ANGRY MOB

There must be something wrong with me. I read Richard Littlejohn's column from 30^th November (Thank heavens my sick mum wasn't at the mercy of the NHS) and I didn't get angry.

Was this because I agreed with what RLJ had to say?

No.

Was this because RLJ extensive research had led to a well thought-out argument that I found interesting?

No.

Was it because his column contained some facts for a change?

No.

So why wasn't I angry?

Simply because it was RLJ being RLJ and I'm told you shouldn't shoot a duck for quaking.

Normally this kind of thing makes me really very very angry. I have a small confession to make at this point. I am an unrepentant apologist for the NHS. I work in it, I am aware of its limitations and issues and I could write long articles on what's wrong with it. I don't for three reasons. Firstly, the NHS is much - and unfairly - maligned. Two, the problems of it are almost always different to the issues raised in the press. And thirdly, and much more importantly, the NHS is an amazing thing and whilst it does have issues they are, in the real world, a price well worth paying for comprehensive healthcare. I am proud of the healthcare the vast majority of patients receive and the work we do in the NHS. It is hugely frustrating to see this constant abuse in the press. And it's not just about the shear insult of this but every week I have to deal with the anxiety created in patients before they even make it to the hospital door. Of course, it is not surprising that anyone who reads our papers is scared of being admitted to hospital.

So, let's summarise RLJ argument;

1.His mother was involved in a traffic accident and was well looked after in a hospital in the states.

2. The NHS might have killed her because all British hospitals are dirty and you will pick up a deadly disease in you are unfortunate enough to be admitted one.

3. American Healthcare is great and insurance works while the billions we spend on the NHS are a waste as there's no good outcomes or accountability.

If I only I knew where to begin with this. I must warn any brave readers that in order to write this I have done some actual research and have provided references at the bottom so that all the facts can be checked. That's right - this article ought to come with a health warning to anyone who reads RLJ regularly; WARNING, the following contains actual facts and not RLJ delusions.

MRSA

I think I want to begin by talking about MRSA. To be fair to Littlejohn, almost no one in the press gets this right. My own personal rant is that MRSA is NOT a superbug. (E.coli 0157 now that's another matter.... sorry, getting of the point). MRSA stands for Methicillin resistant Staphlococcus aureus. Staph. auerus is an extremely common bacteria, it is on the skin of at least a third of the people who read this article. It can be treated with various antibiotics including penicillins. Methicillin is not used in the UK - it is most closely related to Flucloxicillin (a type of penicillin). MRSA is Staph aureus that is resistant to flucloxcillin. This is not a major problem, as the vast majority of strains of MRSA are fairly weedy and are sensitive to multiple antibiotics and are fairly easy to treat. It is quite misleading to say that someone died of MRSA - they died of Staph. aureus infection and the MR bit or otherwise is usually irrelevant. Hospital-acquired infections are common and in general have nothing to do with hospital cleanliness. I know, what a ridiculous thing to say! Well, firstly the majority of infections that patients get come from their own skin. The main reason why people get infections in hospital is not because they're in hospital but because they're ill. By definition the people in hospitals are those that will be most vulnerable to picking up infections. This is why hospital cleanliness matters because it is about minimising the risk to vulnerable people. However, and this is the key, even if the hospital walls, floors, ceilings and beds were entirely sterile it would not stop people getting infections.

So what's all this fuss about MRSA? The answer to that is multifactorial. I think there are two important reasons. Staphlococcus aureus is a very clever bug and can infect multiple sites in the body; it can cause skin infections, urinary infections, pneumonia, septicaemia (blood infection) to name but a few. The other reason is that the methicillin-resistant strains of Staph aureus are only found in hospitals or other institutions. Places where antibiotics have been used. And hence there is an assumption that MRSA has been acquired in hospital. MRSA infection can certainly be reduced by increasing cleanliness but to some extent that's irrelevant, remember that most infections come from skin (and it's impossible to ever fully sterilize a patient's own skin). Do you really care whether you have a MRSA or an MSSA (common-or-garden Staph. auerus) infection, if I can treat it for you either way? There is no evidence that MRSA strains are more deadly that non-resistant strains.

Here's some facts you'll never hear in the press:

1.      MRSA is a worldwide problem. (Probably the greatest problem is in Japan for various historic reasons).

2.      MRSA became endemic in UK hospitals in the early 1990s.

3.      MRSA-related deaths are falling.¹

4.      MRSA is a major problem in the USA. This is a quote from a CDC report. (The CDC is the Centre for Disease Control and Prevention - one of the world's leading authorities on infectious diseases).²

"Hospital-acquired infections from all causes are estimated to cause >90,000 deaths per year in the United States and are the sixth leading cause of death nationally. Nosocomial infections increase patient illness and the length of hospital stays. The direct cost has been estimated to be >$6 billion (inflation adjusted)  costs of longer inpatient visits are shared by hospitals."

So, please, can we move on from the myth that NHS hospitals are uniquely dangerous because only we have MRSA and it's a superbug?

The US Healthcare system and its costs

So let us look at the US healthcare system. The top hospitals in the USA are amazing and provide amazing healthcare, many of them are world centres. However there are a few minor points worth noting. Healthcare in the US is astoundingly expensive.

Here are some interesting statistics;

46.3 million³ - that's the number of Americans with NO healthcare coverage. (15% of the population). In the event of an emergency they do indeed get treatment - but it is strictly emergency only. So cancer surgery is not covered, on-going asthma care is not covered. People with bad asthma need on-going treatment to control their disease. Without this hospital admissions are common. Emergency cover will patch them up (usually) and chuck them out to come straight back in again the next time. The frequency and severity (i.e. whether it is life-threatening or not) of attacks can be reduced with good on-going treatment. Not available to 46.3 million Americans unless of course they pay for it themselves.

The leading cause of bankruptcy is the US is healthcare costs⁴ - even people with healthcare insurance struggle - limitations on cover, the deductible (i.e. how much you have to pay yourself). Imagine recovering from a serious illness to then lose your home.

£92.5bn - the cost of the entire NHS for the financial year 2008-9⁵

$596.6bn - the combined cost of the US Medicare and Medicaid programs⁶. That's £360bn. Medicare provides healthcare coverage for the elderly and Medicaid for the poorest. The majority of uninsured people are too well off for Medicaid but can't afford insurance or their employer doesn't provide it. Both of these programs still involve premiums and co-payments in addition to the government £360bn. Medicare has about 45 million people enrolled and Medicaid 50 million. So, in summary; the inefficient, expensive NHS covers 60 million people entirely for £92.5bn, whilst Medicare/Medicaid provides basic coverage (but not without co-payments) for 95 million people for £360bn. In fact, the US spends more per population on a basic healthcare system that only covers the oldest and poorest than the UK government spends on a healthcare system that looks after everyone. In UK terms that would equate to the government spending around £120bn for basic (so-called safety-net) coverage of less than 20 million of the UK population.

And here's the real shock; for all the money they spend, the US life-expectancy is less than that of the UK.⁷

I am seriously impressed by anyone who's still reading at this point. And this is part of the problem, the sort of trash that the Daily Mail puts out is much easier to read than the complex facts that actually reflect the truth of healthcare. There is so much more I can write - about unnecessary and invasive tests, about the benefits of preventative medicine but I think I should stop now.

The NHS is far from perfect but it is very very good. It is also unbelievably cheap for what we get for our money - worryingly to those who work in it, it is the most efficient healthcare system in the world. The problem is that for ideological reasons (i.e. Government=bad) The Daily Mail and those like it want to force us to take on a US-like model of healthcare. They'll get their 5* hotel room hospital beds and everyone else will suffer. We will see the poor and the elderly left to die quietly or to live with their debilitating disease as the insurance companies make a fortune. And if the American example is anything to go by, ultimately we all end up paying more for sub-standard healthcare coverage for the most vulnerable.

I want to apologise for the length of this article but someone has to stand up to the constant lies of the Daily Mail. The NHS is an amazing thing and whilst it does have issues they are, in the real world, a price well worth paying for comprehensive healthcare. I am proud of the healthcare the vast majority of patients receive.

Dr alienfromzog BSc(Hons) MBChB MRCS(Ed)

References:

1.      Department of Health: http://tinyurl.com/6kjbue

2.      Centre for Disease Control and Prevention paper: http://tinyurl.com/ybvp2p3

3.      US Census: http://tinyurl.com/ln5a2q

4.      Baltimore newspaper article: http://tinyurl.com/ylg2fet

5.      HM Treasury corrected figures: http://tinyurl.com/yzme4ng

6.      Official financial report of Medicare and Medicaid; http://tinyurl.com/yguq2wn

7.      World Health Organisation figures: http://tinyurl.com/yguq2wn