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“I me mine”: why the NHS is doomed if it serves selfish genes

16 December 2009

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AMSPAR Chief Executive

It may just be me, but have you noticed how difficult it is to get on and off public transport these days? (For any GPs that might have come across this article, some of us travel by bus and train, as opposed to expensive cars.) It’s not easy.

When I was young I learned to let people off – and then get on. It’s quite logical. If people get off, then there is more room inside. The same principle applies to any entrance. Simple.

But logic doesn’t seem to play a part these days. You can be on the bus/train/tube, and the minute the door opens there are bodies and prams barging their way in. Elbows, bags, rucksacks are all employed in the manoeuvre. It’s “me me me – I have to get on”.

It gets worse if you are on the outside waiting to board or enter. You show courtesy by standing aside and letting people off – only to be shoved over by someone behind who wants to get to the few remaining seats that are vacant. Don’t they consider my advanced age?

It doesn’t get any better during the journey. Headsets are an obvious annoyance. The stinking burger doesn’t help. And then there are the litter and the germs. There have been numerous campaigns regarding swine flu (you probably knew that) but is anyone – apart from you and your colleagues – listening?

Recently, I saw someone on public transport read a free publication, sneeze into it and leave it on the seat behind them when they left. Obviously someone else would pick it up to read.

Return to sender
We can’t simply blame the youngsters. People learn from example and training. If you have untrained staff with bad habits carrying out induction then your service will continue to deteriorate.

I am constantly flabbergasted to hear of some people’s experience of the NHS. Only last week, my father was a victim of a practice’s sheer thoughtlessness. On Wednesday 4 November, an appointment letter was sent for him to attend a clinic on the following Monday (9 November). Apart from the fact that the letter was sent second-class and arrived on the Saturday (no point calling to say he was unavailable as the clinic was closed), this took no account of the scheduled two-day national postal strike on the Thursday and Friday! Did anyone stop to think?

Constitution without consideration?
Maybe I’m being a Grumpy Old Man, but I find the lack of thought and consideration for others, and the pursuit of self-benefit, truly depressing. It really is a case of “me me me”.

Sadly, the government would appear to be pandering to this tendency in the run-up to the general election. It has focused on the individual in the NHS Constitution. It has looked at the extension of out-of-hours provision and is now considering the right to private care should the 18-week waiting target be missed. It all sounds great – but it has to be paid for.

Take out-of-hours as an example. Clearly there is a necessity – why should people only get ill between 9am and 5pm Monday to Friday? Who would be surprised to learn that the highest death rates during the week are on Saturday and Sunday? Of course it is more convenient if the patient has a wider choice of appointment times, but this takes resources – staff, cleaning, lighting, heating, etc – and this all has to be paid for. We also have the Working Time Directive to take account of, and many people still expect their weekend break.

We all require time off, but life goes on. Those of us who want the weekend off are quite happy to do our shopping, drinking and partying at that time of the week. We assume the staff doing the work on our behalf is being adequately rewarded. Or do we even think about it? Is it a case of, “It suits me – me me me”?

The fact is, it all comes down to money – and UK plc is already heavily in debt. The NHS, along with all the other public services, is in for a tough time, with dwindling resources and increasing demands. We will have to think creatively if we are to hold our valued health service together for the public good.

If we continue down the “me me me” route we will end up like Mimi in La Bohème, the unfortunate seamstress heroine of the opera who died of consumption (TB). As she was poverty stricken, her friends rallied round to buy her medicine and pay for a doctor. But it was all too late and Mimi died. Musetta, Mimi’s friend, had sold her warm coat in the middle of a harsh winter. That wouldn’t help her health either.