‘I can still remember bits of the NHS Chief Executive’s speech, spoken with sad eyes and quivering chins. “Today, we mark our professional honesty by opening our doors to innovation,” followed with something like “We are in a needs-must scenario. Life has been handed an eviction notice. This contract,” here he gestured at the paper he’d signed, “will save lives. Design. Inventiveness. Entrepreneurialism. This is what will save the NHS. We all deserve to be saved.” And then the head of an unnamed private institute, a clean-shaven man in tweed who looked too young to be there, stepped up to the microphone.

Aubrey looked at me then, a lock of yellow hair between her teeth. “Isn’t he the one who makes the squirrels?”’

(From Composite Creatures)

 

In a time of pandemics, mutating viruses, and overcrowded hospital wards, the issue of healthcare inequality is more relevant than ever. Whether you’re in need of a GP to talk about your mental health or a nurse to look at a new mark on your skin—it’s difficult to be certain how your query will be prioritised, or how long you’ll have to wait to see a specialist or hear a comforting voice.

We have to hope that this new reality is only temporary, and will relax once this pandemic (like the Spanish Flu before it) starts to recede. But it doesn’t mean that healthcare inequality will disappear. From the UK’s NHS to the US’s own system which offers some of the most innovative healthcare solutions in the world—for those who can afford it—societal division has been clear to see for years.

My debut novel, Composite Creatures, explores a near-future where corporate greed and healthcare inequality have resulted in a split society. Though the world doesn’t look much different to our own, chemicals and microplastics are seeping up from the soil and the air is tinted lilac with pollutants. Many people succumb to the greying, a fading away of the body. Access to the latest scientific developments and benefits is based on whether you fit the severe and secretive criteria:

 

‘It must’ve been devastating to get this far into the programme and then not make the cut, be relegated to fight for a hospital bed. Some people waited months or even years for a slot to open, and then were told that their initial test results weren’t compatible, or their body type just “didn’t fit the strict criteria”. Easton Grove had received plenty of criticism over the years for its inflexibility and unwillingness to admit members from different areas of society. I did think to myself that the exclusivity wouldn’t last—they surely couldn’t keep accepting so few people while the world watched and wilted? Those who didn’t make it into an intake saw the rest of us as withholding some genetic secret, but the truth was that we had no idea why we were chosen.’

(From Composite Creatures)

 

Norah is a member of Easton Grove—just one of many private healthcare programmes that selects its patients based on its own motivations. Decisions are made by businessmen, and as Norah’s best friend points out, people who also profit from falsehoods and illusions, such as ‘the squirrels’. Not exactly knowing why they’re chosen (and in many cases, why they aren’t chosen) means that applicants soon feel a sense of self-righteousness if they’re accepted, and disillusionment if they aren’t.

But regardless of fitting the strict criteria, applicants also need to be able to afford it, which cuts most individuals from the application process altogether. The mysterious criteria and financial barriers soon result in a split society—each side condemning the other for seeing themselves as more valuable, or as bitter.

But Easton Grove doesn’t only exist to provide healthcare—their members are also advocates, responsible for the Grove’s good PR. There are consultants to guide your career choices and relationships, and to make sure you remain a shining example of what ‘success’ truly looks like. Success becomes synonymous with value, which raises the important question: when we all exist in a dying world, and we’re all sickening—who is priority?

In a real-world society that’s becoming more commercialised every day, this is something that is easy to relate to. For those who can afford it, the US’s healthcare system offers some of the most technologically advanced treatments in the world. But the cost (for those who don’t have the income or insurance) can be an insurmountable sum. Many of us have families or friends who’ve broken a wrist and can’t afford an X-ray, or have had to make life-limiting choices due to how much they earn. In so many cases, money appears to reflect how much your life is worth.

And here in 2021, when it’s a struggle at times to see a specialist, many people even in the UK are turning to costly private healthcare in order to ‘cut the queue’. But this isn’t an option for everyone. Already we’re seeing that levels of disposable income directly affects your healthcare choices and even possible lifespan. Not surprisingly, this can cause division between households and friendships, and damage society’s balance of equality. And imagine the effect on individuals and even communities, when their self-worth and innate life purpose is questioned. Isolation. Hopelessness. And in some cases, action. In Composite Creatures, Norah represents all of us who feel like we’ve been sucked into one side of a battle we weren’t planning for. She witnesses heightened emotions and behaviours on both sides of the divide, and is powerless to do anything to change the dynamic.

But there is hope. We don’t exist in the world of Composite Creatures quite yet. We just have to hope that experiences like the recent pandemic are showing humanity that we truly are all in the same storm, though sailing radically different boats. It’s for our existing governmental powers to recognise that society needs to do as much as possible to help patch up the sails and share its lifeboats.

(You can order Caroline Hardaker’s novel Composite Creatures from Angry Robot Books here!)

Caroline Hardaker is a poet and novelist from the northeast of England. She has published two collections of poetry, and her work has appeared worldwide in print and on BBC radio. She is Writer in Residence for Newcastle Puppetry Festival and is currently collaborating with the Royal Northern College of Music to produce a cycle of songs to be performed throughout the year. She lives and writes in Newcastle.