Another post from the series I wrote for the BMJ, these are less funny than my normal stuff and *designed* to make people argue
Obese, but not morbidly so, the CVA had left her with no movement down her left side. When we arrived she was lying on a mattress on the floor, a spreading puddle of urine under her..
“I just can’t get comfy…my back hurts.”
We advised her on painkillers, helped shuffle her back up the bed and suggested that perhaps she might like to come to hospital?
“I’m not going back there. I only came out today.”
I looked around the foetid room, the bare mattress, the plastic bucket of faeces on the floor.
“Did they not arrange nursing care for you?”
“Well, they said they would, but nobody’s been round.”
“And they let you come home like this?”
“Oh no, they said I shouldn’t, but I didn’t like it in there. They were giving me drugs. I signed myself out.”
“Against their advice?”
“Yes. My husband helped me into the taxi.”
He’s at my shoulder, frothing.
“It’s a disgrace, the way they’ve let her come home.”
She gestured around the room.
“You can see the state of the place, what am I meant to do?”
I bit my tongue.
“He’s shit himself.”
Indeed he had. Nineteen and drunk, you might well, but he’s fully conscious and walking. I prescribe a lift home, a roll of Andrex and a shower. His father disagrees.
“But what if he’s sick in the car? What about the seats? Take him to hospital. I’ll pick him up when he’s sober.”
The NHS was developed to provide free, accessible health care for all. It is, in principle, how health care should be run. Our patients don’t fret about their insurance, or the bottom line. They can worry about getting better.
Sure, the waiting lists may be longer than we’d like, both on the surgery lists and in the waiting room, but we’ll get to you every time, gratis.
We’ve heard plenty about private health care encroaching on the state’s own provision. The debates surrounding “top-up” fees are fierce and always conclude with someone bawling about a “two-tier” system.
Well here’s an idea.
How’s about a third tier.
For those who abuse the system.
We in the NHS will deliver you free health care, accessible to all, at any day or night. We’ll come to your house, we’ll involve you in our clinical decisions, we’ll give you a voice in your care. We’ll do it to the best of our abilities, with the best equipment we have. All for free.
In return, you respect the state’s provision, if you fail to do this, you lose the privilege.
As motorists, we pay an extra premium each month to cover uninsured drivers involved in collisions.
We recognise that the innocent victims of their irresponsibility do not deserve to be out of pocket due to someone else’s callousness or criminal activity.
And when you’re found to be operating a motor vehicle without insurance, you’re reported to the Procurator Fiscal
If employed, we all pay National Insurance. We recognise that our NI contributions go towards funding the percentage of the NHS that cares for those patients who do not pay contributions, through being out of work or otherwise.
But when we find “uninsured” patients who demand ever higher resources from the Health Service, who phone ambulances because they don’t want to risk their upholstery, or check themselves out of hospital against advice with no thought to how they’ll continue their daily lives, then demand the emergency services and A&E haul them out of a problem of their own making?
Is it time we had a third tier for these people? We let the rich top-up their treatment with privately obtained treatments, why not issue bills to those people who waste resources through their own actions, stupidity and flagrant irresponsibility?
“Free health care for all”?
That would be nice.
Right now I feel I’m paying an awful high price.