I have spent much of the last year talking with people about their lived experiences. I have spoken with many patients, carers, NHS and Social Care staff, worried relatives and friends, and just the people I meet. I have been trying to make sense of the range of feelings and anxieties that people have expressed, and I have tried to draw some broad conclusions about them which might help to inform my thinking going forward.
In general terms I have reached a number of broad conclusions:
Anxiety levels are now much higher in the people I speak to than I can ever remember in the past, and this anxiety is affecting people in a number of ways
Ø They are becoming more agitated, more quickly, when faced with uncertainty
Ø They are not absorbing public health messaging as readily
Ø They are more susceptible to, and more affected by, misinformation (such as some of the scare stories about the variants, and the side effects of the vaccines that have been all over social media)
Ø They are more hesitant about seeking the sort of medical help they would normally seek in previous times (paramedics are reporting a greater complexity of needs in the people they are attending for example)
Ø Messaging about the NHS being open for business as usual is not getting past the anxieties some people are experiencing and the misinformation they are being fed
Ø Isolation and loneliness are escalating. So many people are now anxious about social as well as clinical settings and becoming increasingly alienated.
I have been hearing that some of these effects appear to be amplified for (unpaid) Carers, in particular young carers and carers from those groups who are seldom heard. We are doing some work in reaching out to those carers to try and find out the full extent of the difficulties they are facing, I have some trepidation about what we may find
The number of enquiries from people unable to access NHS Dentistry is climbing rapidly, it is now the most common theme. There will be a pandemic legacy about dentistry and oral health which will need to be addressed, a major challenge given that we are hearing about dentists leaving the profession due to the difficulties the service is facing. Incidentally the position seems to be nowhere near as difficult for people accessing private dentistry.
The effects of repeated lockdowns on the health and well being of children is of concern to people. These concerns range from mental ill health through to oral health and hygiene. I could go on and on.
My main conclusions from all of this, and I could go into much more detail, is that it would be easy to be beguiled by the calls for a return to Business as Usual in the shortest possible time. I fully understand that position, but I would argue that the new Commissioning arrangements being proposed for Integrated Care Systems must also commission for the legacies of the pandemic. This does include waiting lists, but also includes a whole range of mental ill health conditions, backlogs in dentistry, clinical assessments and reviews, social care assessments and provision etc etc.
I would also argue from what I have seen and heard that the reduction of inequalities must stand alone as a key target as we look to build back better. This pandemic has in part been driven by inequalities, it has exacerbated existing inequalities and has also created new ones. Many of those inequalities were there under Business as Usual and indeed thrived there, so the new arrangements will need to be clear about how this most fundamental issue is the be tackled including the wider determinants of health and wellbeing.
When taken in the round Business as Usual could be as much part of the problem as it is part of the solution. Long years of Austerity seems to have stripped much of the resilience out of the Health and Care system and that has been brutally exposed by the pandemic. I hope the new commissioning arrangements will recognise and respond to that.
Chris Bain 