58. Dr. George Winder - Don’t medicalise poverty

🎙️ Wildcard Whose Shoes? - “Don’t Medicalise Poverty” with Dr. George Winder, GP in Leeds

In this powerful episode of ‘Wildcard - Whose Shoes?’, host Gill Phillips sits down with Dr. George Winder, a passionate GP from Leeds, to explore a critical issue in healthcare: the medicalisation of poverty. George shares eye-opening stories from his work, revealing how social injustice and poverty affect health and well-being—and why simply prescribing medication isn’t the answer.

Gill and George discuss real-life examples of how local care partnerships and community support networks are making a difference in Leeds. From housing and domestic violence to food hunger, George shares his team’s innovative approaches to tackling the root causes of illness. Listen in to learn how co-produced solutions and third-sector collaboration are transforming lives—like “V,” who went from being dependent on medication to becoming a community leader.

If you’re passionate about social justice, healthcare reform, or community well-being, this conversation will inspire and challenge you.

Tune in and take a walk in someone else’s shoes! 🎧

Lemon lightbulbs 🍋💡🍋
🍋The NHS is medicalising poverty - we need to address the root causes of health inequalities -  the wider determinants of health
🍋 George shares practical examples of how we can work together to create a healthcare system that truly supports those in need
🍋 Use asset-based approaches
🍋 Focus on addressing need
🍋 Go out to where people are, rather than expecting them to come to you
🍋 Storytelling is very powerful in this
🍋  Co-produced solutions and third-sector collaboration are transforming lives
🍋 More resources would mean more people could be helped

Links to earlier episodes in this Universal Healthcare series:
Becky Malby - What is universal healthcare and why does it matter?
Tom Holliday - Children get less

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Chapters

• 0:00 George Winder and his team in Leeds are leading the way with finding imaginative ways to deliver universal healthcare
• 2:16 George introduces himself and his work and explains the effects poverty can have on people
• 4:34 The wider determinants of health, such as poor housing conditions or food hunger, affect peoples overall well-being and capability
• 7:00 The importance of primary care working with local partners, particularly community groups
• 7:19 Upskilling people so that they know how to respond when they see people experiencing domestic violence or other traumatic events
• 8:57 “It’s about working with people, understanding their unique challenges, but also where the systemic issues are”
• 9:27 So is the NHS medicalising poverty? Yes!
• 10:09 The inspirational story about ‘V’ – who went from having serious mental health problems to becoming a community leader
• 14:08 Funding community partners to go out and offer healthcare checks and screening to people, rather than expecting everyone to come to you
• 15:33 Working with people to understand them and offer real help, rather than just sticking plasters
• 16:53 What resistance has there been and how have you overcome this? Start somewhere, rather than waiting for perfection.
• 19:15 Imaginative solutions can be a VERY effective use of the public purse!
• 19:35 Social prescribing can be transformative, but we need to make sure support reaches those who need it most and not diluted
• 22:20 “ if we have more money and more resource, we could do more”
• 22:28 This conversation is to be continued!

Transcript

SUMMARY KEYWORDS

people, work, leeds, support, george, sector, absolutely, shoes, poverty, group, pandemic, community, nhs, health, amazing, wellbeing, services, networks, universal healthcare, access

SPEAKERS

George Winder, Gill Phillips 

Gill Phillips  00:00 
My name is Gill Phillips and I'm the creator of Whose Shoes?, a popular approach to co-production. I was named as an HSJ 100 Wildcard, and want to help give a voice to others, talking about their experiences and ideas. I love chatting with people from all sorts of different perspectives, walking in their shoes. If you are interested in the future of healthcare, and like to hear what other people think, or perhaps even contribute at some point, Wildcard Whose Shoes? is for you.

 Gill Phillips  00:47
So, I'm delighted to introduce my podcast guest today, Dr George Winder. George is a mover and shaker in primary care, and this podcast episode is part of the mini series we're doing around universal healthcare in collaboration with London South Bank University and the Universal Healthcare network. I met George and learned a little bit about his work through Professor Becky Malby, who is the mastermind behind this series. You can hear Becky talking about universal healthcare in Episode 56. So why did we pick George? One of the key themes of the Universal Healthcare National Inquiry Report is not medicalising poverty. George and his team in Leeds are leading the way with this. I'm excited about the conversation today and George and I had a chat a couple of weeks ago and I think it's fair to say, we get on like a house on fire.

 Gill Phillips  01:46
George told me amazing examples of how 'not medicalising poverty' works in practice. I'm sure we'll talk about some of them today, and I hope you will be inspired to think that healthcare systems and people can join up more, can link more with communities, and can seek to get the root of what is making people ill, rather than just applying sticking plasters. So welcome, George. Can you tell us a little bit more about yourself and this important work?

 George Winder  02:16
Hi Gill, and thanks so much for this opportunity. It's just I've been looking forward to this as well. The introduction was lovely, but I think it's important really, to, to mention that I work alongside a lot of people, and they're not my team. This is an absolute - as it should be - collaboration of the good and the people who really want to eliminate the effects of poverty and how that affects the overall health and wellbeing of people. So it's a pleasure to be here. By trade. I'm a GP , so been a GP for quite a number of years, and as part of that, I have become interested, frustrated by seeing a social injust and the effects that poverty has on people. I work in a general practice in Leeds, in an area called Gipton, which sadly has a large proportion of its population who suffer negative effects of poverty, and that really impacts on their overall health and wellbeing. As part of that, I've grown into a number of roles, one of which is that I am a Trustee in what we call Oakley Lane practice health champions, a group of volunteers who ... we co-produce a number of different things that really help individuals change their lives. And that's one of the proudest things that I've done. Was the chair of what we call in Leeds a 'local care partnership'. So that is a coming together of people who support people in our community, so we call it the Seacroft Local Care Partnership. We support Seacroft and the surrounding areas. Those areas are largely defined by, by poverty, really, and people that, people's lives are affected by poverty. And I'm also a clinical director of what's called Seacroft PCN, which is a group of four practices working closer together on meeting the needs of our combined population. So really, my aims in everything I do is around social justice and aiming to eradicate the negative impacts of poverty, and that obviously, because of my background, is associated to health, health and wellbeing, but also, as we all know, and it is always seen in its broadest context, health and wellbeing is a complicated and very single part of a person's overall life, and the influences on that and the wider determinants of health, as we all know, are what really, truly impacts people's health and wellbeing, not so much what their GP's do.

 Gill Phillips  04:46
So, such as housing, or...

 George Winder  04:49
Absolutely, I mean, housing, I think that always springs to top of mind. We know that people's housing in their environment directly impacts their health. So, from things that we hear around black mold to how damp and cold and other things give people respiratory illness, we know where we've done work with those people - national work around supporting people with warmer, drier homes - their health improve, their utilization of health care is reduced, for example. So we work with some organizations in Leeds so Care and Repair, a third sector organization in Leeds around prescribing to help make sure that people with respirator illness, their homes are suitable and supporting their health, not causing to deteriorate. We know that food hunger and poor nutrition affect people's overall wellbeing and ability - children, for example, in schools we. we see, don't we, that teachers are worried by the ability for pupils to concentrate and work in schools because of hunger, because they're not eating breakfast before they get to school, which for some of us, is unbelievable, but that's a reality seen throughout the UK, really. We see the effects of other issues. So access to, I guess, to emotional support, to support structures within family networks impact the individual and their, their ability to function so on a really extreme case of that, you know, domestic violence has a huge detrimental impact on families. Domestic abuse in all its form, has a huge impact on families. We recognize that locally, part of our local care partnership, one of our elected members, one of our councilors, said that during the pandemic, he'd had a lot of families and other people seek help for the effects of domestic abuse. We started to recognize, for example, that in the pandemic, people used to have ways in which they might escape the effects of that, whether that's through community groups, spaces, being out the house and other things. And it seemed to become worse during the pandemic, and that trend has continued. And as a local care partnership, we understood that that impacted their own health and wellbeing, but also their utilization of services. So people are affected by domestic abuse tend to actually attend their GP practice more often. Understandably, you know, they tend to turn up in unplanned care more, more often. And so we, we took an approach across the local care partnership of working with people and with existing third sector organizations who support people who are affected by domestic abuse, and we undertook a program of work about education of people about the different types of domestic abuse, but also supporting staff to know how to support people if they disclose domestic abuse. Um, and that was broad as working with nursery workers, for example, was really, was really telling when you hear from the nursery workers about how they now can talk to mums about what's happening at home, and able to ask those opening questions where they probably knew what was happening and could probably see the signs, but didn't feel safe or able or skilled to be able to get that disclosure, and then what to do that disclosure was was given to them. So things like that are where we recognize that those things have a huge impact on people's wellbeing, also they have an impact on how people access health support, and also not in a way that's going to get them the best help. And so really having an approach that we've taken within our local care partnership to look at the ways in which we can support people affected by domestic abuse has had a really big impact.

 Gill Phillips  08:24
Yeah. I mean, I think, George, you're touching upon so much there, that sort of holistic approach seems to be what you use for running through all the examples that you're going to be giving, and recognizing that you might have really good staff, but they don't know how to respond. You know, they need some training or education awareness. It's looking at the whole package, isn't it, and how individuals that come across those people can actually help move things on for them, rather than not knowing what to do or just referring somewhere else,

 George Winder  08:57
Absolutely, absolutely. And I think we've often said, you know, the broad approach to all of these things this. It's about working with people, understanding their unique challenges, but also where the systemic issues are, and then helping provide support based around that and based around what we know and understand, and through a lot of listening and work we've done with those existing third sector organizations, that's really helped us to then to come up with a better solution, really, to that.

 Gill Phillips  09:27
Yeah, so, we're covering a lot of different issues here. And so, George, do you think that the NHS is medicalising poverty?

 George Winder  09:37
I've no doubt that the NHS is medicalising poverty. I think it's providing sticking plastics, as we say, to the underlying issues. I'm sure nobody's doing that with any malice. It's just the solutions that we have currently. That's what we have to offer. And I see that day-in, day-out as a GP, I hear that day-in, day-out when I'm working with third sector organizations. I will, if you don't mind, talk about a real person. I'm going to call her V, for the sake of just keeping her identity. 

 Gill Phillips  10:09
Of course, yeah 

George Winder  10:09
So I'm going to talk about somebody if you don't mind, called V. She was a patient at a GP practice where I work. She's a woman in her mid 40s, and for a long time, she used to come and see GPs really seeking support for her mental health. And largely she sought that in terms of pharmacotherapy, so tablets, antidepressants and benzodiazepines, which we knew weren't particularly helping, and also addiction to pain medication was one of her things, and we knew that we weren't really helping her, but we felt that that was all that we could to offer to help her, but she wasn't getting better. As part of a meeting that Becky put me in touch with a group called Altogether Better, and they had a suggestion that if we worked better with people for a co-produced model, we could really help many more people and really look at the root cause of their problems and what support they need. Through this, we developed a volunteer group at the practice called practice health champions, and they're into their 10th year this year, so we celebrate 10 years. And V took up our suggestion of becoming enrolled, and she wanted to become a walk leader, so we had some walking groups. We supported her through that, to the extent that we had to buy her shoes and gloves in the winter, because she didn't have that anything would be suitable herself. And out of that progressed, an amazing thing, being that she gained a lot more confidence. She started coming to the meetings that we had where we discussed our plans and what we could do. And then, essentially, she started chairing those meetings. And when I say those meetings, those would be the conventional sort of committee meetings for people who've been on committees their whole life, generally a certain, you know, a certain socio-economic group. And she started feeling confident to chair those. And the last time, the last time I saw her, she, she tapped me on the shoulder in Manchester Airport. And I turned around and I said, 'well hey, I've not seen you in a while!'. She said, ' I know, I got on my Access To University course!', and I was like, 'Christ, amazing. How's it going?'. She says, 'it's great. I'm going to China'. And I said, 'Oh, wow!'. She said, 'Yeah', said, 'yeah, I've never been out the country before, and now I'm going to China with my university course'. And she'd, she'd gone from somebody absolutely dependent on medication, and, you know, other things, to doing something where she was then supporting people to get walking, exercise and activity, to building her confidence, to going on an access to university course, to then flying to China. And I've not seen her sense, which is amazing, you know, I think that's amazing thing, because I don't want to, you know, she, she's, she's doing great. And so I think usually the things that we have are, you know, tablets and medicines that really aren't going to affect or help those problems, and we're just medicalising that. And I think, the approaches that we take, there are ways in which we can help break some of those, but they are challenging. They're difficult, time-consuming, they're not particularly well-supported in our conventional approach, you want to make it easier to do the right thing. The right thing is to do that, but that's not the easiest thing. So how do we make it easier to do the right thing? 

Gill Phillips  10:20
And it's imaginative, isn't it? There isn't a set piece there that you can say, this person - give them shoes and gloves. I love the idea that shoes are involved. There's always a few shoes involved in these things! We need to be telling these stories.

 George Winder  13:43
Well exactly! It's really nice, literally walking in her shoes. And I think the other thing that we see is, we work really closely with our networks of third sectors in the areas who work in Gipton neighborhood and in Seacroft and we, for example, recognize that there are health challenges and the health needs of our population.  

Gill Phillips  14:05
So what might be a good example of that? 

George Winder  14:08
So they might have, this is, a group of people who have really severe mental illness, so usually people who've got Schizophrenia or Bipolar Disorder, and so by nature, they, they need a level of support that typical GP practices don't usually, you don't offer a 10 minute appointment. And so we've taken the approach to work with our third sector organization, where we secured some money. We gave 50% to our third sector partners, and we use 50% to work with the local NHS Mental Health Trust, where we employed a experienced mental health nurse, and instead of people going to clinics or coming to GP surgery for their health checks, she went to the food pantries, she went to the kitchens, she went to places where, when she worked with our third sector organizations, she knew that people who would likely have severe mental illness went, and the aim of that was to build trust, to help us to understand what the barriers were to those people tending for you know, checking the blood sugars and cholesterol and other health checks, increasing vaccination - uptake in the community typically have a lower uptake of vaccinations - and also increasing uptake of screening for cancer, say, cervical screening, bowel cancer screening, breast cancer screening. So we know in this population, uptake of those services are lower. So is the NHS medicalising poverty? And I think, absolutely, you know, poverty has become more prevalent since the pandemic. It's having a huge impact on, on people and access to healthcare. And because of that, we offer the sticking plasters that we can, which sometimes is medication, which is sometimes other things that aren't suitable. And if we had time, worked with people and understand them, I'm sure we can really make a difference. V isn't the only person who that - she's an amazing she's amazing person-  but there are numerous other people where we've really just enabled somebody to get their confidence back, to understand that value and purpose and be able to have a purpose each day that they can do that. And what's growing within that, it's been amazing. 

Gill Phillips  16:22
I could feel that in these case, it was confidence, it was self worth. It was actually believing in yourself. She was going from someone who was very passive to actually a leader and, big time. Then, you know, your first trip abroad, China is not the kind of standard place to get us your very first trip abroad.

 George Winder  16:42
No, absolutely not. No, quite, yeah, it is quite amazing. So you can see that that journey of growth that they have, and that confidence and yeah.

 Gill Phillips  16:53
So have you had resistance? So this reminds me, George, when I first started, Whose Shoes? and my background was in social care, and it was around, at the time, more personalized care, and a really hot topic: personal budgets. And how much did you actually trust people to spend these budgets on things that would be actually of benefit to them? But then, if it's not medicalized, or it's not a service, or it's not something that we're used to spending public money on so shoes and gloves probably wouldn't be the obvious thing to be buying for somebody. But if that's the thing that actually solves the problem and gets them where they need to be, how's that worked out? Because you must have found some resistance along the way, or, I'm sure you You asked for forgiveness rather than permission, sometimes.

 George Winder  17:39
It's an interesting one. Amongst our group, our committee, are a couple of people within if you felt uncomfortable doing that, because it was for one person, and, do you know what I mean, you can't really share the shoes, as it were. And what I'm fortunate in that is we've got very solvent group because we've done a lot of fundraising. The dream was to have a food market within our very economic, deprived area, people could access more nutritious, healthy food. But we started with a car boot sale. We never got to the market, but car boot sale was a real winner from a financial point of view. So we did well, and we accrued enough money to be able to have some liberty with that money. And I think one of the things that holds back NHS organizations and statutory organizations is all the red tape, and I think, in an environment, and sometimes we want to do something, and there's more outreach work in the community, working outside one of supermarkets. And I know that one of the large NHS organizations tried to do that, and it was costing them 100,000 pounds a year, because of all the red tape, all these other things, and I said to my third sector organization, 'If we gave you some money. Could you do that?' And they were like, 'Absolutely'. I was like, 'perfect, great.'  Because I think, understandably, large statutory organizations are nervous and have lots of governance, understandable governance procedures, I think you need to  know how to navigate that. And as I said, working with a third sector partnership, who can do things in a much more fleet way now, at the levels of bureaucracy, not in an unsafe way at all, but just in a way in which you don't have to go to 10 committees to get a pair of gloves and a set of boots for someone.

 Gill Phillips  19:13
Yeah, just in a responsive way, isn't it? 

 George Winder  19:15
Just in a responsive way, yeah, yeah. So I think there are challenges. There are nervousness. It is absolute that we spend the public purse in the wisest way, but I can tell you that less than 50 quid for the gloves and the boots, but the return on investment of that will be, will be huge. And that's, having that freedom, I think, is really important.

Gill Phillips  19:35
Yeah. So, what do you think has happened about them? And I know I got very excited about social prescribing and the opportunities there, and I did a couple of really great visits to Alvanley family practice with Becky's team, and to Bromley by Bow and places that were doing things differently. But it feels as if sometimes the bureaucracy is bitten back, or it's more about signposting now? What do you think is going on there?

 George Winder  20:03
Yeah, I am a passionate advocate of social prescribing and opportunity that it gives to people to find what they need. And I think when it's done well, it can be hugely transformative. And I was an advocate in Leeds. I also went to Bromley, and came back inspired and wanted to do something in Leeds around that. And I think for a number of years, we continue to make a huge difference to people's lives. About understanding, again, it's taking a strengths-based approach, but understanding what people's needs are and connecting them. I think, as ever, when we try to provide a service offer that is, in the NHS, everybody has equitable access to it, instead of the people who need it the most, it's hard to share that resource, so we get a dilution of what we need. And I worry that as it becomes a more industrialized thing, we lose some of the opportunity around it. So again, if it's done well, it can be transformative, and the return on investment is huge, but when we try and dilute back to a much more light touch, maybe signposting approach, I think we lose huge part of that. And our first social prescriber, at my practice, yeah, she worked with one of the third sector organizations. So she was from within third sector. She worked for us for a couple of days, because that's how much money we had. She came into practice. There was a hand-holding service from us to her, to her to the community in which she worked with. And that was the type of impactful thing. And I think it's been hard, hard to scale that up to, to a city wide approach. It still has huge positives. But I think if we are truly going to invest in the right places, those are the places that I would invest more in, because I see that that type of approach is going to A) make the most difference to people's lives, but B) have the biggest financial benefit to the health and social care sector and the economic sector and jobs and I think sometimes that's lost. If we had more money and more resource, we could do more. 

Gill Phillips  22:26
Yes, clearly. 

Well, that’s what George had to say about not medicalizing poverty. But I loved talking to George And we went on to have a wider conversation about the impact of poverty, risk aversion, reaching out into communities and more. So if you enjoyed listening to this episode, please look out for a future episode where this conversation is continued. 

Well, thank you, George. And it’s another contribution to our series.

George Winder  22:54
All right, thank you so much. Gill. It's been lovely to talk, hopefully we'll continue talking. 

Gill Phillips  22:58
Yeah. We will indeed!

Thank you so much for listening. If you enjoyed this episode, it would be fantastic if you would leave a review and a rating, as well as recommending the Wildcard 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 are 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.