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The Royal College of Psychiatrists Improving the lives of people with mental illness

US advice and writing letters

Thursday, 8 August 2013

Advice from the USA

This week, the media has reported on Professor Don Berwick's independent review into patient safety. The former Obama aide's remedy for the NHS - and specific aspiration to zero harm - is a sensible read. It also chimes closely with what is contained in Intelligent Kindness: Reforming the Culture of Healthcare, the excellent book by John Ballatt and Penny Campling that we published in 2011. 

But the question is, will those who make policy and commission services really follow what he suggests? There is growing concern over the overall health and well-being on the NHS's 1.3million-strong workforce. Sadly, we are seeing growing numbers of doctors in the middle of their careers leaving the UK – fed up of being stereotyped as not working hard enough or being compassionate enough. And many young doctors are reporting that they can't spend enough time with their patients and that they're considering leaving the profession. 

So while it’s great to see those in high places express their support for Professor Berwick’s recommendations, yet again the proof will lie in what actions will follow. Will Professor Berwick’s recommendations he be empowered to track and monitor the recommendations he has made, or will it be left to the myriad of newly-created systems to do this? I want to hear what policy makers and employers will do to improve the wellbeing of the workforce - which will in turn make the workforce more likely to deliver safe, effective and compassionate care.


Writing letters


As I reported in my blog last week, I've been writing a series of letters to the editors of national newspapers. I've been delighted to have letters published on minimum pricing for alcohol, plain packaging for cigarettes, internet pornography, payday lenders, and child abuse and neglect. Today', I've sent another on the £500m bailout for A&E departments and what I believe is the real problem behind the crisis - the lack of investment in mental health services and the demise of liaison psychiatry services. This means there is less support for vulnerable groups, including older people with dementia, those with addictions, people who self-harm or are in distress, and those with long-term mental illness at risk of relapse. Unable to access the care they need, these people often present at A&E departments in need of urgent help.

Mental health services were – and still are – an easy target for NHS cuts. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), but only receives 11.9% of the NHS budget - which is why our College has been doing so much work around parity of esteem for mental health. The government and decision-makers need to increase investment in mental health services, which will go some way to taking the pressure off our beleaguered emergency departments.

And it's not just me who's putting pen to paper. I was very interested to read the numerous letters from psychiatrists and services users in today's Guardian, written in response to Will Self's controversial article in Saturday's Review section - 'Psychiatrists: The Drug Pushers'.

I encourage all of you to consider adopt the "pen and quill" approach too, and write to your local, regional or national paper when you see coverage of an issue that sparks your interest. It is a great way of getting positive messages about psychiatry and mental health out there - and I believe it will get a response.


If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

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Re: US advice and writing lett

I strongly agree with the president’s emphasis and comments on the dilemma of hard working doctors whose efforts and good work is less acknowledged in NHS. The fault also lies with some of our colleagues in management roles who are leaving their colleagues in the hands of non- clinical managers. I was shocked to hear one of my senior colleagues mentioning recently that he had an adverse comment on his performance when in fact he had done almost thrice the appraisals than last year that had impacted on his face to face clinical encounters. Two of my colleagues have moved over to their home countries and a few are looking for greener pastures in middle east (salaries upto 3.5 times) and across the Atlantic.

I am not convinced whether Human Resources/ Medical staffing have kept themselves aware of changing equations in the near future considering Obama’s new Medicaid proposals and growing health needs of emerging economies and developed countries (Canada eg).

Sincerely yours

Rotherham Doncaster and South Humber NHS Foundation Trust
Extranet: (NHS Only)
Re: US advice
I think Don Berwick has written a great report.
1. ".... the NHS is a world leading example of commitment to health and health care as a human right". Elsewhere that the NHS is part of the fabric of our society. No mention of it as a business.
2. "NHS staff are not to blame". In most cases when there are patient safety problems it is the working conditions - staff shortages are mentioned. "Trust the goodwill and good intentions of the staff".
3. Staff should be respected and valued and not fearful for their jobs.
4. The emphasis on life long learning reminds me of NHS exhortations before Mrs Thatcher's "Working for Patients" in 1989 and is most welcome. The implication is of job security, "career-long help to learn...", maybe even a 'job for life' which became a reviled concept in the NHS competitive business model. Consultants' Supporting Professional Activities sessions, originally 2.5 sessions per week, have disappeared from current job descriptions/plans.
5. The best way to reduce risk is to focus on the overall quality of the service. "Risk assessments" have wasted millions of hours of staff time. Targets and costs have become the primary foci of attention. HSMRs should not to be used to generate league tables.
6. In contrast to the current low morale and fearfulness, foster an NHS culture that is "buoyant, curious, sharing, open-minded and ambitious".
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