Last, but by no means least, is the 'extra-mural' or 'continuing' adult education provided by many universities for those adults who are not searching for qualifications, but who want to study seriously because they want to know, to understand, to appreciate. Oxford University provides such education to the adult population in Oxford and in the three counties around the city. Many students, though not all, are older people, sometimes even people in their eighties and nineties. The students have had time to reflect on all those areas of knowledge and ideas about which they want to know more. So they come as students to weekly classes, summer schools, courses of lectures and 'day schools'. For the weekly classes and summer schools they have regular home reading, write essays, and take an active part in the lessons.
This is perhaps the place where the tradition of open, liberal education - exploration and critical examination of wisdom and knowledge for its own sake - flourishes most. Such education is very unfashionable in current government thinking which likes to concentrate on 'skills' and 'training', but people across the country yearn for open serious discussion of ideas. When I have introduced Russians to these classes (which are the kind that I teach) they often say, That experience was really wonderful. The students were so committed...' followed by 'Why should adults want to study in such classes?' I do not understand how these two remarks can follow each other, since the answer to the question is contained in the statements - but obviously some implication is intended. In Britain we sometimes say that 'Education is a drug of addiction. The more you have, the more you want.' Which is why not only adults who were deprived of higher education when they were younger, but also highly skilled and highly qualified people - retired professors, scientific specialists, people with great professional knowledge of their own- love these classes, this precious opportunity to explore what we know and understand about human achievement and the world in which we live.
Chapter 6. Our National Health Service: Socialist Heritage and Medical Priorities
A woman is cycling along the road; a car swerves and the woman is knocked off. Traffic halts, someone grabs his mobile phone, others argue whether to lift the victim. Within minutes an ambulance arrives, emergency treatment is given on the spot and the woman is taken away to hospital. Everyone knows that whatever can be done will be done.
A man is suddenly violently sick and confused at home. His wife rings their doctor who will advise her, ask her to bring him to the doctor's surgery or tell her to call the ambulance. In this case she is asked to call the ambulance which arrives within a few minutes. Three hours later the patient is comfortable in bed, having been given oxygen, X-rays, two doctors' examinations, specialist treatment, and, if he wishes it, a careful explanation of what has happened to him. Everybody has been very helpful.
No one has paid or will pay even one pound for this. That is one everyday aspect of our health service. In times of emergency the service functions excellently, according to its original principles.
That is not the whole story - if it were, we would be living in a medical paradise - but it is an important part of our experience. Of all the major institutions in our country, the National Health Service (NHS) is the most popular. It has been the most popular for more than sixty years. It was founded in 1948 under a Labour Government determined to make good medical care available to everyone, regardless of their wealth or poverty, and it remains a monument to what some would call successful socialism. In any case, despite all the problems and despite all the reorganizations and changes, the NHS is much beloved by the British population. Politicians of all political parties often have plans for changing or 'improving' it, but they know that the voters will turn against any government which tries to interfere with its basic principles. The National Health Service provides medical care for everyone, and treatment is entirely free at the point of use. (Of course, we pay for the NHS through taxes, as we pay for the army, roads, schools, etc. Payment comes from central government funds so no individual's treatment is affected by his or her ability to pay.)
Most countries pay for their health service by means of some kind of insurance schemes. If you are rich you buy more insurance and get better treatment. If you are poor you may not buy any insurance - and therefore be turned away from hospitals. Some, as in Russia have a mixture of statutory services and private insurance. In Europe the insurance schemes seem to work quite well, whereas, by contrast, almost everyone would agree that the American health system is a catastrophe for the poor. As I write, the President of the United States is trying to make major reforms to the system. Russians sometimes read about the USA and assume that the British have developed their public services in the same way. While in some cases our systems are quite close, on the matter of health provision the USA and Britain could not be more different. Ill-health is a source of great dread that hangs over the lives of even rich Americans. 'What if I fall ill and have to pay hospital fees?' whereas in Britain we may fear illness, but not the terror of being unable to afford it. Sometimes doubtful Americans ask, 'But why should doctors treat you properly if they are being paid by the state rather than the patient?' This is a question that rightly enrages British doctors. They are decently paid, and being human, some are better than others. But there is something disgusting in the assumption that care for patients can only be equated with money. The 'market' is an efficient mechanism for trading, but not for basic human services. British patients and British doctors understand this very well.
The structure of our service is not quite like yours. Essential health provision includes (1) a personal doctor; (2) specialist services which do not require a period in hospital; (3) hospital treatment. In the Russia system you combine (1) and (2) in Polyclinics, whereas in Britain we combine (2) and (3) in Hospitals with Outpatients Departments and Inpatient Hospital Wards. There are good arguments for both arrangements. Nowadays we are moving towards your system with the creation of 'Health Centres' which are rather like small polyclinics. In a typical health centre there will be, for example, five or six personal doctors called 'General Practitioners' or GPs; two nurses; a health visitor; a specialist midwife who looks after pregnant women and mothers who have just given birth; two trainee doctors working part-time in this centre; a part-time paediatrician, a dentist, a chiropodist and assorted receptionists and secretaries. Each GP has his or her own room or 'surgery' where they attend to the sick people who are on their list and are their responsibility. More often now than in the past, GPs are also encouraged to undertake minor surgery at the health Centre rather than sending people to hospital for non-serious, nonurgent treatment. We can chose our GP, and once we are on his or her list (there are about equal numbers of male and female doctors in Britain), the GP is expected to get to know us personally. Obviously they will know us better if we suffer from bad health. Some fortunate people almost never visit their GP.