Thomas Paine

Thomas Paine
"These are the times that try men's souls. The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country; but he that stands by it now, deserves the love and thanks of man and woman."

Monday, 5 December 2011

O death, where is thy sting?

It might be thought that Cameron, given the many difficult and unresolved issues he is presently facing, would be eager to avoid any more contentious issues at the present time. However, this is not the case, he seems determined to press ahead with his plans to open up the NHS to private healthcare. This plan is contentious in itself, but it is likely to raise objections - even the most Thatcherite of Tories may bulk at sharing NHS records with drug companies.

It is a continuing source of wonder that the Coalition, never having been given a mandate from the electorate, is prepared to make so many structural changes to the nation's affairs and in the case of the NHS, one of great unpopularity. Earlier in the year, research showed that the vast majority do not support Cameron's plans to reform the NHS, with two thirds believing the Tories wish is for full privatisation - this is opposed by a ratio of 10 to 1!

Perhaps the most telling fact arising from the research is that very nearly two thirds, of those polled, believed that Cameron's primary motive is a desire to benefit business rather than patients - that is to say, his reforms are nothing less than a cynical attempt to reward those who back his Party - rather than concern for patient's wellbeing.

It does seem that, yet again, the root of the problem is that a political parties is not prepared to be honest with the people. The truth is that a nation, with huge debts and no real prospect of standards of living rising in the foreseeable future, cannot afford to provide the same level of health care, or other public services, as it could in more affluent times - in fact quite the reverse is true when our standards of living are falling.

This fear of honesty misjudges the stoicism of the people generally - particularly those having the lowest incomes. They are used to having to face the harsh realities of life, unlike the cosseted political class who are far more sensitive to minor losses of comfort. Providing that the cuts to NHS services are approached with intelligence and fairness, a people, knowing that savings must be made, will accept reductions - but not if any one group is clearly being advantaged at the expense of another.

Even before the current financial crisis, there were health services provided that were more questionably, the responsibility of the taxpayer to provide, than others. Perhaps foremost in this class were those services which were required to treat acts of self abuse. Included here might be illnesses that arise from obesity caused by the simple refusal to take sufficient exercise, illnesses related to smoking and drug taking along with the abuse of alcohol.

Provided that an informative public campaign had been undertaken to warn of the dangers of such behaviour, it is more difficult to justify asking the taxpayers to pay for any expensive treatment required as a result of ignoring this advice at a time when the level of service has to be reduced. Clearly the provision of, relatively inexpensive, pain killers is acceptable, but expensive procedures, unless there is unused capacity, cannot be justified if they deny the treatment of patients who have become ill through no fault of their own.

If the private sector is to be used, it can be used to provide health insurance to pay for additional treatments that are not provided by the NHS. Alternatively, the wealthier can pay for these treatments directly. By approaching the cuts required in the funding of the NHS in this way, an affordable service, free at the point of use, can be made available. Such an approach would be best made without making any significant changes to the 'commissioning procedure' as it is important to make single changes, and to find out their effect, before adding complexities that will distort the impact of the primary change.

Many issues that relate to healthcare impinge directly on our current view of death. In times of greater spirituality, when the general view was that some form of existence continued after death, this event was not kept so well hidden as it was not viewed with such dread. However, when so many of the population believe that nothing follows death - it is unsurprising that it is kept so far into the background. It is for this reason that our health service is used to extend the life of those who can and never will be able to have a meaningful life and are often condemned to continuing an empty existence more for the sake of their loved ones rather than for the benefit of those so stricken.

If the state has limited funds, and the current and continuing decline in the nation's wealth means that we cannot provide such a high level of state funded healthcare, surely the practice of extending those lives that, for all intent are over, has to be examined carefully - better this than denying treatment to those whose lives can be returned to a meaningful existence.

Viewing these sensitive and disagreeable subjects does go to the very heart of Cameron's justification for privatising at least parts of the NHS. When this subject is broached he often portrays the extra money supplied by corporations as a resource used to develop new drugs and treatments to that will continue to raise life expectancy - when the truth is, probably, that human life, free of life threatening diseases, has a natural active span that no amount of scientific research will be able to extend materially.

History tells us that many people in the past lived long lives, this was due to avoidance of life threatening diseases and work related activities that cut lives short. Now that many of these diseases can be cured and legislation has generally removed the threat to life in the workplace - there is little likelihood of average life spans increasing a great deal more.

It is Cameron's pretence that the scientific community will be able to extend life markedly that justifies many of his reasons for wishing to use private companies in the provision of NHS healthcare - and of course his justification for extending retirement age and increasing pension contributions in the public sector.

At a time when the global population has passed seven billion, when precious resources are increasingly difficult to find and, as a Nation, we are finding it difficult to provide jobs, homes and support for our existing population - should we really be making any further attempts to extend the current life expectancy?

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