Politics – The Daily Opinion

Great Expectations: The Cost of Misunderstanding the NHS

The NHS has a big problem. I’m not talking about questionable financial management, the dangers of excessive entanglement with the private sector, or even superbugs on the wards. The biggest problem I see in the NHS today is a chronic lack of understanding on the part of the public. The very group of people it was set up to assist is contributing to its downfall.

Sitting in a waiting-room in a hospital department recently, I couldn’t help but overhear some of the comments made by other patients. One gentleman, perusing the reading material set out by the water cooler, complained that the magazines available were old issues. Another voiced the opinion that the department’s nurses didn’t ‘look professional enough’. Yet another, upon hearing that she would be seen by a locum doctor as her usual clinician had been called away on an emergency, demanded to know why she should bother turning up for her appointment if her doctor didn’t.

Expensive uniforms. Robotic medical professionals. Magazine subscriptions. Such are the expectations of a service set up first and foremost to provide decent and affordable healthcare for all who need it. Of what possible relevance would the latest issue of Heat be to your health? How could the last-minute substitution of one doctor for another equally well-qualified one be less convenient than having your appointment cancelled? And why on earth would you think that spitefully missing your appointment would be hurting anyone but yourself?

It’s on this last point that I would like to concentrate – because, actually, you aren’t only hurting yourself. Each missed appointment has a knock-on effect on patients, doctors, and hospital services. Allow me to take you through the process.

Imagine you have an ongoing health problem of some kind. Let’s say it’s a skin condition. It flares up like eczema, but the usual creams and ointments don’t seem to have any effect. You’re scratching your elbows down to the bone and climbing the walls in frustration, so your GP refers you to Dermatology. You are sent an appointment letter from your chosen hospital, asking you to attend on a certain date.

At this point, the following people are already involved in your care:

Your GP, who referred you
A Consultant Dermatologist, who checked over your referral letter to assess whether you had been referred to the correct department
A secretary, who scheduled your appointment, created the letter and sent it to you

These people are paid to work in the NHS. The NHS is paid for through taxes. Taxes are paid by you.

Let’s continue.

So now the wheels have been set in motion. You have your appointment date, but – glory be! – your inflamed skin has miraculously cleared, and you see no need to attend your appointment. Fair enough. It’s your health, it’s your decision. At this point, according to the information detailed in your hospital appointment letter, you contact the Dermatology department to let them know that you no longer need the appointment. They now have an empty slot in that day’s schedule, which they fill by offering it to another patient who needs it, which helps to cut down their waiting-list.

Only… you don’t contact Dermatology. It’s only the NHS, after all – it isn’t like a private medical clinic, or even the dentist, who would charge you if you didn’t give at least twenty-four hours’ notice of cancellation. The NHS doesn’t charge anyone, because it doesn’t actually cost anything.

Before we debate the ridiculousness of that viewpoint, let’s return to our scenario.

We now have two conflicting realities: one, in which you have decided you won’t be attending your appointment, but haven’t let the hospital know this; and two, in which the hospital has arranged for a highly-trained specialist in skin complaints to review you and offer their expert medical opinion in order to help you.

The day of your appointment arrives. Over in the Dermatology department, the receptionist has created a file for you in anticipation of it being filled with notes about your condition. Down the hall, a trained medical professional is waiting in his (or her) office to help you, not knowing that you won’t be turning up. He can’t just call in the next patient, because perhaps you’re running a few minutes late. Perhaps he could use the time to answer some of the many written queries that arrive from GPs and patients every day, but again, he can’t really get stuck into anything, because you might be about to walk through that door.

Any minute, now.

Had you attended your appointment as planned, the clinician would have then dictated a letter to your GP, which would then be typed by the departmental secretary and sent out. Your lack of attendance doesn’t mean that this doesn’t happen. The clinician still dictates a letter to let your GP know that you didn’t attend, and the secretary still types it and sends it. This is part of what is called continuity of care. Communication keeps everyone informed.

Let’s just remind ourselves how many people are currently involved because you asked for help:

Your GP
One secretary
One receptionist
One Consultant Dermatologist

And now for some very rough numbers (because I’m no statistician) – please take the following as averages:

A GP earns around £100,000pa (call it £50/hr) – 15 minutes spent seeing a patient and making the referral therefore costs around £12.50
An NHS secretary earns £23,500pa (call it £12/hr) – 20 minutes spent typing a couple of letters, scheduling an appointment, and printing and sending said letters costs £4 (not counting the cost of stationery and postage)
An NHS receptionist earns £16,500pa (call it £8.50/hr) – 10 minutes making up a file costs around £1.50
A consultant earns around £100,000pa – the initial consultation (or, in our scenario, the vacant slot intended for it), plus time to dictate a letter and make any necessary onward referrals within the hospital network, takes about one hour (often longer, in fact) of their time, at a cost of £50.

That’s £68 wasted, according to this rather conservative estimate of time and money spent. That doesn’t include all those little extras like postage, stationery, electricity. I guess if we wanted to include those we could round this figure up to £70. So that’s £70 of public money – your money – down the tubes every single time a patient does not attend an appointment and doesn’t let the hospital know. Taking into account NHS England’s recent estimate that 6.9 million hospital appointments are missed every year in the UK, that’s a sizeable chunk of public money gone for no good reason.

If we, the public, thought of the NHS as a “real” business, rather than a fantasy world where doctors and nurses toil merrily all day and night for free just for the warm fuzzy feeling of knowing that they’re doing good, we’d more easily be able to compare costs and make the right decision – to spend a few minutes and less than 50p cancelling an appointment by phone, or to waste £70 and a good couple of man-hours by not doing so. It’s a financial no-brainer.

And yet the status quo persists, the NHS continues to haemorrhage money, and many people continue to complain about the services. But is it any wonder some of the waiting-lists are so long if patients habitually miss their appointments and fail to give any notice that a slot has become available? And is it any wonder that so many departments are grossly overspending, given the amount of money wasted on empty appointment slots, rescheduling, and extra letters?

I think so many people miss their appointments because they take the NHS for granted. They see it as a free service that they can take or leave. The money that funds it is taken out of our wages straight off – we never see that money so we don’t see it as a loss when it’s inefficiently spent. It isn’t perceived as being the same as missing a private appointment, where you’re charged for it if you don’t cancel in time and the money comes straight from your own pocket. But it is, in a very real, if less direct, sense, money taken out of your pocket and tipped down the drain. And in the case of missed appointments, it’s a very preventable waste of money.

We take the NHS for granted because we don’t think about how it works. We don’t understand it and we only talk about it when it disappoints us. We make demands of it as if it has limitless funds; we complain about the money being wasted, yet we refuse to acknowledge our part in that wastage. This is our own money we’re throwing away! These doctors and admin staff are here to help you, but they can’t help you if you don’t turn up and they certainly don’t deserve your vitriol when the service you receive is inevitably less than perfect. We need to meet the NHS halfway for it to work efficiently and cost-effectively. We have a responsibility for our own health and a responsibility for our public services. It’s time for each and every one of us to recognise our part in it.

…up in a puff of smoke

It probably came as a surprise to most to see that The Economist’s ‘Country of the Year’ for 2013 was Uruguay. Their decision was in no small part down to the nation’s recent move to regulate the production, sale and consumption of cannabis.

“Prohibition”, observed the late American economist Milton Friedman, “is an attempted cure that makes matters worse—for both the addict and the rest of us.” It’s time for the industry to be decriminalised and regulated, not because drug taking is acceptable, but because drugs create a problem too complicated to leave to the black market.

Think of a friend who desperately wants to use cannabis but who doesn’t use it because it’s illegal. Stumped? That’s no surprise. Whether they’re prohibited or regulated, those who want to take drugs will. All we do by banning cannabis is shove them into the open arms of dealers, and hamstring society’s ability to persuade them not to bother.

Organised criminals can sell whatever product they like, using whatever methods work, charging as much as they can get away with. The result: adulterated drugs, potential for violence, and hugely inflated prices. Prohibition simply fattens the criminal underbelly. What’s more, cannabis becomes a ‘gateway’ drug as soon as the dealer pushes his customer to try something stronger.

Just because we legalise a substance doesn’t mean we endorse it. Anyone over eighteen can down a bottle of vodka every day until they die. The fact that it’s legal doesn’t make it socially acceptable; but it does remove the taboos that stand in the way of open, honest discussion about substance abuse and its consequences. In a decriminalised Britain, advertising campaigns and accurate statistics (on drug-driving, for example) would stand a good chance of deterring many cannabis users from harming themselves and others.

Decriminalisation, then, doesn’t solely benefit the user. It would save taxpayers money, for one thing—up to £1.25bn in total, according to the Institute for Social and Economic Research, and it’s not like we couldn’t use that at the moment. Prisons wouldn’t be so strained; acquisitive crime would tumble; and guns, ninety-five per cent of which are linked to drug gangs in Britain, would hold less sway on the streets. The more drugs we decriminalise and regulate, the greater these impacts.

Further afield, it’s even harder to justify prohibition. In Mexico, drug-related violence has claimed the lives of over 60,000 people since 2006. Topple one kingpin, and another tries to fill the void—it’s a never-ending merry-go-round of violence. Perhaps more relevant to Britain, though, is the case of Afghanistan. Taleban fighters only strengthen their influence through the drugs trade, as farmers grow the crops that make the most money: marijuana plants and, much more extensively, opium poppies.

The basic model isn’t that complicated—and it’s viable. Portugal decriminalised way back in 2001 and has seen positive outcomes; Uruguay and two American states have followed suit with new strategies. In a legal marketplace, production, preparation and purchases can be carefully controlled. Rather than concentrating on punishment, efforts can be channelled into prevention instead.

Like it or not, people take drugs, always have, and always will. Relying on criminal gangs to supply them is like flipping a weighted coin: heads they win, tails you lose. A new year calls for a new approach, and cannabis should be top of the list.

COMRADE FOX: Low-living in Revolutionary Russia (The Life and Times of Archibald Brinsley Fox) by Stewart Hennessey

“I never gave a monkeys for Marxism or Monarchism or Liberalism or Conservatism or Socialism or any ism. I’ve always been leery of anyone brandishing an ism – an excuse to howl at the moon if you ask me. And they’re all moralists too, always got it in for someone else, usually someone like me.” – Archibald Brinsley Fox.
Written in the style of a diary, ‘Low-Living in Revolutionary Russia’ is Archie Fox’s story of his time spent in Revolutionary Russia. He spent his time cosying up to Lenin, trying to seduce his mistress and hunting for a Faberge egg, but all that is just the surface level of this book. He marks the difference between bolsheviks and Mensheviks, describes the call to arms in Petrograd and even prisoners of war going on strike. With a large collection of well researched endnotes adding to the story, this is one for those with an interest in The October Revolution and those with a liking for adventure and intrigue.

Personally, I’ve never been a huge fan of historical novels, although I always feel like I should be, but Archie Fox’s adventures are genuinely captivating; so much so that I found myself reaching for the endnotes to learn more. Archie is headstrong, with loose morals and yet you can’t help but like him. You might not want to spend any time in his company, but as a character in a book he offers the perfect balance of intrigue and despicable behaviour. Simply put, it’s a love-hate scenario.

The writing style is what really makes this novel captivating, as it has an upbeat rhythm which ensures that you can’t stop reading. Combine that with Fox’s escapades and you very quickly become swept along with the story and forget that it is rooted in historical accuracy; until the name Lenin pops up. Hearing about a man trying to seduce Lenin’s mistress catches your interest like nothing else. It simply isn’t the type of thing you learn at school or college and for anyone who doesn’t have a firm knowledge of revolutionary Russia, this is one of the most effective ways of learning about it.

I imagine that this could be a book to divide the audience, as those who are particularly sensitive to political correctness might not see the humour in it, but in my experience anything that doesn’t beg to be accepted by the masses is usually worth a read and a little controversy never did anyone any harm.

Bullfighting Awarded Cultural Status Despite Opposition

Bullfighting may be one of the last bloodsports to disappear completely, due to a legislation which has awarded it with a special status in Spanish culture.

According to the Guardian, the bill – which was passed with twenty-four votes to six – solidifies the status of bullfighting as “part of the cultural heritage worthy of protection throughout the national territory”, despite strong and vocal opposition from every direction. However, almost all of the amendments put forward by these opponents were rejected by the right-wing People’s Party.

Although conjuring up a stereotypical image of Spanish culture, there has been a gradual decline in the popularity of bullfighting, due to ongoing pressure from animal rights groups and campaigns which demand greater recognition of and support for animal welfare; in short, to stop citing entertainment and culture as reasons to put animals through deaths preceded by great torment and suffering. It is notable that some of this support for animals comes from within Spain, in the form of “Torture is not Culture”.

The growing awareness is also in part due to tourists seeing for themselves exactly what the animals go through; in the annual Running of the Bulls in Pamplona, the event does not stop with the “running”, and in fact the bulls are rounded up into an arena and meet a similarly violent and distressing end to the bulls in bullfighting.

The ban of bullfighting has been successful and complete in Catalonia and the Canary Islands, but as yet is limited to these places, as other regions attempt to preserve bullfighting as a tradition. But one of the only things going for bullfighting, in this day and age, is the notion of “tradition”, which is not dissimilar to the tactics used by many countries to boost tourism, and thus the economy.

In this respect, one of the best ways to stop events featuring animal cruelty, such as bullfighting, is not to have any role in it while travelling abroad, even as a spectator, as this involves contributing to suffering, which must sooner rather than later lose its “status” as a national tradition.

UK Has 6 Universities in Top Global Ranking

According to the most recent global table, the UK now has six universities in a top world ranking.

In the World University rankings it has emerged that, unsurprisingly, Oxbridge continues to remain in the top 10 (with graduates from there deemed to be “the world’s most employable”), along with Imperial and UCL, with Edinburgh and King’s College London holding a place in the top 20. In the context of the global ranking, Cambridge holds third place, beaten only by Harvard in second place and Massachusetts Institute of Technology in first place.

The type of subject also has a bearing on an institution’s position in the table; Oxford and Cambridge are the best subjects for seven key subjects, and according to the BBC website, “Oxford came top for English language and literature, philosophy, modern languages and geography in the QS World University Rankings by subject… Cambridge was first for maths, linguistics and history.” So while the UK is evidently the best place in the world for subjects such as English literature and geography, American universities such as MIT are clearly the places to go when it comes to the best education in technology.

However, many academics and educational spokespeople maintain that – with the detrimental effects on UK educational spending brought on by the recession, rising student fees and fewer applicants to university – the UK must increase funding in its education in order to remain at the top of the table.

Given the relative small size of the country, the UK has consistently proven that it can produce graduates whose education is highly valued in the global marketplace; the great influx of foreign students to the UK to seek a British degree is sufficient evidence of its great value.

A spokesperson for the Russell Group – an organisation of prestigious UK universities – has emphasised the importance of keeping the doors to UK higher education open, saying “If our universities are to compete in the future they need the government to provide light-touch regulation and continued investment, and to be welcoming to genuine international students.”. With international fees being several times higher for foreign students than for UK students, this is likely to be a challenge.

A university minister has remained cautiously optimistic about the future of the UK’s position in the world’s university ranking; “Our reforms to undergraduate finance have put universities on a sustainable financial footing and sharpened incentives to deliver a world-class student experience.”

Arrests Over Badger Cull Protests Continue

Four people were arrested early on Tuesday morning during a police operation covering the badger cull protests in Gloucestershire.

The people arrested were two 46-year-old women, a 23-year-old man and a 34-year-old woman, who was suspected to be carrying an “offensive weapon”. They were arrested at around 3.10am and remain in police custody at the time of writing.

These are merely the latest of a series of arrests being made in the Somerset/Gloucestershire since badger culls began there, with “aggravated trespass” being the most common charge. Although police have allegedly attempted to maintain a fair approach towards all participants in the badger protests, their recurring role in these protests indicates the sheer strength of feeling, and division of opinion, when it comes to the badger cull which was commissioned recently.

The main reasoning for the badger cull is that badgers are responsible for spreading bovine TB, although this is highly contested and there are plenty of reports of evidence indicating otherwise. Despite a government petition gaining over 300,000 signatures in the two weeks since the cull began, unfortunately it still looks set to continue for the foreseeable future.

Above all, the badger cull is widely condemned as being inhumane, with many claiming that many badgers are left alive and in great pain and suffering – leading to many volunteering for a “badger watch”, taking it upon themselves to keep watching and listening for signs of badgers who may be in distress nearby.

An RSPCA representative has remarked upon the sheer inefficiency of this measure being taken to control bovine TB, and how this will ultimately cause widespread animal suffering; “The cattle deserve a long-term sustainable solution to this devastating disease which we believe is vaccination and better biosecurity – and the badgers do not deserve to be sacrificed for no real gain.”

High profile figures such as Queen guitarist Brian May are bringing more attention to the cause and urge the public to keep protesting and condemning the inhumane practice.

Go to http://www.rspca.org.uk/getinvolved/campaigns/wildlife/badgers for more information on the cause.