Monday 30 July 2007

The Maternity Bump

Some of you might have been wondering where I have been. In fact, those of you who did wonder had probably assumed that I had run out of things to write about and was about to do the very thing I had promised not to do - letting the blog die. Nothing could be further from the truth. The simple fact is that I knew I wanted to write about this next, but didn't know quite how to phrase this. I still don't. This post therefore comes to you with the caveat that I reserve the right to entirely change my mind about it in a couple of months.

The idea for this piece came at me from two directions. From one side, more vacuous nitwittery from our beloved government about what pregnant women should and should not do. From the other, a whole hour of prime time television devoted to one woman whinging about the standard of maternity care when she had her most recent baby back in April.

People whining about the NHS really, really annoys me. Yes, it isn't perfect, but it is full of hard working, dedicated people who could make a hell of a lot more money doing what they do somewhere else. And yes, there are far too many bureaucrats with far too much power and far too little financial acumen running it. But the whole point of the NHS was not that it would be a Rolls Royce service; the whole point of it was to provide a base standard of healthcare for all, something which didn't exist back in 1948 when it was founded.

You get the NHS that you pay for. If you want a better level of service, the only way it can be paid for is (a) cutting out the bureaucrats (which most people are in favour of) and (b) paying more taxes (which most people are against).

Applying all of this to the whinging reporter, what you get with NHS maternity services is therefore a whole load of women competing for the same few resources. You don't have any right to any better a service than the next woman. In that respect, it is almost a perfectly Utilitarian system - to each according to her needs, from each according to their means.

This doesn't mean that the system is perfectly balanced. Next time you are in a major shopping mall, or at a major train station, stop and look around you. Count the women aged 13-50. Each of them will, on average, produce a couple of kids during their lifetime. It's not an exact calculation - some will choose not to have them, some may sadly be unable to have them, one or two will die before they can have them and one or more (depending upon where you live) will become a nun - but it is a good starting point. Count them up, double it and then multiply that figure by every shopping mall or every railway station in the country. That is what the NHS is up against in funding maternity services. Men may all need to go to hospital a couple of times during their lifetime, too, but not all for the same thing.

Factor in that most maternity professionals are female (and will therefore require the service at some point themselves) and most NHS managers are middle aged men and you start to see the real reason why government policy on this is cock-eyed. You can't get more people into the profession without funding it properly, because you are trying to increase the service using the people who actually use the service themselves.

It isn't even a difficult equation. If the birth rate rises, the number of females in the population will rise. Assume that each of those females needs a service twice in their lifetime and you have a very high and increasing demand for something very specific with no way of paying for more people to be trained to do it. Unless you shed some extraneous paper pushers, some unwanted external consultants (not the medical kind, of course) and divert those resources to the very area where you have a growing demand.

Make babies, not bureaucrats.

No comments: