Equality and accountability
By Bart Day
Marketing professional and NHS patient
For the last 25 years (following a climbing accident), the NHS has put me back together and has looked after me with unwavering reliability. This is a long-term relationship that has been more meaningful to me than many I’ve had with those I class as friends. It has given me peace of mind and allowed me to raise my family in the knowledge that, should things not go according to plan, there’s someone who’ll help make it better.
But does something need to change for my children to be saying the same in another 75 years?
Looking forward : Prelude
I read headlines. I talk to others. I see the tales of waiting lists, the postponed operations, the delays, etc... However, everyone has an opinion, a conscious or unconscious bias, and so I only receive their truth. Waiting lists are longer than ever before, but the population is also larger than ever before and if the number of medical professionals has decreased, then perhaps they are all related? However, with improvements in care and more reliance on technology, do we need as many people? And… it’s a rabbit hole of inter-reliance that is way beyond my comprehension.
Leaving the above to those who are more capable, I find myself wondering what else can be done, and I come back to the concept of freedom of choice – whether it’s a one-dimensional notion, or three-dimensional one? Bear with me…
Free at the point of use… but with conditions
On the day you’re born, everyone has roughly the same odds of a healthy life. From that day onwards, we start to put ourselves into one of two NHS customer groups – those who have illness and infirmity thrust upon them through no fault of their own, and those who actively court illness and infirmity. Okay, it’s far more complicated than this and you can be in both groups at the same time, but for the sake of brevity, we’ll assume it’s one or the other.
I fall into the second group. I used to rock climb. I made that lifestyle choice. I loved the fresh air, the freedom, the adrenalin rush as you reach the top of a particularly challenging pitch, the look of terror in my friends’ faces, the helicopter ride, the anaesthetic, months of hospital food, and years of follow up appointments with a promise of an old age filled with mobility and joint issues. But it’s okay, I have freedom of choice, I pay my taxes and the HNS will pick up the pieces.
This is a one-dimensional notion of freedom.
My sister is a librarian. She’s hardly broken a bone in her whole life and only used the NHS for the birth of her sons. Is it fair that we pay the same percentage of our income to tax, or should I take accountability for my actions and lifestyle choices by admitting that my decisions increase the likelihood of me needing to use the NHS, and pay more?
Or looking at it another way, should we reconnect freedom of choice with equality and accountability.
What if there was a way of me paying more tax, depending on my likelihood of needing NHS resources that are considered over and above the average requirements of the general population? Conversely, if my lifestyle was such that I reduced the chances of requiring the NHS, I receive some form of kickback? A sort of loyalty scheme crossed with an insurance policy.
Don’t get me wrong, I firmly believe in a fair and free NHS at point of use for everyone. But that should go both ways and those using the service must play fair too, right? Or is this too George Orwell?
A less ‘Big Brother’ approach
My daughter is about to embark on a university course that will see her being taught how to coach the community to look after themselves. It focuses on improving the general community's participation in sporting activity – from new parent groups all the way through to octogenarian walking football – in order to improve their social, mental and physical wellbeing. The theory behind this is that, by spending a relatively conservative sum of money to get people moving, interacting and generally behaving like a ‘proper civilisation’, the NHS saves a far larger sum of money further down the line by not dealing with what would otherwise have been the results of a sedentary life of solitude.
Maybe if there were more focus on helping people make better lifestyle choices and if it were incentivised – carrot and/or stick – then this next 75 years might allow the NHS to focus its efforts more fairly on those who need it through having illness and infirmity thrust upon them, rather than on those who court illness and infirmity.
Looking forward : Epilogue
The NHS is awesome, but it must evolve its use model, while not losing the fundamental basics of what makes it so great – that it’s free at the point of use.
Maybe the NHS needs to give a little tough love to the UK population and explain that it will only be here in the years to come if we all take accountability for our actions and behave accordingly.
We live in a free country, but with that freedom comes equality and accountability.
Read Bart’s account of his orthopaedic journey previously published in the JTO here.