plastic chairs, you’ll get a nice consulting room.
Nurses, and specialists like physiotherapists will often have a NHS day job too. This is just the side hustle.
Here’s the first really big difference. In a NHS general hospital you could have 12 men in each ward, separated by a curtain. They could all have different ailments too. You’re usually sharing a toilet with a few sections of the wards, and at the height of a global pandemic it’s absolutely crazy.
There’s a massive difference in NHS facilities across the UK. Some NHS hospitals are really tired, noisy and very basic. Aside from a couple of new bits, Princess Alexandra in Harlow needs to be demolished. The Lister in Stevenage is better, and it’s improving all the time. St Georges, the biggest hospital in the UK makes the best of its facilities. But it’s probably time for a new building there too.
Others are incredible, like the two new ones they’ve built in Cambridge recently. The new QE2 in Welwyn Garden City is brilliant too. There’s an enormous ongoing investment in new hospitals, but unfortunately they don’t get built overnight.
You don’t get much rest on the NHS. They wake you up all the time and if it’s not the nurses, it’s your fellow patients. If you want to watch the telly, pay for it. Phone? Pay for it. Parking space? You guessed it. The food is absolutely shocking too. (unless you’re at St George’s and can nip down to M&S Food)
In private hospitals you get your own room. You always get a lovely big telly, usually an armchair and sofa, and your own bathroom too. The food wouldn’t get in the Michelin guide, but it’s pretty decent.
Private hospitals have nice rooms, and a bit of a hotel experience. But, there’s not much that can compare to the might of the NHS on stuff. When it comes to sheer purchasing power, research might and manpower, they are a monster.
The NHS is a behemoth, with almost limitless public money and goodwill. (although it’s just the £2.65 billion each week currently, but the goodwill doesn’t look like it’s waning.)
If you’re going to have a big, complicated operation or you’re critically ill, the NHS is the place. Accept no substitute.
You don’t get robotic surgery in many private hospitals, or tens of thousands of researchers, or much innovation. But I wouldn’t have wanted to recover from my first big cancer operation in a general men’s ward at St Georges. Or even one in Harlow.
In the best of all worlds, you’d do your consultation in a private hospital, have the operations and treatment in a NHS one, and do your recovery and recuperation back in your private room again.
For me, the Royal Marsden is a brilliant example of a hospital that does everything well. It’s truly brilliant, and you can see why it has such a special place in the hearts of so many brits. We should be taking their template and using it everywhere in NHS hospitals.
It’s fair to say that NHS hospitals are brilliant in a crisis, world class even – but they’re absolutely shocking in lots of other areas. It’s not like we’re short of cash, do better.
Joined up thinking
NHS bureaucracy is absolutely mind blowing, and nothing is joined up. They exist in a series of vacuums, where everything is handed over from one department to the next. Things get lost, needs get ignored and there’s very little personal service.
I know they’re desperate to improve everywhere they can, but just having a single point of contact that can join everything up (like they do in private medicine) would be an incredible step forward.
We often forget just how enormous the NHS is. It’s the biggest employer in Europe and the 5th largest on the planet. It has so many moving, but disjointed parts. My own experience could be an anomaly, but it doesn’t seem that way. It just doesn’t work for its customers.
In private medicine, you just call your consultants secretary. They know everything about your case because they’re the ones managing it. They’re proactive and always trying to move things forward. If they don’t have an answer to something – they’ll get it and call you back.
And what is it with the NHS and letters? Sometimes (often) they send you a letter about an appointment which arrives a week after you’ve had the appointment! The Royal Marsden are surprisingly brilliant with all this.
Although they will spaff paper letters everywhere, which is incredibly wasteful, they’ll also put everything on the patient portal. This means you can see what’s happening, all in one place. All your appointments, all your corrspondence. Why is that so hard to roll out across the country?
As for some other NHS hospitals (which I won’t mention), they just send out all kinds of automated appointment spam. Spam which you then have to call up and cancel, if you can ever get hold of someone on the phone!