John McLellan: Back in hands of NHS again

The NHS is used as a political football in which the reality of a chaotic system is denied on all sides because it is in no-one's interests to admit the truth. Picture: AFP
The NHS is used as a political football in which the reality of a chaotic system is denied on all sides because it is in no-one's interests to admit the truth. Picture: AFP
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When my back went it went properly. I couldn’t stand up straight, couldn’t take a step without agonising pain and couldn’t lie down in anything other than total agony.

After playing rugby for far too long, I thought I knew what back pain was all about but this was off the scale. I couldn’t work for two weeks and even when I returned I was bent double for the best part of three months until it eventually it calmed down.

Thanks to the Scottish Government, all the Amitriptyline, Tramadol and God knows what else I got from the GP to kill the pain didn’t cost a penny. The NHS free at the point of need in action.

Except it wasn’t quite as simple as that. The doc recommended some physio and so I duly went along to a local practitioner; as she tried various treatments, including aquapuncture, a bill of well over £200 was racked up.

I was also referred for an MRI scan to get to root of the problem and amazingly I received an appointment within a month. Even more amazingly, the appointment was not somewhere in the bowels of the ERI, but in the brand spanking new Edinburgh Clinic just round the corner from our house. Yes folks, the brand spanking new PRIVATE Edinburgh Clinic with the very latest in Magnetic Resonance Imaging.

In the far off days when someone else paid for private health insurance for me, I’d had a few of these done at the Murrayfield or the Nuffield in Glasgow, mainly for rugby-related neck and knee problems. The bill for each scan was around £500.

So here I was an NHS patient getting the same treatment at a private clinic as the private patients, but the £500 or whatever it was now costing would be going to a private operator from NHS Lothian’s budget.

In fact in 2013-14, the same year, NHS Lothian sent over 2,000 patients for private treatment and by 2013 the Scottish NHS was spending £40m a year on private healthcare.

Not that I have a problem with that, if that’s what it takes to keep waiting times under control so be it.

We now know NHS Scotland is paying out around £40m in bonuses to consultants, £6.6m of it by NHS Lothian. Good luck to them; as far as footballs are concerned, I’d far rather big money was paid to life-savers than to someone who kicks one into a net.

Yet in our bizarre health system in which every penny should count, people like me who could afford it didn’t ask to stop paying for prescriptions at the privately-owned pharmacy. Nor did I ask to go to a swanky private clinic for a “free” scan, but I did choose to go to a private physio and was happy to pay.

Now I am in the hands of the NHS once again and unlike the previous, arguably self-inflicted, situations this time it’s serious. I have, I’m assured, a very fixable condition but the op is a big one without which the problem will only get worse and the looming outcome something I’d rather hoped to avoid for another 30 or so years.

The possibility something might be up was identified by the same GP (he runs a private business – they are all private businesses, but unlike the dentist all their cash comes from the state) in a routine check-up back in October and tests later in the month confirmed the problem.

Five months on, two more tests, and I still don’t know exactly what’s going to happen or when; the waiting list rules only kick in when you’ve actually seen the person who wields the knife.

So I have an agonising but hardly terminal back problem and I’m in a private clinic, the problem pinpointed and dealt with in three months. But something much more serious has already taken six months and it will now looks like it could be the best part of a year before there is light at the end of the tunnel (although I don’t like to think of it in those terms).

There are hundreds of people in a much worse situation than me; take Gordon Aikman, pictured right, the young political researcher stricken by Motor Neurone Disease and battling valiantly like 
fellow sufferer Euan MacDonald to fund research to find a cure for their dreadful condition.

I should be thankful I’m not regarded as an urgent case – yet – but it means being in the limbo of not knowing what the immediate future holds. Not that I expect sympathy, but it does give me a different perspective on all the election talk of “saving our NHS” from the evils of “privatisation”.

What, preserve it as it is? Or at the very most just chuck more money at it on demand? Or deliberately mislead the public about the extent to which private health provision can actually help patients and already does? Even worse, deny a system designed in 1944 cannot cope with ever more sophisticated treatments and longer life-spans which is medical reality 70 years on?

What I will undergo is relatively routine now but pioneering, cutting-edge you might say, 40 years ago. But it will still cost thousands.

And so in the Referendum and now in this campaign the NHS is a political football in which the reality of a 
chaotic system is constantly denied on all sides because it is in no-one’s 
best interests to admit the truth.

I experienced the darker side of private medicine years ago when my baby son was suffering from persistent ear problems – the cure was a simple grommet operation taking no more than 20 minutes but for which the waiting list was over nine months; for him that would be nine months of persistent sickness and anti-biotics.

But with private insurance the job was done in three weeks because the surgeon simply stuck a ninth private case onto the eight NHS ops he was performing at the Sick Kids the same day.

Is such queue-jumping acceptable? No. But which reader wouldn’t do it for their kids if they could? And was it not a failing system which produced such situations in the first place?

Botched reforms, like the costly private finance schemes and the vast expansion of bureaucracy to deal with internal markets, have discredited the need for change yet the need has not gone away.

Here are some facts. Health spending in the UK is lower per head than the EU average. That needs to change. The most up-to-date figures show the proportion of private to public health services has remained virtually unchanged for the past ten years.

In Scotland the proportion of government spending on health has actually fallen compared to England, down 1.2% compared to an increase of 4.4% by next year according to the Institute for Fiscal Studies.

In France, life expectancy at 81.5 years (according to the World Health Organisation) is six months longer than the UK and two and a half years more than Scotland. French health funding is proportionately higher, at 11.7% of GDP against the UK’s 9.1% and £3,200 per person against £2,400.

But the vast majority of the cash comes from compulsory health insurance, mostly with private, not-for-profit mutuals. The World Health Organisation rates it as the best system in the world.

What about Japan, where an average of 86 makes them the longest-living people in the world? Health spending per head is approximately £2,600 a year, nearly all hospitals are private, there were more CT scanners per head than anywhere else in the world (according to the OECD) and funding comes from a mixture of private insurance and ring-fenced payroll taxes.

New Zealanders live till 82 and a third of them have private health insurance, again mostly with not-for-profit organisations. A half of all elective operations are performed 
privately and GP visits are subsidised but not free.

Any of that would go down like an overdose of Syrup of Figs here. Lifespan is admittedly a very crude comparison and there are many 
factors at play, but the 
figures show the relationship between health outcomes, spending levels and private provision is far from the simplistic one politicians are painting right now.

Here is something else to consider; surveys show the more centralised the health service, the longer the waiting lists. And which country relies more on the state than any other to directly fund its system? Correct. The UK.

So the next time you hear a politician talking about keeping private provision out the NHS, that it’s better as it is, that more government money alone will make things better, either reach for a spoonful of sugar or a pinch of salt.


More howls of outrage down Stockbridge way at the latest episode in the long-running saga of the Edinburgh Accies rugby ground development on Raeburn Place.

This time the pitch-forks and flaming torches are out because, shock of shocks, the rugby club has applied for an alcohol licence till 1am for its new facilities. This will, apparently turn Comely Bank Road into the Grassmarket. What utter tosh.

Apart from there being nothing wrong with the Grassmarket, this does nothing more than put the club in the same position as other clubs like Watsonians, Stewart’s Melville and Heriot’s – all of which regularly hire out their facilities for weddings and birthday parties without the immediate area turning into something from the last days of Ancient Rome.

These gripes are from people who for some reason must have thought they were living in a Costwolds hamlet rather than a vibrant retail and leisure street with a historic sports ground at its heart where parking is never easy. And guess what, I’m told on good authority the police will have no objections. With so many of them round the corner at Fettes only miserabilists could predict a riot.

Charity’s plan could end up in the bunker

The Friends of Hermitage and Blackford Hill are gearing up for a scrap over a plan to expand the outdoor activities around the Hermitage children’s golf course.

The proposal by the charity Autism Ventures Scotland is to turn the current clubhouse into a centre for golf, “disc golf” (which involves throwing Frisbees at a series of targets) and mountain biking.

Opposing a charity for people with learning difficulties requires a certain degree of diplomacy and the FoHB have avoided the more extreme positions such conservation groups have been known to adopt. But there is no disguising their opposition.

The architect’s images of the new centre look like a positive improvement on the “temporary” buildings which have been there for around ten years now, with plans to cut the turf-roofed construction into the slope to make the visual impact minimal. But there are the usual concerns it would “set a dangerous precedent for the Green Belt”.

Objections to the disc golf in what is an unused field smack of pig-headed principle being put well ahead of a harmless idea which will not spoil the environment but benefit people in need of help.

But the FoHB is on stronger ground with fears about the impact of mountain biking on the area. Mountain bikers and pedestrians don’t mix and the trails from the Lang Linn path down to the Braid Burn are very popular with walkers, especially at weekends.

The canal towpath is bad enough for anti-social cyclists and that’s on the flat, but to put bikers hurtling downhill onto the same routes as walkers, many with dogs, is a recipe for disaster.

It’s nothing to do with the Green Belt or preserving natural heritage, it’s just plain dangerous, and the only way mountain biking could be accommodated safely would be an unacceptable ban on walkers.

As it happens, biking isn’t particularly kind to paths, with the heavy treaded tyres churning trails into a quagmire in wet weather – it’s a growing problem on Craighouse about which, by contrast, the Friends of Craighouse Grounds have little to say.

But with plans to turn the old Lothianburn golf course five minutes’ drive away into an outdoors and biking centre any demand there is in the area could soon be met.