Strokes and why the NHS isn't a good health care system

We’re told that the NHS doesn’t treat strokes well:

The procedure can reduce hospital stays by months. Some patients have been able to leave hospital the next day, instead of spending months in rehabilitation units.

Stroke specialists say a 24/7 service would save £73m a year due to the reduced costs of looking after people with stroke. But just 25% of thrombectomy centres operate as such, while 42% are only open from Monday to Friday during office hours, the report says, in part due to a lack of biplane suites, which contain specific radiology equipment.

Juliet Bouverie, the chief executive of the Stroke Association, said: “Thrombectomy is a miracle treatment that pulls patients back from near death and alleviates the worst effects of stroke.

The coverage rate is apparently some 0% in some areas outside London, up to 8% inside it.

It’s true that mechanical thrombectomy is a fairly new treatment, full trials showing effectiveness seem to have been completed in 2015 and 2018. But then this is exactly what ails the NHS - the length of time it takes new and better treatments to come into general use.

The American experience is of “The percent of patients with AIS receiving IAT increased from 1% in 2008 to 5.3% in 2018 (p>0.001).” They reached a much higher level ( yes, 5% of all is greater than the 0-8% range across Britain given that London isn’t by any means the majority of population) 5 years earlier than we did.

Which is exactly the NHS problem - productivity. Fortunately, we also know how to increase productivity. That comes from competition. No, it doesn’t have to be like the American health care system, it can still be tax paid, it’s that the organisations doing the actual work need to be competing to produce the finest results possible with the currently available technologies. That’s what does spark the adoption of the newly available and better - more productive - technologies over time. It’s also a self-sustaining process, it will apply to each and every new technology as one comes along.

That’s the argument for markets within the NHS. That they makes the system more productive, better, over time.

Or, even, markets in the NHS will stop some to many dying from mortality amenable to treatment, the one measure by which the NHS does appallingly in international comparisons.