Friday, 1 April 2011

Big Society and Health Care: a personal reflection

I have just been signed off by my doctor to start back at work after some serious surgery so I think it’s a good moment to reflect on my experience in the light of the Big Society initiative in the UK and its implications.
Two of the main Big Society concepts are privatisation and voluntarism. I have been reflecting on how the imposition of these two concepts would have affected the treatment I have received here in Spain. To what extent can privatisation and voluntarism replace an effective national healthcare provision?  
I am lucky to live in Spain, with the access I have to the public health system, and this was confirmed by today’s article in the UK Guardian newspaper:
(Spain’s) healthcare is highly regarded – it ranked seventh in the World Health Organisation's top 10 in 2000 (the UK was 18th) – and, like the NHS, it is free at the point of delivery. It has an excellent network of family doctors and a health centre within 15 minutes of every home.
Through my workplace, I pay a monthly fee to a private health company. On its web page, the company describes itself as serving millions of customers in many countries.
This may be so, but in my case I was unable to get an effective course of medicines for my health problem through the doctors associated to this organisation, and  I was not happy with the arrangements offered for other treatment. 
My luck changed when I returned to the fold of the state health system, where I received an excellent diagnostic service and surgery at the hands of an experienced, expert and committed team of specialists who took a personal interest in every detail of my treatment before, during and after surgery.
I have been asking myself during these last few weeks of treatment why I am spending good money on private health care: in my experience, the state system has been a much better option, even taking into account the rather irritating delays in waiting for specialist appointments. Obviously I am not alone:
 "We only spend 6% of GDP," says Dr José Martínez Olmos, secretary general of the ministry of health, although if you add in private sector spending, it reaches 8%. Most people use the state sector. As in the UK, the private sector offers shorter waiting lists, but for major illness, emergencies or cutting-edge treatment, public hospitals are the place to go.
In my experience, the gap in provision between public and private provision is huge, and falls in favour of the public system. In Spain, at least, it’s not even costing the country an unreasonable amount, as explained in the same Guardian article:
"The healthcare system in Spain is not expensive," Olmos continues. "We spend €1,600 per head per year. This is a price that a developed country can afford."
So much for privatization as a pillar of Big Society’s ambitions.
What about Voluntarism?
Volunteerism, the idea of Burkean small platoons taking on the functions of the state, is the trickiest part.
When it comes to medical treatment, speaking as a patient, believe me, it certainly is the trickiest part. When I was lying on the operating table I asked myself how any of the 8 persons present could be replaced by a volunteer. The specialist who was to cut my nose apart and leave me free of a tumour which has been growing there for 15 years? No thanks. The anaesthetist, whose minute by minute care kept me from suffering pain and brought me around at the end? No thanks.
I suppose all the other guys were superfluous? As this was a local anaesthetic, I could hear the doctors’ conversations, including the lead specialist, who said at one point: You’d better keep a close watch on this one, or he’ll end up in Intensive Care. I am sure I needed every one of those highly trained persons to be there, and I cannot imagine replacing any of them with a volunteer. Volunteering is ok, but it has its limits. Would I be happy for a volunteer surgeon to operate on my nose? Stupid question.
Imagine a volunteer anaesthetist calling in to say sorry, can’t come today because it’s the grandchild’s birthday and I have to buy a cake…. Imagine a volunteer Dr Gray, well I’ve never really chopped a nose up before, but I guess it can’t be that difficult…..
The Economist writer certainly got it right, voluntarism has its place, but also its limits:
In practice, however, the idea has flaws. Running your local library sounds attractive, but most people lack the time and expertise required, and there is not a lot of money around to help them (thanks to the spending cuts)...
Never mind looking after library books, what about the high level skills required in cutting up my nose!
I don’t want to be completely negative, so I can give you two excellent examples of private enterprise and of voluntarism which I saw working perfectly during my time at the excellent Ramón y Cajal Hospital in Madrid.
Every time I visited the hospital I stopped on the way in to buy my newspaper at the press kiosk outside the front door. This kiosk is privately owned and operated and provides an excellent service with a wide range of reading materials to satisfy every taste. Privatisation stops at the front door, thank you.
On the day of my operation I was glad to see a group of volunteers, clearly of retirement age, working their way through the corridors offering soft drinks and light refreshments in exchange for a donation to the national cancer research charity, the excellent AECC: https://www.aecc.es/Paginas/PaginaPrincipal.aspx. Great volunteers and a magnificent cause, at the right time and in the right place, but no further.
So, that’s how I have lived the last few weeks, and that’s how I see the Big Society.
When you consider privatisation and voluntarism in health provision, imagine some really invasive surgery, and imagine it was your nose and your face.

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