. Service or Disservice? | London Progressive Journal
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Service or Disservice?

Fri 5th Aug 2016

Back in 1969, astute British playwright Peter Nichols proved prescient with The National Health, his multi-award-winning satirical probe of the NHS. His technique involved interweaving fantasy musical-comedy numbers in a glam hospital ward with some brutal home truths of NHS underfunding and consequent deterioration.

Given the current obscene chaos stewarded by mainstream politicians, there's not much mirth these days. It will take more than some punny tweets to dip us further into despair - we who are all potential patients, and who all deserve the NHS promise of care from cradle to grave.

Safe in their hands? Uh-oh! Those appendages, apparently, have been chopped off at the wrists, leaving only a memory of feeling or compassion. We're fortunate indeed that what the politicos lack is generously supplied by medical practitioners at all levels - from senior consultants to cleaners.

One of the prime defining tenets of Britain's celebrated Greatness is the concept of healthcare free at the point of delivery, as and when required. As the Health Minister who ensured the creation of the NHS, Aneurin Bevan stated, "We now have the moral leadership of the world."

And, yes, it's a gift and exemplar to every nation, though most have chosen to ignore and even denigrate it. Care for the population, they reason, must be prioritised by ability to pay. Upfront.

Of course, the most conflicted country in respect of universal care is the US. Having arrived here to live at the age of 26 back in the late 1960s, I'd grown up in that society, which doled out stigma as well as tablets to those who could only afford blue-collar health treatment.

The social attitudes conflict became acute post-WWII. Before that, the very wealthy truly were an unknown quantity to most people. Even popular cinema could never reveal what privilege implied. But when the soldiers came home, their babies got dosed with free cod liver oil and orange juice, school kids were given free milk, and wounded veterans were entitled to free hospital care for life. I know - my dad was one.

Those who more recently have bowdlerised the term socialism as akin to child murder or incest, seem reluctant to acknowledge the enlightened social welfare policies of yesteryear. Now, with grandkids of their own, they're incapable of making connections between the erosion of those policies and the health and social welfare issues plaguing the poor. What's more, it's increasingly clear that when it comes to care - they don't!

Those of you who remember that era in the UK know how successive governments tried to ensure the health of the nation. Sadly, as in the US, our NHS has witnessed a continual dilution of its moral advantage, all with excuses measured in cash over care.

Unless you're very unfortunate as a young person, the majority sail through their early years in blooming health. Gradually, of course, time takes its toll, and visits to the GP and even the hospital pop up to complicate daily life.

It's this increase in medical-related requirements when the precious jewel in the nation's crown comes into its own. Still overwhelmingly valued by those who need it most, it's now regarded by the young with a growing resentment toward increasing budget demands.

Should there be a cash limit to caring for the nation? No! Should there be restrictions on long-term and ultimately wasteful schemes that address any and everything but people? Yes! When policy makers are all a-dither about how to reconcile the support of their electorate for the NHS with their anti-socialist convictions, their "proof" of shared concern for the health service is to spend on car-parks, on closing wards for efficiency, on outsourcing cleaning staff, and above all, on managers who confuse leadership with accountancy.

Heard about the scandal of Katrina Percy? She's Southern Health's NHS Trust CEO, who refuses to resign despite her awarding contracts worth millions of pounds to a succession of her mates without following procedures and failing to prevent budgets escalating to the tune of 2,000%. Guess who'll be footing that bill? Yep, the good ole' NHS - with our money!

Or what about Circle Health Ltd. so aptly named to run rings around public and private? In addition to its PFIs elsewhere in the UK, their galomphing hobnail boots have trampled through Cambridge's Hinchingbrooke Hospital, initially hailed in 2011 as the first privately run hospital. After years of accusations and counter-finger-pointing about waste, overspends, and mismanagement, last year Circle Holdings announced its withdrawal from its contract. There's plenty of detail online, but however you analyse the outrageous catalogue over some five years, nothing comforting emerges as protecting the essence of a National Health Service.

Nation Health Disservice, I'd say. Who are those twonks determined to diss our jewel in the crown?

Meet the Health Destroyers. Ultron has nothing on these guys. Check out those who pit cash-strapped youth against their parents and grand-parents, those pledged publicly or covertly to send the NHS to the morgue, or at the very least to cripple it to the wheelchair of privatisation. It's those political manipulators who take such generational dissatisfaction as an unspoken mandate to push NHS services to the dubious guardianship of hedge funds and similar profit-driven vested interests.

Safe hands? Unh-uh - computer sez no!

HEALTH CRIMES IN THE USA

In my own young adulthood, I first became aware of a change in US health policy when I was rushed to the emergency department of a Manhattan hospital with an acute abdominal infection. Till then, I'd been typically healthy. So as I waited in the emergency ante-room, doubled up in agony, I had no idea that the first question I'd be asked was whether I had private health insurance.

I was given a couple of pills and summarily dismissed. And promptly collapsed on the pavement actually blocking the entrance.

It's only because the doctor who'd referred me insisted I be admitted, that I found myself in a semi-private room being attended to by a bevy of nurses and specialists. But the first person I saw carried a clip-board, not a stethoscope. I was still near-delirious with pain, but the question was "How will you be paying for this?" "I don't know," I muttered before sinking into sleep.

Yes, of course, from a medical standpoint I was treated brilliantly. All but a few deficient doctors are like that and will put patients first. But there was a stigma undercurrent. And it's only got worse over the decades.

Just a few years later, when I'd re-located to England - almost unable to believe that socialist principles drove the NHS - I learned that from then on, Americans brought in to a hospital emergency ward could only be seen if they had the money to pay there and then. At the time it was a hundred dollars. I imagine it's far more today.

Stigma? Oh, yes. It's still true throughout the US, that the most reviled social crimes are to be ill, old, non-white, and poor.

So, as a point of contrast, here's a more recent personal anecdote. To compound the chronic cardiac condition my doctors and I have been trying to control, a few months ago, I suffered a stroke. Bleeding in my brain - which has always been my favourite organ.

Of course, I know a stroke is a serious matter. But when my stroke struck, I honestly didn't know it was happening. From the start, I viewed the whole thing as a tad absurd.

Looking back, I just had to laugh.

Here's the thing. A few days before the ambulance whisked me to hospital, I'd visited my GP because my face had swollen up with an infected gum. I was prescribed a course of antibiotics and strong painkillers. The latter really knocked me out. I was woozy as a boxer about to kiss the canvas.

The first weirdness I noticed was settling into bed. I sleep on my side and was about to close my eyes when I saw a very strange shape beside me. The room was pretty dark; I live alone, except for Bubble the Cat. But this didn't look at all cat-shaped. I've never experienced anything like that ever before. It truly felt as though something alien was lying next to me Then, within a milli-second I realised it was actually my arm. I could move it as normal. But whew! it was weird.

I later learned it was a condition called "Dead Arm." Which seemed pretty funny, and a bit zombie-esque. Admittedly, I have a strange sense of humour.

Next on the weirdness list was another fluke of perception. This one happened the next day, seated at my computer. At the time I was trying to meet my self-imposed deadline to finish my kindle autobiography [available at all good Amazon sites].

So there I was, frantically typing away. And, you should know, I'm normally a very fast typist; I barely glance at the keyboard. But I noticed on the monitor that I was making way more mistakes than usual. I mean, we all make a few, don't we? Then I saw the errors were mostly on the right side of the keyboard. Strange, I thought.

Yep, in my sweet little brain, I was trying to figure out what was wrong with the keyboard. NOT what was wrong in my brain. Or in my fingers. Aww!

Later that day a friend popped round, and I don't know what made me say it, but I told her I thought I was having a stroke. She thought I was joking. Then, when she realised I might be serious, she made me promise to ring the doctor. Which I did.

When I repeated my suspicion to the receptionist, it caused a mini-panic in the surgery. "Ring for an ambulance!" she said. Then another voice interrupted, "WE can ring for an ambulance!" she shouted even louder.

And they did. Within a few minutes, an ambulance arrived and delivered me to my local A&E. Now I am extremely fortunate on many counts. First of all, my local hospital was re-built over the past few years and boasts state-of-the art facilities that serve both NHS and private patients equally. And, as it happens, it has one of the finest Acute Stroke Units in the South East.

I'm relating this whole tale because I want to personalise my assessment of the NHS which has been so recently maligned, and to make some observations on the steady erosion of its reputation and function by the right-wing power elite.

THREATENING DOCTORS WITH LIES

It was during the time of my stroke that the then Secretary of State for Health, that Jeremy Euphemism plonker, was baiting the junior doctors, peddling Cameron and Co's lies about their terms and conditions and most especially promising a seven day NHS service. Despite reports in some less biased broadcast and print media, the public were beginning to doubt that they actually already enjoyed 24/7 Health Service.

In the increasingly rabid argy-bargy between government and union members, the populist press rarely reported that decades of under-funding were causing dedicated doctors, nurses, and ancillary workers to endanger their own health by covering extra shifts to put their patients first. The government line kept trying to make it a matter of greedy doctors. Specious reports appeared quoting misleading statistics about week-end hospital death rates. These were contrasted with alleged exposés of doctors playing golf while waiting times grew.

And there I was, in a state of the art ward, an NHS patient given a room of my own, with en suite bathroom, the most assiduous care around the clock, including doctors, both junior and senior, on call daily and over the week-end until I was discharged. I was given a battery of tests and treated at all times with care and courtesy and kindness.

Apart from just one thing, it was flawless. And I'll get to that in a moment. Before that, however, I want to take the wider view about funding. As usual, I'm not parroting any particular party policy. Instead it's time to question what care actually implies for all of us, young or old, rich or poor.

The starting point is a matter of civilization - social values which are beyond price. These must be the essentials for life we all share to survive and thrive on our planet home. Air. Water. Nutritious food. Shelter against the elements. Love and cuddles.

Some will say the list must include some concept of security, by which they usually mean a stockpile of weapons to deter or conquer whichever people are branded The Enemy. My fierce objection to that flawed argument is for another day.

Just now, I want to stress the priority of those civilisation necessities. However we choose to organise the structure of our lives, if those priorities are taken care of, I contend they will ensure the majority of our healthcare and welfare triumphs.

But if any of those requisites of life is devolved to barely accountable departments or companies, consortia, or individuals whose policies result in profits before people, then health and welfare have already been amputated limb by limb. That, imho, ceases to bear even a passing resemblance to civilisation.

Such a path is marked by signs which variously blame the destruction of the NHS on too many immigrants - whether desperate refugees or economic migrants who largely pay their way in society, and who staff so many hospital posts. Or divide and rule policies which foment different generational attitudes toward caring for others - caring for strangers as well as family.

This pre-Dickensian picture of our communities which relies on the fickle beneficence of the wealthy, has long been used as a weapon of social division, most especially since one Mrs 'No Society' Thatcher. All this begs the question of inward investment, but that will have to be for another day.

FEEDING TIME

And so, with all this food for NHS thought, here's some thought for NHS food. It's a fraught issue, but one of the most ignored areas of concern; concern both for those designing and implementing policy, and for those at their most vulnerable, whose need for nourishment is greatest.

Because the NHS has been almost imperceptibly transmuted from a service devoted to the health of the nation into a business model, its touchstones of success are in the paws of so-called managers who can figure out ways to centralise the supply of powdered soup, but have no concept of the economy and superior nutritional value of chucking fresh veg into a pot of boiling water, adding seasoning and a few herbs and assuring patients are being fed actual food.

Depite media-fuelled battles against the irrational "freedom" to feed junk to kids, and objections from councils to increase per capita meal spends, Jamie Oliver's campaign to feed schoolchildren effectively, placed health and welfare before budget minimums. It also showed the subsequent benefits to the nation down the line.

Why has feeding hospital patients become an excuse to cut corners? I've read feeble objections that try to turn away concern, citing how complicated it would be to cater for such a wide variety of medical conditions. Funny, though, innit, when we learn from a TV documentary that Prince William's family enjoyed the Michelin-style restaurant options in the maternity ward that brought George and Charlotte into their golden world.

No one is suggesting that NHS patients are offered such choices [though wouldn't that be nice!]. But even I - totally untrained in wholesale food ordering and preparation - even I can think of at least a half-dozen ways to cater for folk so ill they require hospitalisation. And still keep the costs down.

Indeed, even while I was enjoying the magnificent medical care during my recent stroke, I was shocked to learn that the ward had no kitchen facilities. They could only reconstitute powders to heat in a microwave. They couldn't even boil an egg. The ward probably spent more on printing menus each day than on providing anything resembling actual food.

Salad was pre-packaged with preservatives and shipped from a central supply depot. Poultry wasn't poultry, but chicken roll. Tasteless veg were fished from huge industrial-sized tins. The promised fruit was only available because one of the lovely cleaners found some in another part of the hospital, and only after I declared there was literally nothing I could or would eat.

Trolleys were brought to me. Cellophane-wrapped packets of spongey bread, little pats of butter, and powdered hot drinks already whitened with something that may have been a distant relative of a cow. I had told them I was diabetic, but if they served a hot drink it invariably came with two packets of sugar. White processed sugar. The kind every media outlet is screaming at us to avoid. Nothing, needless to say, was organic.

Now I've written many columns here and elsewhere about the benefits of organic food both for people and planet, but if there's one sector of society for whom the safest meals should be provided, surely it's those in hospital. Anyone with even a cursory knowledge of cell and organ repair knows that. The relationship between one's culinary intake and one's overall well-being is a recognised discipline. You can take courses in it!

Anyone, of course, who has an accountancy degree as their primary qualification for ordering all the food for all the in-patients is driven by how many brownie points they can score on the bottom line. Their palates, as they say on those cookery shows, are decidedly not well-developed. And if anyone requires an imagination transplant - those are the puppies right there!

This really has got to stop. Even some supermarkets, responding to Hugh Fearnley-Whittingstall's War on Waste, have been trialling offers of so-called ugly fruits and veg to school dinner ladies. Why not hospitals? Shops like Ikea sell space saving kitchen facilities that can fit in the area of a hospital cleaning cupboard. And speaking of cleaners, if they are to be the ones delivering bedside food and drink, they must receive training to offer only condition-appropriate items, they must assure that patients can actually reach the food, and they must alert medical staff if patients consistently cannot or will not eat.

Traditionally, prisoners weren't provided with any kind of food, and sometimes not even with water. It was either up to families or to good-hearted if unreliable rich people to attempt to bring or fling in food before people perished or were hanged. I'm guessing our Health Minister, so determined to undermine junior doctors, wishes their patients were similarly catered for.

THE PRICE OF PRIVACY

I wish I could shake off the nagging doubt that skipping along to Jeremy Hunt's long-standing tune of objection to the NHS itself, hospitals are preparing to privatise and/or outsource more and more of their services. It's not that long since his co-authored report of 2005 was published mooting exactly such goals. You can read the whole booklet online; I assure you it's based on extremely selective statistics and half-truths.

Hunt and colleagues refer not to privatisation - that would be too provocative. Instead they cite denationalisation. They want to swap National Insurance for private policies that rich people can parlay into stock market gains and investment takeovers. They cite US policies without mentioning such cover doesn't include maternity provision, mental health issues, or pre-existing chronic conditions.

For Patient Choice, read two-tier health care. For state monopoly targets, read management budget balancing. As for assuring residual universal health care for all, well that's means testing by any other name.

No wonder PM May was eager to keep Hunt in post. His Parliamentary voting record includes being in favour of the "bedroom tax" for social tenants; voting against raising welfare benefits in line with prices and against paying higher benefits to those unable to work because of illness or disability. He's been in favour of reducing welfare benefits, and for devolving to local councils all decisions about those in financial need while simultaneously reducing council allocation from central government. Catch 22, anyone?

May's recent pre-holiday announcement to scrap the £800m in bursaries for nurses was bound to get his support. The justification? No money, honey! Now, remind me - how many million equals the £200 billion approved for those Trident warheads that even the world's nuclear industry are calling outdated and redundant.

Service or disservice. You decide!
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