The Anonymous Widower

The Power of Twitter

It would appear that Twitter has been having a hard time, as a war of words goes on about the NHS between Britain and the United States.  Or at least between some people with axes to grind.

I am quite a regular user of NHS services in that I am a coeliac and have a B12 injection every three months, free prescriptions for bread mixes, ongoing issues with cholesterol, my left foot, which got injured on a beach by a shell and my left humerus, which got broken by a bully at school.  Nothing is that serious and I suspect, I’m quite a way below average in my consumption of services. I never have a problem and I can always get an appointment when I want with my GP.

If I look at the last few weeks of my late wife’s life, I can’t fault the services she got from both the hospital and from the GP.  She eventually died at home in her own bed, which is surely the way we’d all like to go.  If we have to go at all!

But I’m not saying the NHS is perfect, but on the whole in mine and my many of my friends’ experience it works pretty well.  I think we’re also lucky here in West Suffolk, in that we have two hospitals within reach; Addenbrookes and Bury St. Edmunds.  For specialist problems, Papworth and London are not too far away.  So if I have a problem, I’d make sure I get the right consultant from a choice of several.

I have never used the US healthcare system so I can’t comment directly, but whereas none of my friends in the UK would put healthcare to the top of their list of worries, many of my American friends do. I worry about living alone and perhaps having a heart attack by myself, but I don’t worry about the care I would get.

Recently, I’ve had experience off two other health systems in Europe; Italy and Holland.  So in the latter it’s only indirectly, but the episode in Naples was only the second time, I’d had a ride in an ambulance.  The ambulance was rudimentary, the hospital was very tired, but the care was good and there were lots of doctors and nurses.  Compared to the UK, the buildings are a lot worse, the staff seem to work a lot harder, but the result is probably about the same.

Holland is interesting in that everyone has to take out insurance, even if you’re unemployed.  If you don’t then you don’t get treated.  So take your European Health Insurance Card with you! One guy in Holland got charged 740 Euros to remove a tick!

So we can find holes in every health system and these are going to get publicised all of the time.  But they actually stop real debate about the way we’re going to have to manage health care in the future.

When I had my last B12 injection, the nurse told me that increasingly her time is taken up by the problems of the obese.  It would appear that what the US and the UK do, that they can’t get to grips with this problem.  I suspect it may be solved in the US, by the health insurance companies charging a lot more and people will either have to diet or take the consequences.  So perhaps, their system has this control and that because the NHS is free at the point of delivery for all, the system will overload here in a big way in the next few years.

And then there is smoking!  And excessive drinking, that leads to all sorts of problems. And don’t forget illegal drugs.

So to me the key to getting health costs under control, is to take action against obesity, smoking, excessive drinking and drug abuse. Do this and I suspect that the money will be there in the NHS for all the exotic drugs coming on stream.

According to this article in the Telegraph, in 2007, the NHS spent £750 million on drugs to combat unhealthy lifestyles.  That is about 9% of the total drug spend of £8.37 billion.

But I do wonder about some of these drugs. And also the effects of the drug companies.

I am a coeliac and although it has been shown to affect about one-in-a-hundred of the population, there is very little research into the subject.  Why?  Because, everyone knows that the cure is to keep to that gluten-free diet and that if a drug came, that allowed you to eat gluten, most coeliacs wouldn’t trust it and would leave it in the pharmacy.  You could argue too, that if we tested everybody for coeliac disease, this would save quite a bit of the drug bill, as many undiagnosed coeliacs suffer all sorts of problems like arthritis.

I wasn’t on any drugs before diagnosis, but I nearly had a couple of serious operations on my knees.  Luckily I didn’t!

So better and earlier diagnosis would probably cut the drug bill.

I should also say, that many patients think that for every disease they need a magic pill.  We are prescribing Tamiflu to all and sundry, when many commentators, think that bed, whisky and paracetamol might well be better for the run-of-the-mill cases.

I’m not taking it for a start, unless I get a serious dose of flu.

My late wife had a horrific cancer and they tried to use a drug to prolong her life.  It failed and made her life worse.  So on another point, I would never take a drug unless I had all of the facts.  We must not judge success by an extra day of life, but by the quality of that life as well.  The number of people in favour of assisted suicide shows that the general public rate the quality of life pretty high.

But we must also remember that over half the costs of the NHS are staff costs, whereas the total cost of drugs is a lot less than that.  I can’t find accurate up-to-date figures, but the drug cost is probably between ten and fifteen percent.

So to get a better health service, we need to cut out those bad lifestyles and provide the tools for the NHS, so that we get more greater value for the large amount we pay staff.

I’ll give one personal example here.

To be diagnosed for coeliac disease, you need to have a full endoscopy. I’ve had two and they’re not that bad, but they cost the NHS a lot of money.  On the other hand, before I had the first endoscopy, I was diagnosed as a very likely coeliac by just a simple blood test.  I went on a gluten-free diet, my chronic dandruff disappeared immediately and I felt a lot better.  In other words why bother with the endoscopy?

NHS rules say you can’t get gluten-free goods on prescription unless you are diagnosed by endoscopy.

There are several things wrong with this policy.

  • Some coeliacs have a negative diagnosis by endoscopy, despite losing all symptoms on a gluten-free diet.
  • My wife said that it could be construed as child-abuse to use a gluten challenge and endoscopy on a child.
  • A lot of coeliacs get little on prescription, as much better offerings are available in the supermarket.  I only get a bread mix.

How many other areas could better and more scientific procedures make the NHS more efficient?

Whoever wins the next General Election in the UK has a lot of scope for efficiency improvements in the NHS, but the entrenched views of those who work there will make it difficult.

What am I going to do?

Keep slim and fit!  And not stand on any more razor shells on Holkham Beach.

And also use Twitter to publicise all the waste.  It has a lot more power than anything else.

August 14, 2009 - Posted by | Health | , ,

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