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An echo of yesteryear

In the early 1940s, my dear departed mother had all of her teeth removed in a single sitting.  Even by the standards of today’s NHS dental service – which is a pale shadow of the comprehensive pre-Thatcher service – the reasons for this will be considered barbaric.  My mother had just one bad tooth (which today they would probably save).  What she – or rather her parents – did not have was the spare cash to pay for anaesthesia.  And so, rather than have to pay the huge cost of having a series of bad teeth extracted one at a time, it was considered cheaper to have them all out in one go and then be fitted with false teeth.

The story was all too common across Britain during the first half of the twentieth century, when private health services failed to keep pace with a big expansion in medical knowledge and practice.  Surgical treatments won the hard way on the battlefields of Flanders, for example, might have reversed injuries that routinely crippled men who worked in heavy manual industries like coal, steel and agriculture if only they could afford it.  Few could, although some private health providers took on charitable cases.

One result was that some communities and some groups of workers set up their own contributory insurance schemes to provide treatment to those unfortunate enough to succumb to injury or sickness.  It was one of these schemes, based in the South Wales town of Ebbw Vale, which provided the post-war Minister for housing and health with the model for the National Health Service – a rationalisation of the various insurance and charitable health services which had been found wanting in the emergency of war; and funded out of National Insurance contributions.

The flaw in the scheme – one which Aneurin Bevan, who was largely occupied by rebuilding the UK’s bomb-damaged housing, readily admitted – was that it was undemocratic.  “The democracy,” Bevan said, “will have to come later.”  It never did.  To this day the NHS is run by management boards appointed by civil servants on behalf of the government of the day.  And while – except for dentistry – the service remains free at the point of delivery, it is colonised by all of the usual neoliberal corporate welfare firms that overcharge for the services while underpaying the workers who deliver them.

National Insurance – the means by which the NHS was supposed to be funded – was long ago turned into just another revenue stream to be raided at will by the government of the day in the same way as private company directors raid company pension funds for personal gain.  Today, National Insurance is just another tax; and a pernicious one at that, since the employers’ contribution amounts to a tax on jobs.  Once the insurance principle is abandoned just about any other tax would be more sensible.

In the last few weeks, most people have been taken up with news about Covid-19; and particularly the UK’s high death rate – which is skewed by the large number of elderly residents of care homes who died without receiving medical treatment.  There is, though, another health crisis brewing; one that is an echo of the days before the NHS.  In those days, people – like my maternal grandparents – avoided medical services because of the cost.  Today, it is the entirely reasonable fear that clinicians who have not been issued with adequate protective equipment, and who have not been tested for SARS-Cov-2 will likely infect anyone who sets foot in a surgery, clinic or hospital department.  The consequences, though, are the same.  As Tom Gillespie at Sky News reported on Saturday:

“Health officials are worried many people are not seeking treatment because they fear contracting COVID-19, thereby jeopardising their survival and potentially becoming collateral damage to the virus…

“It is predicted there will be one million fewer visits to A&E this April compared to 2.1 million visits recorded over the same period last year.”

The same thing is happening to GP practices across the UK, despite most refusing face-to-face consultations with patients with Covid-19-type symptoms.  As Ann Robinson GP explained in the Guardian last week:

“Some doctors have expressed concern that A&E departments are almost too quiet and calm. And my GP surgery is somewhat similar: we’re busy with calls, emails and video consultations but almost all of them are Covid-related. And therein lies a question: where is everything else?

“Normally, I see around 30 patients in a day. This will be a mix of acute infections (respiratory, throat, ear and urine), mental health problems (anxiety, depression, stress), chronic conditions (diabetes, asthma, high blood pressure, arthritis), skin rashes, lumps and bumps. There will also be people with worrying new symptoms such as weakness, dizziness or bleeding from one orifice or another.”

Robinson explains that most of the people who visit a GP will get better on their own; although in many cases recovery will be quicker with medical support.  It is, though, the handful of patients in the early stages of something more serious which will become a problem later on:

“In a typical week, I would see at least a few people in this last category. Now I am worried that in the past three weeks, non-Covid-19 problems seem to have vanished.”

With so many people avoiding medical services because of the pandemic, treatment is likely to be more difficult – and a lot more expensive – later on.  Indeed, there is some evidence that people – even those with severe and immediate conditions – avoiding medical services is already having an impact on the UK’s death statistics.  As Private Eye’s MD column reports:

“Not only were there 6,000 more deaths in a single week than the average of the previous five years, but half of them weren’t linked to Covid-19.

“It could be that people are dying from Covid-19 but because we’re not testing and GPs aren’t seeing them before death, it isn’t certified as such.  Or it could be that people have been so frightened by the ‘stay at home and save lives’ message, and so fearful of catching Covid-19 in hospital, they’re not seeking emergency help for heart attacks, strokes, appendicitis, meningitis, sepsis, etc.  It may also be that cancellation of clinics and routine treatment have allowed stable conditions to deteriorate.”

If only Bevan had been given the time and the resources to democratise the NHS it might have all been different.  But the pandemic has revealed in the cruellest way possible the negative impact of decades of neoliberal privatisations and spending cuts – especially the austerity cuts of the last decade.  Frontline healthcare staff are dying for want of basic equipment even as thousands of older people die untreated in care homes.  Meanwhile tens of thousands of people who would ordinarily seek care from GPs and A&E departments are going untreated out of fear – not, as in the 1930s, of the financial cost, but rather the threat of an infection that better-resourced health systems have fared better with.

A privatised NHS would be different only to the extent that an over-paid American insurance firm would stand between us and the health services we need – either depriving us of services because we are not ill enough, or refusing them because they are too expensive.  It would, nevertheless, look very much the same – medical facilities populated by over-worked and under-paid employees standing almost empty while the poor and the unlucky die at home untreated.

As you made it to the end…

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