A Case Study Analysis of Accessibility and Service Delivery in the UK's National Health Service
The UK’s National Health Service (NHS) is acclaimed globally for its inclusivity and quality of healthcare (Appleby et al., 2018), standing under the umbrella of the United Nations declaration of human rights, article 25 that 'Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, [...] sickness, [...] or other lack of livelihood [...] beyond their control' (United Nations, 2023). However, a recent narrative brings forth concerns regarding its accessibility and service delivery. This article examines such an experience of an EU immigrant struggling to obtain urgent dental care within the NHS framework.
The case study focuses on an EU immigrant, legally residing in the UK on and off for about five years, a homeowner, and married to a British citizen. She faced an abrupt health emergency - a mouth abscess. Her ordeal exposes key gaps in the current NHS healthcare delivery model.
Initially, she sought assistance via telephone but was confronted with a substantial wait time, an issue often reported across the NHS (Healthwatch, 2020). Undeterred, she visited the doctor's surgery in person where she is registered with, only to receive a dismissive response of 'we can't do anything to do with the mouth'. Indicative of primary care's limitations within the NHS system (NHS Constitution, 2015).
Next, she contacted NHS 111, designed to offer non-emergency medical help. Despite being 17th in the queue and a 45-minute wait, she was told to go see a dentist, emphasising an often-criticised classification system (Palmer, 2019). She then contacted 15 dentists in the region who all told her that not one of them were accepting new patients, a problematic trend reported within the NHS (Merrick, 2021).
Faced with a systemic deadlock, she turned to her home country in the EU. A quick phone call to her mother resulted in a rapid prescription for antibiotics by the local doctor over the phone with the mother, demonstrating an ironic contrast in healthcare efficiency. Even though the medication couldn't be procured immediately due to geographical distance, it would reach her sooner through visiting friends on the weekend in 2 day's time, rather than just trying to gain initial access to the UK health system.
This account raises fundamental questions about the NHS's accessibility and effectiveness, seemingly at odds with its principles of universality and comprehensive care.
Her struggle to secure assistance within the NHS framework brings forth numerous concerns about its efficiency and inclusivity.
Her initial attempts to get help via telephone met with long waiting times, a widely reported issue across the NHS (Healthwatch, 2020). Furthermore, the geographic location of the individual, North Yorkshire, brings into question the effect of the North-South divide on healthcare access. Literature suggests that this regional divide potentially exacerbates healthcare inequalities, with the North experiencing less favourable outcomes (Buchan et al., 2017).
Her visit to her registered doctor's surgery resulted in a dismissive response, which is symptomatic of the limitations within NHS primary care (NHS Constitution, 2015). Such experience points towards a potential class issue, where individuals from lower socioeconomic backgrounds might face similar or worse barriers.
Contacting NHS 111 led to advice to seek a dentist on her own after a 45-minute wait. However, 15 dental centres within a 30-mile radius would not accept her. This situation might also hint at a racial bias, as racial and ethnic minorities in the UK have been found to experience unequal access to dental care (Szczepura, 2005). It would be easy to see in the system what kind of person they are dealing with.
Her experience as an EU immigrant reflects the challenges facing many non-British citizens in the post-Brexit era. Additionally, post-Brexit migrants face a significant financial burden, with costs up to £4000 for a visa of 2 years and 9 months for access to NHS services, as well as 'other' migration costs which are outsourced to an EU-based company in Paris, France! This raises questions about the fairness and transparency of the healthcare access system for immigrants (Hiam et al., 2019), not to mention the stories told of locals accessing their own health service. Some stories have had people in the emergency waiting rooms coughing up blood and after 5 hours later, just told to go home. Another story is how the NHS had misdiagnosed an elderly person of a melanoma, which could have been easily preventable, but upon later detection through private health cover, told another story that lead to his sad, untimely and early demise.
It is clear that the verified case study exemplified in this account is affecting British citizens as well.
The detailed account not only exposes critical issues in the NHS's accessibility, bureaucratic systems and service delivery but also forces us to reflect on deeper, systemic inequalities based on race, class, geography, and post-Brexit policies. As a universal healthcare provider, the UK Government, the NHS, and all British citizens who vote, must address these disparities as a primary importance to ensure its services are effectively accessible to all in the country.
So what are you going to do about it England?
Appleby, J., Baird, B., Thompson, J., & Jabbal, J. (2018). The NHS at 70: How good is the NHS? The King's Fund.
Healthwatch. (2020). Access to NHS dental care continues to be an issue. Healthwatch England.
NHS Constitution. (2015). The NHS Constitution for England. NHS.
Palmer, K. (2019). Why your NHS emergency may not be the paramedics' priority. The Guardian.
Merrick, R. (2021). Thousands unable to get NHS dental care after coronavirus lockdown, watchdog warns. The Independent.
Buchan, I., et al. (2017). North–South disparities in English mortality1965–2015: longitudinal population study. Journal of Epidemiology and Community Health.
Szczepura, A. (2005). Access to health care for ethnic minority populations. Postgraduate Medical Journal.
Hiam, L., Dorling, D., Harrison, D., & McKee, M. (2019). Why is life expectancy in England and Wales 'stalling'? Journal of Epidemiology and Community Health.
United Nations (2023) Declaration of Human Rights [online] Available at: https://www.un.org/en/about-us/universal-declaration-of-human-rights