Friday, February 10, 2012

The Flip Side of the NHS Coin

I think I will draw a veil over the day after the operation, when my daughter was hobbling around with her catheter & bag, like a little old lady with a bad dose of piles. It was quite pathetic to see. She couldn't sit down either. However she coped well & just got on with it. I think we both thought the cystogram would be a breeze. (This was to check the reflux had been cured.) Unfortunately that wasn't to be. She was in a lot of discomfort, it didn't go smoothly & the radiographer seemed quite inexperienced, being told by the motherly, very competent nurse-in-charge how to move the bed up & down & kept making helpful suggestions about what to do next.

Thankfully, the surgeon himself arrived at the door after they called & said the op had worked. The cystogram showed no reflux. She was in the 70% of patients it works for. Hooray.

We bought a sticker book on the way out as a mini reward for being so brave & I offered my daughter a hot chocolate in the cafe but she said, still very shaky,

"Mummy I just want to go home." Who could blame her.

On arrival home she donned her beloved new dance dress, spotty tights (with no bulky 'wee' bag stuffed into them) & glittery shoes with heels & spent the day lounging glamorously on the sofa, putting her stickers in her book.

But actually, the thing I was going to write about was the less good side of the NHS: the NHS's 'low priority' policy. Or perhaps would be better called NHS Austerity Measures.

My daughter, as you may or may not remember, has a facial scar from a light fitting falling on her in Albania when my husband was changing the bulb. It slashed her cheek necessitating 3 stitches which were very quickly & ruggedly done by an American doctor there.

I went to see the GP back here & asked for a referral to a plastic surgeon. I wanted to see if the scar could be improved upon, as it is on her face & quite noticeable, particularly when she is either hot or cold it goes quite red & angry looking.

We went through all the hoops before getting a letter back saying that Oxfordshire PCT (primary care trust) has a low priority status for such things which meant, they said, they wouldn't even give her an appointment to get a plastic surgeon's opinion.

The GP was not happy about this, but said although we could appeal, it was unlikely to be successful & printed off for me the policy for 'aesthetic surgery'. This details all that they will not do.

Much of it is fair enough e.g breast 'lifts', augmentation, breast reduction (including male breast reduction..), tattoo removal, hair grafts for male baldness, laser hair removal, surgery for 'bat ears, face lift, liposuction etc.

All seems reasonable enough. But neither will they remove any warts, benign skin growths, skin tags, sebaceous cysts, pigmented or benign moles, OR keloid scars or any cosmetic 'revisions' of scars, even on the face it specifically says. I think facial scars should be an exception.

My husband gets keloid scars & 12 years ago the GP suggested to him that his keloid scar, post shoulder surgery could go on a non urgent waiting list & be dealt with. So he no longer has an ugly 5 inch caterpillar snaking across his shoulder, caused by the scar bursting open. The plastic surgeon did a beautiful job of it!

Both he & I commented on how we would be a whole lot more warty & moley given this current policy as we both had lots of finger warts, verrucas & moles removed as children, as I think many children do.

My brother is a GP & he told me he has had a verruca for 5 years. He treated it every day for about 18 months with liquid nitrogen which didn't work but even he can't get it cut out.

I had a 5 year old verruca cut out by a Singhalese dermatologist in Sri Lanka. It created quite a hole, the root was so deep. This dermatologist clearly loved her job, she used to sing as she worked & whilst removing 2 of my husband's suspicious moles on his back said "I might as well do a few more whilst I'm at it."
And she proceeded to dig away at his mole-strewn back with the passion of a person who has discovered her life's work.

So unless we pay £200 for a private consultation &, what the GP called 'substantially more', for the actual scar revision, my daughter will have to live with the scar & cover it up with make up as best she can. It is not disfiguring & people say they hardly notice it. But when near her it is very obviously there, plumb across the apple of her cheek.

At times like this I confess I pine for the health insurance we had whilst abroad, which still couldn't buy any decent treatment in Tirana, but it meant we could probably have got this seen to on our insurance if we had flown back especially. It hadn't occurred to us to do this as we assumed it could be done on the NHS once back. And we couldn't have claimed for the flights as it was non urgent.

Overall though, I think the NHS is fantastic & am so grateful for it, & for the dedicated, friendly & unstuffy medical professionals we have dealt with.


Iota said...

Good to hear that the cystogram showed positive results. Poor A, having to go through all that (poor you too), but great that the reflux has been solved.

I suppose the NHS has really got to prioritise, hasn't it? I remember the phrase "finite resources, infinite demand" being a catchphrase at one point, and that really is the case. But where and how to draw the lines is far from simple.

Expat mum said...

It is too bad really! Health systems both state and private have their pros and cons. My family has just had extensive dealings with the NHS and are singing its praises, but it was considered critical.
Over here (USA) you can pretty much do whatever you want, but you pay through the nose for health insurance premiums, deductibles, co-pays and the like.