NHS is not a four letter word – by Olly Double
Because of the Olympics, people are thinking back to the last time we had them here in the UK, back in 1948. What I’ve not heard much talk of is the much more significant achievement of 1948 – the foundation of the NHS. Britain was stony broke and still getting back on its feet after the worst war the world had ever seen, and yet the Attlee government pulled off setting up this extraordinary institution which made quality healthcare available to all regardless of their ability to pay. Nowadays when we have an economic crisis they talk about cutting back on public services. In those days, they actually set one up from scratch. The man in charge was Nye Bevan, who makes today’s politicians look like the vacuous, cowardly, self-interested timeservers that most of them really are.
I took my sons Joe and Tom to their diabetes clinic in London last week. As usual, the care we received was exceptionally good. Their specialist is a fantastic doctor, a man who treats children and teenagers as his equals, in spite of his formidable expertise. He asked Joe and Tom how they were getting on, and took a genuine interest in what they had to say, whether it was directly about diabetes or not. The conversation is so casual and jokey, you sometimes forget it’s a medical appointment – and yet since moving to this clinic, the control of the boys’ blood sugars has improved enormously. They spend much less of their time with their glucose too low or high, and their HbA1Cs have fallen significantly, thus improving their chances of avoiding long term complications.
The week before, I was in Orlando, Florida, for Friends for Life, a conference for individuals and families affected by type 1 diabetes. It’s a lovely event – I’ve previously blogged about the one they run every year in Windsor. While I was there I found myself seeing a lot of coverage of President Obama’s health care bill on various news programmes. The newsreaders refer to it as ‘Obamacare’, and its opponents were trying to turn this into a big, scary word so as to persuade people to hate and fear it without thinking. ‘Tidy your rooms kids, or the Obamacare will crawl out from under your bed and bite your toes off!’ Amazing to think that people can get so angry about something with the word ‘care’ in it. I’ve never thought of ‘care’ as a four letter word.
Obama’s bill is far, far less radical than the NHS and will offer Americans nothing like what we enjoy, and yet it still apparently has the power to send many apparently ordinary people scurrying for a piece of carpet to chew on. I’ve spoken to people at Friends for Life who can’t say the words ‘socialised medicine’ without scowling, and see a National Health Service as the nearest thing to parading across Red Square holding a giant banner with a picture of Comrade Stalin on it.
What they seem to fear is that an NHS would mean having no choice over your healthcare, and just having to passively accept the care your government-appointed doctor gives you. And yet the funny thing is that when I hear Americans talking about fights they’ve had with their health insurance company over getting the insulin pumps or blood glucose monitor they want for their kids, it reminds me so much of fights people in the UK have had with their doctor or primary care trust – or indeed the fight we had to get Joe and Tom moved to a clinic which would put them onto the insulin pumps that have done so much to improve the control of their condition. (Hopefully the new Paediatric Diabetes Tariff will help with this kind of thing, but if not we used NHS Choices to be referred to another clinic.)
The big difference is that even with health insurance, Americans have to pay for a lot of their diabetes care. Even though their insurers will cough up for some of it, they will still find themselves having to shell out a lot of money on equipment and supplies. As if diabetes wasn’t enough of a pain in the tender spot already, in the American healthcare system you also have to pay for the privilege of having it. How difficult must that be for families on a low income? What if you can’t even afford health insurance?
I can imagine that for anybody who’s less than 100% financially comfortable, the cost of diabetes care would change your relationship with the condition. For example, research has found that the more regularly you test your blood sugars, the more likely you are to have good blood glucose control. Pricking your finger to check your blood isn’t exactly something you’d do for fun in the first place, but imagine how much less fun it would be if each strip you used was costing you money. And how much more annoying would it be when you get a duff strip that gives you nothing more than an error message on your blood glucose meter? Surely, paying for your strips is a subtle disincentive to test?
Then there’s the question of getting health insurance in the first place. What about the young adult with diabetes who’s going off to college? As well as coping with having to manage your condition all by yourself and adjust to your new life away from home, you’ve got to get insurance sorted out so you can pay for the care that you need to keep you healthy. One great thing about Obama’s bill is that it will allow young adults to stay on the parents’ health insurance until they are 26. That’s a detail that more than one parent I talked to at the Florida conference was extremely grateful for.
Now I know the NHS isn’t perfect, and I’m aware that not everybody gets the kind of excellent diabetes care that Joe and Tom benefit from. But if we want to make it as good as it can be there are things we can do. For a start, we can make sure we don’t vote for anybody who’s looking to cut it back or undermine it in any way that would take it back towards a private healthcare system. We can also support organisations like Diabetes UK, which campaign for better care for people affected by the condition. On an individual level, we can refuse to sit back and accept poor care, and fight for the best that’s available.
When we came away from last week’s clinic appointment, Joe and Tom were buzzing from the whole experience. They’d talked to their specialist about anything from telling friends about diabetes, to the nature of hypos, to how the magnets in rollercoasters might affect an insulin pump. They’d been complimented about how well they’re coping with the havoc that adolescence can wreak on blood sugar levels. They’d greeted the results of their HbA1C tests with the glee that they might greet a particularly high score on a Nintendo DS game. And for all of that amazing care – helping to keep my sons as healthy as they can be – there was no charge.
It’s at times like this that I have cause to give thanks to good old Nye Bevan.