Andrew Neil, writing in the Daily Mail, bemoans the ‘sickie culture’ of this country.

Welcome to Sick Note Britain, a country whose people are succumbing to all manner of medical ailments almost as quickly as they are losing the will to work.

Oh Andrew, you so very nearly ‘get it’ when you mention the NHS waiting lists, before segueing into all the immigration stuff. But you know it’s not that simple. Let’s back track a minute, and briefly look at the issues around medical care.

Have you got any idea how fucked up the NHS is for people genuinely seeking treatment for the most common medical problems that keep them off work, even when they do get an appointment?

How about we look at back pain and arthritis?

Are you aware that most of the patients developed these problems at work in the first place? (I have the twin scourge of the time-served archaeologist, arthritis and skin cancer, along with inflammatory arthritis that is exacerbated by physical stresses.) Are you aware of how difficult it is for such patients to obtain successful medical treatment?

Just for starters, even if patients get a referral from their GP to ‘the specialist’, Rheumatology treatment thresholds are so high for access to the effective treatments, such as biologics for inflammatory arthritis and orthopadedic corrections for osteo-arthritis, that by the time patients get there they are either (a) buggered, or (b) dependent on painkillers, or (c) ill from the side-effects of all the drugs they had to try on the ladder to effective treatment. Some patients may possibly be all three.

I was made very ill by a medication called Sulfasalazine, to the point of needing emergency medical treatment during the Great Lockdown of 2020 (which was fun); and others have been felled and their liver function damaged by Methotrexate. My sciencey archaeology friends me that another drug routinely prescribed by Rheumatolgists because it’s ‘cheap’ has never been properly clinically tested on women. Women, eh? You know, that part of the workforce, Andrew, no longer prepared to skulk away dedicating their old bones to mildewed housewyfery but perfectly able and determined to claim the benefits that will bring them crucial national insurance credits and pension entitlements when they reach 67, or 68. Or 70. Some of us haven’t forgetten the WASPI women.

When I was finally prescribed biologics for my debilitating illness, it was via another hospital department, and not Rheumatology which seemed to value protecting its budget and its precious protocol over my health and ability to work. This is a familiar story, hearing that patients with systemic auto-immune diseases are being fobbed off by Rheumatology and finally prescribed biologics by Dermatology or Gastro-enterology, often after a medical crisis initiated or exacerbated by a drug prescribed by Rheumatology in the first place.

My research has shown that Rheumatologists, rightly or wrongly, are gate-keeping access to imaging scans too, advising patients in agony to go private if they don’t want to wait 9-12 months for an MRI. (A whole back scan is in the region of £1290 with Spire.) Meanwhile, patients like me are being brought in for pro tem ultrasound scans where the junior doctor left in charge of the appointment doesn’t have an ultrasound machine in the consulting room. Yes, really.

‘Would you like a diagnosis of fibromyalgia?’ a doctor might ask a patient, possibly trying to appear helpful. ‘Er, what’s the treatment for that?’ the fatigued patient might respond, clenching their gnarled hands. The reply? ‘Oh, there isn’t one, really. Just carry on as you are.’

And meanwhile my lumbar discs are degenerating more and more, year on year, while my hands and feet play orchestral overtures of pain to me in my head on a daily and nightly basis, conducted by the devil.

No-one is ever allowed to talk about cannabis, and all alcohol consumption is treated with contempt, while patients have at their disposal repeat prescriptions for the shit drugs mentioned above, plus potentially a heady cocktail of opiates, strong NSAIDs like Meloxicam, Pregabalin, steroids, Nortriptyline and SSRIs.

The genuinely exciting new model the NHS is promoting through local Persistent Pain Services is only available to patients who have completed all available diagnoses and treatments - again, as a patient you have to be pretty buggered and hitting the point of googling Dignitas to access it.

So before critiquing ‘Sick Note Britain’, Andrew, maybe think about what it’s like to want to work but be stuck in the Kafka-esque nightmare that is the departmental hospital system in this country, ill-equipped, ineffectively staffed, and working to backroom protocols that are hard for the majority of patients to understand.

And still I send thank you cards to the nurses, doctors and other staff, because somewhere there is a solution and they will be part of it. Many of them certainly are working their arses off, well aware that they are rationing care and denying timely treatment to people with disabilities as well as illnesses.

Will it be a Labour government-led solution? I’ll believe it when I see it. Yes, I despair at this government; but then again I probably trust Wes Streeting and Lisa Nandy about as far I can throw them. I do know that we need to focus on treatment, as well as the holy grail of waiting lists. There’s no point reducing waiting lists if the appointment that’s obtained sooner rather than later turns out to be a protocol-driven, process-dependent, treatment-lite damp squib.