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Wednesday 26 October 2022

Letter to: The Prime Minister - The Rt Hon Rishi Sunak MP - THANK YOU for for backtracking on fines for missing medical appointments

 Dear Prime Minister

Firstly, congratulations on being "elected" as the UK's newest Prime Minister.  It's not a job for the feint-hearted, and I don't envy you - especially with everything that's going on in the World right now.

Out of interest, given that you voted for Brexit, how's it going these days for getting and keeping housekeepers and cleaners for your properties in the UK?

Anyway, I digress...

Today I read on the BBC website that - after "listening to GPs", the government had decided it was "not the right time" to introduce fines for patients who miss medical appointments.

This backtracks a pledge you personally made whilst campaigning to become the new leader of the Conservative party, back in July 2022.

Whilst it is a great relief to myself and millions of others that your colleagues talked some sense into you and you have made this u-turn so early on in your new Prime Minister-ship, it's also worrying that you'd made the pledge (a) at all, and (b) around the time you told the Sunday Telegraph you were a candidate who wanted to look “transformational”, “brave and….different”. 

How exactly did you think punishing people for not turning up to see medical professionals was a sign of bravery?  Picture the newspaper headlines:  "Widow opens late-husband's post to find a fine for no-show with GP".

As you were previously the Chancellor of the Exchequer, perhaps you thought the income from the fines could help offset the cost of the UK's annual mental ill health bill - currently estimated at £105 billion per year[1].  

All very well in theory, but how EXACTLY were you proposing to pay for the cost of enforcing the no-show fines, such as:

  • admin?
  • legal costs?
  • increased NHS costs because of (for example) increased numbers of people being:
    • added to long waiting lists because of stress-related illness, low self-esteem, anxiety and depression 
    • taken by ambulance to hospital and admitted as acute emergency cases because their place on waiting lists had  been extended by months and months?
    • increased numbers of medical professionals going on sick-leave or leaving the profession because of extra stress and burnout?
  • Increased social care costs because patients have become too unwell to return to chaotic/unsafe homes (delayed discharge/bed blocking)?

I could go on…..

As you’re an analyst by profession Mr Sunak, a wealthy person in the fortunate position of not having to worry about attending NHS appointments yourself and probably have secretaries and chauffeurs who help you to get to appointments on time (especially if there are PR/media/photo opportunities), my hope is that perhaps your colleagues asked you to analyse a few simple questions, such as:

  • How EXACTLY do you expect the health and wellbeing of the nation to have been improved by punishing no-show-ers?
  • What evidence do you have to justify the lack of EQUALITY in penalising people who:

    • quite probably have hidden disabilities and impaired Executive Functioning, which means they would have been likely to struggle with time blindness having been born with conditions like ADHD, Autism, Dyslexia, Dyspraxia, Bipolar Disorder, or acquired conditions during their lives such as brain injuries, Long COVID or other viral infections, possibly with chronic co-occurring health conditions – and therefore more likely to:
      • need reminder text messages about appointments - if hairdressers can do it, why not the NHS?
      • feel so unwell that they can’t attend appointments and forget to cancel/re-schedule because frankly they're simply too busy using their precious energy trying to:
      • remember to eat or drink or get to the toilet in time
      • take the right amount of medication at the right time
      • have nobody they can ask to contact the hospital/practice on their behalf
      • become overwhelmed by having to attend multiple medical appointments, or have sensory, trust and social interaction issues that means they need positive encouragement and practical help and support to enable them to carry out activities of daily living
      • be unwaged and amongst the poorest and most vulnerable members of society – and therefore need the most help and support
      • be less likely to have strong support networks, and therefore probably struggle to get adequate practical assistance to meet their complex needs - including to get to appointments
      • be more likely to miss appointments unless they get help to attend – such as a text message to remind them (if hairdressers can do it, why not the NHS?)
    • perhaps have caring responsibilities - for children, relatives who are sick, disabled or have dementia
    • feel frustrated that they can’t get through to departments on the phone, end up being cut off or put through to the wrong people because of faulty NHS telecom systems
    • feel frustrated and angry if their appointments are cancelled – particularly at short notice, or they’re put back at the beginning of the waiting list if they accidentally miss appointments
Speaking as someone with late diagnosed ADHD who also happens to be a Trustee of an ADHD support group, I'm here to tell you that many Neurodivergent individuals live for years (even entire lives) with undiagnosed ADHD (and often other Neurodevelopmental conditions too) or get mis-diagnosed with mental illnesses, and experience all manner of traumas during childhood and beyond because of our vulnerability.  

Often we don't fulfill our true potential, and end up living chaotic lives - perhaps involving alcohol, drugs, relationship problems, employment issues and poverty/debts (because it can be difficult for some of us to manage money).

The stress this can cause takes its toll on our health so that we burn out and potentially end up with stress related illness such as Fibromyalgia, ME, high blood pressure, heart problems, kidney/liver problems, or even cancer.

Doctors rarely have the time/energy to investigate the root causes, and resort to applying a sticking plaster cocktail of prescribed anti-anxiety and/or anti-depressant tablets.  And even if patients do receive the correct diagnosis, they rarely receive the right kind of trauma-informed help and support.

And how come they struggle so much?  Because the Government  invests more in TREATING illness rather than PREVENTING it.

EVERYONE needs a better understanding of how to recognise Neurodevelopmental conditions, and the challenges and difficulties experienced by those of us with impaired Executive Functioning. 

Instead, try investing in GOOD Neurodiversity training for ALL Government employees (irrespective of whether they’re MPs, teachers, NHS staff, Civil Servants, etc), to reduce the apathy  and stigma about hidden disabilities. 

Finally Prime Minister, as you're an analyst, here are a few numbers that speak for themselves:

  • 1 in 2 adults with Autism have anxiety[2]
  • 1 in 3 adults with Autism have depression[3]
  • 1 in 4 people experience mental illness at some point in their lives[4]
  • 1 in 8 workers in the UK (interviewed for research) admitted experiencing symptoms of burnout[5]
  • 1 in 6 people report experiencing a common mental health problem (like anxiety and depression) in any given week in England[6]
  • 1 in 7 people in England with a diagnosable mental illness receive no treatment at all[7]
  • 1 in 8 workers in the UK have experienced burnout[8]
  • 1 in 8 people with PTSD also have other mental health problems such as depression, persistent anxiety, panic attacks or phobias, or misuse drugs or alcohol[9]
  • 1 in 10 people in the UK have Dyslexia[10]
  • 1 in 10 people who have died by suicide had evidence of Autistic traits[11]
  • 1 in 13 disabled people have no qualifications[12]
  • 1 in 14 people aged over 65 have Dementia[13]
  • 1 in 15 disabled people aged 16+ reported feeling lonely “often or always”[14]
  • 1 in 20 people have had suicidal thoughts at some time[15]
  • 1 in 50 people have Dyspraxic (Developmental Coordination Disorder) traits[16]
  • 1 in 100 people in the UK have an Autism diagnosis (with around 50% of those also having ADHD)[17]
  • 1 in 200 adults in the UK have ADHD (only 8% of them have a formal ADHD diagnosis)[18]
  • 1 in 200 people in the UK have Long COVID[19]
  • 1 in 200 people in the UK have an Acquired Brain Injury (ABI)
  • 1 in 400 people in the UK have weakened immune systems, which means they’re more vulnerable to infection

And remember Prime Minister, whilst these numbers may not represent the majority of people in the land (or indeed the healthiest or wealthiest), they/we are fed up with being treated so badly and unequally, and we DO have the ability to transform the life of you and your colleagues at the next election.

So Mr Sunak, to summarise:

  • I applaud your bravery for choosing to admit your mistake by retracting your pledge to fine people for not attending medical appointments.  
  • If you want to prove you truly are a brave, different and transformational Prime Minister, PLEASE pledge to support and protect the most vulnerable members of society instead of punish us, and make our lives and those of NHS workers  and other Government employees (and their families) a whole lot easier by doing so.
It's a vote-winner - I promise!

Yours sincerely

[1] Mental Health First Aid – MHFA

[2] National Autistic Society

[3] National Autistic Society

[4] WHO

[5] Mental Health UK, 2021

[6] Adult Psychiatric Morbidity Survey (APMS), 2014

[7] Annual Report of the Chief Medical Officer, 2013

[8] Ceridian, 2022

[9] Dr Lawrence Scott, article in Patient, 2017

[10] NHS

[11] Cassidy, Baron-Cohen, 2022

[12] ONS, Outcomes for disabled people in the UK: 2021

[13] NHS

[14] ONS, Outcomes for disabled people in the UK: 2021

[15] Mind

[16] Lingham, Hunt, Golding, Jongmans, Emond – 2009

[17] National Autistic Society

[18] ADHD Action

[19] ONH, 2022