Who monitors the monitor?

who monitors the monitor?

(This post is by Kim Moore : BCU Mental Health Nurse Lecturer)

Current debates on health services are never far from headline news these days. In the wake of the Stafford Hospitals inquiry and the emerging issues of Morecambe Bay Hospital the role of the Care Quality Commission in monitoring and applying quality assurance standards to others seems somewhat hypocritical.

Public confidence in the work of the CQC has been seriously undermined by its own management team and the ability as an organisation to meet its own stated objectives (parliamentary business post can be found here).
What of CQC’s new role in policing “openness and transparency” in the NHS?  Recommendation 16 in the Francis enquiry (Vol 1, pp 415) clearly called for an independent examination of the commissioning, supervisory and monitoring bodies on learning to identify “failing hospitals” with a “level playing field for accountability” (Recommendation 82) with the clearly identified the consequences of “hiding information about poor care to become a criminal offence” (PM statement Feb 2013 ).

The breaking news of Morecambe Bay Hospital highlights the problems of who monitors the monitor, and to whom they are accountable for poor or misleading practice. The finding from the Parliamentary committee was to severely criticise the function and performance of the CQC, despite the criticism what remains unclear to me are those consequences that Francis outlined when such a clear management failure has been found.

Troubled to trouble maker? Misrepresenting the ‘120,000 troubled families’ in England

(This post is by Will Murcott Lecturer at BCU) With great interest I again see statistics being used to marginalise and foster unhelpful beliefs about the most vulnerable in society.

I welcome the injection of thought and funds into helping those in need, but as shown in a report by Ruth Levitas of the University of Bristol (full report is here http://www.poverty.ac.uk/sites/default/files/trouble_ahead.pdf), the figures being touted appear to be used in a misleading and misrepresentative fashion.

Thankfully, as a non-statistician, the More or Less programme on Radio 4 explains the case of the 120,000 very nicely (http://www.bbc.co.uk/programmes/b01hl4h2#synopsis).

Ruth Levitas found that the figure of 120,000 problem families originated from research in 2004 http://webarchive.nationalarchives.gov.uk/20100416132449/http:/www.cabinetoffice.gov.uk/media/cabinetoffice/social_exclusion_task_force/assets/families_at%20_risk/risk_data.pdf) which surveyed disadvantaged families, not disruptive or criminal. This found 2% of the studied population had 5 or more out of 7 characteristics. These were:


  1. No parent in the family is in work
  2. Family lives in overcrowded housing
  3. Mother has mental health problems
  4. At least one parent has a long-standing limiting illness, disability or infirmity
  5. Family has low income
  6. Family cannot afford a number of food and clothing items
  7. No parent has any qualifications


The overall figure was adjusted (i.e. reduced) and made relevant for just England. Ruth Levitas argues that this could in fact be a vast underestimation of the actual number, as most families with these problems drop out of such lengthy studies. The ’120,000’ figure also stands alone quoted without it’s sample error. Which in this instance is +/- 3%. Meaning a figure ranging from minus families to 300,000!

Now, where things get a bit cloudy is in the shifting of focus from ‘troubles’ to ‘trouble maker’. A second government report (found here http://www.dwp.gov.uk/docs/social-justice-transforming-lives.pdf) was then brought into the mix. Part of the definition for troubled families included families that are involved in crime and antisocial behaviour. The immediate effect of this was to then associate a family which has significant problems to one which is criminal, as David Cameron demonstrates in a 2011 speech:

That’s why today, I want to talk about troubled families. Let me be clear what I mean by this phrase. Officialdom might call them ‘families with multiple disadvantages’. Some in the press might call them ‘neighbours from hell’. Whatever you call them, we’ve known for years that a relatively small number of families are the source of a large proportion of the problems in society. Drug addiction. Alcohol abuse. Crime. A culture of disruption and irresponsibility that cascades through generations.

Recently the ‘troubled-families tsar’ Louise Casey interviewed ‘over a dozen’ of these families and found:

The prevalence of child sexual and physical abuse and sometimes child rape was striking and shocking. Some discussed it as if as it was almost expected and just a part of what they had experienced in life. Children often had not been protected by their parents. In many of the families the sexual abuse repeated itself in the next generation … There were also incidents where families talked about incest. http://www.guardian.co.uk/society/2012/jul/18/report-englands-most-troubled-families

I welcome the raising of interfamilial abuse into the mainstream agenda and the potential cycle this has and its devastating impact on people’s lives. However, I fear that these associations will distort the necessary understanding of families in need of significant support from children’s mental health services, adult mental health services and social services. The associations made by linking poverty, crime and abuse and ‘identifying’ these families in way that gives the impression that there is a department somewhere with a list of families misrepresents this and those that we aim to work with.

We do need to be able focus and respond to families that are the most vulnerable, especially when it comes to early intervention of mental health services. But to do so under misleading evidence of whom and where these are will not help them or the understanding that the public has of these issues.

Courageous MPs speak of personal experience of mental illness in Parliamentary session

Houses of Parliament

(This post is by Will Murcott Lecturer at BCU) I was very pleased to see the issue of mental health and discrimination being raised in parliament the other week, and at the bravery of four ministers who stood up and spoke openly about their experiences of obsessive compulsive disorder, depression and postnatal depression. It’s not often I’m made to sit up and take notice when listening to recaps of parliamentary sessions, but this was something unique and special.

For those members of parliament to speak about their illnesses when their positions ultimately depend on the votes they receive from the general public was exceptionally brave.

The excellent article by Clare Allen http://www.guardian.co.uk/society/2012/jul/03/mental-health-stigma-mps-courage?INTCMP=SRCH outlines some of the discrimination from current legislation faced by members of the public, and also for MPs, an area I was not familiar with. In particular the rule where an MP automatically loses their seat if they are detained for more than 6 months under the Mental Health Act 1983.

http://www.bbc.co.uk/news/uk-politics-18444516 has a video extract of Kevin Jones MP, Charles Walker MP and Sarah Wollaston MP speaking in Parliament. Charles Walker’s very personal, eloquent and funny speech is here in full http://www.charleswalker.org/14062012_mental_health .

A private members bill introduced by Gavin Barwell MP proposes to change existing legislation which discriminates against those with mental health difficulties. This will hopefully continue to place much needed pressure for the continual revision and open debate of legislation in this sensitive area.

Time to talk?

This month the mental health team is giving its support to the new campaign hoping to end discrimination against mental health.

It’s time to talk, it’s time to change.

The statistics show that 1 in 4 of us will need help from Mental Health services during our adult lives. However, we also notice that if we break a leg we celebrate it with our friends, signing the cast and showing us care, but if we have a mental health problem we keep it to ourselves and our friends may even avoid us. This campaign wishes us all to address this imbalance.

As someone who has suffered depression I welcome this initiative. I have always believed that I have the right to talk about my experience and be accepted for who I am. The response I get when telling people about my mental health issues is varied. I have met incredulity, one student’s reply on hearing I was a service user was “no you’re not”.

I was not believed because I did not fit their idea of how the mentally ill present. I have also met with a lot of kindness and a wish to know more. Talking about mental health also empowers those students who have issues themselves. I have found that those who have felt alone with their problems, and there are more than you think, welcome this approach

So now it’s up to you. Get involved in this campaign, end the silence and misconceptions about mental health issues and be a friend. Hopefully a little bit of kindness and care will help someone return to a healthy happy life.

The following addresses will take you to the websites where there is a lot of information for you to read

Time to change campaign website Facebook page & Twitter

Shrek theatre asks autistic boy to leave – what do you think?


The mother of an autistic boy said she was “ashamed of society” after her eight-year-old son was asked to leave a performance of Shrek the Musical.

James Geater, from Worthing, West Sussex, was taken to the Theatre Royal Drury Lane in London with another autistic boy by four carers.

They were asked to leave the auditorium because they were too noisy. James’s mother Karen said it was unacceptable.

The theatre said the party was asked to sit outside until James calmed down.

©BBC News 31st August 2011 (Link to full article here)

James’s mother is ashamed of society, but I would like to pose the question “Should poor behaviours be acceptable if they are the result of an illness”. In a recent blog Tony mentioned road rage. Is it the fault of this condition that people assault one another or do they still have choices? For many years I have told young men who have schizophrenia that assaults on others are not acceptable. Is it really unreasonable to ask that having paid to see a show I should be allowed to do so without distraction?

I remember travelling from New York to Baltimore on a bus with a very noisy child, who threw high pitched tantrums at any opportunity. His mother was asked to either control the child or leave the bus. What sort of society would strand a mother and small child because of its behaviour?

The phrase “For the greater good” has been used to allow some terrible acts in mankind’s history and maybe James should never be allowed to go to the theatre again so the rest of us can watch in peace or maybe the theatre should put on special shows for people with problems?

Photo of Shrek on Wikimedia Commons click here for information re author

Learning Disability nurse vacancies?


Image: FreeDigitalPhotos.net

This post is by Fiona Rich, senior Lecturer in Learning Disability Nursing at Birmingham City University.

I am disappointed to learn that our first year student nurses are yet again being told that there are no jobs available for learning disability nurses, because in fact there are many vacancies for learning disability nurses – just Google ‘Learning Disability Nursing Vacancies’ and see for yourself.

The NMC have recently re-written competencies for entry into Learning Disability Nursing… they would not have done so if the role was going to be obsolete.  In addition, this university alone was commissioned for 35 Learning Disability Degree students by the Strategic Health Authority for our next intake… again, they would not spend money training student nurses if they intended to make the role obsolete.  The Strategic Health Authority only commission student places for the jobs available within the NHS, but only 45% of learning disability nurses work in the NHS – the other 55% work in the private, voluntary and independent sector.  This means that there is actually a shortfall of 55% of learning disability nurses to meet the demands throughout the UK.

All of our students get jobs when they qualify – whether it is in the NHS or other sectors is irrelevant as they still provide the skills needed to support this vulnerable group of people which is growing in demand not decreasing.  Many people with learning disabilities are living to an older age and therefore have very specific needs.  In addition, people with LD tend to acquire the problems associated with older adults (eg Alzheimer’s, Dementia, physical disorders and diseases such as sensory defects, cancer, diabetes, respiratory and cardiovascular illnesses) at a much earlier age than the general population so there is a growing need for very specialist learning disability nurses.

Sadly, I have been hearing this misinformed argument about the future of learning disability nursing for decades but there is still a demand for such a role and it grieves me to see genuinely dedicated learning disability nurses dissuaded from qualifying in this branch.  I would urge all first year learning disability nursing students to think carefully about who will support this vulnerable group of people if there were no learning disability nurses in the future because the very specific needs of individuals with learning disabilities are not going away.

A Tough Question

Gautier - Salpetriere

“So, what is madness?”

This was the question posed to me by a friend. Obvious and easy answer I thought, seeing as this is part of the job I do day in and day out.

“Well, its…” and then I stopped. I couldn’t answer it. Not if I wanted to produce an accurate and true answer. What is madness? Is it simply when people are not acting in their normal fashion? If that is the case, then we are all mad as when we are angry or upset then we do not act in our normal manner. ‘Road rage’ means many people are mad if the ‘normal’ fashion definition is accepted as well as love.

Is madness not conforming to the norms of society? Well, many people I know have speeding tickets so either they are mad because they have broken the law of the society or they are the sane ones because speeding tickets appear to be the norm! And what exactly are the norms of society anyhow?

So, is madness an illness? If it is then rates of this illness would be fairly consistent across the globe but we know that depending on where you live defines your illness. For example – schizophrenia. If schizophrenia is an illness then why are there different diagnostic criteria in countries around the world? Why do immigrants show higher levels of this illness but not in their own countries?

Do medics define madness? Insight appears to be on the diagnostic criteria for most illnesses (or the lack of it to be precise). I once read (Ron Coleman) that a patients level of insight simply depends on the extent to which a person agrees with their doctor – disagree with your doctor and you are obviously lacking in insight and are therefore mentally ill. Or agree with the doctor that you are ill and you are again obviously ill. So madness cannot be defined by doctors (as any reader of Thomas Szasz will understand).

Perhaps madness is the system we live in, where budget cuts mean people are unable to access basic and fundamental needs/services yet some people are paid millions to kick a ball around a pitch.

Perhaps madness is trying to define madness.

I still cannot answer this question satisfactorily.

Do you have an answer?

(NB we have a temporary fault blocking comments – hopefully this will be resolved soon)

Image above from Wikimedia commons:

“English: 1857 lithograph by Armand Gautier, showing personifications of dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotic mania and paralysis in the gardens of the Hospice de la Salpêtrière. Reprinted in Madness: A Brief History (ISBN 978-0192802668), from which this version is taken.”

Child and Adolescent Mental Health – Every child matters!

Copy of Copy of park apr 07 006

The recent dept of Health document “No health without mental health” emphasises the need to prioritise preventative and early intervention services when responding to the mental health needs of young people.

Yet, I believe that people are unaware of the numbers of young people suffering with serious mental health problems.  Mental health promotion for young people is vital, in my opinion; failure to intervene early enough contributes to a life of distress, barriers, and problems for too many young people.  I am aware of many children struggling with the challenges of education, learning and growing up whilst also experiencing low mood, depression, self harm and suicidal thoughts.

More young people are being referred to CAMHS services.  It is worrying that at least 1 in 4 young people are likely to be referred to CAMHS during their childhood or adolescence.  Within the West Midlands CAMHS community and in-patient services for young people have been developed in response to this growing need.

As a CAMHS nurse and a senior lecturer at BCU I believe passionately that the comprehensive health care needs of young people and their families must be integral to our courses.  We must ensure all pre-registration student nurses have opportunities to consider child and adolescent development issues, the importance of attachments and supportive relationships, risk and resilience factors which impact on health, the incidence and nature of mental health and related challenges, the structure, and how to access  CAMHS.

Child and adolescent mental health is “everybody’s business” whether we are engaged directly or indirectly with children and their families.  We have a timely opportunity to integrate this perspective within our student population: tomorrow’s registered nurses.

I hope we do not miss this opportunity.

We also offer a Learning beyond Registration CAMHS pathway as part of our BSc(Hons) Mental Health Studies programme for registered nurses, allied professionals, and other people interested in the health and wellbeing of young people. Please contact me if you are interested in hearing more about our learning beyond registration BSC(Hons) CAMHS pathway.  We are currently planning the two double modules which will be offered during the 2011/12 academic year which is scheduled to commence in October this year.


Course details

Wake up and smell the (decaffeinated) coffee.


So Great Britain isn’t so great after all. Perhaps this isn’t news for many but I was very surprised to read that Britain is well down the list on the WHO league table of health care

(see link and go to p18)

I always thought, in true English stiff upper lip and arrogant fashion that ‘we are the best’ and Johnny foreigner should be envious. But hold on – it turns out that Pierre, Gustav and Ricardo all enjoy a far better health system that poor John English. It turns out that we are 17th and that our partisan friends in Europe have a far better time than us.

Why is this? Well, I have the answer.

You see, England once ruled the waves and Queen Vicky dominated the world with the Commonwealth reaching all corners of the globe. England was the dominant world force and when Britannia spoke, all listened in trepidation. But all we did was speak and not act. We were so confident that we were ahead of everyone that we didn’t try as hard as the others – and try they did.

The result was the rest of the world very quietly, caught up with this country and left it behind.

Unfortunately I think that this is true of many facets of life in this country not just health. Perhaps there is some solace in the countries that we are ahead of – two countries placed in the 30’s caused me even greater surprise (and delight admittedly).

So what next? I would like to think that we are waking up and realise that arrogance does not make a world leader. Hard work, effort and a driven desire to be the best makes the leader – the question is, are we waking up to the smell of coffee or pressing the snooze button for ten more minutes sleep?

Cruel world

The events in Bristol must be a source of shame and disgust to us all. I make no attempt to condone the actions of these appalling people but it got me wondering. If you take the conditions in that “hospital” must we fear similar events in the NHS?

A national company set up for profit, where workers seldom if ever meet the bosses, work long hours and are poorly paid, is it just Castlebeck or is this the future of the NHS?

Lack of support, control and training can affect the morale of workers leaving them embittered and shattering their self esteem.

I once heard a nurse jokingly (I hope) remark that “this job would be okay if it weren’t for the patients”

When demoralised staff begin to view those in their care as “The Problem” then resentment and bitterness can take over.

I stress again I am not trying to defend these people and I hope their prison sentences are long, although Ken Clarke would probably prefer community sentences. That’s a thought now, what service could these evil people do to the community? I just think that where money is the basis for all care I hope never to get sick.

PS This is the link to the Care Quality Commission inspection reports on Winterbourne View