When it comes to politics, I make no apologies for being a staunch lefty. I support people being individuals, with the rights to live however suits them. My outlook is very much that if you’re not hurting anyone, why should anyone mind? When it comes to healthcare, I’m eternally grateful for the NHS and I always struggle to understand why the US allows its healthcare system to be so broken.

Now that I work in the NHS, I’ve had the advantage of seeing it as both patient and provider. With the government’s recent 1% pay rise announcement — much touted by them as very generous in times of austerity and simultaneously condemned by the public as a shameful display of national gratitude to a service that has carried us through the pandemic — I find myself conflicted. As a patient and a member of the public, the NHS is incredible. As a provider, I find it more complicated.

Pay to Win

A lot of the folks I follow on Twitter are US-based, especially after some work I did with a volunteer corps based there late 2017, so I naturally see a lot of US news and opinion in my feed. The intersection of that and my interest in healthcare that the Twitter algorithms have picked up means I get a lot about the US healthcare system… and how broken it is. I can’t think of a worse healthcare system in a developed country, anywhere.

In my understanding, no healthcare is free in the US. There’s a bill for everything, and it’s usually significant. If you’re lucky enough to have insurance, the bill goes to them and they decide if they’ll pay it or not — but if they decide not, or you don’t have insurance, you’re stuck with the whole bill, sometimes running into tens of thousands of dollars.

What I consistently fail to understand is why the government over there continues to allow the system to be so broken. There’s only one answer I can ever come up with: corruption and kickbacks. Which… honestly wouldn’t surprise me, but you’d like to believe that a supposedly world-leading country could manage something better.

Don’t get me wrong, the NHS isn’t perfect — and in some cases even takes free-at-the-point-of-use too far — but it’s never forced people to choose between debt or death.

Patients: A Virtue?

Personally, when I’ve had cause to use the NHS as a patient, it’s always been incredible. Like, for instance, having a moment of complete mind-blank and getting bitten by a squirrel when trying to help. Yeah… that’s a story for another day. But entirely aside from me, the feedback that comes in from patient experiences departments and from surveys and so on from the public about the NHS is overwhelmingly positive. I’ve listened to folks describing experiences of flawless end-to-end care, from ambulance call to hospital A&E and admission, inpatient treatment, and outpatient rehabilitation, with personalised and sensitive care right the way through.

Folks are appreciative of having a system to fall back on when things go wrong — whether that’s getting too drunk on a night out and waking up with a paramedic picking you up, or whether it’s a serious long-term diagnosis that the doctor takes time over to make sure they’re being supportive.

Availability and access to urgent care has also increased significantly in recent years — more easily-accessed minor injury units and urgent care centres, and the rollout of the national 111 urgent care number to unify quick access to advice and care. Urgent care systems mean that as a patient the choice is no longer between self-treatment at home or going to A&E — if you’re just not sure, you can get some advice or simple treatment relatively quickly, without the 6-hour wait at hospital because you’re not an emergency.

Gratitude and Generosity

Covid has made a huge hole in national finances — that’s not just the UK, that’s worldwide. It wasn’t exactly a surprise when the government over here announced a public sector pay freeze. That’s not to say it’s not a kick in the teeth, and it comes on top of other knockbacks for some folks who’ve worked hard to get us through the pandemic: the government has also repeatedly refused to prioritise teachers and police officers for vaccinations, despite clearly higher potential for exposure. However — and this was made a Big Deal of — the NHS would be getting a 1% pay rise for being the “heroes” who got the country through the pandemic.

To be clear, a 1% rise puts a grand total of £2.30 in my pocket per week. An average nurse ends up with more like an extra £4 per week.

In the impression that I’ve got, the government has made it clear that we’re expected to be grateful for this, because we’re the only ones getting a pay rise. Now don’t get me wrong — if someone’s going to increase my pay, I’m not going to say no to that, but this feels like someone in government has asked “what’s the minimum we can get away with giving them?” Earlier in the pandemic there were billions being thrown around (or, as one Twitter commentary brilliantly put it, “spaffed up the wall”) for PPE and tracing systems that never worked properly, so I can fully see where the public outrage at the lack of proper recognition for the NHS comes from.

On the Other Side

Why did I join the ambulance service? Well, mostly because I’d been furloughed off my previous job and I was sat at home getting very bored. But why the ambulance service, rather than any other job that had to keep going through the pandemic? Same reason as everyone else in the service — to help people. Sure, exact reasons vary from person to person, but the fundamental desire to help people who need it is there in everyone in the ambulance service.

Working for a healthcare provider has given me a whole different outlook on the NHS and how it works for the public. While all the outrage about the paltry pay rise was going on, certain figures were pushing an alternative argument that the NHS didn’t need any more, because it had been “nothing special” through the pandemic — that the NHS was just doing its job, which is nothing out of the ordinary.

This is what had me conflicted. On the one hand, the work the NHS does is incredible, but at the same time… that is what it’s there to do. Certainly as an organisation, the ambulance service and the wider NHS are just doing their job as they always do, but when it comes down to individuals within the services, it gets more fuzzy. To me, personally, I mostly knew what I was stepping into when I joined in the middle of a pandemic, and I’ve never known it any different, so as far as I’m concerned it essentially is just my job. For others, the pandemic has vastly changed how things work, and there are innumerable cases of individuals going above and beyond to make sure compassionate, sensitive care won out despite the challenges Covid has brought us.

For me, it doesn’t matter quite as much as it does to others. I’m (thankfully) financially stable — but there are plenty who work for the NHS who aren’t, who need a fair pay rise to keep them above water. Are we a country that gives them the bare minimum? Or is it time to start treating the NHS as the essential public service it is?