Rat-arsed

Joe Farrington-Douglas tweeted last week an article on Lib Dem Voice posted at the time that Norman Lamb  took over the Lib Dem health brief. Lamb wrote a paper about his thoughts and followed up with interviews with newspapers. In particular Lamb said:

"If you get rat-arsed on a Friday night and get taken to A&E where you are foul and abusive to staff, is it right for the taxpayers to fund your life-saving treatment?"

The implication being that it isn't and we shouldn't and hence there should be a charge for A&E in these circumstances. The Guardian said:

He called for wide public debate on whether the community should pay for the excesses of the individual. There was a strong case for charging drunks for stomach pumps or treatment of injuries, and pubs and clubs should also be made to contribute if their complicity could be proven.

This is not only wrong, but it is very unliberal. Lamb was suggesting that we create a concept of deserving patient and undeserving patient. Under Lamb's plan the undeserving patient has to pay for their treatment. Where does it stop? Do we charge smokers for their treatment? Do we charge drunk drivers for the injuries they receive, or the injuries they cause?

What happens if someone is foul and abusive but sober? Is Lamb concerned with people's behaviour, or their condition? If a person does something illegal (they are foul and abusive to A&E staff) then the legal system can be used: they will be punished for their behaviour. But what if they are drunk but polite, do those drunks get a discount, or get the treatment free? Who decides what is foul or abusive, will there be national standards or will some areas be allowed to be more sensitive? What if the patient has mental health issues which is the cause of the abusive behaviour and is unrelated to the alcohol they consumed?

The whole idea was poorly thought out.

It didn't matter that this policy was unworkable because Lamb wanted to get a different message out to the public. The message came straight out of the Lib Dem's Orange Book. Lamb wants to deliberately break the cherished free-at-the-point-of-delivery principle of the NHS. Once you start charging for treatment, regardless of the reason, that principle has been broken and charges will spread throughout the NHS. Imposing charges will encourage the development of an insurance market. Insurance companies will produce products so that you pay a small premium every month (say, for the cost of 5 pints) and the insurance company will pay your A&E bill if you get injured when rat-arsed. Of course, this may backfire. Just as some people are rather "clumsy" with a paint pot "accidentally" knocking it over the carpet that they want replaced, or like some people foolishly put all their valuable electronic items in one bag which they lose "by accident" so that they are replaced with the latest models. Just as there are always people who will abuse insurance, there will be people whose behaviour will be worse if they have "A&E drunk coverage" because they know that whatever they do, whatever injuries they get, they will be covered. Indeed, since they have paid for the insurance they may well want to get their money's worth.

Such ill-thought-out policies are fine for a spokesperson for a party that will never be elected, but these were the policies of Norman Lamb, who was just appointed Minister of State in the Department of Health. It is a cause for concern for health policies in the future.