Consciousness of Sheep
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In 2002, I was invited to the inaugural meeting of the Health and Wellbeing Council for Wales. At the meeting, two esteemed academics – Peter Townsend and Derek Wanless – presented papers on the future of health and social care in Wales. Their reports were stark. Wales had, for many decades, had some of the worst health outcomes in Europe. Rates of metabolic illnesses like type-2 diabetes and heart disease were high, life expectancy low. And Wales had a particular problem with “disability-free life expectancy” – with too many of its people succumbing to disability and long-term illness at a young age.
The broad point was this: without a concerted effort, led by the Welsh Government itself – to improve the general health of the Welsh population, then in twenty years’ time – i.e., in 2022 – it would no longer be possible to provide a comprehensive NHS free at the point of delivery. And so, the Health and Wellbeing Council was established in an attempt to secure participation from various “stakeholder groups” – local councils, NHS departments, trade unions and non-profits (I was running a mental health charity at the time).
There was a lot of goodwill for the initiative, as well as a new pot of money made available by then UK Chancellor Gordon Brown. But Wales more than any of the other nations of the UK faced the biggest political dilemma between meeting the immediate healthcare needs of the population versus setting aside resources to promote wellbeing in an attempt to lower healthcare needs in future. And predictably, since the future can never be quantified, the needs of the present won out. The pro-health promotion Health Minister was replaced with a medical hack… a former GP with all of the usual Big Pharma connections – which promised a hi-tech solution to our ills – and a desire to be judged on lowering immediate waiting lists rather than being concerned with the state of the NHS in 2022.
Life, as they say, is like a toilet roll – it goes faster the closer to the end you get. And those twenty years rolled around all too quickly. By the end of 2022, the Welsh NHS was in chaos due to staff shortages, lack of funding and unprecedented levels of demand. And while some of the problems can be blamed on lockdowns – which the Welsh government was more enthusiastic about than their colleagues in Westminster – the fact remains that many of these problems were evident in the years prior to the pandemic, with winter crises the norm.
It is in this light that we should treat the current Welsh Health Minister’s admonishment that:
“The public [must] take more responsibility for their own health [and that] if people did not change their behaviour, the NHS could have to offer fewer services.”
As good an example as you will ever find of someone pushing shut the rusted hinges of the barn door even as the sound of horses’ hooves is fading in the far distance. As it happened, the number of smokers in Wales was reduced dramatically and accidentally. Not as a product of investment health and wellbeing, but as an unexpected consequence of the ban on smoking indoors in public venues. Other initiatives like the exercise on prescription and mental health first aid programmes though, were underfunded and poorly managed. And in any case, taken together, government programmes were mere pinpricks compared to the sugar, alcohol, gambling and tobacco industries. Even if all of the funding released by Gordon Brown had gone into health promotion, the best we could have hoped for was to delay the collapse of NHS Wales by a few more years.
Nor is this an entirely local issue. The same pressures, exacerbated by years of lockdown, are impacting the English NHS too. Moreover, age-based and health-based rationing has been going on beneath the radar for years. Over a certain age, or with certain underlying conditions, people are routinely denied operations and other treatments. In the near future, we can expect such rationing to be more overt and far more widespread. As the Welsh Minister puts it:
“What I’ve asked the NHS to do next year is to focus on five or six priority areas and if they can do anything beyond that, that will be great.
“We need to understand that there is only so much money in the system and we’ll have priority areas that we’re going to have to focus on.
“And that will mean very, very difficult decisions for those health boards.”
I’m sorry Mrs Williams, your illness doesn’t meet our criteria, so please f**k off and die somewhere else… preferably not in the back of one of our ambulances.
My more perceptive readers will have already spotted that this sorry state of affairs is typical of the way in which we universally fail to deal with our problems, even when we have had ample forewarning. The twenty year warning given to NHS managers and Health Ministers in Wales being a relatively short time compared to the 50 year warning of the eventual collapse of the fiat currency system, the 70 year warning of oil depletion and more than a century of warnings of the environmental impact of industrial pollution.
In every case, dealing with immediate problems has always taken precedence. And in every case, the siren voices of monopoly interests have always been on hand to promise implausible hi-tech solutions to our future problems – economists assured us that they would find a way to “decouple” the financial from the real economy, energy companies promised hi-tech renewable energy substitutes for fossil fuels, and various technocrats promised implausible “green” methods for maintaining economic growth without the inevitable environmental degradation that goes with it.
Just as the Big Pharma pill that was meant to put in an appearance to save the Welsh NHS failed to arrive, so too, will those other promised hi-tech solutions be notable by their absence in the coming months and years, as crises which we have been putting off dealing with for decades are now coming home to roost. If we get through the next year without a systemic failure of the post-1971 fiat currency system, we will count ourselves lucky. But it is hard to see how we can continue for much longer, given that the two parts of the economy – the financial fiction and the material real world – never were decoupled. As the energy available to us shrinks with each passing year, a process of economic simplification becomes inevitable. And one way or another, this means that much of the financial “wealth” – in reality merely a claim on future energy – is going to evaporate. And of course, hanging over humanity like a Sword of Damocles is the environmental damage from 250 year of industrial growth… a catastrophe which, very soon, we will no longer have the wherewithal to address.
As you made it to the end…
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