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Tooth Hurty – time for the dentist

Ellie Rogers's picture
By Ellie Rogers |  June 22, 2015 |

We often say at GATE if you get things right for Gypsy and Traveller people you will get things right for a whole range of people, I often think of this in my own experiences of trying to access healthcare systems.

How difficult the processes can be, the way you’re made to feel a bit like a nuisance and the reaction that provokes in me (okay, well I’ll just get on with it myself then). And if I am white, reasonably middle class, literate, a professional who works with healthcare providers all the time and, to a certain extent, I know how to codify my language to the situation – how difficult must it be if you find reading and writing hard, you haven’t got much credit on your mobile, you’re super stressed and you’ve got 3 kids to look after? Frankly,  I’d think to hell with it.

So I tried to get a dentist appointment last week. I rang the dentist I was registered with to be told I’d been unregistered because I missed an appointment (I remember it, I was 10 minutes late because traffic was bad and was told I couldn’t be seen). Nobody had told me I was going to be struck off, but you know when you’re not going to get anywhere so I asked who to ring to get registered somewhere else. I was told to ring 111. I rang 111, gave a whole range of personal information and explained my situation, and then 111 said they didn’t offer that service. After a whole a lot of discussion I ended up with three numbers for local dentists registering patients. Then I thought, I’ll check them out on NHS choices before I ring up. I look at all the reviews, first one sounds great, 5 stars, ring it up; we’re not registering for 6 months. And now I have a list of two dentists with terrible reviews and I’m left thinking, to hell with it.

And again let’s just think of all the ways our multiple identities impact on the way in which we access services – to borrow one of my favourite words from feminist theory – let’s look at intersectionality. This means the way in which the multiple facets of our identity interact to form the way in which our identities relate to the rest of society – i.e. – how our sex, race, religion, class, health status, sexuality combine to form our own specific experiences of oppression and discrimination, or indeed, of privilege.

So what if my identity was a Mum, a Worker, a member of an ethnic minority that experiences regular discrimination? What if I lived in poverty and I didn’t read and write very well? How do I then begin to overcome the barriers presented above to get the time, resource and capacity to jump through the hoops to get what I need? With a great deal of grit and determination, I imagine.

In Bradford we recently did an event where 9 out of 15 people I spoke to weren’t registered with a GP and you begin to understand how and why that happens, especially where there aren’t advocacy organisations (like GATE) to offer a leg-up over some of those barriers.

But let’s not be gloomy because I still maintain that getting it right isn’t actually that hard. It’s about excellent customer service  -listening, giving clear information, kindness, accounting for difference and being flexible, taking time to do things right. It’s about the NHS Values. http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx

In saying if you get things right for Gypsy and Traveller people, you get things right for a lot of people, we imagine commissioning like a circle. In the middle you have the” regular patient” who is often modelled on the people who are most like those that are commissioning – so say they’re white and middle class. At the outside of the circle are people who are on the outside of our society – people like Gypsy Traveller people, Asylum Seekers, Trans* people – the people perceived to be most not like the “regular patient”.

So to include those people at the very outside of the circle you need to start with listening to them and their experiences and listening critically, crucially, with an understanding underpinned by theories such as intersectionality as a grounding point to interpret complicated experiences. If you started with listening to those in the middle by the time you get to the outside, inevitably, all of the resource will be gone. But also, in starting at the outside and being inclusive of those most seldom heard, the practice you will build will have to embody NHS Values – it will have to listen, be clear, be kind – in order to be a success. And in creating what is essentially a very good service you will deliver a service that is also great for whole swathes  of people on the way back into the middle, including me. An inclusive service is a good service, the more we are challenged to be inclusive the more we think about how we deliver our service and the better we make it. Starting with ourselves doesn’t challenge as much as starting with difference and that difference helps us make things better for everyone.

So how might the experience above have been good for a Gypsy / Traveller person – well they might have rung up and on the initial phone call been given an appointment or  the direct number of a registering dentist with clarity and with kindness – and would that work for me – yeah, I reckon it would – it’s a good service.

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