Finding a different place for healthcare: its the future

I’m habitually beaten at University Challenge by my classically educated wife J. Sometimes I just sit in wonder as she plucks a seemingly obscure answer from somewhere deep in her mind. In fact, I have little understanding as to how her mind works. Last week, for example she sat outside watching the garden birds feeding. Coming in she posed the question – ‘Of course, the birds don’t know about the Covid19 pandemic, do they?’. It’s a metaphysical question, like, ‘why is there something rather than nothing?’, that is almost impossible to answer.

However, on one level there is a relevance to the question. Since 14^th December 2020, all poultry in the UK has been required by law to be kept indoors because of several outbreaks of avian disease, or bird flu as its more commonly known as. The order applies to all poultry keepers whether you have a few hens or 100,000. This was rather a blow to our small hen enterprise. Whilst we have a super building in which to house our hens (and goats) it is normally used only for them to sleep in, the rest of the time the hens and goats are free to roam outside. As the weeks rolled on with no sign of the lockdown restrictions being lifted, we became concerned that our lovely hens were suffering unknown harm. Taking things in hand, we decided we had to do something to give our hens a chance to see and feel the sunshine on their feathers and live their best life.

Under Paragraph 35 of the Defra Code of Practice for the welfare of laying hens, it is permissible to provide a ‘veranda’ or ‘winter garden’ attached to the main hen accommodation. We got straight onto our builders who came round, weighed up the job and quoted us £3,250 to build it. Hmm, we thought, let’s build it ourselves. We measured up, ordered the materials, and started to build what came to be called the ‘hen house extension’. We started work on it just as the weather turned for the worse. We had decided to use 4 inch square posts, as we wanted the building to be strong and last for many years. Each one (6 in total) needed to be set in concrete. Try digging 3 feet deep holes in ground that is frozen while the snow falls around you and the wind turns your ears, nose, and fingers blue! 

But we eventually succeeded and have been rewarded by seeing happy hens protected from their pandemic, and yet still able to enjoy fresh air and sunshine.

Sadly, seeing their obvious joy, it did make me think about all those living in care homes, who have been isolated and in lockdown for so long over the past year. As the vaccination and the current lockdown reduce the rate of infections, hopefully, we will soon be able to see and hug our loved ones once more. However, I think there is a related but longer term problem we need to consider.

Last week I took part in a Good Governance Institute webinar that looked at the recent White Paper on the proposed changes to the way the NHS in England is organised and how future services might be provided. To my mind it was horribly ‘acute hospital service’-centric. There was very little said about the contribution community services, primary health care or mental health services could make to improving the health and wellbeing of individuals and the communities they live in. Information about the so called ‘place-based care’ was both vague and hard to find.  I think this will increasingly become a problem for many folk.

In England some 25 million people live with a long term health condition (LTC). We know that LTCs are much more prevalent in people over the age of 60 than any other age group. Likewise, 50% of all GP appointments and 64% of all hospital outpatient appoints are for those folk living with a LTC. Perhaps more importantly, 70% of all hospital bed stays and 70% of health and care spend is for people with a LTC. The reality is that the more people than not, aged over 65, have two or more LTCs – many more of those aged 75 years or over, have three of more LTCs. This is a health problem of the same magnitude as we face with the pandemic.

I believe that as a society we ignore this problem at our peril. I don’t think that our acute hospitals are going to be able to return to the pre-pandemic levels of performance or capacity in the near future. The Covid19 demands for every increasing infection, prevention, and control measures, coupled with the unresolvable constraints of many hospital buildings will mean that the numbers of patients being seen will be considerably lower in number. Not a good thought. We need to do more to help those with a LTC to live the best life they can, and to do so without having to come into hospital for their care. This is why developing ‘place-based care’ will be so important in the future.

We know the number of people with non-Covid health conditions have been massively impacted by the restricted nature or unavailability of healthcare services. Sadly, this is likely to be the case for some time. Our NHS colleagues are exhausted, burnt out and in need of some time away from what has been an unceasing call on their skills, knowledge and experience. I find it almost impossible to believe that, in the traumatic health context brought about Covid19, colleagues will not have experienced some level of psychological harm. People are not like our hens. But we do need to find way to better protect them from the causes of harm, which are often as unseen and unknown as those faced by our hens.

One of the speakers at last week’s webinar was Dr Claire Fuller. She is a GP and the Integrated Care Service Lead and Interim Accountable Officer for Surrey Heartlands Clinical Commissioning Group. She was also a totally inspirational speaker. My take home message from her was the thought she had that: ‘the legislation [NHS White Paper] should not be the limit of our ambitions’ – in effect we know what the problems are and will continue to be unless we do something, so seize the time, and make a difference. It won’t be as easy as building a ‘hen house extension’ but it could be just as powerful in terms of helping others live a better, healthier and longer life.