Frail and doddery

There's a plethora of stereotypes about older people, most of which are nonsense - or at least they apply to some oldies but not to others. For example:

• We're dripping with wealth
• We're frail and doddery
• We're overwhelming the NHS
• We don't like young people
• We're living in the past
• We're intolerant right-wingers
• We're terrified we'll be mugged - or burgled
• We drone on about our medical problems

Well, let me see now. How many of these stereotypes apply to myself?

• Dripping with wealth? I'm well-off but not wealthy
• Frail and doddery? Not yet. Still pretty healthy
• Overwhelming the NHS? I hardly ever need a doctor
• Don't like young people? Only if they're stupid or nasty
• Living in the past? I've been on the internet for decades
• Intolerant right-winger? I'm a dyed-in-the-wool leftie
• Terrified I'll be mugged? Not in this low-crime neighbourhood
• Medical droning? I never mention my health issues to others

Stereotypes are just that, aren't they? One-sided clichés that never give you the full picture of anything. Stereotypes of young people are just as one-sided and incomplete as the stereotypes of oldies.

The stereotype that really annoys me is the idea that we oldies are overwhelming the NHS. If the NHS was properly funded, properly staffed, and properly equipped with up-to-date machines and technology, then it would cope very well, oldies and all.

Well, we can dream....

What I dread

I really dread getting seriously ill these days, given the huge crisis in the NHS. People are waiting hours for an ambulance, then maybe more hours outside a hospital waiting to be admitted, and maybe more hours still before getting any effective medical treatment.

If I have a heart attack or a stroke, I'm highly unlikely to get prompt medical attention, because of long waits for medical treatment. By the time an ambulance arrives I could either be dead or much more seriously ill.

Significant numbers of people are dying unnecessarily because of long waits for medical treatment. It's estimated that there were almost 300 deaths a week associated with long accident and emergency waits in 2023.

Neither the British government or the Northern Irish government show any sense of urgency in getting the NHS back to its former high standards, the standards that were once seen as the envy of the world. Now the healthcare systems of many other countries are seen as better than the NHS.

We oldies and our multiple medical issues are often blamed for the parlous state of the NHS, but of course that's nonsense. The problem is a much more general one - lack of staff, lack of money, lack of up-to-date equipment, lack of efficient organisation.

More and more people are resorting to private healthcare as the NHS fails them. People who've been waiting absurd lengths of time for surgery, scans, physiotherapy or other procedures, people who've been in agonising pain for months or even years, are having to fall back on private provision to get the immediate attention they need. But of course many people simply can't afford to go private, they just don't have the spare cash.

And the situation isn't going to improve any time soon.

Making yourself ill

The idea is regularly mooted in the UK that people shouldn't get free medical treatment - or any medical treatment at all - if they've "made themselves ill". It's only a small minority who take this line, but they always get plenty of media attention, as if it's a wonderful idea.

If people drink too much, take drugs, smoke, engage in risky activities, or become enormously fat, goes the argument, then they shouldn't qualify for NHS treatment and they should be left to their own devices. If their behaviour leads to severe medical conditions, they should be left to seek treatment at their own expense and not expect the taxpayer to step in and sort them out.

Well, apart from the fact that the NHS has always pledged to be free at the point of use, regardless of personal circumstances and regardless of financial status, deciding that certain people shouldn't qualify for NHS treatment would be the start of a slippery slope. Once you begin turning away certain individuals, where would it end? The exemptions would proliferate until whole swathes of people could no longer use the NHS.

Furthermore, if people happen to have engrained psychological weaknesses that have led to illness - lack of self-control, recklessness, impulsiveness, whatever - why should be penalised for it? They may have tried many times to change their behaviour and failed. Or their behaviour might be a response to distressing personal circumstances they find it hard to cope with. People don't simply "make themselves ill".

Another case of engaging mouth without engaging brain.

NB: Of course all this only applies to the NHS because health care is organised quite differently in the States.

Dental crisis

I'm lucky to have had free NHS dental treatment for all my life, as private treatment costs many times what the NHS charges. I can get a routine check-up, X rays and a scale and polish for £25.80 ($33), plus fillings or root canal work for £70.70 ($90).

Unfortunately the British government is trying to privatise dentistry and is deliberately paying dentists less than the actual cost of treatment so that (very reluctantly) they give up on the NHS and go private to get a decent income.

Our first NHS dentist in Belfast retired and sold her practice to another dentist who promptly went private. Our second NHS dental practice has just announced that the whole practice of seven dentists is going private from the end of July. We've found a new NHS dentist, but how long will it be before he goes private as well?

Our current dentist's charges for private treatment will be hefty - for example, new patient examination £75 ($95), fillings £80 to £120 ($102 to $152). There's no dental insurance, only a scheme to spread your payments rather than pay them upfront.

The situation is worse in England, where many people can't even find an NHS dentist willing to take on new patients. Or an available dentist is so far away (like 50 miles), it's impractical to sign on with them.

There are reports of people in horrendous pain extracting their own teeth, or using over-the-counter emergency fillings, such is their desperation. But the government does nothing to make NHS treatment more viable for dentists and is happy to let NHS dentistry (the proud achievement of Health Secretary Aneurin Bevan in 1948) slowly collapse.

The old normality

Belfast is rapidly returning to a kind of normality after two years of pandemic restrictions. Very few people are still wearing masks or using hand sanitiser and few shops still have limits on customer numbers.

But it's not the new enlightened normality a lot of people were predicting, it's more the old restrictive normality that people wanted to change.

When we were all outside our houses on Thursday nights clapping for the health workers who were dealing with incredible pressures in an underfunded NHS, and we were aware of all the other frontline workers who were keeping society going - teachers, lorry drivers, supermarket staff, transport workers, postal workers, the emergency services - it looked like a big step forward.

A lot of us hoped that once the pandemic was over, those frontline workers would get the proper appreciation they deserved - big salary rises, special bonuses, better staffing levels, better working conditions. They would be seen as vital cogs in society and not invisible minions nobody cared about.

Some businesses did indeed compensate their employees generously, but most didn't and in fact if anything salaries and working conditions are now worse than they were pre-pandemic. Not only are wage levels still in many cases dismal but the rapidly rising cost of living is eating into them.

Most people are once again taking frontline workers for granted or even abusing them when they slip up. The politicians are setting the tone by refusing to reward them for their hard work and their high exposure to covid.

Health workers who always went the extra mile and did absurdly long shifts (and still do) are now taking out loans and using food banks in order to keep going.

The old normality is reasserting itself quite ruthlessly.

Going private

Many people outside Britain still think of the NHS as the envy of the world, but it hasn't been anything of the sort for several years now. The NHS is seriously underfunded and understaffed and many of its employees are so overwhelmed and so exhausted they're thinking of quitting for less stressful jobs - or they already have.

I've always been a loyal supporter of the NHS and a critic of private medicine, which provides swift treatment if you've got the money, but leaves those who can't afford it at the mercy of a declining public health service.

I'm very conscious that with rapidly lengthening waiting times for both consultations and surgery, there might come a day when I face a choice between waiting indefinitely for the NHS to attend to me or going private and getting the sort of care that should be standard practice.

I don't mean waits of a few weeks or months. I mean years. Some people in Northern Ireland are waiting up to seven years for a medical procedure. Some are waiting over three years for pain management appointments. There were long waits before Covid, but now they're totally off the scale.

So suppose I needed a hip replacement, a knee replacement, cataract surgery or some other operation, and I was told I'd have to wait years? And suppose things would get worse in the meantime? And suppose a private clinic could treat me tomorrow? I would seriously consider going private, despite my socialist principles.

I had to wait 18 months for a routine prostate operation under the NHS. I could have gone private but it wasn't urgent and I wasn't in pain so I was prepared to put up with the long wait.

But I can see myself being forced into some agonising decisions.

Health emergency

The NHS in Northern Ireland is in dire straits. More than 288,000 patients* were waiting for their first outpatient appoint-ment at the end of March. It's now routine for people to wait over a year to see a consultant or receive medical treatment, unless it's a life-or-death emergency.

Felicity McKee, who ironically is a nurse, has moved from Northern Ireland to Wales to get proper healthcare, after getting the brush-off from one health worker after another in her home country. In Wales a patient is nearly 50 times less likely to be waiting over a year for care than in Northern Ireland.

The main reason for the crisis in the NHS is the 2½ years shutdown of the Stormont government because of a row between the two big political parties. There has been no Minister of Health to take the necessary decisions, and the civil servants have had to keep things going as best they can.

The reason I tell you all this is because I dread the possibilities if my trace of prostate cancer turned into something much bigger, or if I developed some other major illness. How long would I have to wait before I got the necessary treatment? Would my health have got a lot worse by then?

Of course there's always the option of going private, but our savings are limited and if I needed major treatment on a regular basis, we simply couldn't afford it. If I arranged a private session with a consultant, the NHS wouldn't accept the consultant's findings and I would still have to wait to see an NHS consultant before I could get any treatment.

In any case I'm strongly opposed to going private (a) because I'm fiercely loyal to the NHS and (b) because if large numbers of people go private and vanish from NHS waiting lists, then the situation in the NHS doesn't look quite so bad.

There are rumours once more of a return to direct rule from Westminster, in which case the situation might improve. But at the moment things look pretty bleak.

*Out of a population of 1.7 million. That's 17 per cent.

Pic: Health workers at Ulster Hospital.

Demanding oldies

I get annoyed at the constant refrain that the mounting pressures on the NHS stem mainly from the soaring number of oldies and their complex medical needs.

There's a definite implication there that we oldies are just a burden, a millstone, an endless drain on the NHS, that we should feel guilty and irresponsible for living so long and needing so much care and attention. Shouldn't we just hurry up and die and stop being such a bloody nuisance?

Okay, so the growing number of oldies puts a strain on the NHS. So there's a rising demand from a particular segment of the population. So just deal with it. Provide the necessary funding and staff and other resources to meet the demand. As one of the wealthiest countries in the world, there's more than enough money available.

Just don't keep harping on about oldies and their medical needs as if we're spoilt children asking mummy for a new smartphone. Are young people with housing needs made to feel they're a burden? No. Are women who get pregnant treated as a burden? No. So why this judgmental emphasis on unhealthy oldies and their failing bodies? Can someone change the record?

The irony is that it's very much the NHS itself that's enabling people to live so long nowadays. All sorts of new drugs have helped people to stay alive by preventing heart attacks, strokes, asthma attacks, diabetic comas and many other medical emergencies. And new surgical procedures are rejuvenating people's hearts and arteries.

But of course that means we're all living much longer and needing more medical attention farther down the line. Well, you can't keep us all alive on the one hand and then complain we're overwhelming the NHS on the other, The NHS is there to provide a vital public service. So stop whinging and provide it.

I'm not a burden, I'm a human being.

Whistle stop

New laws were passed a while back to protect whistleblowers and stop them being penalised for exposing things other people would like to keep hidden.

But in practice the laws have had little effect and people who're brave enough to ask awkward questions and challenge malpractices are still relentlessly persecuted.

They can lose their job, lose their home, lose a lot of friends, and be quite traumatised by hate campaigns and personal attacks. They still take a huge risk in speaking out.

Julie Bailey, the woman who exposed the substandard care and unnecessary deaths at the Mid Staffordshire NHS Trust, has been so persistently harrassed that she has had to sell her business, sell her home and move to a caravan park fifty miles away. She has effectively been run out of town.

Hers isn't an isolated case. Others who "tell tales" in the same way have been similarly persecuted and hounded to try and shut them up and prevent them telling the truth. I know personally of one woman who can no longer find work in the food trade after she complained of sexual discrimination and had to change career to make a living.

The fact is that unless you're prepared to have your life ruined and your professional reputation trampled on, you shouldn't speak out about wrongdoing and corruption but should pretend you know nothing about it and everything in the garden is rosy.

Too many people and organisations still object to their work or their behaviour being criticised, even if the criticism is well-deserved and in the public interest. They'll go to any lengths to close ranks and silence the troublemakers. No wonder whistleblowers are still such a rarity.

Pic: Julie Bailey

Go treat yourself

Every so often some bright spark suggests that the NHS shouldn't treat people with "self-inflicted" ailments. Things like alcoholism, drug addiction, obesity, anorexia.

It sounds good on paper, for about five minutes. It would save the NHS millions of pounds, we would all pay less tax, and it would encourage people to take more care of their health.

But in reality the idea just doesn't stack up. For a start, how do you decide that something is self-inflicted? If someone is overweight, they may be over-eating or they might have faulty genes or a hormone imbalance. They might say they've genuinely tried to lose weight but nothing has worked.

If you refuse to treat a "self-inflicted" illness it could get worse, meaning far more expense farther down the line as the illness becomes terminal or the person loses their job or becomes a burden on others.

Also, any ailment can be seen as self-inflicted if you so choose. The hill-walker who breaks a leg on a mountain-top. The gym enthusiast who has a heart attack during a workout. The rock musician with hearing loss. If they hadn't been doing those things in the first place, they would be fine....

And who exactly would make the fateful decision? A doctor? A petty official? Your right to medical treatment would be subject either to someone's personal whim or some baffling set of guidelines. You sometimes use the lift and not the stairs? Sorry, mate, we can't help you.

Not to mention the awful choice for someone who's hard-up whether to scrape the money together for private treatment or somehow live with the illness.

In the end, it's just an attempt to blame the victim for their problem instead of giving them what they need. Of course we all try to avoid getting ill. Nobody wants to be swallowing a load of medicines or languishing in a hospital ward. But despite our best efforts, we can still succumb to ill health and it's up to the NHS to help us.

This half-baked idea belongs in the dustbin.

Size matters

Should a transsexual be entitled to breast enlargement on the NHS, just because it makes her feel better about herself? Couldn't you say the same of a £5000 dress or a facelift?

A transsexual known only as "C" has had her request for the operation turned down by West Berkshire Primary Care Trust and is now suing them in the High Court.

Among other things she is claiming her rights under the Sex Discrimination Act and the Human Rights Convention.

She says that as a transsexual, her flat-chestedness causes her psychiatric distress because she doesn't feel sufficiently like a woman. The operation would relieve this distress.

But surely natural women come in all shapes and sizes and bust dimensions and if you think flat-chestedness makes you less of a woman that's purely a subjective opinion. So why should the NHS cater for personal opinions?

If she feels so strongly about it, she should find the money and get the operation done privately - as thousands of women do every year. It isn't a medical need by any stretch of the imagination.

Of course transsexuals are coping with a unique psychological dilemma which is different from those of other men and women. I understand that. But there's nothing unique about wanting bigger breasts. If you want them, go out and buy them.

Pricey advice

If you had any sneaking suspicion that private health care might be better than the state-run system, the way a worried Times journalist was fleeced should be a wake-up call.

Richard Kerbaj phoned a private doctor because he thought he might have swine flu. The doctor asked if he had any symptoms, pronounced him fit and well, gave him the number for the NHS helpline - and charged him £99.

But suppose he did actually catch swine flu, he asked? Stay in bed, said the doctor, ring the NHS helpline and if necessary they'll provide some medicine.

And the cost if he had got exactly the same advice from his NHS doctor - or from an online source? Precisely nothing.

Despite all the evidence, there's still a general assumption that private care is always superior to public provision, that paying huge sums of your own money guarantees something extra.

But apart from merely being told something you could have been told by the NHS, you're just as likely to experience medical errors. It's simply that they're easier to conceal in private clinics.

If a routine operation leads to a serious complication like cardiac arrest, a private clinic may not have the specialist equipment or staff to deal with it. If they can't get you to an NHS hospital fast, you could die.

Many private surgeons are the same surgeons who work for the NHS, and the chances of their making a mistake are much the same. They're equally likely to be overworked, stressed, tired or simply incompetent.

Yes, you can probably jump a queue for treatment and get an operation in a few days. But if the operation goes wrong, what have you gained?

If I ever have £99 burning a hole in my pocket, it won't be going to Dr Tell-You-The-Bleeding-Obvious, that's for sure.

Unhealthy ravings

American Republicans out to sabotage President Obama's health reforms are spreading the most absurd lies and smears about the UK's National Health Service.

Their vicious campaign to portray Obama as a Nazi claims that his reforms are based on the NHS, a supposedly inhuman, uncaring organisation that writes off human lives.

According to them, it denies treatment to the elderly or anyone who's not "cost-effective", it has "death panels" that decide if people should live or not, it has endless waiting lists and expensive treatments are rationed.

This grotesque parody would be totally unrecognisable to most users of the NHS. They would be utterly bewildered by such a deranged travesty of a service that by and large works remarkably well and gives effective medical treatment to everyone and anyone.

I'm well aware of the NHS's flaws and failings, but the fact is that these flaws are trivial compared to its massive achievements. Far from writing off human lives, in general it goes to extraordinary lengths and spends extraordinary sums to relieve people's illnesses and maintain their quality of life.

The Republicans are not only telling breathtaking lies to prevent American citizens getting proper health care, they're insulting Britain and the million-plus NHS staff who are dedicated to their patients' well-being.

Yes, there are waiting lists for some high-demand procedures. Yes, a few expensive treatments are denied because they're of doubtful value. But anyone who needs urgent, life-or-death assistance gets it immediately with no questions asked and no expense spared - whether they're nine or ninety-nine.

Those in favour of Obama's health reforms should not imagine for one moment that the Republicans' deluded ravings are in any way based in reality.

They're just the desperate flailings of those who still want medicine to be the preserve of the rich, while the poor suffer and die helplessly.

PS: I read that the Twitter campaign #WeLoveTheNHS now has over a million followers

PPS: See Barack Obama's new webpage on the health reforms "Setting the record straight"

Blood disorder

Over the years I've given 29 blood donations, pleased that in this simple way I could help save a few lives. Now it turns out I may have been killing people.

New research shows that blood transfusions actually increase the risk of a patient dying or having a post-operative illness. Many surgeons are now reluctant to given any blood transfusions unless it's an emergency.

The reason for the increased risk, it seems, is toxic chemicals produced in stored blood when red blood cells die.

When these chemicals are produced in the human body, the body can process or excrete them so they're harmless. But in stored blood, the toxins simply accumulate and endanger whoever gets the blood.

They can cause widespread inflammation, damage vital organs, and trigger heart attacks and strokes.

Good grief! Why did we not know this earlier? How come me and other donors have given millions of donations in blissful ignorance of the possible lethal effects?

Of course, transfusions are still necessary in emergencies, where they're the only way of keeping someone alive. Then obviously the risk is worth taking.

But if it wasn't an emergency and my blood was merrily poisoning someone, how tragic is that? Am I an unwitting NHS serial killer?

Don't worry, I'm not having a nervous breakdown from this shocking discovery. After all, I was ignorant. But it shows that good intentions are not enough. And that medicine is still fallible.

PS: So maybe the Jehovah's Witnesses aren't that crazy after all?

Down in the mouth

The tooth fairy who’s so shamefully neglected Heart has been neglecting me too. I have a raging tooth abscess that makes eating or drinking virtually anything extremely painful. It’s the first time I’ve had an abscess and I sincerely hope it’s the last.

Clearly that feckless tooth fairy has been down the Wand and Tutu with her hedonistic Fairyland mates, happily supping the fairy nectar and forgetting all those mere mortals relying on her diligent protection. I’ve already sent a furious email to the Fairyland Directorate.

I went to the dentist because of a persistent toothache. Liz couldn’t see anything wrong so she took an x-ray and then showed me the nasty little shadow creeping around the root of my molar. That’s an abscess, she explained in her most professional, seen-it-all-before, nothing-to-worry-about tones.

There are two options, she added. Either extract the tooth or suck out the toxins and do a root filling. I looked round for the tooth fairy to ask her advice but she still wasn’t there. There weren’t even any lingering traces of fairy dust on the windowsill. She had obviously gone on a week-long binge without a care in the world and I was on my own here.

Well, since as some of you know I’ve only got 26 teeth anyway, I decided to defend my poor little molar and prevent it being sacrificed to the forces of bacterial darkness. I shall endure the rigours of the dental chair to save my frail, embattled chopper.

I’m sure it won’t be that bad. It can’t be worse than waxing, surely? Or maybe it can. I hope Liz has the epidural organised. And maybe a few bottles of whisky, just to be on the safe side.

In the meantime, I’m taking a course of high-dose antibiotics to clear the infection and hopefully the pain. At the moment chewing my favourite foods is more like chewing a rose bush. Jenny’s culinary expertise is wasted on my failing machinery.

If I ever catch up with that wretched, indolent tooth fairy, she’ll get a piece of my mind. And I’ll confiscate her magic wand for a week. That’ll wipe the grin off her face.

PS: It’ll all cost me an arm and a leg because the whole surgery’s just gone private and I carelessly hadn’t got round to signing up with a new NHS dentist. Rats.
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Good grief! Jesus with an erection! Whatever next?

Distressed nurses

The vast majority of NHS nurses say they sometimes or always leave work in distress because they can't give patients the dignity and quality of care they would like to give.

They say they are hampered not just by lack of time and staff shortages but by management failures that mean patients have to put up with embarrassing and dehumanising stays.

Patients are often denied single-sex wards, adequate washing and toilet facilities, help with eating and complete privacy when required.

In a Royal College of Nursing poll, 81% said there times when they left work feeling patients had been let down. Some 86% said dignity should be a higher priority.

Surely such issues as appropriate privacy and being able to wash properly are so basic they should be automatically guaranteed without nurses having to complain and make do and apologise to angry patients.

If we wouldn't accept these shortcomings in our own homes, why are they considered acceptable in hospitals, particularly when they just cause further stress to patients already suffering the stress of being hospitalised?

The feeble assurances by government ministers that patients' dignity is a top priority are not convincing when the everday reality is that this is clearly not the case and there is no sign of any radical improvements.

As in so many areas, the government is again fanatically penny-pinching with a vital public service that needs to be urgently upgraded.

There are shedloads of cash available for a new generation of nuclear missiles and a hugely ambitious ID card project, but the tottering NHS is apparently not so deserving. So nurses are left frustrated and despairing.

Operation blues

Countless cancelled operations in the UK's health service are prolonging misery and pain for thousands of people. The latest cause is cock-ups over surgical instruments.

Surgeons say they are more and more likely to be broken, missing or dirty. In which case an entire surgical team, ready to operate, has to down tools and tell the patient to go home again.

Yet again the government has handed over a job to private businesses which are failing to do the work properly. Ward cleaning was farmed out and still isn't up to standard. Many nursing posts were farmed out to agencies, again causing lots of complaints. Now it's providing and decontaminating surgical instruments that's being screwed up.

The politicians are still besotted with the idea that private firms can do the job better than their own NHS staff, even though they've been proved wrong repeatedly.

So people like Helen R. in Leeds, whose hip operation has been postponed twice because the surgeon didn't have the right instruments, is angry and upset at such elementary blunders.

"This is supposed to be the 21st century. We're supposed to have sorted these things out" she said.

There are already tens of thousands of cancelled operations because of sick staff, vacant posts, funding problems or emergencies taking priority. A lot of operating theatres aren't even used in the evenings or at weekends.

Now even more people are finding they have to put up with that excruciating pain or disabling condition for longer than they thought because of the results of political dogma.

Clearly the politicians could do with a bit of emergency brain surgery themselves.
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The BBC reports today (Sunday) that there are 10 times more deaths across the UK from the superbug clostridium difficile among over 65-year-olds than in any other country in the world. And one person dies every hour in our hospitals from this deadly infection.

Ungrateful patients

I sound like an old fogey when I bemoan the lack of personal responsibility, but the way people treat nurses and paramedics simply trying to do their job disgusts me.

They get punched and kicked, threatened with weapons, insulted and abused, and even have cigarettes stubbed out on them.

There are an estimated 75,000 attacks on NHS medical staff every year in the UK, mostly caused by binge-drinking and drug use. But only a minute number of people are convicted of an offence.

We're talking about health professionals doing the absolutely vital job of treating the sick and injured, yet there are thousands of people out there who think the best reward for that is a punch in the face or a menacing knife blade.

For them, gone are the days when you respected medical staff and courteously accepted treatment. Let alone not getting so high on drink or drugs that you are no longer in control of your actions and violence is inevitable.

The idea of personal responsibility, that you act sensibly and considerately and behave to others as you expect them to behave to you, is lost on them. Their needs come first and nobody else matters.

The problem is that nurses and doctors are reluctant to refuse treatment, even if a person is being totally uncooperative. They are committed to doing their work even when their personal safety is at risk.

We're lucky so many NHS staff are willing to continue working in such conditions and don't just walk out in favour of a more civilised workplace. But they are determined to provide a crucial service despite being permanently under seige. They all deserve medals.

Sicko

I've often criticised the National Health Service, but after seeing Michael Moore's film Sicko I'm bloody glad I have the NHS and not the horrific set-up that exists in America.

In the USA, 50 million people have no medical insurance whatever and those who do are frequently refused treatment for all sorts of bogus reasons, as the insurance companies make higher profits by denying as many claims as possible.

The idea of free universal health care is seen by the country's leaders as a communist conspiracy that threatens democratic freedoms and civilised values.

But what a payment-based system produces is thousands of people dying needlessly, a greatly increased risk of serious illness and shorter lifespans. Not to mention widespread debt, despair and destitution.

Moore interviews a middle-class couple who had high-earning jobs but ran up such heavy debts after heart attacks and cancer they had to sell their home and move into their daughter's spare room.

He shows video footage of a woman unable to pay for hospital treatment who was removed from the hospital by the insurance company and dumped on a city street.

A man who sliced off two fingertips on a circular saw was told an operation to sew back one fingertip would cost $60,000.

People with terminal illnesses needing vital treatments are refused payment on the grounds that the treatments are experimental, ineffective or inappropriate. Or that it was a pre-existing condition that invalidates the insurance.

Moore travels to Canada, the UK, France and Cuba, where he is gobsmacked by the high-quality care available to any citizen for free, simply to improve their quality of life.

You could describe the USA's health chaos as third-world standard, except that many third-world countries have far superior (and free) health services.

It's a shocking and shameful film, which I hope humiliates the USA right across the globe. Go see it.

Photo: Michael Moore interviews an NHS doctor

Baby shambles

If the NHS is getting better all the time, as the government claims, why did pregnant 22 year old Karen Shaw have to be airlifted from Northern Ireland to a Scottish hospital because neo-natal cots weren't available?

This was hardly a rare medical condition that took the Causeway Hospital by surprise, with the resources needed simply unplanned for.

Karen was expecting twins and her waters broke seven weeks prematurely - as happens frequently to mothers-to-be. But the hospital was unable to cope and had to send her elsewhere.

Her stepfather Paul Parry said she had been "terrified and traumatised" and criticised the local health service as "underfunded and farcical".

Karen has already lost one child after a miscarriage so naturally she was scared of losing the twins. She nearly lost them early in the pregnancy.

The hospital didn't explain the lack of neo-natal cots but claimed there was no risk as two specialist midwives accompanied her on the flight.

But you have to ask why the cots weren't available when premature birth is so common and maternity services are one of the major elements of the NHS.

How can such a basic failure occur when so many billions have just been pumped into the health service? And isn't it ironic that the airlift across the Irish Sea (over 100 miles) probably cost more than the missing cots?

PS: Karen has now given birth to healthy twin boys.

Photo: Karen Shaw