now not then

For many years I worked in an NHS health promotion department, with the unenviable topic of smoking. Unenviable, because it became political, empire building, a them and us view, us being in the health board as opposed to the frontline, considered to be locked in ivory towers with no understanding of what it was like to be a smoker trying to quit. In fact, I ran a smokers' clinic so did have an idea of the hour-to-hour struggles faced by someone in that position.


What was more frustrating was the GPs who grumbled about nicotine replacement therapies being paid for out of their drugs budget. Despite the well-documented evidence that smokers using such products were twice as likely to give up this addictive weed. I could never understand why a doctor sanctioned paying for drugs for emphysema, heart conditions - both of which have smoking as a main risk factor - but not for something which might stop people developing these killer diseases. It seemed that many medics couldn't embrace the long-term view. A fire-fighting, not a trouble-shooting approach. The GP opinion that if a patient could afford to smoke, they could afford to pay for nicotine replacement therapy further demonstrated a lack of insight into how many people on a low income think. Budgeting is, although not exclusively, a middle-class activity.



In my private life, I've recently experienced another example of the short term view, with the treatment of M. (blogs 23 & 28/9). She was discharged from hospital having suffered a bad stroke, with no plans to refer her for community physio. It was highly unlikely she'd ever walk again, I was told. She was told she never would. M. doesn't have financial worries, so we arranged for a physio to assess her privately. The outcome was quite positive. Of course the physio couldn't guarantee M. would walk again, but she couldn't rule it out. A second assessment is planned with the aim of getting her standing again. And it will go from there. M. isn't alone in being written off walking-wise. That same physio told me of another patient who'd been discharged home with a poor mobility prognosis. A year later he is walking with sticks.

It shouldn't be the case that those who can afford private care have a better chance, but it is. Health inequalities are as alive and kicking as ever. And yet, when it's us, or someone we love, we're bound to shove such principles aside, aren't we?


Likewise, with education. Having the wherewithal to send our children to private schools, aren't we likely to disregard equalities issues, forking out thousands in the hope our loved ones will have a better experience at school? Not that this is guaranteed.

And with regard to facilities for those who're not doing so well, whether it's mental health, learning disabilities, young offenders, we might support plans for a new building, as long, perhaps, as it's not near enough us to cause problems. 'Not in my back yard' is the expression which rears its ugly head.

I suspect the reality is: principles, in moderation.


Realistically yours

Jane