Thursday, July 05, 2018

The NHS at 70

I was born under private care. I am older than the NHS and so have experience of it for all of its and my life.
   The good points. Care free at the point of need. No worries there. It does not include your car parking, your dental or optical care or your prescription's . The latter you only pay for in England, not the either parts of the disunited kingdom.
   It is the sacred cow of British politics. Cut it in any way and it is like infanticide ( differentiated of course fro killing the unborn in the womb. We dispose of them on the NHS). It is also bottomless pit. You can never fund enough to meet unlimited demand. But this sacred cow status is one of the big divides from our transatlantic cousins. There socialised medicine is anathema. Have a care - no Obamacare etc.
   I am grateful. It kept me alive around fifteen years ago when I had cellulitis. I owe my life to its IV antibiotics. I sorted ny left ventricular failure, cardiac arrhythmias and colon cancer.
   The staff are of diverse origins and very good. I did notice though that when public transport ceased in a blizzard it was the indigenous English staff who trudged in through the snow. I also noted that nurse recruitment from the far east concentrates on catholic Christians from the Philippines and Kerala, India. The keep the good ethical standards. I had two weeks in two different hospitals last year. The only department which failed to function was the chaplaincy. No chaplain visited though requested. There were no church services except at visiting hours and no mention of and free church chaplaincy. Complains to PALS produced nothing.
   But onto the are of my speciality I do have criticisms. First of all hospital pharmacy is inefficient. They keep you waiting in outpatients. In community pharmacy with me you would not wait five minutes. In hospital half an hour is normal. The they may tell you what your doctor ordered is not in their formulary so tour GP will have to write a script. When you are to be discharged they take for ever to send your n]medicines to the ward - and them nay mess it u. I write from personal experience.
   The the NHS community pharmacy contract. A stitch up between the NHS administrators and big pharmacy firms. An annual customer satisfaction survey is redundant. If you do not like my service you go to the next pharmacy. But who checks the hospital pharmacy's inefficiency. Audits twice a year. Often the one the administrators send you is out of touch with reality. I had to do one on Lithium and I found patients on the drug for decades who knew nothing of the protocols evolve. Administrators ask for ridiculous things. What was I doing in case of disruption to staff attendance during the London Olympics? I ignored that one or I would have said I was too fat to run.
   Prescribe everything generically and GPs are incentivised so to do. Sometimes there are differences between brand that are significant but not often. The main headache with generic prescribing is dressings. The generic drug tariff nomenclature is a nightmare. Brand prescribing is far simpler.
   But the real scandal is the pricing of generics. Pharmacists used to be paid a dispensing fee per item plus an on cost percentage of the drug price. This was changed to a fee pus the flat tariff price revised each month if necessary. But the secret unpublicised agreement is a DT price well above the reality of what pharmacies are paying wholesalers or manufacturers. It is hugely profitable to the pharmacies and expensive for you the tax payer.
   Finally I have no fear of a post Brexit collapse of the NHS nor of significant privatisation in the foreseeable future.

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