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16 October 2007

Question for British Bunnies I was listening to a health care show on the radio yesterday,[More:]and one speaker said that if a person is diagnosed with cancer in the UK, there is a yearlong waiting list to start chemo.

Now, this sounds like anti-nationalized-health sensationalistic hogwash, but I thought I'd ask: is there truth to this?
It depends on where you live. In the UK there's something commonly described in the press as the 'postcode lottery' - in other words, depending on where you live, treatments for, not just cancer, but many other kinds of acute illnesses, can vary enormously because patients fall within different NHS Trust areas and the standards of service can vary accordingly.

When I found a breast lump last year I waited 9 weeks from seeing my GP to my first hospital appointment for a mammogram, then it was 4 weeks between each appointment for ultrasounds, needle & core biopsies, a 6-week wait for surgery and I got the pathology results two weeks after that, even though they could probably have told me before I left hospital that it was benign. The worry was crippling at times.

Long waiting lists for any kind of NHS treatment are common, but I think that for certain kinds of cancer (e.g. bowel) the waiting lists are shorter.
posted by essexjan 16 October | 09:12
Here's some more information, about Scotland particularly.

Where my own treatment was concerned, I expect that if the lump had been malignant, I'd have started therapy fairly soon after diagnosis, but it was the length of time it took to diagnose that was unacceptable (although within the parameters of my local Health Trust), the lump getting bigger month by month and the worry increasing daily.
posted by essexjan 16 October | 09:18
Hm. That's interesting - in the U.S. that would have been accelerated even without insurance (and I wonder what the systems are that cause this delay and why they are necessary?)

I really wonder what the outcome differences are , if any, from delayed treatment. And if there are not outcome differences in some types of illness, then perhaps our system is sometimes needlessly accelerated.
posted by Miko 16 October | 09:20
No, that's not true, but it's not a million miles away from the truth.

Waiting lists are hugely difficult to boil down into a single journalist-friendly figure, so the media often resort to sensationalism. There is massive variation in waiting times across the UK, and even between neighbouring hospitals. I couldn't find a central 'national average' waiting time for chemotherapy - the NHS and the Department of Health are not good at collecting and providing useful data, partly because of the intrinsic difficulty of aggregating data across the country, partly because of the decentralisation into regional authorities and primary care trusts, and partly because the figures probably wouldn't reflect well on them.

This article illustrates the degree of variation. Bear in mind that it highlights the extreme cases, not the norm, and also that Scotland's waiting lists are likely to be longer than England's.

The Department of Health mentions that it has a 'long-term goal' of ensuring no-one waits more than a month from referral (from a GP to a hospital for diagnosis - GP waiting times are a whole 'nother story) to treatment. Out of interest, I looked at an October 2006 NHS report on this. It says there was a target of a maximum two month (62 day) wait from urgent GP referral to first treatment for all cancers, to be achieved by 2005 (GP referrals not categorised as 'urgent' presumably aren't counted). This was only achieved for 78% of patients, and little progress was achieved from 2000-04.

So it's maybe not as bad as your radio pundit says, but it's not good either.
posted by matthewr 16 October | 09:22
(and I wonder what the systems are that cause this delay and why they are necessary?)

Not sure I understand you here. Nobody is intentionally delaying chemotherapy, it's just that the system works slowly and inefficiently. There are lots of patients and not enough hospitals, doctors, surgeons, nurses and operating rooms. There is a plethora of potential culprits for this, such as long-term underfunding, poor management and low productivity, and each side (government, doctors, nurses, NHS managers) tends to blame everyone else.
posted by matthewr 16 October | 10:33
Not sure I understand you here

That's what I meant: what are the barriers to speed? Your explanation helps to understand.

This is what I think is behind a lot of American fear of national health: we're afraid of health care that functions about as well as the DMV.
posted by Miko 16 October | 18:28
If the British NHS is anything like Medicare here (and I believe there are lots so similarities), it is all about budgets. There is a lot of sensationalism in the media about the waiting lists sometimes but, in my experience, people who really need care get it. The media sensationalises people dying on waiting lists sometimes, but the reality is usually that the person was a high risk because of advanced age, lifestyle choices, other complicating conditions or some other reason that makes them a poorer candidate than others. If you only have x amount of money and y amount of people needing treatment, you have to treat those with the best chances. Funnily enough, some areas of the media often compare Britain's NHS favourably with ours.

My experience is very positive with regard to the health care system here - although I have had to wait for long periods at times in emergency departments, I have always received the care I needed and it has never cost me a cent. Hearing some of the horror stories here and elsewhere, I can only be thankful for what we have. My son was born with a complete complex syndactyly of all five digits on his right hand and he has to date undergone three operations from one of the most highly regarded surgeons in this field in the country, along with occupational therapy support over four years - all at no cost whatsoever to us. Sometimes, there have been delays in scheduling operations due to shortages of suitable staff, but he has received all the care he needs and I hate to think what would have happened if we have had to pay for the cost of this care, which is probably in the region of $50,000 and which will continue until he stops growing.

Several people I know have been involved in serious accidents and have nothing but praise for the public health system. All four of my children have been born in public hospitals and we have received excellent care at all times.
I scratch my head at times when I hear the bitching about health care here and ask people if they have any concept of how good we have it.

In our case, the problems are complexified (is too a word!) by health being nominally a state responsibility, but the money coming from the federal government, so there is lots of buck-passing and arguing over whose fault everything is.
posted by dg 16 October | 19:32
Um, I know you asked this of the British contingent but, you know, more information is good, right? Right?
posted by dg 16 October | 19:33
I would take the British system over the American one (which is based on greed and elitism) any day. I've not had to wait long at all (even for dermatology, an infamous one)... but I live in the sticks.

*shrug*

In the states, I didn't have any insurance at all. The lowest estimate I could get for a self-employed musician was $750/month - $100 copay - £2000 deductible. I was completely fucked. Did this contribute to my decision to leave? You betcha.
posted by chuckdarwin 17 October | 03:16
Now, this sounds like anti-nationalized-health sensationalistic hogwash, but I thought I'd ask: is there truth to this?

No.
posted by chuckdarwin 17 October | 03:21
Death || And if the Foodle’s on a poodle, and the poodle’s is eating noodles, we call this a…

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