I was exhausted last night and went to bed at 10.30m, slept for nearly ten hours, overslept slightly and woke up with the sense of having woken short of breath several times in the night, but uncertain as to whether this was really the case, or to what extent.

It was good to go back to volunteering after a break of several weeks. I find it’s good to do something social without the actual pressure of socialising. Mostly I just the other volunteers talk and I listen. Everyone wanted to hear about the civil wedding and was excited for E and me. They wanted to see photos and I felt a bit bad that I don’t actually have that many photos of the day on my phone. I didn’t take any (I was too busy, and I can’t take good photos on my phone because of tremor issues), but I have a couple E’s mother took and one or two from the dinner we had with E’s friends and family in the evening, but that’s it. To be honest, the wedding itself took literally one minute. There wasn’t much time to take a photo, although we do have a short video of E jumping up and down excitedly and hugging me when we were told we were married.

I was pretty tired when I got home, even though volunteering doesn’t actually take that long.  I did a few things this afternoon (collected my prescription, collected the parcel a neighbour took in for us yesterday, and cooked dinner, somehow forgetting to add the coriander and so cooking it extra long once I added it in), but I felt I didn’t actually do that much.  It is hard to do energy accounting to balance my activity level with my energy level when I don’t know how much energy things will need, nor is it easy to reduce my desired activity level when I feel so overwhelmed with things to do.

One thing I did do today was a cheshbon nafesh. This literally means “an accounting for the soul,” which sounds very pompous and portentous, but it basically means a self-assessment of how I’ve been over the last (Jewish) year, in advance of Rosh Hashanah (Jewish New Year). I won’t go into what I wrote, but it seemed less illuminating than in previous years, but maybe that just means I have a more realistic view of where I am in my life than in previous years.

***

I got a letter offering me an appointment with a psychiatrist, I assume to talk about reducing my medication. It spelt my name wrongly (my first name, the most popular boys’ name in the country for the year I was born). The letter said I needed to phone to confirm the appointment or it would be cancelled, but it didn’t specify the number to call. I called the appointments line number printed on the letterhead, but no one answered. So NHS. I phoned a second time, more than five minutes before 5pm, but it went to the answerphone even though the message said they’re open until 5pm. I left a message saying that I didn’t know if this was the right number and could they phone back to either confirm my confirmation or give me the right number, but I was flustered enough that I forgot to give my number, so had to phone back again.  It is a worryingly Kafkaesque thing: you have to phone to confirm, but we won’t tell you the number and we won’t answer the phone.

Coincidentally, someone on the autism forum was complaining about lack of NHS funding for autism support and mental healthcare in general. I didn’t say anything, but lately I’ve been wondering how much it would cost to fund the NHS to such a level that everyone who used it got good treatment, equivalent to the lowest level (at least) of private healthcare. I don’t know how to calculate this, but I suspect it would be far more costly than any government could ever afford, even without taking into account the fact that some healthcare is potentially limitless in application.

I did a quick back of an envelope calculation with some statistics via the internet (from The Office of National Statistics and health charities).

UK population: ca68,000,000.

Adult population (approximate, as the statistics did not break down easily that way): ca56,000,000.

Approximately one in four people experience a mental health problem each year.

Therefore the adult mentally ill population each year: ca14,000,000.

I’m not sure how much “good enough” therapy costs.  I’ve usually been charged around £30 an hour, but those have been discounted rates as I am on a low income.  Looking online gave anything up to £100 as hourly rates, so I guessed at £50 as an average “normal profit” level (“normal profit” is the economic term for the rate where all costs are covered with no extra profit).

This being the case, one hour of therapy per person in the UK: ca£700,000,000.

Therefore one hour therapy per person per week for one year: ca£36,400,000,000 (£36.4 billion).

Annual NHS annual budget for the next few years is currently predicted in the range of £175,000,000,000p.a. (£175 billion).  (Incidentally, the table shows that, in real terms, the NHS budget has risen a little since the last Labour government, not fallen.)

Therefore funding one weekly therapy session for a year for every person diagnosed with a mental health issue in the UK would take up more than 20% of the entire annual NHS budget – not the mental health budget, the entire budget.  This is clearly not feasible.  I don’t know what the solution is, if there is one. At any rate, it shows why NHS admin is so far below par; it really isn’t a priority in an inherently overloaded system.

(Obviously there are a number of assumptions here that may not be correct, as this was just a quick calculation.  For one thing, not all patients would need a full year of treatment, although others would need more than one session a week. But I just wanted to illustrate my thesis that the NHS is always going to be overloaded; it’s not the fault of this government strategy or that funding cutback.)

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6 thoughts on “Energy Budgets and NHS Budgets

  1. Trying to communicate with medical providers has been a nightmare lately and even worse, they don’t communicate with each other. It affects patient health very negatively. As the advocate for my 90-year-old mother, I’ve experienced that way too much the past few years.

    Liked by 1 person

  2. I think the reality of healthcare generally is that things cost money and resources (money, staff, doctors, hospitals, equipment, etc.) are limited. So any system will necessarily have to ration access and care either by cost or limiting service (either the service/care provided and/or the population served) or both in some fashion. I’m not defending the US system (it’s a truly awful system) and I don’t have enough information about NHS to comment. But I think that a universal free healthcare with full care and coverage with no rationing on service, access, quality, or cost is not realistic almost by definition.

    Liked by 2 people

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