Reflections from Peoples Board meeting 18/07/19
Written by Peoples Board member, Adam Deacon
Today’s PB (People’s Board) meeting was a productive one, which raised many challenging issues, not least for the PB, health professionals, and the general public to carefully consider the immediate consequences and serious implications to meeting health needs. My personal reflections, will hopefully bring some useful insight into what’s needed to address the most essential issues.
Twice this year, PB members met outside of their standard monthly meetings, to discuss the content and presentation of our pending annual Report. Sam had been working hard in preparation for today’s meeting by pulling together the ideas into a PowerPoint presentation, for the whole of the PB to see where we’re at in our development stage, and to elicit any further considerations or contributions. The points from the presentation I would most like to focus on are the Report’s value, audience, and the PB as a public voice.
Personally, I feel it’s essential that the value of the PB stands out, as this is what defines our purpose and significance on what are life changing or life ending health implications. It’s been a longstanding frustration for the PB to know how we present or demonstrate our value, as our benefits (contributions) can’t easily be defined or quantified in a tangible or financial sense, to determine our performance or to justify our existence. My view is that the main role of the PB should be to help the CCG (Clinical Commissioning Group) on how to best meet the health needs of the Bradford population. Readers who seek to measure the value of the PB, it would be best view it in a similar way to family values, i.e. the health and social care role which family provide to their own family members (you might not like or agree to everything they say or do, but you know that overall it makes an essential difference to the quality and length of one’s life).
Theoretically, the audience for our report is everyone (including many organisations and services) within the Bradford Metropolitan District – as our commitment is towards helping to meet or improve the health outcomes of the City. However, this doesn’t mean the Report’s focus needs to try and be anywhere as wide-ranging as this – –we’re not trying to open ‘Pandora’s Box’ on the health issues in Bradford. The audience and public (and also the PB at times) needs to appreciate that the PB isn’t trying to replicate, the work of the CCGs Engagement Team, and doesn’t have the same remit or level of resources to do so. The PB needs to find better ways of communicating the distinction, and also avoid trying to involve ourselves in all of the functions of the CCGs. Alternatively, the PB needs to focus more on where it can make a critical difference, for example during meetings I’ll interject if something is unclear, confusing, there’s no apparent justification behind what is being presented or serious issues have been overlooked. PB members are patients with specialist skills, experience or knowledge in health care, we’ve already identified and made links with other similar groups, to establish mutual working relationships, however we need work more closely and better together, and there is still more that needs to be agreed.
We unanimously agreed, that the PB is (or at least should be) the public’s voice of the patient behind local health services, for me much more consideration needs to be given to what this actually means. Through my personal experience of representing the health and social needs of patients, more often than not, I will be encountering obstacles and barriers that require questioning, and at times challenging the public on how they are meeting their own needs (when I’m expected to ignore well established risk factors, to agree with opinions that lack any clinical foundation). Despite of the medical proven information the general public are already aware of, there seems far more creativity and determination goes into making excuses than complying with what known. There are many contradictions, inconsistences, fallibilities, denial and dangers in the public’s voice, actions and behaviour towards their own health needs. As a PB we need to be setting a standard, of a quality that justifies our existence.
URGENT & EMERGENCY CARE
Louise Atherton attended our meeting to do a presentation and discuss the various ways Urgent and Emergency Care is accessed by the General Public. It is clear that urgent and Emergency service are still inundated with patient who are not making appropriate use of alternative primary care service such as extended access, extended hours, social prescribing or applying essential self-care skills, medicine optimisation etc. 90% of people admitted to hospital could be cared for elsewhere.
The issue I would to like to highlight and explore more is the discussion that took place on COPD (Chronic Obstructive Pulmonary Disease). Last year, I attended a Patient Network Meeting on COPD and Asthma, where I learnt much more than I already knew about these conditions. It was astonishing to learn today, that such a high number of people are wrongly diagnosed with COPD, the anxiety and errors in treatment this leads to aren’t difficult to predict. I already knew that COPD was a terminal condition that people can live for up to 20 years with, and that majority of sufferers are smokers. I asked the question, which Louise wasn’t in a position to answer, about how many of these misdiagnoses were for conditions that were later found to be terminal? Mike interestingly made a statement in response, which was either his own view or one which is widely held in society that ‘everything is terminal’ (maybe to move the discussion on). My immediate reaction to this comment was, ‘that certainly isn’t true for example I have asthma, it can kill you, but it certainly isn’t terminal’. I’ve proven to myself over the years that with the right treatment and making healthy lifestyle choices I’m able to enjoy a level of actively, at 43yrs, which is certainly above what most of the population are doing, but not necessarily what they’re capable of doing.
I appreciate honest contrasting points being raised, as many of the most common health conditions are one’s which are either preventable or can easily be severely delayed and better treated with better public engagement such as Type 2 Diabetes, Heart Disease, COPD. However, if it wasn’t commonly believed, that such conditions weren’t inevitable or pre-empted, then you could rightly expect much more acceptance of the causation and compliance with the methods of treatment and prevention by making the necessary changes to personal lifestyle choices. From my time on the People’s Board, meeting various health professionals, I’ve not gained the general impression that people are willing or able to make the necessary lifestyle changes. Similarly, I haven’t gained this impression that people who later develop irreversible, degenerative or terminal conditions, related to poor life style choices, believed in advance that there was never a medical or financial remedy.
As adults I recognise we have the right to make our own decisions regarding our health and wellbeing. However, I struggle to see anything approaching a similar level responsibility or acceptance of the social, emotional and also financial costs, which our poor lifestyle choice forces onto our nearest and dearest, and the next generation. The CCG has a QIPP (Quality Innovation Prevention and Productivity) obligation, I’m concerned if people aren’t making use or wasting vital and precious resources, as it’s taking away a life-line from someone who genuinely can’t meet their own needs (a lot of people are unfortunately born in this position e.g. disabilities). Sue raised and illuminating point that Bradford’s health needs is like a cruise liner going in the wrong direction, it’s not suddenly going to stop and go into reverse. Maybe the PB’s role should be viewed more in terms of helping to turn the wheel in a better direction.
Final thought, if the PB’s is seen to be leading by example and practicing what it preaches, for example in terms of health services and self-care, this will show our values, and undoubtedly increase our credibility, confidence and influence over those we seek to reach or network effectively with.