ANOTHER VOICE
Where all these health anxieties are going to end
AUBERON WAUGH
Two friends of mine — a nice, newly engaged, idealistic, leftward-leaning vege- tarian young couple of clean and healthy habits -- recently settled in Islington and decided to register with the local GP's panel on the National Health Service. On 24 January, the female of the pair, whom I shall call Jo, visited the doctor with a minor skin complaint which might have been a form of dermatitis or eczema. The doctor examined her and said he thought she should see a specialist. Two weeks later, she received notification of an appointment to see a dermatologist at the Whittington Hospital in Highgate Hill for 10.50 a.m. on 4 October 1996 — in 237 days' time. She telephoned to check this was not a clerical error, and was assured that this was the first possible date when a dermatologist would be able to see her.
This story neatly illustrates one direction the National Health Service is taking, although it is a different direction, illustrated by the experience of Jo's young man, whom I shall call Paddy, which interests me more. Let us stay with Jo for a moment. Some will say that her story — which is a very familiar one — exposes the way this Tory Govern- ment is destroying the Health Service by starving it of funds. In point of fact, if we are to believe the official figures — and those for increased government expenditure are about the only official figures I tend to believe spending on health has increased by over 45 per cent in real terms since 1979.
The collapse of the National Health Ser- vice has been caused partly by the idleness, incompetence and greed for money of its employees — these are built into any organisation removed from the normal commercial disciplines, and flourish despite the appalling burden of overwork put on young doctors in hospitals — partly because of an insatiable demand for free health, and partly because of the appalling cost of new drugs and new procedures, bearing with them the cost of almost unre- strained research in every direction.
The most interesting, not to say humor- ous, thing about the National Health Ser- vice is not so much that it is collapsing, which was always inevitable, but that it is collapsing at a time when there is a frenzy of anxiety among a substantial proportion of the population about its health. It is both poignant and ironic that this frenzy should be on us at exactly the time the NHS will have to throw in the sponge. One has only to look at the newspapers to see how the neurosis has taken hold. The Independent informs us in a headline: `Mother's diet affects child for rest of life'. The Sunday Times led the world news with the story of five-year-old Charlotte Schroder: 'Race against time to save leukaemia girl'. The Observer gave us `Agony of skull surgery babies' and 'Hospi- tal levy on wheelchairs: patients must pay £1 deposit as theft bill hits £600 million a year', as well as boasting about a nation- wide survey of drinking habits of 13- to 14- year-olds it had sponsored.
This brings me to the second direction the NHS is taking, as illustrated by Paddy's experience. Paddy went simply to register with a new doctor — he had nothing wrong with him. The doctor gave him a general examination, and then addressed him as the headmaster of a prep school might address a new boy: `Now then, young man, I can feel your liver, and those are words you don't want to hear from your doctor.'
Paddy, who is 27, and admits to having been celebrating something or other the night before, then had to put up with an interrogation about his drinking habits. When he returned a week later, the doctor could no longer feel his liver, but gave him to understand that he had been diagnosed as someone with a serious drinking problem.
This did not surprise me, because I had been reading the pages in Health Trends (Vol. 27 No.3) containing the report on the identi- fication of 'excessive drinkers' among medical in-patients, stipulating that all patients admit- ted to general medical wards should have an alcohol history taken, quantified in units per week. Those owning up to more than 21 units a week (men) or 14 units a week (women) will be diagnosed as an 'excessive' drinker. This will then be put on their discharge sum- maries and remain in their medical records for the rest of their lives.
An even more fatuous system is pro- posed for diagnosing those with a 'serious' drinking problem, but I have no room to explain it here. This is the second direction the National Health Service is taking, as it quietly retires from providing any Health Service at all. Never mind that the number of units taken to indicate an 'excessive' drinker is laughably small and discredited by most medical opinion. It is the oppres- sive intention which counts. The gigantic administrative structure, while being unable to provide an aspirin for a toothache, busies itself preparing huge lists, committed to computer storage, on every aspect of our medical history. At present they may confine themselves to inaccurate statements about our drinking habits, but we have heard rumblings among anti-smok- ing fanatics in the medical profession that smokers should not only be denied medical or surgical care but should be avoided by would-be employers.
I have noticed there is a strong element in the BMA which is opposed to sexual intercourse in any form — hence the men- dacious claim that men can catch Aids from women. Many of these voices turn out to come from elderly Scots Presbyterians or members of Moral Rearmament, but they are very powerful. It cannot be long, whether in furtherance of the world-wide campaign against Aids or to tackle the recognised neuroses of nymphomania and satyriasis, before we all have to supply details of our sex lives, frequency of inter- course, preferred positions etc.
None of which would matter in the least, except that as soon as any information is on a database it can be linked to other databases -- driving or criminal record, credit rating, tax history — to provide a gigantic dossier of inaccurate, unchecked and secret details about any and all of us. The threat is not in the 'smart identity card' with a chip, which contains a limited amount of information, but in ordinary magnetic-tape cards (like our bankers' cards) which can provide access to informa- tion stored in linked computer databases all over the world. It does not matter so much that the National Health Service is unable to produce some cream for a face rash in eight months. What matters rather more is that the huge resources should be devoted to regulating and enslaving us all. On that sour note, I must say goodbye. I have been writing this column for 20 years without a break, and that is long enough.
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