TOO DEPENDENT ON WELFARE?
believes he knows the answer
MR John Moore's well-publicised observa- tions have highlighted a commonplace of Conservative thought that the hypertrophy of the welfare state has not only damaged the economy but has produced moral deterioration in a significant proportion of the population as well. That which the Left blames on the deficiencies of capitalism and the hopelessness of unemployment, the Right blames on the removal of incen- tive and consequent loss of meaning in life. ' One can't help pondering such ques- tions, even if they are unanswerable, in a present-day doctor's surgery. The great mediaeval physician, Moses Maimonides, once uttered the prayer that he should never see in his patients other than suffer- ing human beings; but then, Moses Maimonides never worked in the National Health Service. I'd give him about half an hour before he changed his prayer.
My surgery one morning did not start well. I was acting as locum in an area of London unlikely ever to be gentrified. I received a call from a lady whose eldest, illegitimate daughter had run away (again), whose house had been burgled three times in the last fortnight while she was in it, and whose neighbours regularly staged knife fights outside her ' bedroom window at night. She called to tell me that the sleeping pills I had prescribed for her the previous day hadn't 'touched' her. Strange to relate, a solution to her problems did not spring ready-formed to mind.
I had two telephone calls in quick succession from social workers. The first concerned a young woman who was far too ill to come to the surgery, even under escort. Apparently, she had collapsed on to the floor immediately after opening her door to the social worker. I asked the latter whether she was quite sure the collapse belonged to the realm of medicine rather than the theatre; she was not amused. The patient, being of Jamaican descent, suf- fered from the racial tension in her council flats, she said. I did not dare point out that this was scarcely an answer.
I visited, as requested. The patient made it to the front door and back up the stairs before again 'collapsing', this time on to her bed, where she rolled carefully in simulated agony. She did not pass the time of day or thank me for having come; on the contrary, she breathed resentment. Her only remark, other than an incoherently dramatised account of her symptoms, was that she 'couldn't' take pills — any pills. She had a mild infection that could not in any way have impaired her ability to come to the surgery.
The second call from a social worker concerned a young man, reportedly threat- ening to kill his mother. He was probably psychotic and possibly dangerous. The social worker asked whether I would pay a visit to his home to find out whether he was indeed mad. I said I would go, after I finished seeing my patients in the surgery.
It later occurred to me that, as the social worker knew the patient and I did not, it would be a good idea if she accompanied me. I telephoned her, and she said she would have to ask permission of her `senior'. Shortly afterwards, she rang back to tell me her senior had insisted that if she came with me to visit the patient, there should be a police escort, an ambulance waiting and a hospital bed arranged. In other words, it was perfectly in order for her to despatch doctors into the jaws of death, but she was far too precious to risk it herself.
I went to the boy's home. It was in one of those vast estates where the flats are numbered by a random-ordering device, specifically to confuse doctors on their visits and waste their time. Naturally, the grounds — such as they were — had been deluged with litter, particularly beer cans. All the corridors and stairwells smelt of urine or vomit, and the lifts did not work; the immensely long corridors of the flats were protected, prison-like, by heavy iron gates, supposedly operated by entryphone from each flat, but long since broken. The corridor walls (where there was light to see them) were covered in graffiti, often National Front slogans, or messages from gangs. I noticed 'thought' was spelt 'fort' as in 'I fort you was. . .
There were three television sets in the flat, which was dirty from years of neglect. The boy was mad, his mother slatternly beyond description. I prescribed some pills and left.
I then visited another young woman, on a similar estate, who had also 'collapsed'. She was resting beside her illegitimate child as I arrived. She, too, had a slight infection that would not have prevented her from coming to the surgery, had she wanted to. Naturally, she did not thank me for my visit: it was no more than she had the right to expect.
As soon as I returned to the surgery, I received a call from an old lady obviously in severe distress. I visited her at once: unbeknown to her she had cancer, which had caused a sudden attack of breathless- ness and pain in her chest. She apologised profusely for having dragged me out, as she termed it, and thanked me for having come. She begged me not to send her back to hospital where she had been so much lately, without benefit (they hadn't ex- plained what was wrong). I said we would try and make her comfortable at home and, again, she thanked me. She asked me whether I should mind taking her prescrip- tion round to the chemist, who was always kind enough to deliver it for her. Though she was incurable I felt, for the first time that morning, that I had done good.
I have noticed many times that those born before the war behave to their doc- tors with civility not always encountered in postwar generations, and this is true across the classes. Where everyone is convinced and watchful of his rights, genuine sym- pathy dies. The effect of the welfare state on the general population is a matter of dispute; its effect on those who purported- ly provide the welfa're is not.
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