It's taken me longer than I planned to finish my reflections from our holiday in Stixwould - I knew there was more I wanted to say, but wasn't quite sure how to frame it. However, one of the headline stories from this morning's Today programme on Radio 4 has left me ranting, and given me the shove I needed to get me started.
The story if you missed it, was this:
It's a complex issue that'll need a bit of teasing out, so bear with me. But whatever you conclude about what is or isn't appropriate use of the NHS budget, what for me is beyond doubt is that both the BMA and the BBC are behaving irresponsibly by commenting and publishing in a way that can only fuel prejudice against the most vulnerable.
Let me go back to our little holiday in Stixwould. I wanted this post to be largely about gratitude, because the truth is that without the generosity of others, we would almost certainly have decided that any sort of holiday was beyond our budget this year. There have been other spending priorities that have had to take precedence. I haven't been earning since I was diagnosed, and as the financial advisers from MacMillan confirmed, I hadn't a snowflake in hell's chance of qualifying as entitled to any benefits beyond free prescriptions. I would almost certainly be classed as fit to work down a coal mine in the current climate, after all. The fact that we have had our Manchester mini break and the Stixwould holiday, complete with theatre and cinema, meals out and lovely comfortable accommodation, is solely due to some generous financial gifts from friends and family, and charitable grants from trusts set up to support church workers.
Most of us don't find is easy to receive "charity". Most of us would rather pride ourselves on working to pay for our own treats. But what has made it much easier to accept the position we're in is the realisation that our friends have wanted to do something to help me feel better. And they have succeeded. They've made us all feel better; but they have also, very specifically, improved my health. By giving me the chance to enjoy real, restorative rest and good food. By giving me time away from the business of a clergy house. By giving me the mental and physical stimulus of a new environment to explore gently. By making me feel loved and cared for. These things are not, I would argue, some sort of hedonistic self indulgence; they are therapeutic tools, and they have contributed to my mental and physical well being as surely and concretely as the - much more expensive - drugs, medical procedures and hospital accommodation bill I have run up on the NHS budget this year.
Not everyone has friends and family, however; or charities for whose help they are eligible. For some people who are long term sick or disabled, managing their own NHS health budget involves some hard decisions about what is going to be the best investment for their own health and well being. And some have decided to use this money - to which the NHS has deemed their condition renders them entitled - on 'treats' such as holidays, riding or music lessons, a sat nav, massages, or - the extravagance of it! - £7 on hiring a pedalo. If they had spent the same money on additional drugs, mobility appliances, etc, presumably no one would have batted an eye. But who is to say that their health has not been more improved and their quality of life more enhanced by the choices they have made?
So - my first reason for exasperation with this story is the assumption that only drugs or medical equipment could possibly be of therapeutic value to a patient. The British Medical Association bewailed "the inappropriate use of scarce NHS money on non-evidence based therapies . . .While individuals may themselves value a massage or summer house, others will understandably start to question why they can't also have such things paid for by the state - and that will just fuel demand." Yet no one questions the huge amount of money spent on drugs for patients which may in some cases be less effective than an activity or item promoting physical or mental well being. "Doctors have to follow the evidence, they have to make sure everything they do is effective. To see in other areas of the NHS money maybe being spent on things that doesn't have such evidence behind it, particularly at a time when the NHS is trying to save lots of money, is hard to swallow." But how can you produce 'evidence' of the health benefits of a holiday?
I understand the instinct that a "Health Service" ought to be about providing items that come with a prescription label. But the NHS' own charter talks as much about well being and patient centred care as it does about illness and treatment: it's a health service, not a medication service. And if someone's mental or physical health will be more helped by a holiday than anything else, and the NHS has deemed them deserving of a budget for their mental or physical health, then I for one can't see that it is a problem to spend it on a therapeutic holiday rather than therapeutic drugs.
My real problem, though, is with the way in which this story has been reported. The highlighting of 'horse riding' and 'holidays' and the use of the word 'treats' all seem subtly designed to promote the idea of the long term sick and disabled as scroungers, misusing hard earned tax payers money for frivolous ends. But their decisions that this use of the funds to which the NHS had deemed them entitled were wise and justified were all approved and agreed by NHS representatives. They have done nothing wrong. And yet the article gives the impression that they are some sort of fraudsters. I think there's plenty of "evidence" to suggest that that will be quite the opposite of therapeutic for their mental health.
Meanwhile, I'm just grateful that I have people who love me to thank for my 'treats', rather than a Health Service which gives a benefit with one hand, and takes away the dignity of those who receive it with another.