I’m a consultant vascular surgeon specialising in complex aortic repair. In simple terms I repair aneurysms in the aorta, which is the biggest blood vessel in the body and our most important piece of internal plumbing. The aorta starts at the heart and travels in almost a candy-cane formation down along the spine. It gives blood to everything else in the body.  I spent eight years working at the Cleveland Clinic in Ohio, which is rightly seen as one of the best hospitals in the world. It’s a great hospital, which is a thought leader in aortic and vascular surgery, and attracts some of medicine’s best and brightest minds. It is also very big on innovation and its facilities are world class. It’s somewhere any doctor who enjoys their job would want to work.  But in October 2014 I came to work at the Royal Free hospital in north London. It was an opportunity I couldn’t pass up. It was a great job, heading the aortic team. But I also came because I wanted to work in the NHS because it is a publicly funded and provided healthcare system. To me, access to healthcare is a fundamental human right. Everyone in the world should have access to it. Sadly, the reality is that in many countries people don’t.  I like the fact that the NHS is a tradition in this country and is revered by the population. I have a great deal of respect for the NHS and the way it delivers care to every member of society – all walks of life. In my 15 months here I have treated everyone from homeless people to celebrities. I like the fact that the NHS has guiding principles and values – almost a moral compass – and is a fair system, where treatment is on the basis of need, not ability to pay.  The US puts about twice as much of its GDP into healthcare as the UK does, so I knew there would be differences in resources between here and there. There are fewer doctors and fewer support staff around to do what feels like sometimes more work. The nursing staff, for example, is chronically underpopulated throughout London, not just at the Royal Free. Yet we still manage to treat large volumes of patients because people work overtime and put a lot of hours in.  Staff here seem to me to be working harder than I’ve seen people work in other places  There are fewer scanners here than in some hospitals in the States. The interior design here isn’t always as nice. And for example, while we still have wards in England, many facilities in the US are moving towards single-patient rooms, which can make a difference to a patient’s experience in hospital.  Although we may not have all the bells and whistles and latest technology, we have everything we need to provide good care. The NHS has a very committed and extremely dedicated workforce who go above and beyond for every patient. We’re also very creative. We figure out how to get things done in ways that are cheaper than other techniques but are just as effective.  But the NHS is a system under visible pressure. It’s extremely busy. We are constantly full to the gills. The beds crisis? That’s real and tangible, and we have to deal with it absolutely every day. When it comes to getting patients in and out of hospital there’s very little room to breathe in terms of that fine margin of error. We’re on a razor’s edge of how close we are each day to not being able to accommodate everybody.  At some point when you keep asking staff to go above and beyond every day there will be a breaking point. Staff are stretched to the limit. Staff here seem to me to be working harder than I’ve seen people work in other places. There is an extra burden of stress on people here because things are always right on the razor’s edge. It’s clear to me, though, that for the majority of people I interact with in this system it’s not a job – it’s more of a purpose. They’re here to do good things for patients. I love this system because there is a general feeling of caring. Other places may have nicely appointed rooms and a great deal of resources, but here that kind of compassion is integral to the success of healthcare.  Related: Which country has the world's best healthcare system?  The NHS isn’t perfect. It has to change with the times. The IT system is cumbersome at best, behind the times and phenomenally frustrating. Occasionally this means that patients veer off course. There is no question in my mind that it needs to embrace new and innovative ways of caring for patients and generally be a bit more what I call “nimble for change”. We can’t just trundle along with our grandfathers’ NHS. Luckily for me, I work at a hospital where most of the people in charge feel the same way.  The weakness of private healthcare systems is that there are barriers to care, including geographic and social barriers that are largely manifest as ability to pay. I can’t believe that a system that limits care is socially just, or even ethical. Whether I’m justified in that belief is for society to judge. But for me, who took an oath to do no harm, systems that limit access to care break that oath because someone will not be getting treatment for their disease or not getting the care they need.  The NHS may have its problems, and there is no question it needs to continue to evolve and progress, but as a solution to society’s healthcare needs seems to me to work very well from a social justice point of view. Global statistics reflect that overall population quality of life seems to be better in countries in which healthcare is accessible to all. The boundaries to care that exist plentifully elsewhere don’t seem to exist here. The NHS may not be perfect, but it is a just system, which makes it worth my effort to improve.  Tara Mastracci is a consultant vascular surgeon at the Royal Free hospital, London
Canadian-born surgeon Dr Tara Mastracci explains how the NHS ethic lured her away from a top US hospital