A cure for society's ills
Posted on 30 November 2012 by Flora Tristan
Economic circumstances, as we all know, are major, perhaps the major, determinants of health and they certainly impinge very closely on health care.
So when Retail Giant plc decided to site a vast new emporium on that scruffy weed-overgrown patch next to the main road, it was clear that practice life would inevitably be affected, for good or bad.
First there was the danger to practice staffing. The Politburo often chooses the sports hall next to the weedy patch for those meetings at which we all earnestly peer into the future and try to plan how to deal with galloping demographic change. Five months ago, at such a meeting, our nurse practitioner went through the wrong door and found five Retail Giant people behind recruitment desks. She only just managed to get out without having signed a contract to work on the tills.
More seriously, the jobs that RG can offer are very good news for many patients. Even this week I have seen four patients who now have regular employment after many months, and in one case years, of no work. Esmeralda, aged 45, has only just managed to get off methadone completely after 20 years and she is delighted by the camaraderie and purpose afforded by her 25-hour post at the delicatessen counter. Whatever we might think of the supermarket as a model for distribution and exchange and human interaction, it is undeniable that people are getting jobs at RG who did not have jobs before — many more people than would be employed at a community-owned, low-carbon, organic vegetable garden or whatever.
But it’s not all so positive. Why was Albert, aged 92, stuck in the acute medical ward for 10 days after he simply had a fall and could not get up? Because there were no beds in the elderly care acute ward. Because half the people on the acute ward should have been going to the rehab ward, where there were no beds either. Because many older people should have been going home with care packages, but social care arrangements in Innercitysville are in an even more critical situation than usual. Because many carers are understandably packing it in and making their way to the RG recruitment desks. Because RG is paying people doing even the most basic jobs quite a bit more than many long-term carers are getting.
It is obviously a Good Thing if our patients can earn a reasonable wage — but what if this results in great gaps in the public sector? Here’s the sharp end of the effect of economic change and development on health and social care. Here’s the problem which has baffled clearer heads than most of us. Economics, innit?
Flora Tristan is an inner-city GP