Steve Turner
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Everything posted by Steve Turner
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Community PostThank 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.
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Content Article CommentThis 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/
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Community PostAbout 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
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Content Article CommentI am delighted to see Bernie Rochford recognised with an MBE and recommend people to read Bernie's story.
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Content Article CommentGreat 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..
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Content Article CommentThank 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.
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Content Article CommentAn 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
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Content Article CommentThanks. 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.
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Content Article CommentThanks 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.
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Content Article CommentThis 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.
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Content Article CommentIn 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
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Content Article CommentSupports the argument that all consultations should be recorded. Everyone will benefit from this approach. What do others think about this? #mentalhealth #mentalhealthawarenessweek #mentalillness #bipolar
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Content Article CommentAn 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
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Content Article CommentAs 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.
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Content Article CommentI'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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Content Article CommentHere'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:
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Content ArticleThe Serenity Integrated Mentoring (SIM) model is described as "an innovative mental health workforce transformation model that brings together the police and community mental health services, in order to better support 'high intensity users' of Section 136 of the Mental Health Act (MHA) and public services." The SIM model is part of a 'High Intensity Network' (HIN) approach, which is now live in all south London boroughs. In this hub post, Steve Turner highlights the benefits and risks of this approach and seek your views on it.
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Content ArticleFor some time now I've been looking to find out more about mental health services in Trieste, Italy. Then I met Vincenzo Passante Spaccapietra, co-host of the Place of Safety? podcast series. This has enabled me to learn more about the closure of the mental institutions in Trieste, Italy, and the work of Franco Basaglia. I was keen to find out what really took place, what this really means in practice and how we can adopt this model in the UK. We were delighted to have become involved and to have recorded a couple of podcasts. I recommend this resource to everyone interested in safe, compassionate, patient led mental health care.
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Content Article CommentI 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.
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Content Article CommentRelated consultation on the RPS Prescribing Competency framework for ALL prescribers now open: https://www.rpharms.com/resources/frameworks/prescribing-competency-framework/consultation
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Content Article CommentI 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
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Content ArticleIn my tweets and posts I have suggested that patients themselves need to take more responsibility for the medicines they are prescribed. But what about vulnerable groups who may depend on decisions being made for them, and in their best interests? Whilst there are circumstances where antipsychotic (psychotropic) medicines are an appropriate option for people with autism and learning disabilities, these occasions are limited. In all cases the patient matters most, and any decision to prescribe must be part of a team based, patient-led decision, which is regularly reviewed.
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Content Article CommentSteve Turner commented on Steve Turner's article in Investigations, risk management and legal issuesI 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' : 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
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Content Article CommentThis 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.
