The Real Problems With Health in Britain
Lord Truth 12th April 2006
Not a day goes by without more problems for Britains famous National Health Service.
The Blair government, knowing that healthcare and education are the things by which it stands or falls have been throwing money at these areas like an insane lottery winner.
Is it doing any good?
Since I am often called upon to explain aspects of British society to many foreigners I will attempt to throw some light on this problem but in doing so I will have to widen my examination to include areas that may not at first sight be related to it and that are seldom if ever properly touched as being too sensitive
The brutal reality about life in Britain is that, just as nothing in America can ever be examined properly except through the lens of race and racism,in Britain its even more true that nothing can be properly explained unless looked at through the the lens of class and classism.
The eternal power of this phenomenen bewilders foreign visitors who are generally amazed by Britains leading position in taking up and using high tec technology-who are 'with it' in ways far advanced from other countries -including the US-yet who still are the most culturally and socially screwed up people in the universe-despite claims to the contrary
In no area is this more true than the NHS.
The NHS was created in 1949 to provide universal health care in a country socially united by shared wartime experiences and united by a shared sense both of difficulty in post war Britain and a sense of exhilaration as well in that the enduring problems of poverty were at last being dealt with by the Labour government
In a hospital ward right up to the late sixties you might find,side by side a middle aged local 'aristocrat' an unemployed tramp,a bus conductor, an orchestra conductor ,a priest,a teenage biker and a factory worker.All together ,all getting ,and expecting the same warm quality of care
All this had begun to change in the early sixties however as Conservative governments drove a wedge through the system by introducing tax breaks for people usually professionals signing up for 'private 'non profit health insurance schemes. These gradually incresed their membership so that today virtually all professionals ,their families and indeed huge swathes of middle class people now have access to private care.
The differences in this care and NHS is connected mainly with speed of consultation and examination results etc though other factors are involved-its doubtful if the 'private patient would be put in a ward where -a frequent complaint-the toilets were filthy and urine wasnt cleaned up for a day etcetc
In many areas however - as specialists -who work in both areas like to say- the differences may well be only in the quality of the china that you drink your tea from
The unfortunate fact is however that this separation between private and NHS has accompanied other social changes that are even more important.
The first is the creation in the last thirty years of an even more stratified class divided society than ever before. It is one thing to grow up in a society where one is discriminated against and where ones ability to progress is hindered-its quite another thing to know that with every opportunity offered one is still somehow at the bottom of the pile and perhaps worse of all to know that with the various entertainments of modern life available ,its not unpleasant down there. This can produce a huge level however of bitterness and resentment producing in turn a huge level of social aggression .
When this is coupled with the consumer power of the mass market and the democratically empowering effect of mobile phone ownership for example, a level of social confidence is produced which is expressed in various aggressive ways-some unique to the British.One strange phenomenen for example in recent years has been - the obssession with speaking with a 'cockney 'accent.
It almost impossible to find any actor or entertainer -unless their 'style'is fixed as upper class -who speaks publicly in anything other than cockney. The sight of the very expensively private educated putting on phony working class accents -and not being laughed at or treated with contempt - is one of the most bizarre aspects of contemporary British life.Yet it represents a startling fact.That there is an assunption that the prosperous working class have now taken over the nation.
Now this may well be a reasonable thing except that of course with differences in wealth and education levels greater than ever before it is completely untrue.Once again we have a circular situation that produces even more resentment and latent aggression.
Before attempting to link all this to the NHS there is yet another area of peculiarity that is unique to Britain.
Until 1964 or so ,Britain was a nation characterised by deference and repect to age. Pubs were filled overwhelmingly with the middle aged and elderly-the young were not not really wanted there-at work the young were regarded as grossly inferior to the old and experienced on the factory floor and at higher levels as 'young whipper snappers' with prospects in the far distant future.
All this changed with the social revolution produced by the Beattles.Now it may seem absurd to suggest that a great nation can have its ethos changed permanently by something as insubstantial as pop music and a cult of youth but there is no doubt that that happened and prevails today. London is a remarkable youthful city full of young energetic on the go people, there is a sense of youthfullness about Britain that is tangible -its everywhere ,it has never stopped.Britain has been swinging now for forty years.
How then does all this impinge on the health service?
First with private healthcare schemes mopping up the traditional middle classes the overwhelming bulk of NHS patients are definably working class
Secondly with an aging population many of these patients are elderly.
With this situation several problems arise
If working class patients are clearly working class they will be accepted as naturally deserving NHS patients.
But many apparently working class patients are in fact 'genteel' people who do not have definable working class characteristics-they may not speak with a working class accent- they may not be fat -dont swear etc. Such elderly people are immediately classed -this being Britain - as 'stuck up ' snooty' 'think themselves better than other people'
In any case being elderly classes them as being 'out of the loop' totally irrelevant in modern Britain-unable to connect to the nurses conversational world of all night raves, interacial sex and soft drugs.As such they are at best neglected -at worst almost killed off.
Indeed other factors add to this unhealthy situation.In Britain many people live unhealthy lifestyles -they are overweight smoke and drink ,eat unhealthy food.In America because such people are (usually) privately insured they are treated with respect. In Britain with its free service there is a palpable sense that these people dont really deserve the best and -if they get diseased and die that is their fault.
An even worse situation faces the real middle class patient who can find themselves in a world that is almost a horrific nightmare. Endless stories abound , my own personally concerns a friend who had a cancer operation. The treatment was excellent but the condition of the ward was appalling,the toilets filthy and urine left uncleaned all day.
Recently an elderly lady I know whose husband is a private school teacher had a cateract operation on the NHS. Surprisingly it went wrong and the follow up treatment was negligent-protests were met with the repeated statements that it was a NHS hospital with the clearimplication that these ,middle calss people should have used private healthcare
It may be that I have painted a too gloomy picture . My cancer operated friend did have excellent medical care despite the filthy toilets, the cateract operation problem was dealt with again with excellent care at another NHS hospital-all this completely free-and I repeat -with an excellent level of medical care-no discrination there. And visits to the doctor are still completely free with prescription charges very modest and completely free for the over 65s and unemployed and disadvantaged.
The NHS is still in my mind ,a wonder of the world but its problems do need to be tackled and they are problems of ETHOS of spirit more than of funding
There should be no more regarding the genteel or well spoken or middleclass as aliens in the NHS environment nor should the elderly equally be regarded as irrelevances on their way to the death house.
The NHS is not just an adjunt of sink estates , an East Enders lifestyle or teenagers recovering from street violence or underage car accidents
I believe Blairs government recognises these problems and is doing something to address them but it could and must do more even though they involve dealing with that most sensitive and explosive area of British life :Class attitudes
Not a day goes by without more problems for Britains famous National Health Service.
The Blair government, knowing that healthcare and education are the things by which it stands or falls have been throwing money at these areas like an insane lottery winner.
Is it doing any good?
Since I am often called upon to explain aspects of British society to many foreigners I will attempt to throw some light on this problem but in doing so I will have to widen my examination to include areas that may not at first sight be related to it and that are seldom if ever properly touched as being too sensitive
The brutal reality about life in Britain is that, just as nothing in America can ever be examined properly except through the lens of race and racism,in Britain its even more true that nothing can be properly explained unless looked at through the the lens of class and classism.
The eternal power of this phenomenen bewilders foreign visitors who are generally amazed by Britains leading position in taking up and using high tec technology-who are 'with it' in ways far advanced from other countries -including the US-yet who still are the most culturally and socially screwed up people in the universe-despite claims to the contrary
In no area is this more true than the NHS.
The NHS was created in 1949 to provide universal health care in a country socially united by shared wartime experiences and united by a shared sense both of difficulty in post war Britain and a sense of exhilaration as well in that the enduring problems of poverty were at last being dealt with by the Labour government
In a hospital ward right up to the late sixties you might find,side by side a middle aged local 'aristocrat' an unemployed tramp,a bus conductor, an orchestra conductor ,a priest,a teenage biker and a factory worker.All together ,all getting ,and expecting the same warm quality of care
All this had begun to change in the early sixties however as Conservative governments drove a wedge through the system by introducing tax breaks for people usually professionals signing up for 'private 'non profit health insurance schemes. These gradually incresed their membership so that today virtually all professionals ,their families and indeed huge swathes of middle class people now have access to private care.
The differences in this care and NHS is connected mainly with speed of consultation and examination results etc though other factors are involved-its doubtful if the 'private patient would be put in a ward where -a frequent complaint-the toilets were filthy and urine wasnt cleaned up for a day etcetc
In many areas however - as specialists -who work in both areas like to say- the differences may well be only in the quality of the china that you drink your tea from
The unfortunate fact is however that this separation between private and NHS has accompanied other social changes that are even more important.
The first is the creation in the last thirty years of an even more stratified class divided society than ever before. It is one thing to grow up in a society where one is discriminated against and where ones ability to progress is hindered-its quite another thing to know that with every opportunity offered one is still somehow at the bottom of the pile and perhaps worse of all to know that with the various entertainments of modern life available ,its not unpleasant down there. This can produce a huge level however of bitterness and resentment producing in turn a huge level of social aggression .
When this is coupled with the consumer power of the mass market and the democratically empowering effect of mobile phone ownership for example, a level of social confidence is produced which is expressed in various aggressive ways-some unique to the British.One strange phenomenen for example in recent years has been - the obssession with speaking with a 'cockney 'accent.
It almost impossible to find any actor or entertainer -unless their 'style'is fixed as upper class -who speaks publicly in anything other than cockney. The sight of the very expensively private educated putting on phony working class accents -and not being laughed at or treated with contempt - is one of the most bizarre aspects of contemporary British life.Yet it represents a startling fact.That there is an assunption that the prosperous working class have now taken over the nation.
Now this may well be a reasonable thing except that of course with differences in wealth and education levels greater than ever before it is completely untrue.Once again we have a circular situation that produces even more resentment and latent aggression.
Before attempting to link all this to the NHS there is yet another area of peculiarity that is unique to Britain.
Until 1964 or so ,Britain was a nation characterised by deference and repect to age. Pubs were filled overwhelmingly with the middle aged and elderly-the young were not not really wanted there-at work the young were regarded as grossly inferior to the old and experienced on the factory floor and at higher levels as 'young whipper snappers' with prospects in the far distant future.
All this changed with the social revolution produced by the Beattles.Now it may seem absurd to suggest that a great nation can have its ethos changed permanently by something as insubstantial as pop music and a cult of youth but there is no doubt that that happened and prevails today. London is a remarkable youthful city full of young energetic on the go people, there is a sense of youthfullness about Britain that is tangible -its everywhere ,it has never stopped.Britain has been swinging now for forty years.
How then does all this impinge on the health service?
First with private healthcare schemes mopping up the traditional middle classes the overwhelming bulk of NHS patients are definably working class
Secondly with an aging population many of these patients are elderly.
With this situation several problems arise
If working class patients are clearly working class they will be accepted as naturally deserving NHS patients.
But many apparently working class patients are in fact 'genteel' people who do not have definable working class characteristics-they may not speak with a working class accent- they may not be fat -dont swear etc. Such elderly people are immediately classed -this being Britain - as 'stuck up ' snooty' 'think themselves better than other people'
In any case being elderly classes them as being 'out of the loop' totally irrelevant in modern Britain-unable to connect to the nurses conversational world of all night raves, interacial sex and soft drugs.As such they are at best neglected -at worst almost killed off.
Indeed other factors add to this unhealthy situation.In Britain many people live unhealthy lifestyles -they are overweight smoke and drink ,eat unhealthy food.In America because such people are (usually) privately insured they are treated with respect. In Britain with its free service there is a palpable sense that these people dont really deserve the best and -if they get diseased and die that is their fault.
An even worse situation faces the real middle class patient who can find themselves in a world that is almost a horrific nightmare. Endless stories abound , my own personally concerns a friend who had a cancer operation. The treatment was excellent but the condition of the ward was appalling,the toilets filthy and urine left uncleaned all day.
Recently an elderly lady I know whose husband is a private school teacher had a cateract operation on the NHS. Surprisingly it went wrong and the follow up treatment was negligent-protests were met with the repeated statements that it was a NHS hospital with the clearimplication that these ,middle calss people should have used private healthcare
It may be that I have painted a too gloomy picture . My cancer operated friend did have excellent medical care despite the filthy toilets, the cateract operation problem was dealt with again with excellent care at another NHS hospital-all this completely free-and I repeat -with an excellent level of medical care-no discrination there. And visits to the doctor are still completely free with prescription charges very modest and completely free for the over 65s and unemployed and disadvantaged.
The NHS is still in my mind ,a wonder of the world but its problems do need to be tackled and they are problems of ETHOS of spirit more than of funding
There should be no more regarding the genteel or well spoken or middleclass as aliens in the NHS environment nor should the elderly equally be regarded as irrelevances on their way to the death house.
The NHS is not just an adjunt of sink estates , an East Enders lifestyle or teenagers recovering from street violence or underage car accidents
I believe Blairs government recognises these problems and is doing something to address them but it could and must do more even though they involve dealing with that most sensitive and explosive area of British life :Class attitudes
posted by Lord Truth at 12:07 pm
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