“We miss so much of the eye care need that is out there”

On the Tuesday of the Labour Party Conference, I played hooky from hobnobbing with the big nobs to visit Liverpool’s Metropolitan Cathedral. Not just because it is a fantastic piece of architecture, but because it was where I had my first proper job, working in a (now closed) homeless persons shelter in the cathedral crypt.

If slogging up the hill made me conscious of every one of the 45 years that has passed since I Iast visited, that feeling was deepened still by the blank looks on the faces of every one of the Cathedral guides when I asked to be shown where the shelter used to be. The crypt itself has now been restored to its original Lutyens-designed glory and is used to house a dazzling display of Catholic silver, failing also to show me any clue as to where I had spent 12 of the most formative months of my life.

It was only when I got into conversation with an elderly security guard in the car park that I got confirmation that I had not been making it all up. Taking me back into the crypt, he showed me the scorch marks on the wall from where the residents had tried to burn the place down, the final straw in a very large bale of such incidents. Not only did he know of the place, it turned out, but he also remembered a few of the same people: Nuggy, Big Mick, Jimmy Mac. When I had been working in the night shelter, he had been working up the road in Walton Prison, where they also occasionally lodged.

Later that evening, I found myself talking at a fringe meeting at the party conference itself, an event organised by Specsavers in order to showcase its work bringing optometry to homeless people.

The consequence of a system which views people only through the provider spectrum is that we miss so much of the eye care need that is out there

As frequently happens, as I was standing there trotting out my usual carefully-rehearsed ad libs, my mind was wandering back to that incident. What struck me then and continues to strike me now is the way that we structure our services not around the individual, but around the provider.

To me, Nuggy, Big Mick and the others had been homeless people. To the security guard, they would have been prisoners. Their probation officers would have called them service users; their benefits clerks, claimants; their lawyers, clients. To any optometrist they managed to get to see, they would have been patients – or, had they had money to spend, customers. But with the passage of time, the security guard and I simply remembered them as what they were: people.

Worryingly, the way party conferences are structured merely replicates those fault lines. Most of the events, speeches and meetings I attended during my time at party conferences this year were populated by the same faces; insiders from their own sectors speaking to each other not about the needs of the individual, but about sector issues. If the individual citizen features in that conversation, it is as someone from one of those categories – client, patient, pupil, immigrant, service user – rather than as a rounded individual who could simultaneously be all of those things. The Specsavers event was brave in trying to tie two disparate but important policy issues together, yet that was a rare event.

The issue is not finding some of those who need us; it is how we organise our services to suit their needs rather than suit our own

The consequence of a system which views people only through the provider spectrum is that we miss so much of the eye care need that is out there. It is easy to blame people who we wish to connect with for not engaging properly with us, to wonder why people obstinately refuse to see themselves as patients, or do not automatically follow the patient pathways we so laboriously construct for them. But we have to challenge ourselves about whether the services we are offering are really as “person-centred” as we like to imagine or whether we are, in truth, designing things in a way which suits us as providers rather than them as, in this case, patients.

Nuggy, Big Mick and Jimmy Mac all had their health issues and all, I’m sure, would have been counted by hard-pressed healthcare providers as “hard to reach.” In actual fact, the opposite was true: for one, Jimmy Mac’s whereabouts were utterly predictable – in the prime begging pitch outside the Cathedral entrance after mass to offer an immediate means by which penitent Catholics might expunge some of their guilt. The issue is not finding some of those who need us, it is how we organise our services to suit their needs rather than suit our own.