ANOTHER VOICE
The people are angry with the Cleethorpes sextuplets. An official policy of eugenics looms
CHARLES MOORE
Few of us know the truth about Jan and Jean and Susan and Sid. Possibly they, or some of them, have been deficient in maternal or paternal or marital responsibil- ity. Possibly their way of managing things is just the sort of life-enhancing, imaginative and honest response to personal relation- ships which the Bloomsbury Group advo- cated for the educated classes before the war and which has now spread to almost everyone. Who can say? But it does seem rather hard to come down so heavily on them because we find ourselves paying for Jan's and Jean's sextuplets. Jean, it is reported, had something wrong with her ovaries. Was this affliction not to be treated because she was not married to Jan and he was living in Grimsby, she in Cleethorpes? Perhaps she should never have slept with Jan in the first place, but that is hardly a matter for Mrs Virginia Bottomley. Jean cannot really be blamed for having sextu- plets. Are people suggesting that, once she knew there were six, she should have had them aborted? If so, no further discussion is possible. But if not, shouldn't they simply be welcomed?
At about the same time that the story of Jan and Jean became public, another health story broke. According to the Sun- day Times, two hospitals, one in Manch- ester, the other in Leicester, will refuse to give heart operations to patients unless they give up smoking. Mr Christopher Ward, a cardiologist at Wythenshawe Hos- pital, says, 'If people don't stop smoking, they don't get the surgery. It's a good way to persuade them to give up.'
Mr Ward's idea of medicine seems to be like the Church's idea of communion: only when you have confessed your sin and resolved to lead a new life and been par- doned are you entitled to it. The principle is capable of wide application. If Mr Ward is right, why should doctors treat homosex- uals who contract Aids? After all, they have been warned. Why should they mend the bones of masters of foxhounds, or stitch up the faces of drunken motorcyclists? Indeed, why should any motorist of any description get any treatment at all, since each is know- ingly persisting in an activity even more dangerous than smoking? A doctor I know once had to treat a man who had a light- bulb stuck up his bottom. Mr Ward, pre- sumably, would have sent him on his way sorrowing and untreated, for there can be no good, responsible reason for having a light-bulb up one's bottom. It can only be the result of a deplorable carelessness, and wasting doctors valuable time with such a problem shows a lack of respect for their high calling.
These painful questions seem to arise more and more often. One explanation may be that people have always, though perhaps only implicitly, thought of the National Health Service as related to deserving. The British people, it was believed, were worthy of health care free at the point of use, and that idea partly depended on what the British people were thought to be like. In 1945, they were believed to be hard-working and honest and to have suffered much and deserved better. It seemed the thoroughly right thing to help them to be healthy. Now there is a question of who 'they' are. Taxpayers are conscious of a large class of people who live off them, who expect everything free, who give nothing in return and who do not even recognise their own responsibilities. This is the world Theodore Dalrymple describes in these pages every week. If such people are having their tattoos removed on the NHS and being given miracle babies and expen- sive treatments for their drug addictions, resentment grows. The subject of breeding is particularly sensitive. The underclass probably breeds almost twice as much as the middle class now because its pregnant mothers are so young. Each illegitimate birth in that class means a heavy prospec- tive welfare bill for the taxpayer, who there- fore gets more and more tetchy. I have a nasty feeling that taxpayers now hate the idea of people being born at all. Hence the anger at the sextuplets. An official policy of eugenics looms.
In the meantime, and so, as endlessly ris- ing expectations clash with endlessly rising bills, people start looking for a policy about who should get what. The service will do what it calls 'prioritising', and the depriori- tised, such as smokers confronted with Mr Ward, will tend to die.
I cannot see any solution to this problem that can be contained within the NHS. It is not much use setting up some great distinc- tion between what is essential and what inessential. That is done in practice, day by day, by working doctors. But there is no general way of doing it. What is essential depends on cultural attitudes, not on any- thing objective. Indexes of poverty in Britain today now regard a fridge as a necessity. Forty years ago it was a luxury. The same thing has happened in medicine.
As it is, spending on the National Health Service has risen in real terms all through the Thatcher years and it is now Conserva- tive government policy that it should do so. If the Chief Secretary to the Treasury is right about the public finances, this will have to stop in two years or so, and when it does its effect will be agonising because the cut will not be in doctors' fees or adminis- trators' salaries, but in services to patients.
There is no point in looking to politicians to solve this. They will instinctively turn to Christopher Ward-style solutions. The only escape is to buy one's way out. One must subscribe to a private health insurer, to which the obvious objection is that most people cannot afford it. The same was said about private housing, yet we have moved from about 10 per cent owner occupation in 1914 to about 65 per cent today. In fact, it is surprising that more people are not on Bupa and its rivals. Relatively poor people will pay money for cars and mortgages and foreign holidays that they still would not consider spending on medicine. Perhaps that shows that people are not as discon- tented with the NHS as they say. But if society continues to get richer, the dissatis- faction can only rise. In 50 years or so people will look on the NHS rather as they look on council housing today — as a necessary, if badly run, piece of public benevolence which saves only a minority and from which it is best to be emancipated. The idea that it could ever provide the best health for all will seem an historical curiosity, like the notion that the League of Nations could secure world peace. If the NHS is the League of Nations, I feel we are shortly approaching the inva- sion of Abyssinia.
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