It's Free?

One of my clients last week told me about an encounter she had with a member of NHS staff. When she questioned aspects of her care, she was told that she should appreciate access to free care instead of complaining about it!

It’s ‘free’?

Really?

Let's take a look!

This is straight from the Autumn Statement published by the treasury in November of last year:

‘The government has provided record levels of funding to the NHS and adult social care in England. At Autumn Statement 2022, up to £8 billion of additional funding was made available. This resulted in a total NHS budget of £162.5 billion for 2024-25 in England’.

I wouldn’t call this ‘free’, would you?

No doubt, a fraction of this funding goes to the person my client was speaking to, and given that governments do not have any money of their own and all of the money that the government spends is raised by taxing its citizens (ALL of it), my client ultimately is using a service that she has been paying for in good faith for many years. 

‘Free at point of contact’ does not mean ‘free’, it means that you don’t have to get your purse out there and then but you do pay for it. Collectively we will raise over £162,000,000,000 in one year to pay for NHS buildings, fittings, equipment, staff, (crappy) software and (let’s not forget) pharmaceuticals for NHS England alone. 

But this colossal amount of fiscal spending is not the only price we pay for a ‘free’ NHS and in many ways the other, often unrecognised costs are much greater. 

Conventional medicine operates by matching symptoms to a diagnosis and then ‘treating’ the illness with pharmaceuticals. The body is reduced to mechanics (anatomy) and organ systems that are understood largely in isolation from each other (physiology). Doctors, nurses and midwives operate purely on this premise and they get a reward for it. 

Working in the NHS I have often heard doulas and other holistic pregnancy services criticised for ‘making money off pregnant women’ and my usual response used to be that as a midwife, so was I. Pay was reasonable, there was opportunity for progression, contractual holiday and sick leave are generous and the pension scheme is second to none. Nothing really to complain about and if the overarching narrative is authentic to who you are, this could set you up for life (and it does for many people).

It has always been curious to me that, despite all this, the popular narrative within society portrayed healthcare workers as pinups for altruism, martyrs sacrificing themselves at the pyre of a ‘free’ NHS. At its pinnacle NHS workers were even declared national heroes in the events that unfolded at the beginning of 2020. I recognise that many health care workers were scared due to the uncertainty that lay ahead and they showed up anyways, so regardless of how everything unfolded in the end, the respect that was paid then was earned. NHS workers are generally highly committed to their cause and that is commendable and it is also why, historically, NHS workers have been paid in respect as well as the secure wage and pension. Martyrdom and heroism, however, are misplaced and they don't serve the relationships between staff and service users. 

The NHS likes to see itself as a progressive service, too! Occasionally ‘holistic’ services sprout up within it; I have seen reflexology, aromatherapy, active birth and hypnobirthing services and I was lucky to work within a caseloading midwifery team that could prioritise the human and relational aspects of pregnancy and birth over the needs of the institution (until it wasn't). That'’s a start, sure, yet over the years I learned three things:

First: Generally those services are on the fringe and depend wholly on the drive and determination of those who set them up in the first place. 

Second: Over the years I have observed more and more that ‘risk management’ and ‘guidelines’ are prioritised to the extent that a truly individualised holistic healing, or in the case of pregnancy and birth, a holistic health approach is impossible to implement.

Third: When it boils down to it and we are running out of the allocated billions, those services are the first to go.

I have come to suspect that they might be there for cosmetics, never truly taken seriously by those at the helm and certainly not by the institution of industrial medicine. 

That leaves us with business as usual and with prescribing pills! As I see it, with or without the little niche attempts at humanising it, the ‘free’ NHS is a distribution outlet for big pharma and it represents the medical industrial complex by transferring vast amounts of public money to private industry.

‘Health’ is defined by absence of ‘disease’ and 'disease' is treated with 'medicines' aka pharmaceutical drugs. To me this is how we are increasingly creating a society that is wholly dependent on the ‘free’ NHS. It's self perpetuating and it will get more and more expensive.

The cycle could be broken by allowing practitioners to truly individualise their approach. Helping people out of their rut and adapt healthy lifestyle changes requires compassion and it can't be done on a ten-minutes-per-patient conveyor belt. Practitioners who want to connect are not given the time or the opportunity to see the same clients again. Pressures increase as the population becomes more dependent and less able to take responsibility for themselves.  We now have a society who take a trip to A&E with even the most basic ailments expecting 'medicine'. We see this happen more and more as it gets more and more difficult to gain access to your GP. NHS policy makers have created a rod for their own backs with their protocols and guidelines, a lack of curiosity in the intricate workings of the human body, mind and spirit and the willingness to throw pharmaceuticals at the problem at the drop of a hat.

As a practitioner this is not for me.

As a service user it is not for me.

Personally, I like to speak to therapists whose understanding of the body, mind and spirit is similar to mine. My herbalist for example, who has helped me live well with a thyroid condition that the NHS initially diagnosed as ‘hyperthyroidism’ some twenty years ago (given how it evolved, I reckon it never was). According to the endocrine consultant who was not one bit interested in connecting with the 27 year old woman rolling into her office, baby in tow, trying to understand the issue at hand, I only had one option. My questions were interpreted as questioning authority, I guess, given that I ended up getting myself discharged and ‘put to the bottom of the list’ for the misdemeanor of asking for time to think. According to the consultant I was 'refusing' to take the pills she was offering: some drug to ‘paralyse’ my thyroid and the contraceptive pill (no way!) because the aforementioned drug would likely cause foetal anomalies should I conceive. 

‘If that doesn’t work, we’ll give you radioactive iodine’. 

Hard pass!

Thank god for my herbalist Robert whose knowledge of the human body is incredible. His intuition is remarkable, too, and he actually has time to listen and to care! We have such stimulating conversations each time I visit and that is a big part of healing, isn’t it? Feeling understood, conversing, learning how you might be keeping yourself stuck in your dis-ease? We don't just talk about my health, we talk about health in general and the small prism through which the body is (mis)interpreted in conventional medicine!

Recently Robert and I chatted about how wrong conventional medicine gets the whole iron supplementation in pregnancy thing. The aggressive iron supplementation protocols totally neglect the relationship between circulatory iron levels, tissue iron levels, magnesium, retinol (which is the form of Vitamin A you are told to avoid) and copper.

Mainstream maternity care is so far off the mark when it comes to their understanding of 'pregnancy anaemia' that I reckon they create some of the problems they find later down the pregnancy timeline themselves, particularly when it comes to ‘small’ babies and preterm labour.

A high price for 'free' care!

In a retrospective study of over 150 thousand pregnancies, those women whose haemoglobin (red blood cell) concentration did not fall during pregnancy had a five to sevenfold increase in the incidence of low birth weight and preterm birth when compared to the women who experienced the normally occurring drop of red cells in mid-pregnancy (I have referenced the study authored by Dr Steer in 1995 below).

I find it concerning that in recent years women who tick the box of ‘risk factors for anaemia' at booking are simply handed a box of ferrous fumarate, without even waiting for their red cell test to come back, when we know that women whose red cell counts fell to 8.5-9.5 have babies with the healthiest birth weights according to Dr Steer's study. This has to do with a healthy iron metabolism and the ability to pass iron to the baby and taking iron tablets to keep the red cell count high does not ensure that your body metabolises it optimally.

The fact that this level of red cells would risk you out of guideline for birth at home or in a birth centre because of the presumed increase in your chance of experiencing  postpartum bleeding shows that we still have much to learn about how the human body works. Iron metabolism is much more complex than what I was taught in midwifery school and copper deficiency may be the association when it comes to bleeding rather than your red cell count alone. There is an increasing amount of studies that show that copper regulates microcirculation (the circulation of blood into your tiniest blood vessels). I'll link a fabulous podcast in the reference list, too, if you want to delve deeper into this topic.

It'll be interesting to see if and how the NHS protocols will change in the future.

As a client, I have never been fully satisfied with my experiences in the NHS when it came to my general health. I put this down to my appetite for digging deep and for connecting with my own body as a source of information. I absolutely listen to my intuition when it comes to evaluating wether a certain 'treatment' is for me or not. I don't expect the National Health Service to cater for this or even understand it. As a result I have always invested time, money and effort in maintaining my own wellbeing according to my values and beliefs to the best of my ability. Fair enough, I didn't like their approach to trying to help me with my thyroid but I liked knowing that, should I ever find myself in an emergency situation, I would most likely receive exemplary care from the NHS.

That’s where modern medicine shines, isn’t it?

When an acute thing happens in pregnancy and in life in general. 

Miracles are made possible.

People survive tragic accidents and acute incidents because of ambulances, infrastructure and the skilled doctors employed by the NHS. They are saved for ‘free’, disaster will not cost you home and hearth in the UK and at its conception that was the whole point of a National Health Service. 

That's beautiful and remarkable and I can see that this is very much worthwhile; not really 'free' but definitely an investment worth making. 

However, it doesn't justify the attitude that my client received nor does it transfer ownership of one's body to the midwives, nurses or doctors who represent the institution.

There is a line!

My eyes were opened to the fact that there was another currency the ‘free’ NHS demands: Sometime between 2020 and 2022, I got the choice to pay either in bodily autonomy or freedom of movement.

I chose to sacrifice the latter and I learned something new about myself. I learned that there is nothing that would ever make me bypass my intuition or compromise on what I am willing to put into my body. 

When the pressure was on for those of us who declined the newly available pharmaceutical we were told by various press outlets that we should not be able to access ‘free’ NHS care anymore on account of our unreasonable position.

The surrounding climate at the time was one of heightened emotions and people were prepared to cast us out. Given that I had already lost the freedom to travel and been turned away from a restaurant for not being able to produce the documents required for entry and given that my NHS colleagues in England were facing dismissal for making the same choice that I was making, I considered loosing access to the NHS a strong possibility.

Check out my blog 'The Day The Bubble Burst' for more on what was happening for me at the time. 

It was bleak and I doubt that you can relate to this experience unless you shared the same journey. I started to accept that access to the ‘free’ NHS was going to be a thing of the past for me.

Imagining myself without access to my general practitioner didn’t evoke any fear whatsoever. I could always pay to use a private GP should the desire arise (rarely if ever).

Would I be able to have my taxes reduced accordingly? 

Oh, but what about acute care? 

What if I fell out of a tree or was struck by lightning? 

What if…

Either way, I decided to hold my own and accept whatever came my way as a result. I am glad I did and it seems that there are more and more people who wish that they had done the same. More and more people are seeking solutions for themselves outside of the tired and unsustainable way that 'health care' is delivered these days. 

NHS care is poor in many areas, acceptable in others and exemplary in some. Occasionally the medical profession pull off results that are bordering on the miraculous, but NHS care is most definitely NOT 'free'.

Do you like to explore the big picture like I do and like my clients do? Would you like to be part of a WhatsApp community and monthly zoom calls to get into the nitty gritty of pregnancy health?

Then I have the perfect place for you in my R.O.A.D. To Birth Community.

Doors are open!

Just send me an email to [email protected]

Resources:

https://www.gov.uk/government/publications/autumn-statement-2023/autumn-statement-2023-html

Steer P, Alam M A, Wadsworth J, Welch A.  Relation between maternal haemoglobin concentration and birth weight in different ethnic groups BMJ 1995; 310 :489  doi:10.1136/bmj.310.6978.489 

Innate Wisdom Podcast: What your OBGYN won't tell you, https://open.spotify.com/episode/399zFOkG5ejGWC4VDsHDYC?si=CS6IChV2Q6aENGZ2izOJ6A&nd=1&dlsi=34648c8869d9446e