Health is wealth. Few of us win the lottery or land million-pound deals, but at some point in our lives, most of us need the services of doctors, nurses and care workers, whether for ourselves or family members.
Being healthy and having access to appropriate healthcare as necessary, allows us to have fulfilling and productive lives, provide for our families and contribute to the nation’s economy. Unfortunately, England’s current Tory government, ideologically super-glued to private healthcare, refuses to accept the relationship between health and national prosperity, and therefore will not acknowledge the necessity for government to properly fund health and social care.
“Independent analysis we published recently reveals a direct correlation between investment in health and economic growth. It shows that for every pound of public money invested in the NHS, £4 is recouped through gains in productivity…” wrote Lord Victor Adebowale and Matthew Taylor, respectively chair and chief executive of the NHS Confederation, in a letter to Steve Barclay, when he became Secretary for Health and Social Care in October 2022.
Sunak may have stood in Downing Street and clapped enthusiastically for healthcare workers during the pandemic, but the government’s ‘reforms’ in the NHS have generally increased the role of commercial healthcare, with lucrative contracts going to private companies, laying the paving stones towards a gradual, full privatisation.
“The NHS is about as safe with them as a pet hamster would be with a hank hungry python,” says Sir John Major, a former Conservative prime minister himself, on BBC1’s The Andrew Marr Show. Consider the government’s latest move to cap student numbers in medical schools, at a time when we’re in desperate need of more doctors. Even The Telegraph, that bastion of the right-wing, declared the decision to be ‘insanity’.
“…Conservatives may prefer, as a matter of ideology, a private sector performing inefficiently to a public service delivering well. Indeed, neoliberals seem to find more joy in one person joining Bupa than 60 million people using the NHS.” Gordon Brown has commented.
A properly funded health and social care system are foundational services: facilitating the economy, investment, education and every other area of society. England is still one of the richest countries in the world and well able to design its public expenditure to fulfil the country’s most important needs. Unfortunately, ideology, whether political or theological, is ever impervious to reason, evidence, and humanity. Ideology tends to impoverish the people and enrich the elite. It’s no accident that truckloads of taxpayers’ money was shovelled into the pockets of Tory donors and cronies, particularly during the pandemic, through the illegal VIP lane, often for unusable PPE, e.g. Baroness Mone and her hubby, who’ve walked off with over £200 million.
Lord Prem Sikka, Emeritus Professor of Accounting wrote recently @premnsikka: “Tory Economics: 5% to get even richer in the next two years. A typical household to be £2100 worse off. High inflation, cuts in real wages/benefits means the poor will be worse off. Never-ending austerity = Premature death and misery.”
An advanced society has complex needs, requiring varied responses from government. Although, perfection can seldom be achieved, the social contract implicit between rulers and the ruled, places a duty on government to work in the best interests of the people. An extreme free-market ideology, by its very nature, advantages the rich and privileged.
The services which are used by everyone, such as medical and social care, must be the responsibility of government. Taxpayers entrust government to apply a portion of the public purse to meeting such needs. Profit and business have their place, but not in the hospital or care home.
“Once is a mistake, twice is a coincidence and three times is a pattern. This saying came to mind on hearing that the long-awaited health disparities white paper is no longer going to be published. While this is not a surprise, it is nevertheless a decision that is deeply disappointing. Particularly when we know that good health remains out of reach for far too many people in the UK, that deep inequalities in health between the poorest and wealthiest slow the economic recovery the nation desperately needs.” (Katherine Merrifield and Gwen Nightingale from The Health Foundation).
Our government may love its culture wars, decry the idea of being ‘woke’ (i.e. being concerned about social injustice and discrimination), but even that venerated pillar of the establishment, the Church of England has taken up the cause of fully funded social care, in a specially commissioned report, Care and Support Reimagined: A National Care Covenant For England . “The power of valuing those outwardly powerless is a test of a society that acts well,” Welby and Cottrell said. No one should be “treated as surplus and ‘just a burden’ because of their age or ability.” Amongst its recommendations, the report calls for a tax rise to fund a universal social care system. Much as we all hate the idea of paying more tax, I doubt anyone would begrudge a tax rise specifically for a social care budget, enabling all those in need to receive the care they require and allowing for care-workers to be paid appropriately.
Currently social care is provided by local authorities, private companies and families. Payments are calculated after an assessment of a person’s assets; described as “the meanest of means tests,” in the Church of England report. For anyone with assets above £23,250, there is no state support for care, and costs fall entirely on the individual. These represent the majority of social care users in England. Family members giving care suffer exhaustion, loneliness and burn-out.
The idea of an integrated, universal health care system, bringing together the NHS and social care, is being increasingly advocated, possibly through the mechanism of multipurpose local clinics, where GPs would work in groups with community and social care. The objective being to treat people early and thereby unblock hospital corridors. Such clinics could be modelled on the renowned Kentish Town Health Centre in North London.
Kentish Town Health Centre (KTHC) “…is a new health building in central London, housing… a wide range of health facilities. … Ideas of transparency and connectivity were embraced by the architects and the whole team worked collaboratively to create a building that expresses the new, holistic approach to healthcare. …The building houses a large GP practice, paediatric, dental services, children’s services, breast screening and diagnostic imaging, plus supporting office space, staff facilities, library and meeting rooms. … special tea points and break out areas mean that different staff groups can easily meet to discuss and liaise about clients to avoid replication and unnecessary appointments.”
The government can’t argue it doesn’t have the money to fund the NHS and social care, given the astronomical sums it’s happily shovelled into the pockets of Tory donors and cronies, mostly for unusable PPE, and the £4.3billion written off by the treasury due to fraudulent Covid loans. Our government could even adopt the advice of the good bishops, Welby and Cottrell, and increase tax, specifically for a health and social care budget. I can’t imagine people rioting in the streets over such a tax hike.
Perhaps what we should be rioting about is the profiteering by care company owners who take multimillion pound dividends, while providing substandard care. Gordon Sanders, who owns Runwood Homes, the sixth largest for-profit care home group, paid himself around £21million in five years. Residents are charged more than £1,000 a week, with many of the payments coming from the taxpayer. Yet inspectors found appalling conditions in the homes: not enough staff; many staff who didn’t have training and hadn’t been checked for criminal records; residents left in dirty incontinence pads; residents feeling “trapped” and “at risk of harm”; “awful food”; and many other breaches of the rules. In one home, inspectors found residents were restrained by staff strapping a table top to a chair.
The increasing presence of hedge funds, property investment trusts, and private equity in social care has allowed predatory financial techniques. A screen of financial jargon helps investors avoid public scrutiny, but a slew of recent reports has begun to detail the many tactics used to ensure “healthy” returns on investment – and the profound and troubling consequences that these strategies have for the care sector. Their convoluted financial structures require ever increasing revenues to meet rising interest payments, rents, and to fill the pockets of investors, many of whom are based in low-tax jurisdictions. For the sake of clarity, it must be emphasised that increased revenues are not used for delivering better quality care or paying higher wages to staff.
“This competitive, for-profit model of social care provision has had 30 years to deliver on its promises of efficient, high-quality services. … increased competition between providers has undermined care quality. It is time to stop pursuing the same strategy and expecting a different outcome….” writes Christine Corlet Walker, a researcher at the Centre for the Understanding of Sustainable Prosperity, and asks “…who is benefitting from this dysfunctional model? And who, ultimately, is paying the price?”
Carers looking after family members at home, find themselves exhausted, overwhelmed and isolated, affecting their own physical and mental health. The BMA report on Social Care in England set out four key actions:
1. Increase long term funding
2. Provide free personal care at the point of need
3. Ensure social care workers are paid the Real Living Wage as a minimum
4. Introduce a standard work contract and improved training opportunities for social care staff
In Scotland, since 1 July 2002, free personal care has been available irrespective of income, capital assets, marital status or the care contribution currently made by an unpaid carer. The personal care provided includes: personal hygiene, continence management, food and diet management, assistance with mobility, counselling and support, simple treatments and personal assistance. I wonder if our hospital wards would be struggling to discharge people if this model existed in England?
The government can hardly complain they haven’t been provided with evidence, examples, road maps and recommendations to ease the stress on the NHS, improve social care, benefit the health of all and thus improve the country’s economy and prosperity. “Health is repeatedly shown to be the Nation’s top priority. And so it should be – it is quite simply a matter of life or death of wellbeing or sickness. Good health is an indication that society is thriving and that economic and social and cultural features of society are working in the best interests of the population.” Begins the introduction to the Health Equity (report) in England: The Marmot Review 10 years on.
The original Marmot Review had been commissioned by the Health Secretary of 2008, when Professor Sir Michael Marmot had been tasked to propose the most effective, evidence-based strategies for reducing health inequalities in England. The review called for health equity to be at the centre of all decision-making. Its findings added to the evidence that ill-health costs the economy approximately £40billion through lost taxes, resulting welfare payments and pressure on the NHS. Shockingly, the Marmot Review also found that in England, the majority of people die approximately seven years earlier than their better-off counterparts.
The Marmot report argued that health inequalities are not inevitable, and set out a framework for action; with therecognition that disadvantage starts before birth and accumulates throughout life. The 6 policy objectives in the report, place the highest priority on the first objective.
1.giving every child the best start in life
2. enabling all children, young people and adults to maximize their capabilities and have control over their lives
3. creating fair employment and good work for all
4. ensuring a healthy standard of living for all
5. creating and developing sustainable places and communities
6. strengthening the role and impact of ill-health prevention
A government truly desiring to minimise social ills, improve the country’s economy and wealth, would see these recommendations as gold-dust, and place Marmot’s six principles at the heart of their policies. Yet, it appears the only people really putting them into practice are shrewd local authorities, such as Cheshire and Merseyside, Greater Manchester, Coventry and others, who’re part of the Marmot Network.
“Areas awarded Marmot community status are those which can provide evidence that these six goals are seen throughout local policymaking and decision making, and that improved health and reduced inequalities are at the centre of how the area develops approaches to early years, education and skills, transport, housing, places and spaces, and jobs and businesses.”
In Coventry, the difference between the life expectancy of men in affluent areas and those in deprived areas was around 10.7 years, and for women it was 8.4 years. An appalling difference of more than a decade in the case of men and nearly so for women. The early death of adults in already deprived areas, creates a huge human cost, with the effect cascading down the generations; impacting a family’s income, creating hardship, insecurity and lack of support. Since Coventry became a Marmot city in 2013, a report notes: There have been improvements in school readiness at age 5, health outcomes, life satisfaction, employment and reductions in crime in priority locations.
Inequalities in society will continue to persist; nevertheless, severe disparities affecting health, education, and life opportunities will lead to economic weakening and social instability.
We all deserve to live the best lives we can; to work and to enjoy a dignified old age. A universal health and social care system is perfectly feasible and morally imperative, underpinning the nation’s prosperity, well-being and cohesion.
I’m including some basic information on dementia as nearly a million people in the UK suffer from the condition, and form a large segment of those requiring care.
The number of people suffering from dementia is set to increase as aging is the strongest known risk factor for dementia. This predicted increase will inevitably add to the existing pressures on healthcare services and families. A resilient, universal healthcare system needs to be in place to provide the appropriate care, and minimise suffering for patients and families.
The signs and symptoms of dementia are issues with: memory, attention, communication, reasoning, judgment, problem-solving and visual perception.
The risk of developing dementia is increased by the following factors: increasing age; family history; race, ethnicity; poor heart health; traumatic brain injury.
How is dementia diagnosed? Healthcare providers can test the following: attention, memory, problem-solving and other cognitive abilities. A physical examination may help to determine if there’s an underlying cause.
Most common types of dementia: Alzheimer’s Disease; Vascular Dementia (linked to strokes or other issues with blood flow to the brain).
Lewy Body Dementia is characterised by: 1. movement or balance problems like stiffness or trembling. 2. Daytime sleepiness, confusion, staring spells. 3. Fronto-Temporal dementia: changes in personality, behaviour etc. 4. Mixed dementia: more than one type of dementia may be present, particularly in those aged 80+.
Reversible causes: side-effect of medication etc.
Actions to follow if dementia is suspected in a loved one: medical assessment and discussion.
A new treatment for Alzheimer’s was announced in November 2022, following the results of clinical trials. The new drug, lecanemab has now been approved by the US Food and Drug Administration as a treatment for early Alzheimer’s.
Lecanemab has yet to be approved in the UK. The Medicines and Healthcare products Regulatory Agency (MHRA) has yet to give its assent. Further, for lecanemab to be available on the NHS it also needs to be approved by the National Institute for Health and Care Excellence (NICE). To agree to its use NICE will consider the benefits and risks, as well as the cost-effectiveness of the treatment.
Quotes from some experiences of the NHS and comments from carers:
“I can’t believe how much worse the NHS is, than it used to be. There’s no longer the notion of a family doctor, as there used to be when my children were little. And government’s reluctance to fund; people shouldn’t be lying in hospital corridors.”
“There’s a change in the attitude of doctors – a culture of blaming the older generation for their ills and pains. More and more there’s a dismissive, cavalier attitude towards older people; telling them to look up stuff on the internet. Many of them can’t do that. Or they’re told to take painkillers. I feel sad when I can’t find a packet of Panadol on the supermarket shelf, because it means that’s what so many people are using.”
“But it is a joy to go to the National Hospital for Neurology and Neurosurgery (NHNN), in Queen’s Square, London. They provide excellent provision, and even create a digital page for patients to access their records.”
“Dad’s dementia has affected me in more ways than I could have imagined. I feel like I’ve forgotten how to laugh: things I used to find funny just don’t make me smile anymore. I think about all the things he is going to miss out on in the future. There have been days when I have just cried because I want my dad back. Even though he is still here, he isn’t the person he was.”
“My mental health has been affected massively since becoming a carer, and a lot of people might question why? The answer is because all of the added responsibilities eventually take a toll, when you are a carer, you are not only having to care for yourself but another person, or in my case 2.”
“I find it very difficult to connect with others who haven’t experienced responsibility in the way that I have. The time constraints of my caring role have also lost me many friends as I simply didn’t have the time to maintain friendships. When I did go out, I felt guilty. I frequently daydreamed about running away. When I ‘woke up’ I felt selfish. For me, caring was very lonely.”
“My husband can’t be left alone so he has to go wherever I go. This also means I struggle to be able to attend events arranged for carers. There is no one else to look after him. A break would do me the world of good but it’s not something within my reach at the moment.”
“Some days I do not even think about being a carer. I just do the things that need to be done, and I have got into such a routine with everything that I just flow through things. Other days I cry for hours.”
“I would say that I am a different person now compared to who I was before I was a carer. Having to be that rock for someone else has forced me to look inwardly and grow emotionally in order to support my husband when he needs it. I’ve also had to find ways of coping that work for me, to help keep me grounded when things get tough. It can be an emotional rollercoaster so making sure I am strong and resilient emotionally is the most important thing for me.”
“It is tough to say as every carer experience is so different, but I think the thing that has helped me the most is to know my own capabilities and limits. It is a strange concept that in order to provide for someone else, you need to provide for yourself first, as it feels wrong or backwards somehow. But I know first-hand that you need to know yourself very well to be so unconditionally present for someone else. For example, when I’m struggling, I start to get messy and things start to build up around me. So, when I see this start to happen, I know I need to take a little time to clear things up, emotionally and physically. A cup of tea, a hot shower or a run are normally my go to ‘me time’ things to hit the reset button and pick things up again.”
“The mindfulness course I did was really useful as I provide care 24/7. I have developed some coping mechanisms through the years, but there are times, I must admit, that it is all a little bit much for me. As a carer there is no time for activities that I enjoy, even watching football match made me feel guilty. The mindfulness course helped me to recognise that this was not selfishness but a form of generosity and kindness to myself, as we best care for others only when our own basic needs are met.”
Some Support organisations:
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