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The lucky generation


My understanding of the NHS became a little more real in 2013, and now, in 2014, with the vultures circling the NHS, it’s good to reflect on what I know now with a clarity that I didn’t have in 2012.

It started with a phone call from one of my siblings. They’d been diagnosed with a congenital disorder that probably killed one of my grandfathers, and possibly, by coincidence killed the other (they weren’t related – this isn’t one of those stories). Without surgery my sibling would have  a better than 50% chance of dying of this disorder within the next ten years, and a better than 90% chance of it being the primary cause of death before they were due. Surgery was the outcome – life saving, life changing surgery.

Ihad to be tested for the same disorder. There is a measurable coincidence of more than one family member having this disorder if one of them has it, and the general risk is much greater that men will have this disorder as compared to women. I am a lucky man – the test came back negative, and I don’t need the surgery.

I am lucky in one hundred ways too tedious to list, and several too personal to put on show, but today, knowing my sibling has returned to full health, I thank Beveridge, Bevan and Attlee and all the other stars of the socialist firmament for my grandfathers and grandmothers, working men and women who campaigned and organized for a national health service, so that never again should their children, like them, have to wonder if that ache or pain was worth the price of a visit to the doctors over the cost of food for clothes or books for the kids.

I am, irretrievably, a lucky man who lives in a time when conditions that slaughtered our grandparents before their time can now be detected, diagnosed and treated, with no thought on my part for the expense. The risk that I also have the condition is low, but I do not have to make that calculation – the NHS will care for me.

I am such a lucky man; in this case, where the worst that could happen within the bounds of probability was some inconvenient surgery, this has never been truer, and the fact that Jem and all the others who matter to me will share the conviction that the NHS is the greatest gift our forefathers gave to us is another blessing.

So when Lord Warner comes along and suggests we should all pay a £10 fee for being members of the NHS I ask myself some hard questions. Do I believe the NHS needs more funding? Yes. Do I object to paying extra taxes for the NHS? Ah, well…. Here’s the rub. Why is Lord Warner proposing a membership fee and not a tax rise? You might think it’s all just a slippery use of language to hide a tax rise from the general public. I understand that, but I think it’s slightly more complicated.

There are two reasons why politicians opt for taxes that aren’t taxes – the poll tax of the 1990s was originally called the community charge, for instance. The first is that they’re ashamed of introducing a new tax. That’s obvious, and clear. The second, more complex, is that they want to use pseudo-hypothecation to hide the regressive nature of the tax they are proposing.

Pseudo-hypothecation is the lie that the tax you pay funds a specific service. National Insurance for instance. National Insurance is a regressive tax introduced allegedly to fund pensions and benefits on a contributory basis, but which now makes sure that the poor and in work pay more in tax, as a proportion of their earnings, than the rich and feckless. Council tax? Leaving aside that the vast majority of council funding comes via the ruthlessly gerrymandered formula grant from central government, what does get paid in council tax bites hardest on the poor and in world, not the wealthy.

So it is with Lord Warner’s membership fee. First it would be introduced, then exemptions would be offered if you could prove you had private health insurance, or a private GP. Soon, only the poor and unlucky would pay it. Do you doubt me? Take a long hard look at the rise of contracting schemes and bonus schemes that enable the middle classes to minimize their national insurance contributions. Those tax dodges are available because government makes them possible, and winks at them.

I grew up in the lucky generation, for whom the health of the nation was a national priority, funded, if necessary, from taxation. The current government, dedicated as it is to letting the wealthy keep more of their wealth, doesn’t want to admit that if they keep shrinking the tax take, they will have to shrink the services that made us the lucky generation. Useful idiots like Lord Warner aid them in that mission, of making the poor pay so the rich can consume and accumulate without hindrance.


4 comments on “The lucky generation

  1. korhomme
    April 4, 2014

    I worked in the NHS for many years. I fully support the concept of “free at the point of service/need”.

    But, and this is what Lord Warner was trying to address, for many people “free” means that they think that any abuse will be tolerated. Some people make appointments, and don’t keep them, nor do they phone to say they aren’t coming. People get prescriptions for stuff that they don’t use. And so on.

    Lord Warner’s suggestion was a £10 fee for seeing a GP. His aim was to stop these sorts of abuses; I’m uncertain whether it would work, and the idea makes me unhappy.

    Many, many years ago I did extended locums for a couple of very well run GP practices. The GPs saw people immediately, did home visits promptly and were generally very caring towards their patients (sorry, we now call people ‘clients’.)

    But if any patient started to abuse them by requesting visits when none was necessary or whatever, they were warned; and a repeat ‘offence’ meant that they were put off the GPs’ lists. It was very effective; the GPs treated people well, the patients didn’t abuse the system. (Of course, as the GP has the right to put patients off the list, so the NHS has the right to assign patients to GP, usually for 3 months. If such patients continued to abuse the system, they got a new GP frequently.)

    One of the GP practices I worked for had, so I was told, another parallel method to sort out patients. There were several families of gypsies on the books. In the waiting room, they could be seen constantly scratching themselves. Those others with trivial complaints didn’t wait for the GP…Not that I’m recommending this, but it’s how things used to be. Perhaps.


    • jemima2013
      April 5, 2014

      obviously its Carters post not mine, but beyond the attack on universality which the 10 fee is, it seems to me that assuming all no shows are simply negligence isnt useful. Many of the people who need support the most have the most complex needs, also lead disorganised lives. They may fail to attend out of depression, addiction issues, failure of childcare, a whole host of reasons. Putting another barrier in their way will help no one.


  2. korhomme
    April 5, 2014

    I’m not going to disagree with you; but there are other perspectives. The £10 fee does go against all the principles of “free at the point of need”, but it can only have been considered because of a perceived problem.

    I should make it clear that my experience is in N Ireland, where the social services are integrated with health services; an entirely different situation from the rest of the UK. “Problem families” are in fact well known to GPs, who can then discuss with social workers.

    The people you describe above have multiple problems, indeed they are often described as “problem families”. And their problems aren’t always medical; they are social, particularly deprivation, poverty, lack of education and lack of opportunity.

    The concept of “mental bandwidth” has been recently introduced; it’s the idea that those with multiple problems, including poverty, use so much mental effort simply to stay alive, fed and heated, that they have no “energy” for anything else.

    Perhaps part of the problem is the “nuclear” family; there are no older relatives, such as granny, to advise the younger members about things. The newish mother has no “support”, and turns to the GP at the first suggestion of problems. A return to the “stem” families of yesteryear might obviate much of this. With the problems that the young have with housing etc, living with the parents/in-laws might well be necessary, if not seen as desirable in terms of independence.

    The “non-shows” are also caught in a sort of trap; it can take a week or more to get a non-emergency appointment with the GP; and after a week, the problem whatever it was, is likely to have resolved. Granny might have said that there’s no cause for alarm…

    So, you can go to A&E, and wait around for hours. But if you go on a Friday or Saturday night, tread carefully, like Agag, for there may well be the blotto unconscious on the floor, with their accompanying pools of puke; now, just how is this a medical emergency?

    I’m an outlier. I can count the number of private patients I treated on one mutilated hand. And I’m now a “client’ at my GP; I’m quite capable of checking my own BP, but this isn’t acceptable, and I have to go to be seen and get it “properly” checked by an expert, so that I get the pills for another six months. I can see both sides of the problems; but I don’t have any easy answers to the problems.


  3. cartertheblogger
    April 6, 2014

    One of the things I know with some certainty is that, as Jem describes, people with messy lives behave in messy ways that are resistant to systems. I also know that our increasingly atomized, dysfunctional society does not provide sufficient training and education in avoiding mess, and does not provide sufficient incentives for some of our neighbours to want to step out of mess and into a more organized life.
    If the NHS has problems with people who don’t behave in a way its systems can cope with, there are two solutions. One is the punitive approach you describe, of building obstacles to service use and excluding those who do not conform. That doesn’t address the problem – it merely segregates it.The other is to ask yourself why these issues arise, and address them. Warner’s approach actually won;t work, because there’s nothing in his proposal to change behaviours – it’s simpy a tax.


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This entry was posted on April 4, 2014 by in Uncategorized.

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