Wednesday, 30 April 2014

some observations and thoughts as a spectator at yesterday's NHS Fife health board meeting in St Andrews

Yesterday I was a spectator for the first time at the NHS Fife health Board meeting in the Medical School, St Andrews.  I'd only googled up yesterday to find out when the meeting was on after hearing from another activist, at the Poverty Alliance conference on Monday, that the public could view these meetings as an observer.  And found the information on the NHS Fife website.

Where it says:

"Fife NHS Board holds its Board meetings in public every other month. In the spirit of openness and in an attempt to meet local people, the meetings are held at different venues throughout Fife. Members of the public are welcome to attend and observe proceedings and at the Chair's discretion may be invited to contribute comment."

When I got to the venue there were printed papers on seats for the public which meant I had access to all the documents.  I'd had a quick look through before setting off from home and noticed that the meeting went on for most of the day, starting at 10am, so I planned to stay until the lunch break at 12.45pm. Which I did.  I had another meeting on in Dundee at 2pm, a workshop with the Scottish Medicines Consortium.

I recorded 5 pages of notes from the board meeting in bullet points, identifying topics, who said what and quotes that stood out from my perspective, also questions that I would have raised if a participant. 

Here are my observations from yesterday's board meeting in the morning session and points that stood out for me:
  • the first topic mentioned was the chair saying targets had been met or suchlike about "managing obesity in pregnancy".  My first thought was of when I was pregnant in 1976, 1978 and 1984, with my 3 sons, and how I put on much more weight than was recommended.  It's just how it was for me.  I was enormous when other folk hardly had a bump.  Nowadays I would likely be one of the "managed" pregnant women and I don't like to be managed.
  • I noticed throughout the meeting that consulting with the public or service users or carers was highlighted as being very important. Questions were asked as to what was being consulted on, the context and clarity. I was pleased to see this highlighted.  Tokenistic and tick-box exercises are the bane of my life in trying to be "meaningfully involved" in mental health service improvements.
  • Another interesting part of the morning session was an agenda item: Person Centeredness where yesterday a carer, who was also an NHS Fife nurse (in her uniform), spoke of her experiences trying to access support for her mother who had dementia and had a crisis, a psychotic episode.  Alongside her was a community mental health nurse who also spoke.  The main point that came across was the difficulties in accessing a social worker.  In fact this point was repeated while the CMHN input was praised by both carer and nurse.  I know from personal experience of being a carer how difficult it is to access a social worker, the waiting lists.  However the continual praising of NHS by these two nurses and the bashing of social work I thought detracted from the testimony.  It came over as biased and a conflict of interest.
  • Another observation about the carer testimony was the package of care at home eventually accessed for her mother who had a "full-blown" psychosis, "tried various meds" and was prescribed olanzapine.  The nurse didn't want her mother to be put in Stratheden.  I know how she feels.  I've had 2 sons in that hospital with psychoses, and was an inpatient there myself, and it was a risky business.  It would be useful if adults with psychoses could have the option of intensive home-based care and treatment.  It could be more cost effective in the longer term and help to prevent the "revolving door" scenario that is often the outcome for psychiatric patients in Fife who experience a psychotic episode and are mentally incapacitated, whether due to life circumstances or to neuroleptic drugs/medication.
  • Another question I have about working with a person experiencing psychosis: what about a clinical psychology intervention?  I noticed the head of psychology was present at the Board meeting but had no input to this conversation or in fact to any of the morning's proceedings.  I would like to see psychological therapies available for people experiencing altered mind states or psychoses as a first choice rather than drugs or nothing.  Psychiatric drugs are problematic in the longer term, causing physical health issues and disability, shortening lives.  It's not fair that mental health treatment continues to be the "cinderella service".
  • Next agenda item was the Health & Social Care Integration report by the lead officer in Social Work. I thought this was rushed through and would have liked more time spent on it but I suppose it was a health board meeting and not a social work one.  I want to study this report as it mentions their "organisational development approach" which on first reading seems to say all the right things, use all the right words but will it do what it says on the tin?  Eg "embed patients/clients and their carers in the decision making process".  How are they going to do this?  My experience of social work service involvement of users and carers is not a positive one.  Therefore I'm going to study this document and ask questions of the lead officer as to how they are going to implement the strategic objectives.  And I will keep on asking until I get a response.  I've learnt to be persistent when engaging with Fife public service managers.
  • Being a health board meeting the comments and input from the councillor on the committee, in a sense the odd one out, were a challenge to the group "norm" and he used phrases like "cuckoo land" when talking about budgets and overspend of £8million by NHS Fife.  When of course the Fife Council social work also has an overspend of £10.7million plus.  So tit for tat in terms of going into debt.  I think that it requires a persistent attitude to be the only council rep among health workers.  So well done to this councillor for sticking to his guns.  The other council social work high heid yin only came in to deliver his bit quickly then left.  You might describe it as ducking and diving.  There's no doubt that social work services nationally as well as locally are being targeted for criticism, and I heard this from the MSPs themselves at the carers parliament in 2012. 
  • I found that statistics were a major part of the Board proceedings but these don't show the whole picture and are only useful when the feedback from customers/patients/carers is equally taken into consideration.  Qualitative as well as quantitative feedback.  Complaints processes need to be robust, staff accountable for their actions.  In Fife psychiatric settings I haven't found this to be so.  Resulting in human rights issues and bad practice.  When patients are mentally incapacitated by an emotional crisis, mental health condition or psychiatric drug treatment then their critical voices may not be heard.  As in silenced.  This is where independent advocacy is needed.  Advocates who can help a person to speak up for themselves even when incapacitated.  A good advocate will get to know a person and be able to represent their views as if the person were speaking out themselves.  An advocate who isn't independent or who is unskilled will be of no use in helping a detained mental patient speak out.  In my opinion and experience.  I have advocated for people when a paid worker and for family members.  It is a crucial service that is emancipatory in its influence.
  • Finally there were other topics of interest to me like patient safety, delayed discharge at Stratheden, mention of "integrity", psychological therapies target, mental health strategy, FOI requests, MH Tribunals, serious incidents.
I found myself enjoying watching and reflecting on the proceedings, glad that I didn't have to be a member of the board.  I've never liked being on committees since the 1980's, living in Rigside, Lanarkshire, when I served on many, as chair, secretary or treasurer.  I'm more suited to writing, activism, community development, leadership and non-conformity than being a conscript and having to sit through reports and screeds of statistics that tell us little of human stories.

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