The concept of the NHS as “socialized medicine” contains many myths that were made visible in the debate about health care reform in the United States. Perhaps the silliest example was the story published in the Investor’s Business Daily and on television that “People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.” In fact, Stephen Hawking is British, does live in the UK, and is sustained by the services provided by the NHS. Hawking himself responded via the UK newspaper The Guardian: “I wouldn’t be here today if it were not for the NHS; I have received a large amount of high-quality treatment without which I would not have survived.”
Other myths include:
The UK countries’ governments do set national policy priorities; and, at the local level, health authorities (Primary Care Trusts in England, Local Health Boards in Scotland and Wales) do plan services for their populations based on assessment of need. But at the level of the individual patient, clinical freedom is demanded and given, both by nurses and by doctors—and is probably greater than in a system in which insurance companies specify what they will and will not pay for.
The organization that appears to perpetuate the myth to U.S. audiences is the National Institute for Health and Clinical Excellence (www.NICE.org.uk), which, in fact, was originally modeled on the U.S. Agency for Healthcare Quality and Research. This organization, established in 1999, is the independent organization responsible for providing national guidance on the best (and most cost-effective) treatment (including drugs) for specific diseases and conditions. NICE guidance is developed using the expertise of health care professionals, patients and caregivers, industry, and the academic world. Health organizations are not compelled to follow its guidance, but they usually do; problems arise primarily when a new and expensive drug (often for the treatment of the terminal stages of cancer) is not recommended by NICE, and is therefore not provided by a particular health care agency.
In the past, waiting times for non-urgent hospital treatment were unacceptably long, and waiting was used as a form of rationing. Over the past decade, waiting times have been dramatically reduced; in 2008 in England the median waiting time between referral by a primary care or general practitioner (GP) and admission to hospital was 8.3 weeks, and the accepted maximum was 18 weeks. For an urgent condition, the waiting time is much less. A consultation with a GP is usually achieved within 48 hours. Access to an emergency department is immediate; after initially being seen by a triage nurse, patients must receive treatment within 4 hours.
Every UK citizen has the right to “register” with a GP of his or her choice. About 96% of the population do so, although there are sometimes difficulties for some mobile or homeless people. Patients often remain with the same GP from birth until death or until they move to another locality, although they may change their GP at any time, subject to the GP’s willingness (usually limited only by geographical practicalities) to accept them on his or her “list.” Except for access to the hospital emergency department, the GP is the point of first contact for people needing health care and acts as “gatekeeper” to other services to which he or she refers patients as necessary. Patients will usually accept the advice of their GP about treatment and about which hospital specialist is most appropriate, but every patient has the right to a second opinion and at least a limited choice of which hospital. (In England, patients may choose any hospital, but for most patients, especially outside the big cities, choice is limited by practicalities such as nearness to home, travel facilities, and so on.) Currently there is debate about the right of UK patients to receive treatment in any country of the European Union (EU).