A bit of personal news

by TCW | Nov 29, 2024 | Uncategorized

I’m taking a break from writing about history or books this week to return to something more personal.

Decades of use and abuse have resulted in me wearing out my elbow joint.  I used to think that the elbow was one of the less important joints (and I am incredibly grateful that it was my elbow rather than knees or hips) but it turns out that once your elbow packs in, so does a lot of control in your wrist and hands. Plus, in my case, it triggered rheumatism that led to joints everywhere else coming under a lot of strain. The upshot is that I’ve been seeing the inside of hospitals quite a lot lately. And that’s made me think about the NHS, an institution that is, understandably, coming in for a lot of criticism these days. Perhaps you are American – I know this blog gets American readers – and you may be one of those people who believe that socialised healthcare is bringing Britain to the brink of communism. Or you are one of the small but increasingly vociferous number of Brits who think that spend on the NHS is out of control and we would be better off with some sort of insurance based system. So it’s worth a quick reminder of what actually happens when you get sick.

Firstly, to be fair to the NHS’s critics, you spend a lot of time moving through the system until you belatedly arrive at the right place. In my case, the right place was a rheumatology consultant at my local hospital. As I began to panic that my body was suffering from more and more aches and pains and bits of it were increasingly often refusing to do what they were supposed to do, she reassured me that modern drug treatments meant that everything was going to be OK. I was put on to the standard medication for the sort of rheumatism I was suffering from. (There are different sorts. Who knew?) When it didn’t work, this was supplemented with another. There was definite progress but I was still far from well.

Had I been paying for my own treatment or having it funded by an insurance company, I strongly suspect that would have been the end of the story. As it was, my consultant explained so there is a newish drug that should do the trick but that, as it is ridiculously expensive and I will have to take it for the rest of my life, she would have to make a special case and get it approved for use with me. It took a couple of months and then I moved onto it and the change has been spectacular. All the aches and pains vanished and, although there is some residual damage here and there, I’m basically sound except for the elbow that created the problem in the first place. My rheumatology consultant admitted that even her wonder drugs could do nothing for it. The elbow was literally just worn out. (An X ray showed that where cartilage should provide a relatively friction-free surface to the bones in the joint, there was nothing.)

Elbows are notoriously complicated joints, enabling you to move your forearm at all sorts of weird angles, rotating it as you do so. I was not surprised to learn that my local hospital could do nothing about it. However my consultant referred me to another nearby hospital where they told me that elbow replacement is now an option. There was a long waiting list – around a year – but I wasn’t even absolutely sure that I wanted it. After all, I could sort of get by with just my left arm and I developed lots of ways of working around the problems with my right. As time went on, though, things began to get worse and a routine checkup pointed out that I could no longer pretend it didn’t need dealing with. So I was moved up the list and, surprisingly quickly, I was in hospital having my arm cut open.

That was just over a week ago and I am amazed at how much the new improved elbow is already capable of. I can, for example, write my name. (My inability to write for the past few months has been hideously embarrassing, even though I use a keyboard for most things.) And I can open a jam jar and eat with a knife and fork. Once the dressings are off, I look forward to the really exciting stuff like being able to touch my nose.

And, overseas readers, what has this cost me?

Nil, zada, zilch, nothing.

That’s for an innovative and hideously expensive drug that has fixed one problem and surgery that didn’t even exist when I was younger that has fixed the other.

Seeing the NHS from the inside, it is all too clear that it’s a mess. It’s grown so much that even the hospital is a collection of buildings, some quite old, some brand new, all connected by miles of corridors. Expensive MRI scans have gone missing, my GP frequently doesn’t read all he is sent about treatment protocols, I get caught up in ridiculous arguments about which bit of the NHS bureaucracy picks up the bill for some of the dozens of blood tests that I’ve been given, though that’s nothing compared to the overall costs of my care.

It’s a ridiculous system which relies on dedicated, underpaid staff going above and beyond in a system that has massively outgrown the structures that were set up in 1947. But the important thing is that it works. Creakily, slowly, sometimes inefficiently, but it gets there. I am better. I have friends who are only still alive and active and happy because the NHS has saved them.

Yes, it could be more efficient. Yes, it could be more streamlined. But you know what it needs most? It needs money.

I haven’t seen any of the most recent studies, but I’ve seen studies in the last 10 years that have compared costs and outcomes across different health systems. The British system is not the best in the world – but it does provide the best outcomes for the budget that it is given.

I am older, though not that old, and the problems I have had are increasingly being seen in younger people. Nor are they “complex needs”. Bodies wear out, and as the population gets older, so more bits need to be repaired or replaced. If you are young and healthy, you may not see money spent on people like me as a particularly wise investment. But I was young and healthy not that long ago and eventually you will be old and you will need medical care. (Or you will be dead, which not everybody sees as a preferred alternative.)

The sad truth is that everybody, everywhere, wants to see the best possible medical care available to them and the people around them but nobody wants to pay for it.

Next time any government tells you that they can square the circle without putting up taxes or cutting services, they are lying.

Look after your NHS. One day, god willing, it will be looking after you.