NHS: Why the Choice Agenda won’t work (for you*)
* Of course, it will work if you have the money to make use of the options it gives you, or the free time, which as we know, is also like money.
OK, less of the sarcasm. Choice is something we humans value in many contexts, and its hardly a bad thing in itself. But the way choice is provided to us, often as a selection of options rather than actual free choice, quickly becomes problematic.
I want to start with an analogy that I believe I owe to Naomi Klein (who you should all read, but not automatically agree with): once upon a time a child received a box of lego bricks of all sizes and colours. When these bricks were scattered on the floor, the child could pick up almost any two pieces and begin assembling just about anything. The only restrictions were the number and selection of pieces (theoretically endless if the child knows how to access Daddy’s bank card) and the possibilities within the child’s imagination.
The child, genuinely, has a choice and a rather bewildering choice at that, seeing as what can be made includes creatures, vehicles, plants, terrain and objects, terrestrial, alien, historical, speculative in each of a myriad directions. I’m sure I designed some fairly steampunk creations when Lego was really like this, however anyone who grew up with Lego at my stage in society’s development will recall, even if it was never explained to them, the shift towards pre-defined kits: sets of more intricately designed pieces with which only a limited number of outcomes are available.
To be sure, many children managed to come up with designs outside the mould of these products. But each time, instead of smashing up a previous model, the child requires Dad’s bank card just to get a new model, and that model can only be selected from those already on the shelves. Lego as a company have destroyed Lego as a concept, it would seem.
When I’m ill, I don’t exactly have much choice in the matter, and only a limited number of options from which to select (the word choose, as I’ve hopefully demonstrated, means something completely different). If my condition isn’t too serious, I can probably make some serious choices, like ignoring my condition altogether, but generally a drug company somewhere would like me to visit my chemist and select one of their over priced products, and not the Boots own-brand remedy made to a recipe from the 80’s, and now out of a patent. This is because I neither have the money nor the inclination to support the pharmaceutics industries monopoly on access to life.
If I’m more seriously ill, I don’t make any selections or choices. Usually, this means I’m injured, as thankfully I’ve yet to develop anything too serious other than clumsiness*. I select a means of getting myself to the hospital, and I dammed well get myself there. Living in somewhere other than London, I basically have one A+E department that I can get to, and it’s the same one that single parents with little understanding of bureaucracy and highly agitated children frequent, and also the one drunks frequent, but I’m fine with that, as there’s no reason I should have better access to treatment because I’m a single male with no dependents and no alcohol dependency, though nurses shouldn’t have to treat drunks if violent. If I see the doctor and I’m actually ill enough to need referring, I don’t really think there is much of a choice in the matter. I want the next available appointment with someone qualified to do something about it.
If English wasn’t my first language, or if I wasn’t educated to a level whereby I can make some of the more complex decisions, I would be in difficulty even within the current configuration of the NHS. The “choice agenda” would mean nothing, other than a higher likelihood I would simply slip through the system. Evidence based medicine requires a one to be able to assess the evidence, but without time, language and education, this would be difficult. If I’m mentally impaired to start with, the problem becomes a vicious circle.
Without being able to afford to take time off work, I would be pushed into selecting certain options by default. In fact, I can’t really think of a time when I’ve wanted to select something that wasn’t the default option except when I’m allergic to a kind of medicine. And I can usually decide to select an option that requires travel time and expense.
In almost every situation, of which healthcare is by far the most acute, the ability to make any selection at all is based on privilege and wealth. This new choice agenda will only work for those who already have the option to go private, and perhaps a few who are just beyond the reach of private medicine. But private medicine is not practiced for people’s well being, it is practiced on the basis of what will make the most money. The same can be said for private and part-privatised education, the latter being the proposal of “free-schools” we are currently seeing rushed through into reality.
Personally, I can only conclude that any use of this choice to better my own personal position would be an act of selfishness and individualistic ambition, based largely on the fact that I’m an enormously privileged individual.
* Ask anyone who’s lived with me, including the 3 who witnessed me arrive home after I fell off my bike, leave again for a meeting, return, sleep, go to work by bus, return and then conclude that an x-ray might be required. I had, in fact, damaged a bone in my right elbow and would wear a sling for the next week.