Gratuitous photo of the Doctor. Thanks online forums galore!
With all the talk of doctors going on strike, practice ratings out of ten and Health Boards limiting patient services in the name of Essential Care Provision, the NHS is taking rather a lot of flack from the public and press. In apparent retribution for daring to take industrial action to protest against the pension plan payment reforms, the Public Conscience has been trying it’s level best to drum up all that it can against the National Health.
The issue all comes down to the perception of access, and what a National Health Service for all actually means in real terms. On the one hand, a core principle of the NHS is that it is a service accessible to all members of the public who are ordinarily resident in the UK, with some providing the same service to asylum seekers and other non-residents. With prescriptions now free for many, this means that any one who requires a certain healthcare service should be able to access and utilise that service free of charge within their local area. If a man needs a hip replacement, he can have one with full care before, and after, the operation. Should a lady want her cataracts seeing to, she can expect to see a fully-qualified opthalmic surgeon, receive the treatment and any further care without question or any outlay on her part.
Patients and their families can expect full care and engagement by health providers without any outlay on their part. This concept is important: no outlay on their part. The expectation is that all should have access to all without cost, charge, or any involvement of time and effort on the patient’s side. The reality of all professional relationships, however, does not follow such a pattern. The NHS cannot function as an entirely altruistic organisation: it has neither the financial, nor the human resouces, to provide such a level of care across the population. The NHS has a finite amount of provision designed to allow for what many believe should be infinite healthcare.
When politicians and healthcare professionals sound off about “resources” and “cuts” and all those other vague bon-mots alluding to this finite capability, we tend to switch off and dismiss it as not applicapable to ourselves. When we need to see a doctor or whoever else, when we need a hip operation, when we want a gastric bypass…we get it, right? And when we don’t get it, we feel short-changed, hard done by, and abandoned by the insitution we are led to believe we can fully rely upon to fulfil our needs. However, there is a difference between ‘need’ and ‘want’, and it is a distinction that the NHS has to fully enforce in order to remain the utalitarian organisation it so desperately tries to be. As a result, some procedures that may seem urgent to the individual who is living in discomfort, are not urgent to the Health Board that will be picking up the cost. The service may be so ‘not urgent’, in fact, that the Health Board in question has made the difficult decision to not provide it at all.
The rights of the individual to health care is a founding principle of the NHS, and an impossibility in practice. When asked if we want to be able to see a doctor we know at any point during the day, we will say ‘yes’, but we would also express disbelief if we ourselves were being told we should be onhand 24 hours a day, 7 days a week. We expect to be seen in a hospital clinic within days, perhaps even hours, of an initial diagnosis, but at the same time we would refuse to work an extra three hours a day, ever day. Yet, when an individual cannot get an appointment within 48 hours to see a doctor at their surgery, or is placed on a waiting list three weeks long, we somehow lose the ability to match our expectations for ourselves with the expectations we hold over these workers. In all areas of the public sector, the individual tends to forget that while these are services available to members of the public, they are also available to the public as a whole. Holding these unnatural expectations over capability and access leads only to a growth of resentment between providers and individuals. One need only look through the newspaper to be confronted with countless stories proclaiming the greed of doctors as they seek to safeguard their salaries, the danger of hospitals struggling to keep the renal ward clean, and the injustice of Mrs X from Upton-on-the-Sea, who deserves a gastric bypass but is too fat to qualify in her area.
Painted as greedy, dangerous, under-qualified, over-worked, work-shy, narcissistic, bureaucratic, and unsympathetic (to pick a few), it is a wonder that so many still choose to work in the NHS, never mind aspire to excel within it. And why do individuals continue to attend these terrible creatures, called doctors, if they are indeed so far out to get them? The press and public figures love to rail about the NHS and its ineptitudes, its inequalities and its failings. It is a sad fact that with a utilitarian and egalitarian approach to public health services comes the inability to accomodate everyone all the time. Would a doctor prefer to give their patients free and easy access to whatever service they needed as soon as they needed it? Of course they would. Would they like this to be extended to services as the patient wanted it? Probably not. Most healthcare professionals are resource conscious: if an alcoholic, obese man over the age of 50 needs a liver transplant, and a young girl with liver failure needs the same transplant, but the man has been waiting one day longer, who do you give the organ to? Many would argue that the second patient has the greater need and will derive the greater benefit. And yet that means that the first patient’s individual rigths are being suspended.
The restrictions health trusts place on what operations and services can be performed within a certain area or demographic are not borne out of spiteful cost-cutting. They are borne out of the trends of neccessity within that area and population, what doctors are available, what hospitals have beds, and which specialists run clinics. There are masses of reasons behind such decisions. Cost plays an important role, but it is not the sole defining factor. The press and the public needs to let go of the out-dated notion that the NHS is trying to prevent people from gaining access to healthcare, and remember that at the heart of this institution the people making these difficult decisions as to who gets what and when, are individuals too.
Talkin Bout Ma Generation
Brought up in the boom time of the 1990s and the excesses of a Labour government determined to spend its way to success, you would be forgive for thinking that young people have a distorted idea of personal entitlement and individual opportunity. Young people were told that their education would be a lower price, more widely accessible and provide them with the necessary tools to secure a highly paid and exciting job at the end of the day. We would never be homeless, we would be supported in our every endeavour, and we would not be left, abandoned and struggling to survive in our rich and noble democracy. In reality, there are so few jobs that a quarter of 16-25 year olds are unemployed. In reality, more and more young people are turning to drug abuse, violence and petty crime as a way to pass the time. In reality, thousands of young people are facing the reality of homelessness and lives defined not by wealth of opportunity, but by terrible poverty and abandonment.
Listening in shock and awe to David Cameron’s proposals for the new Conservative manifesto, I was struck by the deliberate targetting of the younger generations. The Prime Minister proposed taking housing benefit away from under-25 year olds and scrapping employment benefits for under-21s, citing a “culture of entitlement” that had led young people to believe they should be paid by the state to have many babies and live in a nice house in a good area without doing a day’s real work. These reforms would save the government hundreds of millions of pounds in welfare costs each year, should the cost of welfare remain static. When challenged on where these young people would go when they had lost tehir housing benefits, the Prime Minister glibly replied that they should just move back in with their parents until they could afford to move out permanently. The under 21s who would lose employment benefits should enter into training schemes or further education, or live with their parents and be supported by them. Not only would this put pressure on parents to encourage their children to go into employment and further education, but it may also keep young people at home and in school for longer. It would also remove all expectation that leaving home and starting a family you could not personally afford to support should be a viable option.
The reality, however, is not so rosy. Expecting people under the age of 25 to just move back into the parental nest creates pressure upon the individual and their family. Perhaps the individual’s parents are dead. Perhaps they had lived with a legal guardian or foster care organisation. Maybe they have a terrible relationship with their parents. And the parents themselves: what happens if they refuse? Perhaps they can’t afford to keep their child in adulthood; they may never have had a steady job themselves, or may even have become the latest casualty of the recession. Perhaps in the intervening time between the child leaving and then being forced to return, the parents have sold the family home and moved to a smaller one bedroom apartment, with no physical space available to keep another adult in. Hell, maybe they went to France to become onion farmers. Whatever the reason, the government cannto seriously expect under-25s who cannot afford to pay rent or a mortgage to automatically be able to move home.
It sounds great though, doesn’t it? Stop those 19 year old beenfit scroungers having babies to get more cash and put them back in the parental home to get a Proper Job. Justice will be done. Certainly, to many traditional Conservative supporters, such a proposal seems like a great idea. Teach the hoodies a lesson, make their feckless parents pay for their sins in not bringing them up properly. More money will then be freed up and made available to those who have worked hard and deserve the state’s support in their old age. Many of these young people don’t vote, and if they do it is often not for the Conservatives. The youth support base for the party is relatively small, and this overall apathy is often exploited in policy decisions, leaving young people to face the consequences of decisions on their future without any real appreciation of what the realities of that future are.
Blaming young people for unrealistic expectations will not solve our welfare issue. The welfare state in Britain is unsustainable, true. But the move to blame young people, and then leaving older generations to choose between “us and them” in the cut backs is not a solution. If David Cameron’s proposals ever see the light of day in the legislature, then thousands could be left homeless, creating a new and wholly more challenging issue for the government to struggle with. Young people will never leave their home town, struggling to find employment in skilled or unskilled jobs within a specific locality dictated by the location of their parents’ home. And, even if they do make enough money to afford rent, how then can they help themselves to move out when there is a housing shortage, rent rates soar above general inflation and no one is building new homes? Even if they were to commute from less expensive areas, with fuel prices also hitting the high notes it is practically pointless trying to save money this way.
Suzanne Moore at the Guardian has written a brilliant comment piece on the issue of turning generations against each other in the face of financial and social hardship. The government has momentarily forgotten that young people will soon be those leading the country. If they want it to be a pathway out of recession on a long term basis, then they need to be prepared to drop this outdated notion of Towerblock Tracey and actually face the realities of a highly ambitious, over-qualified and abandoned generation trying to face up to a life defined by an employment, housing and social crisis not of their making. Of course Cameron’s reforms would cut the deficit, but they would wreak such damage on the economic and social future of our country that any hope of sustainable recovery will be futile.
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