A public inconvenience: the provision of future health care services

One of my favourite pieces of art from one of my favourite living artists is a piece called ‘Who’s chairing this meeting’. Urpu Sellar is this favourite artist; originally from Finland, she now lives and works in Scotland. I have probably the largest collection of her work, and if I had another room in the house, I would buy more. Each piece she creates gets its name from a play on words, and she is very clever as well as being very creative. A few years ago, I saw the chair in her workshop during a Spring Fling event (where artists open up their studios to the public over a weekend), and it was very much ‘work in progress’. I asked if I could buy it when it was completed and although she agreed, she didn’t know when she would finish it as her husband was living with cancer and her focus was on caring for him.  

I was surprised when about nine months later she phoned me and said that she had finally finished it, and if I wanted, she could bring it to me – at that time I also had a house in Scotland. We arranged a time and one evening, she and her husband brought it across. Her husband’s condition was not improving. He had just finished another round of cancer treatment in Edinburgh, which was a 200 mile round trip. Although it must have been tough, he had no complaints about making the journey, as that was where the cancer specialist worked. Despite his having more or less given up drinking alcohol, he asked if he could join me in having a small whisky. It wasn’t a problem for me, I am always happy to share a glass or two of whisky with anyone, particularly if they know their whiskies.  

Urpu later told me that he stayed in bed all the next day, but he had really enjoyed having the drink, the conversation, and doing something that wasn’t cancer-focused. He continued to travel to Edinburgh for his treatment, but sadly died a few months later. Whilst I no longer have the house in Scotland, Urpu has remained a good friend. Every time I see the chair, with its 62 little birds on it, I am reminded of that evening together.

Last week the ‘Who’s chairing this meeting’ chair came into my mind for similar reasons. The week was jammed packed with meetings, although that is not unusual. One of these was an interview panel for a new Consultant in Acute Medicine. I have been used to chairing such panels in my previous Trust and was expecting to do so with this panel. The Divisional Director had other ideas and assumed the Chair. I didn’t mind and certainly was not going to have the discussion about it in front of others. I’m seeing her next week and I’m sure we will have a conversation about what happens next time. It’s often the case that the Chair sets the tone for the meeting and helps keep people engaged or conversely, and more easily, allows people to become disengaged with the discussion.

A couple of my meetings last week were concerned with exploring the progress being made with folk who continue to find themselves on waiting lists. There are currently more than 5.2 million people in England on waiting lists. Of these 385,000 have been waiting for over a year. Where I live there are 450 folk in every 100,000 waiting for over a year. Where I work, one in eight people are waiting for their treatment. The age of particular populations is a factor in the number of people on waiting lists. Some of the areas across England with the highest numbers of those waiting have the oldest populations. Those with the lowest rates also have the youngest populations and these are folk who are less likely to require hospital treatment.

Age is also important for other reasons too. Last week I heard tales of the many folk who simply won’t go somewhere else for their diagnostic assessment or their treatment, preferring to wait until a place becomes available at their local hospital. Some of the reasons for these choices are perhaps more understandable than others. Like many NHS services, we are using the independent sector to enable those most in need to have their operation. It seems that a number of the older patients offered this service don’t want to take up their place because they need to have their bowel preparation done before they pitch up at the hospital for their operation.  I can understand the anxiety this might cause. It’s the same kind of anxiety that has kept many older folk isolated because so many public toilets have been closed as a consequence of the pandemic. Speaking from experience, when you need to go, you need to go.

Other reasons are more difficult to understand. Simply not wanting to travel somewhere to get your health care seems inexplicable to me. Unlike Urpu’s husband, who was prepared to travel hundreds of miles to get his treatment, some of our patients simply don’t want to receive their treatment unless it’s from their local hospital. I think if I were faced with a possible life-shortening illness, I would want to get my diagnostics and treatment where I could, and get it done in the quickest possible time.

Like many places across England, Greater Manchester has developed a ‘waiting well’ approach to help patients who find themselves on a long waiting list. I think it is a great initiative. Not only does it help keep patients in touch with the progress of their referral, but it also provides an opportunity to promote healthier life choices. Communicating with patients is particularly important as many folk, understandably perhaps, are going to their GPs to ask how their care is being progressed. The unintended consequence of this is a huge rise in people seeking an appointment with their GP. Not getting one quickly enough, they then pitch up at the Emergency Department to get an answer. Likewise, the ‘waiting well’ approach also allows for proactive discussions to be had over alternative ways that they could receive their care – including day case care, or receiving their care at a different location.

My sense is that this is a conversation we will increasingly need to be having as place-based services are developed. Helping communities and neighbourhoods to better help themselves, addressing inequalities, and tackling the underlying social determinants that give rise to poor health and wellbeing is clearly a way of avoiding long waiting lists in the future. This is how we might effectively ‘build back better’ and create a post pandemic world where I don’t have to chair so many meetings and more importantly, folk don’t need to travel 200 miles to get their treatment.