Healthcare… or something else?

A few weeks back, I ruminated briefly on aspects of the nature of modern policing, which at times seems to have very little to do with justice, or with catching criminals, or anything much which resembles that which we used to deem maintaining the rule of law. If the police have been co-opted as the willing stooges of every latest piece of half-baked progressive ideology, then we have definitively lost the basis for a democratic consensus.

It turns out that the rot has spread rather further. Recently, in pursuit of attending ailing family members, I have been spending increasing amounts of time on hospital wards. It has been an illuminating and somewhat harrowing experience. There are staff on these wards – nurses and auxiliaries and (very rarely) the occasional doctor. Clearly, there are not enough staff, and whilst one could offer a justifiable critique of the nature of care, where the carers lack de minimus language skills to enable them to communicate with vulnerable patients, the chief observation has been of the underwhelming impact of that care in practice, and its meritless elongation.

Generally, the picture was of hospital staff operating as particles in brownian motion. A steady plodding to and fro, symptomatic of an absence of direction, or purposeful activity; a tending to basic bodily needs (toilet, meals, cups of tea, the dispensing of prescribed drugs), indicative of a kind of passive maintenance mode. The enforcement of the waypoints within the daily regime, often at the expense of the patients. Occasional instances of more obvious human interaction, but little that appeared to demonstrate an underlying informed intentionality. The consultant had written in my mother’s notes that her legs should be propped up, due to the gross oedema (this preventing any progress with mobility), but there was no sign of such a basic support. Raising the matter (!) with the attending nurses caused consternation, partly because merely mentioning the fact appeared to be an affront, and partly because there was no piece of equipment that performed such a function. A futile experiment piling ill-assorted cushions in an unstable column was the nearest we got to following the consultant’s (painfully obvious) recommendation, and the resulting solution was short-lived. Indeed, the only time we saw a nurse galvanised into something resembling decisive action was when one lady decided we had exceeded the allowable number of visitors and evicted my wife from the ward. The humiliation of the only clinically-trained visitor who was able to communicate clearly about my mother’s needs did not seem to be an especially admirable moment of action in an otherwise desultory atmosphere of disinterested passivity.

In toto, my mother spent twelve weeks declining in a hospital, and was barely able to return to her own home, such was the degree of neglect on a ward that was (we were told) dedicated to rehabilitating patients. Three months of this kind of treatment is quite long enough to become institutionalised. This is not medical care, as I observed in relation to my father’s similarly disinterested treatment in another Essex hospital. This is warehousing, and it seems to be predicated upon the twin concepts that (a) the patient has no intrinsic value, other than as a consumer of services, and (b) the notion of intentional clinical purpose is simply too big a burden to be placed upon the staff. No sense of urgency is detectable. Patients will either get better, or they will simply decline, and there is no pathway visible which might move them from A to B, based upon the idea that B is considered to be an improved status.

Now – of course – I am quite aware that not all hospitals are like this. Even in Essex, which seems a scary place to be seriously unwell, I am aware of wards where there is a more palpable sense of focus, where the observable activities are suggestive of telos. But that was not what I was observing in relation to my parents’ treatment in two very different hospitals – the pattern there was undirected, and the activities were simply oriented around maintaining a kind of status quo, one that nobody had any real interest in modifying or even questioning. When you enter wards (as a patient) that function like this, there is a very real risk of not leaving them at all, due to the stultifying impact of habituation. The practice of medicine has been eviscerated of its directional or aspirational motivations by a kind of Neo-Darwinian apathy, where tautology rules the day, and the patient will improve providing that he or she improves. Hitherto, I had understood the phenomenon of ‘bed-blocking’ to be a function of dysfunctional Social Services implementation at the point of (potential) discharge – my observation over a sustained period of time is that it may just as well be due to the internal NHS culture, which indefinitely and needlessly postpones the moment of discharge. In relation to this, and as a broad aside, I have recently been informed that, in Wales, NHS physiotherapists are no longer permitted to require their patients to cooperate in their rehabilitation. They may coax. They may wheedle – but that clinically necessary historic practice of benign bullying is no longer permitted. And as a result, as one might expect, mollycoddled patients no longer play their part. But male patients must be supplied with tampons in their toilets, given that ideological novelties now supersede clinical priorities.

No wonder the UK’s healthcare system is so expensive in comparison with the rest of Western Europe. Each successive government is goaded into flinging more money at the problem and (usually) complies with such pressures, because that feels like the easy option, compared with the far starker challenge of reinventing the culture of care within a postmodern world that has been systematically deprogrammed of the Christian ethos which gave rise to the hospitals in the first place. Modern secularists fondly imagine themselves as participants in a kind of evolutionary process, where the contributions of earlier, unaccountably religious generations lay the groundwork which may be casually discarded for a newer, better model, something that feels more satisfyingly Darwinian, where we happily cut the umbilical cord to our own epistemological foundations. Increasingly, that kind of faith in the inevitability of human progress, denuded of its own metaphysical framework, looks like the kind of empty, wishful thinking that you would expect those of a Dawkinsian mindset to lampoon. That they do not is depressingly suggestive of a void where, historically, one might have expected some kind of critical self-awareness.

It’s time we stopped blaming the NHS’s deficiencies on whichever colour of inept government that may currently be underwhelming us by its shallow insights and predilections for short-termism. What has crippled the culture of care is naturalism, and the resulting erosion of concepts such as human dignity and purpose.