Pros and cons of the NHS – for a CKD patient
The UK’s NHS is a socialised healthcare system, and was one of the first in the world, when it started in 1948. It certainly has strengths, and these are felt by CKD patients. We will now go through the pros and cons, with a focus on CKD patients.
5 Pros of the NHS
1. Universal access to care (‘universal coverage’)
One of the most significant advantages of the NHS is its universal coverage. Every resident of the UK is entitled to comprehensive healthcare, regardless of their financial status. This ensures that everyone, from the wealthiest to the most vulnerable, has access to medical services.
Relevance for a CKD patient. The cost of CKD (especially ESRF) is high. In a private system, the costs – especially dialysis and the drugs to stop kidney transplant rejection – would be too much for many patients.
2. Free at the point of use (and accessibility)
Healthcare services under the NHS are free at the point of use, meaning patients do not have to pay out-of-pocket for doctor visits, hospital stays, or emergency treatments.
The NHS has a large network of hospitals and clinics right across the country. Most people live less than 10 minutes from their GP and less than 30 minutes from their nearest A&E. Most larger hospitals have a renal unit with dialysis facilities. A local NHS-linked pharmacy is usually in walking distance.
Relevance for a CKD patient. Almost all CKD patients can access healthcare locally, and their nearest renal unit will not be far for most. No money has to paid when CKD patients access NHS care (which is often).
3. Quality of care (and regulation)
The standard of care provided by the NHS is high (and warrants significant respect). Quality is monitored and ensured by:
- Regulation by the Care Quality Commission (CQC)
- Robust monitoring systems
- Monitoring of key targets (see below)
- Measurement against a framework that considers various dimensions, including technical quality, responsiveness, and patient views (Friends and Family).
Relevance for a CKD patient. Renal units, like all aspects of hospitals, are inspected regularly.
4. Cost-effectiveness
Another major benefit of the UK’s healthcare system is its cost-effectiveness. It can deliver comprehensive care at a comparable cost compared to other developed nations.
The average cost of healthcare per individual per year in the United Kingdom is about £2,700; with an NHS approximate budget of £180 billion in 2023/24 (with population of 67 million). This represents 10% of GDP (i.e. of your hard-earnt taxes).
Relevance for a CKD patient. Despite the costs of CKD care, this can be afforded. And it can be offset against more economical diseases.
5. Focus on preventive care
Preventive care is a cornerstone of the NHS, with numerous programs aimed at early detection and prevention of diseases. It promotes healthy lifestyles and screenings.
This includes vaccination programs, health education, and regular screenings for conditions such as cancer and cardiovascular diseases. Preventive care can lead to better health outcomes and reduce long-term.
Relevance for a CKD patient. GPs are rewarded by ‘looking for’ CKD and starting treatment, e.g. with ACE/ARBs and SGLT2is. These simple interventions will slow down CKD in many, and prevent dialysis in some.
5 Cons of the NHS
Even with its numerous strengths, the NHS has a variety of challenges, and some weaknesses. These include funding challenges, long waiting times for treatment, poor IT, regional difference and workforce shortages. All these disadvantages have relevance for CKD patients.
Not only is the NHS not perfect, it does not compare well to the better socialised healthcare systems especially in Europe. Netherlands and Switzerland have socialised systems (in the form of social insurance) that cost similarly but have much better outcomes and low waiting times.
1. Funding challenges
The NHS frequently operates under significant financial pressures. Budget constraints and rising healthcare costs can lead to underfunding, which impacts the quality of care and the availability of services. Resource limitations also mean that some facilities and equipment may be outdated or in short supply.
The NHS, which is primarily funded through general taxation and National Insurance contributions, is grappling with serious financial concerns such as:
- Decades of underfunding
- Inflation
- Elective care backlog
- Rising energy costs
- Staff shortages.
Relevance for a CKD patient. Some more expensive (but potentially better) treatments are not freely available to CKD patients in the UK – e.g. haemodiafiltration for haemodialysis patients.
2. Poor performance (especially waiting times for treatment)
Extended wait times for treatment represent another serious issue within the NHS. For example, patients are not meant to wait more than 18 weeks (about 4 months) for planned surgery. This exceeds the wait times in certain other countries.
In reality the waiting time can be over a year, sometimes 18 months. This is poor. We will now explain what are key NHS targets with current performance data mainly from the House of Commons library (July 2024).
4 Hour A&E Target
Known as ‘4 Hours’, this is for emergency care. It states 95% of emergency patients should be seen, treated if necessary, and either discharged or admitted, within four hours from arrival at the emergency department (ED).
4 hours was last achieved in July 2015. Currently 60% achieve the 4 hour target. This means almost all patients going through ‘majors’ (the sicker patients) will breach the 4 hour target.
18 Week Referral to Treatment (RTT) Target
Known as ’18 weeks’, this is the key target for elective (i.e. planned) care, especially operations. In other words, 18 weeks is the maximum waiting time for non-urgent, consultant-led treatment in NHS (e.g. CKD or a hip replacement). 92% of patients should achieve it. It is also known as ‘18 weeks’. It is measured from the day from when the GP refers the patient to the start of treatment (or the decision not to treat).
Of these, about 300,000 of these patients have been waiting over a year for treatment, with a median waiting time for treatment of 14.3 weeks – almost double the pre-COVID median wait of 7.5 weeks in June 2019.
18 weeks was last achieved in February 2016. Currently (Feb 2024) 58% achieve the 18 week target.
Cancer targets: 2 Week and 31/62 Day Targets
In England, if a GP suspects cancer, at least:
- 93% should see a hospital consultant within a ‘2 week wait’ (2WW), from when the GP’s referral arrives at the hospital. This is being changed to a 28-day ‘Faster Diagnosis Standard’
- 96% should wait no more than 31 days from receiving diagnosis to first treatment plan (31 days)
- 85% should wait no more than 62 days to have ‘First Definitive Treatment’ (e.g. an operation or chemotherapy or radiotherapy) from arrival of original referral letter (62 days)
2WW was last achieved in December 2015. Currently 92% of patients achieve the 31 day target and 66% achieve the 62 day target.
Extended wait times have a significant correlation with poor patient outcomes, more errors, diminished patient satisfaction. This not only affects the patient’s health but also leads to increased healthcare (and economic costs in the long-term).
All of this leads to huge frustration amongst patients.
Note. Most of the data above is for England. Targets are different in the 3 nations. These are compared on the ONS website here.
Relevance for a CKD patient
- 4 hours. CKD patients, with problems that need a kidney specialist to sort, often wait many hours (days sometimes) in A&E on a hard trolley in a corridor, waiting for a bed, which is often not on renal ward; so they end up under more general doctors and nurses that dont know enough about their diseases and needs
- 18 weeks. This poor performance is of great concern for CKD patients. When referred to a renal unit, they cannot be guaranteed rapid review by a consultant nephrologist. A few patients will end on dialysis unnecessarily as they are not seen soon enough
- Cancer targets. Kidney transplant patients are prone to cancer (especially skin and anogenital cancer, and lymphoma) because of their immunosuppression. Delayed referral to cancer specialists occur. But if you have a hospital-based nephrologist they will speed up the system.
3. Workforce shortages
Shortages in the workforce, especially among doctors and nurses, greatly affect the quality and accessibility of care within the NHS. Recent data indicates an increase in vacancies, also with 100,000s vacancies in adult social care. This results in a backlog of patient care and affects the overall availability of services.
The contributing factors to the workforce shortages in the NHS encompass:
- Lack of adequate investment in training new staff
- Recruitment and retention challenges
- Demanding working conditions characterised by low remuneration, high pressure, and burnout.
The NHS often faces staffing shortages, particularly in nursing and general practice. These shortages can lead to increased workloads for existing staff, burnout, and a reduction in the quality of care provided. Recruiting and retaining skilled healthcare professionals is an ongoing concern.
Relevance for a CKD patient. There are often problems with recruiting (and retaining) dialysis and other specialist renal nurses.
4. Bureaucracy and administrative burden (including poor IT)
The NHS is a large and complex organisation, and with that comes bureaucracy and administrative challenges. The need for extensive paperwork and adherence to numerous regulations can slow down processes and lead to inefficiencies. Administrative burdens can also divert resources away from direct patient care.
IT is poor, with few computers linking up – either hospital to hospital, or hospital to GP, or both to mental health – leading to many mistakes (especially with prescribing). Though the NHS app is developing as a very useful tool.
Relevance for a CKD patient. Many CKD patients have care coordinated [“or not, actually” MyHSN Ed] by their GP, local and more distant hospital (with a renal unit). Computers don’t link up, blood tests, xray and scan results cannot be seen, mistakes are made; and many have to travel to have blood tests just so they results are easier to see by their nephrologist. Nightmare expensive parking etc.
5. Rationing and regional disparities
There is rationing, with limits on the types of treatments and medications available. An organisation called NICE is responsible to to assess (and sometimes not allow use of) new drugs and technologies – if they are not thought to be cost-effective.
The distribution of the NHS budget across different regions in the UK is based on a statistical formula that is meant to ensure equitable geographic distribution. This takes into account the diverse health needs and population sizes across regions.
But, perhaps not surprisingly, this system does not work perfectly, leading to regional disparities in the quality and availability of healthcare services within the NHS. Patients in some areas may have access to better facilities and shorter waiting times compared to those in other regions.
Relevance for a CKD patient. There are wide differences in waiting times for a kidney transplant; from 235 days at Oxford to 707 at the Royal Free, London. This is a major concern.
Summary
We have described 5 pros and 5 cons of the NHS, and their relevance for a CKD patient. We hope it has been interesting. What do you think?
Last Reviewed on 2 September 2024
