Free healthcare is a disincentive to personal responsibility for health

I've just come off the phone after a regular chat with my mum. She's 88, living in a tiny bungalow in what was once a development of sheltered accomodation in South Cambridgeshire. (I say 'what was once' because, some years after she moved in, the council gave up on the 'sheltered' idea, just giving the residents a phone number to phone if they needed anything, and once-a-week visits from a council officer.)

My mum was quite mobile in January 2020, but, as our leaders gradually put the fear of God into people, she stayed indoors in her tiny home from March that year. 'Use it or lose it' is the phrase my osteopath uses with regards to muscle strength, and, by February 2021, my mum was hospitalised due to her legs not working. She then spent maybe ten days in Addenbrookes followed by a couple of weeks in a rehab unit, where they were apparently much in demand due to the numbers of old people who'd stopped walking during the lockdown.

By March my mum was home but only just able to get around. We all encouraged her to build up her strength, to do exercises and to walk - with her zimmer -  around the courtyard outside her home, so that her leg strength improved.

I suggested she should try to get in and out of a car, so that she would know whether she could, perhaps, contemplate a trip to church or the local pub for a (socially distanced) meal. She managed the car at the end of last month, and then, on Wednesday, my sister took her to the pub for lunch - her first day out in over a year.

Unfortunately she let slip details of this excursion when she was later visited by the district nurse. 'We are not allowed to visit you if you can get out', she was told. 'We are only for the housebound.'

So, there you have it. You can have NHS services but woe betide you if you make any effort to improve your quality of life.

Sadly, this is not the only time I've encountered such a problem. When Viv was really ill, four years ago, the community physios were able to visit for a few weeks, but after that we were on our own. There was no ongoing support, no encouragement to try to improve Viv's mobility, and no help whatsoever to improve Viv's quality of life. We had to pay for a private physio to help me work out a safe way to get Viv in and out of the car, and up and down stairs (neither easy for a disabled person, but hugely significant steps in terms of quality of life, and in improving strength).

We've also seen this sort of thing with the eye hospital with regards to Viv's cornea, which was a problem as a consequence of her tumour blocking the nerve that makes her right eye shut. Viv was being seen by NHS specialists, but that stopped with the pandemic - we were only able to have phone consultations (how can someone's cornea be properly assessed over the phone?). We knew Viv needed an op but there was diddly squat the NHS was going to do about it with all the 'virus' going on; we had to pay to go private. 

Private medicine is a totally different experience from the NHS. Your specialist listens to you, and will, as far as they can, do what you want - you, after all, are the customer. They'll even phone you up personally to check how you are, and encourage you to tackle new challenges, and improve your health generally - not in the nagging way the NHS adverts do, but they'll listen to you, find out what you want to do in life, and suggest how they can help. The NHS seems to have lost track of what people need and want from a health service - to be better able to do certain things, but things that may vary from one person to another - and is trying to treat everyone the same way, in a patronising, 'nanny state knows best' sort of a way.  As a consequence of this, and of the finite amount of resources available within the service, the NHS will categorise everyone, and set limits on what services they will provide and to whom, in terms of the patient's condition. This discourages patients from attempting to get well, which is a service objective the NHS seems to overlook.

If, as a country, we're going to get the ever increasing level of demand on the NHS under control, we simply have to incentivise patients to improve their own health themselves - to try to get well, to improve their lives. Encouraging people to not do this, by threatening to withdraw support if you get 'too well', is, dare I say, stoking up trouble for the future.