Policing the decline in healthcare
The police are playing an increasingly prominent role in the NHS and social services. As health services are more and more stretched there is a greater emphasis on maintaining public order.
One example of this is the increasing tendency to treat the mentally ill as if they were criminals. You can get a ridiculously sanitised idea of this from the police training video in which the handcuffs go on as part of a caring and calming process leading to the patient, who’s been causing a disturbance, being delivered to a place of safety. The reality is not so pretty – half a dozen police raid the home of someone who is already frightened and unable to cope, cuff him and take him away in an ambulance. Sometimes dawn raids are carried out as though the mentally ill individual is some sort of terrorist.
If the way the police deal with the mentally ill has become more systematically brutal in recent years, there never was any golden age within capitalism. Not only does the stress of daily life within capitalism directly trigger mental illness, capitalist society is also incapable of providing adequate support that might enable the mentally ill to continue to lead normal lives. Instead, it relies on repression and compulsory treatment (organised in Britain under the various ‘Sections’ of the Mental Health Act) - necessary because the most severely mentally ill cannot cope in what passes for ‘normal’ society within capitalism. As conditions worsen, what care there was tends to be progressively replaced with an inflexible and terrorising mode of enforcement prioritising naked repression.
In terms of treatment of the mentally ill, the closure of the old asylums in the 1960s and 70s was presented as – and believed to be – a great liberation from the old repressive impersonal institutions. But hopes were dashed by the paucity of provision and ‘care in the community’ was really about ‘neglect in the community’. It turned out to be just another cost cutting measure, enabled by the development of new drug treatments. But the overall issue of the treatment of mental illness throughout capitalism is beyond the scope of a short article.
Another example of the increased weight of repressive forces relates to the laxer rules for divulging patient information to the police. For decades it was believed that information was confidential unless the law (in the case of road accidents and terrorism) or a Court demanded it be divulged. Now the Department of Health’s Code of Practice on Confidentiality, 2003, states “Under the common law staff are permitted to disclose personal information in order to prevent and support detection, investigation and punishment of serious crime…” Furthermore, unlike the disclosure of patient information for medical research, or the disclosure of Oyster travel information to the police, there is no clear framework for making such decisions which are simply left to the particular organisation or individual members of front line staff who are likely to be most vulnerable to police pressure. There are not even any records kept of police requests for information or whether these were acceded to or refused. (See ‘Police access to NHS confidential medical records’ http://webjcli.ncl.ac.uk/2010/issue4/pdf/dickson4.pdf).
The NHS is often seen as a protector, in contrast to private institutions which are presented as being solely driven by the profit motive. And we have seen two glaring examples of the dangers of the profit motive recently with the torture of people with learning disabilities at Winterbourne View care home; and with the example of Southern Cross which has put its residents’ homes at risk though a sell and lease back financial manoeuvre. However, while the private enterprises are motivated by their immediate profits, the state and its institutions – including the NHS – exist to ensure the smooth running of the capitalist system, to provide the best conditions for the private institutions to carry on making their profit. So it is hardly a surprise to find the same kind of cost cutting in the NHS that creates the conditions for the sort of scandal that occurred in the Castlebeck home. Nor is the NHS immune to leaseback financial manoeuvres – isn’t that exactly what the PFI (Private Finance Initiative) is?
The way a society treats the sick and vulnerable is one way in which it can be judged. On this standard, state and private capitalism are to be condemned.