Cancer 60

We are on holiday again. Every fortnight, immediately after my three day chemotherapy, I get a six day period where NHS staff are not poking around, shoving things into me, pulling things out, and making me sit quielty while a chemical mix is dripped through my body, hopefully attacking the cancerous growths and showing them what for. We like to use these six days productively so we are in a cottage on a farm in the middle of nowhere in Northumberland, one of my favourite counties.

On the way up we listened to the Today programme, where there was the usual talk about problems with the NHS, and how the government are going to train more staff to deal with the current shortages. That is all very well, but the problems run much deeper and wider than that, and we are in need of a new Beveridge report. In 1942 William Beveridge, a social economist, published “Social Insurance and Allied Services” which was a blueprint for social policy in the UK after the war. He proposed three guiding principles; 1) a revolutionary time in world history is a time for revolutions, not a time for patching, 2) the five giants of reconstruction are idleness, ignorance, disease, squalor and want, and 3) social security policies should be achieved by cooperation between society and the individual. Beveridge did not approve of means-tested benefits; instead, everyone should contribute and everyone should benefit.

The report provided the basis for the welfare state the Labour Government set up just after the war, only part of which was the NHS. The rest included various benefits such as family allowance, National Insurance and an increase in pensions.

We are in trouble with the NHS, but it is not a problem confined to the NHS. It is a much wider problem, which is why we are in need of a new Beveridge Report. Within the NHS there is a lot of disquiet about pay and conditions. Equipment is expensive and sometimes insufficient for need. Many hospitals are getting older and in need of updating or replacing. Management systems are top heavy. There is inevitable waste in such a large and complex system. We are treating so much more than we were when the NHS was set up. The sophistication, and the price of sophistication, is incredibly high, and we should be examining the problems more widely to see what we can do about it.

In the Guardian yesterday a consultant proposed six changes to the NHS: link primary care to social care and clarify the role of GPs, agree national standards (levelling up), change attitudes to the caring professions, improve preventive health, an effective obesity strategy (starting at school), and tackling the gap in mental health services. These are hard to disagree with, and they do draw on those wider problems, but how do we solve them? This might take a few blogs.

Perhaps we need to begin at the beginning, with children. We are bringing our children up in dangerous ways. I obviously do not mean everybody, but many of us. We are not enabling risk, we are mollycoddling, and we are providing dreadful diets. It is ironic that in these days while we think we are protecting children by not allowing them to have proper unsupervised play, whether that is a bike ride to the unknown, climbing trees or playing football unsupervised by parents or teachers, etc, we are actually endangering them. We stop them from exercising properly, which obviously has longer term risks for physical health and just learning about risk generally. Boys and girls are different. I know it is not trendy to say so, but they are. A big help for children would be for junior school boys and girls to go back to separate playgrounds. Boys and girls at that age do different things. Girls learn about social interaction (they are the ones who hold society together throughout their lives – controversial but true) and they learn those skills in the vicious land of the playground. Boys don’t care about social interaction, they want to run around and learn to use their physical energies effectively, again in a vicious playground, and in a social way. Give them a football. At junior school most boy played football at least three times a day, in each break (and after school and weekends – unsupervised by parents). It expends the excess energy boys have, it enables them to be rough with each other, and it teaches them social skills (the rules of football). It has the added benefit that they will be more physically tired in the classroom which will enable them to concentrate more on tasks instead of fidgeting and eventually being labelled with some so-called mental health syndrome. Boys and girls play differently. Let them. Stop thinking equality is about sameness.

What is there to say about children’s diets that has not already been said many times? It ranges from not being provided with three good meals a day through to the ubiquity of fast food, unhealthy snacks, and links with lack of real exercise. We used to have breakfast before going to school, eat school dinners, and return home to a properly prepared meal, which has implications for the nature of the workforce and the social structure of the home (I will save that for another time!). Now breakfast is often skipped, unhealthy snacks are eaten at all times of the day, too many inappropriate choices are provided at lunchtime, and there is not always a decent meal in the evening. Part of this is due to poverty (hence the need for wider action), part is due to ignorance (people don’t learn to cook), and part is due to the availability of over-processsed ‘food’. Developing bad eating habits in childhood leads to obesity and later health problems. It is not a sophisticated argument. We all know it, but we don’t do enough about it.

To return to mental health and the vicious land of childhood. Our children are not allowed to learn naturally about interactions with other people. Calling each other names is frowned upon, language is regulated, social interactions are too often supervised. Children are not learning the real difficulties of social interaction and, through this, developing resilience. We used to have a dog eat dog system where those children higher in the hierarchy looked down on other kids, knocked them around verbally and possibly physically, those kids lower down then did the same to ones further down the hierarchy while fighting to get higher up in the system. I am sure this still exists to some extent but parents and teachers are now far too much involved. Over time people learned how to live with each other, became more sophisticated and, while the hierarchy doesn’t go away, it becomes more manageable and people learn to be adults. Very little real harm occured. Those at the bottom of the hierarchy might have had some problems but generally they learned to deal with it. If not, they were the odd ones who might some mental health problems. The current system means many more have problems. By removing the old system we end up damaging our children. We create mental health problems. If they never learn to deal with the vicious interaction that is childhood they end up claiming a ‘syndrome’, having ‘anxiety’ and ‘depression’ and so on. I think a lot of our current problems with young people and mental health is occuring precisely because we do not let our children grow up properly, with all that entails. Let them learn as children then we will (ironically again) resolve the problem of mental health, particularly if we also stop telling children and young people that they have a mental health problem.

Why is it that I keep wanting to end these blogs with telling people to get a grip?

I have written this in the middle of the night because as usual, I can’t sleep in the middle of the night. Today we are off to Craster to buy smoked fish and to eat fish in the local pub. That is my contribution to healthy eating, better late than never!