A breath of fresh air
If you have not encountered the policy commentator Matt Black you have missed a rich source of critical thinking about the NHS. Matt argues that media headlines are, more often than not, driven by lobbyists with an agenda or journalists looking for link-bait and not by people who are really concerned to fix anything. In some cases they are simply pushing a partisan agenda with little regard for the facts about where the real failings are; in other cases they are deliberately trying to distract you from the real problem.
His blog Policy Skeptic – subtitled “I’m mad as hell and I am not going to take it anymore” – dissects three examples:
Have a look at these examples on https://policyskeptic.blogspot.com/, it might just make your day.
Vaccine resistance – a rich world problem?
Matt Black is not suggesting that anti-vaccination ideas are not around and potentially harmful, only that they are not the primary cause of low vaccination uptake. Confidence in the safety of vaccines in Europe is lowest among all regions in the world, according to the Wellcome Trust’s report Wellcome Global Monitor 2018. The report finds that while vaccine confidence in the UK is higher than the European average, only three in four (75%) agree that ‘vaccines are safe’. In France, the proportion believing vaccines to be unsafe is as high as one in three (33%), while one in five believe them to be ineffective (19%).
This report also finds that:
The report also points to the potential impact that the “spread” of misinformation across social media could have on public confidence in vaccines. This comes after the release earlier this year of the government’s Online Harms White Paper, which outlines plans for a new regulatory framework for online safety, including establishing a duty of care on social platforms to limit the spread of misinformation on their platforms.
(Source: Royal Society of Public Health calls for vigilance over low vaccine confidence in Europe www.rsph.org.uk)
A bullying and rotten culture
Baroness Dido Harding has said if NHS boards took culture and staff management as seriously as finance, the service would “shift from a bullying and rotten culture quite quickly”.
At the launch of a workforce plan the NHS Improvement chair argued that improving leadership and the working environment including by reducing bullying would stop many staff from leaving.
“If all of the boards in the NHS chose to take culture and people management more seriously and put it on a level footing with financial and operational performance we’d see a huge improvement in culture and outcomes for patients as well. Over the course of the last 20 years the NHS has become increasingly good at financial and operational management and it has not been good at putting people management at the core of the way you run the system both nationally and locally…” News from Nowhere moles agree, but have also heard it all before.
The on-line responses (mostly anonymous) were broadly positive, but Andrew Vincent had this to say:
It just grates when people say “dependent on the spending review” because the full sentence is “to hell with what’s actually needed, the plan will start with the pennies available dependent on the spending review. A properly thought through REAL plan, working within financial constraints might go like this:
– Here’s what is actually needed to solve the crisis
– Here’s what we can afford
– So here’s what you no longer have to do so the work fits the capacity
It defies comprehension that the NHS is expected to still do pretty much everything on wildly insufficient workforce, which accelerates the exodus and undermines safety, when doing just some things really well, within a rewarding and sustainable environment, would create a platform to rebuild NHS as a career choice.
(Source: HSJ 3/6/19 Shaun Lintern Exclusive: Dido Harding: Boards should take culture as seriously as finance).
Staffing increases in general practice
The decline in numbers of general practitioners was news in June, but the staffing figures for general practice tell a different story than the tabloid headlines. Compared with March 2018, general practice had more clinical and no-clinical staff in March 2019. The proportion of all GPs (including trainees) rose by 0.8%, nurses increased by 2.1%, other direct care staff by 3.9% and admin (non-clinical) by 1.1%. These are not massive increases, but if sustained they will start to take up some of the burden off general practitioners. The problem for doctors is that the increase in GP numbers comes from the recruitment of trainees, rather than the retention of experienced GPs, who are taking early retirement in significant numbers.
Rolling back the market?
The NHS has big plans for mental health services, quite a lot of which are provided by private companies. Initially NHS England avoided discussing the presence of the private sector within its new care model plans, but that has changed since the revelations about the abuse of patients with learning disabilities at Whorlton Hall, a privately-run hospital in Durham.
NHS England has sent a letter inviting all providers of specialised mental health, learning disability and autism services to make submissions to form NHS led provider collaboratives from April 2020.The letter says:
“Applications are invited from a lead provider organisation, on behalf of the collaborative. The lead provider will hold the main contract with NHS England. This must be an NHS organisation with experience of delivering specialised mental health and/or learning disability and autism services”.
Under the new care model plans, provider collaboratives must reduce the number of patients in specialist inpatient settings. Commercial providers form a sizable part of the expansive specialist inpatient market, and new care model plans could reduce their profits. The private sector will probably respond with plans to treat service users in the community.
An on-line respondent pointed out that the NHS is required to “treat providers equally and in a non-discriminatory way, including by not treating a provider, or type of provider, more favourably than any other provider, in particular on the basis of ownership…. Banning them from being able to compete fairly is in and of itself a clear breach of the law”.
(Source: HSJ 30/5/19 Rebecca Thomas Private firms banned from ‘lead provider’ role)
Another blow for Circle
On 28th July, private healthcare provider Circle will cease management of a treatment centre in Nottingham, when its contract expires. Nottingham University Hospitals will take over services from the centre on 29th July, after winning a fiercely-contested procurement process. It looks likely that services will be reduced significantly in the first few weeks and patient care disrupted.
The CCG’s decision not to extend the contract with Circle should have resulted in a seven-month transition period, but for various reasons handover will now be just eight weeks. Circle is to blame because its legal challenge disrupted the process and reduced the transition period. Circle argues it is well within its rights to challenge the decision. The legal battle is not over, and Circle is seeking damages.
(Source: HSJ 5/6/19 Crashing out with no deal)
Social work revival – not before time
The Bulletin of the Social Work History Network may not be your first choice of holiday reading, but it carries radical thoughts. With social workers disheartened by bureaucracy and relationships with computers rather than clients/service users, there is a need to return to a focus on relational and community approaches to practice. For instance, in relation to children and families, social work practice should eschew a model geared to crisis intervention/child protection, instead seeing the value of community social work where practitioners are based in local communities with children and families treated both as individuals and members of the neighbourhood. From this, a different child protection narrative is required, one that acknowledges the impact of poverty and inequality on children and families and interrogates their causes. It involves critical thinking, with practitioners addressing the connections between theory and practice and having a commitment to social justice. And so say all of us!
(Source: Steve Rogowski Neoliberalism, Austerity and Social Work: some initial thoughts
Bulletin of the Social Work History Network June 2019 volume 6 (1):34-37)
Mersey Care Foundation Trust took over the services of Liverpool Community Health Trust in 2018, and identified around 17,000 incidents between 2010 and 2014 which require further scrutiny due to inadequate investigations. These are thought to include around 150 deaths. The review could also challenge local commissioners, regulators, and the Care Quality Commission, after an earlier inquiry criticised them for failing to identify the seriousness of problems at the trust earlier. Another Mid-Staffs? We hope not.
Student mental health
In recent years, there has been an increase in symptoms of depression, anxiety, eating disorders, and other mental illnesses in college student populations. Simultaneously, there has been a steady rise in the demand for counselling services. These trends have been viewed by some as a mental health crisis requiring prompt investigation and the generation of potential solutions to serve the needs of students. Subsequently, several studies linked the observed rise in symptoms with the ubiquitous rise in use of personal computing technologies, including social media, and have suggested that time spent on these types of technologies is directly correlated with poor mental health.
While use of personal computing technologies has dramatically shifted the landscape in which college students connect with one another and appears to have some detriments to mental health, the same technologies also offer a number of opportunities for the enhancement of mental health and the treatment of mental illness. A recent paper describes the challenges and opportunities for college student mental health afforded by personal computing technologies. It highlights opportunities for new research in this area and possibilities for individuals and organizations to engage with these technologies in a more helpful and wellness-promoting manner.
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/