Eulogy to the NHS

I was really moved by this piece by Harry Smith in The Guardian on Wednesday.
It described perfectly the sadness I’m sure a lot of British people feel with the slow decline of the NHS and the cynical way governments – of the left and the right – have used the rhetoric of neoliberalism to dismantle this once proud institution.
I can remember the stories my parents told me about the hardships they had suffered and the huge impact social welfare had in their lives.
My grandfather was a coal miner in the English midlands and his family were so poor that my great grandmother would rattle plates around on Sundays so that the neighbours thought they were eating Sunday dinner. Like Harry Smith’s parents – who were denied the dignity of caring for their dying daughter – my grandfather knew the shame of impotence in the face of suffering. My great grandmother’s death certificate registers her as dying of starvation. I can’t imagine how this must have affected him throughout his life as a father trying to bring up three children after the war.
The move towards social welfare certainly didn’t fix all the ills that poverty brings, and it didn’t remove the suffering from their lives entirely, but it did at least provide them with a council house, free education for their children, and a pension in their old age, and for that I will always be grateful.
I trained in the NHS as a physiotherapist in the 1980s and have always worked in public health care and education. I’ve witnessed the way that successive governments have put tax cuts ahead of public services. And now we hear that social welfare budgets are going to be slashed further and that we will have to take much more personal responsibility for our own health.
But this cynical rhetoric only plays into the hands of those who can afford to make choices about the health care they prefer. What about the mass of people whose choices are to buy food or buy a prescription; who cannot afford privatised health care so wait until their condition is dire enough to warrant a trip to A&E; or who endure an appalling quality of life out of poverty, unemployment, substandard housing, or unmanaged illness?
Harry Smith reminds us that we are all our brother’s keeper. Social welfare was a tangible manifestation of that ideal and in the NHS it idea achieved one of its many high points.
Sentimentality, it seems, will not save this once great institution and just like the D-Day commemorations, subsequent generations will soon enough lose sight of the conditions that once made grand governmental actions necessary. But if free publicly-funded health care is replaced by pay-as-you-go privatised care, only a precious few will benefit, and we will all be looking around wondering what happened and what a terrible mistake we made.
Consumerism, notions of patient ‘choice’, health promotion, etc., are anaemic substitutes for health care that targets the social determinants of health. We cannot ignore these and leave the health of the nation in the hands of the lowest bidder for privatised services.
The lessons of history tell us that poor health is a generational legacy and everyone born into the time of the NHS has benefitted from its existence. The alternatives are going to be much more costly, and not only in a financial sense.