Steve Turner

I am delighted to see Bernie Rochford recognised with an MBE and recommend people to read Bernie's story. 

Great discussion and important points from all perspectives.

Information and perspectives which we all need to reflect on.

I hope StopSIM campaigners, the Police & emergency services, NHS trust leaders, NHS England, academics & AHSN leaders are looking at this, and will feel able to contribute. 

One  thing that I see as important is discussing what's behind the comments that 'SIM promotes the withholding of potentially life-saving care'.

I don't know what's exactly behind this (are there examples?) However I do believe that England's current approach to mental heath care and its delivery  frequently denies people access to potentially life saving care in the long term. I say this openly as a mental health clinician. 

We have a system that too often is set up around short-term (fixed time) initiatives, very poor access to psychological & other therapies for people with complex issues, no drop in facilities for people in crisis, very little sharing of medical records with patients, poor interdisciplinary & trans-disciplinary working, and frequently medicines prescribed by clinicians who don't follow the competency framework or monitor their effect with the patient.  I see this every week in my practice. Including subjective, demeaning and totally inaccurate comments in people notes, and reports of awful practices such as transferring people back to the care of their GP because they are 'too complex'. 

Don't get me wrong... Sometimes coercion is the only safe approach if the risks are high and, for example, someone lacks capacity. 

We all need to talk openly and sometimes those who hold all the cards (the service leaders) are just too interested in reputation and 'awards' to engage in open & inclusive discussions..

Thank you Dan, and everyone who has contributed to this discussion. So much to reflect on.

Three things stands out for me right now,

1. The lack of suitable community based (long-term) therapies.
2. Diagnostic overshadowing.
3. The way in which national bodies have responded to being challenged by patients. Which seems at times unhelpful, insular and defensive.

I work with people with multi-morbidity. Time and time gain we see diagnostic overshadowing and inappropriate 'labeling'; a desperate unmet need for appropriate non drugs based community therapy or treatments, set against a  background of provider organisations that don't hear what their patients are telling them.

An interesting development:

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Royal College of Psychiatrists  calls for urgent and transparent investigation into the NHS Innovation Accelerator and the Academic Health Science Network  following the High Intensity Network [HIN] suspension

https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/06/14/rcpsych-calls-for-urgent-and-transparent-investigation-into-nhs-innovation-accelerator-and-ahsn-following-hin-suspension

Thanks. I find you comments helpful, informative and also (on data sharing) familiar and disturbing. 

I agree SIM is small fry and, from what you say, potentially valuable.

Rather than taking information off-line I think the HIN / SIM Leaders should be openly discussing and defending it. Otherwise it feels like service leaders only listen to the patients / users of services who shout loudest, rather than those who are most in need (many of whom may feel unable to speak up).

The bigger issues which may be mixed up in SIM criticism's (something I have been guilty of) are:

• The decline & disbandment of Assertive Outreach Services.
• The decline of Drug Services, including the over-emphasis on abstinence as opposed to harm reduction.
• Inappropriate data sharing, which includes sharing inaccurate information (and 'labels') that adversely affects people's care. 
•  Mental Health Service deficiencies that contribute to deterioration in people's mental state. For example, people being transferred back to the care of their GP because they are 'too complex'.
• Incarceration of people with autism and learning disabilities in inappropriate settings.

I hope more people will feel able to comment on this.

Thanks Barry, you raise some important points. It made me think. Like you, I have not yet encountered anyone (outside of social media) who is or was mentored on a Serenity Integrated Mentoring [SIM] or related programme. 

I agree about the importance of not stopping moving forward on something because it hasn’t been fully evaluated, and the need to try any approach (behavioural or otherwise) if it works for people.

The High Intensity Network [HIN] approach needs an independent and patient / service user  led evaluation, so we don't miss the opportunity to make the most of what works and learn from what doesn’t.

When I hear talk of areas where ‘potentially life-saving treatment has been withheld’, I am very concerned. This is something which needs looking at as part of any evaluation.

Overall, I am concerned about how I believe High Intensity Networks operate.

 Here is a personal reflection on my main concerns:

1.    Person led approaches to care.

Is the HIN / SIM approach focused on the patient or on services? Is involvement time limited?

My worry is that people , especially those who are vulnerable,  under pressure and feeling disempowered will derive less benefit from a formulaic approach to their care, than from an individual, tailored  long-term approach.

There’s a power imbalance that need to be addressed so that people can begin to trust the services and open up on what happened to them, and how this has affected them.

2.    Services working together in a network.

Do the services work together as a single team or as a more loosely connected network?

I believe in joint working and a linked approach to care, however some people I have worked with benefited from the fact that different services took different approaches. For example, I’ve worked with people who told me they  trusted the Police more than the Mental Health Team. This was to their advantage and helped them, when in a crisis.

In my experience, patients / users of services frequently tell me that the most important things for them were to be believed, to be able to trust individual members of services and build a relationship that helps them manage their own care.

3.    Data sharing.

If a  care plan (or suchlike) is shared between services, how is the person encouraged to own their own plan and how much of their information is shared?

I believe it is vitally important only to share information as agreed by the patient /user of services and nothing else. The exceptions being if there are safety of safeguarding issues that need to be shared, as part of a professional duty to the patient and the public.

The idea that the patient has control of what information about them is shared is vital to build trust. (This, of course, is also enshrined in data protection law). I have seen people make amazing progress after being confident to disclose past trauma to someone in the services that they trust, knowing it will be handled carefully and shared only as agreed.

I base these concerns on my personal experience as an Assertive Outreach Nurse, working with some of the most vulnerable and isolated people in society. In this job I saw people make major steps forward in their lives. Sometimes over and above what anyone expected.

When I asked people, ‘what helped most?’ the most frequent comments were that they were ‘believed’ (sometimes for the first time), and that they found people to work with who they trusted.

When dealing with emotive areas and people in distress there are, in my view, as many approaches to care as there are people. These approaches must be transparent and recognise everyone’s rights and responsibilities. The HIN / SIM approach feels like it is primarily designed to benefit the services rather than the patients /users of services.

I am happy to be corrected on this and to learn more.

We need an open and honest discussion on this led by patients / users of services and supported by professionals. Let’s share everything and learn together.

This is very worrying in my view. I believe the National Guardian Office and Freedom to Speak Up initiative and process is fatally flawed. Spreading this to Primary Care and integrated settings is a waste of money, and potentially harmful.

As I posted on social media:

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#FTSU is potentially harmful because the Trusts employ the Guardians. This is another example of organisations marking their own homework. As a #healthcare professional I feel obliged to speak out on this. ...as one  commentator says Freedom To Speak up has 'no effective legal safety net, riddled with COI issues, strong risk of detriment.'

I tried to engage with the National Guardian Office without success. Since then the organisation I raised concerns about (10 years ago) has been 'found out' and the CEO left suddenly. Slipping away quietly. But the wider issues underlying the situation appear to have have been brushed under the carpet. So much for Freedom To Speak Up!

I discussed my concerns recently at a round table forum set up by Whistleblowers UK.

In response to the Letter from Claire Murdoch the Stop SIM Coalition has published a response: https://www.stopsim.co.uk/coalition-statements/

Extract from the response:

"To conclude, we consider multiple local reviews insufficient in light of the following:

• HIN/SIM’s rapid rollout and implementation was initially facilitated and resourced by NHS England. 
• SIM is directly commissioned by NHS England in some areas. 
• NHS England retains accountability and responsibility for safeguarding and overseeing local CCGs commissioning contracts.[22] 
• NHS England has statutory and legal duties which it must uphold.
• Due to the severity of risk posed to service users under SIM, we consider a centrally coordinated investigation of urgent importance. 

We reiterate our call to NHS England to:

• Halt the rollout and delivery of SIM with immediate effect, as well as interventions operating under a different name, which are associated with the High Intensity Network (HIN).
• Conduct an independent review and evaluation of SIM in regards to its evidence base, safety, legality, ethics, governance and acceptability to service users."

....as  a mental health nurse, with experience in and Assertive Outreach Team working with some of  the most vulnerable and often most misunderstood people in our society, I support the Stop SIM coalition. 

#mentalhealth

#mentalhealthawarenessweek

#mentalillness

#StopSIMMH

21 hours ago, Steve Turner said:

As a mental health clinician I'm sorry to read this. I hope you seek a second opinion. This is your right, and good clinicians offer this routinely.

 

Supports the argument that all consultations should be recorded. Everyone will benefit from this approach. What do others think about this?

#mentalhealth

#mentalhealthawarenessweek

#mentalillness

#bipolar

An important development. Letter from Claire Murdoch, NHS England National Mental Health  Director, in response to the Stop SMMMH Campaign:

'NHS response set out in my letter. The model is not sponsored by NHSE and is not part of the LTP and we have written to medical directors to ask them to review for evidence base, values and compassionate care.'

#mentalhealth

#mentalhelathawarenessweek

#mentalillness

#StopSIMMH

As a mental health clinician I'm sorry to read this. I hope you seek a second opinion. This is your right, and good clinicians offer this routinely.

I've now signed the #StopSIM Petition: https://www.change.org/p/nhs-england-stopsim-halt-the-rollout-and-delivery-of-sim-and-conduct-an-independent-review

As a mental health clinician, and former mental health Assertive Outreach Team member  I was appalled to read about the way mental health 'High Intensity Networks' are being implemented. Without any meaningful involvement from patients / users of services and with an apparent lack of regard to data protection laws.

People in crisis need help based on their individual needs, not to be put on a 'programme', I believe this represents a potential abuse of vulnerable people. Imagine if this approach was taken in physical health care. Yes, the services need to work together, with the person involved at the centre. 

'No decision about me without me' applies to us all. 

Here's the reason I posted this. As a former #mentalhealth #nurse in an Assertive Outreach team I share these concerns from users of services. 

Related post:

I am a supporter of NICE Guidance and former NICE Medicines & Prescribing Associate, having said that I have reservations. The NICE methodology is to engage with organisations, rather than individuals. I believe for this type of guideline, where there are multiple perspectives & gaps in evidence, this approach is flawed & old fashioned. You end up with a guideline written by a committee & open to misinterpretation.

People can forget that this is guidance only, something that is supported by the NICE Guideline on Medicine Adherence: https://www.nice.org.uk/guidance/cg76

Also NICE Guidelines are lengthy documents, so I'm hoping a  one page summary (or 'detail aid' ) will be produced.

Related consultation on the RPS Prescribing Competency framework for ALL prescribers now open:

https://www.rpharms.com/resources/frameworks/prescribing-competency-framework/consultation

I agree Dom, patients are their own best experts. So we (us prescribers)  have to build this into our practice. Then everyone benefits.

I'm building a vlog series on this and other #medicines related matters: 

#Medicines

#Prescrining

#MedLearn

#TeamPatient 

#share4safety

#medication

#medicinessafety

This is important for patient safety.  It's one of a number of major challenges for the Patient Safety Commissioner, who I hope will be able to act independently and focus on identifying and resolving root causes of patient safety failings.

An insightful and important article, that highlights the worst aspects of what is happening (in plain sight) in the UK public sector, across local government, health and social care. Speak out on this and your career ends. 

I am pleased to see this landmark case on #dutyofcandour has finally been acknowledged by the Care Quality Commission. It now appears on their web page 'Background to the Duty of Candour' :

Quote

 

'Until 2014 there was no legal duty on care providers to share information with the people who had been harmed, or their families.

The tragic case of Robbie Powell and the perseverance of his parents through the UK courts and then the European Court of Human Rights exposed the absence of this legal duty....'

 

Source: https://www.cqc.org.uk/guidance-providers/all-services/duty-candour-background
 

Will Powell & his wife sacraficed £300K compensation to expose the absence of a Legal Duty of Candour in the High Court in 1996, Court of Appeal in 1997, House of Lords in 1998 & the European Court on Human Rights in 2000.

In 1999 the Health Select Committee recommended a Statutory Duty of Candour as a consequence of Robbie Powell's  1997 Court of Appeal ruling, which the Government ignored.

#share4safety

#patientsafety

#robbieslaw

 

This long standing  #patientsafety issue needs more than 'measures ...to limit the prescribing of this drug' that are being implemented.

In my view, one of the first jobs for the Patient Safety Commissioner should be to look at what is needed nationally to improve standards and competency in #prescribing, and also to increase #patient involvement in prescribing decisions. To make the mantra  'no decision about me without me', a reality, in a way that can be measured through a reduction in drug related harm.

Since the demise of the National Prescribing Centre there is no national body that covers the prescribing practice, competence and learning across disciplines. I believe #patients are suffering as a result.

This important blog, in my view, highlights the need for national action on prescribing & for greater support for Care Home staff. They have been working under extreme pressure and don't always have access to the resources or learning needed to ensure prescribing is appropriate and safe. 

There is also, in my view, a wide variation in the processes for prescribing, reviewing, de-prescribing & monitoring the effect of medicines in Care Homes  and many opportunities to share best practice.

'We would like to hear your views

We are keen to explore this issue further and would like to learn more from people’s experiences concerning the prescription of antipsychotic medications for people living with dementia.

• Are you a carer or a family member of a person living in a care setting with experience of this issue?
• Do you work in a care home, nursing home or in domiciliary care and have a view on this issue?'

There are now several different guidance documents for prescribers in the UK.

Not necessarily a problem if they link back to the National Competency Framework for all Prescribers.

Worryingly, in my view, this new GMC Guidance doesn't.

Good to see the issue of referrals getting lost mentioned. This is usually a 'systems problem', and it needs attention. Nobody wants this to happen.

I recommend that #patients are encouraged and helped to be part of the referral process. Doing this prevented a friend's urgent referral for cardio-version / cardiac ablation being missed. Had he not chased up the referral himself, and been persistent, he would not have been treated. The referral had not got through to the relevant team. We never did find out what had happened to it.

I recommend all patients (who can) keep copies of all letters / summaries / consultations /test results and referrals, and follow this up themselves if there is a delay.

Worrying figures. Especially as this is based on the NHS staff survey which some staff are very wary of taking part in.

I believe that the survey responses (although anonymous) can be viewed by managers at Team level. This puts some staff off, as they fear they may be identified, especially when they work in small Teams. In the past I've asked the Picker Institute about this to check my facts. If anyone can expand on this, or correct me if I'm wrong,  that would be helpful for us all.

A promising development.

The person specification & job description of the Patient Safety Commissioner will be key. E.g,  someone who is credible and comfortable at all levels, with patients, carers, the public and with professionals, has a background in inter-disciplinary working, and is able to consider things from all angles. A tall order indeed.

I believe this will need an open recruitment process, and the role will need involvement of ALL stakeholders spanning professional boundaries / hierarchies, and fully including those who raise difficult questions and issues.

#OneTeam

#patientsafety