Sunday, 12 October 2014

What Have You Done For Me Lately - the NHS

What does social responsibility mean and how far-reaching does it need to be?

It’s 6pm. There’s not a cloud in the sky and the temperature is holding at a steady 76 degrees. This is bad. Very bad. In the distance, I can hear the prolonged hiss of a water hose. One of my neighbours is not water, but dousing his lawn. The D word is in the air more frequently now in Southern California or SoCal as only people on TV seem to call it. Drought. It strikes me as odd that the authorities aren't taking more definitive measures to curb excess use of water. Attitudes seem a little, well Californian, dude. Here in LA an alarming 40% of water usage goes on watering gardens. You gotta respect the defiant spirit of the Los Angelinos that, despite the fact that this city is built on desert land, they still expect it to be as luscious as the Hamptons.

I had a very interesting conversation with my mum the other day about the NHS. As is the case, often over breakfast, what starts out as quite pedestrian chatter often transforms into big, topical discussions about everything from theology to relationships, from  existential inquiry to why Strictly is better than the X Factor. Like I say, we deal with the big topics.

That morning, we were discussing the NHS and more specifically, the crippling deficit. As a loyal employee of the NHS for four decades, mum had a thing or two to say on the matter. Her observation was on waste. She said, for example, that in the old days, equipment would be sanitised and reused and that now everything was disposable. My thought immediately went to the plastic speculum they use for smear tests instead of those evil duck-billed torture devices. 

Mum also observed that in the early days, the hospital had a very small and transparent management team but that now, the system was crawling with them. She sees the introduction of the trusts as the beginning of this problem, fracturing the whole into many parts, with managers of departments, managers of managers and managers of manger’s managers.

Necessary or not, that’s a lot of salaries to find.  

The NHS, rather like the BBC is one of those institutions that has such an inconceivably large mass that it’s impossible, due to its sheer size, to run efficiently. I’d guess that probably 25% of money spent is wasted. That’s not to say that that’s where the deficit comes from but it certainly poses a challenge when trying to make economies.

I saw a news clip of George Osborne telling us that one of the strains put on the NHS is that we are all living longer. “But not healthier!”, I blurted at the TV. It prompted me to ask, do we have the right to expect all services to be free if, not only do we not have enough money to provide them but also aren’t making even a chink in the deficit? The NHS in its current form is going bankrupt. Now obviously no one will let that happen but clearly something needs to be done.

As me and my mum are natural born fixers, we started tossing ideas back and forth as to what the fix was. People who go into A and E with alcohol-related issues should pay for their treatment. We both agreed that, with 70% of peak time admissions to A and E being alcohol-related, we’d get that bill passed in the House but what else? I tabled the idea that perhaps, low level procedures may need to be paid for? But where do you draw that line so that one group or another doesn’t wind u getting penalised? Mum proposed some form of means testing but then we realised once again, there would be groups of people who straddled pay thresholds and would be screwed by the new Osho rulings. Also, the danger of making people pay is that you to give insurance companies too much power. Once a charge is levied for some procedures, it's a slippery slope until all services are billed.

I started to wonder if the problem was more basic than we’d first thought. We speak often about having the right to a free national health service and that evil people wearing blue rosettas are trying to take it away from us but we don’t often discuss the financials around  providing such a service for a growing population which may soon resemble a massive Cocoon live action role play.

The balance sheet doesn’t add up but what if the action that needs to be taken isn’t just about what the government, the politicians and the trust managers are doing, what if we too have a role to play. Beyond our tax contributions, what might our further responsibility be as the beneficiaries of this globally envied service? Well, it is simple. We need to start taking out own health seriously. This isn’t me being a hippy saying “guys listen yah, your body is a temple” and swigging bottles of homeopathic water, no this is about saying, OK, if you want a free health service, you’re going to have to work for it. You don’t get to live an unhealthy lifestyle and get a free health service. Perhaps we can no longer expect this overstretched and often taken for granted resource to pick up the pieces of a carefree, or maybe careless lifestyle.

When the NHS was initially conceived in 1948, they told everyone that though it was expensive it would gradually become cheaper because the nation would become healthier. In hindsight, that seems a little naïve. No pun intended but the service has become a crutch rather than a safety net and we don’t even know it. The cost of lifestyle-related illness is at an all-time high and will, unless we start to take our own wellbeing seriously, continue to grow.

We have a social responsibility to see to it that we do all we can to look after our health to preserve this service for when it’s really needed. At the moment, the system is stretched to breaking point because so many people take no responsibility for their wellbeing and simply expect the NHS to patch them back up so they can carry on as before.

This is no longer sustainable.

Type 2 diabetes, most commonly brought on by obesity, cost the NHS £9billion and will rise to £20 billion by 2035.

Over a million admissions a year are for alcohol-related issues and costs the NHS nearly £3billion.
NHS England has a budget of 108billion. The Foresight Report (2007) concluded that half the UK population could be obese by 2050 at a cost of £50bn per year.

And of course the cost of smoking to the NHS is nearly £3billlion. And whilst drinking and smoking bring in some tax income that doesn’t all filter directly into the NHS.

But look, I’m not saying shame on you for not stopping smoking or enjoying the occasional drink I’m just throwing out a different way to look at the problem we currently face. People often disempower themselves by speaking about this mysterious “they”, the government, police, teachers, schools, parents, who aren’t doing enough, who could and should do more but they always forget that they themselves are a “they” for someone else. We’re all “they”.

Perhaps it’s time to stop thinking about “them” and ask what can I do, what more can I bring to the table? Rather than having my hand out, what can I offer?

For a society to function, we must all tread a delicate line between maintaining our sense of free will and autonomy while taking care of our collective obligations. That is the only way a society succeeds. Without those two sides, it collapses. If we exhibit too much autonomy and opt out or flaunt the rules (i.e. become lawless) there’s anarchy, even as briefly as what flared up in the UK riots a while back. Equally if we go the other way, putting society above self, sacrificing personal need, the human spirit is crushed. We want to be able to do and have nice things too!

Perhaps the guy watering his garden was well within his rights but perhaps he could have the best of both worlds i.e. have a garden and conserve water. With the Landscape Incentive Program, the Department of Water and Power is offering homeowners $2 per square foot of grass removed. LADWP is also providing rebates for water-efficient landscape equipment installed. Now there’s an idea.

One of the problems with social responsibility is that we often worry we’re the only ones making sacrifices, that, while you’ve removed the verdant meadow from your front lawn and replaced it with boring cacti, your neighbour is creeping out in the middle of the night and draining the local reservoir just so his hydrangea stay in bloom. We have to put these thoughts aside. There will always be selfish pricks but does that mean we can’t do our part?

I think us Brits forget how good we’ve got it, sometimes. I’m spending a lot of time in the States, a country where a free health service is practically non-existent. Where 50% of all bankruptcies come from unpaid medical bills, where pharmaceutical companies and insurance firms have America by the balls. If the America dream is about happiness and wealth, then that is the American nightmare, its dark underbelly.

So in the UK, we should remind ourselves that no matter what its shortfalls, the NHS is magnificent and wholly worth looking after but living a reckless life is not the way to preserve it. If we want it to continue to be free, we need to start stepping up. It’s as simple as that.

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