Perceptions of Health Care

The article I have linked to caught my attention because the headline is;

Satisfaction with NHS 'hits 11-year low'

https://www.bbc.co.uk/news/health-47472472

Being a BBC article I knew it wasn't total clickbait, maybe a little dramatic but I knew there was at least some research behind it.  Overall satisfaction has dropped but only by 3% since 2007, but in 2010 the satisfaction rating was 70%, so in the last 7 years there has been a fairly steep drop.  Satisfaction with GP services seems to be thing bringing the numbers down the most.  People seem to be upset by wait times for appointments and lack of resources, but are happy with the services they receive when they are seen.

Now I read the article trying to imagine what things must feel like if this is your norm and what you've been brought up in and I can see the issues that are caused by lack of funding for a system that absolutely needs government support to remain viable.  

I also read the article knowing what a for profit medical system looks like and I wish for just some short period of time people who are able to access a National Health Service, no matter what it's called, could see how good things are.  

Until shortly before we left the United States I relied on Health Insurance provided through either my family's workplace or at times based on my working.  A large chunk of our wages were taken monthly to pay the 'premium' and then every appointment and prescription had a 'co-pay'.  The co-pays ran somewhere between $10 - $50 dollars depending on what service was being used.  Regular everyday doctor appointments averaged $25 for each time I was seen, and being chronically ill I was seen a lot.  Prescriptions varied depending on the medication and whether or not the insurance company had any sort of deal with the drug company, big Pharma at work.  Testing beyond run of the mill blood work usually needed a pre-authorization, where the insurance company could deny the test even if the doctor deemed it necessary.  Co-pays for testing could run $100 or more depending on the test being done.  The insurance companies typically had hospital systems that they either ran or worked with and so they would dictate where and when tests or even surgical procedures could be done.  Many people have run afoul of this system when in an emergency they are taken to the 'wrong hospital' and their insurance will either refuse to pay for the services or only pay the bare minimum.  Many people, including our family, are forced to declare bankruptcy at some point because the amount of debt that accrues is unpayable no matter how many payment plans you set up with the hospitals or doctor offices.

Waiting times for appointments seems to be a universal issue.  It was not uncommon to wait months to be seen by specialists, and appointments with primary care physicians could run 2-4 weeks at times (my last PCP office was amazing and if it was an urgent type appointment would usually get you seen yet that week, but this was not the norm).  I spent 4 years trying to be seen by a pain management doctor and because they are so rare I never even made it on to a waiting list.

Since I have arrived here I have been referred to and been seen by pain management, it took 3 months to be seen but that sure beats 4+ years.  I am able to see my psychiatrist on a fairly regular basis and have not gone more than 6 weeks without seeing her, I am also seen by my CPN in between those appointments.  I have been seen twice by a GP, one appointment was scheduled within a week of calling and the other took 2 1/2 weeks, I will be seen in the coming week and again it was roughly 2 1/2 weeks between contacting them and an appointment being set.  I have been seen twice by a pharmacist to tweak my meds, twice by nurses for blood work, and had a telephone appointment with a GP when there was some concern with my lab work.  I have support people who come in 4 days a week to help with different issues and I go to the chemist once a week to pick up my medications which are prepared into a medi-box to allow David to not have to do it for me.  I have also had one hospital admission, and two tests to assure that my heart vessels were not clogged because I have a weird variant on my ECG.

Because we are foreigners here, on David's student Visa, we did pay for our access to the NHS, but it was a one time fee that covers the full four years of his student status.  He also paid for a prepay card for my prescriptions which will be a yearly expense.  All of this has been covered by these two fees and that is something that would never have happened in the United States.

I am not saying that the NHS is perfect or that there are some major issues with it that so need to be fixed so it does not collapse, but it is a whole hell of a lot better than some of the other systems out there that will literally bleed you dry.

Cheers!

Welcome to Our Neighbourhood

You've seen the inside of our place so I thought I'd give a brief tour of the neighbourhood we live in.  When we moved here I had some apprehension about moving to the big city since for the past 20 years or so we have lived in small towns or fairly rural areas.  My husband did a lot of research online looking for good student accommodations that would be at least partly furnished, close to campus, and would be close to doctors and hospitals (just in case).  We had a friend in the area who was willing to check out potential locations so we could see beyond the online hype and make sure the flat was as good as it seemed.  The flat we are in now was our second choice after our first choice was rejected by the letting company. Thankfully, this flat has turned out to be perfect for us.

We are in an area that is sometimes referred to as Heaton and sometimes Byker (we are kind of on the border between a couple of areas).  Even our mail is split between the different names.

Our little corner of Newcastle Upon Tyne is close to all the services I need (and some I had no idea existed), but far enough from the city centre so it doesn't feel overwhelmingly big. We are 0.4 miles from the Molineux Street NHS centre that has my GP (General Practioner), Psych, and pharmacy all in one building (the building also houses a Walk-In Centre, Dentist, Physio, Pain management and a whole list of other things I'm probably forgetting).  

Google estimates an 8 minute long walk and I would say that's about average.  If I'm walking with David it doesn't take nearly that long, and if I'm by myself it's probably closer to 10 minutes to get there.  The art studio (Chilli Studio) is just a bit farther at 0.5 miles but tends to take longer to get there (I average 12-15 minutes to get there).  

https://www.chillistudios.co.uk

These two are in opposite directions from each other, so that I take a left turn for the studio and a right turn for the medical building.  Both walks are relatively easy with not much in the way of hills between here and there. The worst part of the walk to the studio is having to cross a bridge that is very busy, so it's really noisy, but even that isn't too bad.

Looking right, up the road

Looking left 

The next great thing in this area, that we visit a couple of times a week, is our local grocers.  For most of our weekly shopping we use the local Morrison's, which is also about 0.4 miles from our flat, so when traveling empty-handed its about 8-10 minutes to get there. On the return with our bags full, it does take a little longer, but still not more than 15 minutes at our slowest.  Our Morrisons is huge, at about the size of the Walmart where we lived before, but this is almost all food stuff.

David will also stop on his way between campus and home at smaller stores to pick up something essential for that evening's dinner.  We both carry bags with us at all times just in case we need to pop in and get something so we don't have to pay for a bag (single-use plastic bags are not used in larger stores and there is a nominal charge for reusable bags depending on size) just to get something home.

As a quick run in, run out and to get a very random assortment of products, Wilko can't be beaten.  It's kind of like a high-end dollar store.  The prices are very reasonable, and while the quality isn't top shelf, it's decent, and you never know what you'll find if you spend any sort of time wandering the aisles.  So far Wilko is the main shop I can handle on my own without having a huge panic attack, because it's not as crowded and not as big, but I have my eye on Morrisons and I will conquer it.

Something I didn't imagine we would come to claim but this is our go-to pub, that serves decent food, has vegetarian options for David, and is quite reasonable.  It is basically next door to Wilko and not even a parking lot away from the GP surgery, meaning it's perfect.  It's called The High Main, but it is part of a chain called Wetherspoons, so there are lots of them with each having unique characteristics but being basically the same.  

There are multiple historical markers throughout our area mainly marking spots that relate to the coal mining that was done right under our feet early on in Newcastle's history.

Most neighborhoods we travel through have play areas for kids that can be used for multiple sports (but my guess is they are mostly used for football practice). The one closest to us has basketball hoops as well.  There are more traditional playgrounds for younger kids that have some very cool activities beyond just basic swings and slides. 

The park we walk through to get to the city centre has exercise equipment along the walking path with things like an elliptical machine and multiple ways to work out your abs.  Down along Quayside they have a similar set of equipment, but their equipment looks much newer.  I keep telling myself that I will go check it out, but for now walking through the neighbourhood is plenty.

This gate is at the very end of our street, and is closed most of the time, but if we leave the flat at just the right time we will find groups of mums (and dads too) dropping off their children to the school that is through there.  Such a beautiful schoolyard and during the day you can see lots of blue dots running around in the field (bright blue is the colour of the jumpers the kids wear as part of their uniforms).

If you exit the flat via the backdoor our gate opens into an alley, this lineup is what you will find.  We are amazed at how much easier and accessible recycling is here, and this group shows that.  The little blue bins are for glass, the big black bin with the multi-colour sticker on it is for recycling everything else (cans, aluminium, plastic bottles, etc), and the next big bin is for all of the things that don't seem to fit in any of the other categories.  This makes keeping up with and taking care of the recycling so easy; other nations need to get on top of this too.

At the end of our row of houses these pretty little flowers are already growing so well.  It's hard to believe that February is not over yet, but new growth is coming through.

This ring of flowers is in the green space around a high-rise set of flats and I can't wait for it to finish coming in, it will be beautiful.

Coming up the path from the studio at the end of the row of houses directly behind ours this famous face will greet you.  I haven't been able to find out a whole lot about Mr. Shakespeare and how he came to oversee our area, but you have to admit he is pretty cool looking and some serious work went into arranging the bricks into his likeness.  I've been told that during the Summer there are people who gather in the grassy area here and do yoga at least once a week, so I'll keep my eyes open for that.

In one of my earlier posts I talked about one of the reasons for not being interested in driving is all of the roundabouts.  This one here is outside of the Morrisons and is the smaller of the 2 that seem to be right on top of each other.  I had hoped to catch a shot of when the multiple busses will work their way around this at the same time with cars weaving in and out, but this is what I got.  Even without busses coming through there is way too much going on and I'm thoroughly impressed by anyone who can drive these things on a daily basis.

There is so much more I could show you all within an easy walk of our flat.  We have all of these amazing things at our disposal and we aren't even in the middle of the city.  We have found our perfect little nook of Newcastle Upon Tyne and we will stay here for as long as possible. 

More to come soon.  Cheers!

GP Surgeries and Hospital visits

If you asked anyone who knows me for a description of me, I think most would say I'm complicated, especially when it comes to anything (and everything) medical.  We knew that in coming here the medical system would be completely and drastically different from anything previously experienced,  starting with the reality of a National Health Service (NHS).  Imagine having almost everything to do with the body included within one system that does not require separate and expensive insurance policies.  As a citizen of the UK, a person is automatically included in the program and care is provided at no cost (except for some prescription and dental charges).  As guests here my husband and I had to pay for access, as part of our visa fees.   Once we did that, though, all of my GP visits, psych team visits, and hospital testing and stays are included.  So far I have more than gotten my money's worth with the care I've received and it's only been since September.

To be seen by a GP you must register with their practice.  Once registered, a primary GP is assigned to you even though you may or may not see them most of the time (seems to be a NHS requirement).  Most GP surgeries (offices) have multiple doctors of varying levels and specialties, and many have nurse practitioners that can be seen as well.  The GP acts very much like a primary care doctor does in the United States.  They are the hub for all of the specialists to work through, and they approve or send in referrals, and handle/manage the prescriptions.  The practice I'm a part of has more than 13 GPs (spread over two locations) and has a few Nurse Practitioners as well.  There are also 2 pharmacists that work with the doctors and patients to manage medications but they can also prescribe medications when appropriate.  There is an online portal that can be used to request appointments and medication refills, and it also allows you to see who has accessed your medical records.  If you are really adventurous you can also request an e-consult.  By answering some basic questions they decide what to do and promise to call back within 24 hours to tell you if you need to be seen, get a prescription, or just follow their advice.  Because the number of patients is so high and appointments are at a premium, they are scheduled in 10 minute intervals and if more than one topic needs to be discussed you must request a double time slot.  So far I have not run afoul of the time limit but I have not had too many appointments with a GP yet.  Routine appointments may be scheduled a few weeks out, but the staff have the ability to triage you into a sooner appointment if your condition warrants it.  Treatment by the GP is fully covered by the NHS so no copays are required.  Most of the time the appointments are right on time or very slightly late.  The only exception seems to be if you come into the office and request a same day appointment then the wait can be quite long because they will be slotting you in when a break in the schedule allows it.

Included in the building that holds my GP surgery is a walk-in clinic that can be used if you are experiencing something very basic that can be treated by either an advanced practice nurse or their equivalent.  This sure beats going to an A&E (ER) and waiting for a really long time to get the same treatment.  Like any government service, the NHS is underfunded and overwhelmed but it also has better service than I experienced in the United States.   Universal healthcare seems to be a dirty phrase in the US but so far the advantages far outweigh any drawbacks.

I have had a quick 1 day/2 night hospital stay relating to my mental health that required me to be monitored while IV medications were given.  Because of the NHS all of this was done at no cost to me, including a chest CT, many vials of blood, constant monitoring of heart rhythm and blood pressure.  The results of my ECGs were abnormal and because I had been experiencing intermittent chest pain a cardiologist was called in and decided to do further testing on my heart.  Within a couple of weeks of my discharge I received a letter telling me to report to one of the many hospitals in the area and have an echocardiogram done.  Later that week another letter came with an appointment set up for more specific CT's of my heart and the vessels leading into and out of it.  Both rounds of testing have been completed at this point and again all of this was done at no cost to me (other than the Uber to get to and from the hospitals). Fortunately all tests look great and I can be done worrying about my heart and just worry more about other things.   My tests were completed at Freeman Hospital, and my original stay was at The Royal Victoria Infirmary (RVI).  It seems that with multiple hospitals in a relatively small area they specialise in certain things instead of having all of them doing the same things.  So for an emergency I was taken by ambulance to RVI because of it's A&E, but the testing on my heart was done at Freeman because they have a specialised cardiothoracic centre.  I know if it becomes necessary to have an inpatient psychiatric stay that will be at another hospital.  This is so much better than having multiple hospitals in an area all doing the same things and trying to one up each other instead of focusing on what they do best and working together.  So for both inpatient and outpatient treatment I have had amazing experiences, and the waits are no longer than what it would take to be seen by most US specialists.

My next big encounter with medicine will be at my evaluation by the Pain Clinic at RVI in mid-March.  I've been counting down to this appointment pretty much since we received a letter saying where and when to show up and a packets of papers to complete before the appointment.  In our corner of Colorado there were no pain specialists and my various doctors did their best to help me cope with chronic pain from multiple sources.  I hope I'm not putting too much hope for answers and treatments into this centre.

I'm happy to keep my experiencing of the hospitals in this area to the three I've been to or know about.  The other six that are technically in the area but are a little farther afield can stay unvisited, although we've passed one of them multiple times walking up from Quayside. (It's a hospital in name only, but has an amazing history if you want to look into the Holy Jesus Hospital).

The practice of medicine is pretty universal, but the culture from which that practice originates can make all the changes in the world.  It's been good for me and I think I will find answers to questions I've been asking for a very long time.

Cheers!

Medication and the Elixirs of Life

I originally started a post that was going to take on the whole of the NHS, medications and hospital visits in one go, but as you can imagine this turned out to be way too much for one post.  So I'm going to start with what I interact with most on a daily basis and work from there.

Because my Husband and I are here in this lovely country as guests, on a visa that allows him to study here for the next 3-4 years, we are not automatically included in the NHS but had to pay a very reasonable yearly fee (£150 per person per year) for coverage.  On top of this fee we purchased a prescription plan (£100 per year) so that my medications would be covered for the first year and that we will most definitely renew.

Medications are turning out to be one of the biggest challenges I've faced since arriving.  As soon as we knew for sure we were coming here we started reaching out to Drs we had corresponded with previously to find out how to make the transition as easy as possible.  We sent them lists of the medications I was taking and except for one that is available here but not used for the same reason it seemed like things were going to be okay.  We prepared for the lag time in meeting Drs and getting prescriptions sent in by arranging to bring 90 days worth of prescriptions from Colorado, so things were not desperate at any point in the prescription waiting game.

My first physician interaction was at my assessment by the Community Mental Health team. Towards the end of the assessment the Community Practice Nurse left the room with my medication list in hand and returned with the Psychiatrist who would be handling my care.  Right away I knew things were going to be changing dramatically with my medications.  She started out saying that two of my medications were not available at all in the NHS, both were ones I considered crucial but now I would have to work on weaning off of from my private stock. There were also concerns based on the extremely high doses I take of several medications, so one of the P-Doc's goals would be reducing those doses, ideally until I could be weaned off of them completely.  The goal for my psychiatric medications is to find ways to get me as stable as possible and start withdrawing medications in a controlled way so the weaning can be stopped at the first signs of increasing symptoms.  The practice of throwing meds at me hoping for improvement with more and more complicated treatment regimens is not the way things are done here (and I'm reminded it of frequently). Instead, I will be taught how to cope with symptoms and triggers and when I can take at least some control over my mental health the medications will be reduced and eventually removed.   I'm already on fewer medications than when I came here and lo and behold I'm improving, so maybe their system works.

On the physical health side of things, changes were made as well because again we were told that some of the medications I was on were not available at all or that are very rarely used and at different doses than I was taking.  It didn't seem to matter that the one thyroid med had made drastic differences in my mood stability when it was added around 9 months before we landed, they only had a higher dose available and it was not routinely used.  It is also a bad sign when the Drs, RNs, or Chemists can't pronounce the medication.  I have used pain medication for years because of my Fibromyalgia and osteoarthritis, with occasional dips into my stocks for my chronic headaches.  I had heard that low dose codeine paired with paracetamol would be available OTC here and so weaned off of the last of the narcotics when landed.  For most days a couple of doses of this Co-Codamol is enough to decrease my pain to the point I can be as active as possible.  I have been referred to a pain clinic for an evaluation and I'm just trying to make it until the mid-March appt and see if there are any new options.  I'm willing to try just about anything to keep my pain levels below a 5 out of 10 for most days, and manageable for the rest of the days.

When we first went into one of the local pharmacies to purchase basic OTC medications (paracetamol, ibuprofen, cold medicines) we were amazed by how little they cost.  A box of paracetamol with 16 tablets runs around 20 pence, and even cold medications are less than a pound. Other than the bottle of aspirin my husband brought home the other day all of the other medicines have been in boxes and the medications inside are the kind you push through the foil backing to get them out.  I haven't found a specific reason for this type of packaging for everything, but because while my son was visiting some of his tablets either exploded (kind of like popped kernels of popcorn) or melted (became sticky or just started disintegrating) our theory is that this kind of packaging protects the medication from the constant high humidity levels.  I kind of like the cards of meds they are much easier to pack in a bag either for a day trip or overnight.  The biggest exception to this is my medications that are delivered in a medi-box weekly.  The pharmacy prepares my medications for the week into daily compartments that are divided for morning, mid-day, tea time, and bedtime.  They then sort my meds into each compartment and a seal is put over the top that allows me to punch out the appropriate meds at their scheduled time.  It really is a handy feature and it allows my husband to not have to sit and sort meds for an hour or so each week.

The paper boxes themselves have a really cool feature in that there is braille lettering on all of them. No one in our family is in need of this feature, but having it there and that it is so universal is brilliant and is another area where the U.S. needs to catch up a little.

I've been told (repeatedly) that I am an anomaly to be on so many medications at such an early age, but it is what is necessary to keep me going and as healthy as possible.  Between my prescription meds and those we pick up OTC I'm on a regimen that helps me stay safe and satisfied with what is going on in life at any given moment.  The NHS has made caring for medications almost effortless and even the ones we add out of private stock are perfect cost wise and in availability.  I'm trying to prepare for a time when many more of my medications are withdrawn, but I'm trying to take it one day at a time.

Cheers!