An Alien’s Take of the NHS

We can all agree that being a medical student is hard enough as it is. Now, imagine having to go through it all while adjusting to a new life thousands of miles away from where you’ve lived and grown up your entire life. With every new cohort of fresher’s, there is an intake of a handful of international students from every corner of the world. At such an early stage in the degree, their experience resembles a holiday far away from home. But what is it really like being an international student? What is it like working and learning within the National Health Service (NHS), an institution there is no comparable equivalent to in our countries of origin?

As an Indian having grown up in Singapore, I can safely say that I had never seen any establishment like the NHS. Simply put, Singapore’s healthcare system is a hybrid of public and private sector services. Primary care is covered both within the public sector by subsidised outpatient polyclinics, and in the private sector, where patients are required to pay themselves unless they are covered by their employers on private healthcare insurance. Hospital-based medicine is similarly divided.

The World Health Organisation ranked Singapore’s healthcare system as 6th best in the world in 2000. However, is this country’s method of resource allocation optimal for everyone? Well, that entirely depends on who’s involved. For those who are covered by private insurance from their employers, or those who can afford to pay for private healthcare; Singapore is a dream. A patient with chest pain that decides he or she needs to see a cardiologist can get an appointment within two days, even without a general practitioner (GP) referral. Amongst other positives, patients who access the health services this way are likely to have more personalised, and efficient care. They are also able to see the same consultant each time to ensure continuity of care.

Upon first arriving in the UK, I was shocked at the concept of a “10-minute GP consultation”. I was perplexed further when I learnt that a patient could only discuss one presenting complaint for every booked appointment. Surely, this was paradoxical considering our numerous first-year lectures on the importance of holistic medicine and patient-centred care. Not only that, but as a young fresher who had fallen ill for the first time so far from home, I found myself in shock after being told the first doctor’s appointment I could get was three weeks away. My symptoms would be long gone by then! I remember wondering to myself about other patients with problems more severe than mine. How long did they have to wait? Surely a patient with a two-week history of depression shouldn’t have to wait another two weeks before seeing a doctor? Is that safe for them? This made me reflect on my own experiences with primary care in Singapore. The waiting time for the walk-in clinic was usually less than half an hour, and I would get to see the same doctor who had been seeing me over the past ten years.

As I delved further into my medical training into specialty surgery and medicine, I realised the lengthy wait times within the NHS were not restricted to general practices. Surely a patient with suspected bladder cancer shouldn’t have to wait 2 weeks to see a consultant urologist? More than anything, I found myself wondering what safety net was in place for those patients during that stressful 2-week period where their diagnosis was unknown. However, as time went on, I came to realise that every healthcare system can be viewed as a simple economy system. There is finite resources for which there is limitless demand for. The two week wait and the 10-minute consultation limit are ways in which the NHS rations their resources in order to maintain their ultimate goal of providing the fairest possible method of healthcare delivery. In actual fact, for all intents and purposes, despite how much ever we like to complain about the institution, this goal is more or less met.

When comparing Singapore and the UK, another cohort of patients that must be discussed are those Singaporeans that do not have private insurance and cannot afford private healthcare. For those patients who rely on government subsidies, their plight is similar to anyone receiving healthcare on the NHS. What’s the difference between Singapore and the UK then? The fundamental difference lies in the fact that no service provided at publicly funded hospitals is ever free at the point of delivery. The government limits the subsidy, and the aim of this is to reduce over-utilisation of the healthcare services. Furthermore, despite the public hospitals being government funded and owned, they are run on a daily basis by independent private healthcare groups such as SingHealth and National Healthcare Group. Seeing as these institutions are ultimately businesses, they utilise highly specialised entrepreneurial skills of efficiency and productivity to ensure maximal service delivery and patient satisfaction.

This begs the question, should the NHS be privatised? While there are strong arguments supporting either side, I believe there are benefits that would be gained from privatisation. To an extent, a degree of privatisation has a potential role in filling certain gaps within the NHS by reducing consultant waiting times, and generally relieving the public system of the exceedingly high demand. On the other side of the argument, open opportunities for private companies to be involved in privatisation schemes means that the NHS will be left with the unfortunate task of dealing with difficult patient cases that the private companies stay away from due to lack of profitability. Furthermore, the idea of privatisation and making profit from ill-health contradicts the fundamental ideals of the NHS and is likely to lead to fragmentation of services and may increase the inequality gap. Based on the current economic and political climate, with recent increased private equity expenditure within the NHS, in the long term, privatisation seems almost inevitable.

Having had the opportunity to compare the NHS with another world-renowned healthcare system has made me appreciate and understand the policies that the NHS have in place to ensure fair allocation of scare resources. While being an international student is trying at times, it is the most rewarding experience because we get to study medicine, explore a different culture and discover a new healthcare system all at the same time. Something I have discovered over the years is that a doctor needs to not only have meticulous clinical skills, but also an appreciation for the larger institution for which they are working in.