Thursday, 6 March 2014

An odd form of parity

I've had concerns about access to healthcare for a long time now. When I started working in mental health in the early 1990s, it became apparent that access to basic healthcare was far from simple for many people. Whether because of being away from their home healthcare providers, fear tht saying the wrong thing would raise concerns (and lead to being sectioned), or feeling stressed of not being able to express the problem in a short appointment, getting the right healthcare wasn't easy.

That's without taking into account the credibility gap; the uphill battle of being believed, that this was not "all in your mind"   when you have a mental health diagnosis. The idea that you are somehow "unreliable" combinded witht the  pernicious term "attention seeking" often made people's  journey to healthcare harder. As I started to work with more groups of people I found the same issues. Mencap's report "Death by indifference" gives a chilling catalogue of how poor access to healthcare has led to many deaths. Most advocates will have a story about someone they work with finding out that a DNAR notice had been put on their notes, without their knowledge or consent. In a recent presentation to the Human Rights Law association, Joanna Owen of EHRC spoe of reports demonstrating that older people get less spent on their care packages than younger people with equivalent needs. It can make it hard to have faith in the idea of parity in healthcare.

Recently, the Care Quality Commission's report Monitoring the Mental Health Act 2012/13  raised the issue of physical healthcare of peoplep in psychiatric wards. The picture that emerged was not good. 14% of people were on wards with no access to a GP. None. It described the case of one woman in sever pain, limping badly who was not povided with access to chiropody. Having been forced to miss one appointment due to hospital transport not turning up, the staff felt it acceptable for the woman to wait another 2 weeks for an appointment.

Another case was described where a woman had been left without access to her glasses, dentures or a change of clothes for a week. She had also requested a dressing for an injury to her foot that was not provided. If someone were to not change clothes, put in their dentures, wear their glassess and leave an open wound on their foot when on a community treatment order it might be used as evidence of poor self care and self neglect. In a hospital environment it was seen as an unfortunate side effect of staff beign busy.

The  final example given in the report is of a woman on a psychiatric ward who, after returning from an invetigative procedure at another hospital, was told she must go out as there were not enough stafff on the ward to look after her. This was depite a letter from the hospital saying that she would need someone to remain with her at home after the procedure.  When she returned to the ward, unsurprisingly unwell, she was put into seclusion.

How can it be that people are having problems getting basic nursing care in a hopsital? How can the level of expectation for support be greater in someone's own home than it is in a building staffed by care professionals?  Surely you should be able to see a doctor in  hospital?

Looking at the CQC report into deaths in inpatient units, many are noted as having natural causes. I suggest that risk of death by natural causes greatly increases if you do not have access to healthcare.

The Royal College of Psychiatrists report "Wholeperson Care: from rhetoric to reality" sets out an agenda to tackle disparities in the provision of physical and mental health care. It's a bizarre way of achieving this parity, degrading the level of physical healthcare in psychiatric hospitals to that of mental healthcare in general. In both cases, the other side of healthcare is seen as another service's problem. So much for whole person care. So much for the person.

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