It’s up to us to care for our elderly, not the NHS

Injections of money alone won’t rescue our health service. A broken social contract must be repaired

The granddaughter of Clement Attlee says that if Clem were alive today, he’d be appalled at the way people mistreat the NHS: turning up to casualty drunk, missing appointments, etc. I think that’s a powerful observation. When the NHS was founded – this week in 1948 – Britain had a strong sense of social contract forged in war. Rights came with responsibilities, many of which were so self-evident that they didn’t have to be written into law. Seventy years later, we demand more from the welfare state than ever before, but the narrative of obligation is less strong. It has broken down on both the societal and the personal level.

For example, a friend recently spent time in a hospital ward. Nearby lay a woman who screamed all night long. She had dementia and, from what my friend could gather, was one of those tragic individuals described as a “bed blocker” – someone who belongs in social care but, for the lack of it, winds up being housed on a regular ward. The popular instinct is to demand more public money, and that’s part of the solution. As we all live longer, so the cost of care rises and it cannot be borne solely by the NHS – so it’s time to put new funds into looking after the elderly. But if we’re going to have to dig deeper into our pockets, it’s not unreasonable to ask: what role for the family? Shouldn’t they, if possible, be the primary care givers?

Of course, that’s not always the way in Britain any more. We like to pretend that we’re a nice, tolerant society, but this often extends to just the young and the fit. Yes, there are millions of carers out there doing a smashing, largely unrecognised job of looking after their families, but there are also countless cases of the elderly being hidden away, forgotten, even “dumped”.

The phrase “bed blocker” is horrifically loaded. It suggests the elderly person with dementia is depriving a youngster with a future from getting help, and it echoes grim attitudes that are often found in state-run bureaucracies, even those built to fulfil egalitarian principles.

If you see patients not as individuals but as numbers on a sheet, and if you have to ration a finite amount of resources, you’re inevitably going to make Darwinian choices about who does and doesn’t deserve treatment. This is the real sense in which the NHS is “our NHS”: not in the mumsy, socialist way that Labour puts it, but in that our healthcare model reflects the inequalities and imperfections of our postwar society.

The Tories claim that the way to save the NHS is to give it an extra £20 billion. Labour has raised its offer to £22.4 billion. Fine. If it takes a bidding war with taxpayer money to fix the health system then so be it, but this has to be accompanied by some serious changes. For a start, drop the notion that the NHS is a charity for which we should be grateful. Its staff are trained, conscientious professionals who work wonders – but they do get things wrong and we do have a right to demand better. We patients also have a responsibility not to exploit a public service paid for by our neighbours. If anyone misses an X-ray or turns up to A&E drunk as a skunk, let’s fine them. There can be no excuses. Missed appointments cost NHS England – which means taxpayers – around £1 billion a year.

We can go further: stop asking the NHS to take care of things that are our responsibility, starting with our own families. It’s odd that parents have a defined duty of care towards their children but children don’t have one towards their parents, even though a sick parent can be just as vulnerable and helpless as a child – and the essential bond of blood relation is no different. This co-dependent relationship is recognised in other societies; in fact, where traditional responsibilities have started to fray, they’ve written them into law. In 2013, China declared that offspring must visit their parents “frequently” and make sure their financial and spiritual needs are met. This law was written partly in reaction to the discovery that a farmer had kept his 100-year old mother in a pigsty with a 440lb sow.

I’d love to see a similar law passed in Britain, even as I struggle to imagine it happening. We are at a crossroads in British history and have to make some big decisions about how we want to organise our society. We could “tax more to spend more”. But why not revisit a few old ideas in search of a new social consensus? I suppose because the blood bond is an unfashionable concept in the modern world, as it suggests there is an organic, defined relationship between individuals that defies liberty or self-definition. It’s uncomfortable. It’s inescapable. And the obvious challenge is: why should a child that was mistreated by a parent have to care for them in their dotage?

The answer must be left to rest with the individual’s conscience: the state should never compel us to go beyond the bounds of reason. All I can offer is a surprising personal revelation. My father and I did not like each other, but something in me said I had a duty to be with him when he died. After years of recrimination, I couldn’t quite walk away. In fact, I don’t think I could have lived with myself if I had.