I’m on the verge of leaving England.
I write that as my flight from São Paolo, Brazil, descends towards Heathrow and, for a moment, I see the arch of Wembley Stadium. I used to live near there. I lived in the area for 10 years. It’s the kind of place that most Londoners never see unless it’s from the windows of their taxis. For me, the arch reminds that this is home.
At least it has been.
But it may not be for a few years.
While what’s taking me away is personal – and is the right decision – I struggle with the idea of not being in my country. I know that going to medical school put me into a demographic in which people are used to – almost expect – living abroad for a while. That demographic is not where my roots are. For me, I’m English. This is home. Moving away feels like I’m abandoning my home, my people, my country.
As I think about staying in London, though, I can feel the fatigue rising through me. It’s been brewing for a while, a few years, but it’s almost always there now. A sense of fatigue that I’ve done what I can in this great city, that I don’t have any fight left in me, and that it’s time for a new chapter in my life.
Fighting for change in health care is nothing short of a relentless slog. I suspect that’s true everywhere (well, in high income countries as they’re the ones I know most about), which is why ‘system change’ is such a big deal. But I sense that the fight it almost pointless in England now. The recent injection of cash into the National Health Service (NHS), combined with the seeming waffle of the so-called long term plan, feel like a lid closing over a fountain of possibilities. The course has been set. It’s badly thought through but it’s set. And that’s that.
Some readers may think that an uncharitable assessment of a plan that I’ve only read commentaries of. I can see that argument but I’ve been in this game for a while. It’s perhaps my third or fourth national ‘plan’. I’ve sat through the cacophony of the previous few, sensed moments of optimism, and then seem them dashed by the relentless drive of the medical industrial complex. Words are just words. I’m 99% sure this ‘plan’ will go the same way as all of the others. Fanfare followed by nothing much.
Some readers may just think that I’m tired. Or that I’ve lost my fight. Or that I’m too cynical and jaded. I am tired, of course, I’ve admitted that, but I think I’ve just wizened up to the fact that nothing much changes because the powers that be don’t want them to. People of low income backgrounds in England endure worse health because those that run our health-creating and health care systems simply don’t care. They might say they do but, as I said, words are just words.
I see one ray of hope, though. Brexit.
I realise that the demographic that I’m in – “the elite”, as my mentor tells me – is supposed to be devastated by the idea of leaving the European Union. On a personal level, I’m not crazy about it. But on a wider, more national, level I think an important signal has been sent. Life simply cannot go on the way it has. The elites know what’s wrong, from poor health to rubbish education to non-existent economic opportunities, but the masses now have mechanisms that give them a voice. How that happened has undoubtedly been ugly, and the short term consequences even uglier, but there is no doubt that there is a new voice out there – or at least the need to listen to one that was previously easy to ignore.
The fact that our self-appointed political classes are making a complete hash of the negotiations (at the time of writing) isn’t remotely surprising. Political leadership in this country has been possible by ignoring the masses (or to use the current buzz term, “the left behind”). Leadership has been based on a falsehood that the Baby Boomers created, enjoyed, and are now reaping the benefits of with their fat pensions and great health. Leadership was based on only leading those whose needs could be easily met. Because the others simply didn’t matter, social or politically.
But they do now.
Sadly, I don’t think the newly-heard voices of the masses will have much impact on health and health care in the U.K. Sure, they’ll be tinkering about the edges – a little activity around the social determinants, some greater emphasis on prevention – but the medical industrial complex, aided and abetted by ill-informed and spineless politicians – will continue its relentless march. Each drug must be funded. Every baby must be saved. That life-saving procedure must be done. The idea that health has little to do with health care is a topic that’s yet to reach the majority. Indeed the voices of the masses are all too often manipulated to meet the ends of the medical-industrial complex.
And so, as I wait on the inevitably delayed Circle Line train, I hold this sense of anticipation that it’s time for a new challenge. Not to turn my back on England, as such, but to broaden my perspective, see if there is a different way to catalyse change. I’m sure there is. I just haven’t found it yet. And something tells me I might be able to see it better from a distance.
The photo behind the title is by Dan Roizer (via Unsplash) and is of a factory in my home town of Leicester, England.