The state giveth and the state taketh away

I work in the public sector. In the NHS, specifically. In Audiology. Hearing and balance.

To do my job in the private sector is tricky. There are precious few equivalents. An exact equivalent (working in a private hospital) would mean working in London, or doing consultancy work and I am not a suitable position financially or career-wise to do so. The alternative (being a hearing aid dispenser in a high street branch) often utilises unpleasant tactics, poor standards, far too much emphasis on sales, and is considerably limited in terms of the scope of the job.

 

• I consider myself lucky. The private sector effectively pays my wages. Via the government. I am very grateful for this. It allows me to do my job impartially, with no element of self-motivation as regards the care I provide.
• I will never reach the dizzying heights of salaries available in the private sector. I’m ok with that. I have ambition as regards my career. I want to reach as high as I can. I want to be involved at high levels. Because there I can do the most good, I can get the best job satisfaction and the most enjoyable challenges of the job.

 

• I have excellent conditions. Lots of holiday, sick pay (which I will only use if I am genuinely sick), the opportunity for flexible working, a good pension and an incremental pay scale.
• I don’t need 27 days holiday (plus bank holidays). I effectively don’t even work a full 11 months out of the year. Ridiculous. I don’t need a pension that good. I can save money. There are private pension schemes I can enter. I most certainly do NOT need an automatic pay rise every year as if it were my DUE???? I can work hard, excel and be offered a pay rise in accordance with my performance. And if I want it badly enough, I will get it.

 

• I am also in the hands of the government. This is far from an ideal position to be in. They can choose to interfere and meddle at will. They can slash pensions, they can cause redundancies, they can close hospitals, they can kick entire fields out of the NHS (as is likely to happen with mine if we don’t get our act into gear and evolve to meet the needs of Lansley’s health bill).
• I have made my peace with this. I will not rely entirely on my terms and conditions staying the same. I will not trust the government. I will put into place contingencies, personal savings and other investments to ensure my long term security. I am in charge of my own destiny. The government will, undoubtedly, try to mess with it. It is up to me to ensure they cannot do so irreparably.

 

I am not, never have been, nor ever will be a member of a union. Biting that hands that feeds me is stupid. I work in the public sector in order to serve the public. I am proud to do so and I am paid to do so. I will not let my patients, colleagues or managers down by going on strike.

The state giveth and the state taketh away. Public sector workers should accept this, or move on.

Revising my opinion on caesarean choices

Approximately a month ago a story appeared in the news about all pregnant women being offered the option of a caesarean delivery rather than traditional push-it-out birth.

I was seriously hacked off when I read about this. We’re all aware of the yummy mummies, the celebs, the people who are too posh to push and don’t want the inconvenience of giving birth naturally.

In a way, I can understand. Having a chuff like a wizard’s sleeve holds very little appeal, likewise the prospect of having stitches down there, needing to pee in the bath for six weeks after giving birth because it stings too much, incontinence issues and having to hold off sex (not to mention the psychological difficulties one imagines that both woman and partner can experience after going through childbirth).

Now I’m sure all of the above is totally exaggerated. And doesn’t happen to everyone. But it is the perception of a natural birth.

I also felt annoyed that people could choose to have a caesarean on the NHS, paid for by the NHS, when there was no medical reason to do so. In my opinion, I would have preferred to see the NHS offer the option, if women were willing to pay for it. They wouldn’t have to go privately, but the taxpayer wouldn’t need to shoulder the burden. (At this point it would be easy for me to digress into talking about the NHS needing to offer more options, including the option to pay for certain options but that’s another story).

Today I woke up to see that more details had been revealed about the caesarean option.

And I felt utterly ashamed of my initial reaction. As someone who works in healthcare, and a profession which is particularly focussed on patient motivation, providing information and adopting a very patient-centred approach, whereby the patient takes ownership of their experiences (the logic and evidence being that if they do so, they are more likely to have success with their care), I should really know better than to have jumped the gun with my uninformed opinions last month.

Today I see that caesareans won’t be refused to women who ask for them. Well that’s a very different issue to offering them out like sweeties. And quite right too. It’s the woman’s body, and in the spirit of personal responsibility, freedom of choice, patient centred decision making and stepping away from authoritarian clinician-led decision making (which the evidence shows is a massive NO-NO), this is absolutely what should be done.

Today I see that the guidelines are being updated to reflect what is already taking place. I.e. counselling women, discussing the options, the risks, the benefits.

The following struck me as particularly important to take note of:

Malcolm Griffiths, a consultant obstetrician and gynaecologist who led the development of the guidelines, said: “Caesarean section is a major operation, it’s about as major as a hysterectomy.

“It’s not a major operation that most pregnant women are interested in or want to have.”

Very few people want a major operation. But they may be misguided and misinformed about caesareans being an easy option. They may see it as preferable to traditional birth. In fact, both ways have advantages and disadvantages and every woman will rank these differently. Some people may want to get the hell out of hospital as soon as possible. Other people may be concerned about recovery times. Some women may have specific concerns about the different medication and pain relief provided when comparing caesareans and traditional births. There can be no one-size fits all policy. And these guidelines ensure that healthcare professionals give women all the necessary information.

I absolutely welcome the guidelines which state that mental health support should be given to women with anxiety or phobia of giving birth. There’s 9 months in which that baby needs to be looked after in the womb. Spending those 9 months feeling petrified and anxious will do no good for mother, baby or partner.

Up until now, it’s been a medical reason that has lead to caesareans being performed on the NHS. Well, stop me if I’m wrong but isn’t the brain an organ too? Just like the liver, the kidneys, the lungs? Sometimes the brain gets ill too. If anything it’s more susceptible because it has a consciousness that livers and lungs don’t have and can be influenced by outside factors. Having a phobia or anxiety IS as good as a physiological/medical reason, in my opinion. Simply because we don’t fully understand the physiology of the brain does not give cause to dismiss psychological issues as being non physiological.

Something which really stood out for me about the new guidelines is that it’s so much bigger a picture than whether women are thrown the choice of a caesarean. There are upgraded guidelines about HIV positive women giving birth, the issue of antibiotics during caesareans…and I’m sure much else that hasn’t been covered by the media.

I know, from my profession and from the evidence base that exists, that if patients feel in control, informed and are able to make the decision themselves, there is much higher satisfaction with the care provided, anxiety levels drop – and this has both a psychological and physiological benefit.

Giving birth is obviously a massive deal. I didn’t know before today but there’s a Birth Trauma Association. The after effects are difficult to predict. But I suspect that if a woman is happier with her labour, there is likely to be a reduced chance of post-natal depression and this can only be a good thing. It lifts the longer term burden off the NHS, it improves matters for mother and partner and helps the baby form healthy attachment during those critical early weeks/months.

So yes, women will not be denied a caesarean if they request one. But as always, life is not so black and white as to be the case that requesting a caesarean is akin to asking Starbucks for a skinny latte versus full fat. The new guidelines are about ensuring women get the facts and information and support that they, as individuals, require. This means more likelihood of the best decision being made, not just the easiest. And with relatively minimal costs involved, that’s alright in my book.

What is wrong with being rich?

For hundreds of years, being rich was something which inspired awe and respect. Granted, it also brought envy and resentment, but it provided aspiration – if it hadn’t, we wouldn’t have had the industrial revolution, the then middle-class professions wouldn’t have grown as large as they did.

Yet, today, I sense that being rich is something to be…despised? I struggle to understand this. Surely there are only a few ways of obtaining wealth: theft, work (hard work, or clever work), inheritance and winning the lottery.

Theft is obviously unfair, but one would have to give kudos to anybody who manages to steal a life changing sum of money – it takes courage and intelligence. This doesn’t make it morally right, naturally.

Hard work, or intelligent, clever work, seems to be a barely acceptable way of obtaining wealth. If you do, the government takes half of it in income tax, and most of the rest of it in other forms of taxation. Meanwhile, the left clamour for you to be stripped of more of your earnings because somebody else is more deserving.

Inheritance seems to be totally unacceptable any more, which I find a bit baffling. So somebody hasn’t necessarily worked hard, or used their talents and abilities. But who else would you leave your money to other than your children, whom you have created, born, raised, influenced, invested in, shaped, advised and loved and adored for a significant portion of your life? Leaving a donation to a charity in your will is admirable but if you are so inclined, the likelihood is that you’ve been philanthropic throughout your living years as well.

Which leaves us with winning the lottery. Absolute pure luck. No familial ties involved. Yet this method of obtaining wealth is met with positive wishes, and any other less approving response gets silenced with a snarl of vitriol.

I do not begrudge anybody their wealth (theft aside). Naturally, I might feel envious – I am only human. I wish lottery winners well. I think inheritance is a fair choice of the person departed and the recipient shouldn’t be made to feel ashamed of something which was out of their control. I think hard work and using one’s intelligence is admirable and should be encouraged.

I have enough faith and hope in human beings that anybody fortunate enough to have significant amounts of money would be philanthropic, and generous.

I think some people earn disproportionately large amounts of money. Banker bonuses encourage risky behaviour, when the competition required to perform a high pressured, performance related job could be obtained with lower levels of financial incentive. Certain sports players command mind boggling salaries, and significant increases have been seen in this regard over the past decade in particular. There’s an upwardly increasing spiral, with nobody willing to be the one to stop it. It feels somewhat like the date at which retailers start advertising Christmas – they all do it earlier and earlier simply because everybody else is. Footballers get paid more and more simply because all the others are too. Bankers’ salaries and bonus packages go up and up because the element of competition has to be retained.

I would love to see bankers’ remuneration packages capped. I despise the risks they take. And they’re a bunch of smarmy, cocky, slimy, arrogant individuals too. But I’m not sure I approve of the principle. I’d love to see the reset button pressed – where they competed for a £25k salary and a 5% bonus instead (just an example!). The element of competition would remain – who wants to earn the most, be the best, have the nicest sports car out of all the bankers – but the spiral would only begin again.

I don’t have the answer to that particular dilemma. Only questions.

But I digress somewhat. Why is wealth so looked down upon?

Yes, there is a small proportion of wealthy individuals who seem so far removed from reality, such as it is for the rest of us, that one despairs of their empathy. Some might call these people toffs, snobs. But not all rich people are like this.

And there is a small proportion of poor individuals who could be called chavs, for example. Who make no attempt to help themselves, who abuse the benefit system and slag off the toffs. But not all poor people are like this.

My parents were both born to quite poor families (my mother more so than my father). My maternal grandfather is a vehemently passionate socialist. My grandparents worked their backsides off to provide for my parents. My parents both won scholarships to good schools, and were then able to attend university thanks to grants (woo yeah socialism in action, apols to all the students having to pay for it now and for ever more).

From their very humble backgrounds, my parents made a success of themselves. In part this was due to the education they worked hard to achieve and succeed at. In part due to some luck with the housing market – however there was no small amount of effort that went into this. A very run down property (detached, old farmhouse) was purchased cheaply. It had no electricity. This, my father installed himself (whilst my mother was 7 months pregnant with me, incidentally) and we proceeded to renovate the property over many years to its full potential.

One evening when I was about a year old, and my parents were keen for me to sleep, some teenage boys decided to submit our house to an onslaught of eggs and tomatoes and whatnot. My parents went outside to enquire as to the cause of their discontent. The answer? “Your house is bigger than ours. It’s not fair.” My parents explained what I have already detailed above. The boys understood, somewhat grudgingly.

So. I was fortunate enough to grow up in a comfortable household. I think most people would say I was middle class.

My parents were in a position to give me a private education – and given that they could, why wouldn’t they? Going privately meant we had a choice of locations, schools, methods of teaching, curricula, class sizes. My parents were able to work with my brother and I to find schools which would suit us individually and give us the best education.

I grew up with an appreciation of quality, for example: good quality food, which is enjoyable and healthier, good quality clothes, which last longer and fit better. This was because my parents worked their way to this position.

This is socialism in action, surely? A free education, paid for by the taxpayer, enabled my parents to better themselves.

So why do certain people (lefties, socialists) now look down on me for being middle class?

Maybe it should be viewed with a more right wing perspective? My parents took responsibility for themselves, accepted their origins and worked hard to acquire their (relatively modest) wealth.

Either way, taking money from the rich and giving it to the poor means that the poor become richer. So what is wrong with being rich? Clearly anybody can do it. Or is a certain amount of wealth acceptable but once over an invisible line it becomes acceptable to look upon an individual with disdain? Where does this line lie? How much philanthropy does one person need to undertake before their wealth is considered acceptable?

There are horrible people in the world. Some are rich. Some are poor. Some are reasonably financial secure. Some are horrible because of these facts. Some are horrible for other reasons. There are also wonderful people in the world, in the same situations. Why must people make assumptions about people based on their circumstances?

We are all individuals, with different morals, beliefs, attitudes, histories and hopes. These things matter more than our bank accounts when it comes to defining us.