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What if there really was a different relationship between the NHS and people in communities?

3 May 2017 - 17:20 by Nigel Rose

I wrote this essay for a competition (which I didn't win), run by the King's Fund, called "The NHS if’ that explored future scenarios for the NHS. I wanted to write something in a different style, with a bit more of a human feel than the example essays that they commissioned "policy" people to write. I wrote it about the area I live in and the GP surgery I go to and it has some people from Chorlton in it (suitably disguised). In the end, I thought the winning essays were pretty good. Hope you find it interesting and uplifting despite the somewhat gloomy scenario.


It’s 2025 and we are in Chorlton, in the community room at the health centre. Chorlton used to be one of the richer parts of Manchester but now times are hard, inequalities between rich and poor have become ever deeper, there is not enough paid work, not enough money, infrastructure is crumbling. The NHS remains a beacon of light, with more popular support than ever. It’s Christmas and it’s cold.

The people in the room all know each other, many of them have lived in Chorlton for years. There’s a long history, a long memory in the room, there’s been many disagreements but they all feel a deep responsibility to maintain and improve the health of local people. They are part of the NHS. They understand that loneliness kills, that hopelessness kills, that bad housing kills and that services that treat people once they’re ill are not enough.

Dave (the GP): “The next item is Greenfields Care Home. I understand that it’s no longer managing to get people out of the home to do things”

Alison, the chair of the local care home association, explains that she spoke to the manager of Greenfields to find out what was happening. The problem is that one of the staff is off long-term sick and he was the one that worked with volunteers. The volunteers were the only people with enough time to take residents out. The other care homes were trying to help out by asking their volunteers to go round but it was only a short-term solution.

Someone says that the manager of Greenfields just doesn’t care. Someone else objects, saying that he’s known him for years and he’s just going through a hard time at the moment. The man from the local neighbourhood association says that they might be able to help out. The business association says that one of its members has retired recently and might be able to offer some business support. There are no easy answers, there rarely are. Everyone knows that there needs to be a solution soon or it will be too late for those people living in the home, they will start to decline without regular opportunities to be part of their local community.

The next item concerns National MIND’s new campaign on the dangers of social media to young people and how they can use it responsibly. The head of the local primary school talks about the difficulties in the playground and how children don’t seem to be interacting and the high levels of social anxiety even among young children. Dave confirms that there have been more parents coming into the health centre with worries about their children. They talk about a ban on social media at school but the Head knows she can’t make it stick without the support of others locally. They wonder if they can get more support from the Big Friends group at the secondary school.

Air pollution is the next item. 2 years ago, Dave, with the help of the local university, carried out a local study on the impact of wood fires, a particular problem in the area because of old, cold and draughty houses and difficulties with affording electricity. People use poorly dried wood or wood from skips which had led to increasing respiratory problems. They’d tried various things; local shops were selling more and better quality firewood; the local magazine had published a set of articles on how to use wood fires more efficiently; they’d held a public meeting with an expert. There was some good news, a follow up study had shown that the levels of pollution had dropped.

They stop for a break and enjoy some mince pies with a spicy twist, made by the community pharmacist.

Over the break, they chat and, as they often did, told stories about the past, about their collective history.

“Do you remember when we employed Dave? The old GP wasn’t happy, she wanted the other candidate. Didn’t like not getting her own way. She walked out of the meeting but we knew she’d come back eventually. She still thought she should have the final say.”

Every year at the 2 day annual convention of Manchester Community Health Centres, held at the town hall, they find out what other health centres are doing, locally and across the country. Everyone tries to attend, to meet old friends, exchange stories, learn about the latest technology, to browse the stalls. The highlight for many is the meal on the last night, the dancing, the performances from the choir and the awards from the Lord Mayor. Last year Chorlton Community Health Centre narrowly missed out on a prize for most beautiful health centre in bloom.

The meeting meandered on. Somehow, out of the chaos and the jokes, and the reminiscing, and the occasional moments of anger things got done. There wasn’t a local action plan, a raft of papers to read, a slideshow, a governance chart, a cost benefit analysis, or a set of questionable statistics. However, there was no lack of expertise, no lack of knowledge, no lack of creativity, no lack of leadership and they shared an vision of what was important and how things needed to be done. Just as importantly, the members, on the whole, did what they said they’d do.
The meeting closes with everyone sharing their new year resolutions are.

Gerry says he’s going to give up smoking but no-one believes him.

Dave walks home, it’s not far.

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