\n<\/p>\n
T<\/span>he same 11 young women turn up around the clock at the emergency ward of Furness general hospital in Cumbria. The group are well known to staff, other services \u2013 and each other. Aged between 19 and 35, they have all led troubled lives. Some grew up in care, most need mental health support. All have fallen through society\u2019s cracks and now gamble with their lives for a safe place to sleep.<\/p>\n They know where to look to find the precise amount of medication to take for a non-lethal overdose, guaranteeing them an overnight stay in hospital. Some resort to swallowing household objects to secure a bed for the night.<\/p>\n These 11 women accounted for a staggering 9% of the 45,228 A&E admissions at the Barrow-in-Furness hospital last year, at a cost to the NHS of at least \u00a3250,000. But they are far from unique. One NHS leader described a \u201cchilling pattern\u201d of self-harm among vulnerable people whose regular refuge is now their local hospital.<\/p>\n It is not confined to the young. Older people, known on some wards as \u201crevolving-door pensioners\u201d, are deliberately self-neglecting so they can be looked after in hospital, particular in winter when energy bills are high.<\/p>\n The Guardian has spent months interviewing GPs, nurses, social workers, NHS leaders, academics and residents in some of the most deprived corners of Britain as they grapple with the worsening effect of deepening poverty on a health service in crisis.<\/p>\n Through a series of pioneering schemes in north-west England, clinicians have uncovered what one NHS manager described as \u201cmedieval\u201d levels of untreated illness. In poorer places where GPs and community nurses have all but vanished, A&E attendances have almost doubled since 2010, driving up ambulance call-outs by 61%.<\/p>\n Wes Streeting, the health secretary, is due to unveil the biggest NHS transformation plan in a generation next month, aiming to shift healthcare from hospitals to communities and from treatment to prevention.<\/p>\n The challenge is stark. Britain has the lowest life expectancy in western Europe and one of the highest tallies among rich countries for preventable deaths. NHS bodies in the regions have been ordered to slash their budgets in half, cutting as many as 13,500 jobs, leaving senior figures alarmed about how this squares with Streeting\u2019s focus on community care.<\/p>\n In parts of Blackpool, Barrow, Burnley and Blackburn, areas with some of the worst deprivation in England, the Guardian learned of children suffering from both obesity and malnutrition as families increasingly rely on cheap processed food. Babies are being fed reheated formula milk, potentially causing serious bacterial infection. Other families risk food poisoning by turning off their refrigerator overnight to save money.<\/p>\n \u201cThere\u2019s a certain sense of despair among professionals,\u201d said one NHS leader. \u201cWe\u2019re trying our best but I\u2019m not sure how much we can do. It\u2019s deep-rooted, it\u2019s extreme, but it\u2019s a symptom of something broader and deeper happening across all society.\u201d<\/p>\n <\/span>Nurses speak to residents in one of north-west England\u2019s poorest estates as part of a new NHS scheme aimed at tackling health problems.<\/span> Photograph: Christopher Thomond\/The Guardian<\/p>\n The NHS has become focused on treatment rather than prevention. But in parts of Lancashire and south Cumbria, health leaders have been taking a new approach aimed at tackling conditions before they become crises.<\/p>\n On the Ryelands estate, a pebble-dashed maze in Lancaster, Lizzie Holmes, a community nurse, has spent two years persuading residents to have free health checks.<\/p>\n The community, historically one of the poorest in Lancashire, is a desert for doctors and dentists. Residents are all but invisible to the NHS until they are blue-lighted to hospital or turn up at A&E. Many have not seen a doctor for years, pushed away by the 8am scramble to see a GP and the months-long waiting lists.<\/p>\n Holmes, who was awarded the prestigious Queen\u2019s nurse award last year, has become an unofficial social worker and even amateur plumber to win the trust of reluctant residents. Last year she unblocked a patient\u2019s kitchen sink in return for his promise to get checked out. The man, in his late 50s, was a virtual recluse and was thought to be living with multiple chronic conditions but was refusing to get help.<\/p>\n Her DIY plumbing turned out to be a life-saving intervention: he had been living for years with undiagnosed pneumonia, suspected bowel cancer and chronic obstructive pulmonary disease (COPD). COPD is a collection of lung conditions that kill people at a higher rate in the UK than anywhere in western Europe, and are much more prevalent in poorer areas.<\/p>\n \u201cThere\u2019s two outcomes if Lizzie hadn\u2019t kept knocking on his door,\u201d said Claire Niebieski, the head of population health in Lancashire and South Cumbria. \u201cHe would have been found dead at home or he would have been a 999 call away from spending months and months in hospital.\u201d<\/p>\n To date, Holmes\u2019s team has reached 164 residents, almost all of whom were highly unlikely to seek help before presenting at A&E. For just five of these patients, this preventive approach saved the NHS more than \u00a3170,000, according to an internal analysis. Most of this saving is mainly because they would no longer need a hospital bed (\u00a32,089 per patient per day). The savings to the NHS would rise to millions of pounds across the Ryelands estate.<\/p>\n The proactive approach has reduced A&E visits from the estate by 5% over two years, compared with a 5% increase in parts of the community without this focused approach, according to NHS modelling. A similar pilot in Poulton, in Lancaster, has led to an 11% fall in A&E attendances.<\/p>\n <\/span>Claire Niebieski, a nurse in north-west England who is working in her community to help tackle health issues among residents.<\/span> Photograph: Christopher Thomond\/The Guardian<\/p>\n It is a reversal of the trend across Britain since 2010. As more of the NHS budget is spent on hospitals, community healthcare has gone into retreat.<\/p>\n There are far fewer neighbourhood nurses and GPs per head than in other wealthy nations, driving up A&E visits. With nowhere else to turn, some people attend A&E as many as 300 times a year at a cost of \u00a32.5bn to the NHS, according to the British Red Cross. A fifth of these repeat A&E visits come from the poorest 10% of the country.<\/p>\n The retreat from preventive care has harmed the NHS and the wider economy, experts say. Britain now spends more on health-related benefits \u2013 \u00a375bn a year \u2013 than on defence. One in 10 people in England and Wales receive either disability or incapacity benefit, the number having grown from 2.8 million in 2019 to 4 million today. The cost to the economy of long-term sickness is estimated by the government at more than \u00a3300bn a year \u2013 one-and-a-half times the budget of Streeting\u2019s Department of Health and Social Care.<\/p>\n As poverty deepens, the NHS feels the pain. A comprehensive study for the Joseph Rowntree Foundation in 2014 estimated that \u00a329bn of spending by the health service was associated with poorer areas, where people are sicker and more likely to use A&E.<\/p>\n One of the report\u2019s authors, Prof Donald Hirsch of Loughborough University, said the cost of poverty on the NHS today would be closer to \u00a350bn a year if those ratios were the same. \u201cIn fact, it could be much higher,\u201d he said.<\/p>\n The preventive approach in Lancaster is one of several quietly radical programmes under way in Lancashire and south Cumbria, a vast area spanning Blackpool, Barrow-in-Furness, Burnley and Blackburn, towns with some of the poorest and sickest communities in Britain.<\/p>\n One senior regional manager said less affluent areas were bearing the brunt of the NHS\u2019s retrenchment. \u201cPeople are attending hospital with cancerous lumps bursting through their skin,\u201d they said. \u201cIt\u2019s almost like medieval times when healthcare wasn\u2019t available.\u201d<\/p>\n Dr Andy Knox, the medical director of Lancaster and South Cumbria integrated care board, said Britain\u2019s health and social care system was not sustainable without an \u201cunrelenting focus on tackling health inequity\u201d. He said: \u201cThe truth is that right now, in the UK, we value some people significantly more than we value others. And this is actually costing us in terms of economic and societal wellbeing.\u201d<\/p>\n The need for action was urgent, said Knox, who was awarded an MBE in 2013 for tackling health inequalities. \u201cWe have not created a healthy society and, particularly for our most disadvantaged communities, this is now having a profoundly negative effect and placing huge pressure on our health and care system.\u201d<\/p>\n <\/span>A Ready Steady School session for children and their parents at the North Family Hub in Blackpool.<\/span> Photograph: Christopher Thomond\/The Guardian<\/p>\n The mortality rate among under-75s in Blackpool is by some distance the worst in England for cancer, cardiovascular disease and for all causes, with the average man dying at 73 \u2013 six years younger than England\u2019s average, and now the youngest in the UK.<\/p>\n Blackpool has four times the average number of drug deaths, nearly double the rate of smoking deaths, the highest proportion of alcohol deaths and the highest rate of serious mental illnesses in England. Deaths from alcohol, drugs or suicide are the highest in England and more than twice the national average.<\/p>\n In 2021 the then health secretary, Sajid Javid, made a speech in Blackpool in which he described the huge differences in health access and outcomes related to race and socioeconomic status as the \u201cdisease of disparity\u201d. Last week his successor Streeting also chose the town as the location for his first speech on health inequalities. In it he pledged to ensure more NHS funding goes to poor areas to help tackle the fact that they have fewer GPs and longer waiting times for care. \u201cThe NHS doesn\u2019t do enough to address the unjust, unequal way in which illness presents itself in our country,\u201d he said.<\/p>\n Preventing the continuation of deep multi-generational illness is the work of Blackpool Better Start, a national lottery-funded initiative bringing together the NHS, NSPCC, council, police and, crucially, a six-strong team of trusted local parents, known as community connectors, who are better at winning the confidence of families than official agencies.<\/p>\n The work starts before children are born, with a community connector making regular visits to Blackpool Victoria hospital\u2019s antenatal ward to enrol new parents and offer advice on drinking and smoking in pregnancy. Birth registrations have been moved out of the town hall and into three family hubs, formerly Sure Start centres, so every newborn must come through its doors to be given support.<\/p>\n Every expectant parent in Blackpool is offered free perinatal classes, typically costing about \u00a3296 in other parts of England. Other universal courses are aimed at nurturing the bond between mothers, fathers and their babies \u2013 a key issue in a town with the country\u2019s highest proportion of children in care, at nearly three times the national average.<\/p>\n \u201cIf a baby doesn\u2019t feel safe, even though they\u2019re being fed, there\u2019s a failure to thrive,\u201d said Tracy Greenwood, a health visitor for more than 20 years, who has seen babies failing to gain weight due to attachment issues. More than one in seven new mothers contacted by Better Start reported having four or more adverse childhood experiences, such as abuse and neglect, which is associated with higher levels of health and behavioural difficulties in their own children.<\/p>\n Since 2019, the multi-agency scheme says, it has seen a 19% increase in breastfeeding take-up and a 6% fall in babies being born pre-term. It reports an 11% drop in the number of five-year-olds suffering from tooth decay \u2013 an issue affecting one in three children of that age in Blackpool, compared with one in four nationally \u2013 in part thanks to \u201csupervised brushing\u201d programmes in schools.<\/p>\n Blackpool\u2019s use of community connectors, local parents employed by the NSPCC and often recruited on Facebook, is seen as crucial to its success. Families in the most deprived areas felt judged and feared being reported to social services, said Jenny Armer, the chair of the Ryelands estate residents\u2019 group in Lancaster.<\/p>\n <\/span>Jenny Armer from the Ryelands Community Association.<\/span> Photograph: Christopher Thomond\/The Guardian<\/p>\n Prof Jennie Popay, a sociologist who leads Lancaster University\u2019s Centre for Health Inequalities, said this mistrust was understandable. \u201cThe overwhelming message [from the NHS and other institutions] is that [poor health] is how people behave and that\u2019s really stigmatising for people who live really difficult lives,\u201d she said.<\/p>\n Thousands of families in Blackpool are in the grip of the worst living standards on record. Emma Hobbs, a Better Start community worker, has heard new parents talk of reheating old bottles of baby formula instead of \u201cthrowing money down the sink\u201d, increasing the risk of bacterial infections.<\/p>\n \u201cWe\u2019ve had parents telling us they were turning off their fridges at night because they couldn\u2019t afford the electricity,\u201d said Vicky Morgan, a development manager. She worries every winter when money-saving experts encourage families to \u201cheat the person, not the room\u201d. \u201cIt\u2019s dangerous [and] it doesn\u2019t apply to under-fives,\u201d she said.<\/p>\n Across England, 40% of 11-year-olds are overweight or obese, a trend that has grown steadily since 2010. Children in poorer areas are more than twice as likely to be obese at ages five and 11 than those in wealthier areas.<\/p>\n Prof James Fleming, a GP in Padiham, near Burnley, has observed a troubling new phenomenon in children nationally: they are obese and malnourished.<\/p>\n The cost of living crisis has normalised diets that rely on cheap and calorie-dense foods, he says, with disastrous lifelong consequences such as increased risk of disability, premature death, diabetes, osteoarthritis and some types of cancer.<\/p>\n \u201cWe\u2019re normalising poor nutrition and poor health,\u201d Fleming said. Last year he organised a grant for a local school, expecting it to spend it on the playground. Instead, it spent it on food. \u201cThe teacher said: I want every child to have a full tummy. That was really upsetting,\u201d he said.<\/p>\n Back on the Ryelands estate in Lancaster, the school summer holidays are looming. Armer, the chair of the residents\u2019 group, organised 42 food parcels for the estate at a cost of \u00a32 each last year. In the final week of the summer holidays, only six families could afford to pay.<\/p>\n <\/span>Volunteers at the Big Food Project in Blackpool.<\/span> Photograph: Christopher Thomond\/The Guardian<\/p>\n Children are missing school, she says, because the bus is too expensive. A four-mile round trip costs \u00a34 a day \u2013 \u00a380 a week, or \u00a3780 for a full school year. \u201cThat really concerns me and just shows how much families are struggling,\u201d she said.<\/p>\n In Fleetwood, eight miles north of Blackpool, NHS bosses spotted that a large number of children were failing to turn up to mental health appointments. They realised it was because families could not afford the two-hour round trip on public transport. Since moving the service to Fleetwood, the child and adolescent mental health services waiting list has fallen to almost zero. A&E attendances for children in mental health crisis have decreased by 59%.<\/p>\n At Furness general hospital in Barrow, the 11 young women are no longer routinely found in A&E. They sat down with clinicians to explain why they self-harmed to secure a bed for the night. They described a complex range of mental health issues, dating back to childhood, that had never adequately been addressed, even though many, if not all, had been seen by NHS professionals. A more comprehensive support plan is now in place and the A&E attendances are starting to fall.<\/p>\n \u201cHealth has to work in a different way,\u201d Niebieski said. \u201cIt can\u2019t continue to expect that these people will access care in the usual way. For some people the barriers they face are so great that it\u2019s impossible.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" The same 11 young women turn up around the clock at the emergency ward of Furness general hospital in Cumbria. The group are well known to staff, other services \u2013 and each other. Aged between 19 and 35, they have all led troubled lives. Some grew up in care, most need mental health support. All<\/p>\n","protected":false},"author":1,"featured_media":9755,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[2293,1206,187,896,1713,1541,2295,2292,2294],"class_list":{"0":"post-9754","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-battling","9":"tag-britain","10":"tag-crisis","11":"tag-europe","12":"tag-illness","13":"tag-man","14":"tag-poverty","15":"tag-sick","16":"tag-untreated"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/9754","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=9754"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/9754\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/9755"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=9754"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=9754"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=9754"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}The return of door-to-door nursing<\/h2>\n
Turning the tide on poverty in Blackpool<\/h2>\n