Friday, September 14, 2007

Rat-arsed Drunks and the NHS

Via Duncan Borrowman comes some unusually direct political language from Norman Lamb, Lib Dem spokesman on health.
"If you go out on a Friday or a Saturday night and get very drunk and you end up in accident and emergency, and you are foul and abusive to staff who are already overstretched, then is it right that you should get that care entirely for free, or are there consequences to your actions? "And I think there is a case for saying that someone in those circumstances should be asked to pay for their care."

Now, Duncan rightly makes the points that there are laws to deal with abusive drunks, and the consequences for such actions - in particular, being foul and abusive to staff going about their work, should be dealt with via the justice system.

There is a deeper issue here, though, which is the fact that the conscious actions of the binge drinkers are leading to a costly strain on the National Health Service - ultimately, they are placing a strain on all of us, as it is tax money that deals with the problems of drinking to excess. Is it right that such behaviour - particularly if it is repeated, or obstructs the access to service of those who are ill through no fault of their own (as would be the case if staff are facing abuse) - should ultimately be met through the taxpayer, rather than the person who has caused the problem?

That, of course, is how the system works in theory. For everyone who buys a pint of beer or a glass of wine pays a specific duty on that. Presumably the rationale for this is that it is a hypothecated contribution towards the larger problems that spring from the consumption of alcohol. There may be a rationale for making that contribution higher - a sliding scale based on strength of beer, perhaps? - but as things stand, those being foul and abusive already do pay for the cost.

Under this system, of course, those who drink responsibly and those who drink to excess are punished equally for the decisions of the latter. Is that fair? Not by any construction I can come up with. (The fact that richer people subsidise the healthcare of the poor is justifiable by the social good that it brings about. Subsidising violent or abusive behaviour doesn't bring much good that I can see). One of the reasons for the costs of the NHS is because we are encouraged to think that free healthcare, for anything, is a right, on demand. Regardless of personal agency in the problems that are caused. In any case like this, there's a fine line to be walked. How exactly do you define which problems should be charged and which shouldn't?

I don't have answers to these questions off the top of my head. But there is an important case to be argued here. The NHS shouldn't be expected to bail people out at no cost for injuries caused by knowingly drinking to excess. And those who have put themselves in such a position should at least appreciate the service being provided. Expecting the NHS to provide full cover for everything is ultimately economically unviable. Norman Lamb may well have identified one of the cases where we shouldn't automatically provide.

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