THE NATIONAL HEALTH and OUR VALUES
Social values equal social policy
Some of you may know that I had been in hospital for three weeks. Before I go on, I want to say how extraordinarily professional, helpful and kind were almost everyone who took care of me, yes, for those who took such care. One nurse said, “you know Robert, when you enter the hospital doors you leave your dignity outside”. This is all too true because of the nature of healthcare and the events surrounding it – it is a consequence, in part, of bodily needs and functions. In relation to those things, the nurses and others in attendance on the ward, were discreet, humorous, and professional. There was never an awkward moment.
Having said those things, and having been there for so long, I think there are conditions worth mentioning because the doors of a public hospital open onto the assumptions and values that reveal much of the underlying nature of our society.
What we have is a result of history: immediately following World War II the Labour Party understood that to attempt to push newly demobbed, military-experienced working class men back into pre-war poverty, poor educational and medical care, always on the edge of being thrown out of their houses for lack of rent money, always on the edge of hunger, was a poor political* decision. Also, with the newly victorious and extremely powerful Soviet Empire offering a (false) worker’s paradise, the British ruling establishment needed to buy off the workers, proving that capitalism was better for them than Communism. At the same time the ruling elites did not want to concede any real financial or commercial power as did the Germans to their battered ex-soldier working class, giving them access to boardroom decision-making leading to a long strike-free economically successful period of growth. Although Labour dithered over democratic control of industry and equality, one of the achievements of those pressures and politics was the creation of the National Health Service, a sterling example of European humanism (informed by politics).
CROWDING
I have been in private hospitals as well as public ones. The difference is shocking. In the private ones there is no sense of rushing energy, crowded spaces, nor noise of any kind. The rooms are well designed, the sitting/waiting areas are comfortable and generally handsome. The oh-so-tragic downtrodden poverty-stricken end-of-the-line purple haired drug-addicts giving everyone a hard time are not to be seen hanging around the entrances.
Traversing the corridors of a large public teaching hospital there was the sense of being in a London underground station at 5:30 PM. Shops selling cheap children’s furry things, unhealthy high carb and sugar ultra-processed foods, endless cups of coffee, and large groups of plastic chairs lined up in columns enveloped by a continual din of voices and shuffling feet.
In our class stratified capitalist economy where all things submit to the will of the rich, the idea of calm and decorum is thought to be wasted on the people. This is filled with assumptions about superiority, class and false assumptions about the meaning of Darwin’s theory of the Survival of the Fittest**.
LACK OF PRIVACY
In the wards at night, there are shouts and cries of men in fear, or terrified by their aloneness in a public space, or by disappointments or thirst. The thin blue curtains hardly provide privacy, and certainly not from sounds. My nights were riddled by these things and the sounds of the always attentive night nurses rushing to help or administer a medicine or a test. Lights on, trolleys rolling, medical staff whispering as quietly as they could. The were fervid conversations, more fear rising and my own struggle to stay sane with my own pain and away from the nightmares, the actual details playing out around me of people’s personal expressions of madness, anger, fear or appreciation. At moments I felt I was in a Bruegel painting of the early 16th century abounded in madness. There is no one to blame outside of history for the poor nights and lack of sleep but they do provide views into values of this country.
MIND/BODY HARMONY
Previous to the operation it was delayed several times due to a lack of available trained staff or a free post-op bed and care, or because of emergencies there were exhausted operating theatre staff including the surgeons, and or course because of insufficient investment, low wages, etc. When I was finally operated on and awoke to my delight, every day a different team of surgeons came by to check on my progress and to answer questions. Why this rotating team? I suspect it is down to who is free and who knows a bit about the case. But as before the op, this was disturbingly alienating. There was professional concern but no acknowledgment of one’s individuality, there were no relationships, so I felt adrift. These encounters separate body from mind, Not only is it a somewhat unpleasant experience but it is indicative of a society oriented over the commonality of all but the wealthy.
CLASSISM
Over the last two days there was an elderly man with an upper-middle accent who continually complained, didn’t answer questions the medical staff needed to have responses to, and seemed to pass judgement whenever he was attended to. He insisted on calling the nurses ‘girls’. In one incident he said to a senior nurse, “oh thank you, that was a magnificent executive decision you made earlier,” pause, “ but I suppose you don’t know what ‘executive decision’ means.”
Later that day his wife came in. She demanded the immediate attention of a nurse and bayed at her for the state her husband was in. The nurse apologised and explained that three times during the day they had asked her husband to help them stand him up so they could change his bedding and clean him, but he simply refused to use his legs to help us”. The woman shouted at her, “you’ve done this, you’ve reduced him to this.”
The head nurse and a physio appeared and tried to explain to the wife that her husband was being less than helpful. “No, that’s not it, it’s all your fault. Our private nurse, Mary knows exactly what to do and there is only one of her. No, it’s you people.”
It was that entitled, ‘It’s you people.” that got to me. That assertion that she is dis-attached from and superior to them in terms of class, education and wealth,’ an attitude that sang so loudly of English upper middleclass attitudes. Given the long hours, short breaks, struggles to get to and from work on time and the low pay these doctors, nurses and the entire staff work a devoted back-breaking job with such grace.
I thought ‘ok, this woman is under stress, but one’s default nature and attitudes reveal themselves in such moments of stress’, and there she was, arrogant, superior and threatening. Ugly and yet still profoundly indicative of the real historical divisions that run so deep through British society.
SOCIAL VALUES = SOCIAL POLICY
These phenomena are an example of decisions based on human values. “If they are too poor to pay for private health care, what do they expect? “No”, and through nudge and wink the rich signal to each other in public, “we will spend less and charge ourselves lower taxes, and then, when our kind privatise the NHS, we will screw the the undeserving public for every penny. Look, the Americans get away with it.”
It was clearly decided that only the best was to be harboured for the wealthy and for the rest, we can make-do. We allowed the Tories to get away with austerity and to run down the welfare state. These decisions are not only political, they are also about values and morality.
WHY CLASS
As a final word about this I want to address the question of why one should be
concerned with the nature of class in the early 21st century. All the other problems we struggle with, migrations, climate change, corruption, inequality, racism, sexism, gender issues, poverty, poor educations, deteriorating health service, alienated youth, high suicides rates, etc are not isolated unrelated conditions but rather all a consequence of a class riddled society in which small number of ultra-rich rule the rest of us.
For each of us to understand where we are and how we fit into society we must understand what exactly is our relationship to the means of production? That indicates the more intellectual and physical tools you own and control, the greater your levels of wealth which foretells your place in society. Your life is defined, whether you like it or not, by how you fit into that hierarchy of wealth and ownership. Once you accept the powerful similarities that actually bind you to others and to the system, the more you comprehend the nature of your own life. Understanding the importance of Class is a powerful tool for finding ways to take control of you own emotions and attitudes.