With great power comes great responsibility

As many readers of this blog know, I seldom offer any political views in my weekly postings. So it was with some amusement that I sat down to think about what to write for this week’s post general election post. Of course, I could do the historical thing and note that the first general election in the England was in 1708, a time when the Whigs were fiercely dominant and kept the Tory party out of power for long, long periods of time. Or that, during this time, most politicians were very rich and often landowners, but that might be straying too close to the ‘making a political comment’ wind. I can say that I have voted in every one of the 13 general elections that have been held since I turned 18, and I have always felt it was a real privilege to be able to do so.

Last Thursday was no exception. Early in the morning I went and cast my vote. It turned out to be a momentous day; it was our Trust Board Christmas dinner, and for the first time in several years we had an almost complete Board sitting down for the meal (which was delicious). Going home by train later that night I was able to look at the election exit polls and knew that Friday was going to be a difficult day for many. I went to sleep, but J stayed up to see the results emerging.

Whatever the outcome you were looking for, the actual results were astounding. My heart went out to all those candidates who lost their seats, many of whom had worked so hard to serve their constituents and their various parties. There was sadness tinged with joy in our house as we saw the local results get announced. J has been a parliamentary candidate since the 2017 election and for lots of reasons chose not to contest several North West seats, all of which were filled by the Conservatives, one for the first time in its history. I was sad for her and with hindsight, maybe it was the wrong decision not to stand this time. However, I was glad that I didn’t have to face the prospect of sharing her time and energy with a parliament in London and the concerns of constituents in a neighbouring town.

I take my hat off to all those who did choose to put themselves forward and now have the daunting job of delivering on all their campaign promises. It was good to see the NHS foregrounded by all the political parties during the election campaign. But all the issues identified remain wicked issues. Promising extra staff is likely to prove easier to say than deliver. The demographics work against increasing the workforce, as do the economics. The percentage of population living longer, but often with complex needs, continues to grow. The capacity issues in meeting an ever-growing ask of the NHS won’t be solved by building new hospitals, even if it were possible to do so. And I hope I’m not being too political here in saying this.

Whatever your politics might be, I think we as society, have got to make some hard choices in the near future. Extra doctors and nurses, more modern well-equipped hospitals are welcome, but we need to address a much more fundamental set of issues, to truly make our NHS a health providing service. Many of the health issues we face are the result of choices we make during our lives. Smoking, overuse of alcohol, unhealthy diets and a more sedentary lifestyle are all major contributors to both physical and mental ill health. But its not that simple. Good health and wellbeing are multi-factorial and often complex. They will be influenced and shaped by a number of things including our age, employment, where we live, family history of illness, and of course, those lifestyle choices.

There is plenty of evidence to suggest that many people choose unhealthy lifestyles and behaviours because they tend to be thought of as being effective in managing stress and other life challenges. I was surprised to see at my recent visit to a mental health hospital in Portugal that both doctors, nurses and patients were smoking, something that’s allowed in law. In the UK, 50% of all tobacco smoked is smoked by people with a mental illness (although you can’t do so in hospital!). Likewise, alcohol (and drug) misuse are commonly associated with mental illness.  People gain an average of 13lbs in the first two months of taking antipsychotic medication and the weight gain continues over the following 24 months. These are the kind of iatrogenic consequences best described by the Austrian philosopher and priest, Ivan Illich. His book, ‘Medical nemesis: the expropriation of health’, published in the same year I started my nurse training, suggested that the practice of modern medicine had led to an ever increasing number of health problems resulting from medical interventions. We have only to see the justifiable concern over hospital acquired infections such as MRSA, C-diff, and CPE or the focus on Hospital Standardised Mortality Ratio (HSMR) and serious incidents like wrong site surgery, to have a sense that this might still be an issue.

Perhaps more importantly, Illich described that contemporary medicine, in appearing to offer cures for nearly all conditions, (even those previously thought not pathological) raised the false hope that all suffering could be avoided. The impact that results from such thinking is that over time, people’s, and communities’ self-sufficiency, freedom and dignity are all undermined. Many people will simply become passive consumers of healthcare services. Consider the demand for help and care in most Emergency Departments – all the research consistently notes that over 30% of all presentations do not need the intervention of A&E, and of these, many are simply uncomfortable but ultimately self- limiting health problems. Providing more hospital beds to relieve the pressure at a hospital’s front door is not the answer.

Concentrating on reducing poverty and social inequality, both of which are also linked to poor health, might make more of a difference. That said, all healthcare professionals, wherever they live can also help. I remember with fondness the MECC (Making Every Contact Count) public health initiative from 2013. It’s an evidence-based intervention that supports people to make healthier choices and directs them to the best place to help in doing so. My hope is that the newly-elected politicians and all healthcare professionals can work more closely together to ensure we have a healthier Britain in the future. After all, as Spider-man said on many occasions, ‘with great power, comes great responsibility’.