The Price of Compassion

On Saturday 17 November Public Matters took part in a workshop on the NHS for the Centre for Labour and Social Studies (CLASS) bootcamp. Also on the panel was James Skinner from Medact who talked about access to healthcare. He contrasted an entitlement-based service with a universal one. He discussed how Matt Hancock (Secretary of State for Health and Social Care) shifts the focus away from his own responsibility for systemic problems that drive poor health by emphasising lifestyle changes and individual responsibility as the main ‘cure’ for the NHS.  

James focused on the exclusions happening right now in the NHS at a local level and contrasted it with the action that needs to be done at national level to tackle the social determinants of health. He explained that the indirect benefit to society of all people being able to access good healthcare can only be done at a national level and it is not compatible with a privatised model of delivery.   

In November 2016 Deborah spoke at an event in Oxford called The Price of Compassion sharing a platform which included author AL Kennedy and Oxford GP Helen Salisbury who provides healthcare for asylum seekers held in detention at the Immigration Removal Centre Campsfield House 

With the increase in exclusions and charges for NHS care we think it is timely to reproduce Deborah’s speech from that evening first published by the NHA Party in December 2016.  

“I am part of the National Health Action Party’s campaign team. It’s rather a nice party to belong to. People love the NHS and will campaign to ‘save’ it so tend to look rather favourably on us. However, in truth their fight is often limited to their local services not the whole shebang. And pushed on the details of what we, as NHA, want to see, a rather less wholehearted support is sometimes in evidence. 

And it very much has to do with the price-tag people put on compassion. 

A few weeks ago the government announced that it would be introducing  ID checks for anyone wanting to use the NHS. Not only ID but proof of eligibility. For everybody. My colleague Jessica and I wrote a post on Facebook which started ‘your papers, please’. 

We did not get the support we are used to. Clearly touching on a raw nerve for many, we found ourselves subjected to a barrage of criticism, varying from the UKIP style of ‘it’s the National Health Service, not the International Health Service’ and ‘the NHS is being bankrupted by health tourists’ to the voice of the pragmatic modern practitioner saying ‘this is outdated nonsense, other health services charge foreigners and so do we and so should we’.  

And the loudest message repeated over and over was ‘I pay for it. If you contribute you can use it, if you don’t you have no right.’ 

I think that the founder of the NHS, Aneurin Bevan would have been unsurprised to know these arguments are still in vogue. He had to defend the NHS from just such allegations in 1952 when he wrote his book In Place of Fear. And he told his readers that the interests opposed to the NHS – political and financial – would not give up their attacks. He was right, but I think he would be cross to see how poor our defence of the principles have been. Too many defenders, in my opinion, have given up on arguing for principle and for the deeply compassionate ethos of our NHS and too ready to argue for it on grounds of utility and cost effectiveness. Even in defence of its values its low cost often trumps its founding compassionate ethos. 

Bevan wrote, “One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.” 

He went on – 

“How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody.” 

With the threat of ID cards and proof of eligibility, you can see how right he was in that assessment. 

“The whole agitation’ he said ‘has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, opponents of the NHS have tried to exploit the most disreputable emotions in this among many other attempts to discredit it.” 

So, I want to move on to tell you about something I witnessed at a major London hospital recently after a physiotherapy appointment. I was at the bus stop, waiting for my bus home, when two security guards came out of A&E pushing a wheelchair. In it was a man who looked semi-comatose. At the bus stop one security guard tipped the wheelchair, while the other helped the man out. He couldn’t stand. They laid him down on the ground and left him there. It was a cold, wet day. His shirt and jacket were twisted up and I could see his back. It was covered in what looked like fresh burns. I called out to the security guards. They replied that he didn’t need emergency treatment so had no business being there. He was ‘just a drunk’. 

There’s no good end to this story, I failed to do anything heroic about it, I’m not recounting it for that. I am telling you because I need you to know that that is what an NHS run on the financial ‘bottom line’ looks like, a business where targets mean more than people, not a service based on care and compassion. 

If your reaction is that ‘people like that are abusing the NHS’ or ‘I don’t want my taxes being used to pay for drunks’, ‘it’s his own fault’, or ‘what’s that got to do with saving my local hospital’ then my answer is ‘everything’.  

Because as my extracts from Bevan show, since the NHS was created it has been attacked by those who dislike it on principle using the same arguments over and over again. We have a growing population. We have an ageing population. People will keep demanding more if it’s free. If you let tourists use it the same as us then it’s not fair on those who pay. And during the baby boom years the ‘ageing population’ argument became a ‘too many babies’ argument. And they say that we will never, ever, be able to bear the cost. 

The NHS is nearly 70 years old. So are all those arguments. And they are no more true now than they ever were.  

I could rattle off statistics, percentages and billions of £s, but I am not going to take up your time. I will stick instead with this:  

The NHS is political, and all political parties over the last 30 years have allowed the arguments against the NHS to be heard louder and louder.  

Now we have to make sure we make our arguments loud and simple and strong in response. 

We want an NHS which is accessible. That means GPs and hospitals which provide acute care within easy reach of where we live. 

We want an NHS which is comprehensive. That means it doesn’t target people’s lifestyles and blame them for their illnesses. 

We want an NHS which is universal. And that means treating the street homeless drunk and the newly arrived migrant as well as those we think of as ‘deserving’, the ‘people like us’. 

We need to fight for these principles, which can only be delivered by a publicly owned and provided service. And we need to do it with as much ferocity as the attacks that have been made repeatedly since the NHS was created.  

Otherwise it won’t be just that drunk being turfed out on the street. It will be you and it will be me. Compassion which stops at borders, be they geographical, personal or perceptual, is no more than self-interest, the desire to keep what’s ours for ‘us’. 

Bevan’s ethos of the NHS, the proud conviction that human needs are elevated above cost, above price, is on the brink of being lost. I feel that as a society we will lose a lot more than health care with its passing. Societies need vision, they need moral values. They need compassion. If we reduce everything to ‘you get what you pay for’ then we may find that what you get isn’t worth the price we paid.” 

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