A drunk is worthy of NHS care just like anyone else
It is a fact of British politics that the NHS is in crisis. Whichever party, or coalition of parties, enjoys a pleasant honeymoon in the sun drench gardens of Downing Street will be charged with saving the NHS. This at a time when each and every politician professes to have their hands tied behind their back by a fiscal rope. The NHS will face profound changes in the coming years. Either it will adapt to changing demographics and demands or it will implode. However, if we are to save the NHS, the second religion of the British State, we must save its testament and scripture, and not only its pews, arches and steeples. In this article I want to restate one principle, and argue for it to be paramount in NHS’ future. That is the principle that any healthcare system, but particularly one with the history of the NHS, is not means of moral judgement.
What do I mean when I say the NHS is not a means of moral judgement? I mean that the NHS should provide healthcare without moral constraint, restriction or, indeed, judgement. That is to say that the NHS should provide healthcare to any patient without holding them to a set of moral criteria by which they are deemed worthy or unworthy patients. This is not to say that healthcare workers don’t have to make moral judgements, they do so constantly, but that the provision of care is not conditional on being a ‘good’ person. Being worth of healthcare should not require anyone to meet a set of moral standards or criteria.
That care might be subject to moral restriction seems unlikely, but the logic is only too straightforward. The NHS is under great financial and logistical pressure – NHS’ Simon Stevens has outlined a potential £8 billion NHS funding gap by the end of the next parliament. One way to cut costs is to restrict the obligations of care to deserving patients. This may still seem farfetched, but calls for it are continual. The example I will unfairly pick on today is comments made by North Ireland’s former Minister of Health, Social Services and Public Safety Edwin Poots. (Unfair because Mr Poots is not the only example, not because he is undeserving of criticism.)
Once again, as New Year’s Eve approached, the morally upstanding citizens of this country cast about, aghast at the celebratory catastrophe that is to come, searching for a sanctimonious sanction to save all that is good and pure. New Year’s Eve is a fulcrum for concern with the British problem with drinking. The tradition of drinking too much, so that we begin each new year with a stone pit of sickness in our bellies and a headache which obscures our bright future, is a bit of fun which is evidence of the ‘moral decay’ and ‘collapse’ of our society. The only thing more traditional than drinking even more than usual on New Year’s Eve is complaining about drunks even more than normal on New Year’s Eve.
Joining in these great British traditions Mr Poots has muted the idea of charging drunks who end up in accident and emergency. A&E is a particularly pressurized part of the NHS, and its is perceived that, at times such as New Year’s Eve, drunk patients massively increase the workloads of healthcare workers. “The principle has merit” he has said – though he has more hesitations about the implementation. The chattering of one former minister are of little importance, what is of more importance is where that chattering falls in a wider condemnation of ‘problem drinkers’, and the creation of a category of ‘undeserving patients’ who fail to meet moral criteria required to be treated as a regular NHS patient.
The point of this article is not really to criticise Mr Poots or his proposal itself, but to use him to ridicule the very notion of an ‘undeserving patient’, and the danger of allowing moral criteria for NHS treatment. Poots is a DUP member, a passionate, and fundamentalist Christian. He is a creationist, and holds very traditionalist, conservative Christian views. As Health Minister he attempted to use healthcare as a tool for puritanical social judgement. In 2013 he attempted to ban blood donation from gay people, sighting (obviously not existent) evidence that being gay was a kind of risky behaviour that should bar a person from donating blood. I’m not attempting to claim that this case is closely comparable to charging drunks who stumble into A&E, but I am saying that it strikes me as being as absurd as the idea of an ‘undeserving patient’.
What exactly is motivating Poots’ suggestion to charge drunks at A&E? It cannot be a purely financial one – otherwise would we charge all patients? There has to be some specific reason that drunks should be charged but not other patients. Nor could it be a logistical one, designed to discourage drunks from coming to A&E at all. Not only would that be deeply morally questionable, but why not apply the same to the 2 million non-emergency patients (according to The College of Emergency Medicine) who go to A&E when they should instead see their GP or pharmacist?
It is far more likely that Poots wants to impose punishment on sinful consumption, or maybe it is a more bog-standard prejudice towards ‘binge-drinking louts’, a highly classed grouping that plays into worn discourses of working class feckless drunkenness. That is unless Poots intends that middle aged (71% in alcohol treatment are 30-54 according to 2012-13 data), and increasingly middle class (according to 2013 studies from the Universities of Newcastle and Sunderland) patients who suffer from long term harm due to alcohol consumption are to be charged as well. Presumably this could also be extended to smokers, to over-eaters, to reckless extreme sports enthusiasts, even those who self-harm or attempt suicide? Of course the very notion is revolting, but what sort of moral criteria can be constructed to prevent this whilst still charging drinkers and not being based on blatant puritanism and prejudice?
In this short article it was not my intention to consider every possible justification for every possible set of moral criteria for care. It was rather to suggest that any consistent criteria that avoid blatant prejudice will be unacceptable, and that an inconsistent, or worse prejudiced, moral criteria has no place in any healthcare system – and especially not in one with the history of the NHS. Mr Poots’ musings about New Year’s Eve revellers was just an example to help explicate my central point, but it goes without saying that his proposal must be prevented from going any further. Moral judgement has no place in the decision to provide care on the NHS. In an NHS hospital you are a person first, a patient second – ‘drunk’, ‘Christian’ and ‘criminal’ can be left at reception.