Broke: Fixing Britain's poverty crisis by Tom Clark

Author:Tom Clark
Language: eng
Format: epub
Publisher: Biteback Publishing Ltd
Published: 2023-10-15T00:00:00+00:00

All true, but a generation on we might have hoped to have made some progress in closing this chasm. Instead, the statistics suggest, we are doing precisely the reverse.

PLUGGING THE DEEP END

Before meeting David at the allotment, I spend a morning shadowing Lorna Robertson, one of those links practitioners at Drumchapel Health Centre, a few hours that demonstrate all too clearly the myriad ways poverty has of getting under the skin. All the GP surgeries at the health centre are ‘Deep End’ practices – the term used for the 100 practices serving the most deprived areas in Scotland, whose expertise is pooled in the hope of tackling health inequalities through the Deep End Project at Glasgow University. Eighty-six of those 100 practices are in Glasgow.

One of the biggest challenges of such practices is the ‘inverse care law’: the principle that there is an inverse relationship between the availability of healthcare and the populations that most require it. Patients who attend Deep End practices tend to be suffering from a combination of conditions: diabetes, chronic obstructive pulmonary disease (COPD – that is, lung disease, which doctors overwhelmingly blame on smoking), asthma, high blood pressure, heart problems, strokes, along with depression and addiction.

These conditions, their immediate causes and the capacity to manage them can all be affected by past trauma, including childhood sexual abuse, which a significant proportion of patients will have suffered, and homelessness or the urgent need to find money for food or the gas or electricity meter. These are not problems that can be easily dealt with in a ten-minute GP appointment, but they still have a deleterious effect on people’s well-being and prognosis.

Links practitioners were created out of a desire to address this shortcoming in the system. Today, there are more than seventy of them based in Deep End practices in Glasgow, helping patients access benefits, dealing with housing associations and connecting with third-sector organisations that run the likes of bereavement counselling or recovery cafes. On the morning I spend with Robertson, she sees Christine,* a 45-year-old wheelchair-user born with cerebral palsy, and Michael,* who suffers from long-term mental health issues.

Christine had always coped well with her condition, living independently with little outside support, but a recent cancer diagnosis knocked her for six. She is struggling to perform tasks she once took for granted and is distressed about the loss of her hair. Robertson contacts the social work department to chase up a homecare referral and scours the internet for a pre-tied bandana which Christine will be able to pull on and off with ease. Transport is also an issue for patients like Christine. ‘The health system is designed by – and geared towards – people with cars,’ Robertson says. ‘Those without cars may be taking three buses to get to an appointment in the Queen Elizabeth University Hospital one day and another three to get to an appointment at Gartnavel [Hospital] the next. That adds to the financial pressure and the stress.’ And, of course, where the

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