Why missed GPs' appointments have a lesson for Scotland's criminal justice system

It is important for patients to keep appointments to see their GP (Picture: Charles Milligan/Hulton Archive)It is important for patients to keep appointments to see their GP (Picture: Charles Milligan/Hulton Archive)
It is important for patients to keep appointments to see their GP (Picture: Charles Milligan/Hulton Archive) | Getty Images
The reasons why people miss court dates have similarities with those behind the number of missed GPs’ appointments

As an ex-nurse (although I think you never are really ex) and advocate of preventative medicine, I have lots of conversations with people about their well-being, exercise, blood pressure or high cholesterol.

I’ve realised that there is no question I feel embarrassed about asking, including whether people are taking advantage of preventative opportunities. A fantastic GP spoke to me recently about the patients who don’t attend the GP surgery and about a concept they call ‘missingness’. It’s defined as the repeated tendency not to take up offers of care resulting in a negative impact on the individual and their life chances.

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‘Missingness’ is more prevalent in socioeconomic deprived communities and urban environments. My ex-colleague Adam Burley, the head of trauma services at NHS Lothian, put it succinctly: “Healthcare systems are designed for healthy people for use by healthy people.”

Psychological factors

The causes of missingness include poor physical and mental health, transport costs, ability to take time off work etc, but also psychological factors, where people have low expectations for their own health or believe services ‘are not meant for the likes of me’.

How many bowel screening envelopes lie unopened in households around the country, with people turning up at emergency rooms with late-stage cancers. Health colleagues have realised this is not about patients causing health system problems, but that the health system has caused issues for the patients.

We too have ‘missingness’ in the justice system. My organisation has been carrying out work with Police Scotland around people who miss their court dates and then receive a ‘failure to appear’ warrant, leading to an arrest and sometimes remand in prison. There are many thousands of failure to appear warrants, a time-consuming and expensive endeavour for services which also impacts victims and witnesses.

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GPs and lawyers become bloodhounds

It’s easy to write people off as ‘feckless’, ‘criminal’ and so much more. But when we interviewed people in custody to see why they didn’t turn up, the picture was complicated. Letters sent to old addresses, no money to get to court, chaos in their lives (and a court date is almost the least of their worries when they are hanging on by their fingertips), sofa-surfing women who had moved eight or nine times since the offence had been committed with no connections to any services.

There are many great defence lawyers who are like bloodhounds searching out clients amid the chaos to ensure they turn up, but my, do we make it hard for people. If we compared the health and justice services data on missingness, we would see a huge overlap with the same people.

I have heard of patients not turning up to get cancer test results, of GPs turning detective to reach out to people in extraordinary ways to ensure that they engage, for the alternative is people with appalling health outcomes and premature deaths.

In justice, people can end up in the spin cycle of the system, having their liberty removed in police custody. I am reminded of the proverb ‘for the want of a nail’. Alas, it is not one thing that will lead to change, but the solutions are in the hands of us, who run the system, and in recognising the system has to work for those in it first.

Karyn McCluskey is chief executive of Community Justice Scotland

Related topics:
Dare to be Honest
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