'the only thing that matters is a healthy baby'

[RevoltingPeasant]

I was talking to a friend about ttc and wanting a homebirth recently (whooooole other thread there) but in the midst of trying to dissuade me, she said, 'Birth isn't an experience, it's a process, and really the only thing that matters is a healthy baby'.

Okay - I'd agree with the first bit. I don't expect to go into it and have a Magical Experience Which Will Last A Lifetime. I think it'll hurt and large part of it will be boring and literally shit.

But - it occurred to me that the second bit is something I have heard lots of people say when discussing birth, inc HCPs. And tbh, it really gives me a chill. There are two people involved in birth and the mother counts as well. I do think the mother has the right to think about herself too when negotiating interventions, choices etc. AIBU to think this attitude is really horrid and totally devalues women?

Or is that just because I don't have DC yet?

Excuses? I don't work in any field related to childbirth or delivery. There is a lot of delusion about the financial state of the NHS though and a lot of silliness where people think the public sector can provide one to one perfect care. if everyone who could do chose to pay extra things would be different for all. No one wants to.. just to believe they could do a better job of managing all the varying demands based on a bit of knowledge. Most people have a perfectly acceptable birth and anyone who doesn't should complain.

"You have to be a fucking idiot to think that high induction rates which result in more medicalised births, just to suit hospital policy are a good idea. You are ignoring the costs of the surgery, the costs of any repair surgery, the costs of mental health care etc etc. If there is a risk to the baby then yes, but as the other thread clearly demonstrates its got very little to do with risk and is about connivence for the hospitals. Its a total false economy.

Stop making excuses and wake up."

As for this, again there is an assumption that high induction rates = inevitable surgery/repair surgery/mental health care. Are there figures to show that this is the case? To be honest, reading this board you would really believe that every woman who has an induction is one step away from institutionalisation because of it, with non-functioning genitals and a learning disabled baby. This is not, as far as I am aware, the case.

I repeat, if any woman receives care that compromises her health or that of her baby she should of course complain and if practices that have been followed have not been in the interest of mother or child that should rightly be challenged and any malpractice flagged up and dealt with to avoid a repeat.

However, suggesting that "all that matters is a healthy baby" (and mother, as I have repeatedly said) is "emotional crap" is patently ridiculous. What do you think healthcare is for? It is not for a blissful life experience, it is to optimise healthy outcomes. The NHS, as I said above, is currently a conveyor belt and decisions are made on broad probabilities but anyone who thinks it is a straightforward case of money is spent on x when it should be spent on y has a very poor grasp of health economics indeed. Even small departments dealing with non-urgent care really struggle to devise optimal care pathways based on evidence in the face of constraints. The public perception is that it's because a lot of fat cats are attending lavish lunch meetings but that's not really the case either. It's multifactorial. If people are unhappy they really do need to think about paying for alternatives. Only in the UK would saying this be considered tantamount to sacrilege.

Birth is always uncertain, it is always unpredictable and there will always be trauma, death and devastation in its wake as well as joy and wonderful experiences. That is absolutely a fact of life, regardless of how birth is done. Where painful and negative outcomes can be avoided, that should always happen.. but a line has to be drawn between people being "traumatised" by midwives being mean to them and dismissing their pain for an hour or two and serious medical malpractice. I had the most horrendous midwife and I did get PND but I'll wager my PND had more to do with my previous history of depression and family factors than some careless thoughtless comments by some bint on the delivery ward. It's very easy to put every negative outcome and experience down to one factor e.g. induction in a hospital. I think too, as someone who has had PND, that our entire society makes us ill-equipped to deal with the very real natural trauma of birth. One of my friends who had serious mental health issues after birth had these triggered by giving birth in 40 minutes at home and alone and no one understanding the terror she experienced. Everyone wants to find someone to blame, but the truth is that birth is pretty overwhelming and often gruesome and in our world we are not used to that level of trauma, uncertainty, unpredictability and many of us lack the resources to adjust in the event of things not being quite as we hoped.

Again, I am NOT talking about those cases where women have been subject to illegal or wilfull negligent care, or whose babies have died or been in special care etc when if things had been done differently those outcomes could have been avoided. However, there is such ridiculous idealisation of birth on some forums and such an insistence that if only people would do things right, birth could always be an amazing, safe experience devoid of trauma or pain or that sense of being out of control. I don't believe this, and I don't believe that all the singing about the horrors of inductions/VEs and yes, EVEN EMCS, is particularly helpful always, particularly where women are being advised against following the advice of their medical and health providers where full medical facts are unknown.

"There are some things you need to spend money on, as they have knock on effects for downstream costs of healthcare. Maternity care is one of these."

I couldn't agree more. I also agree with those who say we're being unrealistic to expect good care under current funding frameworks.

Part of the problem here is seeing maternity services as just another part of health care. Now I know maternity services are funded by the NHS in the UK and the HSE in Ireland and this isn't going to change anytime soon. It is not surprising to read some-one here writing that all birth is "a medical procedure".

Maternity services are underfunded and administrators will, quite rightly, seek first to protect those services like high-risk obstetrics and neonatology (forgive my spelling!) that save lives.

Healthy women are then told that their needs don't matter, and more insiduously, that any expectation of spontaneous labour with unassisted, vaginal delivery is a dangerous delusion. Should money be diverted away from medical care for those babies and mothers who need it, to provide more midwives and space for those lucky enough to have a healthy pregnancy? No, absolutely not. Should money be diverted away from other areas of the health service? It's debatable. I myself have experience of the Irish mental health "services"and saw plenty of truly shocking waste going on there. Should money be found from outside the health services eg from ministers' pr and toner budgets? Absolutely.

It comes down to the value we place on children and , to an extent, on women. I am a teacher and we accept differentiation as an essential part of our job. We don't dumb down the whole system because some children have special needs. (we dumb it down for political reasons). why do we medicalise childbirth because some women need medical care while giving birth?

Should money be diverted away from medical care for those babies and mothers who need it, to provide more midwives and space for those lucky enough to have a healthy pregnancy? No, absolutely not.

I don't think it's quite as black and white as that. The recent Place of Birth study showed that for low risk women the cost of birth in a CLU was £1442.90, an Alongside MLU £1302.60, a Freestanding MLU £1248.5 and homebirth £998.3. These costs took into consideration the higher midwifery cost of homebirth. By diverting more women into MLUs and homebirths we would reduce costs and be able to provide better for everyone.

The 'cost saving' in the CLU of having one midwife between 2-3 women is a false economy in my opinion.

The MLU in my town closed down a number of years ago; and it didn't even save the health authority any money. The building is still there, so if the will was there it could be reopened.

I believe it is probably medicalised partially due to fear of malpractice claims. Also, I appreciate your point about differentiation, but to an extent, this happens. What doesn't happen (as it rarely does in teaching, either) is that every case is dealt with entirely on its own merits, with a care pathway/curriculum being designed purely on assessment of the needs of the individual.

In terms of this:
"Should money be diverted away from medical care for those babies and mothers who need it, to provide more midwives and space for those lucky enough to have a healthy pregnancy? No, absolutely not. Should money be diverted away from other areas of the health service? It's debatable. I myself have experience of the Irish mental health "services"and saw plenty of truly shocking waste going on there. Should money be found from outside the health services eg from ministers' pr and toner budgets? Absolutely."

I agree, but in terms of diverting funds away from other areas of the health service, I do believe there will come a point where people have to make decisions about what warrants funding and what doesn't. I worry that mental health and LD services are often the first to come under fire, as they represent the most vulnerable and often the impact of services is poor because the problems are so huge. Of course if there is waste, that is different.. but these are difficult services to run, I think. I understand why they frustrate people, I can see why people think "if it's not obviously working, let's get rid of it", I do.. but I would rather see people pay some sort of money for routine things on a sliding scale e.g. when healthy working adults need toe surgery, or knee operations from football injuries etc or just have insurance for these things than to deny people with MH and LD any access to appropriate services. I know that wasn't what you were saying, but I know that there is a danger of it sometimes.

Again, I appreciate that in the UK payment across the NHS for these things is seen almost as a sort of cultural suicide and ideally, yes, every service would be free at the point of service. However, given the potential negative outcomes from birth and their huge impact, it would seem to make sense to me to keep this service as available as possible. I still believe people should consider paying more into their care where they can.

I am not at all a Tory type person, but I think there is a grain of truth to the idea that the "sharp-elbowed middle classes" create a massive fuss to ensure optimal treatment on the NHS when they are the very people who could often afford to supplement their care, and then services are diverted from those who have no option. If you don't want VEs or continuous fetal monitoring even though hospital policy dictates they would be important, I have NO issue with that.. but I would like to see a situation in which women who wanted to go against hospital protocol in these situations contributed to their care in some way. I know that this is problematic at the moment because of the issues around independent midwifery and insurance, but it seems wrong to me that people can go against advice in a way that perhaps takes time and energy away from others who also need it. If you want extra time with a midwife or additional antenatal reassurance visits etc, why not pay for some of this, as people do for growth scans? Get that doula or IM, have your homebirth that you want against advice.. but for God's sake, appreciate that your decision has an impact on others too. If you NEED that care because without it you or your baby will suffer death or disability, fine. Harass the life out of them to provide it. But if it's preference and because it's really important to you to have a water birth/1:1 care in a low risk spontaneous labour and/or you don't want to follow hospital procedures because you feel you know better rather than that those hospital procedures are inherently wrong (e.g. in the case of induction for certain medical conditions), pay.

"a lot of silliness where people think the public sector can provide one to one perfect care"

But actually some hospitals and MLU's are providing fantastic care for women. And some aren't. You have to ask yourself why this is.

"If you don't want VEs or continuous fetal monitoring even though hospital policy dictates they would be important. I would like to see a situation in which women who wanted to go against hospital protocol in these situations contributed to their care in some way"

Could we extrapolate this to any other sector of healthcare? So if the standard treatment for depression is anti-depressants, and you opt not to take them because you don't think it's appropriate for you, you should be fined, and the money put towards the NHS?

Actually I find your comments quite chilling. Horrible. My nightmare vision of birth. Women coerced into accepting medical treatment they find unacceptable or face a crippling 'fine'. Yuck. Especially when you take into account the fact that historically, obstetrics has over the decades, often got things so very, very wrong. (scopolamine births anyone? routine forceps with mothers under g/a? routine episiotomy?....)

"If you want extra time with a midwife or additional antenatal reassurance visits etc, why not pay for some of this"

I suppose it depends what you want to class as the 'standard' care over and above which women are getting something 'extra'. NICE guidelines are that all women should be given one to one care while they are in active labour, and that they should have intermittent monitoring unless there is a clinical rationale for CEFM. These guidelines are evidence based - because this pattern of care is associated with the best clinical outcomes. So a woman requesting one to one care isn't asking for 'extra' - she is asking for the type of care associated with the best outcomes, and the type of care recommended by government guidelines.

"Get that doula or IM, have your homebirth that you want against advice.. but for God's sake, appreciate that your decision has an impact on others too"

Yes - your decision to have a doula will probably result in you costing the NHS a lot less money, because it halves your risk of having a c/s. Do you think you should get a cash handout on your way out of hospital?

TBH the women costing maternity services more than their 'fair' share right now are healthy women choosing to give birth in consultant led units. As a group they have disproportionately poor maternal outcomes - really quite startlingly so. And no better outcomes for babies compared to women giving birth in MLU's and (for second time mums) at home. Should you have to pay a surcharge to give birth in hospital because your labour is more likely to go shit-shaped there?

Really - it's very grim what you're suggesting.

I would go private if it were an option available to me. Sadly I live outside the SE. This means the only option I have is the NHS. You idea about fines is so wrong I have no words.

It is patently obvious you don't realise the dire straits the NHS is in which will compromise all sorts if care for all types of conditions. I am not talking about fines I am talking aboit the reality that the NHS cannot remain free at the point of service for all forever. This will involve hard decisions across the broad range of services. Some areas that 'get things right' in maternity care ay well be getting them wrong in mental health or stroke care or provision of basic things like wheelchairs or communication aids. These are ALL umportant. The se are ALL worthy of adequate funding and have huge impacts on real people. Chilling my arse. This is just reality. It just IS. Whether we like it or not we will get a bare bones service if man the current financial climate continues and if we can take responsibility for aspects of our care.financially it seems morally right to do so. As for the anti-depressant analogy pple can and do seek private counselling and many private providers offer pro bono or sliding scale rats to make this accessible. I would rather this were facilitated within the system to allow joint working and to make this cheaper as NHS could potentially lessen cost of insurance but of course it is such a political no no to even suggest paying a fiver ann hour that ill never happen. Fair play to women for going the doula route who can and saving on cs costs, ideally nhs subsidise more of this if able to centrally charge for some services. Though I know in reality it is not that simple as the NHS is so large and bureaucratic now, and so

Ok fair enough oneplan.

But on current evidence the best way to reduce NHS costs in maternity care without impacting on health outcomes would be to do the following:

Ban low risk women from giving birth in a CLU (so no access to epidural for low risk mums) or charge them extra to use this facility.

Create more free-standing MLU's

Or if no money for this then to massively expand homebirth provision for second/third time mums.

Create a surcharge based on maternal age, bmi at booking and smoking status, as fat, old and smoking mums cost the NHS a humungous amount of money.

Like the sound of any of that?

Should add - the biggest threat to the survival of the NHS isn't selfish women wanting waterbirths. It's the fucking Tories who are on a mission to destroy it.

I don't accept it has to be like this and I hope that other people feel the same.

Cos hiring doulas etc is going to solve problems... nope. It just means that you are letting decision makers off the hook too. And creating a two tier system which is entirely acceptable and indeed encouraged.

People are up in arms enough about private health care becoming acceptable in the UK. And the irony is with maternity is people like you are trying to actively encourage it. Are you one of those people who is anti-NHS bill? Cos there seems to be an awful lot of those who have one foot in one camp and one in the other over the two issues.

I'm not looking for water births to be available everywhere or fancy facilities or what not. I'm talking BASICS which don't cost, or cost next to nothing in the grand scheme of things. I'm talking making sure hospitals are actually following NICE guidelines rather than making up their own policies about Best Practice which are completely contradictory to the NICE guidelines and completely different to the next hospital down the road. I'm talking about stopping misleading, out of date and factually incorrect information being given to patients. I'm talking consent rather than coercion. Risk being explained properly as increased risk as well as absolute risk. As well as being presented alongside the alternative risks for going along with advice. I could go on.

The emphasis needs to be put on 'prevention' rather than 'cure' when it comes to finances/allocation of resources.

Some figures for you:

• £15bn is expected to be pay out in legal costs/claims in the next 10 years for all EXISTING NHS claims. That doesn't count any that will arise in the next 10 years.
• The annual cost of obesity is estimated to be about £4.2 billion. We have a huge campaign ongoing about this as its such a worry.
• In 2008-9 the entire NHS budget was around the 100 billion pound mark.
• In 2008 1 in 6000 births resulted in a negligence claim. (according to Royal College of Obstetricians and Gynaecologists)
• Well over half of all NHS claims are in maternity cases. And a significant percentage of total payout bill (in the region of 30 - 40%) are for childbirth.
• That means that those unsettled claims in maternity related cases already account for as much of a problem to the NHS as obesity does annually.
• Oh and its all on the rise.

Yes, heres some fascinating reading...
www.mumsnet.com/Talk/pregnancy/1338650-Why-do-midwives-lie-on-your-notes

And heres an article about the NHS watchdog was condemning care back in 2008.
www.guardian.co.uk/society/2008/jul/10/health.nhs
Note the part at the end about having 4000 more midwives by 2012 btw.

Yep, we should all just sit and say its all ok because we have to make budget cuts... there wasn't a problem before 2010, and litigation isn't a huge issue that needs to be tackled. And those midwives that Brown and Cameron have both pledged are all magically appearing and the RCM hasn't got an epetition about the subject which no one is signing as the only thing that matter is a healthy baby. Nope not at all. We'll just sweep it under the carpet by adding a bail out to the NHS compensation fund cos that makes good economic sense...

"Ban low risk women from giving birth in a CLU (so no access to epidural for low risk mums) or charge them extra to use this facility."

Misogynist claptrap. It's all well if you don't want to have pain relief, but banning it for women who are not hard as nails, is just wrong. It's great to campaign for freedom of choice when it comes to how women want to give birth, but I can't see how taking choices away and forcing women who don't want it into the whale song is making the situation better. You'd just end up traumatising a different set of women with different means.

No - I don't agree with doing that!

That's not why I said it.

It's just that the poster I was responding to was suggesting ways of reducing costs to the NHS that were basically pretty unethical and inhumane (as denying women their choice of birth setting would also be!)

I also think people say it to prepare you for perhaps not getting the ideal birth experience you wish for. Most want to avoid a c section but if it is the best course of action for baby,s survival it is the best thing.
Sadly not all births end up with happy outcomes as poor whatever's experience shows. I am so sorry for your loss of your daughter whatever.
A friend chose home birth for her fourth. The baby was stillborn due to the cord being round the neck. The thing is sometimes things go sadly wrong and this is the worst possible outcome to be avoided whatever this means for the mother,s experience.
I do think people can get a bit hung up on the experience of childbirth being how they want it when actually your control is pretty limited in any cases.

It is "unethical" and "inhumane" to suggest that people should consider voluntarily doing their bit to reduce costs within the NHS vs actually actively going out of their way to "play the system" to secure one to one care for themselves throughout labour?

It would be "unethical" and "inhumane" for the NHS to provide, say, a system where people contributed some small amount to labour, say £50 - £100 per birth which could be ploughed into central provision of resources like doulas? Why? What's "unethical" about contributing financially to your medical care? What's "inhumane" about suggesting that people should consider not only what they should get but what they can give?

It would be "unethical" and "inhumane" for the NHS to suggest in any way shape or form that actually it can't provide the care suggested in NICE guidelines because the money isn't there to provide it at that level?

I think what people don't get is that if no one contributes voluntarily to their own care when they can, what will happen is that decisions will be made arbitrarily which affect everyone. That might well include banning women of a certain type from receiving x or y or z. It's all very well saying it's those damned tories, but essentially the money is running out at a time when health needs are increasing. That is a sad and unfortunate fact of life. We would all like an ideal, evidence-based, NICE approved service for women who birth, for people with strokes, for the mentally ill and the learning disabled and those with dicky hearts and children with cancer and old people who are immobile because they need foot care. It's just not feasible at a level that offers true quality.

I personally think it is "unethical" and "inhumane" that people who could afford to contribute to their own healthcare above and beyond the paltry amount they pay in NI and taxation come on forums like these to work out how to play the system by refusing CFM for high risk pregnancies because they feel midwives "should" be watching them more closely and it's all a grand conspiracy instead of a resourcing issue.

The NICE guidelines on CS actually say that if the rate got above a certain level, it would be cheaper than a VB.

NICE also say an ELCS is as safe as a VB. So in theory we should all be having ELCS where possible. As afterall the only thing that matters is a healthy baby - (oh and NHS finances).

If you want a VB you are being selfish.

Obviously.

C/s is 'as safe' ONLY because emergency c/s accounts for 14% of planned vb's.

And NICE figures don't take into account increased costs and risks of subsequent pregnancies.

Safest and cheapest option for low risk women is to plan to give birth in a freestanding MLU where their risk of emergency surgery is only half that of a hospital.

Shag you don't disappoint... you said the exact answer I hoped you would in the context of Onebirthplaneveryminute's understanding of funding and finance.

Thank you.

One I'm not sure what solution you are suggesting in terms of birth. Going down the privatisation route very quickly leads to people not being able to afford healthcare. I could afford £100 as a one-off, or more if necessary. I had a doula at my birth, that was expensive but affordable, so theoretically I could have paid that same money to the NHS instead. There are many people who would really struggle to make that payment though. What then? It's all very well to say it would be means tested, but I would fear that the bar for means testing would be set too high, meaning that some people wouldn't be able to afford healthcare. And those who develop chronic conditions, or are born with them, would be severely financially affected even more than people are currently.

"Ban low risk women from giving birth in a CLU (so no access to epidural for low risk mums) or charge them extra to use this facility."

actually, merely making the 'MLU' the default (on the grounds of good solid medical evidence) choice which low risk women are booked into is sufficient in those areas where it is done to get higher usage of those facilities (also Birthplace study :) evidently anyone who at outset says 'i must have an epidural' could then opt in to a CLU.

better results for mothers and babies, cheaper provision also.

but in general, in answer to the OP

...'the main thing is a healthy baby'

true.

'the only thing that matters is a healthy baby.

not true. the welfare of the mother matters. a healthy baby should come out of most cases.... justifying crap treatment of the mother by the fact by the baby is ok ..is not right. the welfare of mother and child generally go hand in hand...

the truth of either statement however becomes less... when it is used to..

1. berate women questioning medical advice. Even when that advice is contrary to current NICE guidelines, their own common sense, even when that advice conflicts with that given by other HCPs. Someone will always defend poor medical practice with this phrase.
2. dismiss women who have had traumatic experiences as complaining about nothing.
3. dismiss any thinking that is minimum-interventionist. (and stupidly, as minimum interventionist approaches are medically proven to be appropriate in many cases)

onebirthplaneveryminute
You raise a number of interesting points here.

"play the system" to secure one to one care for themselves throughout labour?

Personally I think that one to one care should be a basic entitlement for all women. One to one care by a known midwife has been proved to provide better outcomes. In my opinion cutting back on midwifery care is the biggest false economy we have made in maternity services.

What's "unethical" about contributing financially to your medical care? What's "inhumane" about suggesting that people should consider not only what they should get but what they can give?

I think many would agree with you here ? we are thankful that we have a health service (whatever its flaws), so that the old, the sick, the poor can access medical care without worrying about paying for treatment. We do contribute financially to our medical care via our taxes, and I doubt if I am alone in being willing to pay more, if we could see it spent on health care or care of the elderly or education. (Personally I think that?s the mark of a civilised society and I get angry seeing money spent on illegal wars, weaponry, and bailing out profligate banks to name just some things, but how our taxes are spent is a debate that we should have elsewhere.)

It's all very well saying it's those damned tories, but essentially the money is running out at a time when health needs are increasing. ..... It's just not feasible at a level that offers true quality.

No, indeed not, and some hard choices have to be made. I saw my mother crippled with arthritis for a number of years before her name got to the top of the waiting list for a hip operation, so I do know the reality. I agree we need a proper debate about this. At the moment we have the authorities making ?easy? short term cuts ? a local hospital closed here, a children?s centre there, without consideration of the long term effects or anyone taking an overview.

As far as maternity care goes the situation we are in now is not unlike that of the immediate post war years ? a near bankrupt country with a rising birth rate. At that stage we chose to concentrate on staffing and the local authorities provided a free midwifery service for everyone. One option would be to revisit that model for a substantial number of women and see how it could be adapted to today?s circumstances. We have some advantages now that were lacking then ? better housing, better communications, which could facilitate this as an option. It was only when the country got on its feet more and the birth rate was declining rapidly that we decided that providing a hospital bed for every woman was the way to go. Providing a hospital bed ?in case it goes wrong? but then leave the woman unattended because there are staffing shortages makes an absolute mockery of this provision.

....come on forums like these to work out how to play the system by refusing CFM for high risk pregnancies because they feel midwives "should" be watching them more closely and it's all a grand conspiracy instead of a resourcing issue.

I have been following this forum for about a year now. In that time I haven?t seen many high risk women refuse CFM because they should be being watched more closely. I have seen an awful lot of women describing the shitty service they get where being banged on a monitor is the only form of attendance they get until they are almost at the point of delivery. This is why we are beginning to have doulas ? we are not machines, we need supportive companions for our emotional needs in childbirth. This is what midwives were supposed to be: ?with woman?, but are very often not allowed to be. (As for postnatal care ? don?t get me started ? I am tempted to say, ?what?s that??)

I would also like to see more money invested in preventive work: a campaign to tell women that the foundation for a healthy pregnancy is to start by looking after their own health, advice on how to give up smoking, controlling your weight if necessary, and consistent well researched advice on breastfeeding for a start. In the present climate, pigs might fly.

So many improvements could be done with the existing pot of money if the will was there.

"Shag you don't disappoint... you said the exact answer I hoped you would in the context of Onebirthplaneveryminute's understanding of funding and finance.

Thank you."

My, my. How passive aggressive and rude!

It's hilarious how a simple point is being so misconstrued. Literally, I am suggesting that it would be nice if people in our society who could contribute to their healthcare considered doing so to ease pressure on the public coffers.

Shock! Horror! I am saying everyone should have CS! I am saying everyone should suffer on without pain relief! I am saying that people should be fined for wanting something different to the mainstream. I want money in the hands of fat cat corporations!

Only in the context of the NHS would you have such hysterics about absolutely NOTHING.

Realistically, it really is possible to have a system in which people contribute voluntarily where they feel able to if they weren't all so smug and self-entitled. I can't believe this is the same Britain that fostered Dunkirk spirit when I read such ridiculous responses to the mere SUGGESTION that it would be good for people to contribute.

CONTRIBUTE.

Not "be forced", "punished", "coerced" etc. Is our society really SO egocentric that the mere possibility of a different outlook in which people say to themselves, hey, this stuff is pretty expensive, I'm pretty well off, I can pay so I will is so outrageous, "unethical", "inhumane" etc?

I have no interest in forced privatisation (though this will come, this is what the Tories want, in many regards it is inescapable, particularly when so many people are so adamant that the service MUST remain free at the point of delivery for all NO MATTER WHAT). I think there are all sorts of creative solutions that an interested, egalitarian society could do to make the NHS affordable and accessible across society... but what I read on these boards is people with very, very poor understanding of the pressures that there are on the NHS and how NHS financing works bandying about figures that imply that there is no resourcing problem it's All In the Big Bad Man's Head. Suggesting that a situation in which people pay additional money in NI contributions where they could, or pay for certain procedures themselves that were equivalent to those provided on the NHS just to reduce the pressures is some sort of demonic dismantling of all that is good and holy is just plain ludicrous.

And again, there IS a two tier system. There always has been. The middle classes play bloody hell if their "rights" and "entitlements" aren't met to the letter because it says it in some guidance somewhere, and the poor and the vulnerable and the weak get less quality care because in the NHS, everyone is terrified of being sued by the scary sounding legalistic ones. It's disgusting, frankly. Unethical. Inhumane.

However, REALLY what's wrong is suggesting that people assume some modicum of responsibility and pay for what they can afford where they can afford it. No, we couldn't be letting the NHS "off" could we? When obviously it is just out to get us poor beleagured wimmins with its misogyny and double dealing, manipulation and lies. The paranoia is staggering, honestly.

There are only so much "efficiency savings" that can be made, and no, Joe Bloggs, removing all management or admin from the NHS won't cut it. Quality across all services will be reduced if the squeeze continues and frankly, I want the NHS to be there when I really, really need it and if I am ever high risk or become high risk, not to have one to one care in a straightforward, low risk birth just because I feel I am entitled.

Sorry LaVolcan, cross posted with you there.. hopefully obviously!

I'm sorry, I can't get past onebirthplaneveryminute's notion that I should have to pay extra because I don't consent to someone routinely putting their fingers into my vagina every four hours, because that's 'protocol'

I mean, that is basically what is being suggested there, isn't it?