Accessibility Therapy Trans

Trans healthcare, Britishness and the NHS

I’ve been thinking about something since watching this video recently and reading people’s comments about it. If you have an hour and a half and a relatively strong constitution for emotional turmoil, I recommend watching it. It’s pretty heart-wrenching, and it has some interesting philosophical points about the nature of large institutions and some of the fallacies that lead to healthcare being used as an agent of social control, which is something that happens to mentally ill people, trans people, disabled people, women, and people of colour.

The other thing I’ve been thinking about is the concept of “Britishness.” Seems like a weird non-sequitur but hear me out. There’s a lot of debate about what it means to be British, and I’ve scoffed at it because it’s not something I particularly identify with and it doesn’t feel like something that should be used in the ways that it often is, most often to express that immigrants don’t belong here because they don’t embody it. However, I realise that I feel quite strongly that Britishness is creating a self-defeating set of circumstances around the NHS.

What do I mean by that? There are a few things I’ve noticed in any kind of discourse about the NHS that feel uniquely British.

Personal Care

Firstly, it is pretty much compulsory to love the NHS. Not to love having healthcare free at the point of access. Not to love or respect the people who work in the hospitals and clinics we use. We must love the actual institution itself. It is akin to how it feels almost compulsory to love the Monarchy, but stronger because everyone has the chance to see direct benefit from the NHS whereas the direct relationship with the Monarchy is much less clear.

The way individuals, governments and the media refer to the NHS seems to give it personhood. I don’t think I’ve seen a single opinion shared about the NHS and its failings that doesn’t start with “don’t get me wrong, I love the NHS but…” You’re not allowed to say anything bad about the NHS without prefacing it without how much you love it because otherwise, you’ll get shouted down.

It sometimes seems like we’re expected to relate to the NHS as if it were a problematic family member. You must reinforce how your uncle is still a member of the family and you love him even though he used racial slurs at dinner that time because otherwise you’ll be called disrespectful.

The NHS as a legally defined collection of loosely affiliated organisations under one funding umbrella that regularly fails to meet patient needs or live up to the expectations of a modern healthcare system, but we can’t say that because it might be offended. We apply lots of individualised traits to the NHS as the largest single employer of people in the UK and the largest provider of healthcare. It’s under a lot of pressure. It’s doing its best. It doesn’t want to let you down. It’s always been there for you when you needed it most. Some of these things are true; some less so. In any case, it’s not accurate to portray the NHS as a single organisation, let alone a person in its own right. The NHS can’t be offended by your criticisms.

This may be just me, but the personification of institutions and then putting them on a pedestal feels very British.

Gratitude Journal

Second thing that feels very British is the need to be gracious for what you are offered, even if it’s not what you want or need. Almost all the criticisms I see of the NHS seem to be disclaimed with gratitude. ” I’m so grateful for all the NHS has done so much for me and my family, but…” To draw on another family metaphor, it is like when you get an ugly, itchy, too small sweater for Christmas as a kid. You are told to express thanks and appreciation to the person who gave it to you, even though it’s not remotely what you want or need.

The metaphor breaks down, though, when taking into consideration the nature of NHS funding. We tend to think of the NHS as being free healthcare, but it is not. We all pay for it. Even those of us who can’t work. Anyone who spends money in the economy gives a portion of that expenditure to taxation through corporation taxes, VAT and the taxable proportion of employees’ income paid through the money you spend. As such, we are buying our own gift and thanking the person who wrapped it.

When you add the personification of the NHS from point one to our desire to be gracious for what we are given, we often see people behaving towards the NHS as though it has personally put itself out to help them. To say otherwise would be ungrateful; and being ungrateful is seen as intolerably bad manners. Being British means being polite.

Borrowed Glory

For a country that has (thankfully) long since moved past the age in which we ruled the waves and “owned” half the world, we still have a lot of the colonial mindset that leads to viewing ourselves as greater than we are through the lens of our collective past experiences. Two World Wars and one World Cup, so the terraces chant goes. Even though we have retreated even further from other nations through the execution of Brexit, we still consider ourselves to be a powerful global player because of how we were in the past.

When the NHS was set up, it was a stunning achievement of its time. Providing healthcare, free at the point of access for every single citizen transformed the way the country looked at itself. It was a proud moment and one that as a nation we are clinging to. But the truth is, Nye Bevan’s NHS is nearly 75 years old and more of a wheezing pensioner rather than the bright young thing full of hope that it was in the summer of 1948.

Continuing to relate to how things were in the past is preventing us from moving forward and making improvements to how things are in the present. We can never again have a young NHS that filled people with hope, but that doesn’t mean we can have a positive future starting from where we are.

Starving Children in Africa

If you grew up in the 1980s or 90s, you may have been familiar with the awful famine on the African continent that led to Live Aid and various other fundraising efforts to support people suffering from the effects of life-threatening food shortage. You may also have been familiar with the phrase that became popular amongst parents to try to get their kids to eat their vegetables: “you mustn’t waste that! There are starving children in Africa!”

The sense that it’s not okay to say you’re struggling if other people might have it worse is a deeply entrenched part of our culture. A huge number of the people I’ve worked with feel they aren’t worthy of help because other people may have bigger traumas than they do. It’s the kind of self-defeating thought process that sadly keeps people trapped in misery.

Applied to the NHS, this tends to show up in the form of saying “lots of countries don’t have any kind of socialised healthcare. We can’t complain when other people have it worse than we do. Be thankful you’re not in *insert country with less favourable healthcare systems here.*”

Rise Up

As a therapist, I have learned many things from people whose life experiences and resulting emotions have kept them trapped for many years.

You do not have to put up with poor treatment from anyone for the sake of family, community, or other such abstract concepts. Being grateful for something that doesn’t fit you or meet your needs is not required or even advisable. Holding on to how things were in the past, whether good or bad, can stop you from being in the present and planning for your future. It’s okay—necessary, even—to admit that your experiences haven’t been great, even though other people have suffered too.

Refusing to accept the conditions that are created by our cultural mindset frees us to heal as individuals and to challenge the unfairness we see all around us. I refuse to proclaim my love for the NHS any longer. I demand a system that is fit for purpose and hold compassion for the people working in what is currently a failing system whilst advocating in every way I can for better things for all of us.

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