It hurts us all: who can heal Scotland’s health inequality?

She is a small figure in black clothes etched on the white hospital bed. When no-one seems close enough to hear she murmurs a low groan.  

Marianne is in pain, I feel sure, but she makes a determined job of hiding it.

“I’m feeling fine. I could go back to work right now, I could.” she insists.  The surgical team doesn’t sound so sure.  Marianne (not her real name) arrived in the ward in the early hours of the morning. She has a bulging hernia and she really should stay and wait in line for a space in theatre, they say.  Her quiet reply echoes in my mind: “I can’t afford to stay, if you can’t operate today I have to go home.”

From my bed diametrically opposite I feel my guts twang. Newly delivered from theatre, I try to imagine getting out of bed to go back to work with aching innards. It hurts to think of it.

Fellow feeling.  Like Boris Johnson I unexpectedly ended up in hospital, though I’m in the Royal Infirmary Edinburgh, not St Thomas’s London. Like Boris Johnson I leave with a debt of gratitude to a health service, which works all hours to tend whoever comes in with the supreme best of human ability.  There is a crucial difference. As UK Health Secretary Matt Hancock said in those far off days of April, the NHS cared for the Prime Minister, “as they would have cared for anybody in this country.” Yet Boris Johnson was deprived of something very special. Inevitably, he had no close contact with other patients, no chance to share in the give and take of ward life. To learn from the lives of others.  

It goes without saying, even if he had been suffering from something other than Covid – an angry gallbladder, a perforated appendix, a ruptured hernia – the Prime Minister would never sit in public waiting rooms among other patients, shifting in pain on hard seats to find a comfortable position. He would never spend long hours of socially distanced space with people from many different walks of life. He missed a lot.

Daily drama of health inequality

In my seven days of hospital care, before and after surgery, I get to do a lot of waiting, looking, listening and learning. It’s a privileged front row seat, a ringside view of the daily drama of health inequality. On my first day in the surgical observation unit there’s an older woman two seats in front of me who seems known and liked by many of the staff. She’s quite ill, I think, but keeps asking if she can go home before the scan results are ready. She needs to relieve the young carer looking after her husband. He’s got dementia, “He’s doollally, I cannae leave that wee lassie with him all day.” There’s laughter in her voice. She’s not complaining, just stating a fact. She has commitments at home that come before her own health.

The young woman in the row next to mine, is impatient to get home to the kids so her husband can get to work. His boss isn’t happy. She leaves before the scan results and I see her back again next morning, waiting to see the consultant.

It takes three days before I’m admitted to hospital, but I’m grateful for the technical expertise and even more for the rigorous, kindly attention to detail in the outpatients department. The clear diagnosis of a badly inflamed gallbladder (how did it become so angry, so quickly?) takes me to the hospital ward, a hefty dose of intravenous antibiotics and the weekend list of emergency operations. The RIE – like hospitals across Scotland and the rest of the UK – is in post-Covid catchup. There’s just one emergency theatre operating at weekends and, rightly, those in greatest need are taken first.  After the first day of pre-op fasting, the consultant surgeon comes to apologise. We’ve missed today’s slot, she says sympathetically. We’ll try again tomorrow but she can’t promise anything. 

Like Marianne, I want to get home (if only for a night’s sleep!) and at next morning’s ward round I tentatively ask if that might be possible, if another day’s fasting ends without surgery…? The surgeon looks me in the eye (masks emphasise eye to eye contact). She’s sympathetic and completely straight. If I leave the hospital I will slip right off the priority list.  It makes perfect sense. With good pain control and ice cubes to sip who am I to complain about lying in a comfortable bed watching the sun slip across the blue sky? I have lovely companions and unsought but compelling scenes from other people’s lives. 

Vivid and recurring images

Marianne lies on the bed by the window. A small, lonely figure in black, she stares into a middle distance.   Unlike previous occupants of that bed she avoids eye contact with the rest of us.  Ward rounds bring good news for me and my friend in the next bed. We’re healing well after successful surgery. We’re getting home today.   Drifting in and out of sleep, I’m aware of repeated trips to Marianne’s bedside as nurses and doctors offer advice on seeking financial help, warning of the risk of going home untreated. Eventually a young man in green theatre scrubs somehow works a miracle. Before I’m discharged I see Marianne, now wearing a hospital gown, being wheeled off to theatre. “Come on chickadee,” says a nurse patting her arm, “we’re on our way.”   

Four weeks later. The anaesthetic has worn off but the images I brought home are vivid and recurring. I hear the gravelly post-op voice of a woman wheeled into the ward in the middle of the night, just back from theatre, relieved of an infected ulcer. When the nurses leave her to sleep she lies awake repeating: “You stupid bitch, you stupid, stupid fucking cow.” She’s talking to herself.

I think of the tense form of Marianne beside the window overlooking the vast hospital car park.  I have the luxury of slow recovery. Can she afford time to heal?

Covid comes back into view. Oddly, in hospital it seemed quite far away. (Covid wards, a nurse had told me, were on the floor above and, at that time, there were only two patients being treated for the virus and none requiring intensive care.)  In our ward we concentrated on the measurable business of getting into and out of theatre, out of bed and back home: temperatures, blood tests, bowel movements, drug trolleys, ward rounds, discharge. The intimate exchange of chance encounters, close bonds with people we’ll likely never meet again. Covid rarely featured.  Now I’m troubled by niggling questions. What of all the people who can’t take time to be ill, can’t afford time to heal? What if they had Covid?

Covid-19 has exposed the great faults in British society. As Build Back Fairer the Marmot Covid19 review reveals, the already existing gaps of inequality and poverty have grown in the last year with cruel impact on the health of people in the most deprived areas.  NHS alert: code red for climate change

Who can heal inequality?

The UK government is trialling a scheme to pay low-paid workers in coronavirus hotspots up to £13 a day, £130 for ten days, if they have to self-isolate – and only if they can prove they are unable to work from home.  Thirteen pounds a day. Who dreamed that up? And what about zero-hours workers with no holiday or sick pay forced to take time off work because they have other illnesses?  What about Marianne?

I cannot read the Covid news without a growing sense of rage. I knew about inequality. Of course I did. As journalist and editor I read and write about people whose daily lives are very different to mine. I did not feel the difference in my guts before. The pandemic has exposed and compounded grotesque inequalities of our society but it did not cause them. There can be no recovery plan, no ‘building back better’ if politicians in Scotland and across the UK do not address inequality.

From my hospital bed I saw no inequality of care. Just the looming inequality of outcome. I don’t know where other women in my ward live but returning home I remember with new resonance the shocking fact that people in my part of North Edinburgh can expect to live 21 years longer than someone living just a short car journey away, on my route to the infirmary.   Our NHS – no matter how kind, committed, or skilled the medical teams, no matter how well funded – cannot by itself heal the diseases of poverty and deprivation. Solving the chronic afflictions of our time – poor housing, low paid jobs, no security, no sick pay, no hope – that’s up to all of us: we citizens and those we elect to make our decisions.  What’s our plan?

Featured image: Building back better? Cranes over Edinburgh city centre. Fay Young 

 Further reading

Poverty and coronavirus in Edinburgh: solutions in shared humanity. Zoe Ferguson for Sceptical Scot  

The Scotland effect: why life expectancy is lower north of the border: New Statesman 

Not OK, the shape of recovery to come: Fraser of Allander Institute 

How to build back better: cut the income gap: Richard Wilkinson The Guardian 

NHS alert code red for climate change: Sceptical Scot