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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.