Should Services be Rationed?

October 12th, 2016 | Posted by Lynn Strother in Health

Interesting… when watching the news or documentaries, whenever there is a failure in the provision of services, health care, housing (or in fact most things in life), it’s always the fault of older people!  Why are you living so long?! Not that there’s much room in the cemeteries where you have to share a space…

How easily it is forgotten that those older people – now remember we are talking about people as young as 50 here – are paying taxes! Many journalists seem to forget that the amount of tax you pay depends on how much you have, so, if older people have all the money and assets the journalists say we have, then we are contributing millions to the tax man!

Older people are undertaking child care (usually without pay), are providing down payments for housing, funding for university and much more besides.

So – should older people be blamed, or should there be more equality of thought? The rationing of services impacts not just on older people, but on the whole community of every age.

We are hearing more and more how there is not the funding to provide services the way we have managed in the past – health, social care, rural bus services, banks, post offices – how many more services have vanished, become almost invisible or been drastically reduced?  I guess I am lucky as I still have a milkman!

I can’t believe that for years and years all these different companies, services, organisations were running at a loss.  For many rural villages there used to be a bus several times a week – nowadays you are lucky if there is one bus service per week!  The banks are closing their branches as it is not cost effective to keep them open.

For once older people are not the main people to blame – in fact they want bank branches to remain open – it is the technological age that is at fault.  High streets are disappearing due to internet shopping.  Do you remember campaigning for post offices to stay in your town?  Now they are in the corner of a small shop or W H Smith’s with usually a queue stretching right round the shop – especially at Christmas time.

Of course the major issue at present is the government’s reduction in grants for councils.  There is no way the hole that represents the provision of council services can be filled.  It’s not even enough to increase council tax or find other devious ways of obtaining more money from the borough residents.

Therefore there is no alternative to cutting services such as libraries, day centres, lunch clubs and “rationing” the services that are available to those in greatest need – and the criteria for those in need becomes tighter every year.  Thousands who used to receive care are now deemed ineligible.  But of course – the blame is put on older people, or those requiring services.

But is this not a bit short sighted?  Do you remember Prevention, Prevention, Prevention – the mantra which would save the councils and the NHS vast amounts of money and make people’s lives better?  Where did that go?  Have you heard it spoken in the loud terms as before or just quietly?

Of course logic tells you that prevention and urgent action – or even action within an appropriate time frame – DOES save money for both councils and the NHS.

For example, if you ration hip replacements, what happens?  The patient is in pain, requires lots of drugs or visits to the GP, may have to give up their job and take benefits, or may even become immobile. All of which leads to more visits to GP and an increased need for council services.

The patient then becomes depressed from being housebound and in pain and therefore needs further community services.  When the patient is eventually operated on, it is a bigger operation requiring more hospital resources and greater risk to the patient.  On discharge from hospital, council rehabilitation and other services are needed.  The patient will take longer to recover and if they have developed mental health issues, they will need long term services.  By this time it may be impossible for the patient to find new employment and so remains on benefits.

Now – please explain to me how rationing is cheaper than ‘in time’ services…

Life is like a jigsaw puzzle, but to get a complete picture the pieces must be joined together, and – in spite of all the rhetoric of the last 10 years or more – services and budgets are still not joined up. People do not exist in one department or the other, people live across departments – so the sooner councils get rid of ‘departments’ and work across the board, the sooner we will have some form of integrated care.

But of course, it is also a culture thing and that lies with the government.  Government departments do not see, or do not want to see, the holistic picture of people – they want to put them in departments.

This would not be quite so disastrous if the departments actually spoke to each other but of course they don’t.  They have soundproofed steel walls encasing each department so that other departments don’t know what’s happening.  And of course, each ‘department’ has to fight for its own budget, so naturally they are not going to share it with another department.  This is one of the major explanations as to why there is not integrated care or services.

The other issue is the very real ‘black hole’ in funding for health services. There is an ageing population of GPs who will soon be retiring – many before their natural retirement age as they cannot continue with the stress.  There is a shortage of doctors for hospitals in all specialities, which results in very tired doctors trying to give the best care they can whilst working all the extra shifts for the government’s grand ‘7 day week’ policy. In fact doctors have always worked evenings, nights, weekends and bank holidays.

There is a shortage of nurses too, which again may increase with the restrictions of trained staff from other countries working in this country.  All Hospital Trusts are in debt and many have no hope of getting back into the black.  Many hospitals are paying for the past government’s brain wave of PFI, which is costing hospitals millions in interest but the contracts are so long nobody can get out of them.

So the future is not looking so rosy.  Further rationing will become the norm only it’ll probably be called something slick like “efficiency savings”.  Don’t think that councils and the NHS are particularly interested in keeping people who need a range of services alive, unless they can pay for themselves – which again highlights the economic divide which is increasing by the day.

Sorry – did not mean to depress you! It would be interesting to hear your comments.

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