Drumchapel GP says people in poorer areas 'don't have equal funding for health services'

A GP working in Drumchapel said there is an imbalance in funding that sees deprived areas lose out to better off areas even thought the need is far greater.

Dr Peter Cawston, from the Deep End group which works in the most deprived communities, said there is an issue with how the NHS is resourced.

He said it is "very heavily invested in hospital-based services rather than community-based services".

He added: "We have access to fantastic technology but we have the balance wrong.”

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He told MSPs on the Scottish Parliament Health Committee it can be three bus journeys away for some people to access specialised services.

Dr Cawston said: “Community spending reflects demand rather than need. High demand attracts funding. Deprivation doesn’t attract resource; resources don’t follow need.”

He said that GPs in areas like Drumchapel are working with people “preparing them to die when they are younger than yourself”, which he said was “something we have to in disadvantaged areas on a regular basis".

He added people end up having lower expectations and health providers can also feel helpless.

Dr Cawston said: “There is learned hopelessness and resignation among people who are living with health inequalities.

“I think there also a learned helplessness in health service providers, which turns into a stigmatisation and a turning back on the individuals and blaming of people for their own problems, and I think that’s really toxic within health services.”

A leading health academic in England told the committee Scottish policies appear better but they have not had an impact.

Michael Marmot, professor of epidemiology at the University College London, said that Scottish Government policies look “far more likely” to have an impact on health inequalities than those coming out of Westminster.

He said: “I remember listening to a Scottish minister speak and what they were saying was far more likely to address health inequalities than what I’m hearing ministers say in London.”

He said the same applied to Wales.

He added, however: “I look at Scotland and Wales and the health inequalities are deeper in Scotland and Wales than they are in England, so that then raises a question what is going on?

“Are these policies not being put into place, are they insufficient to address the deep-seated causes of health inequalities?

“If you’ve got the right policies but they haven’t been applied deeply or for long enough or are there other things that need to be addressed?”

Prof Marmot added: "I hear a lot about poverty of aspirations and my response to poverty of aspirations is it is a legitimate analysis of the poverty of opportunity.

“You can’t say well the problem is young people don’t have aspirations if they have no opportunities to do anything with them.

“Growing up in grinding poverty with little prospects for the future, learned helplessness is a reasonable response to that.”

“It is incredibly intellectually taxing to be poor. If you’re not poor it’s pretty easy to get through the day.

“When you’re hungry you eat something. The fridge is empty you go shopping. Your rent is paid by direct debit. You don’t have to think about any of those things. Being poor is really intellectually taxing, you’ve got to think about that all day.

“Then to blame people in that situation that they’re not thinking medium or long-term is a woeful misunderstanding of the intellectual and mental cost of poverty.”

A spokesperson for the Scottish Government, said: “We are committed to primary care and GP services have received a greater share of NHS frontline investment, with an increase of at least 25% in primary care funding.

“Reducing health inequalities is a priority for the Scottish Government and one of the biggest challenges we face, exacerbated by the Covid-19 pandemic.  Providing people with the right support locally and connecting them to the right services is crucial.

“The Scottish Government established a working group to establish ways in which primary care services could tackle health inequalities. The recommendations to come from the group will have a sustained and long term impact on health outcomes, especially for those facing the most significant barriers to good health.

“We are considering the recommendations including those on how we can better support need in local communities covering more effective outreach to patients.

“We will update on our approach in due course, prioritising actions that will best meet the needs of communities experiencing the greatest inequalities.”