Rights without responsibility… where are we going? by Anne Marshall

“Man must cease attributing his problems to his environment, and learn again to exercise his will – his personal responsibility.”
Albert Einstein


‘It’s not my fault.’

‘It’s not fair.’

‘I want that.’

‘Why should they get that when I can’t?’


Responsibility – one of those words with which no one much wants to associate these days, but a word that I believe lies at the heart of the change that is essential to sustaining not just the NHS through the 21st century, but life beyond the 21st century.

In his blog Ewan Bell asked how the NHS should prioritise its services – what are the essentials and what should we be doing?

I think we need to turn that thinking round and look at it differently – from the point of view of ensuring that as we empower people we also expect them to be accountable and therefore responsible for the choices they make. . . so here’s a few thoughts and a lot of unanswered questions!

Anne 1The more society gives in terms of allowing individuals to renege on any personal responsibility and the more it protects them from the consequences of their actions and decisions the deeper into this complex and costly moral mire we sink.

So where do we start? Can we make the huge cultural shift required without some horrendous intervention such as war, which inevitably enforces change from selfish desire and want to more simple human need.

How do we teach people to take personal responsibility when they know they simply don’t have to take any because someone else will always pick up the pieces? How do we reduce escalating public expectation? The NHS cannot simply cut back on what it does while society as a whole continues to abandon all sense of personal responsibility; expects more and more to be done for it and litigious greed is ready to pounce on any perceived breach of human rights.

When prisoners win compensation for having the slop out their cells what hope is there of change? Don’t the rest of us have to clean our own toilets?

The fact that benefits are capped at £350 a week but someone on the minimum wage earns only £251.25 before deductions seems to be indicative of where we, as a society, are at. There are few or no consequences for failing to take responsibility. Add to this the fact that publically funded advice agencies actually complete forms for people and lie in order to get them certain benefits which they are neither entitled to nor need and you simply perpetuate perceived dependence, engendering more unnecessary demand and expenditure.

The problem is beautifully illustrated by the story of two students, aged 16 and 19 respectively, sharing a flat. The 16 year old gets her bursary and a job and puts some money aside for the summer months. Her wages fail to come through so she asks for support from the college hardship fund. She is entitled to nothing – because she has put a few pounds aside. The 19 year old blows all her bursary, litters the flat with takeaways and empty drink bottles, builds up a huge debt and gets handed out hundreds of pounds from the hardship fund . . .

Unfortunately the ending is not fair or just, or, more importantly in terms of the NHS, sustainable.

It reminds me of the story of the three little pigs and their houses built with straw, sticks and bricks. Two of the pigs learned their houses were not safe because they had to run for their lives from the big bad wolf and find shelter in the brick house built laboriously by their brother.

We have created a society where there is no big bad wolf – no consequences. We have created a society where people simply expect the state (be it NHS, benefits system, social services or whatever) to sort out all their problems and if they don’t many people either kick up a huge fuss, shout and scream until they get what they want or take on a lawyer.

Anne 2So how do we start to change things and find that balance between a society that takes care of its vulnerable and needy and yet engage differently with those who are outside of the vulnerable and needy group but still think they have the right to whatever they want at whatever cost – as long as it is not to their pocket or life style.

How do we start to embrace the massive moral and cultural shift needed from politicians down and ‘minorities demanding the same rights as majorities’ up? How do we deal with the human rights bill which in its purest form is an excellent and necessary thing but which is so open to interpretation and abuse that it forms a rod for our own backs?

Answers on the back of a postcard please. . . !

“When you blame others, you give up your power to change.”

Anne Marshall is a Staff Nurse on the Renal Unit at NHS Dumfries and Galloway

15 thoughts on “Rights without responsibility… where are we going? by Anne Marshall

  1. when you have government coming out with phrases like bespoke care, that nobody should be denied a drug which might work and Putting You First it infers a level of care better than the next person and encourages selfish behaviour and poor spending decisions.

  2. As a retired GP and now volunteer Citizens Advice volunteer I find Ms Marshall’s views paradoxical to say the least to come from a healthcare professional whom I always thought had a duty t o exhibit empathy, care and compassion toward her patients. If she is representative of current NHS staff attitudes it is no surprise to me that I recently heard from a professor of primary care that a course in Compassion is having to be introduced to the medical curriculu.. Where indeed has NHS gone wrong.

    Furthermore her comments about advice agencies are downright offensive, not to say libellous. We assist vulnerable and needy people to claim benefits they are legitimately entitled to, and we do not lie so to do! Her remarks betray a total ignorance of the benefits system. In fact far more benefits ie many more times more, go unclaimed than are fraudulently obtained.

    Presumably she views all the patients she treats with renal failure as victims of self-inflicted maladies. I imagine she views type 2 diabetes in that category. I doubt that she has much experience of being on the receiving end of medical care, always a salutory lesson for a health professional. I suspect it is time she emerged from her insulated hospital cocoon in the renal unit and got out down and dirty in the community where she would witness life in the raw and learn something of the social determinants of health.

    • John,
      I would appear that you have misundestood the majority of my blog and have wrongly extrapolated from it to attribute personal and professional traits to me that are wholy inaccurate and unjustified.
      You do not know me.
      I am sure that renal staff across Scotland will be aghast to have their workplace referred to as an insulated hospital cocoon.

      • Dear Anne,
        Thanks for your reply. You obviously are correct in saying I have no knowledge of you personally but your comments betray a lack of empathy and compassion and total ignorance of and lack of understanding of the bnefit system do not deter you from making comments about it. Your view no doubt arises from its portrayal in the Murdoch dominated press and sensationalist TV programmes.
        I have no knowledge of your career path. If you have spent any time in community or mental health sectors you seem to have leant remarkably little from the experience. I on the other hand have 40 years of both hospital and general practice and I think that the fact I hold an MBE for services to health care in South West Scotland gives me some right to express an opinion on your contentious views.
        Yours sincerely,

  3. I find your remarks about advice bodies encouraging people to lie deeply offensive and extremely misinformed. You have also made the kind of correlation that the worst of our tabloid newspapers would be proud of by flatly comparing the minimum wage with a benefit cap. The benefit cap includes housing benefit and other benefits being paid to those in work to meet the extortionate private rental rates now prevalent around the country. If you want to talk about personal responsibility then perhaps start with your own moral responsibility not to vilify the poor and those who work to support them in such an inaccurate and inflammatory way.

    • Hi Candy,
      I am sorry you appear to believe that I have vlified the poor. Your interpretation of my blog is certainly different from mine and my intention.

  4. Dear Anne,
    At last! Truth Day!
    Can I first of all say that I am sorry to see that the comments you are receiving are somewhat personal.
    I work in the “insulated hospital cocoon” of the Radiology Department – try telling that to my young colleagues who have to deal with referrals from across the spectrum including drunk and un-cooperative patients from the Emergency Department on a daily/nightly basis.
    I started work in the NHS in 1979. In addition to being an NHS employee, I am also a member of the public (strangely) and a patient/potential patient, so my views are informed and valid.
    Also, given that vulnerable and needy people in our Society have been mentioned, I am also an enthusiastic supporter of, and contributer to the Welfare State. Just to be clear.
    The NHS is the jewel in Britain’s crown. I cherish the NHS, as obviously do you. I would suggest that the majority of the public at large also cherish it. However, there is a significant and increasing number of people who use and abuse the NHS and the staff therein. This is to the detriment of the responsible individuals and the Service as a whole.
    The change in service users and their attitude towards the NHS since 1979 is stark.
    Two people on my scanning list have chosen not to turn up this morning, resulting in two precious slots being wasted. Slots that could have been utilised by other needy, and dare I say it more responsible individuals. This relatively small event (yet not inconsequential if you are ill and waiting for a scan), highlight beautifully the overall point you were making in your blog.
    I would completely remove the word “entitled” from the Dictionary or I would move it and place it under the word “responsibility”.
    Unless there is a real and rapid change in our Society, I truly fear for the future of the NHS.
    It probably needs Politicians to sign up to “Truth Day” and tell it as it is but I just can’t see that happening.

  5. Anne

    I have just read your blog and I’m afraid that I can’t agree with the majority of it. I do, however, support your right to air your opinions and I believe you should be able to do so without receiving the sort of personal remarks and character assumptions which you have been subjected to.

    The remarks from John McDonald can be seen as offensive, not only to you, but to every member of staff who works in the “insulated hospital cocoon” and do him no favours whatsoever. I hope that you are able to shrug off his somewhat pompous responses and continue to blog in a manner which provokes thought and ruffles fathers.

      • Hi Cal,

        Thank you for your balanced and fair response. I intend my blogs to ruffle feathers, provoke thought and change if necessary. I certainly do not expect universal agreement! And yes, I hope to be able to continue to blog in similar fashion.

  6. Cal,

    Thank you for your comment whoever you may be. I am afraid Anne’s comments were more than offensive to the many dedicated people who work to relieve the distress of the disadvantaged, most of whom are unpaid volunteers. I shared the blog with my colleagues and I can assure you my response was moderate compared to the outrage that was expressed by the frankly libellous comments about lying to secure benefits. Many suggested that Citzens Advice should make a formal complaint to the Health Board for publishing such defamatory remarks. With regard to the hospital cocoon I don’t think you are often in the position of having to find accommodation, secure food or crises loans at 4.00 pm on a Friday afternoon for people with absolutely no funds because their benefits applications have not been processed on time, or they have been sanctioned for some trivial misdemeanour. And yes we too can be subjected to abuse from drunken, addicted and angry clients, but that does not absolve us of a duty to try to help them if we can. Hospital is an entirely different environment from the community. We should be working together not throwing bricks at each other that is what integration is all about, but your blog made me so angry I had to respond.

    John Macdonald

  7. Pingback: Clinical Efficiency by Ewan Bell | dghealth

  8. John

    I have no wish to enter into a slanging match with you either which is why my comment was directed to Anne. Indeed, in my response to Anne I state that I don’t agree with the majority of her blog.

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