It would have been almost impossible
to miss the various stories about voices last week. There were many. However,
the one that stuck in my mind in particular was the enormous efforts Amazon
have gone to ‘educate’ Alexa over the various dialects and terms used in
different parts of the UK. If you did miss it, you can read about Susie Dent,
lexicographer, and her work with Alexa here. It’s clear that as technology
advances, the everyday world as seen and experienced by others, becomes easier
to understand – more of which later.
Now, if truth be told, I have
been known to raise my voice slightly at Alexa. On rare occasions I have even used
the odd word I wouldn’t want my mother to overhear. Why? From sheer frustration
when for whatever reason Alexa doesn’t understand me. Conversely, Alexa is sometimes
treated like a member of the family, and she gets thanked (for example, telling
me my 20-minute timer is up). Billy the parrot is fascinated with her. He has
something to say about most things, but thankfully he has only learnt to say Alex.
The ‘a’ is missing otherwise I have no doubt Alexa would be switched on and off
all day long. As it is, he speaks with the Radio 2 presenters, and often I will
come in and he’s chatting away to the radio – but with the exception of the odd
recognisable word, most of the time none of these conversations make much
sense.
However, these are voices that
are heard. Last week I took part in a very challenging webinar, organised by
the Primary Care Journal and Public Policy Projects. The focus was on ‘hard to
reach’ groups, using the provision of dental care for homeless people as a
means of getting into the issues. Hearing about the innovative ways people have
found to provide oral health care was fascinating. I hadn’t appreciated
dentists often categorise folk into three different groups: those in pain;
those who have regular six monthly check-ups; and those who want a smile. The
last group are also not who you might think they may be.
During the webinar several case studies were presented of people whose lives had been impacted by the use of drugs, alcohol, homelessness or poverty. Often for these people, buying a toothbrush and toothpaste wasn’t high up on their list of priorities. Many had experienced enormous difficulties in gaining access to any primary or community health care. I did smile at hearing one of the participants, a dentist, describing how he had to take off his white coat to become a person before he could reach out to these groups of people. But they were doing great work, and helping people regain their smile, which in turn boosted self-confidence, leading to many folk being able to turn their lives around for the better.
What was also clear, however, was
that for every individual helped in this way, there are plenty more people out
there with similar problems. Last year there were over 14.3 million people in
the UK living in poverty and a further 320,000 people who were homeless. The
Covid-19 pandemic is inevitably going to exacerbate this situation. As one
participant in the webinar noted, these aren’t so much ‘hard to reach groups’
as the groups we often choose to ignore. Their voice is hidden and as such not
heard.
Additionally, there is another
group whose voice is sometimes ignored. These are the people who don’t own a
smartphone, or have access to a computer. Whilst latest estimates note that 95%
of the UK population own a smartphone, that missing 5% represents over 3,400,00
people. Increasingly we see the use of such digital technology becoming commonplace
in our everyday lives. And whilst I might sometimes get frustrated with Alexa,
it’s nothing compared to my frustration when trying to resolve an issue or a
problem and not being able to find a phone number to actually speak with
someone. Going on-line and using chat boxes, FAQ and so on, or waiting for
email replies that never come increases my frustration. Even if there is a
phone number, the pandemic has meant there are fewer ‘phone associates’ to
handle the calls, so waiting times become almost unbearably long.
But that is nothing like the issues
faced by those who don’t have access to new technology. Indeed, they may not
even know what it is that they don’t know. They are not alone. Last week GP
Helen Salisbury writing in the BMA, noted a problem with remote consultations being
the ‘unknown unknowns’. You don’t always know what you are not seeing. Secretary
of State for Health and Social Care, Matt Hancock, has said that in the future,
all GP consultations should be done remotely by phone or video unless there are
compelling clinical reasons not to do so. Although Helen describes doing her
best for patients during the pandemic using digital communications, she notes
that where there have been successes, it has been a result of the knowledge she
has gained of her patients over many years.
She makes a compelling case for a
more balanced and nuanced approach to be taken with patient consultations as
the pandemic lockdown measures ease. You can read it here. To me she is a good
example of someone speaking truth to power. Helen might even consider making an
application for the role of Chief Executive of the newly created National
Institute for Health Protection. In the ‘Position Specification’ (note it’s
position not person) the successful candidate’s profile needs to ‘demonstrate
credibility and confidence to speak truth to power; they will have the stature
and interpersonal skills to advise all levels of national, regional and local
government with an objective and independent mindset’.
I think Matt is possibly in dire
need of someone like Helen to help him understand he actually doesn’t need to
change the law, so that nurses can give flu vaccinations this Winter. They have
been doing so, and very successfully, for many years. But perhaps like others,
their voice is hidden and not heard too.
Please note: the Alessandro
Bianchi/Reuters mask pictured above is not suitable for Covid-19 use.
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