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I am a big fan of the YouTube channel Extra Credits History, in which interesting historic events are explained in breathtakingly simple detail in 10 animated videos. I have watched every episode, including the ‘Early Christian Schisms’ and ‘The South Sea Bubble’ series, in which these superficially boring subjects really come to life thanks to the skill of the animators.

It was due to my love of this channel that I accidentally clicked on another one of their videos about a zombie game called DayZ that explored the tragedy of the commons through the lens of a multiplayer game set in the midst of a zombie plague. I have never played this game and I don’t much care to, though I was interested in their hypothesis. In a nutshell, this stated that personal self-interest works against itself in a situation of limited resources and that the inherent selfishness of humans means that in a fight between humanity and an overwhelming outside challenge, selfish self-interest and unwillingness to compromise by the majority will doom everyone in a way that it wouldn’t if people simply sacrificed a little to ensure the survival of all. In this context it was used to explore why the zombies so often won this game, as people were too busy fighting each other to prepare proper defences, but equally it can be extended to the fight against climate change, pollution, overfishing and a multitude of other problems where everyone overexploiting a limited resource dooms it for everyone, including themselves.

This was in my mind when I arrived at work and found that a staff member who routinely calls in sick had that day called in sick. Working in the NHS I am somewhat used to many colleagues being off sick but finally the unfairness of this hit me. Public services operate a generous system of sick leave born out of the crucible of great injustice and the fight for the welfare state. These trying times took place within living memory. My grandfather was fond of telling stories from his youth and tended to repeat them 300 times word for word. One of these stories concerned an accident that happened while he was working underground in which the roof of the mine collapsed and one of his colleagues was killed by falling rubble. A team of men, including my grandfather, spent an afternoon digging him free and carrying the body out of the mine. When he received his wages that week he found that he had been docked half a day’s pay for this. As a result of stories like this I developed a deep respect for the welfare state that was born after the war and what that actually meant for the lives of ordinary working people.

The colleague in question had called in sick due to a self-diagnosed “touch of pneumonia”. There was some scrabbling around trying to find out what to do about his booked patients, but in the end most had their appointments cancelled on the day and they were sent home without being seen. There was a time when there were so many people off sick suddenly at once that there was a crisis. In the end the stress was such for those left working that some then started going off sick themselves with stress. One person was so stressed while on sick leave that her leisure activities were not documented on social media in as much detail as they might otherwise have been. A staff member thought nothing of going into town for the whole day while off on sick leave unconcerned that other people might see her. They did.

Why do so many people working in the NHS; doctors, nurses, auxiliary staff, managers and others, think that sick leave is just another form of leave to be taken whenever they want? That cancelled operations, clinic visits and hastily rearranged clinical activity with the associated stress and inefficiency that inevitably result from this mean little to nothing any more is an indication of how low we have gone. It seems the situation is so bad now that people don’t even try and concoct a decent excuse anymore. Instead, there is a story that plays out whereby a malfunctioning organ or joint is chosen, pointless investigations ensue, followed by feigned confusion at the completely normal results. A bit of stress is then mixed in, followed by anger at having to come back to work and annoyance when people inevitably start insinuating that there was no malfunctioning joint in the first place. Some cheeky beggars purposefully come back to work for a short while every six months so that their wages don’t take as much of a hit. And some cheekier beggars still insist on claiming the annual leave they have accrued whilst off on sick leave. I met a nurse in the park not long ago that used to work in our department in the distant past but when we fell into discussion I realised that she still in fact was officially on our books but had been off with headaches. This cumulative effect prevents service reconfiguration, new clinics from being set up and new plans from being enacted.

This is immoral on multiple levels. People with genuine illnesses; breast cancer, prostate cancer, real flu as opposed to that most minor of minor occasional coughs that passes for influenza in this day and age, are at risk of having their sick leave rights damaged by the collective selfishness of those taking advantage of the system. It seems to me impossible that this level of abuse of the sick leave system can go on indefinitely and a point will be reached when the system collapses altogether. As with the real ‘tragedy of the commons’ economic theory, as the end comes closer, abuse of the system paradoxically gets exponentially worse, as more and more people see that the door will soon shut so they individually see the need to get some sort of personal payout. I have overheard trainees openly discuss whether they should take sick leave in the run up to college exams as a reasonable, viable and seemingly moral revision option.

Perhaps just before the NHS finally collapses altogether, a critical mass of employees will be on sick leave so all the NHS staff go to private hospitals and the final end comes. This may seem far-fetched, but the NHS is one of the most perfect examples of socialism still in existence and as with all good things the individual selfishness of man corrodes it for sure. The zombies are circling. We can all see this but it is not too late to act. The first step is to acknowledge the problem exists and if we can at least do that then we can start to plan a way out. Otherwise, in 10 years’ time we will all be doing cataracts in a McPrivate setting for paltry wages locked into a zero hours contract wondering what on earth went wrong. We will be the zombies in our own real-life version of DayZ.

Written before COVID-19 but now truer than ever.


The views expressed are those of the author and do not represent those of the editorial team or the publisher.




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Gwyn Samuel Williams

Singleton Hospital, Swansea, UK.

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