Saturday, 19 November 2011
These days I dread going near a newspaper or the TV. Each day seems to bring another creeping insiduous way to make life more difficult for the sick and disabled in this country from the non stop hassle from Atos, the drip drip of 'scrounger' rhetoric and today, deciding that GPs are not suitable people to decide if someone is too sick to be signed off work for more than a week.
Bearing in mind that GPs are already not seen as suitable to assess whether people are long term sick when claiming benefits, it looks like the government is showing vague consistency by saying they can't do it short term either. Then you realise that they want to hand the entire running of the NHS in England over to GPs and you wonder if they understand what that the word doctor and manager are not actually interchangeable? One requires seven years of training, the other does not. Yet the coalition government seems to think it would help all of us to hand the medical stuff over the managers and the managerial stuff over to the doctors.
Not only do they want to save money, they also seem to be under the impression that GPs are such kind caring people that they are handing out the adult equivalent of lollipops left, right and centre and signing people off work and onto benefits in such droves that it's like a game of roulette as to whether you'll pop in for a prescription or come out signed off. This suggests they have never actually spoken to someone who has been signed off when they get sick but don't actually know what's wrong yet.
It's actually really quite hard to get a sick certificate. These days doctors can also issue something called a 'fit note' that directs employers that you need extra help and can't do your job fully due to ill health, trying to avoid the situation where an injury for example stops people working completely if the employer could try and find you alternative work within your role. This has merits, but sometimes you just need a break from work completely and trying to do bits and bobs just drags things out. I had had a period of employment upheaval for several months and had a few 'fit notes' due to an injury, but at no point did I ask my GP to sign me off even after a turbulent six weeks where I had lost my job, split up with my boyfriend, and been raped. I kept going to job interviews and failing to get them due to the fact I couldn't stop crying in them. I decided to sign onto Job Seekers' Allowance.
Only when my job advisor and his supervisor took me off into a smaller room off the main drag, sat me down and kindly told me that they could not allow me to sign the Job Seekers' contract to be available to work 40 hours a week because I was so clearly unwell and unable to work that the thought of going onto a sickness benefit even occurred to me. They sent me off to my doctor to get a sick certificate to go onto Income Support so that I could claim Housing Benefit at least. Totally and utterly freaked out that the JobCentre were being so nice, I stumbled through the door of the GP tearfully, explained what I needed and then proceeded to have a panic attack and cry for the next 30 minutes to the point where the practice nurse suggested sedating me.
I left without my certificate. The GP refused to say that I was unfit for work and suggested unless things got worse I go back and say I wanted JSA. She didn't think there was anything she could do. I went home and as luck would have it, was made homeless that night by the flaming mob that were my housemates. Shellshocked and unslept, I went back to the Job Centre and explained the last 24 hours. They conjured up a surprisingly formal letter to take to the doctor. I went back to the surgery and had an even more spectacular meltdown this time, but luckily enough, did it in reception and another doctore had to be called out to deal with me.
He took one look at me, signed me off work for 8 weeks and gave me a prescription for anti-depressants, a referral to a counsellor and a Valium. I have no recollection whatsoever of applying for Income Support later that day. The next 8 weeks generally passed in a blur of trips to the housing office, trying to move my stuff, find somewhere to live and continuing to apply for jobs. I was quite surprised when I was signed off again for another 8 weeks. Which took to me to the week I was raped again.
Almost immediately I developed a galloping case of Post Traumatice Stress Disorder and started to become extremely agoraphobic. Just getting to the doctor was an epic struggle and concerned enough about my mental health to only give me a week's medication at a time, but not enough to refer me to the Community Mental Health Team or more specialist services, I continued with the 8 weeks at a time certificates, always aware that everything hung on my doctor remaining sympathetic to me. If he decided there was no certificate, then there'd be no Housing Benefit and no hostel. It was nervewracking.
You might say that removing that pressure from the GP to an impartial body would lessen the pressure but I disagree on several points. What both the GP and I needed were better specialist services. The GP needed someone with more experience of someone in mental health distress to guide him and a faceless council looking to tick symptoms off a list isn't it. It would be better to spend the money it costs to set up this council on retraining GPs to be able to deal with undiagnosed conditions and get them moving people on to specialists to get diagnoses. I also fear that some Atos style pen pusher would have been less likely to sign me off as they'd only have seen me once the problem started, not developed a relationship with me over months and seen how things changed and progressed. They also have bad form on being able to take fluctuating conditions seriously and to see the tie in between mental and physical health.
If the government would like us to stop being signed off work long term, then they'd be better off imposing some kind of rule that you must be referred to the appropriate specialist team within a certain number of weeks if you are signed off for more than 8 weeks with one condition. I wouldn't have had to go through the gamut of emotion of wondering every 8 weeks if my GP was going to sign me off or whether I'd lose my house again if they said no. I wouldn't have had to take up a GP appointment every five minutes. I wouldn't have had to wait three years to get referred to the CMHT and another two and a half to get a proper diagnosis and my PTSD therapy. Waiting almost six years to know what is wrong with you is unacceptable. I literally had no words to describe what was wrong with me and this allowed my mental health conditions to become bigger and scarier and harder and harder to come back from. I had no idea if I'd actually lost my mind completely.
Improving GP services and encouraging them to ask for help and support and link to other NHS services (while we still have an NHS) would be the best thing for the sick and that taxpaying public (who shock horror, are often the same people...). It would also be of advantage to GPs as they'd be able to share the workload better and offer better support to the long term sick which might be a cost effective way to maintain confidence and interaction with the long term sick than yelling at them and giving the impression they are a burden on everyone. Bringing in Atos earlier and earlier will only lead to more money being paid to private companies and diverted from those in need. It will also conflict GPs further and bully them into making decisions only based on cost not care. And it will not help anyone get better, unless your idea of better is ignoring symptoms, rubberstamping forms and tossing people aside in to poverty and fear.
This is total Tory scaremongering to excuse commodifying health and vulnerability further in the UK. There might be a few people in the UK signed off who could work, but do we want to make it that it's impossible to take time of work unless you're dying? Plenty of people need some breathing room when life happens. People's physical health can fail, their mental health may not be stable, conditions fluctuate, people need time to grieve after a bereavement, recover when having a baby doesn't go to plan and cope with an unexpected accident. Unless you're a multi millionaire Cabinet member, you are vulnerable to needing these things on the NHS and welfare state between now and the time you die. Don't let them be sold off. And if you still think it's easy peasy to get signed off because you fancy lying on the sofa for a few weeks, doing some light scrounging, why don't you ask your GP and see how far you get before they hound you out of the surgery, howling with laughter?