In the original description of the former NHS, In Place of Fear A Free Health Service 1952 Chapter 5, a reader would have been reassured by the “universal” nature of the health service. The equality in access to specialist services, surgery and other specialities.
So what am I afraid of?
Firstly the quality of emergency and out of hours services. Casualty department staff are overstretched and undervalued, and there is a shortage of applicants. This is partly due to the gender bias in medical recruitment, but also due to long term rationing of medical places. The most likely acute scenarios for me are a heart attack or a stroke. For the first a stent treatment is 90 minutes away. For the second there is no fully staffed stroke unit with psychologist etc. The Western Mail 19th Jan 2016 reports: Hospital emergency departments in Wales are ‘on the edge’, leading doctor admits
Secondly I am afraid of being excluded from choice. Some conditions are relatively rare, such as thyroid cancer, but I have no choice, and will have to be treated in my own Welsh Trust even if the treatment is only done once or twice a year by the specialist. This exclusion also applies to more common cancers, where advanced treatments, such as for prostate and breast, have been shunned by a government more keen on reducing inequalities than raising standards.
Thirdly, I am afraid there will not be capacity to look after me in my old age. The “cradle to grave” nature of the health services is only free at one end.. Bed blocking and families where all children have to work are actually in a worse place than those with under or unemployed, as they can often cope somehow. Saving for old age has not been done by most of us. What was National is now “post Coded”.
Fourthly, I am fearful of the structure of the UK, and particularly the Health Services. It has been a mistake to devolve Welsh health, and the figures will be out in the end. Deliberately different performance indicators will hide the situation for so long, until the WHO does it’s international comparators… I believe civil unrest could follow.. The public have been sold a pup: larger mutuals are better.
Fifthly, I am afraid for my profession, and for nursing and midwifery. The cynical approach to recruitment, and rationing of much needed places, brutalising the youth of the country where so many are disappointed, is responsible. Unethically recruiting doctors and even worse nurses, from other countries perpetuates the situation. Graduate entry to medical school would help correct the gender bias. It appears that politicians believe in nothing. NHS reality does.
Sixth, I am afraid for the politics in Wales, where a new hospital in my own area should have been started 7 years ago in a geographically central situation. Without the political will to see through “utilitarian” changes and to debate and explain why they are needed, we can end up with wrong decisions. Expanding Carmarthen Hospital is wrong. Carmarthen is only 30 miles from Swansea, (which needs a new Hospital) and has good transport links. We are 35 miles from Carmarthen on slow roads, and have 4 times the population in summer. We have had not had enough infrastructure invested. Good communications to West Wale and Ireland are paramount if rural areas are to have the same life expectancy as the cities.
Seventh. I am afraid that the word “duty” in Health policy does not arise. Patient rights and reparation are more important. Litigation results. No-fault compensation has been ignored as an option. The obesity tsunami coming slowly on us is a case in point. Deserts based rationing is one solution, but it has to be overt.
In summary – I am afraid of bringing back fear.