Wednesday, 10 February 2016

Who Cares About Gay Mental Health?


On the 29nd January the charity PACE suddenly closed because of lack of funds. (1)

PACE opened in 1985 to “support LGBT+ people to manage the difficulties they face in their day to day lives; at work, school and home.” (2) To LGBT people in London, PACE provided counselling, advocacy, training, youth work, research and mental health support services.

This wasn't high profile or glamorous work, it certainly wasn't work that made it into the headlines of many newspaper articles, on even online articles, but it was still to many LGBT people PACE was a lifeline. The singer Will Young became a patron of the charity after being involved in some of its workshop (3). But even a celebrity patron wasn't enough to save PACE.

The deep cuts to Local Government funding have deeply afforded many small charities like PACE, charities that relied on grants and funding from Local Authorities. Especially charities, like PACE, that provide services that are not popular or are not seen as “warm” and “cuddly”. Mental health charities always have problems raising money from public donations.

Unfortunately the need for organisations like PACE has not gone away. To be Lesbian or Gay now is very different then it was back in 1985, we have marriage equality, employment protections, equality protections; and yet many things remain the same.

Will Young has talked about the shame he felt over being gay, shame that he internalised growing up with the homophobia around him. “I will keep coming back to shame because it’s such a fundamental thing,” he said. He described a circle of drinking, sex and watching porn until he finally overcame it (4).

Olly Alexander, the 25 year old singer of Years & Years has spoken of the problems he had coming out as gay. He felt repeated pressure to be heterosexual, was bullied for being gay and at 19 he sort counselling for anxiety. But since coming out Olly has added that his anxiety did not automatically go away. “Once you admit to yourself and the world that you’re gay, there’s an expectation that you put on yourself: you’re fine now, you’ve gone through the whole thing of being gay, and now you have to prove to yourself that you can live a happy life and be happy,” he said. (5)

Homophobia doesn't just affect those coming out as gay; it can affect someone at any age. Stephen Fry recently opened up about low and suicidal he felt after coming face to face with a “frothing” homophobic politician. In 2013, while making a documentary, he had a heated interviewed with Simon Lokodo, a Ugandan government minister. Lokodo said gay sex was “worse than child rape”, amongst other homophobia. Stephen Fry stood by his opinions during the interview, but afterwards fell into deep disappear and depression. Lokodo's homophobia tipped him over into a suicide attempt that night (6).

The year 2014-15 Home Office figures saw a 22% rise in homophobic hate crime (7). In England and Wales there were 5,597 homophobic hate crimes were reported, but this figure is probably only a quarter of the actual homophobic hate crimes committed. Only one in four hate crimes are reported to the police (7). That is over 20,000 victims of homophobic hate crimes, over 20,000 people suffering the psychological effects of being the victims of these crimes.

Homophobia hasn't gone away, and neither has its negative effects on LGBT people's lives, but due to this Government's severe slashing of local Government funding there is now one less place were LGBT people can get support and advice. The skills and expertise that PACE built up over thirty years have now been lost, and will be difficult to re-create again. Now is this benefiting anyone?

This Government's policy of austerity has already cut deep into public services, and again the services to LGBT people are the ones that suffer first and deepest. How can the Government talk about equality and supporting working people when their cuts do this?

Drew Payne.

Wednesday, 3 February 2016

Sorry is the Easiest Word to Say

On 26th January, Jeremy Hunt apologised in Parliament, over the death of a one year old boy from septicaemia. Hunt said: “Whilst any health system will inevitably suffer some tragedies, the issues in this case have significant implications for the rest of the NHS that I'm determined we should learn from." (1)

But how can he say he is “determined” to learn from it when the changes brought in his government party lead to this boy’s death.

William Mead (The one year old boy) died on 14th December 2014 from septicaemia, secondary to pneumonia. The boy’s parents had repeatedly taken him to his GP and repeatedly called to NHS 111 about William’s deteriorating health. The official NHS England report (Only published in January 2016) stated that if the Call Handler (Non-clinically trained staff who answer NHS 111 calls), who spoke to William’s parents the last time they called, had recognised how seriously ill the child was, William’s death may have been prevented (1). This is very demanding.

NHS 111 has been plagued with problems; poor staff training (3) using untrained temporary staff and poor supervision of staff (3), claims of being “dangerously understaffed” (4) and an uncomfortable lack of clinical staff (5). In January this year; Integrated Care 24, which handles NHS 111 and out-of-hours GP calls in Norfolk and Wisbech, was criticised for not publishing a damning, leaked report into their performance. The report stated that people had to wait 12 hours for a call-back, which caused significant patient safety issues, a lack of GPs employed there and the poor level of staff recruitment (2). This was over a year after William’s death.

To be cynical it always looked like NHS 111 was brought in as a cheap replacement to its predecessor, NHS Direct, but what other conclusion can be drawn. NHS Direct employed experienced nurses to triage all symptomatic callers (Any call about a person with medical symptoms) and gave them appropriate advice, these nurses were employed on the equivalent of Band 6 and above. With NHS 111 all calls are triaged by non clinical call handlers, using computer algorithms (a computerised assessment system), which seems to be a tick-box assessment. These call handlers only have six weeks training (6). They do not have the clinical experience to recognise when something is wrong, when symptoms do not sound “right”, when there are complications that increase the severity of a person’s symptoms. There are nurses available in the call centres but they don’t triage calls, they are there to advice the call handlers. There have also been whistleblower claims that NHS 111 is short of these nurses (5).

I used to work for NHS Direct (Back at the beginning of the millennium) as a Nurse Advisor. Telephone Triage (Assessing patients over the telephone) is a difficult and complicated skill, because you cannot physically examine the person so you have to carefully talk to them to get a “picture” of their symptoms. I couldn’t have safely done that without the years of nursing experience I had built up before starting that job to call on. Many of the people I spoke to had a poor basic knowledge of their bodies, what is normal and what are symptoms of illness. I do not know how we can expect non-clinical call handlers to do this complicated assessment, it is more than just reading questions off a screen.

I have repeatedly turned down offers of jobs at NHS 111 in the last four years and always for the same reason, I do not feel it is clinically safe and I don’t want to work for a clinically unsafe organisation. It may sound selfish, but I want to keep my registration as a nurse.

Unfortunately I do not see NHS 111 improving any time too soon. Jeremy Hunt has proved very deaf to the concerns of healthcare professionals and this Government has reduced their spending on the NHS (7). Are they willing to spend the money it will take to make NHS 111 a safe service?


Drew Payne

Tuesday, 26 January 2016

An Day's Honest Pay for an Honest Day's Work?

Not many people come into nursing for the pay but we do need to survive and our pay is the reward
for our dedication and professional development. At least I still hope that it is, but the evidence is rapidity evaporating.

The government has just announced that they want nurses' pay rises to be frozen at 1% until 2020, another four years of below inflation pay rises. They also want to abolish the yearly increments that nurses receive under Agenda for Change (AfC), first introduced in 2004. These yearly increments were designed to encourage professional development, as an incentive for nurses to develop within their role, to improve their clinical skills and therefore their patient care skills.

Yet again this government is attacking nurses through our pay. This plan will mean that nurses facing 10 years of frozen pay or just 1% pay rises (Many nurses didn't even get the 1% pay rise because if you got an AfC increment last year then you didn't get the 1% rise). Nurses got a 2.25% rise in 2010 and since then it has been frozen pay or a 1% rise (though not for all).

But this is nothing new, since 2004 nurses pay has fallen in real terms. In 2004 the starting salary for a Band 5 Nurse (The grade most Staff Nurses are employed on and the starting grade for qualified nurses) was £18,698 (1). Using an inflation calculator, if that salary had increased in line with inflation it would now be £26,364 (2), but it isn't. Today that Band 5 Staff Nurse starting salary is £21,692 (1), £4,672 less than the inflation corrected salary. In the last eleven years, nurses' salary has fallen in real terms by 21.5%. MPs received an 11% pay rise last year to bring their salary in line with other professionals; I do not hear George Osborm or Jeremy Hunt calling for a 21.5% pay increase for nurses to restore the pay we have lost in real terms.

Osborn and Hunt are calling for the opposite. They are saying that any higher pay rise then 1% is unaffordable. Previously there has been a lot of talk about removing unsocial hours payments to nurses too. Many people may say it is all just Government spin, but there is some truth in their claim, a very, very uncomfortable truth. Britain spends almost the least on health out of the original 15 EU countries (3), we are 13th out of the 15 countries (4), well behind countries like Germany and France.

In 2000 we spent 6.3% of GDP on health compared to 8.5% of GDP by the other EU countries. Tony Blair committed us to increasing this amount until we were equal with the other EU countries. We managed this in 2009, under Gordon Brown, when our spending had increased to 8.8% of GDP. Since then, under George Osborn's policies, the spending gap has again increased, as we fell behind the other EU countries. We currently spend 7.3 of GDP on health (compared to 10.1% in the other EU countries) and it is set to fall to 6.6% of GDP (4). Under this Government (During both terms in office) we have seen a real cut in health funding that is starving the NHS or resources – and the Conservatives promised to “ring fence” spending on “frontline care” back in 2010, they must have a definition of “frontline care” that I have never heard of.

Osborn did find an extra £3.8 billion for the NHS in his autumn statement (5), but almost of all of this (If not the total £3.8 billion) looks as if it will be swallowed up the debts already run up by NHS trusts in the first half of this financial year by the cuts to their funding (6). The Government currently has Lord Carter heading up review to find £5 billion of cut from NHS funding (7). That will certainly crawl back the amount that Osborn found for the NHS last autumn.

But how will capping nurses' pay (Cutting it in real terms) affect the NHS? 92% of the 225 acute hospital trusts in England do not have enough nurses to meet the safe staffing levels on their wards (8). Over 9 out of 10 hospitals are short staffed, they don't have enough nurses to fill all their roles. Well staffed hospitals save people’s lives (9). A study published in the British Journal of Anaesthesia found that the third of hospitals with the lowest number of nurses per patient had death rates 7% higher than the third with the most number. The Department of Health has said that staffing levels are a priority (10) yet how is cutting nurses' pay in real terms and stopping our yearly increments dealing with this shortage?

Nurses are leaving the NHS because of the low pay and the heavy, tiring workload. They are joining Nursing Agencies were their pay is higher and they can pick when they work, or else they are leaving nursing altogether for jobs that pay more. These are experienced and skilled nurses leaving the NHS and as they leave so their skills and experience are also lost. This Government seems to be doing nothing to change situation and everything they can to increase it. Are they blind?

I was a Staff Nurse before Agenda for Change (AfC) came in and I remember how hard it was with pay. Each year our pay rise was set by the Government, if we got a pay rise at all, and they were always below inflation. One year (Under John Mayor's Government) I received a 1% pay rise that was phased in over three separate increases. My pay by 0.3% each time, I didn't notice the increase it was so small. The only way to get any decent pay rise was to go after a promotion, either be promoted to the next grade on the Unit were you worked (not always possible) or else look for a new job elsewhere. The turnover of Staff Nurses on wards was terrible, it made professional development and building up staff teams very difficulty.

Janet Davies, Chief Executive and General Secretary of the Royal College of Nurses (RCN) said it best: "We have to keep the nurses we've already got...They're leaving because they're overtired - it's a bit of a vicious circle... Nurses haven’t had a significant pay rise for a long, long time, they are struggling to make ends meet. It is about time we valued our nurses." (11)

The backbone of the NHS and its biggest resource is its staff, we are the people that keep the NHS running and provide its high quality of care, so why is this Government attacking us? Cutting staff's pay in real terms is a direct attack on us. Nurses have always been a soft target for politicians because of our deep reluctance to strike and this Government is exploiting it. This is an issue we need to strike over and make sure the public know why we are doing it. Even a simple one day strike by staff not providing emergency care will deeply embarrass this Government. The very limited one day nurses’
strike back in 2014 did this.

Whether you are a nurse or not, if you were ill in hospital would you be happy to be cared for by a tired and under paid nurse? No? Then why are we tolerating another attack on nurses by this Government?

Drew Payne

Saturday, 16 January 2016

Quality or Quantity

On 21st July 2015, Gill Pharaoh died, aged 75. She was a retired Palliative Care Nurse who had written books about caring for people at home, chronic illness management and palliative care. All this has been over shadowed by the nature of her death.

Gill Pharaoh died in an assisted dying clinic, in Switzerland.

Ms Pharaoh didn't have cancer or any other terminal condition, but she was old age. At 75 she was experiencing the effects of old age on her body and her life and she didn't want the loss of ability, control and dignity that she saw ahead of her.

But this wasn't a woman acting on vanity, this was a woman who knew the realities of old age, she was a retired Palliative Care Nurse and had written books about chronic illness and dying at home, and decided she wanted to choose the time and way she died. Her death should be the wake-up call that we, as a society, are desperately overdue a sensible and adult debate on euthanasia and assisted dying.

A debate that looks at people's wishes and concerns. More and more we are finding ways to treat and manage different health conditions, and people are living longer; but not always living well. We can keep people alive longer, it is now common to see elderly people living with two or more chronic health conditions (Something that was rare even thirty years ago), but is it always right to keep people alive when we also rob them of their dignity and quality of life?

We need to debate, level-headily and calmly, the way people who wish to have control of over their lives and to choose how their lives end, comfortably and with dignity. We also need to debate the safeguards needed in assisted dying. Safeguards to prevent people being pressured or bullied into assisted dying.

A debate that listens to people's wishes and the views of people living with long term conditions and life-limiting conditions, we need to listen to the people involved first.

This debate, I fear, we'll never have, because at the first mention of euthanasia we are swamped with hysteria from our media and religious leaders. We are bombarded with talk of “Doctor Death” and old people being forced into death camps, and this is all we seem to hear. The one word that dominated the reporting of Gill Pharaoh was “healthy”, there was so little reporting of her reasons and rational. How can we have an adult debate in this climate?

Every fortnight a Britain travels from the UK to Switzerland to use one of their assisted dying clinics; of all the foreigners using these clinics Britain's make-up a fifth of them (1). These are the people who can afford and are able to travel to Switzerland.

We are long overdue a calm and adult debate about assisted dying, but in our climate will we ever get that or will we just be drowned out by the hysterical shouting, again.

Fourteen years ago my mother died from cancer. At the end of her life she stopped eating and drinking, by her own choice, because she'd grown too tired of her illness to carry on.





Drew Payne

Monday, 11 January 2016

Why I am Supporting the Doctor's Strike, And It wasn't a Hard Decision

Tuesday 12th January, tomorrow, doctors will strike and I’ll be supporting them. This isn’t us v them, this is a direct attack on my colleges, the doctors I work with.

Jeremy Hunt wants doctors to accept new contacts but these contacts are far from fair. They will radically re-write their conditions of work.

This is why I am supporting the doctors:

1 Junior Doctors are any doctor who is not a Consultant or GP. This isn't just junior House Officers but the vast majority of doctors in the NHS.

2 Under the new contact the number of hours a doctor has to work each week before they can claim overtime raises from 60 to 87 hours. Doctors could be forced to work 87 hours a week (Most of us work 38 to 40 hours a week). How can anyone be expected to work 87 hours a week as their basic hours. Do you want to be seen by a doctor who has already worked 80+ hours that week?

3 This new contract will cut doctors' pay in real terms. They are being offered an 11% pay rise but their unsocial hours payments will be cut by 25%. The new contact will say that working until 10 o'clock at night, night shifts will not begin until 1 o’clock in the morning and until 7 o'clock at night on Saturday will become part of the "normal" working work. Unsocial hours payments are rewards for working outside of normal working hours, a reward for the dedication for doing so, a reward for the loss of social and family time doing so. This new contract says that dedication is worth nothing.

4 The penalties on Trusts for making doctors work more than their contacted hours will be virtually removed. If a Trusts does make doctors work dangerously long hours they will still be fined but they will pay themselves the fines. This is no fine or penalty at all, and says to Trust managements that the government is not interested if they over work their doctors. Of the increase to contact’s basic hours and the near abolishment of unsocial hours makes it far easier to force doctors to work dangerously long hours without encoring even meaningless penalties.

5 Jeremy Hunt claims that this new contact must be brought in to move the NHS to a seven day a week service. But this is a lie! The vast majority of the NHS is a seven day a week service. As a nurse I know this is true. #ImInWorkJeremy proved the lies of Jeremy Hunt's claims.

This is an attempt by Jeremy Hunt to “break” the power/influence of the doctors, but in reality all it will do is give us even more stressed and over-worked doctors. How will that benefit patient care? It won’t, but Jeremy Hunt has repeatedly shown that patient care is not a high priority for him.

If we turn our backs on the doctors who will Jeremy Hunt come after next? As a nurse my pay has already been capped at 1% for the foreseeable future (and with inflation at over 2% this means a cut in real terms), student nurses will lose their bursaries next year and will be faced will the burden of student loans just to train as a nurse, and nurse's unsocial hours payments are already under threat. If we tolerate this who will Jeremy Hunt come after next? Everyone in the NHS has to be united.

A big deal, in the media, is being made about this strike affecting patient care, but it will not damage patient care the way Jeremy Hunt's repeatedly attacks on the NHS and the government's cuts to NHS resources have already done.

I do not want Jeremy Hunts' NHS, it will not care about patient care and quality of care, it will not care about its staff and the quality of care they are delivering (The NHS's staff are its greatest resource), it will just care about how much money it can "save" and how many NHS services can be farmed out to private companies (And they have failed again and again when they take over NHS contacts).

As doctors strike we all need to support them, and not give into tabloid lies. This isn’t just a strike over a pay, but this is a direct attack on doctors and therefore a direct attack on patient care.


Drew Payne

Tuesday, 5 January 2016

“My Own Four Walls”



At the beginning of November I fell down a flight of stone steps at work, as I was leaving a patient's home and rushing on to the next one. As I fell my left foot was twisted back under me and I landed full on it, my full weight landing on my ankle and smashing it into a stone step. In that moment I fractured and dislocated my ankle in three lands.

Apart from a lot of pain, I had to have my ankle operated on to repair the fracture, it was too mangled to heal on its own, which has left me was a lot of metalwork holding my bones back in the right place. The worst part is that I had to have my leg and ankle in cast and be non-weight bearing for eight weeks (This is now week seven).

Once home I could hobble around on crutches but I couldn't leave the house. I am not very stable on the crutches, I can only walk on flat surfaces (The pavements here are far too uneven to safely hobble along on my crutches), and I can only walk for short distances because hopping along on these crutches is so damn tiring. Ten metres and then I need a rest. For the last seven weeks I have been house bound.

Being house bound has not been fun; it has been very frustrating and isolating. I am here, in this house, twenty-four/seven. My world has reduced down the sofa in the sitting room, and occasionally the toilet when I hobble out to it. My human company has been Martin, my partner, and the television. Martin works long days and is tired when he gets home, then he gets quizzed by me about what has happened during his day. Just hearing about the world out there makes me feel I am still part of it. I watch a lot of television, far more than I ever used to. The television doesn't just pass the time, though it does and that can help, but it tells me what is happening out there, it is another thread I can keep in touch with the world by.

But I never realised how isolating staying at home all the time is. I've had days off work, even weeks off work, but I have never been so long without the usual variety of people in my life. When friends telephone me I cling onto those telephone calls for as long as I can. I want to hear about their lives, what is happening with them. My news is so limited, how many different ways can tell someone that daytime television is so crap, but they have stories to tell and they have lives they can share with me and I want to hear everything.

I can spend hours on social media, surfing through Facebook and Twitter and Tumblr, because they are filled with other people's lives. Stories of what they have been doing, what they plan to do or sharing stories from yet other people's lives. I can read those stories, past comments and for a brief moment share in those people's lives.

I don't want anyone to think that this is a pity blog. In just under a week the cast on my leg finally comes off and I start being much more mobile. With mobility will come back independence and contact with the outside world. I will be able to leave our home and will eventually be able to return to work and my old life. Not everyone who is house bound has the same release from it.

I work as a District Nurse and my job is to provide nursing care for people who are house bound. For so many of my patients the only people they see, from day to day, are us District Nurses and their carers. They can be so lonely and crave contact. I will only have a limited amount of time to provide their nursing care (Give them their insulin or other daily injection, help them to take their medication, change the dressing to their wound, etc...) and they emotionally cling onto me, making conversation, asking me question upon question. I'm never cold or brisk with my patients, if anything I talk too much with them, nursing someone you become involved with their lives, especially with the patients we care for on long term. I was always aware of how isolating being house bound is, I have seen it so many times in the patients I have nursed.

Being house bound myself, even only for seven weeks, has forcefully reminded me how isolating and frustrating it is. We as humans are social creatures and most of us need the company of other humans, so why do we allow people to become so socially isolated just because they are elderly or their health is failing. In the last five years, under Tory austerity, council budgets have been slashed, we've seen many day centres and luncheon clubs for elderly people closed. Others have had their resources cut and so have had to cut the number of days people can use them, isolating more people in their homes.

We now have developed an attitude that people should stay in their own homes above all else, and that entering a care home is somehow a failure to be avoided. I have nursed so many people in their own homes who are almost prisoners of their homes, who would be far happier in a care home. In a care home there would be company for them, other residents to talk and socialise with. Staff would be available to meet their needs at their pace, not be rushed into the time bands allowed to District Nurses and carers. Instead they are confined to their own homes, grabbing what company they can from the limited time professionals visit them.

But are there enough care homes out there to meet people's needs even if we changed our attitudes? Care homes are full, good care homes have long waiting lists for them. We are not building enough good new care homes because the private companies who run them can barely make viable profits from the ones them currently run, there are very few incentives for them to open new ones. Also, care homes are not valued as places to work in. In nursing, working in a care home is still seen as professional failure, “Oh, you only work in a nursing home.”

In a week my cast will come off and I will finally be able to leave my home under my own steam. When I finally return to work, though, I will go back to caring for patients who are house bound without any end in sight. When did care of our elderly population become such a low priority?

Drew Payne

Sunday, 27 December 2015

A Worrying Change

At the beginning of November 2015, two people were convicted of manslaughter. They were Isabel Amaro and Hadiza Bawa-Garba, and they were convicted of the manslaughter of Jack Adcock. But Isabel Amaro is a nurse and Hadiza Bawa-Garba is a doctor, and Jack Adcock was a six year old boy in their care.

Jack was admitted to Leicester Royal Infirmary, on Friday the 18 February 2011, with diarrhoea and vomiting, and breathing difficulties. Jack had Down’s Syndrome. He died eleven hours later after a cardiac arrest, due to Sepsis, secondary to pneumonia. This was a very ill child.

Both Isabel Amaro and Hadiza Bawa-Garba missed his deteriorating condition. He had abnormal blood results, high levels of urea and creatinine in his blood, and he was showing signs of septic shock. When he had a cardiac arrest his lips had turned blue. Dr Bawa-Garba had not contacted her consultant about his condition and when he arrested she stopped the crash team, mistaking Jack for another patient who was not for resuscitation.

This was serious misconduct and negligence by both these women, but was it manslaughter? Did these two women deliberately neglect Jack’s care to the extent that he died? There is no evidence of this.

We don’t know the full details of what happened when Jack Adcock died. How busy was the ward? (In her evidence Dr Bawa-Garba said that she’d not had time for a break) How many other patients where Isabel Amaro and Hadiza Bawa-Garba also looking after? How many of them were also very ill? How many other staff were on duty that day? Was the ward short staffed? (Isabel Amaro was an agency nurse so the ward was down at least one member of permanent staff)

Many of us nurses have been on duty when it has been busy and our unity or team has been short staffed. For many NHS nurses this is now a common working condition. This is the time when things can go wrong, drugs errors can occur, lapses in care can happen. Staff are pressured, stressed and short of time, with more and more demands being made on them. They are only human. As resources are squeezed and pressures increase more and more nurses and doctors will be working under these conditions. This is now the reality in Jeremy Hunt's NHS.

Negligence and misconduct should never be tolerated but is a manslaughter charge the right response? But our courts do not deal in the complicated factors that busy and under staffed units are being put through, and are they always the right place to deal with lapses in healthcare practice? They deal in the rights and wrongs of one person's actions, they rarely deal with complicated institutional failings (Because what else are the stresses being put on NHS staff today?)

When working on a busy and short staffed hospital ward do nurses now have to take care so that we don’t end up charged with manslaughter?


Drew Payne