Small steps that make giant difference

“BRUM BRUM!” – many of us will have uttered those two familiar words whilst trying to entertain a child. Although on this day they took on a special meaning. Daisy is a five-year-old girl with delayed development and sensory issues.

Daisy’s mum had politely warned me that Daisy never allows any healthcare staff to touch her or perform a medical examination. However, as I uttered those two basic words – “brum brum” – I realised that Daisy was starting to let me connect with her.

After a few more minutes of playing on the floor with cars and then moving on to feel her teddy’s tummy, her mum gasped with surprise as Daisy allowed me to give her a full top-to-toe check.

I will always remember that moment, because it reminded me of the value of patience, creativity, and compassion; skills that can often be invaluable when working in children’s medicine.

It was fortunate that day; we were well staffed, and I had enough time to play with Daisy and gain her trust and therefore complete the examination.

Time is precious. As a doctor working in the NHS we know this all too well; time is scarce.

This is often worse during the busy winter periods although the type of demand usually confined to this period is becoming more sustained throughout the year – there is no longer any respite. Year on year concerns keep mounting about how we can actually keep our patients safe amidst the pressures on the NHS.

Staff members from the UK and overseas work tirelessly to keep our NHS running: porters, cleaners, ward clerks, doctors, nurses, dietitians, physiotherapists… the list goes on.

The huge team all play key roles in ensuring patients can receive the care they need. Despite their best efforts, hospitals have been dangerously full, and our emergency departments are hitting record lows for the Government’s fourhour waiting time target, as demand now routinely outstretches supply.

Although our new Government has promised increased funding and staff, we need to ensure that sustainable, adequate, and credible plans are made and followed through, not just proposed for votes or to make headlines. The importance of this cannot be overstated.

Of course, the healthcare problems that the UK faces are not limited to our hospitals. There are 4.1 million children living in poverty in the UK; that is nearly three out of every 10 children.

We know that poverty can negatively impact health. Despite being a relatively wealthy nation, health inequalities continue to widen.

The reality of this can be seen on our streets where the number of people experiencing homelessness continues to rise.

Attendance at hospital for those left homeless is increasing, with many of these individuals suffering from a combination of physical illness, mental illness, and drug/alcohol problems. Indeed, a recent BMA investigation showed the number of A&E admissions and attendances has more than trebled over the last eight years.

They are at an increased risk of many serious conditions and have a much lower mean age at death (45 years for men, 43 years for women) than the general population (76 years for men, 81 years for women).

This stark difference is shocking, and sadly we know the number of deaths of homeless people is significantly increasing. Unfortunately, cuts to vital resources, such as alcohol and drug dependency services, and a lack of affordable housing, has exacerbated the problem.

In her 2019 Christmas message, the Queen talked about reconciliation, and said that “... giant leaps often start with small steps… it is often the small steps, not the giant leaps, that bring about the most lasting change”.

I am so grateful for my many fellow NHS team members who make their small steps on a daily basis. For the year ahead, I hope and pray for a year of reconciliation and small steps for our NHS; a year where we show all patients and all staff that they are valued and we will care for them, regardless of their background, past choices, or healthcare problems.

A year where we will choose to make the small steps required to help us make the giant leaps needed to protect and care for the vulnerable in our society.

■ The patient’s details were changed to protect identity.