Feature

Pictures of health

A survey of peoples views on healthcare in Clapham, south London, produced a surprising divergence between lay people and the professionals. Rosemary Dun explains

Community and primary health services are failing those who are most likely to be in need — people with disabilities and their carers. This is one of the conclusions of a survey carried out in Clapham, south London. Answers to simple questions such as ‘What does being healthy mean to you ?’ and ‘What sort of things in your daily life do you think have a harmful effect on your own health and the health of your family?’ were sought and analysed. Perceptions were explored, viewpoints compared and relationships examined. This was according to certain social groupings, such as, class, race, sex, disability, and housing tenure; and between other groupings, such as lay/professional, health/social services and statutory/voluntary sectors.

The results show a chronic mismatch between lay and professional perception of health, needs and services. In some instances, the views of what is important are completely reversed. Time and again, lay-people stress the importance of environmental and socio-economic factors like housing, income, unemployment, traffic, dog mess and air pollution. The professionals are more likely to identify inadequate services and personal lifestyle as more important to health.

It is clear from the survey that disturbing inequalities in health are likely to persist, particularly affecting those with disabilities. Disability or chronic sickness is an end result of ill-health. The survey showed a class gradient in the disabled population that reflects increased ill health in the lower socio-economic groups. Working class people are twice as likely to be disabled or chronically sick as middle class people. Of those who are carers at home, the majority (64%) are women, are married (54%), and are working class (73%).

The inference to be drawn, in health planning terms, is that inequalities are likely to be ‘compounded’ and to feature socio-economic and environmental factors. Planners will continue to get it wrong if they try to direct resources to ‘those in need’ with no awareness of this point. Evidently, the improvement of personal health and the health of local communities is beyond the scope of the NHS alone. Health authorities must work in collaboration with other sectors, particularly with social services, housing, environmental health and the voluntary sector.

On the question of services, the survey, Pictures of Health, found that people with disabilities are three times more likely to think that GP services are poor, carers are twice as likely to think so. Informal carers are four times more likely to feel that other services are poor. These are findings vital to planning, especially as this population is most likely to be in need of community health services, as well as the benefits and services to which the GP provides indirect access.

The bulk of care in the community is being provided by informal and unpaid carers. Only about a third of respondents with disabilities and their carers were receiving additional support, and about a third of those had support from social services — in the shape of home helps, meals on wheels and social workers.

Astonishingly, not one person was receiving help from local health services. Clearly, NHS care in the community for people with disabilities and their carers is just not there, or at best it is grossly underfunded.

The map of provision identified by the survey suggests duplication in some services and gaps in others. The lack of joint planning or joint local action resulted in services appearing patchy. Suspiciously, this may reflect professional jealousies and attempts to guard territory.

At present, planning tends to reflect medical models in an over-reliance on morbidity and morality rates with little analysis as to why people are sick and dying. Community health service planning has been saddled with a focus on ‘priority groups’ which parallel medical specialities. For ‘the elderly, mental health, children and learning disabilities’, read ‘geriatrics, psychiatry’, paediatrics and mental handicap’. These categories serve to exclude people with disabilities in the 16 to 64-year-old age group, along with the carers. As this group is not seen to have medical needs, it goes without any social support.

Pictures of Health found that people not only have clear ideas about what affects their health, but they also want more say in deciding what services they need. What is clear is that without the involvement of users and local communities in planning processes, NHS services will fail to meet public need, and will fail to improve public health. Care in the community policies will continue to have an empty ring for those who are most in need of help.

Pictures of Health is to be published soon by West Lambeth health authority.