Things that don’t mean optional
Earlier last week (before the story about the multiple rapist John Worboys being released from prison) the news was dominated by two stories, one about health and one about transport. The first was that the government had instructed British NHS hospitals to cancel ‘elective’ surgeries and outpatient appointments for the whole month of January in response to increased emergency demand, and there was much discussion about what that says about the government’s health policy and how important the NHS is to the government. The second was that rail fares were to go up well above inflation for the umpteenth consecutive new year. These were the focus of conversation on the morning radio talk shows I listen to when driving in the morning, such as BBC London’s early morning show and Vanessa Feltz’s phone-in after it, and the Today programme on Radio 4. In the case of the transport story, someone referred to off-peak fares as ‘leisure’ fares, as opposed to the peak-hour fares paid by commuters who travel before 9.30am. This tied in to something that stuck out about the coverage of ‘elective’ surgeries: it wasn’t stressed enough that these surgeries aren’t optional, even if they’re not urgent.
Put simply, an elective is any procedure which is scheduled and which a patient needs to consent to, as opposed to an urgent procedure such as is necessitated by a car accident or a sudden illness. Procedures such as mastectomies and tumour removals undergone by people with cancer are classed as ‘electives’; they do not have to be done right this second but they have to be done soon or the cancer may become inoperable or the tumour may do more damage if it’s in a location such as the spinal cord or brain, and some cancers are fast-growing. A couple of years ago I heard on a BBC call-in (on You and Yours if I remember rightly) that the caller’s mother had been scheduled to undergo an operation to remove a tumour and it was cancelled twice because her bed had been needed by people with flu; by the time she could get a bed, her tumour was inoperable. In another case, a young girl with a tumour on her pituitary gland had her treatment delayed for more than a year because her symptoms were assumed to be things less serious or to be psychosomatic; when the operation finally happened, it left the girl blind. The latter was not because of lack of beds or cancellations, admittedly, but it shows how important promptness is in the case of some ‘elective’ procedures. These are not facelifts and boob jobs.
I couldn’t listen to a lot of the discussion; it all came back to the government who bizarrely made out that this was a ‘normal’ action to take during winter. That strikes me as ridiculous; cancelling all electives (assuming they were using the term correctly and did not actually mean “operations that can wait”) is a sign that the NHS is under-resourced and that comes down to government funding. The Tories cannot have failed to notice that some NHS hospitals (like the one here in Kingston, the northern part of which is represented by Tory MP Zac Goldsmith) have whole units dedicated to scheduled day surgeries and to specific areas of medicine — are these teams going to be told to drop everything because someone might be admitted with the flu?
In the discussion about the massive fare increase, a presenter mentioned ‘leisure’ fares, meaning off-peak “walk-on” fares which do not involve a reservation. The fact that you can get a large reduction off your fare if you buy an advance ticket (which ties you to a particular seat on a particular train, and if you miss your train, you have to buy the walk-on ticket) is commonly used as an excuse to justify the high cost of “walk-on” fares, with the implication that the “smart” or “well-organised” traveller doesn’t need them but only those with more money than sense buy them. Quite apart from the fact that organisational difficulties are a common symptom of some cognitive impairments such as dementia, there are other reasons to need a walk-on fare besides being too lazy or disorganised to book ahead; you could have a relative in hospital in another city and been told they are unlikely to make it until the end of the week; if you book an advance ticket they will be dead before it is valid. Advance tickets are as likely to be used for leisure purposes as walk-on fares, if not more so; walk-on fares are for short-notice travel and this may well be the result of a family emergency. On top of this, not all routes are eligible for advance tickets, and when you need to travel there may not be a bookable seat, so if you have to visit your relative in a hospital a long distance away (a common experience for families of people in the mental health system, especially adolescents and those with learning disabilities), you may be stuck with one of these ‘leisure’ tickets, all the more so if they have just been admitted and crying out for their mum and/or dad.
So, these things do not mean optional or trivial. Elective surgeries are still matters of life and death and can’t always wait long. People’s journeys do still matter even if they’re not a morning commute. A group of patients whose needs can be put on the back burner; a group of travellers the rail operators can feel justified in milking for money. I am not suggesting one is equivalent to the other, but reporters assumed both were trivial and were not challenged.
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- On imposing medical treatment without consent
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