The A&E crisis must be all my fault, obviously

News & Analysis

7th January 2015

A preview of Hugo Rifkind’s column in this week’s Spectator, out tomorrow…

Oh, I see. So it’s my fault. There I was, thinking that the general swamping and near collapse of accident and emergency services in hospitals across Britain might be the result of, you know, some sort of systemic problem within the NHS. With me, a mere member of the public, just being an occasional victim. But no! Apparently it’s all because I took my wailing two-year-old daughter in, one Sunday afternoon last year, to get some antibiotics for her ear.

This is good to know. For, had I not been told that all this was the fault of chumps such as me heading to such places for the sorts of trivial ailments better treated by a traditional family doctor, I might in my ignorance have been inclined to blame other people. Such as — to pick an example off the top of my head — Britain’s traditional -family doctors, many of whom might indeed still agree to see a sick toddler at 3 p.m. on a Sunday afternoon these days, but probably only if you stalk them, perhaps with dogs, then chase them through deserted woodlands before pinning them to a tree with a crossbow bolt and holding up your child before their dying eyes. I’d imagine.

Or I might have blamed Tony Blair and his many, many health secretaries, who (I feel it was one of the bald ones) somewhere along the way decided to remove the responsibility for out-of-hours care from GPs and hand it to primary care trusts. Who still employed the same GPs for a while, but forced them to do the same work for far, far more money, poor loves, which was obviously a situation they resented terribly. Or Andrew Lansley, who did… well, God alone knows what to the NHS, really, but whatever it was, whoever it left in charge seems in many areas to have abandoned meaningful out-of-hours care altogether.

Or I could blame David Cameron himself, not only for putting Mr Spock in charge of the Enterprise, but also for the shape of his cuts to local government, which resulted in councils slashing social care, and those who rely upon it falling down to A&E, as crumbs fall to the tray in your toaster. Just so you don’t think this blame I’d have been spreading would have been partisan in any way. Back in my innocence. Before I realised it was all down to me.

Or more terrestrially, I might have blamed the NHS telephone service. Because it’s not as though we want to go to A&E, we trivial time-wasting nincompoops with our red-hot screaming children, is it? No, we do what we are told. We dial 111 and invariably — and really, I don’t know how this always happens — somehow manage to miss the ‘Dial 9 if you’re not a total chuffing idiot who needs to be spoken to like Forrest Gump’ option. So they do speak to us like that, don’t they, asking ‘Is the baby’s head still on?’ and suchlike, before telling you to contact your GP and then — and in quite a tinny, distant manner now, because the telephone is cracked because you’ve smashed it a million times against the wall, because why would you have called them in the first place if you’d been able to do that? — saying, ‘Oh, yeah, well you should probably go to A&E, then.’

Or I might have blamed campaigners who want to ‘save the NHS’. An odd choice, you might think. Yet it is they who have made doing anything — anything — to stall the looming, runaway train of a health -service disaster so politically toxic. They lie. They do. They lie all the time. They wilfully conflate ‘the NHS buying a service from another provider’ with ‘David Cameron selling your health service to his mates from Eton’. Buying and selling. Different things. No? Is that hard to grasp? Then they shriek about ‘privatisation’, knowing full well that this makes people think of America, and insurance, and shudder, even though barely a single politician alive in Britain today believes in anything other than free healthcare at the point of delivery. And the very worst thing about these people is the way they believe themselves to be on a moral crusade. As if caring about anything other than outcomes when it comes to health was not, in fact, as close to the opposite of ‘moral’ as one can be.

Or, while I’m casting around, I could have blamed Andy Burnham, the shadow health secretary, for taking all the above guff and absorbing it, thereby filling Tory hearts with fear as much as he is filling Labour ones with arrant bullshit, and ensuring that the one conversation nobody will have in the long, long run-up to the next election is an honest one about actually improving anything. Although I suspect he’s somebody I’d be better off blaming in the future, when things get even worse.

I’m sure there are other people I might have blamed, had my ignorance continued. I’ve no idea what Jeremy Hunt has done lately, but he’d certainly have been worth a crack. Or I could have blamed immigration, albeit nonsensically, what with the way that a far higher proportion of those working in the NHS are immigrants than of those who use it, thereby showing us that without immigration things would be much worse. But no, it’s none of these people. It’s everybody else. It’s the arse end of the Big Society, in which the populace at large is no longer the solution to every problem, but the cause. It’s me, and my daughter’s ear. And all I can say is, I’m very, very sorry.