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All for one


Andrew O'Brien

I’m working on an idea for a year-long game show called ‘News Bingo’, where contestants get to pick 52 news headlines, stick them into a calendar and see who gets the most correct. The easiest way to pick up points through the winter would be to alternate between ‘Storm Whatever Name Met Eireann Came Up With Batters West Coast’ and ‘Trolley Crisis Worst In Like, Forever!’
The headlines that accompany flu season and the associated bed shortage every year are easier to predict than the weather, but no less important for it. What newspapers and opposition politicians rarely acknowledge though, is that there is no easy solution. The common refrain is that we need to open more beds, and there may be some merit in that. But now, a month after the flu has passed its peak, what do we do with the extra beds and staff that the HSE couldn’t really afford to open in the first place?
A piece in the Guardian this week caught my eye as a possible answer. What if, instead of worrying about how many extra beds we need, we just reduced the number of people going to hospital? But GP clinics are under enough pressure, I hear you say, and you’d be right, which is what made the Guardian’s piece fascinating.
The piece looked at data from a programme based in Frome, a town in eastern Somerset, England, called the ‘Compassionate Frome Project’. The article states: “What this provisional data appears to show is that when isolated people who have health problems are supported by community groups and volunteers, the number of emergency admissions to hospital falls spectacularly. While across the whole of Somerset emergency hospital admissions rose by 29 percent during the three years of the study, in Frome they fell by 17 percent.”
The author quotes Julian Abel, a consultant physician in palliative care and lead author of the draft paper, as saying “No other interventions on record have reduced emergency admissions across a population.”
Incredible, right? A town was able to reduce hospital admissions using community groups!
The project was started by Dr Helen Kingston, a GP in Frome, who found that her patients seemed defeated by the medicalisation of their lives, where they were seen as a series of symptoms, rather than a person who happened to have health problems.
Dr Kingston, with the help of the NHS group Health Connections Mendip and the town council, set up a directory of agencies and community groups. They were able to see where the gaps in services were, and fill them with new groups for people with particular conditions.
They employed ‘health connectors’ to help people plan their care, and most interestingly trained voluntary ‘community connectors’ to help their patients find the support they needed.
Sometimes this involved addressing debt or housing problems, sometimes joining choirs, exercise groups or organisations like the Men’s Shed. The aim was to break the cycle of misery: Illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness.
It’s a brilliant idea, and can be explained from neurophysiological and evolutionary perspectives. Chemicals called cytokines, which function as messengers in the immune system and cause inflammation, also change our behaviour, encouraging us to withdraw from general social contact. Probably because in pre-historic times, sickness made us vulnerable to attack, thus by staying away from wider social contact, we were protecting ourselves.
However, while separating us from society as a whole, inflammation also causes us to huddle closer to those we love. Which doesn’t work at all well for socially isolated people, who have no close group to turn to. It is perhaps no surprise to note that high levels of cytokines are linked to depression. So inflammation causes isolation, and vice versa, and the combination contributes to depression.
And therein lies the rub. By creating a community spirit, a true social network for previously isolated people, we may be treating depression and reducing hospital admissions at the same time. And wouldn’t it be great to see a positive headline for a change!

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.

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