Star Chamber

Is the Welsh NHS in serious financial trouble? I don't mean in terms of not having as much money as it would like (that would not be news!) but rather is it living within its means?

I'm not a health economist but I think there is cause to worry. Today the head of the Welsh NHS David Sissling has sought to reassure us by letting us know he's stuffed a big wad of fivers (£50 million) under the mattress in case things get sticky - see the story here. But the Wales Audit Office has said there could be as much as a £130 million deficit by the end of this financial year. Meanwhile only a few days ago the Assembly's Finance Committee expressed extreme scepticism about the Local Health Boards' ability to stay within budget this year.

I suppose we should be reassured by Mr Sissling's prudence in setting money aside but the trouble is that the LHBs know about it and will find it difficult to resist spending it even before it has been allocated. This runs the risk of resulting in that perennial unfairness where a well-run LHB can end up getting less money overall than a badly-run one - talk about perverse incentives!

It is reassuring that the Minister is talking about three year strategic budgets which could make for better planning but there is no substitute for rigorous control and holding LHBs - and their Chiefs and Directors of Finance in particular - to the fire when it comes to financial management.

I trust Mr Sissling will grill senior NHS execs mercilessly in his Star Chamber to ensure compliance with budgets. It just isn't acceptable for NHS organisations to overspend - by so doing they don't enhance health care but damage it, skew priorities, and make more work and waste more resources in sorting it out.

All this reinforces my view that the ring-fence around NHS funding for mental health services is vital and we need to see transparency and consistent adherence to the ring-fence across Wales. This will take time but meanwhile if anybody notes any reduction or withdrawal of NHS funding from any mental health service (however much that may be justified) they should immediately challenge the LHB concerned to explain what other mental health service (enhanced or new) will be the beneficiary of that saving. Don't accept any argument that "mental health has to contribute its share of the savings we have to make" - the ring-fence makes it clear that the funding for mental health cannot be reduced.

For clarity the ring-fence does not (and should not) protect all existing services - some of which may need to give way to new priorities in mental health - but it does protect the funding - hence my point that the LHB must have answers to the questions which I suggest you ask.

Oh, and let us know if you hear about withdrawal of funding so we can also raise those questions...



See below this Blog's favourite monarch, canny Welshman Henry VII, presiding in his Star Chamber which he used to shake down the English aristocracy in order to enhance public expenditure (well, his expenditure really but then he would have said that's the same thing)

Shameful Injustice

An independent inquiry commissioned by our friends Rethink Mental Illness into the state of care for people with schizophrenia and psychosis in England is calling for a widespread overhaul of the system. See our story plus links to the report here.

It says too much is being spent on the most expensive form of care, secure care, and more should be invested in prevention and community support.

The Schizophrenia Commission says care of people with schizophrenia and psychosis in England is falling "catastrophically short". It says improvements in the understanding and treatment of the condition mean it should no longer be considered a "diagnosis of despair".

Their report, "An Abandoned Illness", describes "shameful" standards of care on some acute mental health wards, which can "make patients worse rather than better". It calls for every ward in England to be brought to a standard where people would recommend them to a friend or relative: spot on - that is exactly the standard which Hafal invites people to apply in assessing services.

The report also highlights the disparity between the money spent on people with physical illness and those with mental illness; only 13% of the English NHS budget goes towards treating mental ill health, even though 23% of conditions dealt with by the NHS are mental rather than physical. It also expresses concerns that highly effective early intervention treatment teams are being cut in some areas; these are estimated to save the NHS £16,000 per person over the first three years of their illness.

My opposite number Paul Jenkins, CEO of Rethink Mental Illness, who sat on the Commission (though he found time too to join us climbing Snowdon in September!), tells us: "It's been over 100 years since the term "schizophrenia" was first coined, but care and treatment are still nowhere near good enough. It is a scandal that in 2012 people with schizophrenia are dying 15-20 years earlier than the general population and that only 7% are able to get a job. Too many people are falling through the gaps in the system and ending up in prison or homeless."

Sadly there's no reason to suppose that the experiences of people with schizophrenia and psychosis in Wales are any better than the experiences of those in England. Indeed in some respects the redevelopment of the in-patient estate in Wales lags behind England. This excellent report is a reality check.

We now have good legislation in Wales and a new mental health Strategy but the truth is that there remains a huge amount of work to do to put right the shameful injustice of how people with a serious mental illness have been treated. Above all this report tells us that the priority is to devote additional resources and effort into providing a decent service to people with the very highest needs.

Uncle Joe

I got up to go to the gym on Saturday morning and almost immediately abandoned the idea. It had been a long, if enjoyable and successful week and so I spend most of the day on the sofa.

On Sunday I do a brisk walk early morning and manage to climb above the mist into bright warm sunshine. After that I enjoy reading (vaguely appropriate for Remembrance Sunday) about the gangsters, con-artists, spongers, tarts, foreign royalty and toffs who hung out in the grandest hotels of London during WW2 in Matthew Sweet's light-weight but amusing The West End Front.

My favourite story is of the 40 members of the Communist Party led by Max Levitas who demanded access to the Savoy's very posh shelter during a bombing raid in September 1940. The police wanted to evict them but the hotel manager wisely let them in and the waiters served them tea for which the occupiers paid at Lyons Corner House rates. The whole affair was politely conducted on both sides - and hushed up in the press (apart from the Daily Worker).

The CP was at that time in a strange position as their ideological masters in Moscow were still allied with Hitler, an embarrassment which was only removed in June 1941 when 4 million Germans marched into the Soviet Union and everybody had to start loving Uncle Joe.

The Communist Party lays a claim to helping Londoners during the blitz by campaigning for deep shelters and this may have assisted in getting the London Underground opened up for this purpose although this is usually ascribed to ordinary Londoners anarchically forcing access and even breaking down the gates - not unreasonably you have to say.

More Fish In The Sea

The Wall of Death experience:-
Stage (1) Starting out. Fear factor 5/10; dignity intact...


Stage (2) On the way up. Fear factor 8/10; dignity still intact...


Stage (3) Reaching the top. Fear factor 10/10; dignity still intact and momentary signs of respect from the audience...


Stage (4) Rapid descent. Fear factor 0/10; dignity shattered by inelegant landing; all signs of respect dissolve in audience laughter...


The "Summit" event yesterday was moving, celebratory, informative and great fun with over 200 attending and massive enthusiasm for all the activities ranging from the frivolous all the way to earnest workshops on medication, psychotherapy, benefits and criminal justice plus rallies for patient and carer activists respectively.

This was a great way to celebrate the culmination of our hugely successful Movin' On Up campaign which brought Hafal together with our partners Bipolar UK and the Mental Health Foundation to fight for a good deal for people with a mental illness and their families.

A fantastic job done by Emma and other stalwarts who heroically still kept their sense of humour long after the show had ended as the vast collection of display matériel was carefully dismantled and loaded onto various vans and trucks. I'm notoriously unhelpful at this stage of proceedings but tried to assist the incredibly painful winching by hand of the VW campervan onto its trailer (you didn't think we drove it around, did you?) only to find that media-man John Gilheany who was steering it up the ramp had left it in gear!

More pics today and next week here.


Postcript:

John is quickly forgiven, not least because he had earlier sung a ballad of his own composition as part of the event's closing session, also including the "Voice of Hafal" Rikki Withers and, a new discovery, Andrew Macintosh - better known as our IT guru and guardian of the sacred VW (few staff in Hafal get away with doing just one job).

I'm surprised to find that John's song is a poean to Hafal's corporate progress with the refrain "There's more efficiency" until I realise that I have misheard what is actually a rather classy piece about unrequited love - the refrain is in fact "There are more fish in the sea".

The "Voice of Hafal" plus John G. (see above)

High Heels

We are gearing up for tomorrow's conference to mark the culmination of our Movin' On Up Campaign - inevitably the event is styled as a "Summit" (geddit?).

Hafal Events Coordinator Emma Billings tells us: "Two hundred delegates, most of them people with a serious mental illness and their families, have already booked to attend the Summit. They'll have a unique opportunity to share experiences with people from other areas and to celebrate the success of this year's campaign which has been praised by Health and Social Services Minister Lesley Griffiths AM."

Activities at the Summit include:

• Workshops on welfare reform, psychological therapies, medication, and care and treatment planning

• A Carers' Forum and Users' Rally

• Updates on Hafal's Learning Centre and Criminal Justice services.

More worryingly there is also...

• Scaling a mobile climbing wall

• Zumba and Tai Chi workouts

The trick if you want to avoid these physical activities is to wear impractical clothes (perhaps a ball-gown or top hat and tails?) and then plead that sadly you have forgotten to bring suitable attire.

Although, now I think about it, Emma was observed (at the Seminar back in May which launched the campaign) climbing to the dizzy summit of our massive "wall of death" in high heels, an impressive achievement the more so because it was done elegantly and without loss of dignity. Sadly no pictures can be found (where have you put them, Emma?) so we'll have to make do with a repeat picture (above) of our Mental Health Foundation partner David Crepaz-Keay climbing the same wall - but without high heels...so big deal!

Moustache

I'm pleased to announce a new secret weapon in the battle for resources: step forward GP and academic Simon Braybrook who has offered out of the blue to grow his moustache in support of Hafal. Now don't hesitate - get your credit card out, dust off the cobwebs, go to his Justgiving page on this link, and max out your limit with a generous payment which befits Simon's noble effort and (of course) the even nobler cause.


Postscript:

Following my suggestions for a budget-but-quality Christmas last week, including mention of the Aldi Christmas pudding at £7.99, former Hafal Chair Peter Davey contacts me to draw attention to rival purveyor of fancy goods Lidl's Snowy Lodge Luxury Christmas Pudding which he describes as "rich, packed with vine fruits, glacé cherries, and with a hint of sherry, brandy, and whisky". It's a whopping 750 grams for (wait for it) £2.99. Thanks to Peter for his canny advice (could there be a Davey ancestor from Cardiganshire who migrated to Merseyside? We may even be distant cousins) and I would add to his tip that while you are in Lidl you can pick up a keenly-priced bottle of brandy with which to set fire to this irresistible delicacy.

P C World

I have frequently used this Blog to urge everybody to use your vote in various elections both so that you can influence the result one way or another but also as a bit of self-therapy - it does you good to know you are ultimately in charge and can hire or fire the politicians.

I suppose I do again urge you to use your vote in the elections for Police and Crime Commissioners on 15 November but I can't say I do so with unqualified enthusiasm. My lack of excitement about this isn't because I don't support the principle of democratic accountability for policing. On the contrary I have long thought that many senior managers in the police have had a tendency to run their forces with an eye to public relations considerations, the classic resort for organisations which are not sufficiently accountable.

Note that this is not a criticism of the police or of their Chief Constables - indeed I speak as a solid supporter of the police whom Hafal's members consistently see as the most reliable agency among those tasked with helping people with a mental illness and their families. No, it's the politicians who are responsible for getting the lines of accountability right.

My view is that the new system might be nearly right for England although it has got off to a bad start and turn-out in the elections may be very low. However, in Wales it makes no sense. It is glaringly obvious that Wales should have just one police force - you may recall that there was previously a plan for this (former Home Secretary Charles Clarke said a single force for Wales was the "only acceptable option") but it crashed and burned because of a lot of flak about "localism" mainly fired in England; further, it is also glaringly obvious that we should make use of the existing Welsh democratic structures, namely the National Assembly, to hold policing accountable. I mean the National Assembly and not the Welsh Government: the Assembly is not the Government but holds the Government to account and that's right for policing too.

Oddly enough you would not necessarily need to devolve policing to Wales at least in the short term - the National Assembly could serve as a Police Authority under the present arrangements with the (London) Home Office still holding overall authority for police matters, although if it worked the argument for devolution could be made.

An important advantage of a single force is that it would be able to perform specialist functions more effectively and efficiently. Mental health liaison naturally comes to mind: an all-Wales force could afford a specialist team led by a more senior officer which could work effectively with mental health services and the courts.

While we waste time voting for multiple Police Commissioners in tiny Wales the Scottish Government is setting up a single force (in a country twice the size of Wales!) and those with expertise in these matters see no reason why it shouldn't work well and save money.





Postcript:

What would you call an all-Wales police force? This was discussed back in 2006 when the idea was still alive and I recollect that "Heddlu Cymru - Wales Police" was suggested but my favourite was just "Heddlu". Everybody in Wales except perhaps a hermit living in a deep cave in remotest Snowdonia knows what "heddlu" means and no other country is likely to copy it - unless there is a devolved force in Patagonia? And "Heddlu" (the root of which is of course "hedd" meaning "peace" so happily "heddlu" means something like "peace-corps") would be superior to the Irish "Garda Síochána na hÉireann" ("Guard of the peace of Ireland") which is a bit pompous and militaristic - not to say extravagant in sign-painting costs.

PPS:

During the recent riots Welsh police vans were observed with alarm on the streets of London (see picture above) as the local twittersphere wondered what the letters HEDDLU stood for, presumably a sinister Stasi-like instrument of state oppression?

Elizabethan Taffia

A weekend of exercise - two gruelling hours in the gym on Saturday and 12,000 steps recorded on the pedometer while walking in the Towy valley on Sunday morning (see above) - after which on Sunday afternoon I settle down as the rain and wind take hold outside to finish reading A.N.Wilson's The Elizabethans undisturbed by the cats who are to hand but entirely supine.

Wilson's book is great. I've read a lot of stuff on the Tudors but this explores some surprising sources (new to me) and overall has a refreshing and slightly provocative approach which is sometimes very amusing, a contrast to the work of, for example, David Starkey who is owed our thanks for invigorating history after years of Marxist tedium but is still rather self-important - he is condescending to his subjects and leaves you in no doubt that if he had been them he would have made better decisions.

By contrast Wilson respects the key players, not least Elizabeth herself, and gives a convincing analysis of their strengths and weaknesses. One intriguing theme in the book is the notion that a Welsh Taffia (Wilson uses the term) was quietly running the kingdom.

Wilson is evidently one of those rare English people who respects the Welsh and their place in history (whereas Starkey has said that Welsh history is just English history if you start from any date that matters!). Wilson points out that the Queen was very Welsh herself, not that she had a lot of Welsh blood but that's not the point of course - she was like her grandfather Henry vii who was cunning, far from headstrong, indeed slow to make decisions except when forced to (as at Bosworth; Elizabeth's equivalent was the Armada), cautious in the extreme with his resources, prepared to play the long game, but in the end courageous. This is mostly the opposite of the stereotypical English character but the underlying point which Wilson makes is that the approach actually worked for both monarchs.

At the heart of the Taffia were the Queen herself and (each side of the "work-life balance") the Cecils (father and son) who were essentially her prime ministers plus Blanche Parry (the Cecils' cousin) her Chief Gentlewoman of the Privy Chamber who was a Welsh-speaker and an influential confidante on matters well beyond the household.

Of course the Queen had other influences, not least her tutors appointed from fellows of St John's College, Cambridge, who helped her to become an accomplished classicist who could hold her own easily with the leading academics of her day; and she learnt a little Welsh too - so I'd call that a good all-round education. It is a happy and entirely plausible thought to imagine the Queen cracking discreet jokes in Welsh with Blanche during formal audiences.

Willy-Nilly

Excellent interview with the Government's mental health Strategy lead Sian Richards here, including a useful answer on the critical issue of the ring-fence...

Q: The current economic climate is very harsh. What does the Strategy say about ring-fencing money for mental health services and protecting existing resources?

A: "Together for Mental Health" reaffirms the commitment made by the Minister for Health and Social Services to the mental health ring-fence, ensuring that mental health funding is protected in these challenging financial times. It sets out clear expectations that Local Health Boards’ expenditure on mental health services must be open and transparent and signals a review of the effectiveness of the ring-fence. Spending on mental health remains the largest single area of the health budget.


The great thing about the ring-fence (so long as it's enforced!) is that it can embolden planners of mental health services in the NHS to reform their services without the risk that their Directors of Finance grab savings when redundant or time-served services are exposed.

Without the ring-fence mental health insiders are more likely to protect existing services willy-nilly even if they are out-of-date on the basis that an old-fashioned service is better than none at all. In other words the ring-fence is not just vital in preserving the resources but it's also an agent for change. For clarity the ring-fence quite rightly does not protect resources for existing services but rather requires that if a service is wholly withdrawn, slimmed down, or made more efficient then the savings must be reinvested in other mental health services.

The Minister has acknowledged that it was patients specifically who persuaded her about this matter (and actually I know which ones!) - little wonder as service-users and their families are interested in the practicalities and know that the rest of the Strategy is just so many words if the money isn't protected.


Postscript:

Revered arbiter of food quality Good Housekeeping magazine has tested Christmas turkeys and the Co-op's British Elmwood frozen birds came top (Mrs Blog had already got this very brand and it's in the freezer); meanwhile the best cranberry sauce was Tesco's at £1.49 (worst was Fortnum and Mason at £10.95). It isn't true that "you get what you pay for" and my advice is to ring-fence your Christmas budget and if you make savings by ignoring snobby brands then reinvest those savings in an Aldi Christmas pud - £7.99 and GH says "delicious" and a "real bargain" (Fortnums £24.95 and "a real disappointment").