The Health Of Nations - Future Shocks - Part 4

Yes, another of these thorny issues that we have had under constant scrutiny in the media and government is that of healthcare provision. Whether it be the current Labour government seeking to make Messers Atlee and Bevan turn in their grave by the slow dismantling of the National Health Service the 1946 Labour Government established, or the Conservatives who would in their dreams do away with the NHS entirely and seek an insurance system to ensure that their supporters got the best provision available and those that didn't support them were slowly killed off, a sort of Tory political darwinism!

One way we can see that governments completely misunderstand what the public want has been graphically illustrated by Tony Blair responding to questions at the House of Commons liaison committee, (which is made up of the chairmen of all its select committees - rather like the Politburo!) Blair recognises that principle voter concern is that there has been systematic under-investment in public services spanning countless administrations, however he makes a serious misjudgement when he continues, "At the same time, the public is saying: 'If you put more money into these services, we want them to be more responsive to us as consumers'. We should respond to that as a government and do it fairly." This is not people's primary concern about public services, responsiveness and accountabilty are all very important but the most important is that public services provide functioning services and that these should be of the highest calibre only after they have suceeded in that endeavour does it become important for the behind the scenes operations to run smoothly. Blair thinks otherwise, his emphasis is made clear by the statement "The idea is to get to the situation where people see that the money we have put into public services is matched by change and reform," Again this is not the most critical thing in most people's lives. The fact that there is still a postcode lottery and their hospital does not have an A&E department or the specialists it needs will not be assauged for most people even if the Customer Complaints department is second to none. The same is true of services such as libraries, public transport and the like, it is no consolation if you have a shit bus service if the company running it is accountable and responsive.

Now I'll grant you what Blair may be referring to is responsiveness etc. to deal with the provision of a service etc. etc. at least I hope that's what he means beneath that mountain of spin, one can't really know for sure. But herein lies the problem, what the public want more than anything else is not to have to put up with the political bullshit anymore.

I have never quite understood why the focus for healthcare appears to be with far greater weighting on cure rather than prevention. For all the negative aspects of what people perceive as a nanny state one of the areas that could be most easily justified would be a strong attitude on prevention of disease and malaise. If we take the various notions of drug abuse as a prime example one has to be very careful to draw a line between an individual's right to choose how they live their life and the potential drain on the resources of healthcare that this person may be. This line is already drawn in society with the outlawing of certain narcotics and the licensing and taxation of others. At the moment though the individual's right to choose seems more like a euphemism for an abdication of responsibility by the state.

For example, in the case of smoking the government would stand to lose a substantial amount of money were they to genuinely wage war on smoking and treat smokers as proper drug addicts who need to be given rehabilitation. Thus they play a game of cat and mouse whereby tobacco is readily available whilst the areas in which it is permissable to smoke it are whittled down. This is simply unacceptable as it hands initiative to the freedom of choice lobby whilst not offering any defence as to the government acting in the population's best interests.

Rather like the pensions, education and energy issues we are told that there are tough choices to be made and yet it always seems outlined that there is no actual choice and it wouldn't be for us to make it if there were. Hospitals and their departments are still being closed and/or moved. Despite huge opposition there appears to be no way of halting the steady progress to foundation hospitals and an even greater postcode lottery than there is now. Foundation hospitals appear to be a way for governments again to avoid the big issue which is that all the NHS needs funding, not just the shiny fashionable parts of it. Whether or not this is intentionally the precursor to the privatisation of the NHS is not important because the end result is likely to be this anyway especially if after the end of this or the next Parliament the Tories were to get in. The Tories are only of the opinion that the NHS should remain free for as long as they feel they cannot get away with dismantling it. Ideologically they do not stand for free public utilities and therefore to make an exception for the NHS is nothing more than temporary political expediency.

What appears no longer to be en vogue is for every person in the country to have local access to all essential healthcare free at the point of use and this should encompass all everyday forms such as access to General Practice Doctors, Dentists, medicines, homecare for the elderly, paedeatric care for children and accident and emergency services. More specialist care should be provided within at least a regional level, it is perhaps optimistic initially to assume that every hospital in the country would have the specialist cardiac units and orthapedics and the like though this should without question be the goal of a state healthcare system. This is most certainly not the case at present. Access to good general practice is often sketchy with patients having to ring up at a particular time of day along with everyone else that wants to book an appointment with their doctor on that day, it is a first come first served basis there is no dispensation for the type of patient or the seriousness of the complaint. Dental care is so prohibitively expensive that it is impossible for most people to even consider all but the very basic of checkups. Prescription charges are such that I have on many occasions decided that I'll whether the storm of an infection or such like reather than pay £12.50 for 2 sets of tablets. How a parent on low income may cope if more than one child over age 16 comes down with something I don't know.

Again, though what I have just outlined as a 'blue sky' scenario is very much all tailored around a strategy of curing ills rather than stopping them occuring in the first place. Therefore these measures should be in place as a final safety net when all else fails and not an everyday occurance to mop up for the failures in other areas of general health and well-being. It is well known that poverty is a major cause of many very curable diseases, furthermore poor dental hygiene leads to many other problems and general malaise. If poverty is too great a cause for the government to tackle (though heaven knows if the government won't who's job is it?) then why not look at some of the other root causes of problems in order to try to stop them before they start. Smoking, obesity, TB, sexually transmitted diseases, heart disease, addiction-related illnesses and some forms of cancer are far better treated by addressing the causes than having to try to address the symptoms.

So why is this not being done? Tobacco companies make large amounts of money and cigarette sales account for a lot of tax revenue. Fast food companies are also creaming large profits at the expense of the taxpayer as the demands of modern life force people to concentrate less on good food and more on the time it takes for them to eat meals before getting back to work. Big business has a knack of being able to ensure they have enough lobbying pressure not to be legislated against so that sorts out why the first two remain a problem. STDs, heart disease and addiction-related illnesses all require effort to ensure that lifestyles are conducive to health rather than problems and this is clearly not being done. Furthermore the sort of screening programs and equipment that would be required to catch many of these diseases in their infacy are high-cost in the initial stages without yielding profit or often tangible results in the short-term. This is exactly why it is paramount that such things stay in public hands without the introduction of the nature of profit which cannnot have any positive bearing on increasing the likelihood of the prevention of disease.

If the nature of the prevention of disease is taken seriously and invested accordingly over time more and more of the budget will be available into medical and scientific research into diseases for which we currently have no cure. At the moment people are dying all over the world both developed and developing of diseases that are perfectly curable and indeed preventable if only the medication and environment existed to do so. Whilst this travesty persists we will be doomed to be fighting the battle from 3 steps behind and never even making it to the front line.