Hundreds of young people to be given potentially life-saving cardiac screenings in Kirkcudbright

Cardiac Risk for the Young will be holding sessions in Kirkcudbright Academy thanks to the David Hill Memorial Fund.
Hundreds of young people will be given potentially life-saving cardiac screenings in Kirkcudbright this weekend.
Cardiac Risk for the Young (CRY) will be holding sessions in Kirkcudbright Academy, with everyone taking part receiving an ECG and a one-to-one consultation with a cardiologist.
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The screenings have been made possible by the David Hill Memorial Fund, which was set up after David died of an undiagnosed heart condition while playing rugby three years ago.
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Since then, the fund has raised more than £80,000, allowing 1,200 free cardiac screenings to be held across Dumfries and Galloway – with 200 taking place in Kirkcudbright across Saturday and Sunday.
David's parents, Rodger Hill and Sharon Duncan, said: 'We hope that by taking this screening to the west of the region, more young people will have the opportunity to have their hearts screened. We want to take this opportunity to thank everyone who has supported us in our fundraising and awareness raising campaigns.
'We, and CRY, believe that every young person from the age of 14 up until the age of 35 should have access to free, expert cardiac screening and that young people and their parents should be given a choice to be screened.
'We will continue our campaign to urge the government to radically re-think its approach to specialist cardiac screening in the UK in order to reduce the incidence of young people dying from the often-preventable conditions that can cause sudden cardiac death in young people.
'Since David's death, just over three years ago, almost 2,000 families have had to experience the pain, anguish and grief that we have had. That is a pain that is preventable with screening.'
Former St Joseph's College pupil David Hill worked for a number of MSPs. On March 19, 2022, he was playing a cross-party rugby match for Holyrood against Dail and Seanad XV in Dublin as part of the Parliamentary Six Nations when he collapsed and died of an undiagnosed heart condition at the age of just 30.
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Every week across the UK, around 12 people aged under 25 die suddenly from a previously diagnosed heart condition – 80 per cent of which happen with no prior symptoms.
This weekend's sessions are follow booked and people are asked not to turn up without an appointment.
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Chief executive of CRY, Dr Steven Cox, said: 'As ever, on behalf of all of us at CRY, I would like to say a huge thank you to David's family and everyone involved with the David Hill Memorial Fund.
'Their ongoing fundraising and awareness efforts are making such an incredible impact to the level of cardiac screening we're delivering for young people in Scotland.
'This year marks 30 years since CRY was launched – with a vision to reduce young sudden cardiac death through screening and research – and it's only due to the support of families, such as David's, that we've been able to grow our nationwide screening programme to the extent that we've now tested more than 315,000 young hearts.
'One in every 300 of those tested by CRY will be found to have a hidden heart condition which, if left untreated or unmonitored, could cause a fatal cardiac arrest. We know that screening saves lives.
'We also know that we desperately need a new, Governmental strategy to prevent young sudden cardiac deaths – and this is an area that David's friends, family and former colleagues have been so proactive in campaigning for, too.
'It's great to see another screening session taking place in June. Thank you – you're all doing amazing work in memory of David.'

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Labour MP backs assisted dying in heartfelt Commons speech

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The Guardian

15-06-2025

• The Guardian

‘I feel like a drug dealer': the parents using black-market melatonin to help their children sleep

The first time I gave him a gummy, I thought, 'Oh my God, have I killed him?' He just passed out in front of the TV. That never happens.' Jen is remembering giving her son, David, six, melatonin to help him sleep. She got them from a friend, a paediatrician who gave them to her own child. 'It was sort of hilarious. She had half a tub of gummies, and her husband met my husband in a car park near a roundabout to hand them over, like some underhand black-market deal.' Her tone is light, but in fact she and her husband were becoming increasingly desperate for sleep. 'They were like gold dust.' By meeting in the car park to exchange the gummies, the husbands weren't breaking the law, exactly, but they were stepping into a legal grey area. Melatonin is a synthetic version of the sleep hormone that occurs naturally in our bodies, rising at night in response to darkness and helping us get to sleep. It isn't strictly illegal in the UK, but it is a prescription-only medication, and it can only be prescribed to children by a paediatrician under a specific set of circumstances, usually for children with a diagnosis of autism or ADHD. The rationale for this pathway is so that the paediatric specialist can rule out any potentially physical causes or underlying disease relating to the sleep disorder. Side-effects can include drowsiness the next day, nausea and feeling dizzy. In other European countries melatonin is far more accessible, often sold in pharmacies, although the guidelines for use in children are the same (both there and in the UK, it is licensed only for children with autism and ADHD). In the US, meanwhile, where it is far less regulated, you can buy it in supermarkets, even from Amazon, and it is often specifically targeted at children. Some gummies come in the shape of teddy bears, or are marketed using cartoon characters. There, it is routinely given to neurotypical children: nearly one in five US children under 14 are now consuming melatonin. In light of more restricted access in the UK, British parents are increasingly looking to the internet to purchase gummies, often with little medical oversight or supervision. David never slept, Jen tells me. Even as a newborn he was unusually alert. Where other babies ate and slept, he ate and was awake, and never settled easily. 'In the early days you're in good company,' she says, of the sleep deprivation. But, as time went on, she began to feel increasingly isolated. 'People kept saying it will improve when he starts nursery, when he starts preschool. It never did. We just never had an evening. We'd be putting him to bed, sometimes, at 11 o'clock or midnight.' David was also having massive meltdowns. Despite trying a calm bedtime routine, nothing seemed to be working, and it was taking a toll on the entire family. Jen was so exhausted she was forced to stop working completely. As David grew, his parents started to suspect neurodivergence. He could count to 20 at 18 months, and was doing 30-piece jigsaw puzzles. An educational psychologist has recently confirmed that he is gifted to the extent that it will affect his life significantly, and he has been on the waiting list for an autism assessment for two years. When he was five, he was taken to see a paediatric consultant in the European country they were living in at the time. 'I think my pineal gland's broken,' David told the doctor, much to everyone's astonishment. He was prescribed melatonin, and their lives changed for the better overnight. Had they been living in the UK at the time, they would almost certainly still be waiting. 'Although people think of melatonin as a vitamin nowadays, it's not. It's actually a hormone that's released by the pineal gland in the brain, and it does lots,' says Prof Paul Gringras, a sleep and neurodisability consultant at Evelina London children's hospital, and president of the International Paediatric Sleep Association. 'The pineal gland connects with all different parts of the body and helps synchronise all the cells in the body to keep our body clock going. Although every cell in the body has its own little clock, they're not synchronised and they need to be held together. Melatonin is one of the main messengers.' David's description of his pineal gland as 'broken' was rather astute, then. Certain populations of children, such as those with autism and ADHD, simply sleep far worse than typically developing children – Gringras tells me the rates are 70-80% of children with those diagnoses. My brother, who is autistic, mostly non‑verbal with very high support needs, was one such child. 'It was soul-destroying,' my mum, Anna, remembers. 'Just mind-bendingly exhausting.' Thanks to melatonin, prescribed by the paediatrician, she could get four hours of sleep a night. 'He didn't sleep for more than two or three hours at a time. What the melatonin did was keep him asleep for at least four hours and I could cope, just about, if I got four and a half hours.' I have seen first-hand the impact that sleeplessness can have on a family, and how neurodivergence and sleep issues are often intertwined. 'Some children with autism lack a gene that helps convert a chemical in the body called tryptophan into melatonin. So if you measure melatonin levels in the urine, they're actually producing less melatonin,' says Gringras. As for ADHD, those children do produce some melatonin, 'but instead of it being the hormone of darkness, produced in the early evenings, they're not producing it till way later, until two in the morning'. These families need help. If their child's sleep is being managed by professionals, their parents are less likely to get divorced, lose their jobs, crash the car or have an accident. That's not to say, however, that all these children must be medicated. Gringras is keen to emphasise that behavioural sleep programmes can be transformative, even in the most severe cases. In one sleep trial he ran, 50% of the severely autistic children who were signed up didn't need to take part in the medicated bit, because the behavioural strategies had been so successful. When he does prescribe melatonin, parents still need to keep the behavioural approach going so that they have learned new habits for when the melatonin stops working. 'Even on the labelling of these medicines, it says: for children who have failed an appropriate behavioural intervention,' he points out. What concerns him, and other professionals I speak to, is the idea of melatonin as a sticking plaster. 'Many of the [paediatric] community are on their knees. 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I'm speaking to Charlotte, who, like Jen, has spent much of her child's life enduring 'endless evenings', which she describes as 'unbearable'. Her daughter, Edie, now 10, couldn't settle. 'She'd lie in bed moving around a lot, jerking her body. She just couldn't sleep.' As a family, they tried everything. 'We'd do bath time and lavender oil and reading a story and talking, and then we'd try leaving her on her own. Nothing worked. We'd just have to lie with her for hours.' They wondered quite early on if Edie had ADHD, but didn't pursue diagnosis. 'She's really brilliant and wonderful, but she was quite volatile, and really quite hyperactive.' They first started giving her melatonin when she was eight, when Charlotte's sister-in-law, a doctor whose disabled daughter takes melatonin, gave her some to try. Charlotte was astonished – not only did Edie go to sleep at 8pm, but the effect on her behaviour and mood was transformative. She started buying it online. Charlotte thinks that Edie's volatility is directly linked to her sleep. A model student at school who struggled with peer relationships, she would mask, or hold it together, until she got home where she could become aggressive towards her parents and siblings. At times her mental health difficulties have been extreme. 'She was getting more and more anxious and having very, very dark dreams and getting very upset,' says Charlotte. 'She started banging her head against the wall till it bled. And then she started banging her sister's head against the wall till it bled.' Things escalated. On one occasion Edie got on the roof and threatened to jump, saying she wanted to die. 'The fact that she couldn't sleep was a massive contributor to her feeling super stressed and highly sensitive,' says Charlotte. 'When we started giving her melatonin it got a lot better. Then last year I ran out of melatonin. I couldn't buy it.' It was like a switch flicked inside Edie's brain. 'She tried to run in front of a speeding lorry because she said everyone hated her. And then she started holding knives to her neck. She didn't want to go to school. And I didn't know what to do.' Charlotte ran to the doctor's surgery with her child in her arms. 'We went to see a counsellor, and we borrowed some money to get her assessed. And it came back as not ADHD, but autism,' she says. She also had an emergency mental health appointment, but all they could offer a suicidal autistic child who struggles with groups was, astonishingly, group therapy nine months later. 'Then they said, 'How is her sleep?' And I said, 'Well …', and the woman said to me, 'If you are about to tell me that you give your child unprescribed melatonin, I will have to report you to social services and they will take action.' And I was like, fuck. And it was really stressful.' Gringras is shocked when I tell him about the safeguarding threat made to Edie's mum. It is true that safeguarding is very important, and buying medication on the internet comes with risks. In the US, there has been a spike in child hospitalisations – poison control centres there saw a 530% spike in reports of melatonin ingestion in children between 2012 and 2021 – and seven reported deaths since 2015, including a child as young as two months. Gringras points out that the lack of US regulation means there often isn't dosage consistency across even a single jar of gummies. A study last year found that some contained an alarming 50mg of melatonin – 0.5-1mg is the recommended starting paediatric dose. Linking these deaths directly to melatonin is a challenge because you can't exclude underlying health conditions or whether other medications played a part. Nevertheless, it is concerning. 'I don't think it's fair to come down hard on a parent if they're not getting the support they need, and they're just doing something out of desperation. I think the real question is: why haven't we been able to support the parent with behavioural advice? Why haven't we been able to see the child and reassure them, maybe, hopefully, they don't have something physically wrong? And why are we going to make them wait three years for a diagnosis?' All the parents I spoke to expressed unease, guilt and even fear at their decision to give their children melatonin bought online or abroad. Jen told me she was worried about being arrested, and, though the school Senco is aware the family uses it, she would hesitate to mention it to a GP. Even parents who were giving melatonin under some degree of medical supervision, usually from a family member who works as a doctor, felt anxious. I spoke to doctors who give their own children melatonin bought online but wouldn't go on the record for fear of professional consequences. Although Edie now has an autism diagnosis, and Charlotte is finding it increasingly hard to get melatonin on the internet, the threat of a social services referral means she is now frightened to talk to a paediatrician about getting it prescribed officially. 'The other day we had a hospital appointment. We were asked, does she take any medication? And I said no. And Edie looked at me and I just shook my head.' But it's not only parents of neurodivergent children who are turning to melatonin. I spoke to a number of mothers who have given it to their neurotypical children. One, Isobel, says she has only used it a couple of times when taking an overnight flight, having obtained it from an American relative. 'The first time, my daughter was four, and my youngest was nearly two. As they were one-offs, and as it's sold for use by kids in the US, I wasn't worried about the side‑effects and felt it was safe in that quantity.' Emily has been giving melatonin to her children – eight and four – for longer. She gave it to her eldest when she started year 1 and began struggling to get to sleep – sometimes she was awake until 11pm, and teachers had started raising concerns about how tired she was. 'We'd have to drag her out of bed and she'd be exhausted. It was really distressing,' Emily said. At her wits' end, and worried that her daughter was falling behind at school, she ordered some melatonin online. She did a lot of research, choosing a brand used by a paediatrician quoted in an article in the New York Times, and says she kept an eye out for side-effects such as sleepwalking or drowsiness the next day. The effect, Emily says, was 'life-changing'. 'It freaked me out a little bit. I was like, oh my God, what have I done? What have I given to her? Why has this happened? But she fell asleep after 20 minutes and it felt very natural. She had a few stories. She just got naturally drowsy. She fell asleep. Then the next morning, she woke at a normal time, bright and ready for school.' After that, Emily gave her a gummy every night for eight or nine months, but says she no longer needs it. 'I was really worried they'd get addicted to it, but it's almost like the melatonin helped them form a new habit [of going to sleep at a decent time].' She now gives it to her youngest child, who at four-and-a-half developed similar issues, and it has had the same effect on bedtime. She has recommended it to a few parents she knows from school and some are also giving it to their children. 'One friend, her partner died when her kid was very little, in a really awful, traumatic way. I think that kid was basically suffering from PTSD, would get really emotional at night and wouldn't go to sleep. She came to me going, 'Oh my God, I'm just having the worst time and I'm not getting any sleep and she's not getting sleep …' I was like, 'Hey, it's up to you whether or not you take this advice, but I would recommend this.'' Whether a child is neurodivergent or not, with the right insight and support, behavioural changes can be transformative for families, Kerry Davies, a sleep practitioner and founder of private sleep support service the Sleep Fixer, tells me. She has many years of experience, including working for the charity Scope as part of a joint NHS and local authority funding initiative within children's services, with the goal of reducing melatonin prescription costs by supporting children to sleep without it. 'I look at the whole picture: where the child's at, where the parents are at. I do a phased, step-by-step guide based on what that family need,' she says. 'How consistent is their morning wake-up time? Because this can often be a difficulty with children who perhaps sleep in late during the weekends but are woken up early during the week, which can confuse the body clock. I'll ask what time are they actually falling asleep, and manage parental expectations around what might be appropriate.' She mentions some parents putting their children to bed far too early as an example. 'Then we look at how much physical activity they're getting during the day. Physical activity really helps to be able to fall asleep and maintain sleep. What's their bedroom environment like? Is it consistent through the night? Do they struggle with noise? Do they struggle with silence?' Having such tailored support from a sleep practitioner can radically improve a family's mental and physical health, but accessing it remains a problem. 'It is a postcode lottery as to whether there's a service or a sleep practitioner that you're able to access,' Davies says. 'The parents of neurodivergent children may have been failed a lot in their journey.' Davies says there should be behavioural support services in every country, regardless of where a child lives, and that with that in place she would feel comfortable if GPs were able to prescribe melatonin. She says: 'If I could wave a magic wand, there would be behavioural support that coincides with melatonin, attempting to taper off while continuing that behaviour support so you have those long-term solutions.' Ultimately, this is about crumbling services, and desperate parents and children being left chronically sleep deprived without any support. Can they be blamed, then, for being at crisis point and trying to find a solution? Were they to be given the help they need, they might not need the melatonin at all. And, by giving it without official medical oversight, how can the children be supported to taper off? Gringras – who as part of a melatonin taskforce has contributed to a guide for caregivers – says we know 'hardly anything' about the long-term effects of melatonin use. 'For children with autism, the best we've got is two years follow-up data, really. So we know over a two-year period it's safe, but if you said to me, well, do we know it's safe over a five-year period? The answer is no, we don't. We hope it is. And whenever we prescribe a medicine, we're never naive. It's always a balance of benefits against harm. But if it's a child who's got significant learning problems, who's tearing the house up and whose parents can't cope, then that tips your balance.' Gringras agrees with the rationale that melatonin should only be prescribed by a specialist. It's the wait for a diagnosis that is creating the biggest barrier. 'I think we've made the diagnosis slightly too involved and time-consuming,' he says. 'We spend less time managing it and too much time diagnosing it. I'll be so unpopular with that [viewpoint].' He says sleep problems in early childhood should be a warning sign for developmental paediatricians who are assessing children with possible neurodivergence. Where he is convinced a child is autistic or has ADHD, due to it being very apparent, or there being a strong family history, he will sometimes prescribe the medicine off-label (legally prescribing a medicine for a different use from the one it is licensed for). It was concerns over the long-term effects – including claims that melatonin can interfere with or even delay puberty (something a 2020 study found no evidence of) – that stopped one mother I speak to from continuing to administer it to her daughter. Like every parent I spoke to, Helen was spending hours each night trying to help her daughter calm down enough to sleep. It was affecting her mental health, and, one evening, out of sheer desperation, she gave her some melatonin in her drink. It worked instantly, and Helen carried on using it for a while, but, she says: 'It didn't sit comfortably with me. I didn't want to be in a situation where I had to use melatonin to get her to sleep, and I didn't feel comfortable using it long-term. I don't really want to give my child something I don't know is completely safe to take.' Charlotte understands this viewpoint, and shares much of the same feelings. Things had reached a point with Edie, however, where she could simply see no alternative. 'I think it saved her life, ultimately, and saved our marriage and saved our family.' Some names have been changed. The Republic of Parenthood by Rhiannon Lucy Cosslett is published by September on 7 August (£18.99). To support the Guardian, order your copy at Delivery charges may apply.

Telegraph

12-06-2025

• Telegraph

‘Nearly everyone I know has one': The borough where one in three people has a sick note

When David was 49, he spent six weeks off work recovering from what he calls a health 'nightmare'. Complications following surgery for diverticulitis, a bowel complaint, kept him away from his role as a healthcare assistant in a local hospital. On his return, his employer minimised his duties. Now in his 60s and retired, David (who doesn't want to give his full name) is making his way across a rainy, low-rise shopping precinct in Knowsley on his mobility scooter. He is one of a disproportionately large number of residents in the Merseyside borough who has taken an extended period of time off work for sickness at some point. Despite, or perhaps because of his own health struggles, he takes a dim view of some of those in the area who obtain sick notes (known as 'fit notes') for physical or mental illness. 'I know of people who have them,' he says. 'Some find it no problem [to get one]. I've heard them say [it was easy].' Research carried out by The Telegraph has found that Knowsley has the highest proportion of working age people receiving statements of fitness for work – documents providing advice to the claimant and their employer about the impact of a health condition on their ability to do a job. It is used as evidence that someone can't work, can't carry out certain tasks at work, or requires certain adaptations to remain in work. In Knowsley, an area to the east of Liverpool that covers several towns, 3.1 sick notes were issued last year for every 10 registered NHS patients, according to the most recent data (which goes up to December 2024), making it the 'sick note capital' of England. Almost a fifth of the sick notes issued were for mental health complaints, making mental ill health the most common stated reason for obtaining one. Fifty-six per cent are listed as unknown reasons, or 'reasons not provided' – a gap in the data that is replicated across the country. David, from Kirkby in the north of the borough, is not the only one to suspect some may be getting themselves signed off work for questionable reasons. 'A lot of them do it because their mothers do it and their fathers do it and so they do it,' says Lele, 48, a nurse in Huyton, a town to the south, where Liverpool F.C. and Everton merchandise hangs side by side in a market stall in the main pedestrianised zone. 'They fall into the pattern. Nearly everyone I know [has a sick note].' When it comes to understanding the story behind the figures, intergenerational worklessness is part of the picture in certain areas that long ago lost their industry and with it, often, their sense of purpose and identity. ' People talk about 'sick note Britain', but there are definitely post-industrial areas like [Knowsley] where you have long-term entrenched worklessness,' says Ed Davies, director of research at the Centre for Social Justice (CSJ). 'You've got Knowsley on one side of the Mersey and Birkenhead on the other, and Birkenhead also has some of the highest levels of incapacity benefit, but what these places have in common is the loss of the shipping industry and they've never quite recovered.' For young people who are fourth or fifth generation unemployed, 'it's not so much that they're shirking, it's that they haven't got a framework, they've literally never seen what it looks like to set an alarm clock and get a job,' says Davies. Life expectancy is lower in poorer areas This doesn't mean that all of the sickness is not genuine. Knowsley is ranked as having the second-highest levels of deprivation nationally, and the link between poverty and ill health is well established, if complex. Life expectancy is generally lower in poorer areas, and residents in deprived communities live a higher proportion of their lives with health problems, a report by The King's Fund noted last year. Reasons for this range from the difficulty of accessing NHS services and a healthy diet, to poor housing and stress caused by financial struggles. 'What I see [locally] is very high levels of ill health because of all those [social determinants],' says Dr Sarah McNulty, director of public health for Knowsley Council. 'The environment, their jobs… the housing they're in, life stresses, financial stresses.' Standing by the cab rank in Kirkby, taxi driver James Catterall, 71, points towards some high-rise apartments in the distance. 'See that block of flats?' he says. '[The residents] have got three weeks to move out.' He's talking about Beech Rise and Willow Rise, which the fire service recently condemned due to problems including broken lifts, badly fitted doors and malfunctioning fire alarms. Many people in those blocks work, say the local cabbies, but they're now on the verge of losing their homes. The knock-on effects of this may well be seen down the line in health outcomes. Residents mention other local issues too, including concerns about the health risks of certain industrial sites. Kirkby developed as an urban centre in the mid-20th century, providing more housing for the overspill of people from Liverpool. Tony Carr, another local cabbie and former local councillor, talks of its decline in the 1980s and 1990s and its recent, tentative steps towards improvement. On the edge of its tired town centre, it now has a retail park with a Taco Bell and a Morrisons. An Amazon warehouse provides employment nearby. But Carr is conscious that such things don't turn around an area overnight. 'It's the generational deprivation in the area,' he says. 'The hopelessness.' The locals, he says, are 'real salt of the earth people [who] look after their own', but many suffer from the mental impact of the stresses and strains they have absorbed over the years. 'They've been through Covid, some have lost their jobs, they're trying to keep their homes and the prospects are not fantastic in this area. The type of jobs people are taking are as minimum wage care workers.' It is against this backdrop that an estimated three in 10 are obtaining sick notes, although the true figure may be slightly lower as one person can receive more than one sick note. Unlike elsewhere, less than three-quarters of these documents are given out by doctors in Knowsley. Some 23.4 per cent are administered by nurses, and another 3.7 per cent by pharmacists. While this is in keeping with government guidelines about which professionals can issue sick notes, it differs from the national picture, in which 90 per cent of all sick notes are provided by doctors. While fit notes don't automatically entitle the recipient to benefits, they can be used to support a claim to receive welfare support. In Knowsley, unemployment rose to 4.3 per cent between 2022 and 2023, compared to 3.7 per cent across Britain in the same period, according to Office for National Statistics (ONS) data. Economic inactivity – people who are neither employed nor seeking work – rose to more than a quarter (26.1 per cent), compared with just over a fifth nationally. However, Knowsley is not an outlier. Fit notes, introduced in 2010, have been following an upward trajectory during the past decade. In 2015, there were 5.2 million issued in England. By last year, that number had shot up to 10.9 million. In 2023, for those economically inactive because of long-term sickness, nearly 40 per cent reported having five or more health conditions, ONS figures show. 'A GP will have seven minutes to assess fitness for work' Politicians have been alive to the problem for a while. In the dying days of the Conservative government, then prime minister Rishi Sunak announced plans to tackle the UK's so-called 'sick note culture', claiming that benefits had become a 'lifestyle choice' for some. He suggested stripping GPs of their ability to sign people off work, handing the responsibility to 'work and health professionals' instead. In April Liz Kendall, Labour's Work and Pensions Secretary, said the sick note system was being re-examined as part of planned reforms to stop people dropping out of work due to ill health. One of the problems with the current system, says Davies, is that doctors have so little time to reach a conclusion about a patient's fitness for work. 'A GP will have seven minutes to assess what's going on in someone's life,' he says. 'Potentially a welder comes in and says 'I have a bad back and can't do my job', and the GP knows nothing about welding. The complexity [they have to deal with] in those seven minutes is huge. Often GPs will follow the path of least resistance.' In places like Knowsley, there is high demand for primary care services. 'And,' says McNulty, 'there will be patients presenting with multiple problems, not only physical but mental health [-related].' GPs, then, have a lot to get to grips with during an appointment. Mental health and behavioural disorders were the most common reasons given nationally for the issuing of sick notes in the past year, according to the data. Again, these tend not to be problems that GPs can get to the bottom of in the course of one brief consultation. The result is cases where patients are parked on medication or signed off work when these aren't necessarily the best solutions for them, evidence suggests. Recent polling by the CSJ found 83 per cent of GPs were concerned that antidepressants were prescribed when non-pharmaceutical interventions would be more suitable. Some 84 per cent of GPs agreed that society's approach to mental health had led to the normal ups and downs of life being seen as medical problems. What's clear is that the numbers seeking support for mental ill health have spiralled dramatically. England has seen a 70 per cent rise in the number of those in contact with mental health services over the last eight years, according to a CSJ report published in January. One reason it suggested for the soaring numbers was the 'over-medicalisation' of mental health. Some of the surge in mental health conditions, however, was 'undoubtedly a rise in prevalence and caused by the gradual erosion of the protective factors that enable good mental health. We have seen a hollowing out of strong families, cohesive communities, economic opportunity and good work'. Jobs might be available in places like Knowsley, but the type of work matters. 'Its not just about work, it's about good work,' says McNulty. In 2024, almost 12 per cent of those in work locally were in roles classed as 'elementary occupations', mainly consisting of simple and routine tasks. This compared to almost nine per cent across Britain. In other words, a greater proportion of workers in Knowsley are employed as, say, cleaners, waste collectors, street vendors or telephone salespeople than elsewhere. David talks of how his first role in a hospital was as a cleaner, but 'you get yourself in the door and work yourself up'. The reality today is different. Cleaners are likely to be working for a cleaning company to which the organisation has subcontracted the work, Davies points out. Opportunities for meaningful progress are far more limited. 'That purpose and identity is often not there any more,' says Davies. Others suggest there has been a cultural shift in our attitudes towards work – perhaps not unrelated to the quality of jobs available, and the accompanying fraying of the social fabric in post-industrial Britain. 'If Rachel Reeves wants to unlock growth we have to look at our culture around work, and why Asian and North American countries that incentivise hard work are growing so much faster,' says former Conservative health secretary Jeremy Hunt. Economic impact of long-term sickness crisis What can be done about all of this? Overhauling the structure of the modern labour landscape is beyond the ability of any one government. But certain reforms could help, says Davies. Relieving GPs of the burden of assessing people's fitness to work would be widely welcomed, including by GPs themselves, he suggests. Other solutions could include easing people into work via 'microjobs', in which those who lack experience of employment do just a few hours a week at first to get them accustomed to it. Taking the time to find out what's really wrong with someone and how they can be supported to work will also be essential. 'Social prescribing', which involves connecting patients to local groups, activities and services rather than just handing them a script for, say, antidepressants, is another potentially fruitful avenue being explored. The economy, as well as people's ability to lead purposeful, fulfilling lives, depends on getting it right. Britain's long-term sickness crisis means the country's economy is 10 per cent smaller than it otherwise would be, according to a report produced for the NHS this week by Frontier Economics. Back in Kirkby, Mollie, who owns a town centre cafe called Mollies Munch, says the main shopping street was once busy and thriving. Now, there are pawnbrokers, bookmakers and cheap clothing stores. A subdued atmosphere hangs over the concrete plaza. 'Nothing much to bring people in,' says Mollie's colleague Rosie. 'No wonder people are depressed,' adds Mollie. There's less talk now of levelling up towns like this than there was a few years back. But the need very much remains. Improving the economy, and people's lives, will depend in part on doing so. It will also require a better understanding of why so many aren't working.