Preparing for Health in Power

Pre-exposure prophylaxis, abbreviated as ‘Prep’, is being made available on the Scottish NHS. The treatment is designed to reduce the risk of HIV transmission. Meanwhile ‘Kadcyla’, a drug for breast cancer, has been given the green light by the Scottish Medicines Consortium. Per annual dosage, Prep costs £5000 and Kadcyla costs £90,000. The English NHS, by contrast, has recently announced the withdrawal of some pills, focusing on tablets perceived as lifestyle choices and pointing out the greater efficiency of private provision for certain goods. Controversies about the choices made by medical authorities, and the values and priorities those decisions involve, are now mixed up in the political differences between Scotland and England.

You might hope that the suffering of patients being treated for deadly diseases would not have to refer us back to an ancient border dispute. Imagine a dreamy utopian world in which one National Health Service, operating across the United Kingdom, achieved broadly consistent policies and principles. The implementation of healthcare would not have to vary much from region to zone to area. Unfortunately the proverbial boat appears to have sailed, or sunk, on that possibility. Blame the Conservatives, or Labour, or the Liberal Democrats, or whoever you like.

Strange, if you give it a moment’s thought. What happened to the vision of about 70 years ago? Britain, collectively triumphant through the trials of Churchill’s anti-Hitler leadership, both the poor and the rich emboldened by brutal experiences and encouraged by the success of communal planning, the nation fairly united around important priorities like survival, food, prosperity and health… in this atmosphere, our NHS grew up. Now it appears that healthcare, free at the point of need, has reached a fragile and senile maturity, limping and squabbling towards retirement. Pressures from demographics and economics were challenging enough, before we started dribbling constitutional dispute into the cocktail.

First Minister Sturgeon must know the power of health issues. Glasgow outcomes are notorious. The Labour Party, which Nicola’s movement has now almost eradicated in Scotland, colonised the topic across the decades — essentially for two reasons. One factor is the coincidence of the political cycle. The Conservative Party cannot easily own a policy area if they did not originate the revolution in that domain. The other has to do with ideas. Sharing the costs of dealing with horrific reality is evidently a strength of socialism. People experience terror at the thought of death and the various torments of the body and the mind. Handling the breakdown of cells and organs, alleviating the attendant anxieties, preventing the worst possibilities and caring for the terminally ill will, probably, always be expensive.

Former Labour Chancellor, Alistair Darling, was replaced as the Westminster Member of Parliament in Edinburgh South West by Joanna Cherry, a lawyer, who was recently ridiculed by an English audience on Question Time. Even after the campaign for independence weaponised the problem of the future Scottish currency, Cherry was not ready for the question. Will we remain entitled to use the UK pound, and if not what will we do? It was awkward television. Darling won his seat from a Conservative in 1987, as part of the sweep of Scotland that undermined Thatcher’s hold on Britain. In that election, the Conservatives lost 11 of their 21 Scottish seats. You might be surprised to learn that there was ever any Tory representation north of Hadrian’s Wall, let alone as recently as thirty years ago.

The nationalists have done a great job of allowing people here to believe that all of Scotland basically speaks with one voice, having almost identical opinions on important matters. The reality is profoundly different. What SNP enthusiasts think is true could fill lochs, bothies, babbling brooks. You can’t force everyone to sing from the same Party Political Broadcast. One of the oldest and most influential Scottish institutions, the Church of Scotland, could not even sustain religious unity between Edinburgh and the Outer Hebrides. Football, perhaps an emotional substitute for Jesus, easily descends into sectarian division. What makes Bute House imagine that a government authority structure will manage it? More importantly, why does anyone trust this new political elite?

If it matters, I have my doubts about the Prep idea. LGBT communities, and other individuals who are classed as being at high risk, might well benefit from prevention strategies. Personal responsibility in sexual behaviour and dependency on medication, however, are not difficulties that should be drowned out by the principle of national healthcare as a universal and free insurance policy. We cannot sustain the NHS if we do not work together to defend it from the sub-Thatcherite zealots. Their great power is the argument that individuals need to “take back control” and stop relying on the state. It is effective because there is some truth in it. Facilitating condom-free promiscuity and piling up the debt burdens, obviously, will not help. As to the expensive breast cancer treatment, please ask a nurse or a doctor.