Five years ago, it would have been unthinkable for me to write a blog with this headline. Growing up in poverty meant my views have always been comfortably left of centre, moderating a little as I’ve grown older. For nearly 15 years I have been working with marginalised groups within the inner city, where we are advocates for people who, for one reason or another, cannot speak for themselves. But it is this passion for reducing inequalities that has led me to reflect on the healthcare currently offered to my patients.
The NHS had been starved of resources for years before the pandemic, and despite annual uplifts in funding, was unable to keep up with the demands of an ageing and increasingly comorbid population. The pandemic has now exposed this resource gap as a large gaping wound requiring major surgery, rather than the intermittent sticking plasters used to patch it up in the past.
We have silently accepted ambulance waits of up to 10 hours, four-month waits for psychology services, six-month waits for physiotherapy and 12-month waits for elective surgery. Yet despite all of this, I have never questioned the fitness of the NHS until a recent conversation with a friend.
This friend shared with me that their teenage granddaughter had not attended school since the start of the pandemic due to her anxiety. The factors leading up to this situation are obvious – a school overstretched by the demands of mental health problems among pupils, an eight-month waiting list for CAMHS and a parent who, understandably, is totally out of their depth.
I reflected on my own experiences with my 13-year-old daughter, whose upbringing has been steeped in privilege and advantage. Who says money can’t buy happiness when it has bought private CBT leading to recovery? My knowledge about graded exposure also enabled me to work with her teachers to devise a back-to-school programme, and she is now attending full time. Six months down the line, though, my daughter remains on the CAMHS waiting list, and I dread to think what would have happened if I hadn’t been able to buy us out of this situation. I can’t help comparing the life chances of these two similarly aged girls and wondering how we could have come to accept this appalling service for the sake of maintaining a health service on a life-support machine.
By attempting to provide a universal service with inadequate funding, we are offering substandard healthcare and widening health inequalities. GPs are often the scapegoat for the resultant failings, including early cancer diagnoses. Yet, fast-track cancer appointments are designed to offer a yield of around 4% and the majority of cancers are still diagnosed outside of these pathways. This means it is crucial to have timely access to elective referrals, but this process has been obliterated by the pandemic.
We are living in a country where those with a bit of cash are increasingly likely to buy their way out of an unfit NHS (as Pulse showed in its recent feature), but my marginalised patients will continue to endure pain and suffering, both mental and physical. The previously cherished mantra of the NHS levelling us all up is no longer applicable as we are all freefalling to the bottom.
If we do not do something dramatic, the inequalities between social classes will widen even further.
Dr Shaba Nabi is a GP trainer in Bristol.
Read more Dr Nabi’s blogs here