IN A surgery in Drumchapel, at the tail end of the pandemic, I listened as John – a middle-aged man with multiple health problems –unburdened himself to community links practitioner Lorna Robertson.

Community links practitioners (CLPs) are employed to tackle some of the social issues that contribute to poor physical and mental health – poverty, damp, isolation, addiction – but which overstretched GPs don’t have the time or resources to deal with.

That morning John couldn’t sit still. He fidgeted in his chair, turning this way and that, as he explained how a glitch with his electricity card had left him without heating or a stove on which to cook his dinner.

On one level, the issue with his electricity card was not such a big deal: a bureaucratic mix-up, easily resolved. But John suffers from anxiety and depression – a legacy of childhood trauma and the frustration of navigating a benefits system designed to humiliate – and he was overwhelmed.

In the absence of a CLP, John might have asked for a doctor’s appointment he didn’t really need. Instead, Robertson was able to calm him down, contact his energy provider, give him space to talk about his fears, and encourage him to join the waiting list for the Moira Anderson Foundation, which supports victims of historic child abuse.

Robertson is one of almost 70 CLPs based in Deep End surgeries in Glasgow. Deep End surgeries are those surgeries which serve the most deprived populations – areas of high stress and low life expectancy, where poverty and ill health co-exist in toxic symbiosis.

No-one who has watched the CLPs at work, or spoken to the patients and GPs who benefit from the service, could doubt their contribution.

Perverse ‘law’

The initiative represents the only serious attempt to address the city’s notorious health inequalities, and specifically “the inverse care law”, a long-established phenomenon whereby – perversely – those in most need of healthcare are the least likely to receive it.

And yet – despite a consensus on the value of Glasgow’s CLPs – they are employed on rolling annual contracts which both deprive them of job security and make it harder for surgeries to plan long-term. It also makes them easy targets when budgets are under pressure.

And, sure enough, last week Glasgow Health and Social Care Partnership (GHSCP) revealed it planned to cut the number of CLPs by 40% to just 42 in 2024.

The links between poverty and ill health are irrefutable. Last year, the Glasgow Centre for Population Health cited the Tories’ austerity policies as a principal factor in decreasing life and healthy life expectancies in the city’s most deprived neighbourhoods.

That the number of CLPs should be slashed at a time when the pandemic backlog and the cost of living crisis is heaping even more misery on the hardest-hit defies belief. Those CLPs who remain will be spread more thinly across two or three surgeries, which will lead to shorter appointments.

Shorter appointments mean less time to get to know the patients, to win their trust, and to gain an understanding of the complexities of their lives. It also means more pressure on GPs, who are already struggling to cope with demand and staff shortages.

No-one has a better insight into the pressure GPs are under – and the potential repercussions for patients and the wider NHS –than author and Edinburgh GP Gavin Francis.

In an extract from his book Free For All: Why The NHS Is Worth Saving, published in The Guardian last week, he told of days when his workload seems overwhelming.

“ I start to hurry,” he writes. “The chance of things being missed begins to rise.”

Francis describes a recent visit from a patient who wanted to discuss “two different medication changes, a new rash, worsening hip pain and palpitations – all in a consultation booked for a cough.”

Now imagine the same patient also expected his GP to contact his housing association about pervasive black mould, refer him to a foodbank, link him in with addiction services and arrange bereavement counselling, and you can see why CLPs are vital.

 

NHS Scotland is in crisis mode

 

The blame game

AS so often, the GHSCP and the Scottish Government are blaming each other for the planned cuts. The GHSCP says it can only agree contracts based on its known income from the Scottish Government and it has been given no guarantee the £1.35 million it received for CLPs this year will be repeated in 2024/25.

But the Scottish Government considers this money to be “top-up cash” and expects the HSPC to continue funding CLPs from the primary investment fund.

However, that there should be any threat to the service flies in the face of the SNP’s insistence that eradicating social inequality is its top priority.

One of the first things Humza Yousaf did on becoming leader was to convene a summit on tackling poverty, while promising more progressive and redistributive taxation.

The First Minister claims to have ditched Kate Forbes as finance secretary because she did not share his fiscal vision.

Five months in, as the Scottish Government begins work on the 2024/25 Budget, Yousaf is being urged by the likes of the Scottish Retail Consortium to plug its £1 billion spending gap by cutting services instead.

And yet, we know that when frontline services are cut, it is always the poorest who suffer most, and that short-term savings can carry long-term costs.

Infinite demand

ON the bleakest of post-pandemic days, it can feel as if the NHS is drowning in a sea of infinite demand and the health problems of those in our most deprived communities are insurmountable.

But in Free For All, Francis writes: “To say that a functioning NHS is unaffordable is to admit to a startling lack of faith in civilised society.”

In the same vein, to say Glasgow’s Deep End CLPs are unaffordable is to surrender to a dystopian future in which the gap in life and healthy life expectancy between rich and poor grows ever wider, and where whole swathes of the population are sacrificed to a desire to keep the taxes of our highest earners palatably low (and secure their crosses on the ballot paper).

While acknowledging the scale of the crisis, Francis believes the NHS is fixable. Pointing to a 2019 analysis of NHS finance and performance, which found the UK was spending less on its health service than Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US, he says the answer lies not in privatisation but in greater public investment, and in politicians who remain committed to the service’s founding principles.

The author called for “a network of home care teams and intermediate care hospitals that can keep frail and elderly people away from trolleys on corridors and queues in A&E”, thus preserving their dignity.

Other dreamers might envisage an NHS which redresses rather than entrenches health inequalities, with the ultimate goal of creating a society in which your chances of good health are not determined by your postcode. That’s what the community links practitioners have been doing.

If the First Minister is truly dedicated to eradicating poverty – if he is committed to the founding principles of the NHS in all their egalitarian glory – he will expand the service, not stand by and watch as its sterling work is wrecked.