61. Becky Malby - Universal Healthcare Round Up

In this final episode of our mini-series on universal healthcare, in collaboration with LSBU and the Universal Healthcare Network, we bring it full circle with Prof. Becky Malby, who commissioned this enlightening journey.

Over recent episodes, we've delved into stories from remarkable guests who are making universal healthcare real in their communities – from children’s services to outreach for those experiencing homelessness. Together, they’ve shown us the power of curiosity, collaboration, and plain humanity in health care.

Becky reflects on their stories and challenges us with a bold question:
If they can do it, why can’t everyone? 

Why aren’t these inspiring, people-centered approaches the norm? 

It’s a call to reimagine healthcare beyond the appointment system and break down walls that hinder access for the most vulnerable. 

We discuss everything from the need for team support in complex care, to the irreplaceable role of storytelling, which has shone brightly throughout the series.

This episode is an inspiring wrap-up and a rallying cry to make healthcare universal in every sense. 

Whether you’re in healthcare, policy, or simply curious about a fairer system, this series has laid out the path forward – and it’s one we’ll need to walk together. Thank you for joining us in this exploration.

 
Lemon lightbulbs 🍋💡🍋

🍋 The Outliers' Challenge – If these guys can create truly universal healthcare, why isn’t everyone doing it?
 Stop treating these stories as “exceptions”, start making them the norm.

🍋 Beyond the Appointment Factory – The NHS is more than an endless round of appointments.
Bring care to people; don't just wait for them to show up.

🍋 Break Down the Barriers – A phone call to get an appointment can be Everest for those without easy access or trust in the system.
Meet people where they are: in a clinic, on the street, or anywhere that works

🍋 Curiosity Is the Key – The best hcps aren’t the “know-it-alls”
Join the magic, curious people who keep asking, “Who else could help?” and “What’s the full picture here?”

🍋 Teamwork - it’s lighter with friends.
From school nurses to team huddles, complex care works better (and is way more fun) when you have support

🍋 Stories Over Stats – what are the stories behind the data?
George helped V get to China - shows the human impact in a way data never could

🍋 Start somewhere
Don’t overthink. Just start. Get moving. Small actions can spark big changes

🍋 Reignite the creative Pandemic Spirit – Remember the “VacciTaxies” bringing care to where people needed it?
Let's ditch the bureaucracy & reignite our drive to make healthcare accessible.

🍋 Universal healthcare is possible - it’s up to all of us to carry this momentum forward

Links:
EPISODES 56-61 in this series!
Universal HealthCare National Inquiry
Gill's Universal Healthcare work with MPFT

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Chapters

• 0:00 Gill sets the scene, recapping the mini-series highlights and welcoming back Professor Becky Malby to share reflections
• 2:28 Becky reflects on inspiring examples of universal healthcare shared throughout the series and asks, "If they can do it, why can’t everyone?"
• 4:15 Healthcare Beyond Appointments - the need for healthcare that meets people where they are, not an “appointment factory” model
• 7:47 Who’s Not Getting Seen? Identifying and reaching out to those who are often excluded from traditional care models
• 10:41 Gill and Becky explore how curiosity and working with others lead to better care and innovation
• 13:37 The importance of teamwork, mutual support, and happy staff in healthcare settings
• 15:14 Fun in Outreach - how to make healthcare accessible in creative ways, from shopping centres to rugby events
• 18:23 The crucial role of the voluntary sector and the need for stable funding to support these services
• 20:54 The limitations of traditional healthcare metrics and the importance of meaningful, human-centred measurements.
• 22:41 The Magic of Storytelling - stories as a powerful way to connect, inspire, and change perspectives in healthcare
• 23:48 Key recommendations from the National Universal Healthcare Inquiry, including funding fairness and meeting needs over demands
• 24:28 A call to reignite the spirit of pandemic-era creativity and focus on immediate, practical action
• 26:30 Gill and Becky reflect on the series and look forward to the ongoing journey toward universal healthcare

Transcript

Becky Malby - review of series

Mon, Oct 14, 2024 12:01PM • 27:57

SPEAKERS

Gill Phillips, Becky Malby

Gill Phillips  00:00

Over the last few episodes of the Wild Card: Whose Shoes? podcast, we've been doing a special mini series in collaboration with London South Bank University and the Universal Healthcare Network. We've been exploring some of the key messages from the Universal Healthcare National Inquiry. We started off in Episode 56 with Professor Becky Malby setting the scene and telling us what universal healthcare is, and why it's important: a bookend to open the series. Then in Episode 57, Dr Tom Holliday, consultant pediatrician in London, talked about how children get less and the fabulous work that he and his colleagues are doing to join up care for children and families. In episode 58, Dr George Winder, a GP in Leeds, talked passionately about not medicalising poverty. Then we had Kim Shuttler talking about how primary care can reach out and work with the voluntary sector and other partners. And in the last episode, Bill Graham gave us loads of examples of how this all works in practice, primary care working closely with communities, making healthcare accessible by going out to where people are, rather than expecting them to come to you. So today, I'm delighted to welcome back Professor Becky Malby, who commissioned the series. So thank you, Becky for returning and recording this second bookend to round things off and provide further inspiration. What would you like to say about what you've heard and what you're hoping people will take away? 

Becky Malby  02:28

Well, thank you, Gill and wasn't it absolutely inspiring to hear those fabulous people talking about the work they're doing. And I suppose the sort of main takeaway is, if they can do it, why can't everybody else do it? So, suppose it's, it's shocking that those are outliers, in many respects. The point of the Universal Healthcare Inquiry Report was to say, this is a national health service. It should be fair and accessible to all. We all signed up to that. We all love that as part of it, and we talk about equity and equality and universality. But what becomes obvious is in that, the examples that we heard, everybody was in service to people's needs, and particularly around complex needs. We need services to join up. And what I think the NHS has become, has become an appointment system. So if you can get an appointment in outpatients, in A and E, in general practice, in a primary care setting, at your opticians, you could be seen. If you can get an appointment, and you can get there, you can be seen. But that isn't the case for a lot of people. Bill talked about outreaching, not just to communities that are scared, communities that are uncertain. We heard stories about people who aren't sure they trust certain aspects of the service. You know, Tom's work about 'keep coming back to the consultant, not too sure about the general practitioner'. And how do you build trust together? What you want to do is you want care and services to be provided as close to people's homes as possible, and it needs to be accessible to everybody, and a phone call to a GP practice from somebody that's homeless, who might not have a phone, first thing in the morning, to get an appointment that day is, is a wall too high to climb. Gill. Well, we have a responsibility to provide services and care, not just in our buildings, not just in the way that we've determined, but in a way that is truly universal. And what I think we found from the Universal Healthcare Inquiry work, and what you hear from those folks is they're genuinely concerned about the needs of their patients and their local population, and they're working out how best to ensure that everybody gets fair access and they meet needs as close to home as possible. So if that's the case, then health services are not provided with the walls of an institution. They're provided on the street. They're providing people's homes. You know, the good old days of the health visitor, Gill, you'll remember! People came, helped you out. It was early days after you'd had your baby, and you weren't sure what to do, didn't know if you could leave the house, you were so terrified - there were people who helped you transition back into a way of life that was reasonable, and that's got to be the case, not just when you have a baby, but also when you have all sorts of complex needs where you just can't get to where you need to get to. So for instance, my lovely dad. Many people have heard about my lovely dad in his electric wheelchair, etc, very elderly and frail. Interestingly enough, for him, the GP comes and sees him. In fact, everybody comes and sees him. And if I get stuck, I'll ring up the GP, who's totally lovely, and he has a named person, they see him reasonably regularly, so it's absolutely fabulous. So for dad with his frail, complex needs, it's entirely possible to ride care in his home. Someone that's homeless on the street, it seems really difficult to provide care where they are, apart from the amazing voluntary sectors and the amazing outreach services that we heard of, but it's not how we do all the time, so I think we have to get our heads around what's our role. And in that maelstrom of huge demand and lots of knocking on the door, we just keep answering the door, and what we heard from all of those folks was that they'd taken a bit of time to think and say, 'Actually, what is our job here? What is our purpose? What are we here for? Our job is to provide health and care, voluntary sector services to people wherever they are. How do we best do that? By working with and talking to patients and communities' -  and it doesn't mean that that's the end point. We're not necessarily providing all our care out on the street, but you have to build confidence and trust and processes that enable people to move back into mainstream services if they need it. And even with Tom and his really great work with general practice, together sitting with the patient and their families, they're building a relationship and building trust so that everybody knows what role they're playing and when best to intervene. And that's got to be the way we design services. So if we carry on providing an appointment system, then those who know how to get,will get more. A one-size-fits-all service is not fair. It absolutely increases inequalities. So if you add in more appointments now on a Saturday anda Sunday, the people who know how to get, will carry on getting, and then will get more; the people who weren't getting them in the first place, still won't get.

Gill Phillips  07:45

Still won't get them. 

Becky Malby  07:47

So, so if we really want to be fair, then you have got to look at your list, whether that's in outpatients, whether that's in general practice, whether that's your referral list, your referral system into a hospital. And you've got to have a think about need and say, where and how is best to do this, and with whom? Is this somebody I should see on my own? Is it somebody I should see with somebody else? Is it somebody I should go out and see? Is somebody I should ask to come in to see? Again, you know, listening to Bill and finding people with unmet need, if you go into most general practices, and ask them of your population, who's not turning up, they don't know. Of the people that rang in the morning,  who didn't get an appointment and what happened to them, and they don't know. But it is a Hunger Games to just get through the door, and the Hunger Games means that those who've got English as a first language - those who got English the second language Gill, are really sunk, actually, in our system, we are really, really bad at providing services for people who don't speak English first. So firstly, if you can speak English, if you've got a phone, if you've got time, if you know how to work the system, you can get what you need. But if you don't have any of those four things, you're going to really struggle. So our call is, look what people have done on these podcasts. They are really great. They are humble, ordinary, fantastic clinicians, voluntary sector leaders, managers, just doing the right thing. And if they can do it,absolutely everybody can do it.

Gill Phillips  09:23

Yeah, I think it's fantastic. And I really enjoyed talking to all the people. And it was only Tom Holliday that I, as you know, I know well already, and I didn't know the others at all. And I think that's what that description you've just given of just humble, ordinary people. That's what came through loud and clear. It was about the work that they're doing, the difference that they're making, rather than about them. And I love picking up on some of the themes that were coming through so strongly in all of the talks. Really, I know you were just talking about with whom, being that imaginative to think, well, I can't do this on my own. Who should I be working with? And I love Tom's example of it would be so easy for him just to discharge someone. You know, you've got a child who's got tummy ache, they've got a headache, they've gotone of these kind of just low level, ongoing kind of problems. And he's looking to think, I don't want to just discharge them, because I've done all my medical tests and I haven't found something, so they must be fine. They're clearly not fine. And rather than just bouncing them off somewhere else, he's working with someone and finding the right person to work with and joining up physical and mental health. I mean, why should that be so difficult.

Becky Malby  10:41

It's a really interesting notion around curiosity. So I think that everybody that we heard was curious about how to do the right thing. And they weren't arrogant about their role, neither were they in charge, neither were they experts. So they said, I have this to bring. I have this expertise to bring, I know this part of the problem, but I don't know the whole solution. Who else knows a part of the jigsaw? Who else has a different perspective? How do I get in touch with them? How do I work with them? What can we do together? And it's that humility, I think, that really matters, which is the, the  founding principle of the NHS, which is, 'can do, should do' (Should do means treatment, treatment means cure) is absolutely fine for those sorts of, you know, transactional type health problems, but we're not talking about this now. We're talking about very complex needs, and so silos of specialists are never going to be able to meet needs. You will just rack up costs and anxiety and distress, and you won't meet needs by just keep passing people around the system. And I think that all of those folk felt responsibility lay with them. They took responsibility for meeting the needs of the people who are right in front of them, there and now, and said, 'how best do we do that? Where do we get help from? Who else can do this? Where's the energy, where the resources? How do we organize?' They didn't just accept that it hasto be like this, because it clearly doesn't.

Gill Phillips  12:13

And I think, to encourage people and inspire people, what came through very strongly as well as it's more enjoyable and it's, it's more doable and it's less lonely. So for example, Tom again, spoke about the school nurses, and he said before he'd have just had a blank really, he'd have thought he should speak to somebody, or perhaps a school nurse. And now they've got a team who know each other. They're on first name terms, and it's helping him, because that's probably an enjoyable phone call, rather than a daunting look at a piece of paper and wonder what to do. And we're we're all human, however senior or, you know, senior clinicians and so on. And I know another one that really jumped out at me was George's Wednesday morning team meeting, and how I think that's a fantastic example of meeting staff where they are in that they've all got their own lives, and people wanted to be part of that meeting and fitted it round what they were doing, rather than actually having to either be there for the whole hour uninterrupted or not there at all. So I think just bringing in people's whole lives into work. George also has spoken, I don't know if it came through on the podcast, about just they've had no turnover and things like that really stand out as being happy staff, feeling valued, to do a job and to work with people who value them, isn't it?

Becky Malby  13:37

Yeah, people need people. Oh, we all need teams. You know, we don't work in little isolated icebergs. It doesn't work for us. You don't end up giving the best quality care. We all need feedback. We all need professional development. We all need review. We all need to explore. We all need to learn. And you could only do that in a group, and working with people with complex needs is hard. You know, Gill, it's, sometimes it's distressing. You don't be doing that on your own. The reality is you have to be able to do that with people that you can call colleagues and friends. Highly personal work is stressful, creates all sorts of anxieties. You're dealing with death and suffering and distress, and so you absolutely need a gang around you who you can do it with. And that speaks to what George says, and I think what Bill was saying about his shopping centre and the whole gang that went out there. And, you know, they they have fun together. 

Gill Phillips  14:35

They have fun, yeah.

Becky Malby  14:37

They had fun. And they did it first in COVID. They kept on doing it, and they still carry on doing it. You know, it's lovely to see the relationships that you form to do good work. We're always in it together, innately. I think in the health service, we absolutely need to be in groups and teams and and collectives, so that sort of isolation model is, is, maybe it's, it's good for people in terms of expressing power and expertise, but it's not good for you as a person, and it's not good for the way we do our, for providing really good quality care.

Gill Phillips  15:14

Yeah, I thought Bill's examples. I mean, I've heard of things like taking health care out to supermarkets, but to actually plan to, with the young people with learning disabilities, go to a rugby event and give them that much fun and get them involved in talking to their heroes, perhaps on the rugby pitch. Oh, and by the way, do the health assessment and to get so much more out of it in terms of what matters to that young person, rather than just ticking some blood pressure type boxes, I think the storytelling in the series was was really strong. I love George's story about V, and someone who basically needed a pair of shoes and a pair of gloves in order to be able to go walking, and how that was transformational in her life and her mental health and moving on to a university course, compared with just taking the ineffective mental health pills that she'd been taking for a long time. So I'm hoping people will be inspired by those stories. 

Becky Malby  16:14

And I think you heard that a bit with Kim's frustration, which is the NHS thing: so it doesn't happen outside the NHS's doors, it doesn't really happen. Yeah, and the amount of resource in communities, in the voluntary community sector,you know, backed up, being, having a bit of humility and being a bit humble... just understanding there are people working in communities, in streets. The charities that we work with are very small scale, but they know their folk really well, and they go absolutely to the end of the world and back for their for their clients, their colleagues, and a voluntary community sector that has no sense of longevity to its funding -and that's, again, one of the findings of the Inquiry Report - if you don't put some stability into that, which is absolutely the heart of many people's needs, NHS is just going to end up picking up something and spending so much more, because we are so much more expensive in the NHS than the volunteer community sector is. It makes it makes no sense to require the VCSE to be on very short cycles of funding for very short periods of time with very few staff. It does make sense to properly partner and to have a resilient and competent and capable voluntary community sector doing all that work. In many respects, Gill, social prescribing was always, I think, supposed to be a temporary space, because that is work that the community, voluntary community sector can often do itself. So back to legalizing poverty: sucking things into the NHS makes them very expensive. It's much better to get things where people are, because most people working in volunteer community sector often live locally. They have very good relationships in all sorts of ways with the community. You get so much more by building into and partnering with that sector, than you do by doing it alone. But we can see that as a sort of peripheral nice to have, rather than... it's core business for the NHS to partner with the VCSE.

Gill Phillips  18:23

Yeah. And I think another key theme that you just touched upon there, which is a big bug bear of mine very often, is measurement, and what you can measure. And, I think it came through particularly strongly in Tom's podcast, that the number of appointments can be measured so you have more appointments, and then that's seen as success.

Becky Malby  18:47

You get more of what you pay attention to. So, you amplify: the things you measure. you amplify, you make them visible. So it's ever so, ever so easy to measure transactional stuff, the number of people who turn up here, the number of people that go there, blood pressure measures and whether they're coming down or going up, or diabetes scores. Whether people are living a good life, whether that... I think numbers of appointments do have a part to play Gill, because what you want to do is you want to reduce overall demand by meeting need, which means that people seekingappointments, that will reduce. So it's not a bad measure. It's just no good all on its own, because on its own, it doesn't say anything about need. So you want to see, it's always about patterns over time. You want to see trajectories. So you want to see a mixture of health outcomes and accessibility and making sure that you're meeting the needs of the whole population, not just part of the population. So numbers of appointments measures the people that turn up. It doesn't measure the people that haven't managed to get through or don't turn up in the first place. So you have got to think of measures that matter. There's a, on my blog, there's quite a nice article -  I'm not saying that because I wrote it, but obviously I did partly write it! - but there is quite a nice article for primary care about measures that matter. What wouldyou look at in the round to help you know whether you were doing a good job? And I think if you were really up for this, one of the things you might do is start where you know people are struggling to meet needs. So I would start by understanding, I'd go into a community where they don't speak English as the first language, and I'd have a look at the number of appointments they're getting and how many checks they have, health checks they have. I would look at their overall health, I would do some screening and say, well, actually, is that population the same as the ones that are turning up in general practice, for example. So you've got to think of your own ways of doing it, but yeah, measures, you always got get more what you pay attention to so, be careful, is the answer.

Gill Phillips  20:54

And I think that's what's exciting about your work, that you're looking for what's not there, not just based on what is there and what is happening, and I think that's, in terms of inequality that's got to be the way forward, because otherwise we're just measuring more of the same. I mean, how do you measure something like George happening to bump into V at the airport and finding out and getting that satisfaction for himself? You know that he's helped her on the way to doing something completely out of her comfort zone. She'd never been abroad, and she's off to China. So I suppose that's part of what I meant about measurement. You cannot measure those things, the kind of long term. 

Becky Malby  21:31

We could tell stories. 

Gill Phillips  21:33

You can tell stories, yeah.

Becky Malby  21:34

Measures are good for, I guess, performance and contracting. But the thing that changes the world is stories, if you look at , you go into the House of Lords or the House of Commons, they tell stories to back up their cases. They come up with one or two stories to show that their argument matters. If we want to change something in our friendship group, we'll tell a story. If we want something to happen, we'll tell a story. Stories are really powerful. That's why I was so pleased that we have these amazing stories on the podcast, because George's story with V is the story. I mean, you just can't forget it, and it becomes sort of iconic around what happens when you look at people as human beings, not as diseases. What happens when you look at the humanity and the potential of human beings? What if you give them some opportunity? And it doesn't happen every time, does it Gill, of course it doesn't. But when it does happen, it's absolutely magic, and it's amazing to see, and you do it for the times when it does happen, and you're resilient with folk, for the times when it doesn't, hoping that it will for them. So that's what makes you get up in the morning, isn't it, it's that.

Gill Phillips  22:41

It really is, yeah, and I think the storytelling, I mean, the storytelling has been a big theme of my podcast. I've spoken to some actual storytellers, you know, professional storytellers, and I've talked to people who just tell brilliant stories. So forexample, I think relevant to this Pippa Kelly tells the story of someone who'd applied for a grant multiple times and not got it, and she coached them to tell a better story, and they got a 3 million pound grant on the back of it. So storytellingis incredibly effective, isn't it?

Becky Malby  23:11

I think that particular story is about, Pippa, is about getting clear what's at the essence, because sometimes it's really hard to describe it in a measured way. But describing something in a story where you've got a sort of, line of direction, you know, where you're trying to get to, you know, what you're trying to prove, say, show, it makes you get clear. So stories also have a heart to them and a purpose to them. So I think overall, Gill across the theories, I'd really encourage people to have a look at the Universal Healthcare Report. It's very straightforward.

Gill Phillips  23:48

It really is, yeah, and it's got some really practical tips. 

Becky Malby  23:52

Pay attention to people that don't speak English as the first language. Partner with the volunteering community sector, because they can really help you.  Go out to where people are and help them transition back. Don't medicalise poverty. Form relationships so that you can really meet needs together. Work in teams. Don't, don't get caught up in the cycle of who comes through the door gets first divvy on everything. Make sure that you fund services fairly. We haven't talked about that, and it wasn't really over the podcast, but in the inquiry report, you'll see: practices that are in wealthier populations, because they tend to have older people, get more funding through the Carhill formula than practices in poorer communities, which tend to be younger, because the funding is skewed towards older people. And no one's reallyaddressing that nationally, and they promised to, and they never do, but that's just not fair. We talked a bit on the very, very first podcast about how funding is distributed around prevention rather than drugs. So think the one for Integrated Care Systems, and particularly for commissioners, is, is the funding that you're giving out...are you doing that fairly? Is it really fair for everybody, or is it actually skewed, and is that right? And what can you do about it? And the lessons were, folks, sort of shop floor, front of house, is try and think all the time about meeting needs, not meeting demand. What can we do to meet needs, rather than how do I just meet demand. And if you're just meeting demand, then you're on that sort of factory of passing things around. If you meet needs, you stop and listen and you work out how best to do that together. And that means you're going to be in a more collaborative space. I think the final thing is that, just a bit of time to think and stop, and just stop rushing around doing but some space where you're thinking, not on your own, but with people who might think differently from you about a solution, means you're going to come up with the, withmany things we did actually during the pandemic, with the VacciTaxies and getting out there, we were very imaginative in the pandemic. We lost a lot of that imagination again since, so we got rid of a lot of bureaucracy, we managed to find our way out to people, and we need to reignite that, I think, together, in order to make sure that everybody has a fair chance of equal access to health care, Gill.

Becky Malby  24:28

Well, thank you, Becky. I think that message to reignite together and another strong one that's come right through the podcast series, which is to start somewhere rather than overthink things, are probably our key messages.

Becky Malby  26:30

I agree.

Gill Phillips  26:31

So thank you so much for inviting me to do the series. I'm sure that some future episodes will build on this, because by nature, as you know, Becky, I like reaching out and people suggesting other people for me to talk to. So it's the end of our little mini series, but it's certainly the beginning of the topic and taking this forward together.

Becky Malby  26:50

Thanks Gill, for just being so enthusiastic and stepping right into this knotty problem and providing such an enjoyable series. I've really enjoyed listening to them, and I thought I knew everybody! So you always find something, it was absolutely lovely. Thank you, Gill, brilliant!

Gill Phillips  27:06

Thank you, Becky. Thank you so much for listening. If you enjoyed this episode, it would be fantastic if you would leave areview and a rating, as well as recommending the Wild Card: Whose Shoes? podcast series to anyone who you think might find it interesting, and please subscribe that way you get to hear when new episodes were available. I have lots more wonderful podcast guests in the pipeline, and don't forget to explore and share previous episodes: so many conversations with amazing people who are courageously sharing their stories and experiences across a very wide range of topics. I tweet as Whose Shoes?. Thank you for being on this journey with me, and let's hope that together we can make a difference. See you next time.