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Steve Turner

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Everything posted by Steve Turner

  1. Community Post
    I have a family member who had a similar experience to the one you describe Helen. This involved an urgent tertiary referral that would have been bounced back to the patient had they not kept their own notes. As he had the notes my relative was able to show copies of all the letters, scans, EEGs and reports that indicated the referral was potentially life saving. In his case I believe his GP would have intervened, however the GP did not have all the notes and was missing a key echo-cardiogram, that showed definitively an urgent intervention was needed. My recommendation to all patients is to keep a copy of your notes in real-time. Insist that everything is copied to you. Most clinicians are more than happy to do this. (They all should be!) Then, if your referral goes in to a faceless 'referral management system', it is less likely to be lost or the priority to be missed. My worry is that this is fine for articulate, English speaking, reasonably IT literate, middle class white people like me. What about those who slip through the net? Who helps them? Who advocates for them? We may never hear of this.
  2. Article Comment
    A worrying story. Really frustrating that it is behind a paywall. Many areas of concern here that need open discussion in order to lead to learning. It's not just the number of investigations that matters, it's the quality of the investigations, and the way they are conducted. This problem is an opportunity if it is brought fully into the open, looked at from all angles and (most importantly ) patients, relatives and carers are fully involved.
  3. Content Article
    The government commissioned Dr Keith Ridge, Chief Pharmaceutical Officer for England, to lead a review into the use of medication and overprescribing.
  4. Content Article Comment
    A really helpful article picking up on the key points. In my recent experience of providing remote 'patient led medicines reviews' I'd also add that this isn't just about Doctors, remote consultations (where appropriate) open up many new possibilities for new ways of working by all clinicians. I use them for my developing work as a Care Navigatior . I'm pleased to see the “remote by default” message challenged. This was such a bad thing to say and harks back to the old way of thinking that technology is the answer to healthcare problems, when it's just a tool. A Secretary of State for Health and Social Care should know this. Finally it's worth remembering that digital consultations aren't something the NHS has just discovered and is now 'educating' patients on. Many patients have been asking for this for years. This tweet sums it up nicely: Source : https://twitter.com/NusratMedicine/status/1382641585184210944?s=20
  5. Content Article
    This competency framework has been developed and updated to support prescribers in expanding their knowledge, skills, motives and personal traits, to continually improve their performance, and work safely and effectively.
  6. Content Article Comment
    A good article. I agree in principle too with 'raising concerns in the right way', however my experience, and that of many others, is that this isn't always possible. We need more CEOs like David Carter, and we need to expose CEOs who victimise those who raise genuine concerns.
  7. Content Article
    In this article in the Pharmaceutical Journal, Carolyn Wickware asks if liquid morphine should be reclassified. She cites research that Oramorph or oral morphine sulphate solution was directly linked to the cause of death in 13 reports since 2013.
  8. Content Article Comment
    Robert Darren Powell, a much loved member of a close family, was just 10-years old when he died on the 17th April 1990. Every parent’s worst nightmare, the tragic loss of a child, became Will and Diane Powell’s lived reality. Their acutely distressing grief, was exacerbated because they quickly learned that Robbie’s death was preventable. Little did they know back in 1990 that their pursuit for truth, justice and accountability would span across three decades, cost them in-excess of £300,000 in compensation, and unveil medical negligence, cover-ups and bureaucratic failure. ' The shocking story of a cover up in the UK healthcare system. It is THE landmark case on #DutyofCandour . As a clinician I am appalled, and support Will Powell in his continuing quest for justice. Because of the cover up vital learning on #patientsafety , particularly around the care of children and communication with parents, has been missed. https://www.open.ac.uk/researchcentres/herc/blog/robbie-powell-time-truth-justice-and-accountability https://www.pslhub.org/learn/investigations-risk-management-and-legal-issues/english-and-welsh-ombudsman-set-out-the-case-for-a-proper-public-inquiry-into-the-tragic-death-of-robbie-powell-r3560/?tab=comments#comment-334 https://twitter.com/MedicineGovSte/status/1424353716040343557?s=20 https://www.youtube.com/playlist?list=PLPtuApYs79-6ie3tnwTpONsxjzc5ooG4d
  9. Content Article Comment
    This 'fortress mentality' & similar attitudes have been around for a long time. I'm a strong supporter of the NHS and its core principles. At the same time, having worked in the private sector, for a US company & in Australia, I can also see why people raise concerns about the downsides of so-called 'socialised medicine'. It's the often mentality that's the problem in my opinion, and this can be reinforced by the leadership and the surrounding bureaucracy. Here's an example from some years ago, which I think is still relevant: I was doing a review of waiting list administration in an NHS hospital that had a military wing. The civilian consultants had very long waiting lists, the militarily consultants did not. I assumed that was because they had fewer referrals to manage. When I looked into it this, I found it was not the case. So I asked one of the military consultants what they did to successfully manage their waiting list. He said 'it's simple, I look through the list myself every week and if I have a backlog or urgent referrals to be seen I add a clinic and do what's needed'.
  10. Content Article Comment
    Great to see this promoted. I will be using this poster in my Clinical Education work & my clinical practice . Thank you David Havard, this is really helpful.
  11. Community Post
    Thank you for your comments Clive. I am so sorry to hear what is happening to you. I'd like to say it's an unusual situation but I know many have experienced the same treatment. Patient complaints are an opportunity not a threat. Sadly the NHS largely fails to recognise this, and fails to provide the right training for staff (at all levels) so that we can all learn and improve. I remain optimistic that this can and will change. There are some good signs of this in some trusts.
  12. Content Article Comment
    This is an incredibly useful resource for clinicians & #patients, I hadn't seen it before. I will be including this in my latest #prescribing CPD work and our #patient led #clinicaleducation work. Thank you. #SOMNMPCPD #medicines #share4safety #patientsafety #MedEd https://yellowcard.mhra.gov.uk/iDAP/
  13. Community Post
    About 1000 angry nurses and doctors have rallied outside Perth Children’s Hospital in Australia following the death of seven-year-old Aishwarya Aswath, demanding vital improvements to the state’s struggling health system. The Australian Nurses Federation was joined by the Australian Medical Association for the rally, with staff from hospitals across Perth attending. Many people held signs that read “We care about Aishwarya”, “Listen to frontline staff”, “Report the executive — not us” and “Please don’t throw me under the bus”. Aishwarya developed a fever on Good Friday and was taken to Perth Children’s Hospital the next day, but had to wait about two hours in the emergency department before she received treatment. She died soon after from a bacterial infection. An internal report into the tragedy made 11 recommendations — including improvement to the triage process, a clear way for parents to escalate concerns and a review of cultural awareness for staff — but Aishwarya’s parents said the report raised more questions than it answered. The family wants a broader independent inquiry to look at all 21 near-misses in the past 15 months – not just their daughter’s case. Some people have been referred to medical authorities, while Child and Adolescent Health Service chair Debbie Karasinski resigned after the report.' I am encouraged to see the way healthcare staff reacted to this tragedy. Imagine a similar event in England, would nurses protest outside the hospital and stand up to authority like this? I doubt it very much, which is very sad reflection on the prevailing culture and health leadership in England. What do others think? Source: The Australian. 9 July 2021 Picture: Picture: 9 News
  14. Content Article Comment
    I am delighted to see Bernie Rochford recognised with an MBE and recommend people to read Bernie's story.
  15. Content Article Comment
    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..
  16. Content Article Comment
    Thank you Dan, and everyone who has contributed to this discussion. So much to reflect on. Three things stands out for me right now, The lack of suitable community based (long-term) therapies. Diagnostic overshadowing. 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.
  17. Content Article Comment
    An interesting development: 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
  18. Content Article Comment
    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.
  19. Content Article Comment
    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.
  20. Content Article Comment
    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: 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.
  21. Content Article Comment
    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
  22. Content Article Comment
    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
  23. Content Article Comment
    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
  24. Content Article Comment
    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.
  25. Content Article Comment
    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.
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