Putting the NHS on a pedestal
Last night, for the third Thursday night in a row, people came out of their front doors to clap in support of NHS workers and carers. For the first time, as far as I can tell, there have been rumblings of dissent: people have started to say that clapping really makes no difference when front-line NHS staff lack basic personal protective equipment (PPE) which the government should be providing but aren’t. The news this morning had a segment on volunteers making masks for NHS staff, which is wholly inappropriate; no mask made by someone who just took up sewing this week and does not have access to anything like the sort of material that would protect a nurse dealing with potentially infected people over a whole shift could be adequate (it might help protect someone on a trip to the supermarket). Various newspapers have had front pages portraying the NHS’s staff as ‘angels’ or similarly when, as has been pointed out, some of these same papers were quite recently calling for junior doctors to be sacked when they went on strike. The new Labour leader, Keir Starmer, has apparently called for them to be given medals. And there have been attempts to raise money charitably for the NHS through the donation of one MP’s bonus and the sale of some extremely amateurish artwork by a TV presenter.
I’ve written about this issue in the past in regard to social care and the welfare of people who are forced to live in institutional settings: these are tax-funded services and the key to resolving deficiencies in any of these areas is to change our tax-averse culture. When politicians run election campaigns off the back of a tax bribe to an important section of the middle class, they are undermining the NHS, social care and every other public service. Banks and other financial services have, for decades, openly advertised investment schemes which have as a major purpose tax avoidance, mostly for wealthy clients. It’s well-known that some of the wealthiest individuals associated with the UK spend much of their time in tax havens in the Caribbean and elsewhere so as not to have to pay much tax. Despite loud public disapproval, this has been allowed to continue for decades: supposedly any interference in people’s right to squirrel their money away anywhere they like would be a deterrent to enterprise. But the responsibility for this lies not just with the super-rich but with all of us: nobody likes to pay “too much” tax, politicians know it and always cater to it. Some councils even hold consultations with their residents about what they would be willing to pay more council tax for and the response is usually “nothing”.
Yet when columnists like Ian Birrell write about the abuse scandals — people trapped for months or years in completely unsuitable or abusive psychiatric institutions when they could be living in the community — they blame everything but the money, and this culture is something the Conservative party and its associated media have fostered over the last forty years. Only this week, when it was suggested that nurses deserve a pay rise for putting their lives at risk to treat people with COVID-19 or otherwise, this was rejected as politicising the outbreak. It was suggested that this year’s Comic Relief be held to benefit the NHS rather than the charities it usually supports; Comic Relief, as of 2015, had raised an amount just over £1bn, when Britain spends nearly 200 times that amount on healthcare in just one year (£197.4bn in 2017, for example). No amount of charitable fundraising could raise the sort of money a public health system needs to reliably treat everyone it needs to treat in normal times, let alone during a pandemic, and if penny-pinching were not the order of the day because people were not so stingy about paying their taxes, if people would rather a penny on income tax than one local NHS unit close after another until they find that they can’t get the specialist treatment they need for months if at all, we would not be in the situation we are in now. People prefer to moan than pay.
Finally we must remember that there are dangers to putting the NHS and its staff on a pedestal. It’s true that many staff have been putting their lives at risk to treat people, in large part due to the government’s incompetence at preparing for the scale of this disaster. But throughout its history there have been abuses and mistakes which have led to people being deprived of their liberty in the psychiatric system, left with permanent pain or injury, or killed, and they have not always owned up or supported families after such incidents, using public money to defend claims from patients or bereaved relatives when in some cases their staff were in the wrong. Just a few weeks ago the BBC’s File on 4 investigated failures by Great Ormond Street hospital, a renowned children’s hospital in London which attracts huge levels of charitable fundraising, both in the treatment of some of its child patients and then to investigate those failures afterwards. A few years ago I followed the struggle of Dr Sara Ryan to secure proper scrutiny and an inquest into the death of her son, Connor Sparrowhawk, who drowned as a result of a seizure while in the bath in an NHS unit in Oxford; the inquest ultimately found that neglect contributed although the senior clinician chiefly responsible for the state of that unit left the country before she could be held to account. Many of the abuses I have been aware of have been in privately-run units, but sometimes NHS clinicians make the decision to send patients there (as in the case of Claire Dyer). There is bureaucracy, bullying in which whistle-blowers are driven out and denied career advancement, and senior clinicians who interfere with people’s treatment because they are wedded to pet theories and overrule other doctors’ decisions. A case I am aware of involves a young lady with Ehlers-Danlos syndrome (EDS) who was denied a replacement for her feeding tube which had perished because of interference by psychiatrists. This situation has persisted for more than a year now; she is still unable to get adequate hydration. I’ve said I’ll clap for the NHS when this lady gets her tube.
In other cases where people have died at the hands of the state (prison officers or prison contract staff, the police, immigration service etc), the history has been of persistent failures to secure justice even though there was evidence of racism or a video of the assault. I believed at the time of Connor Sparrowhawk’s inquest that if the NHS was as politically in favour as the police, prison service or immigration service, some way would have been found to avoid a damning verdict. If the public space becomes full of propaganda that portrays the NHS as being staffed by angels rather than human beings, some of them arrogant and/or uncaring or corrupted by power, particularly at senior levels, it will become more and more difficult to achieve accountability for life-changing or fatal mistakes; in coroners’ courts there is already a tendency towards deference towards medical opinion and their scope is much too limited, but jurors will become more sympathetic to pleas about the difficulty of the job, and local media may well run stories sympathetic to them and critical of families. It absolutely must not become more difficult than it already is to seek redress for abuse, malpractice or injury in NHS care as it will be those already at most risk, those with chronic illnesses, learning disabilities, who suffer most and they and their families will be portrayed as ungrateful or bitter when they try to hold those responsible, some of them earning six-figure salaries leading to substantial pensions, to account.
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