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Entitlement is a funny word

Some conversations over the last couple of weeks have had me thinking

People seem to view entitlement differently – we all pay our taxes to pay for the core services but some of us use them more than others.  I have worked for 15 years and paid my tax but been fortunate enough to not need a great deal from these services – as I see it, part of the equality the tax system creates is that those who earn more pay more and statistically are less likely to use the services and so hopefully pay disproportionally more for services used so that those who have a need can get the care and support that they require.  And yes, it is wrong that often that need for increased medical care or social support is because they are earning less or unable to work.  It is wrong that it is often a vicious circle.

My main issue is that there is a limited pot of money.

Even taxing the top 10% of wage earners more is not going to increase that pot of money dramatically (sorry but evidence seems to suggest that the top 10% whilst earning more are also more likely to up sticks and take themselves and the tax they pay if a tax regime gets too punitive)

The trouble is that with minimal resources and over demand, for example, the NHS is never going to be able to deliver the services we are all entitled to.  Somewhere it has to give.  And some people it appears are more likely to step back and not insist on the system giving them their entitlement.

I was shocked to read a survey on one parenting site asking if people would lie to get an early scan for ‘reassurance’.  Early pregnancy is awfully worrying, early pregnancy loss is horrid but if the NHS could afford to give early scans they would. If someone lies about a threatened miscarriage they take resources away from someone who may have a real and greater need.  When I had a threatened miscarriage with Littler at 18 weeks I was told that whilst guidelines suggested they should scan me to confirm if the baby was dead or not but there was insufficient funding and I would have to wait three weeks for an anomaly scan because they just couldn’t afford to scan miscarrying women after 12 weeks.  They gave me a shot of anti-D, a pat on the arm, advised a bit of bed rest and to come back if the bleeding got unmanageable or the pain unbearable.  Never mind the pain of not knowing what was happening.  Fortunately I had a brilliant midwife who spent a long time listening to my tummy and eventually found a heartbeat.

Scarce resources also come into the argument about what sort of birth a woman is entitled to.  No woman should suffer unnecessarily, should have pain or fear during her births but where do you draw the line between allowing women to make the decision about whether to submit to a c-section and medical professionals doing so.  A c-section costs several multiples of a ‘normal’ delivery plus has the attendant additional costs of post operative care.

Could the scarce resources be better spent on educating women ante-natally to reduce the likelihood of problem births with associate post birth trauma and interventions?

Should counselling be offered to empower women about their birth choices?

Or should women be able to choose to not go through labour, especially if they have had a difficult experience previously?

Where do we draw the line?

Does entitlement mean we should automatically get what we are entitled to or should any consumption of scarce resource be balanced with an understanding that if you use this resource (and perhaps you didn’t need to) someone’s Grandparent may not get rehabilitation after a stroke, someone’s baby may not get sufficient neonatal care, someone’s husband may not have a heart problem detected early enough to save them?

Should use of the NHS come with warnings like cigarette boxes saying if you use this service then x cannot happen elsewhere?

How do we deal with not having enough money to give everyone everything they would have in an ideal world?

Where do we draw the line between entitlement and desire in a world of scarce resources?

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13 comments to Entitlement is a funny word

  • Boat-Wife

    Very well said. I’d like to see this point of view in the mainstream press more, so that people can think about how they use the service. (I worked in NHS admin for 6 years until recently).

  • Great post, and probably something people dont consider very often. Some people always think they are entitled – even if they havent contributed.

    Regarding birth choices, unless there is a medical reason, I think a woman should have a normal birth, there should not be the option of c-section just because, for exactly the reason you said, the cost on resources.

  • Brilliantly put. We need to see the consequences of our actions and be held responible for them especially with the NHS. We neeed a little common sense and we need to use it!

  • It’s such a tricky question with the NHS….coming from the States the fact we can get as much medical care as we can free of charge was hard to believe at first. Unfortunately it is hard to control what people feel entitled to, and I think there will always be those that try to play the system, probably with limited success depending on the checks in place where they try their luck.

    Re birth, I think there would be value better educating women about their birth choices as provisions for this seem to widely vary. Again what is allowed to be elected seems to vary by location….there may be guidelines in place but are they consistently applied?

  • This is a very interesting topic and it could be discussed for ages. I think that there will always be people that take advantage of things but it does need to be highlighted more to the general public. We need to keep writing articles like this to help it find the wider audience.

  • Interesting post with a lot of things to think about. The sense of entitlement that is in this country is not just around the NHS, i think people just assume that the government should support them full stop.

    Back to the NHS, I come from a country that even thou we have a similar set up to the NHS we pay to go to the GP… unless of course you are on a benefit of some sort there is a standard going rate… I do not understand why the NHS does not do that here, even if it was just a tenner it would all add to the coffers.. Also in regards to c-sections, yes, perhaps better education would help to lower the high level performed. However my concern would be how long do you leave someone to try and have a natural birth before the mother and child’s life is compromised?? How many people would be happy to pay the NHS to have an elective? i know i would have paid..

    So IVF on the NHS, that’s an emotive one??

    Sorry for the long comment but its good to read a post that makes you think…

  • Fabulous post. I think part of being in a society is accepting that resources are finite, and just because you are legally entitled to something doesn’t make it morally right that you should have it.

    The NHS is designed to provide for all in the case of clinical need, in order of urgency, and I accept it’s an imperfect system but those seeking treatment they don’t need, only want, are doing a disservice to us all.

  • Emily O

    Very good post which has got me thinking. I think we all need to accept the NHS has limited resources and allocates those in a way which it sees best (although this always causes a clash between managerial and medical professionals – I worked in the NHS in my first job after uni). I think patients need to accept the NHS does what it can which often is far from ideal. But, in my experience, I think NHS staff can often make a better judgement on clinical need than patients themselves. Put simply – if you want a certain type of birth because you feel you deserve it then pay for it yourself.

  • Crystal Jigsaw

    I think there are many, many people who claim any benefit they can get their hands on and a lot of them know exactly how to work the system. The NHS struggles to cope and if people insist on sponging it for more treatment than they know they really need, they are pushing those who do actually need to treatment further down the list. But unfortunately, the types of people who do this probably couldn’t give a toss about anyone except themselves anyway.

    As everyone has already said, this is a great post and really interesting talking point.

    CJ xx

  • Mum2babyinsomniac

    Great post. I think a lot of people in this country just take for granted how lucky we are to have the NHS, the amount that is spent on drunk teenagers is ridiculous and at the risk of sounding controversial, what about the people who have liver transplants then keep on drinking, or the overweight who won’t diet and just rely on having surgery to help them lose weight, or over the heavy smokers who are deliberately putting their health at risk. These people are all using more than their ‘fair share’ of healthcare and like you said there are people more deserving who miss out. Somethings got to give – I would rather pay health insurance than see the NHS run on any less money x

  • I see what you mean. I quite like the Belgian system for conundrums like that – we have (cheap, national, obligatory, tax-like) insurance, and most stuff is paid back except for a very small fee. However, if you want something extra, you can just pay for it. Then if you want an extra scan, you pay thirty euros or something thereabouts, and they give it to you without any problems. I know this means that richer people will get more stuff, but I wasn’t rich when I had my miscarriage, but I was happy to get choices. In the end, though, I think that time was all covered.

  • Very well put. I always felt that the NHS offered a good basic service. Sometimes it’s difficult to go pay if you want something extra – I’m in favour of making that easier as long as it doesn’t compromise the basic system that is free to all. As to reassurance scans – why don’t people just go private for them? It’s 90 quid, but hey, if you’re worried it may be worthwhile? There is though also the issue that according to your postcode you get different service/entitlements on the NHS. For instance we don’t get nuchal fold translucency scans here and I think they are common place in most areas. That to me isn’t a fair system, it should be the same service where ever you live. Where do you stand on homebirths? It has been discussed that having homebirths as an option means more resources are needed – now while I think we agree that it would be nice to keep this choice for women, can we justify keeping it with limited resources and overstretched midwives?

  • The NHS provides a free service for all at the point of need. It is a pressured and challenged service. It’s not perfect but I do believe in the majority the teams and resources are working to do the very best that they can. If you don’t need a treatment then you shouldn’t receive it. If you are faking and by that I include over exaggerating to receive a treatment then you are no better than any other tax evader. No one is entitled to anything they don’t need on the NHS in my opinion.

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