Vic
Id agree with what you are saying. When we only know, what we are used to and what we have experienced, we always want it here and now. But if many have seen medical care in other countries and then compare it to the UK, youd be glad we had it.
However, saying that, we, collectively, pay alot for the NHS per year. I think its far to say that base don what we pay, and what we get, the service and delivery can be extremely poor. But on the other hand, when I see Gareths previous responses on his experience...its clear that he has recieved excellent care and response.
It all boils down to mismanagement and no ownership. Im convinced that the current state of the NHS (Debt, sweating the assets, redundancy) is all a path to being forced into Private Medical Care....but in phases......if you stand back and look at whats going on.....I predict...that within 6-10 years we will see a drastic increase in private health care; above and beyond what is already planned...subsidised through one mechanism or another.....by the UK tax paying public......
Funni old game! Game of two halves!
Moorfields Eye Hospital
Moderators: Anne Klepacz, John Smith, Sweet
-
Andrew MacLean
- Moderator
- Posts: 7703
- Joined: Thu 15 Jan 2004 8:01 pm
- Keratoconus: Yes, I have KC
- Vision: Other
- Location: Scotland
Steven
Yes. It is well known that I attend Gartnavel Hospital in Glasgow (which now houses the old Glasgow Eye Infirmary).
My condition was diagnosed in Aberdeen where I received a service every bit as good as I do now in Glasgow. In Aberdeen they did not, at that time, have a hospital based contact lens service, so they referred me to the high street optician who fitted my first lenses. He was endlessly patient with me, explaining some of the difficulties of fitting KC eyes, talking about the prospect of prpogression, and explaining why he was suggesting one lens as opposed to another. He even got me to put my first lens into my own eye.
My only quibble with the Aberdeen service was the way in which a junior doctor told me I had KC and what the prognosis was. At consultant level, and even Registrar level I found the opthalmologists excellent.
I then moved to Glasgow and came with a fresh referral to the Tennant Institute (the eye infirmary) where I saw first a contact lens specialist and then the ophthalmologist.
In my time as a patient there I have seen several consultants: Dr Fawzi, and excellent man; Professor Kirkness, a thoroughy good man who gave me the option of trying long term contact lens wear rather than move to an early graft. Then a short interregnum when I saw a consultant whose name I regret that I have forgotten (I think his name was Tiernan or Tierney) but he was followed by Dr Ramaesh who has continued the tradition of excellence that I have come to expect in the NHS.
As I said in an earlier post I am really sorry that there are parts of the United Kingdom where my experience in two Scottish Cities is not the norm. There is clearly a need to ensure that where best practice is found, it is shared so that it can become the common experience of all.
Yours aye
Andrew
ps as a footnote, I thought I'd add this. The question is begged above whether I would think it entirely unsatisfactory if the timeous fulfilment of my appointments was not always evident. I think that I am with Vic in this. I hope I should find the forebearance to understand that, even in the best regulated circumstances, things can go wrong.
I also re-read Pat's post about her collar bone. What she describes is exactly what I should have expected for anyone who suffered an injury and I am glad that her experience of Scotland was enhanced by her experience of the NHS as it works in this part of the UK.
A
Yes. It is well known that I attend Gartnavel Hospital in Glasgow (which now houses the old Glasgow Eye Infirmary).
My condition was diagnosed in Aberdeen where I received a service every bit as good as I do now in Glasgow. In Aberdeen they did not, at that time, have a hospital based contact lens service, so they referred me to the high street optician who fitted my first lenses. He was endlessly patient with me, explaining some of the difficulties of fitting KC eyes, talking about the prospect of prpogression, and explaining why he was suggesting one lens as opposed to another. He even got me to put my first lens into my own eye.
My only quibble with the Aberdeen service was the way in which a junior doctor told me I had KC and what the prognosis was. At consultant level, and even Registrar level I found the opthalmologists excellent.
I then moved to Glasgow and came with a fresh referral to the Tennant Institute (the eye infirmary) where I saw first a contact lens specialist and then the ophthalmologist.
In my time as a patient there I have seen several consultants: Dr Fawzi, and excellent man; Professor Kirkness, a thoroughy good man who gave me the option of trying long term contact lens wear rather than move to an early graft. Then a short interregnum when I saw a consultant whose name I regret that I have forgotten (I think his name was Tiernan or Tierney) but he was followed by Dr Ramaesh who has continued the tradition of excellence that I have come to expect in the NHS.
As I said in an earlier post I am really sorry that there are parts of the United Kingdom where my experience in two Scottish Cities is not the norm. There is clearly a need to ensure that where best practice is found, it is shared so that it can become the common experience of all.
Yours aye
Andrew
ps as a footnote, I thought I'd add this. The question is begged above whether I would think it entirely unsatisfactory if the timeous fulfilment of my appointments was not always evident. I think that I am with Vic in this. I hope I should find the forebearance to understand that, even in the best regulated circumstances, things can go wrong.
I also re-read Pat's post about her collar bone. What she describes is exactly what I should have expected for anyone who suffered an injury and I am glad that her experience of Scotland was enhanced by her experience of the NHS as it works in this part of the UK.
A
Andrew MacLean
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GarethB
- Ambassador
- Posts: 4916
- Joined: Sat 21 Aug 2004 3:31 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and contact lenses
- Location: Warwickshire
The experience I have had at the Cov and Warwick hospital in Coventry has been exceptional and it continues to be exceptional now the eye unit has moved into the main University Hospital in Coventry - Walsgrave.
When I was first diagnosed when I lived in Co Durham, the hospital in Darlington was really good and the local high street optom that referred me managed my condition to the best of his abilities with the technology available 20 years ago.
The only treatment I received at Moorfileds was late one evening in the summer of 1991 when dust got lodged under one of my stitches. Stevenage casualty did not have facilities then to deal with my problem and promtly transfered me direct to Moorfields eye casualty and ensured I got home again.
Last year I had a sereous kidney problem that resulted with me going to casualty and I was seen very quickly and the followup scans were also very prompt.
Sertainly the NHS system I have experienced in Warwickshire/West Midlands is more than satisfactory.
When I was first diagnosed when I lived in Co Durham, the hospital in Darlington was really good and the local high street optom that referred me managed my condition to the best of his abilities with the technology available 20 years ago.
The only treatment I received at Moorfileds was late one evening in the summer of 1991 when dust got lodged under one of my stitches. Stevenage casualty did not have facilities then to deal with my problem and promtly transfered me direct to Moorfields eye casualty and ensured I got home again.
Last year I had a sereous kidney problem that resulted with me going to casualty and I was seen very quickly and the followup scans were also very prompt.
Sertainly the NHS system I have experienced in Warwickshire/West Midlands is more than satisfactory.
Gareth
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Lynn White
- Optometrist
- Posts: 1398
- Joined: Sat 12 Mar 2005 8:00 pm
- Location: Leighton Buzzard
Any conversation about the NHS rapidly becomes convoluted!! I would say all of the posts here are equally relevant and represent a wide experience of health care in this country.
Moorfields comes in for a lot of stick here because of waiting times - but you have to look at this historically. Moorfields has built up a concentration of staff expertise in eye conditions that is used by almost the entire country. In this you are talking about the entire spectrum of eye problems - not just KC, which accounts for the long waiting times.
In some ways this is what you get for putting all your specialist eggs in one basket, but on the other hand, it is hard to justify full time professionals expert in every conceivable condition in every hospital in the UK.
The NHS is certainly undergoing upheaval and yes, I would agree that the move is going to be towards increasingly private care because, simply put, the NHS was born in the 1950's based on 1950's technologies. Even by the 1960's when heart operations and transplants took off, it was already struggling to keep up with escalating costs. It is not logical to expect that the NHS can provide top class service in every area without pouring more and more money into the system each year. Unless we as a country authorise an open ended chequebook, hospitals are going to run up debts and more and more imaginative ways are going to have to be found to fund our health service. Its just that no politician has quite the guts to stand up and say the NHS as we understood it can no longer cope.
In fact, there IS existing in the UK a hybrid private/NHS system that runs economically, provides plenty of comptetition so that patients have a wide range of treatment options and get can get an appointment the same day with no waiting if they so wish. Its called optometry.
For years, optometry has been quietly privatised. In fact, it was the very first health service sector to introduce private charges back in the 1950's. Initially all glasses were free - that lasted about 2 years until it was realised how much money was being lost through this. So private charges for spectacles were brought in way back at the birth of our NHS system.
It has evolved to the point nowadays that if you are in financial need, ie recieve benefits, you can have a free eye examination at any high street practice for free. In Scotland, recent law changes means ANYONE can now get a free test at a high street practice. You can take your NHS voucher and take it anywhere to be made up, indeed having the option to use it against a pair of designer frames if you so wish. You can also use this voucher towards contact lenses.
Many high street practices do fit KC and many can raise the same HES (Hospital Eye Service) forms that are used to supply your lenses in hospitals. Some will obviously charge privately for everything.. but the point here is that there is a choice.
Most people end up in hospitals with KC because not enough GP's know enough about local practices who deal with KC. Yes, you really need a diagnosis and for that you need to be referred to a specialist - but to be honest, for a newly diagnosed mild KC, you could be fitted with contacts while you are waiting to be seen at the hospital. Many patients go to hospital only to have the consultant say , yes you have it! Now go and get contacts.
In my mind, hospitals are the best place for KC that has reached a difficult stage of management. Those who are stable can be managed in the community, thus freeing up clinic space. This is the ways things are moving for many conditions such as glaucoma. KC just hasn't caught up yet!
All of the above is behind my creating the KC friendly optom list, so people can see there ARE other ways of handling KC and can see where there are KC friendly optoms in their area.
And talking of other health systems abroad... I worked for a while in Trinidad which has a high number of KC'ers. The health system is based on the UK NHS but has evolved a private health insurance scheme alongside it, so that health care can be affordable and efficient.
So what would happen if I discovered a patient had KC? Well, at the moment there is not a hospital based optometric system, so all contact lenses are private. If you are poor and out of work you will not be able to go via a hospital route for a fitting.
However, if you are in work, ususally you have a work based health insurance scheme. So, I would send my patient to a nearby health centre where he would pay around £10 for a consultation with an ophthalmologist. (To put this in perspective, eye tests there are around £7 to £10 and spec frames near to UK prices) He would return with the diagnosis in a day or two and I would fit contacts, a good portion of the costs paid by the health insurance. All in all patient would be up and running in a matter of a few weeks from initial detection.
As the culture is different over there, poor people often are fitted free as a charitable gesture by practices. Alternatively, family very often rallies round and clubs together to pay for such things.
So yes, we should be grateful that the NHS is so good in this country BUT this does not mean we cannot learn from other so called third world countries either. We have become so used to our NHS, we often do not stop and think laterally. Scotland is already developing a different system of community based optometry and Wales is forging ahead with schemes of its own. Its really here in England we are still bound to the the old style NHS.
Lynn White
Moorfields comes in for a lot of stick here because of waiting times - but you have to look at this historically. Moorfields has built up a concentration of staff expertise in eye conditions that is used by almost the entire country. In this you are talking about the entire spectrum of eye problems - not just KC, which accounts for the long waiting times.
In some ways this is what you get for putting all your specialist eggs in one basket, but on the other hand, it is hard to justify full time professionals expert in every conceivable condition in every hospital in the UK.
The NHS is certainly undergoing upheaval and yes, I would agree that the move is going to be towards increasingly private care because, simply put, the NHS was born in the 1950's based on 1950's technologies. Even by the 1960's when heart operations and transplants took off, it was already struggling to keep up with escalating costs. It is not logical to expect that the NHS can provide top class service in every area without pouring more and more money into the system each year. Unless we as a country authorise an open ended chequebook, hospitals are going to run up debts and more and more imaginative ways are going to have to be found to fund our health service. Its just that no politician has quite the guts to stand up and say the NHS as we understood it can no longer cope.
In fact, there IS existing in the UK a hybrid private/NHS system that runs economically, provides plenty of comptetition so that patients have a wide range of treatment options and get can get an appointment the same day with no waiting if they so wish. Its called optometry.
For years, optometry has been quietly privatised. In fact, it was the very first health service sector to introduce private charges back in the 1950's. Initially all glasses were free - that lasted about 2 years until it was realised how much money was being lost through this. So private charges for spectacles were brought in way back at the birth of our NHS system.
It has evolved to the point nowadays that if you are in financial need, ie recieve benefits, you can have a free eye examination at any high street practice for free. In Scotland, recent law changes means ANYONE can now get a free test at a high street practice. You can take your NHS voucher and take it anywhere to be made up, indeed having the option to use it against a pair of designer frames if you so wish. You can also use this voucher towards contact lenses.
Many high street practices do fit KC and many can raise the same HES (Hospital Eye Service) forms that are used to supply your lenses in hospitals. Some will obviously charge privately for everything.. but the point here is that there is a choice.
Most people end up in hospitals with KC because not enough GP's know enough about local practices who deal with KC. Yes, you really need a diagnosis and for that you need to be referred to a specialist - but to be honest, for a newly diagnosed mild KC, you could be fitted with contacts while you are waiting to be seen at the hospital. Many patients go to hospital only to have the consultant say , yes you have it! Now go and get contacts.
In my mind, hospitals are the best place for KC that has reached a difficult stage of management. Those who are stable can be managed in the community, thus freeing up clinic space. This is the ways things are moving for many conditions such as glaucoma. KC just hasn't caught up yet!
All of the above is behind my creating the KC friendly optom list, so people can see there ARE other ways of handling KC and can see where there are KC friendly optoms in their area.
And talking of other health systems abroad... I worked for a while in Trinidad which has a high number of KC'ers. The health system is based on the UK NHS but has evolved a private health insurance scheme alongside it, so that health care can be affordable and efficient.
So what would happen if I discovered a patient had KC? Well, at the moment there is not a hospital based optometric system, so all contact lenses are private. If you are poor and out of work you will not be able to go via a hospital route for a fitting.
However, if you are in work, ususally you have a work based health insurance scheme. So, I would send my patient to a nearby health centre where he would pay around £10 for a consultation with an ophthalmologist. (To put this in perspective, eye tests there are around £7 to £10 and spec frames near to UK prices) He would return with the diagnosis in a day or two and I would fit contacts, a good portion of the costs paid by the health insurance. All in all patient would be up and running in a matter of a few weeks from initial detection.
As the culture is different over there, poor people often are fitted free as a charitable gesture by practices. Alternatively, family very often rallies round and clubs together to pay for such things.
So yes, we should be grateful that the NHS is so good in this country BUT this does not mean we cannot learn from other so called third world countries either. We have become so used to our NHS, we often do not stop and think laterally. Scotland is already developing a different system of community based optometry and Wales is forging ahead with schemes of its own. Its really here in England we are still bound to the the old style NHS.
Lynn White
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Steven Williams
- Forum Stalwart
- Posts: 316
- Joined: Tue 18 May 2004 10:48 pm
- Keratoconus: Yes, I have KC
- Vision: Other
- Location: North Lancashire
Vic states:-
The NHS is funded by the tax payer through national insurance payments, so your totally wrong to say that its FREE, unless your living totally off the state "benefits" system.
If the countries that you refer to were funded by a similar system at a similar level it would be interesting to see what was on offer there. Its not a fair comparison because your not comparing like for like Vic!
I just thought I would add my two pence' worth re. satisfactory care - I have to disagree with you Steven that it is unsatisfactory to have to wait more than 15 minutes beyond 'appointment time'. Yes waiting for 2 hours can be frustrating, but I think that we DO have an excellent health service in the UK, and we both have and expect free access to doctors / other experts. Sometimes that service doesn't run quite as smoothly as we'd like and we end up waiting hours to be seen / months to get an appt, BUT I think it's worth remembering sometimes that there are all manner of extremely legitimate reasons why a clinic is running behind. Having worked abroad in hospitals in Africa and South Asia and seen just how basic or non-existent healthcare can be, I think we do take the facilities and service here, and the fact that we can access them for free, for granted sometimes. Of course the NHS is not perfect, and somtimes there can be a lot of room for improvement, but I think that waiting an hour to see an ophthalmologist is not synonymous with care being unsatisfactory. But just my view
The NHS is funded by the tax payer through national insurance payments, so your totally wrong to say that its FREE, unless your living totally off the state "benefits" system.
If the countries that you refer to were funded by a similar system at a similar level it would be interesting to see what was on offer there. Its not a fair comparison because your not comparing like for like Vic!
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Steven Williams
- Forum Stalwart
- Posts: 316
- Joined: Tue 18 May 2004 10:48 pm
- Keratoconus: Yes, I have KC
- Vision: Other
- Location: North Lancashire
I just thought I would add my two pence' worth re. satisfactory care - I have to disagree with you Steven that it is unsatisfactory to have to wait more than 15 minutes beyond 'appointment time'. Yes waiting for 2 hours can be frustrating, but I think that we DO have an excellent health service in the UK, and we both have and expect free access to doctors / other experts. Sometimes that service doesn't run quite as smoothly as we'd like and we end up waiting hours to be seen / months to get an appt, BUT I think it's worth remembering sometimes that there are all manner of extremely legitimate reasons why a clinic is running behind. Having worked abroad in hospitals in Africa and South Asia and seen just how basic or non-existent healthcare can be, I think we do take the facilities and service here, and the fact that we can access them for free, for granted sometimes. Of course the NHS is not perfect, and somtimes there can be a lot of room for improvement, but I think that waiting an hour to see an ophthalmologist is not synonymous with care being unsatisfactory. But just my view
Would be interesting to know where and who provides you with satisfactory/top quality KC care Vic!
The waiting time is not the big issue. I'd be happy to wait 5 hours for an appointment if the treatment I received produced a solution within a reasonable amount of time. Two years and still no satisfactory fit of contact lenses, trying mini scerals now.....but problems......maybe another thread when I get time....but I prefer to put something positive on here and offer solutions!
Is the progress of your KC monitored annually and recorded Vic objectively; re: using a keractometer? or is it crisis management and left to the patient to cope/manage?
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Andrew MacLean
- Moderator
- Posts: 7703
- Joined: Thu 15 Jan 2004 8:01 pm
- Keratoconus: Yes, I have KC
- Vision: Other
- Location: Scotland
I can't speak for Vic, but the progress of my KC was and is monitored with three or six monthly examinations. (Three monthly with optometrists and six monthly with ophthalmologists.)
It is clear from the posts of others on this string that a disappointing service is not the universale or even common experience of everybody on the forum.
So the question arises, why is it that in some areas the service is less good than in others? Perhaps Steve is just unfortunate that different approaches have not met his particular needs. KC is known to vary between individuals, and this does create difficulties in fitting lenses to JC eyes.
Perhaps it is not a question of the service being poor in some areas, just an unfortunate combination of a condition that is developing so that lenses are proving difficult to fit.
Andrew
It is clear from the posts of others on this string that a disappointing service is not the universale or even common experience of everybody on the forum.
So the question arises, why is it that in some areas the service is less good than in others? Perhaps Steve is just unfortunate that different approaches have not met his particular needs. KC is known to vary between individuals, and this does create difficulties in fitting lenses to JC eyes.
Perhaps it is not a question of the service being poor in some areas, just an unfortunate combination of a condition that is developing so that lenses are proving difficult to fit.
Andrew
Andrew MacLean
-
Steven Williams
- Forum Stalwart
- Posts: 316
- Joined: Tue 18 May 2004 10:48 pm
- Keratoconus: Yes, I have KC
- Vision: Other
- Location: North Lancashire
Moorfields is a centre of excellence for eyecare and the best the UK has. Its also likely to have the best and most experienced eye care consultants in the world.....presumably thats why an Arab Shiek is "buying them".
Even the top consultant optom, Dr Troumans at MREH advised me last Friday that she was seeking advice from Moorfields regarding coming up with a contact lens solution for me!
This is clearly selling off the NHS assests to the rich, the money men.
Regarding Jayuks comment about privatisation I would agree thats the reality if we just sit back and watch it happen.
How much do you think you would have to pay if it went private and could you afford it?
If you've already got KC you wont get any health insurance and no doubt quotes your kids will get will be loaded because of KC family history or qualified cover offer refusing to cover the KC!
The training and experience these Moorfields staff gained was funded by the UK taxpayer!
Maybe emigrating to Dubai is the solution?
Even the top consultant optom, Dr Troumans at MREH advised me last Friday that she was seeking advice from Moorfields regarding coming up with a contact lens solution for me!
This is clearly selling off the NHS assests to the rich, the money men.
Regarding Jayuks comment about privatisation I would agree thats the reality if we just sit back and watch it happen.
How much do you think you would have to pay if it went private and could you afford it?
If you've already got KC you wont get any health insurance and no doubt quotes your kids will get will be loaded because of KC family history or qualified cover offer refusing to cover the KC!
The training and experience these Moorfields staff gained was funded by the UK taxpayer!
Maybe emigrating to Dubai is the solution?
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John Smith
- Moderator
- Posts: 1942
- Joined: Thu 08 Jan 2004 12:48 am
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and spectacles
- Location: Sidcup, Kent
Whilst I'm happy for this thread to continue to talk about the merits of MEH and the quality of care there; and even a comparison of private versus NHS care, this thread is drifting severely off-topic.
I'd like to remind everyone that the funding of the NHS in general has nothing to do with Keratoconus, and is political in nature. As such, it is against the Ts & Cs of the forum.
I'd like to remind everyone that the funding of the NHS in general has nothing to do with Keratoconus, and is political in nature. As such, it is against the Ts & Cs of the forum.
John
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Vic
- Regular contributor
- Posts: 137
- Joined: Sat 01 Apr 2006 8:19 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and spectacles
- Location: Birmingham
I recently transferred to Moorfields after 7 years under the care of Bristol Eye Hospital. I’m not sure what you mean by a keractometer - but my KC was regularly assessed with a topography scan. Of course the service was not perfect, no service ever is, but for the most part it was good, they were extremely accommodating in terms of trying to fit appointments and the timing of my graft around my medical studies, which I was very grateful for. I have also found the same with Moorfields.
I think Andrew is right in the sense that perhaps the fact that KC can often be a rapidly-changing condition does make things difficult, especially from a hospital eye service / optometry perspective.
I think Andrew is right in the sense that perhaps the fact that KC can often be a rapidly-changing condition does make things difficult, especially from a hospital eye service / optometry perspective.
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