In the first part, I described in detail the structure of the British NHS health care system and the process of interaction with the system simple layman. In this part I will try to describe a wide range of problems.
What is the most important thing in medicine? Health of the population? Not at all. According to the British government is the main achievement of the targets.
For each and every set targets. Each represented by the Minister of Social Service, which monitors the achievement of targets. The standard of living is also indexed in different areas, are included in the indexing of even such factors as the birds singing in the morning. Most carefully indexed work NHS. It is quite natural that the social services began to explore the most sophisticated methods of achieving the desired results.
Managers in hospitals have been particularly cynical. When, according to the ministerial plan, it is necessary to reduce the number of pending operations, managers ordered doctors to take up first the most simple and easy operation, and they are less time and resources to take and difficult to procrastinate. Thus formally turn operated by shrinking, but the quality of medical care is not improving. If the plan is necessary to reduce the number of patients awaiting admission in wheelchairs, wheelchairs just simply replaced with beds so on securities held less than wheelchairs, but the essence remains the same. If ordered to reduce the waiting list of patients waiting in the hospital corridor, the corridor in the accounts can be renamed in the lobby or whatever, so the corridor was quite a queue will not. The plan is executed. Plenty of room for creativity is huge. You can give examples endlessly. Performance was achieved, bonuses received, all preserved slave sites, and patients are minor matters.
The paradox is that Labour’s long-standing policy has led to a huge class of fragmentation of society. The difference in life expectancy has increased since the late 90s, but the unequal ratio of infant mortality among the classes of rich and poor has reached critical exponents. A child from a poor district has twice as likely to die in the first year of life than a child from a secured area. When external well-being of Britain class division grows ever deeper. This also applies to medicine including. I recommend on this topic see the BBC documentary entitled "The Trap, What Happened To Our Dreams Of Freedom"
A couple of years ago, a Swiss professor, head of the Department of Cardiology University Hospital of Berne conducted a survey of British hospitals for cardiovascular disease. Data was collected from the ten thousands of patients who have shown that each of the second was to be held coronary angiography, but in fact it was held only every twentieth. Also, the data showed that people from the higher strata of society this type of survey carried out more frequently. Patients undergoing coronary angiography was not performed, suffered from serious consequences.
In the west, including in Britain, medicine and closely related pharmacology one of the most profitable legal businesses. Pharmacology is the business of clean water, the third most profitable after weapons and drugs. And this business has a direct impact on medicine through contract research, teaching methods, etc. The task of the doctor — to cure the patient, the task of business — and make a profit so that the customers come back. In the Western economic system, it creates an insoluble contradiction. The person must be healthy enough to work, but sick enough to constantly resort to the doctor and pharmacy. I recall that in Britain Medicine officially free (taxpayer-funded), but it works on the same principle.
Nobel Prize-winning Brazilian Drauzillio oncologist Varella said:
"In today’s world we invest 5 times more money in drugs for male potency and silicone for a woman’s breasts than in the treatment of Alzheimer’s disease. After a few years we will have an old woman with large breasts and the elderly with a strong term, but none of them can not remember what it needed. "
In my opinion this is the deep root of the problems with the medicine in all countries tie for profit, not cure
The Hippocratic Oath? No, not heard
In Russia operative intervention into the body almost always occurs on a "save and not touch, all that can be saved" (terrible legacy of the Soviet regime), and the UK does not stand on ceremony, cut the hell out without waiting for peritonitis. Let me remind you that the most important tick in the financial statements: the patient received and the operation carried out. All the rest — inexpedient lyrics.
Hippocratic oath here for a long time is not given, the last century, you just have to know the professor of regulation and to meet them. And what an oath there after some old-fashioned nonsense about the preservation of life and there is something poetic and western Brave New World has long moved away from that of the Middle Ages: phased comfortable euthanasia, British academics are debating that it’s time to start killing children already born when their parents have a change of heart, or a child is born disabled. According to academics — the child is not yet formed and the identity of such a murder would be no different from abortion. By the way, I do not quite see the difference killing the baby in the womb of recycling a newborn if the infant has not approached by any criteria picky parents. Science should be logical, just bring liberal academics achievements to its logical end. Said "a", and is already talking about "blah". More is coming.
Medical education in Britain is decent. The most important plus it — the situation of graduation for bribes completely ruled out. The second advantage — before the doctor starts to practice by yourself it goes a long training under the supervision of senior doctors. But in my experience of interaction with the system I can say that theoretical knowledge is quite shallow, especially for therapists. Basic medical education in high schools here lasts five years instead of six as in Russia, as I understand it is in the sixth year of training in Russia studying the differential diagnosis. In British doctors often do not understand the disease, based on knowledge of pathological anatomy and physiology. Such gaps compensate physicians instrumental studies, good equipment and get practical knowledge in the learning phase, which lasts from two to 4 years depending on the specialization of the doctor.
Items that are being studied on the course for surgeons can be found at the University of Birmingham for example, which is considered very good in their field. It is necessary to click at the bottom of the page to the section "Modules". Can be compared with the list of subjects that are taught in Russian schools (upd I was told that this is the Belarusian university, but I think it is not much different from the Russian, a separate list for Russian universities have not found).
Britons die from what?
The most common cause of death is cardiovascular disease, stroke, cancer, lung disease.
By the way, the statistics on TB is the highest in Europe, and according to some indicators are growing, well, this is not surprising, because in Britain, the largest number of immigrants from Third World countries. Britain is in third place in Europe on AIDS as well.
If you compare the life expectancy in Britain and Russia, in Britain it is, but it is, in my opinion, is not related to the medical service. And due to the economy, the availability of medicines and nekontrafaktnyh at the same time that the country is facing a crisis for decades, that is not true of Russia, which has only recently begun to recover from the 90s.
Collective responsibility exists everywhere. Including the UK. In some cases, the authorities trying to cover up criminal negligence and corruption. Offered bribes to victims, so that they did not file lawsuits. Destroyed evidence. Bribed members of the Commissions of Inquiry negligence. Falsified data in the financial statements. Such incidents have become famous hospital Furness General Hospital, Morecambe Bay Hospital and Strafford Hospital. In the last hospital deaths caused by physician 1,200 patients. Under the influence of the head of the public fund NHS, Sir David Nicholson, which fell under the control of the hospital, has promised to resign. He relied on the occasion of huge payouts. The public is dubbed him "The Man without shame or conscience"
I must say that all ministerial bumps that are dismissed because of what failed in the duties reap huge benefits in compensation. Reward for failure
Widespread bribe to silence dissent. Many doctors, social services workers say that the figures can not be put before the health of patients who are trying to publicize cases of criminal negligence. Such inconvenient people shut up a decent amount. All beautifully drawn, through contracts and formal agreements. People offer decent pay and dismissal as compensation or as a result of the procedure in the pre-trial reconciliation. Many agree on this, because in some cases, then just do not give work quietly, hounded. According to some estimates, over the last 3 years it took about 4 million pounds. One such episode had still officially recognized and respected Sir David Nicholson.
Death by negligence
Data Research Institute of The London School of Hygiene and Tropical Medicine showed that in England every year as a result of medical errors killed about twelve thousand patients.
Cases of medical negligence in fact are monstrous. I can not believe that this can happen quite often in the modern development of medicine. Some of the cases described in the article and the Anatomical Theatre of the Absurd. The reasons for this absurdity I described in the first part
Cutting the budget
In the NHS, there are commissioning groups, ie Commission on the distribution of the budget. Members of these groups are usually therapists and other members of the NHS, which at the same time are the owners or have large shares in various private pharmaceutical companies or companies for the production of medical equipment. It is clear which companies win tenders NHS, it is not even trying to hide something or to powder.
Medications prescribed a certain way, too. If a certain company has good connections to the Committee on the Budget, I will prescribe medications that company, even if the price for them is several times higher than the market. Recently there was a scandal over the fact that physicians prescribed fish oil from some of Kent’s package which cost 80 pounds when in any pharmacy you can buy fish oil for a couple of pounds and without a prescription
Yes, Gogol is also relevant in the UK. In England, the number of the population 52 and a half million, in areas therapists registered 55 million patients. NHS therapists allocates 65 pounds per registered patient, regardless of whether one uses the services of a doctor or not. The main thing is that he was in a file cabinet. Therapists have been slow to update the roster if the patient has died or moved from the area. Thus, the system allocates annually to 163 million pounds on the dead souls. Therapists is beneficial, as I wrote in the first part, "terapevtnye" — a private shops.
Confusion and vacillation
The health care system in Britain is often prevails mess. Use it. In Britain, have long been popular health tourism. System-that is free, plus doctors do not have the right to refuse emergency care to any patient, including strangers. But officially on any non-emergency issues foreigners have to pay, but since there is no established system of payment so far, then stray sick leave per year tens of millions of pounds. They are taken, providing treatment and only then billed for the show, but what a fool he would pay if he is healthy then goes to his Papua New Guinea, for example. Especially popular in Britain to give birth to the inhabitants of Africa and Asia.
Cash flow away freely from one hole, it is not sealed, but try to hold idiotic measures to save money. For example, began to seriously discuss the possibility of outsourcing operations to India, there are cheaper. British patient needed an operation on his plane to India, let them operate.
It has long been saving for diagnosis and treatment, as I described in the first part. But on the PR progressive economists do not save. Under this deal stands out tens of millions a year. Again saw handy. In 1981, in the whole of Britain was only 8 representatives of public relations, now, just in London alone, their 82 with an average salary of about 37,000 per year
But make great sentimental photos
The crisis in
According to official estimates in 10 years if nothing has changed fundamentally, NHS waiting deficit of 30 billion pounds.
Every prime minister at the presidential race gives interesting dialogue about the reforms NHS, which, of course, are not fulfilled. That otfotoshoplenny gladenko Cameron in turn swore that everything will be hunky-dory, but nothing has changed.