Rebecca Coulson is a freelance classical musician and writer, and was Parliamentary Candidate for the City of Durham at the 2015 General Election.
Maybe it’s the competition. Maybe it’s the physical release. Maybe it’s the elegance…I’m not sure why, but I really like tennis. Whilst I’d usually rather play than watch*, Wimbledon is hard to resist: ten million of us tuned in to the men’s final on Sunday.
Two years ago, my dad spent the summer in ITU. And I spent most of each day there (and in the waiting room), too – and sometimes all night, rereading his Evelyn Waugh paperbacks. It’s the modern acronym for what used to be Intensive Care, I assumed, until it turned out that my sister-in-law had worked in one a decade previously. Perhaps it’s to lessen the shock when they’re told where they are?
Nine beds – the tenth, a no-use planning fail – were in a squarish ring. A four-way central station housed a chunky column with a clock on each plane. These clocks neither matched one another, nor the electronic times on the addictively-watchable bedside monitors. Time had no constraint for the hundreds of thousands of pounds worth of that blokey word, kit.
The floor was grey, and less interesting than the pale segmented ceiling, which also wound around wire-filled pillars. The pillars supported the next level up – the one not explained on the elevator charts: the home of the generators, triffid-like, gently interfering with my kindly unseen phone. And there was a Control Suite somewhere – though maybe that’s where the managers hide. 6,800 fewer managers. 9,500 more doctors.
Postcode lottery. A&E waiting times. Cancer treatment waiting times. Keogh reports and Francis reviews. Top-down, management-speak, red-taped, ring-fenced, disaster zone. But, none of that – nothing, indeed anything – for the wonderful, awe-inspiring, greatest-place-on-Earth, please-Lord-need-I-never-go-back, power of the Intensive Therapy Unit. And it’s there all the time. It’s still there now, when I’m not any more – unless my solipsism has won. For the sickest nine people in town.
Anyway. During that time, Andy Murray won Wimbledon. And, as well as being great for Britain, this was momentous for my family, too. The nurses had thoughtfully hooked up a TV for Dad to try to watch the match, and Murray’s victory was one of the first new memories he managed to retain.
Every day, on the way through the hospital to see him, I passed by A&E. And, every day, it was booming: those infamous queues. But then, that day – Wimbledon final day – it was practically empty. Thirty-second waiting times, all the attention you wanted.
Now, I wonder if we can extrapolate something valuable from this – the Wimbledon Effect. Here are some rudimentary suggestions:
a) Some people go to A&E unnecessarily; when it’s inconvenient, they don’t. This doesn’t mean that they’re not ill – just that they’re not experiencing an emergency (the clue to A&E is in its name).
b) Distraction prevents some people from going to A&E, even when they need to. This can exacerbate their problems, which can increase waiting times, overall – not just at A&E, but in GP surgeries, and for 999 call-outs, too.
c) When there’s something big on TV, fewer people are out doing the things that sometimes see them end up in A&E. (The BBC should broadcast all major sporting events, regardless of cost – for the sake of the NHS.)
d) People don’t want to go to hospital at times when senior staff might be absent – whether it’s the weekend, a national celebration, or both (like the Andy Murray final).
You can draw your own conclusions. On initial reflection, however, I thought it pertinent that most of these relate to an ability to exercise choice. That sounded good to me; it seemed like a useful thought.
But then I spoke to a lefty medic friend, and he wasn’t having any of it: ‘That’s the problem with you Conservatives – you think people make rational decisions about this stuff! Most of them don’t know whether they need to go to the GP, A&E, or just stay in bed. They haven’t trained for years like the professionals they should be seeing. Personal responsibility isn’t the solution to everything, Rebecca! It’s like that argument we had about wanting to teach people to eat more healthily, when most of them are just fat because of their genes…’
Whilst I get what he’s saying, some people are fat because of bad choices. And some could make more sensible decisions about how they access healthcare. Just because patients don’t know as much as doctors, doesn’t mean that they are incapable of exercising any responsibility.
And we’re going to need much more of this. Because the unspoken truth is that the NHS can’t last as it is. If the sole issue were money, profligacy would have fixed it by now. It’s how the money is spent, how far it’s expected to stretch, and our relationship with this. We need to consider what we’re willing to contribute to protect the NHS – and our own health.
This is a hard question for politicians, whose popularity depends on simply loving the institution. We need to do more than just clarify what privatisation actually is. More than remind people that the NHS is still free at the point of delivery. More than explain why it’s much more important to have access to excellent care, than who provides it. We may also need to accept the inevitability of a partially insurance-based arrangement, in order to remove some forms of healthcare from the NHS budget.
Almost a quarter of Britons are in favour of introducing limited charging to counter NHS overspending. And we should remember that the p-word has been a quiet part of the scene ever since Bevan allowed the uncooperative GPs to remain in limbo as independent contractors. Not to mention the fully-escapist dentists and opticians.
If you agree that healthcare is one of the protections that the state must provide when we can’t do so ourselves, you won’t want to extend charging to emergency care. But how about the self-limiting ill? You know – those people with genuine, but sometimes chronic conditions, who don’t actually need medical intervention. Ok, nobody wants to say: you’re old, you’re allergic – pay for yourself! And, of course, the diagnosis – or at least the ruling out of potentially medically-curable illnesses – should remain within state-funded care. Maybe we could start with the worried well, and work our way out?
The modernity that accounts for the abundance of these sufferers might offer a solution to their expense. As soon as we cough, we obsess. Our hypochondriac denial fabricates a Rider Haggard world, in which we can live forever, no matter what. And – more seriously – last year’s Ashya King case exemplifies a growing desire to learn about, be in control of, and do anything for the best treatment available. This includes raising funds: pouring ice over each other’s heads, and sacrificing knees and hearts to killer marathons.
So, when almost half of us turn to the internet first to make decisions about our health, and 30 per cent share experiences with other patients via social media, what could be more on trend than pairing digital self-help communities (regardless of how beneficial these are) with the philanthropic crowdfunding phenomenon?
If we could free the NHS from the people who don’t need medical treatment, it wouldn’t just save money, it might also drive the search to find proper care for them. Pills aren’t always the answer, yet they’re often all a GP can offer. Unsurprisingly, the medicine prescribed for those who don’t need it is neither easy to test, nor cost effective.
Nobody is calling for a completely privatised – or changed – NHS. But we must think about what it can and should provide. We need to be more personally responsible about our healthcare – even if we can’t always be educated to know exactly what’s best for us. The sooner we admit that this kind of thinking won’t bring a plague on the NHS, the sooner we can exploit it as its cure.
(*The fun of playing was slightly wrecked for me by the general stress of being involved in this film. If you bother to watch it, the Cameron posters are in the association office, not in my house (as VICE try to imply). And certainly not in my bedroom (as some sweet Twitterers jeered).)