Sending health workers door to door won’t fix the NHS’s real problem

Sorry, Wes Streeting, but house calls aren’t the way to tackle Britain’s sickness crisis or to get the long-term ill back into work, says James Moore

I’ve been grappling with a number of health issues since I was run over by a truck – on top of the type 1 diabetes I’ve had since I was two.

I was once asked, “You see a district nurse, right?”, but it was such a surreal question, I actually laughed.

A district nurse? I’ve never encountered one of these people. Once physiotherapists had done their best with my broken body, I was on my own. Community healthcare? LOL.

And yet health secretary Wes Streeting has trailed a new plan to send an army of “health workers” into the community, going door to door in an attempt to address the record number of people not working through long-term sickness.

Part of a 10-year plan for the NHS to be unveiled in June, the aim of Streeting’s mobile army is to diagnose debilitating illnesses far earlier. It has been likened to the old-fashioned GP “house calls”, but it’s not that. Nor is it the warm-and-fuzzy return of the 1950s-style district nurse that inspires nostalgia for a time when Britain’s health service more or less worked.

Marcus McAlister, programme manager at the National Association of Primary Care, tells me that there are currently 25 sites involved in this trial. Twelve pilot schemes already have boots on the ground and are knocking on doors, with another 13 hoping to secure local funding. Please try not to laugh.

Each community health worker is assigned a “micro-area” of between 120 and 150 households. They visit every household once a month, specifically in areas of high deprivation. Their remit? To “build support around those in need”, which in turn will reduce the number of heavy NHS users, those that Streeting called “frequent flyers” of A&E departments.

There’s the germ of a good idea here – and goodness knows we’ve seen precious few of those lately. Early intervention almost always delivers the best and, crucially, most cost-effective results. But it has largely vanished from today’s NHS.

People with health problems often go untreated and get worse. Those with the means turn to the private sector. Those without? They suffer. Poor health and a life on benefits are the end result.

One major effect of a record number of people out of work through ill health is, of course, the breakdown in GP services. Just getting a phone call can take weeks – assuming you can get past the receptionist. A face-to-face consultation? It’s easier to find a winning lottery ticket.

And that’s just the beginning. Accessing care now requires you to become an Olympic-level athlete in bureaucratic boxing. You’ll need to remain cool and polite in the face of rudeness, write emails with laser-sharp clarity and generally possess the stamina of a marathon runner.

This is doubly hard if you’re already ill. I’ve often felt like I’ve gone 10 rounds with Mike Tyson, only to achieve absolutely nothing.

Streeting’s community health workers won’t require any clinical qualifications or formal training. Recruits will instead be chosen for their character. They will be “natural problem solvers, empathic, culturally competent, emotionally intelligent, honest and integral … Persistent, respectful and able to maintain confidentiality”.

I know – things that make you go hmm.

Still, if these people can help patients break through the godawful NHS red tape and access the help they need – to improve their health, their quality of life, and yes, their ability to work – then it will have been worth it.

Of course, some will look at the lack of qualifications and think this is healthcare on the cheap. But at £300m, this is still an expensive roll of the dice.

The bigger the bet, the bigger the potential win, I suppose. And the early reports suggest it’s working – hospital admissions and A&E visits are down. Hence, all the fuss.

But here’s what worries me: piloting a new scheme is one thing. Scaling it up across the country is another entirely.

More about the much-ballyhooed 10-year NHS plan and the push towards a more community-focused health service will be revealed in time. Exciting – but also concerning, when you think how many good ideas are crushed by Treasury bean-counting, Whitehall obstruction or routine Cabinet reshuffles.

Perhaps, once they’ve finished going door to door, a community health worker could secure a health check for the machinery of government.