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The NHS and a civilised society

Content note for fat shaming, discussion of food, and one brief mention of rape.

There is a common myth that before the foundation of the NHS there was no free or low-cost medical treatment available to the working classes. It’s an easy myth, and one which makes comparisons with the past simple and effective, it is however almost completely wrong. Many models existed from religious cottage hospitals to working mens schemes to provide health care. The most famous of all is probably the Tredegar Workmens Medical Aid Society, something my fellow blogger here is far more expert on than me. Out of a population of 28,000 over 24.000 were covered with universal healthcare, paid for by a weekly subscription, and those covered included the unemployed.

A certain Aunerin Bevan was born and raised in Tredegar, and knew what universality meant to the working classes of his home town.

Image result for nye bevan NHS quotes

The formation of the NHS was based on the experience of men and women like Bevan who knew how these systems worked. They were funded by subscription yes, but individuals who did not work, the unemployed, wives, children, were also covered. This was partially achieved by those on higher wages paying more in each week. This extension of coverage mattered, because they knew that unemployment or pregnancy, or a sick child impacted on every member of the family, not just the working head of the household.

I am reminded here of a family story. One a  union man like Bevan would recognise, since very often unemployment was the result of fighting for better working conditions for others. This was the situation for my great-grandfather, who lost house and job in one morning after speaking to his workmates about forming a union. Several years later my grandmother remembers sitting with her mother in front of the local ladies who doled out assistance to the poor of the parish. With a dismissal the modern tory party would recognise (as they cut benefits to families judged to be too fecund) my great-grandmother was told if she didn’t want to be poor she should have had fewer children.

There will always be a reason to judge the poor as undeserving

Fuck too much, drink too much, smoke too much, eat too much, be too much, exist in a way that your betters do, but is not seen as acceptable to them, and you will be judged, dismissed as unworthy of support.

Bevan knew what universality meant, he knew that those with power would always seek to withhold support from those they deemed to be undeserving, and he knew that it would be the working classes who failed to reach the required, arbitrary standard.

The announcement today that an NHS trust plans to ration healthcare according to the behaviour of patients should make your blood run cold. It is those ladies who dismissed my great-grandmother rising up from their graves and determining who deserves to live. It is contrary to the universality which is the very point of the NHS.

The Vale of York clinical commissioning group will make people wait for up to a year for treatment for non-life-threatening conditions such as hip and knee replacements if their body mass index is 30 or higher.

The group said it had taken the decision because it was the “best way of achieving maximum value from the limited resources available”

The relationship between diet, health, weight and class is a complex one. Carter wrote brilliantly here about how comfort eating and gender is a much overlooked area. For every Jack Monroe there are 1000s  (mainly women) struggling to simply get through the day and feed themselves and their families. They grew up when school kitchens were closed, food tech removed from the curriculum. They live in food deserts where finding a vegetable takes more energy than middle class yummy mummies visiting their local farmers market, the great grand daughters of the grandees who dismissed a woman for over breeding, will ever understand.

Another story, to explain to those who cannot comprehend why an occardo delivery is not in reach of all. When my eldest was a baby they were weaned on home-made food. This caused consternation to their grandparents, who turned up each week with jars of Heinz babyfood, concerned they were not getting a proper diet. “Look” they would assert “This is chicken casserole, all properly prepared for a 4 month old” So convinced were they that science had determined small glass jars were the only way to provide food for babies they refused to even use the pureed vegetables I had prepared. In order to do what a good parent is “supposed” to namely feed my baby a healthy diet of homemade food,as recommended by the state, I had to overcome a number of barriers

  1. Ignore the judgement of older relatives and others who believed packaged food is healthier
  2. Have the confidence to be different to all the other mothers, and resist step 1.
  3. Be able to get to somewhere which sold fresh vegetables (luckily I lived near a market)
  4. Be able to afford fresh fruit and vegetables
  5. Have a freezer (unless you intend to puree one carrot each meal, pretty vital)
  6. Have the energy to prepare the homemade option
  7. Have the time to prepare the homemade option
  8. Have a cooker or microwave
  9. Have a level of literacy to understand instructions not to add salt
  10. Have the literacy to follow basic recipes once the baby is over 6 months.

10 steps, just to follow whats assumed to be the “best” way to wean a baby. Any of the steps can go wrong at any time. For example, one Sunday we discovered that the electricity had gone off in the night, and the small freezer had defrosted

11. Be able to afford the electricity in the meter for the freezer, fridge and cooker/microwave

So, another option was needed. The local corner shop had frozen meals, pizzas, chips but no fresh, or frozen vegetables. The only supermarket within walking distance, whilst pushing a pram, was a Farmfoods, the most misnamed supermarket ever.Whilst the middle classes may have discovered Aldi with the enthusiasm of Mark Ruffallo discovering the transgender experience, they will never be raving over Farmfoods. If you have never had the pleasure imagine a down market Iceland, yes, I said down-market.

Eventually I returned with a bag of frozen spinach, reasoning that potato and spinach was the basis of sag aloo, and so a meal could be made for both adults and baby that evening.

If you cannot still understand why obesity is very often a class issue go back and read this again.

I am not even going to get into fat positivity, the fact the BMI is a rubbish measure, or that fat people can be healthy people. When the NHS refuses treatment on grounds of weight, it removes universality, and as Bevan knew, that removal will target the poorest first.

We are told there should be a “national debate” about the NHS, how it is funded, and what care is provides. This debate would not take place in a vacuum however. We have been fed a diet (excuse the pun) of hate for over 10 years. Hate towards the disabled, hate towards the poor, hate towards those on benefits. No one discusses why whole areas exist without shops, why people are too exhausted, depressed, or poor to eat differently, more acceptably. Even foodbanks, a heresy which should not exist in a civilised country, do not provide the kind of food which would meet middle class approval, instead they offer carb heavy options, to fill hungry tummies, because hunger is not some fun fad diet for a week, but the life of too many in our society.

Another anecdote, because people need to stop seeing “them” the great unwashed, the undeserving poor, and start understanding that them, is actually us, as Bevan did.

As some of you know I was raped by a client last year. In the aftermath, as I attempted to finish college, be a parent, partner, and cling on, with varying success to my mental health, I also had to face having various health checks. These included HiV tests, and the decision whether or not to take PEP.

Given that my treatment was the result of my “lifestyle” choice to be a sex worker am I deserving or undeserving? Where do we draw the line around lifestyle? Who do we determine is worthy of medical treatment?

We need to draw a different line, one around the universality of medical provision, one which says the NHS is for all, one which does not turn people away because the great and the good look down upon the working classes, and their supposed choices, which are actually a response to living in a society which is forgetting what it means to be civilised.

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One comment on “The NHS and a civilised society

  1. Pingback: Compassion, obesity, the NHS and “bad choices” | Valery North – Writer

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This entry was posted on September 3, 2016 by in Uncategorized and tagged , , , , , .

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