The Retirement Newsletter: What is wrong with health care in the UK?
Issue Number: -50 — what has happened to the National Health Service (NHS)
Welcome
Welcome to issue -50 — what is wrong with healthcare in the UK?
Health
Let's face it, as we get older; our health begins to deteriorate. Bits of us that have worked perfectly well for years start to play up. We become more susceptible to infections and diseases. Our immune system begins to falter, and our joints wear out. Getting old sucks.
So, as we age, having good healthcare becomes important.
In the UK, we have the National Health Service (NHS), so retirees rarely used to worry about access to the healthcare they need.
Unfortunately, this is no longer the case.
The UK National Health Service (NHS)
The National Health Service (NHS) was founded in 1948 by Aneurin "Nye" Bevan (Minister of Health — 3 August 1945 – 17 January 1951) during the post-Second World War Labour Governments (26 July 1945 – 26 October 1951). There is an excellent website charting the history of the NHS at The Nuffield Trust, and more information on Wikipedia.
The idea behind the NHS was simple — free health care for all, funded through general taxation and National Insurance (NI).
It sounds like a great idea, and it was a great idea.
OK, so we all paid a bit more tax for our healthcare, which was better than paying the full cost of the care at the time of delivery. And I can say this from personal experience; the NHS is better than having insurance-based healthcare, which I have experienced twice in my career.
Early in my career, I spent several years working in the States. I worked for a university that provided ‘free dollars’ to spend on insurance for healthcare. I was always alarmed at how many ‘free dollars’ I was given (about 10% of my take-home pay) and how little cover they bought.
With the ‘free’ money I got from my employer, I was able to buy insurance that covered the following:
ambulance transport
treatment at the doctors or a hospital — this came with a $500 excess, which was a lot of money to me at the time
no cover for dental treatment
no cover for the opticians
the full cost of medicines at the pharmacy
I only claimed on my medical insurance once during my time in the States, and what shocked me about the claim was:
the amount of paperwork involved
how easily I hit the $500 excess — this was good news as the insurance kicked in, but even having passed the excess, I still had to pay 5% of the bill and all prescription charges
One thing I did like about insurance-based medicine was I could bypass my General Practitioner (GP) and go straight to the specialist.
At the time in the UK, I would not have been paying 10% of my take-home pay for health cover, and I would have received:
free ambulance transport
free treatment at the doctors
free treatment at the hospitals
treatment at the dentists (I should add here that there would have been some charge, and it was almost impossible to find an NHS dentist)
no cover for the opticians
a capped cost for medicines at the pharmacy. And once you are over 60, you no longer pay for prescribed medicines.
Which is the better deal?
The case of the NHS
The case for the NNS is simple, it is there, and it works — mostly.
You don’t worry about the costs and paperwork with the NHS. You know that the service is there when you need it — hopefully.
The service is equitable. All patients are treated the same. And if you have the money, you can pay for private healthcare.
If the NHS is treating you, your insurance can’t run out — as mine could have in the States.
In the UK, we put a lot of money into the NHS. Currently, it is around 12% of the UK GDP; this rose from 10% pre-COVID. In comparison, the US spends about 18% of their GDP on healthcare (Source of figures — BMA: Health funding data analysis and OECD: Healthcare Spending).
The NHS represents excellent value for money and gives you peace of mind. On the two occasions I lived abroad and had to have health insurance, I was constantly worrying that my coverage was not adequate.
How the NHS should work
In the UK, there is a set way to use the NHS. And here is an oversimplified version of the process:
You become ill.
You see your General Practitioner (GP) at no charge.
If the GP can ‘fix’ the problem they prescribe — there is no charge for the consultation and a fixed fee for any medicine.
If the GP can’t ‘fix’ the issue, they refer you to a specialist who fixes the problem (hopefully) — no charge.
If you have to stay in the hospital to receive the treatment, there is no charge.
When you leave the hospital, depending on your condition, you may be offered support in the community. Depending on the support, there may be a small charge, but there should be no charge.
Or for an accident or sudden illness:
You are in an accident or become seriously ill.
Depending on the severity of the illness or the accident, you either call the NHS helpline, and they triage you on the best route to get medical support, or call for an ambulance (999). No charge.
The ambulance takes you to Accident and Emergency (AnE) at the hospital — no charge.
You are treated at AnE or sent to a hospital ward for treatment — no charge.
When you leave the hospital, depending on your condition, you may be offered support in the community. Depending on the support, there may be a small charge.
The above, which is hugely oversimplified, is no longer working.
What is not working?
I am a layperson looking at this, and the system, which has worked well since 1948, is no longer working. To me, the problems appear to be:
Lack of funds — the service needs more money.
Lack of staff — pay is poor, and staff are overworked.
Inefficiencies in the system.
There are currently some 100,000 job vacancies (NHS vacancies in England at ‘staggering’ new high as almost 10% of posts empty, The Guardian, 1 September 2022). Hence, employing more staff would help, but no one seems to be coming forward. Plus, the staff take time to train. A GP takes ten years (five years of medical school, two years of foundation and then three years of specialised training to become a GP) and other specialities even longer. A nurse takes four years (three years of training and one year working under close supervision), after which they may also go on to do more specialised training.
The current lack of doctors has not been helped by the British Medical Association (BMA — the doctors union), which in 2008 voted to limit the number of medical students in the UK (BMA meeting: Doctors vote to limit number of medical students). These doctors would now be coming on stream and would be invaluable in the current crisis.
Finally, inefficiencies in the system.
Over the Christmas break, an elderly family member was hospitalised with breathing difficulties, and I saw how fantastic the NHS was when needed.
The paramedics that came to the house were great. The AnE and ward staff were terrific. But there were problems.
My relative (and I was with them) was stuck in the ambulance at AnE for about 3 hours. They then spent over 15 hours in AnE before moving to a ward.
I watched nurses on understaffed wards running around, doing their best to look after the patients. The nurses spent a worrying amount of time glued to computer screens filling in forms. Time that could be better spent looking after the patients.
And when my relative was well enough to be discharged, they waited for a week for home care to be arranged. They finally discharged themselves with no care in place.
When you look at the NHS, you see patients struggling to get appointments to see their GP. These patients now end up in AnE. This adds to the workload at AnE and causes problems at the hospital.
Patients in the hospital cannot be discharged as post-hospital care cannot be arranged.
The plumbing of the NHS is broken. Too many patients are entering the system, often at the wrong place (AnE when it should be GP) and not coming out fast enough. The system is clogged.
What does it mean for retirees?
Will the NHS be there for us as we age and require more medical care? Will we have to set aside more of our pension to cover our medical needs?
It is worrying.
Useful links
National Health Services (NHS) website:
Next week
In next week’s issue, I will look at pension scams.
Thanks
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Until next time,
Nick
PS, If you have something you would like to contribute to the newsletter — a story, advice, anything — please get in touch.