Friday 27 May 2011

Ponty Party

The “Taking the Wheel” campaign reached Pontypool yesterday.

Hafal's Torfaen Practice Leader Pam Johnson reports: "Our theme for the day was 'Looking after yourself physically'. We chose this theme because recovery from serious mental illness isn't just about medication or other therapies that deal directly with symptoms. These can be very important but mental health is built on much broader foundations and we wanted to emphasise the importance of physical health in relation to recovery."

Exercise and therapy sessions took place during the event and a buffet was provided. Carers, service users and key contacts in mental health services attended along with local school children.

Pam added: “Service users have been talking about the new legislation in Wales; they welcome the Mental Health Measure and hope that the new law will improve the quality of care plans.”

Pam also raised a priority concern in Torfaen: “Service users value the services which Hafal provides particularly the support we give families affected by serious mental illness. Clients would like our family support and advocacy service to be expanded as Hafal can only provide 10 hours a week at present due to lack of funding. This service has to cover the whole borough; to be honest it only scratches the surface at the moment." A useful reminder that bread and butter issues concerning essential local services need to be addressed.

Wednesday 25 May 2011

NHS Cuts...and Opportunities

Health economists indicate that Wales will suffer the biggest real-terms cut in NHS spending compared with England, Scotland, and Northern Ireland (see the story here).

A freeze in cash spending obviously does mean an effective "cut" because of inflation but we need to watch out for NHS Health Boards trying to impose cash cuts in mental health services which actually means they would be being picked on more than other services. That is not to say that savings cannot be made in mental health services but these need to made intelligently and the savings used to fund gaps in mental health services - that's what the promised ring fence means or else it means nothing.

Hafal has pointed to two distinct areas where savings could be made:

(1) "Repatriation" of high-needs patients from expensive and untherapeutic placements out-of-county or even out-of-country where this is in the best interest of the individual patient.

(2) Rationalisation of mental health teams working within the community. This would require reform of the traditional CMHT functions and approach: instead of addressing problems planners and commissioners have "worked around" the CMHTs by setting up new teams, some very good but we need their modern approach to become the mainstream in a joined-up team.

In addition medium-to-long term there is a clear opportunity to rationalise commissioning of all secondary mental health services (80% of spending on mental health) through systematic analysis of the new, universal, individual Care and Treatment Plans required from next January under the Mental Health Measure. A wise LHB Director of Finance (and their Social Services equivalent) will see these Plans not as an additional expense but rather as a focused and efficient requirement for all expenditure on secondary services. In other words if it's not in somebody's Care Plan why are we paying for it?

In this they will have the support of patients who want spending to follow their individual needs, not to be told what's available and take it or leave it.

If LHBs and local government don't see the great opportunities presented by the coming of the new individual Plans for effective commissioning and spending then patients will need to tell them...

Monday 23 May 2011

Hanging and Flogging

It is interesting that populist politicians in the two largest parties in Parliament are falling over each other to prove which is "tougher" on crime - or, put another way, who can polish their "hanging and flogging" credentials sufficiently to gain respect from the Sun's editorial team.

Justice Secretary Ken Clarke is the exception as he argues that he will continue to consider logically how crime can be reduced by reducing reoffending which is not necessarily achieved by banging people up more often and for longer spells.

It was assumed by the media and some hard-line politicians of all parties that his ill-chosen words on rape might finish him. But it is not that simple as the public too may have a more sophisticated view of these matters as witnessed by Question Time (see the story here). Nevertheless Clarke remains on shaky ground not because of the remarks on rape but because he is out of line with the prevailing attitudes to criminal justice of the old guard in both parties.

The significance of Clarke's tenure for people with a mental illness cannot be underestimated. He is the first Justice Minister to acknowledge unambiguously the pointlessness and inhumanity of imprisoning so many people with a mental illness and, though the jury is out on whether he can actually change things, his replacement with one of those "short, sharp, shock" populists could be a grave set-back.

During the Thatcher years when I worked for NACRO I met two Home Secretaries (when that brief also managed justice) of widely differing perspectives - patrician, liberal old Etonian Douglas Hurd and Llanelli-born Michael "Prison Works" Howard. But the fact was that there wasn't much difference in outcomes between these two any more than between Tory and Labour Ministers. Have things changed? Clarke probably offers the best hope in this Government but I think he won't survive long enough.


In case the above would lead you to believe that Llanelli only breeds hard-liners contrast the actions of my great, great, great, grandfather (and incidentally the father of the founder of the Felinfoel Brewery) David John, whose best friend was hanged and gibbeted for sheep-stealing in the early 19th Century. Contrary to law and at significant personal risk David cut him down at dead of night and gave him a decent burial. I'm not sure if the authorities ever caught him so please keep it to yourselves.

We too should find dignified ways to challenge the barbarity of today's system which incarcerates people with extreme psychotic symptoms causing them unspeakable distress.

Friday 20 May 2011

It Asda Be Asda

"Taking the Wheel" reached Newport yesterday to be greeted by a good crowd of Hafal Members, campaign partners and many other visitors in Asda car park - a well-chosen venue as this is veritably the modern equivalent of a public forum in urban Wales.

Hafal's Newport Practice Leader Pam Johnson said: "Our popular campaign camper van and racing simulator have been on hand for visitors to view and enjoy; visitors have been able literally to ‘take the wheel' and race in the camper van simulator which has been a lot of fun. There's been plenty of information on serious mental illness available for people to take away, too."

Pam says the message from service users that has come out of the event relates to service planning by clients both on a local and national level: "Service users run our services in Newport and today's event has been a fantastic opportunity to celebrate that and talk about the ways clients can have greater influence in the planning and delivery of mental health services in the county. On a national level, our clients are also keen to get the most from the Mental Health (Wales) Measure - the first mental health law to be passed in Wales since the tenth century - which means there's been plenty to discuss today."

More about the campaign here.

Thursday 19 May 2011

We've Won the Lottery!

Fantastic news that Hafal has been awarded £199,907 from the Big Lottery. The money will be spent on supporting our new Tŷ Adferiad Centre in Porthmadog to provide a unique service to people with serious mental illness from all parts of Wales, giving them an opportunity to step back from their lives, review their recovery goals and take part in motivational activities.

The grant means that people from across Wales will have the opportunity to spend a few days in a beautiful part of the country where their time will be split between developing their plans for recovery and getting out to undertake challenging activities in Snowdonia and the Llyn Peninsula.

This is right "on mission" for Hafal, fulfilling a particular ambition of our Trustees to extend the opportunity to make use of our recovery programme to many more people. The Centre's doors will open at exactly the right time - as the new Measure comes into force from next year we will be able to support people with a serious mental illness to get maximum value out of their new legal right to a care and treatment plan.

The project was developed through listening carefully to patients who flagged up the value of getting away from the distraction of day-to-day routines in order to take a good look at life plans and sort out how to move forward with the right balance of ambition and realism. Hmm: I think I'll book my place now...


Talking of life plans I'm doing a lot of reading at the moment as my cough keeps me up at night. I recommend The Complete Essays of Michel de Montaigne which, though dating from the 16th C, are earthy, modern, and often very funny. They are also immensely soothing as he explores practical ways to get through life which allow for weakness and irresolution and (most untypical for a French philosopher) he doesn't claim to have all the answers.

Tuesday 17 May 2011

Hands-on, Top-down, Kick-ass?

Congratulations to the new Welsh Government for calling itself the "Welsh Government" (and presumably a spade a "spade"). I remember old Rhodri Morgan introducing the "WAG" name (itself an improvement on pretending the National Assembly was running the country) saying that it was what the person in the street called it. Perhaps some did but on that argument you might equally have called it the "TBC" ("Them B*ggers in Cardiff" as I have heard it very consistently referred to ever since devolution, not necessarily with hostility, in the saloon bars of rural Carmarthenshire).

At least we never copied the original wording (long gone) used by our sister entity up north. "Scottish Executive" sounded like a brand name for a brief-case, hotel room, or possibly a euphemism for some kind of discreet "personal service".

Anyway, a warm welcome to the new Ministers including Lesley Griffiths at Health. Lesley used to work in the NHS and has also been a good supporter of Hafal in her Wrexham constituency. Arguably she has the toughest brief in the new Government as the successor to Edwina Hart's hands-on, top-down, kick-ass approach and the management structure of the Welsh NHS which demands a Minister prepared to roll her sleeves up and beat up on the senior execs and non-execs in the NHS relentlessly in order to make things happen.


Talking of Scotland there has been much referencing of Scottish national heroes since canny streetfighter Alex Salmond scooped the polls up there, among them William "Braveheart" Wallace. Sorry to be predictable but, you've guessed it, Wallace was actually Welsh. "Wallace" is just another spelling of "Welsh" and, more than that, his stamping ground is where the original British/Brythonic (ie Welsh) people got squeezed between the Anglo-saxons to the south and Picts and such-like to the north. Indeed Welsh was spoken up there for hundreds of years, possibly up to the Wallace's own time. Not for the first time the Welsh also featured in large numbers on the "English" side too, Welsh longbowmen being the "Special Forces" of those days. "Yr Alban am byth!" as Mel meant to say...

Sunday 15 May 2011

Moaning Minnie

I'm feeling pretty sorry for myself being assailed with health problems which you are just going to have to hear about (sorry!) or this Blog wouldn't be true to life.

I mentioned previously the tooth falling out and my amateur repair. This has now been replaced with a (still temporary) job and the dentist will install the permanent solution a week tomorrow - so the end is in sight but meanwhile my mouth has an alien presence in it which, inevitably, my tongue dances over obsessively.

Meanwhile I've developed first a sore throat and now a chest infection which necessitated me sleeping (not very well) sitting bolt upright last night because if I lay down it caused paroxysms of painful coughing.

As well as all that I had a glaucoma scare but that at any rate was put to bed yesterday when the specialist in Carmarthen gave me the all clear. Incidentally even if you haven't got sight problems get your eyes tested to check for this and other serious nasties. Top tip: eye tests are free in Tesco for anybody and if you need glasses they have a decent range at £10 including the prescription lenses. The Tesco optician referred me on when he spotted a possible problem.

Reading that I realise that this is all small potatoes really but thanks for listening...


Relative immobility owing to the cough leaves me time to contemplate the news. This Blog has had an occasional but coincidental focus on the wives of dictators in the Middle East (see here and here). I have also performed an important service in outing closet Welsh people (Shakespeare, Oliver Cromwell, etc) and so I feel bound to mention somebody in the news fitting both categories, namely Mrs Mubarak who has been arrested this week for corruption along with her husband the ousted President.

Susanne Mubarak is indeed Welsh I can reveal - her family comes from Pontypridd. Apparently the main charge against Mrs M is that she was scheming for her son to succeed her husband in the family business - not an unusual ambition for a Valleys mam but the lucrative business in question was not a chip shop on Gelliwastad Road but, well, Egypt.

Saturday 14 May 2011

Taking the Vale

The microbus took the Vale by storm on Friday with its message of empowerment for people with a serious mental illness. The "Taking the Wheel" campaign rolled into Kings Square, Barry, featuring not just the bus but the accompanying simulator which already has an awesome reputation having put the wind up delegates at the Seminar on Thursday.

Hafal's staffer in the Vale Rikki Withers said: "The event has a Wacky Races' influence which ties in with the campaign's motoring theme. There's been plenty of refreshments, games for children and entertainment on offer as well as, of course, a range of information available on serious mental illness.

"The message from service users that has come out of today's event has been that the power balance between service users and professionals needs to change. We hope the rights given to clients by the new Mental Health Measure will even up the situation."

For more on the background to the campaign see this link and check when the bus and simulator comes to your town here.

Friday 13 May 2011

Campaign Has Wheels

Chris Eastwood, Hafal's Vice-Chair; Elin Jones, Hafal's Chair; Suzanne Hudson, Chief Executive of MDF The Bipolar Organisation; Dr. Andrew McCulloch, Chief Executive of the Mental Health Foundation, plus me with the campaign microbus...

In spite of a nasty sore throat I enjoyed our Seminar yesterday which was wholly facilitated by users and attended by the great and the good of mental health services in Wales. It was striking how decisively the event left completely behind all the tokenism and patronising attitudes which still beset many efforts to achieve real user involvement.

The tone was set by our Expert Patient Trainer Dave Smith who held the day together wittily and firmly like a nice version of Robert Kilroy Silk. From the off there was a strong sense of a meeting of equals as the 100 delegates discussed in constructive debate how to correct decisively the power imbalance in mental health services.

I was very happy to take a back seat (especially because of the sore throat) only getting my oar in at lunch-time when I and the two other partner Chief Executives spoke about why our organisations were supporting users in running the campaign which will see the “Taking the Wheel” VW microbus and rally simulator travelling through Wales this summer at 22 county events to spread the word about empowerment.

"Taking the Wheel” is a service-user led campaign which will empower mental health service users to take more control of their lives and the services they receive. “Taking the Wheel” will empower people with serious mental illness to:

- Take the driving seat in managing their own recovery from mental illness

- Make use of their new rights under the Mental Health Measure

- Make choices about the care and treatment they receive – and who provides them

- Develop and manage services themselves

- Engage with the providers of mental health services so that they can get more involved in planning and commissioning those services

Click here to find out when the campaign is near you.

The MHF's Dr McC turns out to be a vintage VW fan and courageously takes the wheel in the simulator - not for the faint-hearted...

Tuesday 10 May 2011

Healthy Scepticism

So Carwyn Jones has indicated he will go ahead without a coalition partner, as neither a minority nor a majority government (they got 30 out of 60 seats). This will make for simplicity in some respects but possible difficulty if the opposition parties gang up on him. Carwyn has wisely made respectful noises towards the opposition - see the story here.

We await the announcement of Ministers with interest. I reckon it's evens on Edwina Hart remaining at health. If she doesn't then it's anybody's guess but I hope it's somebody tough enough to take on the NHS vigorously. Edwina's formula for the Welsh NHS - no purchaser/provider split, minimal market forces, and the Minister personally whipping the senior managers into shape - arguably requires somebody of her particular energy (and healthy scepticism about producer interest among senior bureaucrats) to make it work.

Patients surely don't want an NHS run by the NHS Confederation (the "trade union" of health senior execs and non-execs) worthy though many of its members undoubtedly are.

Monday 9 May 2011


Not very active this weekend although I did do something for the first time, namely perform reconstructive dental surgery...on myself. Half a tooth fell out last week and my dentist wouldn't see me until today, necessitating emergency action using a little kit you can buy from Boots. Carefully following the instructions I manage to repair the tooth temporarily - it takes about 10 minutes so Mrs Blog suggests I send myself a bill for £350. Enough information.

More appealingly I read a whole book over the weekend, James Shapiro's "Contested Will" all about the "controversy" over whether Shakespeare wrote the plays and poems ascribed to him. I've never previously taken an interest in this because no serious Shakespeare expert has ever doubted WS's authorship. Shapiro is a serious Shakespeare scholar and doesn't doubt the history but wrote the book as an examination of the strange phenomenon that is "Antistratfordianism".

It is one of the funniest books I've read in ages because the supporters of Francis Bacon, the Earl of Oxford, Christopher Marlowe, etc as the real authors tied themselves up - and still do - in hilarious knots to overcome such difficulties as their man dying long before Shakespeare's last plays were written. In Oxford's case it is asserted that the plays were written earlier and then drip fed later by a secret cabal; whereas Marlowe apparently didn't really die in that Deptford knifing in spite of there being an inquest!

But the book reveals some deeper, stranger aspects of this obsession with the authorship. Delia Bacon (no relation), who championed Bacon as author in the 19th C., was motivated by a curious religion-driven republicanism and ended her days in mental hospital. John Looney (the name has of course attracted much derision which Shapiro rightly deplores) argued for Oxford up until his death in the 1940s: his motivation was a religion-driven "retro-fascism" which required a return to feudalism and dealing with the "Jewish question".

Given this last, sinister matter it's a surprise to find Sigmund Freud to be a supporter of Looney's daft theory, though Freud's motivation seems to have been that it must have been Oxford because Hamlet must have been written after the death of the author's father (which fits Oxford but not Shakespeare) as the play was clearly motivated by an Oedipal crisis following that death - Blimey!

One consequence of Freud's Oxfordian position was a falling out with his biographer and the only English-speaking member of his inner circle, Ernest Jones. Jones, an early Welsh nationalist and one of the world giants of psychoanalysis and psychiatry generally, had rescued Freud from Austria when the Nazis took over but refused to take the theories about Shakespeare seriously, to his credit. But Jones (who had a skeleton in his cupboard from his early career which haunts his reputation to this day - look him up here though I think this Wikipedia life is a bit too kind to him) agreed with Freud that Shakespeare has much to teach us about the unconscious mind.

Perhaps the strangest thing of all about the authorship question is the almost hysterical mass interest in the phenomenon which sucks in quite eminent people even now despite the clear evidence. A bit like creationism or homoeopathy I suppose.

Friday 6 May 2011


It will be interesting to see what Labour does having narrowly failed to get a majority in the Assembly (see the full results here). If they govern without a partner then there could be trench warfare in the Assembly and lots of opportunities for campaigners like Hafal to persuade individual AMs to use their considerable leverage in those circumstances to change things. If they have a partner (Plaid presumably, though you never know) then campaigners will continue to have the two bites of the cherry we've been used to in recent years - I mean in the sense that you can try things out on both governing parties.

Either way it looks like fertile territory, not least for Hafal's Assembly lobbyist Junaid Iqbal who will be introducing himself to the new boys and girls and welcoming back the old hands.

The other unknown is quite what the Assembly will do with its new powers. The Labour manifesto offers clues but you wonder whether there will be more in terms of restructuring of local government, education, etc.

The downside of a government without a comfortable majority is the difficulty of making painful but necessary reforms. Will any government be able to address the elephant in the room - 22 counties in a country with half the population of Yorkshire? Of course the other elephant (22 Local Health Boards) has already been shooed off by the formidable Edwina Hart...

But back down to earth let's remind ourselves what Labour said about mental health in their manifesto. They promised to:-

• Use the legislative powers delivered by the Mental Health Measure to
ensure modern, user-focused care is consistently in place.

• Provide every patient with an individual care plan, informed and approved by them and their carers.

• Review access to the range of ‘talking treatments’ across Wales.

• Ensure access to crisis intervention teams.

• Raise awareness of mental health issues amongst employers and employees so that those with mental health problems can gain and retain employment.

• Continue to improve care and support for people with dementia and their families.

• Continue to reduce the time between the onset of symptoms of dementia and diagnosis.

• Continue to move away from institutionalised environments, focusing on effective community-based care, other than in the most serious and exceptional circumstances.

• Introduce a dementia care awareness programme for all healthcare professionals in Wales, ensuring that general care on hospital wards responds to the prevalence of dementia from a growing elderly population.

Some useful stuff here but we'll need more...

Thursday 5 May 2011

And They're Off!

Today I attend the first of 22 local events in our joint summer campaign with our friends in MDF the Bipolar Organisation and the Mental Health Foundation.

The campaign will be launched nationally next week at a patient-run Seminar but today's advance event gives us the chance to trial our brand new rally simulator and escape the tedium (sorry, I mean of course "excitement") of the National Assembly election and AV referendum - see several previous posts and take another look at Dave Smith's fantastic Manifesto which has attracted a huge response from candidates of all parties and from the public.

There is a big turn-out and the rain mainly holds off until the end. The rally simulator is a major hit although one visitor almost collapses giddily into my arms as she leaves the booth - and she was only watching! Personally I find it terrifying but maybe I should secretly practise on a gaming machine at home so I can fearlessly impress at a later date? Meanwhile in spite of the competition from the ballot we get good media coverage including a slot on the Wave which allows me to puff the whole summer campaign.

So what's it all about? The campaign, led by service users, will empower patients to...

• Take the driving seat in managing their own recovery from mental illness
Service users will learn from other service users how to self-manage, take the lead on care planning and adopt a positive and progressive approach to improving their lives.

• Make use of their new rights under the Mental Health Measure
Service users will gain key new rights under the new Mental Health (Wales) Measure: the campaign will raise awareness about these new rights among service users – and highlight how they can make the most of them.

• Make choices about the care and treatment they receive – and who provides them
The campaign will raise awareness of the ways in which service users can be
empowered to make decisions about their care and treatment and exercise choice when accessing services – for example, by using Direct Payments or by selecting from a choice of providers.

• Develop and manage services themselves
Peer-led services are proven to be effective because service users can identify with those delivering the services. The campaign will encourage participants to be more ambitious about developing and managing services themselves.

• Engage with the providers of mental health services so that they can get more involved in planning and commissioning those services
“Taking the Wheel” will encourage service users to make their voices heard and engage in the running of local services. Consumers of services know best how services should be delivered, and service users will be encouraged to take full advantage of opportunities to get involved.

See more about the campaign, including a list of events and contacts, here. I dare you to try the simulator...

Tuesday 3 May 2011

Caster and Pollacks

And so ends this miraculous period of Bank Holidays and fine weather.

In the end I multi-tasked in order both to see the wedding briefly on my brother's massive HD telly and catch fish.

On the former I make two observations. First, in a tsunami of sycophancy and uncritical puffing by oily commentators it was refreshing to see a drop of objectivity from Hafal's Chair Elin Jones (in her capacity as eminent historian and broadcaster) in S4C's commentary box offering sober and factual observations on the ceremony and pageant (by some accounts of the paranoid security operation she was lucky therefore not to be bundled into a police van for "conduct likely"). Second, at the risk of sounding unchivalrous, the whole affair confirmed my longstanding judgement that, whereas British tailoring for men, whether civilian or uniform, is second to none, British couture for women is shabby and unstylish and further (dare I say it) the choices of the variously aristocratic and establishment ladies, whether of British or foreign threads, leave a lot to be desired. Contrast elegant (and Spanish) Mrs Clegg with Prince Andrew's two...

... my case rests.

On the fishing I can report that both the "rotten bottom" and float rigs were failures but the pollack fell to a silver foil "feather" sent 50 yards off-shore by my trusty telescopic beachcaster rod (Lidl £15 including reel and some tackle) and tasted delicious simply fried in a little butter and olive oil.