I’ve just come back from my 90 year old aunt’s funeral in the USA. She was a feisty, independent and intelligent woman, who had raised two children on her own, but she was ready to go. Life was uncomfortable, she was deaf, in a lot of pain, and a fall in early July damaged her shoulder, jaw and more.
The next two months were a testament to why the NHS needs to be careful of what it throws out in the current brave reorganisations. Anyone who has experienced the health service in the USA will tell you that “free at the point of access” is not a phrase that fits. The cost of every element of care had to be paid for - either by insurance or the patient, or someone else - so the ambulance that took her to hospital after her fall was covered by her insurance (well, all apart from $125) and the medication she needed was also covered (well, apart from the medication the doctor prescribed to help her sleep). The bills for the things that were not covered emerged in the days following her death, to be dealt with by her executors.
Over the coming weeks, her family had to negotiate with the insurance company to agree what care they would pay for, and had to pay many thousands of dollars to cover the “extras” that were not covered. As she transferred (by costly ambulance) from hospital to care facility, and back again (twice) the negotiations were played out with distraught relatives.
When it was clear that her condition was terminal, the local hospice was approached to provide round the clock care. Apparently, she wasn’t terminal enough. Battles fought by her determined family eventually made sure the care was provided.
Throughout the experience, treatment was dictated by her insurance policy rather than need.
The NHS needs to sort out its finances, its structures and make itself fit for purpose - but what it doesn’t need to change is the holy grail of free access to essential care for those at their most vulnerable. Whilst staff in PCTs and SHAs wait to find out whether the new structures will recognise their value, and trusts struggle to reduce management costs, the core strength of the NHS needs to be preserved at all costs. Years ago basic management training told me that a focus on what was working well would improve productivity - focus on what is not working well reinforces failure.
It may not be functioning at its most cost effective or best right now, but it is still streets ahead of the USA .