IMHO a must-read article about the NHS in the current political climate.

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The NHS is a collective endeavour

Some like to describe the NHS as a government-run insurance scheme. But that hardly captures the essence of a public service

Jonathan Freedland
Wednesday September 30 2009
The Guardian


http://www.guardian.co.uk/commentisfree/2009/sep/30/nhs-public-services


There are some people for whom "public services" is a distinctly slippery notion. I didn't realise it at the time, but it used to be that way for me too. Public services was a phrase bandied about on the news, an issue to be debated. But when it came to concrete, direct meaning, for me there was little. That changed when I became a father. I'm not referring to the gradual process of raising children: I mean the night I became a father.

No one wants to read the messy details, but the birth of my first child in 2001 was not a simple affair. My wife's labour took the best part of 48 hours, with more than a few medical scares along the way. It included two long nights of tension, turning, for several hours, into alarm and deep fear.

We got through it, thanks to the NHS. A team of doctors, midwives and anaesthetists at University College hospital in London worked hour after hour, deploying their expertise, their experience, their patience and their compassion to help two people they had never met before bring a third into the world. A truly remarkable event. How often do you witness a group of people work at the very top of their abilities, straining every sinew, not for glory or riches but for the simple goal of helping others?

The gratitude I felt the night of my first son's birth, the desire to climb to the nearest rooftop and bellow my praise for the NHS, was too intense to remain at full heat for ever. Now my son, along with his younger brother, are in a local state primary school. Inevitably, the daily experience of school life burns with a cooler flame. There will always be grumbles and gripes, just as anyone who uses the NHS regularly ? rather than for a once-in-a-lifetime night of high drama ? will always notice the imperfections.

But I try not to let that obscure the core idea, the one I saw with such clarity that night eight years ago. It is an idea that is civilising, humane, and one of the glories of our national life.

It is the idea we should return to when we think about what public services are for and how they should be run, especially now as politicians compete to offer ever more "savage" cuts in spending.

It is the idea that says there are some areas of human affairs that are not a marketplace, because what happens there is too precious to be bought and sold. In these places, you are not a customer or a consumer but a person with a profound human need. You may be sick and need to be healed, or you may be a child and need to learn. But all that matters is that need, not how much money is in your pocket.

Of course, money is part of the equation. British politics has turned for decades on the question of how much should be spent on public services and where the money should come from. But that is not felt by the person who uses a public service at the moment they use it. A Briton who is told he or she needs an operation will think that evening only of their health. Their wealth never comes into it. An American who has heard similarly bad news will have two sets of worries keeping him or her awake that night. Will I get better? And will I be covered for the treatment I need?

Some will want to describe British public services as government-run insurance schemes. We pay into the pot via our taxes, and then take out of the pot when we need to see a doctor or send a child to school. But that hardly captures the essence of a public service.

Something larger ? grander, even ? is at work. The NHS is not simply a mass insurance scheme. It is a collective endeavour. It is as if the people of these islands have come together and declared that we all share a common fate: we live in the same country and we have a duty to look after each other. The NHS, or the state school system, or any other public service for that matter, is the institutional expression of that sentiment. These services are ways we have devised to formalise, to enshrine, our connectedness to one another.

I think this is why some Britons still balk at being called "customers" when travelling by train or waiting for a blood test. For these are realms of our collective life which are ? or were ? supposed to be insulated from the noise of commerce. When we enter a public service, we enter a place where we are not buyers or sellers but something much more precious. We are citizens. We are fellow human beings who need each other.


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