In the opening lines of “A Tale of Two Cities”, Charles Dickens writes, “It was the best of times, it was the worst of times….” And he continues to couple wisdom with foolishness, belief with incredulity, light with darkness, hope with despair.

Can you believe in two opposites at the same time? I think so, when I consider my view of our health service.

The British NHS is a marvellous phenomenon, staffed by wonderfully dedicated, caring people and I am often reminded by friends and contacts who have had powerfully positive experiences.

I am a big fan of the NHS and the people who work in it.

I am also one of the biggest critics of aspects of it. In fact, it is because I believe so firmly in the NHS that I get so passionately annoyed at two things: some, stress some, work in it and let the high standards of the system down. And secondly, the management and politicians who don’t support the high ideals of the service, whether financially or whatever resources are needed.

There are areas of the health service which are creaking at the seams, and it took a drama on BBC on Sunday evening to prompt me again to focus on the way sometimes families are let down when their needs and the needs of ordinary people become blurred into the “system.”

“Care” was a tough watch, superbly written by Jimmy McGovern with brilliant acting by Alison Steadman and Sheridan Smith portraying a hard-hitting, emotional story.

Smith plays Jenny, left by a feckless husband to bring up her two girls on her own without any money from her jobless former partner. Not exactly a bed of roses, but not uncommon in 2018 so she’s managing with the help of her strong, independent mum, Mary (Steadman).

In an afternoon, however, their lives are turned upside down when Mary suffers a stroke while driving and crashes her car. To the shock of everyone, including Jenny’s sister, Claire, they discover that Mary’s not only has had a severe stroke but she is also suffering from dementia.

Despite a number of serious complications, the hospital’s “discharge liaison officer” wants Mary’s bed, and meets the family to get her out. No, I don’t know if this job exists either, but she pushes to get the lady out to a nursing home, where she wanders off on her first day and goes missing before being fortunately found by police.

Conditions in the home are poor, one woman with dementia stands in a pool of her own urine because they’ve run out of the cheap incontinence pads. A care worker, a totally dedicated, caring woman, offloads to the family about the lack of staff. And don’t blame the owner who only gets £20,000 a year for running the home himself.

Jenny brings her mum home, but can’t cope because she needs 24/7 nursing and medical care, and when they do find a really good home it would cost £700 a week.

I won’t relate the whole story here; but there were lines that hit me.

The nursing home care worker knows the “standard of care here is not good enough. But better sub-standard care than no care at all, so everybody keeps schtum.”

The family feel guilt and stress, with one daughter so exasperated she says: “You know the best thing a mother can do for her children? Die.”

And one which shocked me, when the sisters fought to have funding for their mum to have NHS continuing health care, the discharge liaison officer says to them privately that if they’re successful it could mean: “a nurse being called away from a young person fighting for life because an old woman in the next room has sh*t herself.”

How dare she, I thought, make these women feel even more guilty for fighting for care for their mother. But, sadly the system of not providing proper funding for the NHS pits these families against managers “playing God”, as Claire put it, and making decision based on the fact that somebody is getting old and doesn’t deserve treatment.

I know this was a drama, but it was so realistic that it could be happening all over the place day after day. Actually, never mind could, it IS happening.

We are very fortunate in this part of the world to have good nursing homes, but the pressure on families looking after the needs of our older people is immense.

Journalist Colm Bradley reported in the Impartial Reporter that some patients waiting for domiciliary care packages in the Western Trust area could be waiting for a year, and that ““from April to September 2018, 78 patients were delayed an average of 13 days in the South West Acute Hospital, Enniskillen and 49 patients were delayed an average of 10 days in the Omagh Hospital and Primary Care Complex due to delays in securing Care Packages”.

It’s slightly different to the television story where they pushed the woman out of hospital to a sub-standard package, but it also reveals the burden in this sector.

I cannot help but feel that the turning point was when Government abdicated responsibility for looking after older people and involved the private sector some years ago, allowing people to make money out of care.

Indeed, while I’m just focusing on the care of the elderly in this piece, there are numerous issues across the health service with waiting lists a particular disgrace.

Letting poorer people, or people from ordinary backgrounds wait in pain, or letting families struggle on their own is a result of political ideology from those in power who look after

their own privileged few. MPs can make sure they have expenses to build duck houses or moats, but not apparently to fund care workers for working class families.

But it is nothing new.

Remember Harry Leslie Smith, who died a couple of weeks ago at the age of 95, and his stirring speech at the Labour party conference a few years ago when he spoke about the intense poverty of his Yorkshire upbringing.

Bred and drippings for tea, he recalled the extreme hunger and his parents undying love for him and his sisters in “the slum we called home.”

“Common disease controlled our neighbourhood and snuffed out life like a cold breath on a warm candle’s flame,” said Harry, who brought the audience to a tearful silence when he spoke about his sister, Marion.

“Tuberculosis tortured my sister and left her an invalid that had to be restrained with ropes around her bed,” said Harry, who said his family didn’t have any money for doctors or medicine and “Instead she wasted away before our eyes.”

Tragically, when his sister died, the family couldn’t afford to bury her so she was “dumped nameless into a paupers pit.”

Those really were the worst of times.

In a rallying call of “keep your mits off our NHS, Mr. Cameron”, Harry recalled that it was his generation that was galvanised after the Second World War to have the NHS introduced in 1948.

Now, in 2018, many of us rely heavily on the fantastic services provided by the NHS in a challenging environment.

But with austerity becoming almost an acceptable word, who will be galvanised today to make those in power reform and resource what is needed to ensure families don’t suffer today’s problems?