15th July 2015

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Lord Darzi

Health Chat 15th July - King's Fund - London

 Details here.

Weeping Woman
News and Comment from Roy Lilley

Liverpool. On the eastern side of the Mersey River; first a borough then a City and in 2008 the surprise choice as joint European Capital of Culture.


An astonishing history of multiculturalism, wealth and diversity. A rich past of seafaring, trade and the world's capital of pop music. Oh, and let's not forget the Grand National plus; three world heritage sites, two football teams and a fabulous gallery.


Last time I was at the gallery I saw the 1937 version of Picasso's Weeping Woman; based on one of the figures in his Guernica masterpiece, a weeping woman holding a dead child.


It was a very different Liverpool we saw in this week's, BBCs Panorama. 'The Perfect Storm' took us to down-town Liverpool. Poverty, unemployment, benefits, illness, chronic, long-term, old before their time.


A clever programme.  Through the eyes of a GP.  I wanted to be sure what I thought, so courtesy the iPlayer, I watched it twice. If you haven't seen it you should. You should, not because, as a student of the NHS, you will learn anything but because it is important to see what is happening in the round.


A once great City hobbled by its neglect of the publics' health. Work, living conditions, ignorance. Lifestyle, habits and wrong choices. Education, housing, employment each in their own way contributing to a dreadful legacy. Stealthy killers, set to rob families of their loved ones... long before their time.


A picture of neglect. Proof, if it were needed, that public health stopped at adult literacy, childhood immunisation and clean water.  A profession that didn't prepare us for what was next. To be fair; none of our public services were prepared.


In 1948 the NHS was born. Liverpool Cathedral was under construction. The river still busy with traffic. That year the City Council published its 'vision of the future'.


The next three years were to be the most 'socialist years' in British history. War weary Britain had swept Labour into power. In Liverpool they had a Conservative council and it remained that way until 1955.


In the meantime the NHS was getting good at the Five Gs.


Get 'em in,

Get 'em diagnosed,

Get 'em fixed up,

Get 'em out,

Get 'em on with their lives.


Sidling up, unnoticed, some very different Gs, lurked in the shadows of the lives of ordinary people; galloping old age, growing numbers of people, gathering symptoms and conditions, eating garbage dependent on giros, the goggle box and god awful existences without work, decent homes or futures. Panorama painted a grim picture.


How Liverpool has ended up in such a mess is complicated. At the one end an affluent middle class, bling and premier division glitter. At the other; illness, long term conditions and first division poverty.


Now, this time, a Labour led Council has a plan; to hold back an avalanche of demand with budgets half what they were five years ago.


The plan; health, social care and the voluntary sector, working together to keep people healthier longer, out of hospital for longer and make every pound work longer.


The big ideas; preventative care, hospitals at home and persuading incredulous men, crippled by worklessness and depression that their treatment is to go swimming.


Under construction is a glittering new hospital. It has fewer beds than its predecessor. Millions spent on a facility that will require millions more spent... to keep people out of it. It is too expensive to use on the old and frail. The difficulty is; most of their customers are old and frail.


Panorama on Liverpool showed us the utter hopelessness of the task we face. Not just Liverpool. My guess... this programme could have been made in any City in Britain.


Gold standard care is to keep people healthier longer but the changes in lifestyle, attitude and approach put it a generation away. Reorganising healthcare to cope with today's problems has turned into a futile, game of pass the parcel.


Liverpool's health and social care economy is broke. I dread to think what will happen. They currently care for 20,000 vulnerable elderly people. Right now they have the money to care for half that number.


They are not unique. I suspect there will be other great cities who could show us their own version of the weeping women.


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