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Through the keyhole: what the doctor sees

Through the keyhole: what the doctor sees
Aug 11, 2018 Shaking Hands 0 comments
This post was first published by The Croydon Citizen on 10/08/2018.

Through the keyhole: what the doctor sees

How a visit to Croydon University Hospital led to a reflection on what we can do to reduce the burden on the NHS.

In early April, I took a heavy fall on my shoulder while walking my dog in Lloyd Park. When my arm failed to regain its normal leverage after several weeks, I had an X-ray, then an MRI scan to reveal the true extent of the damage. It emerged that I had torn the rotator cuff, or the sheath of muscle and tendons that keeps the shoulder joint firmly in place. My consultant at Croydon University Hospital said this would necessitate an operation to re-attach it as soon as possible before it retracted and became inoperable. Although the condition was far from life-threatening, I was duly admitted a month later.

Doctors Kotrba and Mirza carefully outlined the procedure to me. I rode down from the ward on a trolley to the theatre and was given a general anaesthetic and a nerve blocker in the shoulder area. I awoke from a dreamless sleep in Recovery, feeling none of the pain and nausea I had experienced after my previous operation to repair a knee cartilage fifty years earlier. The cup of tea felt like a kiss of life.

The op had caused my pulse to go a bit skittish, so I was told I’d be kept in another unit for monitoring overnight. In the event, there were no beds available, so I had to remain in Recovery, where I was attended round the clock by Rachel, Hannah, Peace and Amber. Their tender ministrations caused my pulse to settle back at once. They were clearly concerned that I would complain in the face of this unavoidable blockage. They needn’t have worried, since no patients arrived back from the theatre to occupy my space until the next morning, when I was discharged, feeling positively bionic.

NHS staff are coping magnificently against the odds

We need to keep the NHS in perspective. It has become totemic of our national psyche, a kind of cult, something to swear by, a backstop to the overrunning of our existential angst. I believe it cannot bear the weight of expectation thrust upon it, the demands and downright and quite unjustified abuse. The constant harping on how stretched and run ragged it is on TV and in the press can do nothing for the morale of the staff, who are coping magnificently against enormous odds. It is only underfunded from our taxes because it ministers to each and every ailment – real or imaginary – that we may claim to suffer. I think the elderly should be prepared to pay a part of their prescription charges as a contribution to offsetting the overwhelming cost of their treatment and to ease the blocking of beds. As for ‘mental health’ relief, assistance and maintenance, I personally believe this is not the business and responsibility of the state, but of the family, the schools, the churches and, only as a last resort, social services – for, as the poet Philip Larkin describes the human condition: “Where can we live but days? / Ah, solving that question / Brings the priest and the doctor/ In their long coats/ Running over the fields”.

The body may not be the ‘temple of the spirit’ for many people – but it remains the vessel of the mind for us all. In my opinion, if the body is abused, the mind weakens and falters and the will and initiative are sapped. The NHS is on permanent standby as an ever-ready fallback position.

When Sir William Beveridge, a National Insurance specialist, sat down in 1942 to draft his now-famous report on the future welfare of the nation, he felt impelled to extend his remit to cover the root causes of poverty and immiseration. These he memorably characterised in the form of the ‘five giant evils’ – want, disease, ignorance, squalor and idleness – blocking the road to reconstruction after the war. Today, at least two of these – ignorance and idleness – appear to be more like great, fat toads squatting on opportunity. But then attitudes have changed with the spread of the welfare state with its ‘cradle to grave’ provision of social services for all. People were no longer deemed to be ‘arbiters of their own hardships’, but rather collectively in need of protection from (often self-inflicted) poverty and harm in the name of social justice. At the time, the Archbishop of Canterbury hailed the report as “the first time anyone had set out to embody the whole spirit of the Christian ethic as an Act of Parliament”.

We now suffer more troublesome modern scourges

Beveridge’s three remaining ‘giant evils’ – want, disease and squalor – have been largely eradicated, being more concrete phenomena, more easily and visibly addressed. Society’s besetting ‘ills’ today, as Mr Corbyn describes them, are inequality, prejudice, discrimination, neglect and insecurity – all high-sounding abstract nouns, much less easy to qualify and quantify. In place of want, disease and squalor, we now suffer more troublesome modern scourges.

Above and beyond persuading people to live within their means and provide for their futures, the report’s flagship initiative was the creation of the National Health Service. There was much wrangling at the time over whether social insurance was less important than bargaining about wages, as Ernest Bevin held. He called the report a ‘social ambulance scheme’. Social security, the report claimed, ‘must be achieved by co-operation between the state and the individual’. In the event, Nye Bevan as Health Minister won the day. The state would assist the individual to achieve minimal wealth if he or she would take responsibility for his or her health, both mental and physical. This was a bargain that has proven more than difficult to keep. I feel the benefits of the welfare state have become a kind of bounty, which consumes a disproportionate amount of the national budget. Wants have become needs and entitlements to a share of a depleted stock of resources and resourcefulness.

The great irony is that people are now living longer than ever before

The great irony of the situation is, as pointed out by an elderly doctor recently, that with all the advances in medical technology and the plugging of many of the formerly untreatable pathways to death, people are living much longer than expected and need more palliative care in older age if they are not to slip into barely manageable frailty and even total shipwreck, placing mounting demands on the NHS.

The problem of production is likely to remain unsolved as long as as energy and fitness levels continue to dwindle. Productivity is neither a capitalist nor a socialist notion; it is simply the cost of staying in business as a nation. Is the righting of this imbalance in the scales of social justice a matter of ideology or morality? Neither. I believe it’s actually a matter of mobility, an ability to shift for yourself, to harness your habits, to live and work where the means of production lie; in short, to strive to more than stay alive. A government health minister once made an unintentionally hilarious request of his civil servants: “Give me,” he said, “some statistics on the working population who are smokers, broken down by age and sex”.