Illness, if you remember, was the word to be explored in this, the second part of the first crow.
We all know what we mean by illness, don’t we? Sure? Quite – it’s not really that easy, is it?
Think about ‘speed’ in the same way. Speed, as such, is meaningless. It suggests that there is a continuum from not moving to very fast: stationary to the speed of light (if, as I understand it, that is the fasted speed possible within our universe) – and that is all. Nevertheless, we all know what we mean.
In motoring terms, when there is an accident it is usually assumed that someone was going ‘too fast’. We try to ensure that this doesn’t happen by using speed limits. These don’t work. Speed does not kill, as the proponents of fixed speed limits would have us believe. Vehicles kill and need to be carefully controlled to ensure they do not. It never amazes me to realise how very good at controlling these beasts we drivers have become. Sure, car designers have done all they can to protect the people inside the vehicles but that does little for the ones on the outside. Nevertheless, when you consider that the number of car/miles that are driven for every person killed by a driver failing to control his/her lethal beast it becomes clear that, on the whole, we are actually very good drivers. Not that anyone says so.
I think this is the first time I have said that and my guess is that it has never crossed your mind. Why should it? Good driving is not news: good driving goes unnoticed: you are a good driver (I’m sure you are) and I know that I am a good driver but over there I see a bad driver and something needs to be done about it. So we do what we can: we impose more regulations (usually lowering speed limits). What does this do to reduce deaths (or injuries)?
Probably very little because it cannot take into consideration an infinite range of variables: the weather conditions, the state of the road (bad road engineering and poor maintenance is certainly the cause of some accidents although this is rarely acknowledged), the car (model and condition), the actions of other drivers, distraction caused by trying to read and assimilate instructions from numerous signs, light conditions and, of course, the ability and condition of the driver.
Speed limits achieve two things: in places they make people feel safer. I have asked some people living in a 20 mph zone where a fairly main road passes through the narrows of a typical Devon village what the introduction of the 20 mph limits has meant to them. Answers ranged from, ‘Nothing much,’ to ‘well, I feel safer walking down to the shop’. How many accidents were there before the speed limit was lowered? ‘None, but there were plenty waiting to happen,’ was the general consensus of opinion.
I said they achieved two things: the other is connected to attempts to enforce these regulations and especially by the use of cameras. Here the effects are totally negative. They are a cause of further friction between the police and the public at a time when trust in the police is at a low ebb whilst remaining essential in the running of a civilised country: they have become a form of sneaky taxation (as have car parking charges): they have done nothing to improve the ability of drivers to control their lethal vehicles.
Determining the right speed when driving is by a moment by moment appraisal of the overall situation and an almost entirely subjective reaction which (luckily) usually results in the right answer.
We see almost exactly the same problem with the word ‘illness’ which is a central plank of the National Health Service. Just what is meant by section 1(b) of the Secretary of State’s duties as laid down by the National Health Service Act of 1977 – ‘ … the prevention diagnosis and treatment of illness … ‘?
This matters when the end product is to be free of charge and the taxpayer is expected to meet the costs. Nevertheless, trawl as I may, I cannot see what that word is meant to mean in this context. The obvious definition, ‘Poor health resulting from disease of body or mind; sickness. ‘ is of no help. All it does is to move the problem down onto two other words: disease and sickness.
The insurance world has, of course, found the need to have a say in the matter as when it insures people against illness. They have found this a pretty difficult task and a surprisingly large number of claims end up in court simply because of the essentially subjective nature of this whole matter. Just to give you an idea of how subjective, the Association of British Insurers issued some guidelines in (I think) 2005 and this little extract gives you a feel of the problem.
Please remember that the name of each critical illness is only a guide to what is covered. For example, some types of cancer are not covered. The full definition under each heading shows what your policy covers. You can ask your insurance company for this information. The model definitions are grouped into “core” and “additional” conditions. The “core” conditions are generally the critical illnesses most likely to happen.
The “core” conditions are:
- coronary artery by-pass surgery
- heart attack
- kidney failure
- major organ transplant
- multiple sclerosis
The “additional” conditions are:
- aorta graft surgery
- benign brain tumour
- heart valve replacement or repair
- loss of limbs
- loss of speech
- motor neurone disease
- Parkinson’s disease
- terminal illness
- third degree burns
There does not appear to be anything like this approach in the NHS. Should there be? After all, we have defined the things for which we will charge (most of which are not included in the ABI’s list: dental care, prescriptions, spectacles but not hearing aids).
I leave you with three thoughts.
The first is that the answers do not lie in tick boxes or governmental edicts. The right judgements will be made by subjective assessment and therefore we have to find a way of placing trust in people to take those judgements and not to pillory them if every now and then they ‘get it wrong’. Now and then we all ‘get it wrong’.
The second is that the one things that seems NOT to be covered by the Act is injury. No definition of illness includes injury and yet we have no problem with expecting the NHS to treat our broken bones, sprains and gashes. Here the insurance world does things differently. Accident insurance is completely separate from Critical Illness insurance and whether or not you are covered will often be determined by what you are doing at the time and whose fault it was (assuming blame can be apportioned).
The third is that this blog does nothing to provide an answer. Sorry about that but it will require far wiser heads than mine to find a solution. I just feel we should be aware of the muddle at the heart of the NHS lest it is that muddle that finally causes it to collapse.