Seeing hope in a less restrictive future

Here is a word for you: ‘stobuften’ – it’s a German word and has characters and letters that being generally inept and not particularly computer literate, I can’t reproduce here. However, it is the word’s meaning that is important. It refers to the practice of ‘shock ventilation’ – opening a few windows wide for no more than a few minutes. It is something that happens in this household every single day. All the windows upstairs are opened, as wide as they will go, to ‘air the house’. It happens against the backdrop of creaking hot water pipes and radiators, as the central heating system tries (vainly) to compensate for the sudden loss of heat in the house. In Germany, this is a common practice. In this house, it is not me who opens the windows in this way…

Now don’t get me wrong. I’m all for fresh air, and love being outside, as much as I can. Whatever the weather, if I can be outside, I will. I love the sense of freedom I get from being outside walking, gardening and more recently, slowly passing through countryside on our narrowboat. Freedom, or rather the ability to make decisions about what we might do, was something we focused upon in our Board Development Day last week.

We were joined by colleagues from our Human Rights and HOPE(S) team. The HOPE(S) model* is a human rights approach, developed by our colleagues at the Mersey Care NHS FT. Its aim is to work at reducing the time service users spend in segregation. Being in seclusion for long periods of time is known to be counter-productive to good mental health and, wherever possible, should be avoided. The team shared a video of someone who, whilst receiving care for her mental illness, had spent a great deal of her time in seclusion. It was a very challenging video to watch. The negative impact on the patient’s mental health and wellbeing was clearly profound.

Our HOPE(S) team is a result of an NHS-funded national roll out of the roles, training and approach that brings together healthcare professionals, service users and carers. It was good for the Board to see the enthusiasm and commitment the team had for training and supporting others to find compassionate ways to reduce the use of restrictive practices.

The Board development session reminded us that protecting peoples’ human rights is everyone’s business. Over a 90-minute period, and using an interesting and powerful approach, the facilitators took us through what protecting the human rights of the people we care for, looks and feels like. The first exercise involved us being given a piece of white paper, and a stubby crayon each. Some of the crayons were white. We were asked to list five things that were important to us in our lives. Next, we were asked to swap our papers with the person sitting beside us, and to then strike out three of the things on each of the lists.

It was a simple and effective way of demonstrating how easy it might be to take something that was precious away from us. The next exercise was even more vivid. We were joined by three members of our Prevention and Management of Violence and Aggression (PMVA) team. PMVA is a structured prevention-led approach used to reduce the risk of violence and manage aggressive behaviour, safely, lawfully and ethically.

The team asked for a volunteer, and our Chief Medical Officer (CMO) duly stepped up. He was successfully, and safely restrained. Although he wasn’t violent, the team showed how they could escalate their approach, whilst imagining that he was becoming increasingly more aggressive. Importantly, throughout the exercise, the team leader used calm reassurance, as she and her team restrained our CMO. Likewise, throughout the exercise, they ensured his dignity was protected. It was an impressive demonstration of what is possible to achieve in difficult situations, with the right training, teamwork and calm approach.

It was also a wonderful insight into how our Trust-wide ambition to reduce restrictive practices of all kinds could be achieved. There is a way to go, but goodness, we have a great team leading on delivering this ambition. The Board Development Day was just as it should be, stimulating and refreshing - rather like the impact of wide-open window on an arctic cold morning might have.

 

*Here is the Mersey Care FT description of the HOPE(S) model:

• It encourages teams to Harness the system through key attachments and partnerships
• Create Opportunities for positive behaviours, meaningful and physical activities;
• Identify Protective and preventative risk and clinical management strategies;
• Build interventions to Enhance the coping skills of both staff and people in services
• Whilst engaging in these tasks clinical teams and the System needs to be managed and developed to provide support throughout all stages of the approach.

Emergency Care: finding calm in a crisis

Last week, I shared an amazing experience with Jane. I accompanied her to an appointment with her neurology rehabilitation consultant. It was at the Lancashire Teaching Hospital near Preston. It has the worse visitor car-parking of any hospital in the North West. Like many visits I made last year, I eventually abandoned the search for a parking space, and we parked in the nearby local supermarket, and walked across.

The consultation was reassuring and helpful. What made it amazing was the consultant taking us through Jane’s various scans. I still find it fascinating that he was able to show us inside Jane’s head, where her VP shunt was located and where the aneurysm bleed had occurred. It was hard to grasp how the surgeons had both stopped the bleeding artery, and then subsequently fitted the shunt. What the consultant couldn’t show us was the original CT scan taken when we first attended the Emergency Department (ED) at Blackpool Victoria Hospital.

Apparently, the scans ‘belonged’ to Blackpool, and not Preston. One NHS? Shared patient records? Left shift, from analogue to digital? It was disappointing for sure. I was also reminded, in a PTSD type of way, of that dreadful experience, of sitting in a cold, noisy, uncomfortable and overcrowded ED waiting room for hours, waiting for someone to see Jane and tell us what was going on. That said, Blackpool ED is no different from many (most) accident and emergency departments in England.

Many EDs are not fit for contemporary emergency care. They are overcrowded, both because of the unremitting and increasing demand for help and care and because it can be so difficult to find a bed for those who need inpatient care. Increasingly, EDs are being negatively characterised by ‘corridor care’ as being the norm. These are not places you really want to be in, if you can help it. Despite this over 35% of those folk attending an ED for health care don’t actually need emergency care. Why do they go there?

If these difficulties are true for those presenting with some physical problem, it’s arguably more so for those experiencing a mental health crisis. Although people with mental health problems account for about 2% of all those who attend an ED*, one in four people presenting with a mental health problem will wait longer than 12 hours there. This compares to one in 10 of all other patients. Waiting in an overcrowded, noisy, busy and often chaotic environment is unlikely to be conducive to reducing distress or agitation.

The NHS 10 Year Health Plan recognised the problems experienced by healthcare professionals in responding appropriately, and in a timely way, to the needs of those attending ED in a mental health crisis. The plan sets out a transformational investment of £120 million over the next decade to develop a range of specialist mental health crisis assessment centres. These are to be located in, or co-located with existing EDs.

There are currently 10 pilot sites across the NHS. One of which is at the Blackpool Victoria Hospital ED. It is co-located next to the main ED. Anyone who is triaged as needing a mental health assessment, can get this by literally stepping across the road.

Whilst some have described this policy approach as being almost Cartesian in approach (splitting the mind from the body), services such as the Blackpool one can provide access to both mental and physical health care expertise. The Centre for Mental Health note that some 42% of people presenting at their ED with a mental health problem will also be flagged with a non-mental health diagnosis. Whilst liaison psychiatry services can help here, often these folk are few and far between in EDs.

I welcome these developments in mental health crisis care, well at least the Blackpool type model. But I also know that such services won’t, in themselves, deal with the problem of finding a bed where inpatient care is the appropriate way forward. Likewise, I also know that some 70% of people who chose suicide as a way of resolving their mental health problems, haven’t been anywhere near an ED. There really is no health without mental health, and finding ways of recognising this in practical ways has always been a challenge. However, improving ED mental health crisis services does feel like a positive step in transforming how good mental health care might be provided.

 

* Despite recent announcements to invest in mental health care, mental illness represents 20% of the UK’s disease burden but receives only 10% of health funding.

Read, it might change your life

I’ve found out I’m apparently what’s called a ‘mega reader’. That is someone who reads at least 50 books in a year. During the month of January, I have read 7 books. They were all novels, and as such, relatively easy to read. That said, they were highly enjoyable, with great plots and characters. It beats scrolling through TV channels trying to find something interesting to watch. The simple fact is, I love reading. Always have. These days much of my reading is done on my iPad, and although my virtual library is pretty large, it's not quite as satisfying as one I once had made up of real books.

I don’t just read novels. Last week, for example, I discovered that 2026 is the UK National Year of Reading. It is the third time there has been such a reading campaign – and this year the focus is on all forms of reading options. Strangely, this year, it also includes listening to audiobooks. Whilst Jane does this while working out at her gym, it’s not something that appeals to me.

The campaign is aimed at all ages. Interestingly, older folk (over 65) are more likely to be readers then others. The number of books adults might read in a year varies greatly. Around 25% of all adults reported they just read or listened to between one and five books a year. A much smaller number (10%) of people said they would typically read between 11 and 20 books in a year. Twice as many women as men are likely to be regular readers. Sadly, 40% of the UK population reported that they hadn’t read or listened to an audiobook at all in the past year.

I say sadly for a reason. This year there is a particular emphasis on getting more children interested in reading. The latest report from the National Literacy Trust (published in June last year) showed that only one in three children aged 8- 18 enjoys reading. Research suggest that low levels of reading for pleasure in childhood have been linked to poor academic achievements and can have a negative impact on an individual’s life chances.

Encouraging children to read is one of the greatest gifts a parent can give their child. However, if parents are not reading books themselves, it’s unlikely they will be reading to their children. Reading to young children, even before they are able to talk, can help prepare the neurological pathways for effective language use and literacy in later life. Research from the Ohio State University showed that children who are read just one book a day with their parents will hear about 290,000 more words by the age of 5 than children who don’t regularly read books with a parent or some other caregiver.

However, it’s not just about words – reading can help the child gain a sense of perspective, and begin to understand different contexts such as physical settings, a zoo, farm, park, school, hospital and so on. It can also help a child make sense of what they are feeling and learn what their emotional response options might be. Of course, the simple act of being together is obviously also a chance for parent/child bonding to occur.  

Now it might seem to some of today’s readers of the blog that I’m judging those parents who, for whatever reason, don’t read with their children. I’m not. However, I did pause to reflect on the support we provide to families to navigate an ever increasingly difficult world. Last Monday, the UK Health and Social Care Committee published their latest report on the First 1000 days of Life (that is, from conception to age two). You can read their report here. It’s a challenging report. It makes some great recommendations. Equally, there are some fairly unfavourable comparisons to the previous ‘Sure Start’ programme, which was very successful, albeit it was a costly initiative.

There’s the rub. ‘Sure Start’ was one of the most successful health promoting programmes ever. But during a period of economic downturn, the annual costs became more important than any long-term gain, and its momentum stalled, and then stopped. Hopefully, the renewed recognition of investing in our children today, set out in the First 1000 days report, will help improve the future of our children’s and their families. Likewise, let's hope the campaign to get children interested in reading once more helps each child have a better future too.