A comparison of UK and German healthcare provision

This article is not detailed, but I thought some of the numbers given were quite startling :

Title : Why aren't European hospitals facing a 'winter flu crisis' like the NHS?

Link : http://www.itv.com/news/2018-01-31/...tals-facing-a-winter-flu-crisis-like-the-nhs/

Although I don't have a link, I have read articles in the past about NHS provision that make no sense to me whatsoever. New hospitals will get built to replace old and out-dated ones, and in the process the numbers of beds will be reduced by half. And the government of the day will spin this like mad as an "improvement".

 

One problem in Germany is that nurses are not allowed to do anything. Nurses in hospitals are not even allowed to draw blood, it's ridiculous. Nurses in doctor's offices (who are called "doctors' helpers") are allowed to draw blood but not to do much more, they merely do the paper stuff and if you ask a question you're told to please ask the doctor. I read here from the US and UK where nurses even do appointments or make homevisits. That would be very helpful.

 

I think it boils down to the NHS in the UK becoming focused on economics rather than health. It's a socialist system seeking to incorporate capitalist principles, and it's getting the worst parts of both ideologies.

 

Yes, I agree. I thought the dismissal of the difference between 9.9 and 11.1% was very dubious. It's as if the reporter was saying that a few billion pounds here or there isn't important.

Doctor's pay rocketed in or around 2004 when Labour wanted to give GPs a new contract. I can't remember what the government hoped to get out of the new contract. But doctors were laughing all the way to the bank.

http://news.bbc.co.uk/1/hi/health/6314301.stm

Regarding nurses, they used to be paid bursaries while they trained. But these were abolished a couple of years ago in favour of loans. So nurses end up starting their careers many thousands in debt but don't earn anything like the salaries that other trained graduates get to pay the loans off.

At the time the nurses bursaries were abolished the government trumpeted this as a brilliant idea because it would allow this to happen :

Source : https://www.theguardian.com/society...t-nurses-will-end-in-2017-government-confirms

But as any idiot could have forecast (except the government) this is what happened instead :

Source: https://www.theguardian.com/educati...lications-slump-after-nhs-bursaries-abolished

 

The comparison of 9.9 to 11.1 is not appropriate. These look like the 2014 figures where the monetary comparison is 2.8 to 3.9. So instead of expenditure in the UK being 90% of Germany it is in fact 72%. Considering that there are lots of fixed costs this difference is enormous.

 

This just seems to be a pro-private commerce piece. Private finance is one of the reasons the NHS is in so much debt. And there is no central citation of policy to blame in the UK because the government as abdicated all responsibility for any decisions.

 

@Jonathan Edwards

Thanks for shining some light into the darkness.

 

Sadly, I wasn't surprised to discover, yet again, that the BBC hasn't even bothered to report on any protests about the NHS on its website, and not many news websites of any kind have mentioned them either. The Guardian is one of the very few.

https://www.theguardian.com/society...rally-in-london-to-call-for-government-action

The BBC ignores NHS protests regularly.

 

An interesting fact came to light when I surfed around this. In Germany anyone is entitled to book to see any physician. There is no need to see a GP before a specialist. GPs see patients for slots of an average of 7minutes - even less than the UK. I suspect that as said above, GPs in Germany mostly do what practice nurses do in the UK - check a blood pressure and print out a repeat prescription. In the UK a large number of GP visits are a waste of time because they are requests to see a specialist that need not happen.

UK doctors are paid more than they need to be - and one effect of that is that they retire at 60 because they already have enough pension and cannot stick it any longer. German specialists get paid about £85,000 a year it seems. In the UK the equivalent figure may be nearer £100,000 but I am not sure how comparable these are. GPs are I think paid more in the UK but less in Germany.

What the NHS needs is more staff, just to make it humanly possible to deliver the work needed.

 

They are threatened with huge cuts or abolition of the license fee if they misbehave.

 

I've read that the same is true of the French healthcare system as well. Patients don't need permission from a GP to go and visit a lung specialist or an arthritis specialist or a gastroenterologist etc. I would love that system.

What I do find annoying in the UK is, on the very rare occasion I have paid to see a doctor privately, I usually still have to get permission from a GP before the specialist will see me. Although it hasn't happened to me personally, I've read of GPs preventing people from seeing a specialist privately (by refusing to refer) because they don't think the patient needs to see anyone.

Another feature of UK private medicine that annoys me is that the doctors I've seen haven't always felt it was essential to report to anyone what the recommendations or findings were, and some have written to the GP who referred me, but not me - and I'm paying the damn bill!

That is very true. But the government seems to think that GPs are convenient servants who will do anything the government wants, whether it is part of their contract or not. I'd get pissed off under those circumstances too, if I was in their shoes.

I think the problems in the NHS are accelerating. The more staff leave, the greater the workload for the ones who remain, and the more then decide to leave. I really think the NHS is circling the drain, but I hope I'm wrong. I won't be able to afford healthcare if it goes, and I hate the politicians who are letting this happen, and in fact appear to be engineering this whole debacle.

 

Yes, I'm old enough to remember a time when the BBC reported almost whatever it wanted to, but they have been thoroughly cowed into towing the government line for quite a few years now.

 

In theory this is true but I know that I'll be seen much quicker if referred by my GP than if I made a first appointment myself. Repeat appointments (even if requested by me might be a different thing).

There are many differences though between the French and UK systems. While nominally a 'national health service' both funding and provision are a public/private mix. The majority of funding is via taxation at source (earnings) but compare to the UK is hypothecated - money taken from your wages via the appropriate 'caisse' goes to the health service and nowhere else. What isn't covered by this contribution (typically around 75% is covered - it varies) must be covered by a privately provided health insurance top-up (mutuelle) which you pay for yourself. There's also a non-refundable personal contribution of €1 for every €23 GP appointment (paid up front).

On the provision side your GP is self-employed (when discussing an upcoming strike of GP's my own took great offence at me referring to the health minister as his boss). Most tests ordered are carried out by private clinics and typically the response time is within days rather than weeks. Hospitals are another mix. Some work to fixed fees (conventioned) while others can charge what they want.

As for ME/CFS my GP knew so little about it that he asked if the only other patient he had could phone me for a little chat and advice.

Overall the standard of care is excellent but very expensive to administer and as I understand it likely to become more and more unaffordable.

 

The system is quite complicated and depends on the insurance (privat or state insurance) and kind of speciality. I can book appointments for some specialities but need referrals from a GP for most.

A huge difference to the UK is that we can chose our GP in Germany. On the other hand the good GPs are often booked and don't take on new patients (or only patients with private insurance, same with specialists). I had a private insurance for the first 30 years and it was a huge difference.

So, I think we can chose more but the downside is that also doctors can chose their patients to some extend. Also without a referral no one writes a report to my GP. And I have no central place with my results and history and no GP with a real oversight.

 

@Joh wow I didn't know this. So you don't have nurse practitioners in Germany.

Are there nurse practitioners in the U.K?

 

yes, both in general practice/primary care and in specialist/consultant led clinics

 

Doctor shopping is easy in Germany, so it's easy to just change from one you don't like. And I've never had a problem being referred to a specialist, or just going to see one without a referral. When I had an operation they kept me in hospital for more nights than they needed to because they get paid for every extra night they hang onto a patient. I actually sneaked out, spent the night at home and sneaked back the next day, nobody was that bothered. Oh yes, it's a wonderful system here in Germany. Unless you've got ME of course, then it's a f***ing nightmare.

 

Hm...Maybe GP shopping is easy, no matter if you have a private or "state" insurance. In all other cases my experience was it's pretty difficult. Well, I never tried to invent some symptoms in order to get a referral to a specialist, maybe that would have worked.