The research was done by independent consultants and not by the core NHS project team to
ensure a measure of objectivity. This work highlighted not only the core problem of
particular needs for access to the health and social welfare system but also a strong sense of
disempowerment and a lack of trust in the NHS amongst members of this user community.
Dealing with this became a key challenge – lack of trust in the formal health system
engendered an attitude of non-involvement until emergencies developed, at which point the
health care system would be required to deal in crisis mode. As one interviewee put it, the
prevailing view is ‘only go when it’s bad’. So large numbers of people are disengaged from
primary care and turn up at A&E in distress. They expect nothing or they expect everything
right now’.