Category Archives: General

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.

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

Wake up and smell the (decaffeinated) coffee.

British_lion_and_Union_flag

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

NHS fails to care for elderly?

No doubt everyone has heard by now that the Health Service ombudsman has published a report which is critical of NHS care of the elderly (Report available here)

I have not had time to read the full report but what I have seen is a grim catalogue of neglect and incompetence.

It is apparently based on ten complaints – not a big sample but big enough to make a major impact in the news ( BBC , Daily Mail , Express , Guardian )

Would many people be prepared to argue that these cases are unrepresentative of care – and that we really do have good standards of care?

I know a lot of people in NHS health care and of course I get to speak to our students about care –  I am sure that people still want to do a good job and strive for high standards.

Rather than pontificate for ages about this I really wanted to ask you all – what do you think?

Another great reform

Britain's Prime Minister David Cameron (front C) calls an end to a group picture with his new cabinet in the garden of 10 Downing Street in London May 13, 2010. (L-R) Eric Pickles, William Hague, Tom Strathclyde, Andrew Lansley, George Young, Michael Gove, Nick Clegg, Andrew Mitchell, Sayeeda Warsi, Philip Hammond. REUTERS/Andrew Winning (BRITAIN - Tags: POLITICS PROFILE)

Another Great Reform.

Ha, Ha, Ha finally the management are getting their come-uppance. These people who have oppressed the working nurses for years are all going to be put out of work. After all it’s their fault that the NHS is in the trouble it is. Isn’t it?

Before we celebrate let’s take time for some sober reflection. Having been in the health service for over forty years I have seen many great reforms. From Salmon in the seventies, through the establishment of trusts, the move to the community and agenda for change we have all seen how Government policies have improved the service for workers and patients.

Do we know enough about the work of PCTs and SHAs to be able to judge their worth? Everyone is aware that in some areas there are non-jobs that could be swept away, but could we be chucking out the baby with the bath water? For example, who will commission the number of nurses to be trained from Universities?  If G.P.s are to be given control of huge budgets there must be some questions to be answered before this happens. Are they capable of administering these monies? Do they have the time to balance clinical work with the need to run a business? Given that G.P.s have a personal relationship with their patients will they be able to look them in the eye and say “we can’t fund your treatment”? Will mental health and learning disabilities be given the same priority as neo natal or cancer?

A Government spokesman says that G.P.s can be trained and that they will employ managers to help them. So we are not removing a management tier just replacing it. Plus ça change, plus c’est la même chose.

Finally, we have struggled in nursing for years to get our voices heard; we had great hopes for nurse consultants and modern matrons. With all the power being placed back in the hands of medics where will this leave us? So before we sit back and enjoy the cull of the faceless ones let’s take a long hard look at the alternative. We should demand consultation on this as it is our area of expertise and we should be involved in the process.