Tuesday 1 September 2015

A Good Week Part 3: A Therapeutic week or a Scrounger's Treat?

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:

NHS personal health budgets spent on 'patient treats'


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. 









13 comments:

  1. as i sat here reading yet again a lovely written peace of work and feeling for you and questioning myself over my small health problems which is not a bad thing i am drawn by the feeling that whilst i feel strongly about it and i understand i may not the best person in the world to take the fight of the disabled person to this government if i dont at least try then i am no better than they are and this country need to ask the questions the elephant in the room do we wont a health service free at the point of use and if so we need to pay for it and when we can pay for bombs bullets at a drop of a hat so why not the NHS
    i am taking the fight by doing this course so that when i speak they more likely to listern as i have the correct qualifications and that seems to be all trhey are botherd about thank you for the fight in my belly and i will do my best as my way of saying thank you for your wise words

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    1. You do so much for people Phil - thinking of you as you begin your course. All the very best xx

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  2. Very well said Debbie. You should send a copy of this post to the BBC and maybe a newspaper or two.

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    1. Thanks for your encouragement Jeanette - much appreciated. You of all people know of the health benefits of 'frivolities' such as access to music!

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  4. Stories about fraudsters sell papers. I don't like this society we have built ...

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    1. Too true. It's bad enough when it's the Daily Mail, but when it's the BBC it's shocking.

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  5. This is huge area, Debbie, well said. There seem to me to be two problems, or maybe three. (That always happens, as soon as I write two, another comes to mind!)

    1. Bad Language, not swearing but using language that sets up a culture - scroungers, treats, benefits rather than welfare, compassion, generosity, kindness, neighbourliness, holistic care, human being not human thing etc.

    2. The expectation that a problem needs medical intervention is kicking in at a lower level and I worry this is causing loving, caring folk to feel inadequate, not professional enough, and of course the system can't cope and maybe shouldn’t need to. We’ll be outsourcing love soon. And with that goes something some will find hard to take: suffering happens. There are questions to be asked of each of us about how much suffering it is reasonable for us to bear as part of being human. Has our threshold dropped too far now? I’m probably thinking more emotional than physical here, but some of that too, like patients demanding antibiotics when taking them will blatantly do no good and have detrimental consequence for everyone.

    3. I imagine there is inadequate research about ‘wholeness’, though end of life research might have more to say about this, but it shouldn’t apply only then!! Of course drug companies don’t want to fund research into non-medical interventions, and in our increasingly short-termistic view of far too much of life, many things are not amenable to quick fixes. But long-term fixes or ameliorators or compassion givers are not liked because they lack measurability for political gain.

    Do I sound cynical? Too right. I wish some way could be found to depoliticise healthcare while also leaving it in the public sector.

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    1. brilliant Helena - thank you xxxx

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    2. More and more in our consumer driven days (so hard to resist), big questions need asking about what it is to be human, be community. Too right people should have treats. I missed one of your vital words off my list in 1. dignity. I've had a read of the personal health budgets NHS site, they repeatedly talk about health and wellbeing. Quite right too. Illness can be so stripping and isolating.

      If only those who moan and point the finger were to ask themselves before throwing a tantrum: 'What would I want for the person I love most or for me in times of sickness or disability?'

      I'm SO glad you have had treats, had anything that makes you feel more like you, and the family too.

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  6. I'd question whether all medication treatments are properly evidence based, even if the diagnosis is valid and correct

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  7. a very good point, thank you. Let alone how something that is 'proven' to prolong biological life should be weighed against the reduced quality of life its side effects cause,

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  8. Excellent points regarding evidence and effect. Some medications aren`t licensed to be used on the patient group who benefit from them thus skewing the evidence still further.

    Qualitative research seems somehow more wholesome to me, capturing as it does so very often, the non quantifiable aspects of the human experience. Tick boxes, audits, spreadsheets - so difficult to equate to real experience. We are exhorted to apply the `6 C's` to our practise; care, compassion, competence, communication, courage and commitment. I never realised how much courage it would take to be compassionate.

    Your post speaks to me of compassion and of the ability to empathise and understand. The emotive words used in the article are intended to incite the opposite. The therapeutic use of touch, under-valued, undermined. Touch, touched; physical and non-physical. The irony being that health-care providers speak so much about the quality of care and the physicality of the way we produce it yet society wishes to define it in fiscal terms and value for money. The value of the gentle retreat, or the eloquence of different surroundings and different experiences outwith the hardship of the individual`s enduring circumstances yet are not easily quantifiable to the untrained eye. Facts and figures are what counts.

    And yet there, in your post, lies the true value of monies well spent and the therapeutic effects therein, so quantifiable. Healthcare needs to be creative (another `C' ) in its compassion and embrace other aspects of care - with Courage.

    Stay strong Debbie; you are an inspiration.

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