Hahahaha. Can I just say, from the bottom of my heart? You deserve this.
Lets split the answer into parts.
It might not be well understood by laypeople, but health is more complex than just âgot a diseaseâ -> âgot betterâ / âdiedâ. The concept of health is multifactorial. Most experts will refer to the âbio psycho socialâ model of health. That is, your health, your quality of life, your ability to work and your average life expectancy, are all influenced by the different factors that make up your life. The bio (your genetics, sex, race, and age), the psychological (attitudes, behaviours, personality, copings skills, past trauma), and the social (family relationships, social support, environment, cultural norms, education). What evidence has shown us is that these different factors are almost equal in the effect they can have on a personâs health. In areas with poverty, they intersect to give a cumulative effect of mortality and illness that seems radically out of proportion to any diseases that exist in the area. (This is called The Glasgow Effect).
Take heart disease, one of the biggest killers in the UK. Genetic predisposition to heart disease exists, but itâs a minor factor in the scheme of things. Other important factors are exercise, nutrition, stress, and smoking status. The single biggest determinor for all of these factors isnât will power, or a âcan do attitudeâ or exposure to lifestyle gurus - itâs poverty. If youâre poor, youâre more likely grow up in a smoking household, with chronic baseline exposure to stress, so you often pick up smoking young. Eating well balanced nutritious meals requires (a) money (b) time to cook and (c) an education in nutrition, three things which single mothers working three jobs lack through no fault of their own. This means their children grow up without education in nutrition, and likely form lifelong eating habits that will be statistically incredibly difficult to shake. Exercise requires safe, well-lit areas where kids can run around, and preferably also areas where they can play sports or work towards fitness goals without having to put down a sum of money. This is near impossible to find in many big inner city areas. So now you have a generation of children growing up smoking, eating poor quality food, without the means to exercise, constantly marinading in stress and the low-grade constant trauma of being poor, and having everyone you love be poor, with all that that entails - dying young of preventable diseases, getting involved in the legal system, taking drugs because when youâre chronically miserable and have nothing to lose, drugs actually feel like a pretty good option.
And this is JUST HEART DISEASE. Want to talk about chronic pain? Which disproportionately affects those without strong social support networks and resilience borne of a life that is generally otherwise manageable? Want to talk about depression and anxiety? And how itâs near-impossible to function as a human being when youâve just had to lend your mum your rent money because debt collectors are at her door, and your big brother is in jail for a drug charge, and your dad is in hospital with lung cancer? These are the lives that the impoverished in Britain live, every day. And then they open the newspaper and see that the Tories have introduced a bedroom tax, which taxes them for that 'emptyâ bedroom thatâs actually their brotherâs (but heâs in jail waiting for a plea deal, and the waiting times are incredibly long, and thereâs no available barristers), or their dadâs disability benefits are being cut, because heâs a âscroungerâ - their dad, who, by the way, might have had his lung cancer picked up sooner if heâd had better access to his GP, and who might not have smoked a pack of cigarettes a day for forty years if he hadnât had such a terrible fucking life.
The only way to improve your situation, youâd think, would be to get an education, a degree, and then you can get a job that actually puts you above the breadline - but the Tories have just cut maintenance grants for the poorest students, and raised the tuition fees at universities, not to mention slashing trade apprenticeship positions, so like fuck is that going to happen. Hopefully by the time youâre having kids the world will be a better place, but hey, we just voted for the tories again, so maybe not!
If you work in a hospital, the phrase you hear approximately fifteen times a day is âthereâs no bedsâ. No matter what hospital you work at, there will be periods of the year when things just grind to a hault. For some hospitals that period is âevery day that ends in a Yâ.
The general flow of patients in a UK hospital is:
A&E ( should be no more than 4 hours from start to finish, but thatâs pretty aspirational. The first assessment is made, life-stabilising treatments are done, primary investigations are ordered)
Admissions Unit (patients can stay for around a day or two, decisions are made regarding the long term plan. Can they go home after a short course of antibiotics, or do they need to see a specialist doctor and go to their ward?)
Ward bed (a few days to ??? indefinite. Long term medical plans are made and acted upon. Any person who is too unwell to be at home by themselves basically lives here until theyâre better)
Discharge (you go home, or, if youâre too old and frail to look after yourself, you go to a care home or equivelent).
When things grind to a hault, thereâs no movement, fewer patients are getting discharged than are being admitted, thereâs no beds in the hospital wards left, so people start piling up at the front door. This is how you get photos of children sleeping on the floor with IV drips in their arms. I personally have sat on the floor to put IV drips into little old demented peopleâs arms more than once. If youâve never been in an A&E in a crunch situation like that, then you should count yourself very lucky. Itâs reminiscent of a war zone.
Of course, in settings like this, mistakes are made, things get missed. A common solution to bed crisises is to âboardâ patients - i.e. move them to a ward that isnât their own, limiting their access to specialist nurses and doctors whose main base is their own ward. This boarding process can happen overnight, and itâs not uncommon to literally lose patients in the process, and have to spend half a morning tracking them down. It delays discharges and increases the risk of hospital acquired infections.
But why is it happening, you ask? NHS funding is a huge part of it - the hospitals arenât big enough for the patient load, and district general hospitals are shut down without anyone accounting for where those extra patients are going to go. Another big cause is delayed discharges.
Imagine youâre an 89 year old lady. All your family lives in another country, you have nice neighbours that check in with you, but they canât be there all the time. You get forgetful sometimes, losing keys, and worrying about lost jewelry, but youâve not set your house on fire yet so no oneâs really noticed. (You should have had home help. Someone should have been coming in three times a day to get your meals organised and help you shower, but the government hasnât invested in the service and youâve slipped out of the system somehow. You donât know how to get things back in place and really, youâre perfectly alright just eating the odd slice of toast for dinner, youâre not too hungry, although your neighbour does say you look very thin). You trip over a corner of rug in your bungalow and break your hip. No one notices until your neighbours get concerned a day later, and the police break down your door, by which point youâre delirious with pain and have developed pneumonia, which has made itâs way into sepsis. You arrive in the A&E and some harried junior doctor sticks a needle in your arm and you donât understand why, and youâre in the middle of the corridor because a nurse says âthereâs no beds, sorry dearâ, and it doesnât matter how much you cry and scream, it feels like no one comes, and youâre all alone (they do come, but you donât remember, you really need someone to sit with you, but no one is free because thereâs 100 other people in this department and itâs only built to hold 50). Two weeks down the line, when youâve had your hip operation, and your pain is much better, and youâre getting about with a stick - youâre still much more confused than you were, bumbling around in your little flat, and you really just want to go home - some nice nurse or doctor or physiotherapist says âwe donât think youâre safe to go home, we think you need to go to sheltered housing, youâve not been eating, you mix things up, weâre worried about how youâd copeâ, and you donât really want to but your son agrees, when he phones from canada, and the doctors sem to know what theyâre talking about.
You wait three weeks for a bed, because sheltered accomodation is a premium, and thereâs literally not a single care home bed available in the surrounding 50 miles. To make matters worse, five of the people in the ward with you are also waiting for a care home placement. In that time, the A&E has backed up even more, because thereâs no movement in the hospital. This is because the government has no plan for the aging population of the UK, or the fragmented family life that has come with the 21st century. The system already in place is fractured, under immense strain, and the problem is only getting worse. The Tories think that the best way to deal with this is to make older people pay more money for the social care they receive, which in practice means having to sell the home they raised their children in, that they lived their entire married lives in. Even when theyâre 89 and the prospect of emptying and selling a family home is more than they can possibly cope with alone.Â
Now imagine youâre the harried junior doctor. You work ten twelve hour shifts in a row regularly. You stay late almost every night (sometimes by hours) because you canât do your routine work in the time you have, let alone deal with emergent problems (like a patient getting very sick) because your rota, which is supposed to have 10 people on it, only has 6 people on it, and they havenât filled the gaps. You get called in on your days off when other people call in sick, because thereâs no float, or cover. When you call in sick, you hear a pained, desperate silence on the other end of the line. You cry, regularly, in your car, in the A&E cupboard, in your room at night before grabbing six hours sleep and getting up to do it all over again the next day (which is a Saturday, all your other friends are going to a concert tonight). You cry because youâre exhausted, or because you made a mistake, or because the little old 89 year old who has absolutely no idea where she is reminds you of your granny. Youâre 23 years old, you make ÂŁ14 an hour, and you just held a womanâs hand while she died screaming.
You open the newspaper and see that the Torys want to make it a 24 hour/7 day NHS! That doctors nowadays arenât working hard enough, that they have to put in more weekend shifts, because the NHS shouldnât close at the weekends! (It doesnât). They rearrange the junior doctor contracts so that you take a pay cut, and have to work longer and less sociable hours (guess whoâs not going to be a bridesmaid at her best friendâs wedding, guess who hasnât seen their family for christmas dinner in five years). They make out that youâre greedy child for disagreeing with this policy.
You nearly fall asleep in your car on the way home from your fifth night shift in a row - you have an hour and a half commute in rush hour traffic between you and your bed. Your hospital has five beds available for night shift doctors during the day, even though at least 25 doctors work at night. You look down the barrel of a gun that is 10 more years of this treatment. You think about how youâd imagined your life being, and how it is. You think about how youâd like to take up a new hobby, or read a book, or see your mum. You think about the opportunities available to you abroad - half the work for double the pay. You think about how it feels to watch a 35 year old die of a disease that would have been spotted earlier had she been rich, educated, or able to advocate for herself in her busy, chronically underfunded GP surgery.
You think about how at least, at the end of the day, you have some amount of social power. Your salary will go up. You will become a consultant one day (ten years from now), and things will get better. You look at your nursing friends, whoâve had a pay freeze for the last seven years, in spite of the fact that the averge cost of living has sky rocketed. You look at the demands of their jobs, that have only gotten heavier and heavier over the years. You wonder what the fuck the incentive is there, and how, exactly, the Tory government is going to âkeepâ the 18500 nurses that are thought to be leaving the NHS in the next few years. You think âIâd never let my child become a nurse, or a doctor. Fuck that shit.â
4. Your snide little bit about private health care
Iâve been working for the past 4 months in a country with privatised health care. (Iâm coming back to the UK, I would never leave the NHS for good, but I needed a break so that I didnât lose my entire shit, and I wanted to travel). Private health care does not cost âas much as a mobile phone contractâ. Private health care warps the health systems around it like a corrosive acid. The system becomes about how best to âplease the clientsâ rather than deliver appropriate, evidence-based health care. Thereâs lots of discussion about how the fee to see a GP âdiscourages people who have nothing wrong with themâ and very little discussion about how, actually, rich people who have a minor cough are still very happy to see a GP, because whatâs $30 to them? On the other hand, poor people with weird back pain, weight loss, night sweats, and a general feeling of fatigue put it off because âitâs nothing, itâs not worth the moneyâ. (Their cancerous spinal metastases are often found too late to do anything about). Drugs cost money, so people who donât need medication take it, because the only barrier is money and not how appropriate it is. This isnât harmless, antibiotics have some of the highest rates of allergic reactions, which can be fatal in a small percentage of the population - if people with viral throat infections take antibiotics whenever they fancy it, thereâs a rise in side effects and in antibiotic resistance, without any kind of net benefit whatsoever. Meanwhile, the prices of drugs are artificially inflated by supply and demand economics and big pharma. People who do need medication donât take it because they canât afford it, and they die.
Private health care kills poor people, it is systemic class warfare and genocide and it is evil. The Toriesâ move to privatise the NHS will shut out health care for the poorest in the country, and - maybe even more importantly - shift the culture from one of evidence-based medicine in patientâs best interests, to a âgive them what they want, as long as they can payâ approach, which only degrades the quality of healthcare provided overall.
Too long; didnât fucking read:
Healthcare is a human right and this is the hill I will fucking die on. Healthcare is inextricably tied to political agendas, to the treatment of the poor and vulnerable. Health is one of the best social goods we can do; preventable disesase and death is one of the true great evils in the world. Donât come into my house and ask âhow does politics affect health careâ.
