Where's The 'Care' In Healthcare?

Nobody likes waiting, especially not for something important. For many people who have interacted with Student Services, though, waiting is the name of the game. Appointments are backlogged for weeks, communication is often extremely slow, and the deluge of online forms and surveys can make one feel like their counsellor is really Office 365 in disguise. On top of that, knowing what to ask for and who to ask is a whole other confusing, nebulous process. 

I say none of this to disparage those who work in Student Services. I have no doubt the vast majority are good, hard-working people who are trying their best to help those who need it most. The target of my ire is instead what I will call the ‘bureaucracy of care.’ The layers of forms, surveys, administrators, and more, are all a part of this bureaucracy, trapping helpers and helpees alike in a tangled mess of wait times and delays. 

A St Andrews student recently described to me a story of this ‘bureaucracy of care’ at its worst. Seeking to get treatment for a brain disorder, as well as preventative care for a potentially hereditary mental illness, she asked for a counselling appointment that was meant to take place during the very first week of the semester. However, due to a series of administrative slip-ups, what was meant to be a Week One appointment ended up happening several weeks later, in the middle of Week Five. 

On top of that, this belated appointment was with a person the student had never spoken to before, so things very quickly took a turn for the worse. One of the first things the student was asked to do during the appointment was fill out a questionnaire that was meant to evaluate her current level of well-being. Upon completing it and handing over her results, the student was told that because of her score, she was no longer entitled to the services she had signed up for. 

“She literally said to me, ‘You scored less than 15 on this questionnaire and so we’re no longer going to offer you these services.’ I got really pissed off, because I was promised three more weeks, three more sessions.” The student would then go on to, through tears, express her extreme discomfort at both the situation and this new person whom she had no rapport with. Eventually, despite this new person repeatedly pitching going private as a solution to the student’s problems, a new appointment was made. The turmoil of the process will not soon be forgotten by the student, though. “It’s just utterly ridiculous in my point of view. It feels like they don’t really serve us despite being Student Services.”

And this all goes well beyond Student Services. The NHS, Britain’s once world-renowned single-payer healthcare system, has come under increasing strain and scrutiny as of late. Ever-growing wait times have led to many Brits struggling to get the care they need in time, with the wait times for gender-affirming care being especially harrowing (years-long, in some cases). On top of that, the bureaucratic hurdles of referrals, notes, and redirections — once again, especially bad with regard to medical care for transgender people — further complicate the process. All of this has led to the NHS having a 2022 satisfaction rate of 29 per cent, according to the British Social Attitudes survey, which is the lowest level of satisfaction recorded since the survey began many decades ago. 

Bureaucracy of care is a tragedy on every level. It is a tragedy for those seeking help, whether it be students like the one I spoke to seeking help from Student Services, or those across the UK who are caught in the terrible wait times and bureaucratic mess of the NHS. But it is also a tragedy for those who work within these organisations, who are often impeded in their mission to provide care by roadblocks and administrative failures. Only through proper, system-level reform can this problem truly be solved, not (just) through increased funding and not (at all) through privatisation. 

Let’s cut the red tape and help people.