In July 2016 there was the publishing of a paper I have been working on for months at work with a colleague from Voices of Stoke.   The paper is entitled, 
‘Gatekeepers – Access to Primary Care for those with Multiple Needs’ 

It tells the story of those suffering extreme poverty and vulnerability such as the homeless who may also be mentally ill, have substance abuse or criminality issues, and how they struggle to access services that most of us would understand as universal, GP’s.  In a nutshell, it discovered that there are barriers put in place, such as insisting upon ID or proof of address which actively drives people away from these essential services.  These are ‘gateway’ services, leading to other sorts of help beyond the GP that these service users may otherwise never access.  The word here is ‘active’.  For example, one clinic was found to be telling service users (from a hostel) that they were not in the catchment area despite it being less than 150m away.  All this in spite of all guidance from bodies such as the CQC and NHS England.

What is striking about this issue is that, from the people I was speaking to as I built up knowledge about the topic, it appears to be well known amongst professionals.  In fact, reading through academic journals I easily found a paper from 1997 [1]that identified disincentives that surgeries face when being asked to enrol one of ‘these’ patients.  This paper called for incentives to be put in place back then.  Since, nearly 20 years have passed and the same disincentives apparently exist, these being that these are complicated patients who need a lot of support, if indeed they turn up for appointments.  It may be the case that surgeries need supporting to deliver suitable services to these patients.  An organisation such as Voices can support, but are only here for the medium term and is no permanent fix.

How such a problem can exist in plain sight is another thing that is ‘active’, unless you consider doing nothing as inaction, which it isn’t if you choose to do nothing.  It seems to me that this is an issue that can actively be ignored because it is (or has been) unlikely to result in public revulsion or scandal of any sort.  One shouldn’t forget that, ultimately, public services and the shape of them and their delivery is a reflection of broader society and what it demands.  This is moderated through a process that it innately political, especially in the way that organisations are held to account.  Programs such as these are only born of social practice, fact.  It is pure folly to imagine that an organisation would actively pursue inaction on an issue without existing in an environment that facilitates it.  It seems then that the reaction to this issue, and also to the paper that was distributed widely across the health economy last week, is silence because the lack of a service is broadly socially acceptable and there is no desire to hold services to account.

So how does something that is so obviously an injustice become socially acceptable?  The paper introduces the concepts of deviancy and stereotypes and this seems eternal, back to the bible and beyond.  Indeed, this is a sector traditionally populated by the religious, seeking to question their purity of soul through living out the tale of the Samaritan.  However, there are other powers at play.  I apologise now if this seems an obvious thing to say and I certainly do not apologise if this offends certain political views but, since the financial crisis of 2008, there has been a concerted effort to identify and redefine the ‘other’.  There is a mechanism for this.  An unscrupulous politician is likely to make good hay exploiting the differences between us, this recently demonstrated well in the Brexit debacle (yes, debacle) and rise of the right wing across Europe and the States.  Other forms have been ‘Benefits Street’ and the demarcation of the poor and jobless as undeserving.  These are common reoccurring themes throughout history.  A tribal leader can emphasis the difference of the other to solidify their position.  This time politics has fed the populous bastardised concepts of ‘fairness’, such as Osbourne talking about the next door neighbours’ curtains been closed as folk head off to work.  This seems to have appealed to a part of humanity that seeks self-interest and is doused in feelings of envy.  After all, why should you keep them?  It’s not fair.  It seems that people are not interested in facts when they don’t evidence what they like to believe (like the unfortunate fact that unemployment benefits currently account for 1% of welfare spending in the UK[2]).  This has led to horrifying generalisations, also this recent politics has also prompted a liberalisation of old beliefs that for a long time had been buried under political correctness making them difficult to express in a socially acceptable way.  Osbourne’s ‘fairness’ had let the cat out of the bag, Farage ran with it.

“. . . . people in this country have had enough of experts” – Gove 2016

All of this has meant that a culture of blame, specifically blaming individuals or groups of people is now the vogue.  Those people are the ‘other’, they are outsiders and simply made the wrong choices in life.  What’s more, they are outside at night time, waiting to mug you or chase you with a syringe.  Any explanation that leans upon social structure and disadvantage doesn’t seem to fit and sounds tired when sat against this discourse.  Even in spite of the horrifying evidence of the misery in Syria (What?  The ‘other’ have mobile phones and X-boxes?).  It doesn’t appeal.  I think for many people who voted ‘out’ of Europe, explanations focussing upon social structure just sound like liberal whining and meddling, exactly the kind of thing they voted against.


Syria – Before and After

Right, back on track.  For me, all of this feels like a huge step backwards, the exact opposite of progressive politics.  A metaphorical book burning.  It’s incredible how quickly society seems able to unlearn things.  Until society becomes more able to accept concepts such as disadvantage and the effects of structural issues it a seems that this activesilence will continue, the numbers of people on our streets will continue to grow and the services that serve them diminish in number.  Yesterday I received a petition from a colleague about the budget cuts to drug and alcohol services in Staffordshire, perhaps a cut that could be described as low hanging fruit . . . . . . . for me it seems that we have a long way to go until society begins to see the individuals rather than a group of the other.

PS – The paper resulted in a working group at our local authority, was mentioned in the commons and was discussed on 5 live.  Not bad for an electro junky.

[1] Wood N, Wilkinson C, Kumar A, 1997, Do the Homeless Get a Fair Deal From General Practitioners? –


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