Sunday, 24 June 2012

Back from Baltimore, and Back to the Future with Mental Health

From my perspective the 4th Nurse Education Today /Nurse Education in Practice Conference in Baltimore was a huge success. For many nurses and nurse educators, it is the nurse education conference to try and get their work presented. I was involved in 3 papers and 1 poster. Paper 1 examined how newly qualified mental health nurses learn to make ethical and effective decisions, developed and written with a young colleague, Gareth, just after his preceptorship year; paper 2 was a paper that examined the relationship between doing research and doing therapy, a paper developed and co-authored by my long term collaborator Sue.

And whilst I made no direct contribution to the 3rd paper it drew very much on the work we have achieved in the School in finding creative way to facilitate learning. This paper co-authored by 2 colleagues from the School and a student undertaken her pre-registration nurse education at Masters Level. She presented the paper and did so very well. She got a standing ovation and plenty of questions asked of her. Well done Tess.

The poster presented the story so far at the half way point of the EMPNurs project which aims to develop, deliver and evaluate the impact of new mentorship programmes across 4 new European Union countries. Erna and Nicole did a great job of presenting this work on behalf of the project team. At the NET/NEP conference each poster contributor has to make a 5 minute presentations of the work captured in the poster – some of these were very high quality presentations indeed.

Whilst the conference was a success, Baltimore as a place did not do much for me. Walking around the city I was moved by the Holocaust Memorial, and I intend to write about this experience and my feelings in a seperate posting. During the first 3 days of my stay there was a celebration of tall ships in the harbour and this meant there were thousands of people filling up every bar, restaurant and every available place to sit. However it did also mean that there was plenty of noise and colour out on the streets in the evening.

The conference dinner was held in the National Aquarium, and it was slightly strange to be offered fish canap├ęs and buffet whilst being surrounded by fish in tanks. It took awhile for the organisers to realise that being a vegetarian usually meant one didn’t eat fish.

And despite the time difference, thanks to the internet I was able to keep abreast of the UK newspapers while away. Last week The Independent newspaper informed us that the NHS is failing people with a mental illness. The news story was based upon the report How Mental Illness Loses Out in the NHS published by the Centre for Economic Performances Mental Health Group at the London School of Economics. This report found that mental illness accounts for nearly 50% of all ill health in people younger than 65, and that only a quarter 25% of people in need of treatment currently get it. The report concludes that money spent on treating physical conditions could be better spent on cost-effective psychological therapies, which despite some £400 million pound set aside for increasing access to psychological therapies, these are still not widely enough available.

The research was undertaken by a team of economists, psychologists, doctors and NHS managers. It says that mental illness is widespread and is generally more debilitating than most chronic physical conditions. The report notes that 33% of all families in Britain have a family member with mental illness. Additionally, nearly 50% of all ill health in those younger than 65 years is due to mental illness and only a 25% of those needing treatment receive it. The report estimates that 6 million adults have depression or anxiety and 700,000 children have a mental health disorder, that mental health problems account for nearly 50% of absenteeism at work and a similar proportion of people on incapacity benefits.

Mental illness accounts for only 13% of NHS spending on health despite the existence of cost-effective treatments. The report also notes that mental illness can increase the scale of physical illness and that the extra physical healthcare caused by mental illness now costs the NHS £10 billion a year. Arguably, much of this money could be better spent on psychological therapies because the average improvement in physical symptoms is so great that the savings on NHS physical care outweigh the cost of the psychological therapy. The report lead, Lord Layard argues that “mental health is so central to the health of individuals and of society that it needs its own cabinet minister”. Now there’s a thought!

Sunday, 17 June 2012

Attitudes, Altitudes, Pink Suits, Carers and the best Marigold Hotel in the World.

Here in down town Baltimore it is 23.05. The US are some 5 hours behind the UK right now. And that means I have now been awake for some 23 hours. So if today’s blog is a little rough around the edges it’s to do with a lack of sleep, and nothing whatsoever to do with the ethnographic study I have just undertaken with the 2 wedding parties coming together for a for a drink in the bar. I was interested to look at how these two heterogeneous groups came together and each accepted the other. Both groups seemed satisfied.

Being satisfied wasn’t the case back in the UK last week. Last week the British Social Attitudes survey was published. It made for interesting reading. Since 1983, the survey has been asking the great British Public about their views and feelings towards the NHS and peoples experiences of health care in general. The latest survey, published last week, was carried out over the summer of 2011. Overall, it appears that the level of satisfaction with our health service has fallen by 12% to hit an all time low of just 58%. The level of satisfaction with GP services fell overall by nearly 5% in the last 12 months.

Of course in the interest of fairness, there may be good reasons for this downward movement. There is some evidence to suggest that public expectations have risen. If what people experience doesn’t live up to these expectations then satisfaction will fall.

This was my experience yesterday/today, travelling to Baltimore for the 4th Nurse Education Today / Nurse Education in Practice Conference. Three hours into the flight and I felt peckish. I asked the flight attendant if he had any snacks, ‘Absolutely not’ he said,’ 'this is a 8 hour flight and you people get fed twice’. The ‘you people’ part of the conversation rankled. I wondered if had tough about how it was that ‘you people’ were actually paying this miserable example of customer services salary. In the greater scheme of things I guess I have to think no matter, but I did tweet this experience to the world – let’s see what happens.

I met George on the flight. He was someone, who in a self confessing moment, revealed that he was a very important man from Ghana. The fact that we were all travelling economy class did not seem to faze him. He sat in his pink suit; and the photo does not do justice to the level of pinkness of his suit, his self confidence and presence was simply incredible. What was slightly more startling was the fact that my taxi driver was also from Ghana, and had moved to the US some 20 years ago, and one of the occupants in the taxi, Sue from Huddersfield, was born in the very same village as the taxi driver, just some 2 years before he was born.

And equably incredibly, it seems in the UK our GPs are going on strike this week. Given my recent blogs about my personal experiences with my GP, I am not sure anyone will really notice. What I find incredible is that the BMA in its infinite wisdom has chosen National Carers Week to take strike action. It seems to me a blindingly stupid week to take such action.

The National Carers Week celebrates and recognises the contribution the UK’s 6 million unpaid carers make to those they care for, and to the communities they are part of. Incredibly some 10% of the total UK population are carers. There are 1.9 million people caring for more than 20 hours per week and 1.25 million care for more than 50 hours per week. Women are more likely to be carers than men. There are 3.4 million female carers (58% of carers) and nearly 2.5 million male carers (42%). Most carers (5.7 million) are aged over 18 and the peak age for caring is 50 to 59. More than one in five people aged 50-59 (1.5 million across the UK) are providing some unpaid care. There are 174,995 young people under the age of 18 who provide care, 13,029 of these provide care for 50 hours or more per week.

The only time I get to see films these days is when I fly. The notion of the power a contribution from carers can make to our sense of community was reinforced yesterday when I watched the film, entitled the Best Exotic Marigold Hotel for the elderly and the beautiful. It is an absolutely wonderful film. For those of you who have not yet seen this, I would urge you to go on Amazon (or other internet film providers) and purchase it. And for those of you who have seen it, well I can reassure you I have no intention of moving to India just yet!

Sunday, 10 June 2012

Come Fly with Me: England, USA, China, Cuba and Tesco does Social Work in Wales

British Airways sent an email yesterday advising me that I could turn my mobile phone into a boarding card to speed me on my way to America next week (there are other airlines that can also get you to the US). This sign of our obsession with creating a digital modernity, seemed a long way behind the approach used by my favorite airline, Emirates, who always have helpful staff (wonderfully uniformed) to meet me at the airport and speed me on my way and without there being a smart phone in sight.

The US was also in my thoughts for different reasons this week. The Guardian newspaper has been considering the differences in health care systems that share the English language as a common denominator. One of these recent articles looked at the US health care system. There were a number of interesting observations made. For example while most US hospitals are privately run, just over 70% are not-for profit organisations. The numbers of nurse practitioners continues to grow in response to cost pressures, and patient reaction to nurse practitioner is highly favourable.

Some thing’s are not so great. 85% of the population have health care insurance. However, most will have a $1000 excess on their policy, and 62% of all bankruptcies have medical debt cited as the cause. It also needs to be remembered that 15% of the US population will not have insurance. As there are some 313,698,000 million people living in the US, this means that some 50 million people are without health care cover.

The world population is 7.019 billion, so the US has just under 5% of the world’s population, compared to China 1,347,350,000 (19%), and of course there are 62,262,000 people living in the UK, (0.89%) and Cuba’s population is tiny in comparison, 11,247,925 (0.16%). I mention Cuba as the US has the highest infant mortality rate amongst all industrialised nations, and life expectancy is 42nd in the world, way after that found in Cuba! Cuban's can expect to live until they are 77 years old.

Cuba’s health care system is internationally known for the preventative and primary health care approaches to health service provision it has adopted. Health care is provided through an extensive system of community based polyclinics – each serving a population of 30,00050,000 people. Most of these polyclinics provide almost the same range and level of services that might more traditionally be found only in hospital settings, including emergency care, psychiatry, diagnostic radiography, and obstetrics. The aim is to be able to meet the biological, psychological and social needs of individuals, within their families and communities. Sounds like a familiar idea!

And back here in Britain, well Wales actually, the British Association of Social Workers reported that nearly 25% of Social Workers in Wales do not receive professional supervision. Those that do receive supervision are most likely to only get this on a once monthly basis. Like colleagues in health care, regular supervision is an absolute essential requirement for maintaining the quality and effectiveness of professional practice. Perhaps in another sign of a new world of professional practice, some respondents noted that they received their supervision mainly in Tescos, although this was over a coffee in the Cafe, and not a form of 'ready meal' type of supervision. But in this digital age, who knows, this does sound like a gap in the market. So when you get your first supervision app for your i-pads and smart phones, remember, you read about it here first. 

Sunday, 3 June 2012

The Importance of that First Line, Baby Squirrels and God Save the Queen

I sometimes think about my mind as being like an unquenchable sponge, rapaciously soaking up words, thoughts images and experiences. Last week, there was plenty to soak up particularly in the words I got to read, and there was a great deal to read last week. On one morning, I got up an hour earlier in order to read and mark some pieces of student work before the day proper began, on another evening I stayed up late trying to get to the end of a 564 page long paper a colleague had sent me to inform a paper I am writing.

So when I have weeks like this the importance of the first line I read can play a critical part in determining the level of engagement I have with whatever it is I am reading. And of course when I write, I also think about this. Perhaps in acknowledging that last week saw much media interest in the quality of care people receive at the end of life (and well done Martin for a great performance on Fridays early morning BBC News) here is a first line I and a couple of colleagues used in a chapter we wrote for Phil Barker last year:

Death sets limits on life. Death serves as a nexus of concerns about what counts as meaningful and about what makes life not just liveable but good.

Warne T., Keeling J., and McAndrew S., Mental Health Law in England and Wales. In P., Barker (Ed) 2011 Mental Health Ethics: The Human Context. And the best first line I read this week came from the provocative but very engaging report Patent’s Preferences Matter (Ali Mully, Chris Trimble, and Glyn Elwyn) published by the Kings Fund last week:

Many doctors aspire to excellence in diagnosing disease, far fewer, unfortunately, aspire to the same standards of excellence in diagnosing what patients want.

This is an evidence based report well worth a quick read (its just 54 pages long), that convincingly provides a cogent argument for the need we have as educationalists, practitioners and policy makers to challenge 5 entrenched but erroneous assumptions underpinning contemporary health care provision:

1 that science alone determines need
2 that variation in care is the problem
3 that patient choice is about time and location
4 that the ‘market’ can sort out health care
5 that commissioners can calculate need

I really enjoyed reading the arguments, much of which drew upon and analysis of the post 1989 NHS reliance on the adoption of the American economist Alain Enthoven ideas around a managed health care market, characterised by a provider – purchaser split. Enthovens central thrust was to improve teh NHS we should subject doctors to market forces – he had much more confidence in Adam Smith’s invisible hand than he did in a restructured organisational chart!

And talking about charts, the first line I misunderstood on first sight this week was from the Nursing Times (online version) who were reporting on a new study. The first line was:

The distress thermometer is a quick screening tool used to measure psychological symptoms in patients with cancer.

Now I read this and immediately thought how cheesed off our psychology colleagues were going to be that someone had invented a ‘slip under the tongue’ device that could measure feelings of distress, anxiety, depression, anger and so on. Clinical psychology practice would never be the same again. But of course the reality was somewhat different. When I actually read the full paper I found it was reporting on a contemporary adaption of the work undertaken by Andrew Roth and colleagues in 1998. that used the metaphor of a thermometer to record patient responses to a series of questions.

Finally, I saw this year’s crop of baby squirrels for the first time yesterday. There are 3 of them, and as delightful as they are, (in comparison to their parents they are about 60% full size), they are literally into everything, exploring every nook and cranny. They have even brought down the bunting erected to celebrate the Queens Diamond Jubilee this weekend! I hope that the rain that has being falling for the past couple of hours stops soon, so that people get to enjoy their street parties and are able to raise a collective toast to her Majesty.