Monday, December 30, 2013

Good old NHS

Being in Canada makes me so grateful for our British NHS!

There is a certain amount of provincial healthcare for everyone in Alberta. But it is limited: prescriptions and ambulances, for example, are not covered. And anything not covered must be privately funded or paid for by health insurance, often via an employer, as in the USA. With some things you can opt to pay if you want to control the way your healthcare happens. So, we asked for a private room in the hospital when the twins were born and there was a small charge for the privilege of not being on a ward. (Which would have been covered by Alberta Health Services).

Quite how an ambulance can be seen as a non-essential service I don't know. Anyway ....

There are family doctors here, a bit like GPs. They are the first port of call in most situations and are the 'gatekeepers' for other services. But from what I can gather, there are financial incentives for them to see large numbers of patients and to write prescriptions. I like our family doctor but was struck by the speed with which she prescribed drugs whenever I visited her.

Gradually I saw the problem: I was making an appointment in order to chat through a health issue and be advised on how to manage it. She expects her patients to make appointments in order to request a particular drug or referral (and she is paid, at least in part, for doing that).

I see healthcare as a service. She, a commodity.

I have seen my family doctor for initial referrals; a private company handling only blood and urine tests for those; a women's health clinic for obstetrics / gynaecological issues; a local health centre for my babies' immunisations and some post-partum services; a paedeatrician's clinic for my babies' regular check ups; one hospital for the birth; another hospital for a lactation consultant.

There is a certain amount of clunkiness when the services must overlap due - I assume - to the lack of central responsibility for me as a patient. Most frustratingly, when I asked for breastfeeding advice in the hospital (feeding twins is bloody difficult) I was told they didn't have anyone who could help me and I needed to go to another clinic to be referred to another hospital with such a member of staff. I dutifully went to the clinic but either they or the second hospital screwed up the admin, so it was several months before I actually saw a lactation consultant. By which time I had dealt, miserably, with mastitis and various other complications on my own.

Even the wards of a hospital adopt mutually exclusive systems for dealing with patients. So, when Rowan was in the NICU and Willow with us on a post-partum ward, it was impossible to manage conflicting demands. Nurses would come to give me a check up when I was supposed to be feeding Rowan. Wheelchairs to travel from ward to ward after a c-section were not available. Connecting doors to allow me to get from one ward to the other were locked. We breathed a huge sigh of relief when both twins and mum were discharged on the same day. It could have been otherwise.

The NHS may be a bit doddery sometimes. And certainly its admin is not perfect. But, at least in principle, the centre of British healthcare is the patient and her needs. As opposed to the systems, finances and designated responsibilities adopted by a particular provider of a specialist service.

Here in Canada, of course, things are a world better than they are in the States. There, being unemployed and ill is a fate to be dreaded. And having twins, even for those in gainful employment, can lead to bankruptcy.

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