At first, when she walks in to see Dr Dowson, her problem seems quite clear: she has two small boys who are as mad as monkeys. They slide and wrestle around the floor, they yell and scream, they drag anything loose off Dr Dowson’s desk and start a tug-of-war with his stethoscope, while she sits with her shoulders slumped and says that she gets headaches and needs some tablets.
She is a big woman, morose and silent, but Tim Dowson has been doing this long enough to know that he has to dig, so he asks her where she lives – and out comes one long string of problems. She has been through five addresses in the last three months, starting with her own home, from which she was expelled by her husband’s violence, and two flats on the kind of estate where the fire brigade won’t visit without a police guard and where she was hounded out by street gangs. The council then said they couldn’t help her, because it was her own fault she was homeless. So, she and the boys went first to a women’s refuge and then to a single room in a bed-and-breakfast hotel, where they have spent the last ten days with their belongings in bags and all of them on top of each other.
And what about her husband? Out comes another string of problems. He is still in the family home, but he is not the father of the boys. They are two other men, who do nothing to help. And her own family? She has a father, but she doesn’t want to see him, because when she was a child, he forced himself on her. And it’s not just the headaches. She admits she’s been thumping the kids, and she weeps a lot, though she says can’t see why, and the other day she did take a bit of an overdose. All this she confesses through a blizzard of sound from her children.
In theory, Dr Dowson is an “outreach GP”, one of half a dozen in the country whose job is to provide medical help for those who have no fixed address. In effect, he has to offer all kinds of help for those people who would once have been rescued by the welfare state but who have now been shoved through the holes in its neglected safety net – the mentally ill who have been locked out of the hospitals, the young people who have been left out on the street, the homeless who are stranded between the rules. He is the last hope of the hopeless, and one day in his roving surgery is like a slice of the life of all those who have now been rejected by the state.
He works out of all kinds of odd corners. This morning, he is sitting in the middle of the foyer of the Kirklees Housing Department in Huddersfield, with his black bags round his ankles, while council officers wander by and receptionists tell visitors to take a seat. He sits with his patients in a quiet corner and if he needs to examine them, he can take them into the toilets.
Most of them arrive with a single complaint, but invariably he discovers that they are infested with clusters of problems – physical, emotional and material – all feeding off each other, and collectively ruining the lives of their victims. With few exceptions, these are people who were vulnerable because they were poor, who were pushed over the edge by some additional problem, and who then fell with alarming speed, because there was nothing there to stop them.
The first man who ever consulted him here came because he felt depressed. Dowson noticed he was walking rather stiffly, took him to the toilet for an examination, where he discovered a red raw gash around his throat: the man had strung himself up from a tree two days earlier only to have the rope break. It turned out that he had been struggling along in Leeds and started to use a lot of speed. He had fallen out with his girlfriend and then had a bust-up with some dealers, from whom he had fled. He was now completely lost, emotionally and practically, with nowhere else to turn.
With some patients, it is the break-up of a relationship which pitches them downwards. Here is Alan, aged 47, who left his wife seven years ago, lost his home and went to live in a caravan, where he became depressed and eventually subsided into a diet that consisted entirely of beer. By the time he saw Dr Dowson, he had developed problems with his lungs which sounded suspiciously like cancer. But he insists he is “feeling better, just a bit tired, not sleeping too well”.
With others, a fragile life breaks apart in a sudden burst of tension as some underlying problem explodes. One family have been fire-bombed out of their home in north Kirklees, apparently because neighbours did not like the white mother being married to a black man. Another family have fled a rock bottom estate, where their adult son has been systematically attacking them, as well as hospitalising three other people in the street and taking his 13-year-old brother out thieving.
Almost all of them are on the reject list of the new welfare state. There is a steady trickle of homeless teenagers who are not allowed to claim benefit, who come in with chest complaints and ear infections. There is a 22-year-old man, whose step-father has thrown him out of the house. Sleeping rough, he could not get to work on time, and so he lost his job. He tried to sign on but he was told that he was classified “voluntary jobless” and so his benefit was cut to £30 a fortnight – just over £2 a day. With no home, no job and next to no money, he started stealing to survive. He says he feels depressed.
There is a young woman with three children, suffering variously from ear-ache, asthma and hyperactivity, who explains that she is homeless because she defaulted on her mortgage. She had gone to court to try and save the house and agreed to make regular weekly payments but every time she put the money aside, she found she had to borrow from it to pay for nappies and childrens clothes. She was told that the bailiffs were coming, she offered to make smaller weekly payments, but the building society refused, and so she fled. Now she is waiting to hear whether the council will help her or whether they will rule that she is intentionally homeless. Dr Dowson fears she will fail their test.
There is a steady trickle of women with children fleeing violence or destitution, all of them at risk of being told that they can have no help because they have made themselves homeless. One of them has the most vicious asthma and, lugging three children and several bags around with her, it takes her a full ten minutes to gather the breath to talk to the doctor and, when she does, she tells him a story of the most horrible symbolism – how she saw her sister on Sunday and had the most terrible attack because she started to laugh, for the first time in ages, and she didn’t have the breath to do it.
There are some cases where Tim Dowson can see the state’s failure actively adding to the suffering of his patients. One of the women who came to him after fleeing a violent husband, was stranded by the council with her three children in a tiny, temporary flat while they waited to find somewhere more suitable. As the delay stretched on, she agreed to allow her five-year-old daughter to spend a weekend with her father, who then refused to bring her back. The woman went to a solicitor, who arranged an emergency court hearing, at which the judge heard all about the father’s drunken aggression and all about his criminal record and nevertheless decided that since the mother was unable to offer stable and suitable accommodation, the little girl should stay with him.
Sometimes, he can manufacture some kind of assistance. For some of those whose social security has been stopped, he can try to write a sick note, so that they are entitled to sickness benefit. Similarly, for some of those who are deemed “intentionally homeless”, he can try to certify that they are particularly vulnerable on physical or mental grounds and smuggle them back on to the council’s increasingly brief list of responsibilities. He can lever some patients back in to the NHS, as he did with a man in his 30s who had become so depressed about the tattoos on his hands that he had started removing them with sandpaper because he thought they were preventing him finding work. The health service refused him an operation, but Dowson was able to prise him on to a surgeon’s list.
Sometimes, there is nothing he can do. There was a woman of 23 who turned up complaining of inter-menstrual bleeding but who turned out, after gentle questioning, to have heard her mother being murdered in the next room when she was nine, as a result of which she was put into care, from which she emerged at the age of 15 in a state of complete confusion. She moved in with a boyfriend, a decision which alienated her own family. She had two children, but then the boyfriend walked out, so she repeatedly tried to kill herself, as a result of which the boyfriend was given custody of the children. She was now effectively homeless and just before her visit to Dr Dowson, she had swallowed a bottle of paracetamol. He gave her an urgent referral to a psychologist, but she never turned up.
Or there are times when the only cure available is almost intolerable. There was a family who traipsed through his surgery with a familiar cluster of medical problems, whose real difficulty was that the father had gambled away his income, as a result of which they had failed to pay their mortgage and been evicted. The council ruled that they were intentionally homeless and not entitled to housing. The only way in which Dr Dowson and his health visitor could cram them back into the system was for the mother to plead “non acquiesence” in her husband’s actions. That would qualify her and the children for a roof – but not the man. They could have a home, only if the family broke up.
For many, he can offer nothing more than sympathy and tablets. He cannot cure their problems any more than a bucket can mend a leaky roof. Where once these people lived in a society which offered them national assistance and equality of opportunity, they must now rely on temazepam and fluoxetine and amitriptyline. Welfare by Prozac.
