Hertfordshire Mental Health Crisis

The Unkindest Cut - Article in Public Health News (June 5)

2006-06-22T06:56:00.000-07:00

The unkindest cut
Supporting people with mental health problems and helping people to resume as complete a life as possible is not just a matter of NHS finance but about how well the different parts of a complex network work together. Chris Reynolds reports on how funding cuts are threatening services in Hertfordshire

On 17 May, the Hertfordshire County Council health scrutiny committee decided that the mental health cuts proposed by the local primary care trusts were not in the interests of the people of Hertfordshire. A week earlier objections that the cuts were inappropriate, ineffective or put patients and carers at risk had been ignored by the joint commissioning partnership board which acts for the eight PCTs and the county council which funds the Hertfordshire Partnership Trust (PHN, 15 May, page 7). The scrutiny committee took a different view and the matter has been referred to the secretary of state for health.

So should those of us who opposed the cuts be celebrating? Of course we are very pleased that the scrutiny committee agreed the cuts were badly flawed. But celebrate? No. Not yet.

In 2005, the strategic health authority organised a major consultation, Investing in your mental health, in part to rationalise in-patient services and in part to speed up implementation of the national service framework across the county. By providing improved early diagnosis and strengthening the network of community support services, the plan was to maximise recovery and minimise the need for more expensive acute hospital beds. It was clear there were serious gaps in primary care services between the community mental health teams (provided by HPT) and GPs. It was also obvious that more voluntary sector services were needed, on a more reliable funding basis, particularly in some parts of the county.

The consultation was approved in December 2005. It was also agreed that new facilities should be available before old ones were withdrawn. Unfortunately the financial 'cancer' affecting the Hertfordshire acute hospitals spread to the PCTs and, in January, the secretary of state said the rot must be eliminated. The brakes were slammed on throughout Hertfordshire. The SHA responded by top slicing all trusts, including HPT. What has happened since is an example of 'more haste, less speed' with mentally ill patients being the losers all down the line.

The PCTs wanted £5m worth of cuts in place for April - about 10 weeks away - and asked HPT for suggestions. It was immediately clear that most of the money would have to come from cutting real services. Within days, HPT reluctantly came up with a provisional list of possible cuts for discussion, with an indication of the implications and estimated savings.

A hurried meeting of the JCPB froze this discussion list as if it was written in stone. It agreed consultation was needed on £3.2m significant service changes, but with no proper assessment of how one cut affected another if both were made. The effect on patients, carers and other parts of the mental health support network were not seriously considered. As a non-voting member of the board, I pointed out the danger of not properly evaluating the risks associated with the cuts.

At the JCPB's request, the scrutiny committee approved a truncated consultation period ending on 3 May. The consultation document contained no risk assessment table but asked separately about the possible risks associated with each cut. There was a very good response - nearly 400 questionnaires or written submissions were received. Many identified significant risks and more than 60 came from organisations with specialist knowledge of the areas being cut, ranging from patient groups through to clinicians in both primary and secondary care.

Eight days later, the JCPB considered the response document and, by a majority, approved all but one of the cuts. While the consultation document specifically asked for risks, this was skated over - with no analysis of those submitted. There had been some minor variations and some expansion in detail, and all the cuts would be expected to return the exact sum promised in the initial 'for discussion' list.

To most people this appears to be a whitewash. Detailed written submissions from knowledgeable organisations pointing out significant risks relating to specific cuts were summarised in a table - maximum circa 60 words per submission - but otherwise ignored. While the wording is obtuse, it gives the impression that risks to patients are not a matter for the planners but something to be sorted out after the cuts are made by clinicians. I could go on. A few days later the scrutiny committee was asked to accept a response document which failed to properly address patient safety and inadequately covered the consequences of the cuts on other organisations in the mental health support network. It also seemed at that at least some cuts will prove a false economy.

So what happens next? The cuts, coming so soon after the Investing in your mental health consultation, have been a public relations disaster. Mentally ill patients, their carers and support staff are left in limbo until a decision is made. If the NHS insists on extracting its pound of flesh from underprivileged people, the cuts and the associated betrayal will be devastating. Some of Hertfordshire's mentally ill will no longer go on long waiting lists for treatment - the service they need will have been withdrawn.

Chris Reynolds is vice chair of the "Herts Parts' PPI forum, a non-voting member of the JCPB, official PPI forum observer on Herts County Council health scrutiny committee and official PPI forum rep on the HPT board.He is writing in a personal capacity

Scrutiny Committee June 8th - My Report (also covers Foundation Status, the PCT budgets and Hospital plans)

2006-06-22T06:41:00.000-07:00

Notes and Observations on the
Hertfordshire County Council
Health Scrutiny Committee Meeting
held at County Hall
8th June 2006

Agenda Papers – on line at
http://www.hertsdirect.org/portal/eDemocracy/Civic%20Calendar/HCC/archive/Health%20Scrutiny%20Committee_5

HPT – Letter to the Secretary of State.

Letter to Secretary of State: (and related documents) http://www.hertsdirect.org/havesay/scrutiny/scrutinycomm/scrutcomm/healthscrutiny/

This relates to the decision at the last meeting of the committee to refer a number of proposed cuts in the mental health services provided by the Hertfordshire Partnership Trust to the Secretary of State.

It was the first time such a letter had been sent by the County and because of the need to check the text with the county's legal advisers, etc. there was some delay in sending it off. Confirmation of its receipt has been received. The service changes objected to in the letter cannot (in theory at least, see below) be made.

It is far from clear how long it will take to resolve the issue – and it is worth noting that a similar objection to changes affecting mental health services in Cambridgeshire was referred to the Secretary of State in March and has still not been resolved.

HPT – Application for Foundation Status
Links: See Agenda Papers

Because the change is purely a management change that does not directly affect services the Scrutiny Committee is not directly involved – but is kept informed – and was asked for its opinion relating to the Governance arrangements. The aim is to have a membership of some 5-10,000 who will elect a Board of Governors who would influence stratecy and appoint the Chair and non-executive directors, The Board of Governors would consist of 19 public, 5 staff, and 13 representative of relevant organisations.

Because of the arrangements with adult care services some of the later positions would need to represent the County Council.

Timetable: Consultation starts for full period starting 5 July – result to Secretary of State on 3 November

All trusts are required to move to Foundation status so the key question is “When” rather than “whether”. The following seem to be the key issues:

➢ One of the problems is the definition of the boundary between the primary and secondary care trusts.
➢ Would it not be better to leave this matter until the new PCT arrangements had had a chance to settle in.
➢ While funding would be on three year contracts, giving more stability – it might be disadvantageous to sign up the contracts at a time of significant financial problems.

HPT – Closure of St Julian's Ward

Bill Macintyre, CEO of HPT, informed the Scrutiny Committee that St Julian's Ward had been closed on safety grounds, although it could be re-opened if money became available. He reported that even with St Julian's being closed there were currently 10 empty acute beds in Hertfordshire. This was anticipating the cuts which were technically “on hold” and he was given a stiff questioning about it.

The Scrutiny Committee missed the real significance of this. The nature on mental illness id that it is inadvisable to start a treatment and then, perhaps only a week or two later, withdraw it on financial grounds. Change has to be phased in gradually and if the Scrutiny Committee had not taken the action they did on 17th May most of the changes would have been completed in June. The decision was taken some time back to stop new admissions so that patients' treatments would not be disrupted by the closure – and in addition staff had been transferring elsewhere. The greatly reduced numbers of both patients and staff raised important safety issues ...

By concentrating on “the building” issue, the key question was not asked. This would have asked about the possible run-down in the other services in anticipation of the cuts. For instance are GPs referring less patients to the CMHT, and are the 10 empty beds (plus those from St Julian's) empty because new tougher acute bed admission standards are already being applied.

SHA – Financial Recovery
Links: See Agenda Papers

The SHA was asked if the 2006/7 figures were any more reliable than those which were so disastrously wrong in their predictions for 2005/6. I thin it would be fair to say the Scrutiny Committee was not convinced.

I suspect that there are many people in the SHA and the PCTs who are also not convinced that the changes will actually succeed in balancing the books and the much of the exercise is to make the budgets look “acceptable” to the Secretary of State – and the SHA and the PCTs will not longer be here when the silliness of some of the predictions, and increased levels of ill-health in the community, becomes apparent.

PCTs – Arrangements from October

While it has been agreed that there will be two PCTs for Hertfordshire the plan is for them to share a management team under Anne Walker who is currently heading up the “new” management team in Bedfordshire Heartlands PCT which had major financial problems.

PCTs – Recovery Plans
Links: See Agenda Papers

Eight recovery plans were presented in four groups of two. In general each plan (but see next section) was a long list of “efficiency savings” worded in such a way that it was impossible to really know how the changes might affect patient services. Several councillors queried whether they were really efficiency savings, in a way that implied that if they really where there must serious management shortcomings. (One councillor referred to “launching the lifeboat after the ship had sunk.”) In some cases there were large “savings” which had not yet been identified.
Adult Care Services made it clear that the proposals said nothing about the implicalions of the changes. It was far from clear that there were enough resources to cope with the existing demand – even before the proposed cuts begin to bite.

I was very disappointed that the Scrutiny Committee was not more questioning on these plans – although it would be impossible to have gone through them in details – especially as the documents were late in being made available – so it was not really possible to make comparisons between PCTs. From the point of view of mental health this could be an advantage. If all the PCTs need to do is make “efficiency savings” and the cuts on mental health cut hard into real services one can reasonable claim that the cuts on mental health are unduly savage.

When there are 8 PCTs, each with a separate deficit, working in pairs, and which will, in October be working as two boards but one management team it seems rather silly to have eight different plans when the first thing the new PCT(s) will want to do is to get some kind of unified policy in their area.

PCTs – Consultations

Two particular items were separated out for consultation. These relate to the closure of the Intermediate Care Beds at Harpenden Memorial Hospital and changes at the Elms Clinic, Potters Bar. It was agreed that 30 day consultations would be adequate.

West Herts Hospital – Consultation
Links: See Agenda Papers

The document presented to the Scrutiny Committee had three options, two of which appeared comparable, and the other much weaker. The Scrutiny Committee pointed out that there was little point in including a non-viable option and suggested that the only option which would have kept Hemel Hempstead Hospital open should be dropped.

There will be a pre-consultation event on 22nd June, the consultation will start on 10th July for three months . There will be an overall loss of 120 beds. It was stated that the medical staff committee fully supported the proposals.

David Law (CEO) admitted if financial balance was not achieved this could put at risk a new hospital on the Watford site. We could end up with no Hospital at Hemel, an overcrowded hospital in ageing and temporary buildings at Watford (with more patients and less parking?). My own view is that we can thank those who campaigned to stop us having a new hospital at Langleybury some 10 years ago for the current mess.

Could this help the Dacorum Mental Health mess – if the plans go ahead the Watford Hospital will want to get rid of the mental health wards A.S.A.P. And there could be space available on the Hemel Hospital site. ....

North & East Herts Hospital – Consultation
Links: See Agenda Papers

This was keeping the Scrutiny Committee advised on progress to a consultation to be held later.

Chris Reynolds
14 June 2006

Parlimentary Health Committee Hearings start today - My written submission

2006-06-22T06:15:00.000-07:00

Inquiry into NHS Deficits

Submission to the Health Committee

By Christopher F Reynolds

B.Sc. (London), Ph.D. (Exeter),
F.B.C.S. (retired), C.Eng. (retired)

This submission gives details of the NHS Deficit on
the funding of mental health budgets in Hertfordshire and the potential impact of
up to £12 million reduction in funding on services.

1. Following a family suicide in 1985 I have been actively involved in the mental health provision in Hertfordshire as a trustee for Mind in Dacorum, on the North West Herts Community Health Council, as the lay member on the board of the Dacorum Primary Care Group, and on many other committees.

2. I am currently vice-chair of the Hertfordshire Partnership Patient and Public Involvement Forum. In this role I represent the Forum on the Board of the Hertfordshire Partnership NHS Trust (which provides mental health and learning disabilities services), the Joint Commissioning Partnership Board (which commissions mental health and adult care in Hertfordshire and involves 8 PCTs and the Hertfordshire County Council), and the Hertfordshire County Council Health Scrutiny Committee.

3. I was actively involved in the Investing in Your Mental Health consultation, the findings of which were agreed in December 2005. This looked at how better primary care and community services could improve recovery rates and reduce the number of long-term disability patients and the demand for expensive in-patient beds.

4. In making a submission to this committee I am concentrating on the relevance to mental health issues in Hertfordshire and when I criticise local management decisions I am aware that national decisions and policies may have ruled out more rational local actions.

5. A significant problem relates to the acute hospitals – and the rejection of a consultation in the late 1990s to centralise on a new site due to public pressure from those who lived close to the hospitals. Multiple site working on less than ideal locations is at least part of the financial “cancer” which has infected the acute hospital budgets, and spread to the PCTs. The result has been a comparative squeeze on the mental health budgets, with the end of year expenditure being a smaller percentage of the actual spend compared with the start of year budget.

6. When the 8 Hertfordshire PCTs were set up in 2001 the Joint Commissioning Partnership Board allowed them to delegate responsibility for mental health. While things have improved with the SHA led Investing in Your Mental Health consultation, the delegation arrangements meant that the subject was comparatively ignored at the primary care level. Some PCT Boards seem to have initially considered it as little more than a black hole in the financial spread sheet. It seems that the comparatively low profile of the medical aspects of mental health at the PCT board level have made it “easier” to put pressure on its finances.

7. Since it was formed in 2001 the Hertfordshire Partnership Trust has balanced its books in every year. It income has increased during this period (but at a slower rate than some other areas of health in Hertfordshire) and it has been increasingly under pressure to subsidize the overspend elsewhere. For 2006/7 the SHA advised the PCTs to apply a 5% top slice to all trusts – with no medical risk assessment being made to see if this could be done without significantly disadvantaging patients. HPT assess that this brings the total “efficiency” and other cuts it has been asked to make to £12 million over two years. For those working in the voluntary sector there is good evidence that some of the efficiency savings made in 2005/6 have proved to be real cuts in the level of service to patients.

8. Because the decision to make a 5% top slice came only a couple of months after the major Investing in Your Mental Health consultation had been approved it was clear that there would need to be a consultation. This was rushed through on a shortened timescale, received overwhelming opposition and £3.2 million of the cuts have been referred to the Secretary of State by the County Council Scrutiny Committee. The cuts are now in a state of limbo – which is no good for patients or staff.

9. If cuts have to be made it is important that one is honest about them. To present them as if viewed through rose-coloured spectacles misleads both the public and also the Secretary of State as to the real risks to patients and carers. The following examples come from the consultation (I could give many more) – but I am sure they are commonly used to misrepresent the effect of cuts across the NHS.

9.1. Mental health support
is provided by many agencies and not just the NHS. It was assumed that other agencies would have the spare capacity to provide services to replace those which were being cut. However the PCTs knew full well that voluntary sector services were already inadequate in many parts of the county – and their funding was being reduced. Nowhere were there any mentions of the quality of any replacement service of patient support.

9.2. The consultation ignored what would happen to patients between the time the cuts were made (immediately) and the time other agencies could fund (where from???) and establish replacement support services. This would be a period of significantly enhanced risks.

9.3. The consultation specifically asked for risks associated with each cut. Over sixty organisations from user and care groups, through to clinicians in primary and secondary care provided written submissions indicating significant risks – ranging from increased suicide rates to cuts which would prove to be false economies. These were all ignored – in some cases without the area of perceived risk even being identified.

9.4. 1984 newspeak type arguments, often robbing Peter to pay Paul, were used to justify cuts. For example continuing care services were transferred to Hertfordshire Partnership Trust – but under-funded. This represented a cut of circa £1 million p.a. in core mental health funding and a saving of £3 million p.a. by the PCTs. The fact that the PCTs had previously overspent was used as an argument for further cuts on core mental health services.

10. The problem with this consultation, and I suspect many others, is that the consultation was carried out by managers with little first-hand understanding of mental health (see para 6) and who were under orders to make the cuts regardless. I would like the committee to consider the following recommendation, to ensure that cuts in medical services which could adversely affect patients are seen to be approved by suitably qualified expert committees, and not just by managers.

10.1. When any consultation involves cutting services for financial reasons the consultation document, and the final response document, should contain signed reports by the clinical governance committee of all relevant trusts (and the equivalent from any relevant support agencies) relating to patient safety and welfare issues.

11. The national weighting of per capita payments protects the more needy geographical areas of the UK. The committee might consider proposing a mechanism to protect the interests of the more vulnerable members of society, so that money is not taken from mental health and learning difficulties to bail out
overspending acute hospitals.

I will be very happy to provide further evidence if requested.

Chris Reynolds

chris.ppif@codil.co.uk

Herts Mental Health makes BBC TV News

2006-06-22T05:59:00.000-07:00

I write this shortly after seeing the 1.30 pm London news on BBC 1 on 22nd June. There was good coverage with an interview with a service user at Mind in Dacorum, a shot of the outside of the now closed St Julian's ward, an interview with Simon (Viewpoint) and a shot of the protest banners being unloaded from a car. All very good apart form the announcer's opening brief remark which suggested that the mentally ill doulb be a danger to others.

Iunderstand it will be repeated on the 6.30pm London news this evening - and may get a longer shot.

Apologies for my absence ....

2006-06-22T05:51:00.000-07:00

During the consultatio period many other activities got put to one side to do later - and I got myself into the position that if I started to tackle the backlog I started to get depressed - so I would retreat into my "depression avoidance mode" which actually meant the the backlog continued to get bigger (and the dog gets more walks) ...

Blow it. I don't care about the ***** backlog - and will post some of the more interesting "missing" documents directly to this blog without any additional explanation, to at least make sure that they are available.

Friday May 26 - What comes next - Link to report summarising the situation.

2006-05-26T10:08:00.000-07:00

There is still much to be done - and much depends on Patricia Hewitts's response to the Scrutiny Committee letter (which I have not yet seen).

I have attended to meetings. I reported on the current situation to the "Herts Parts" PPI Forum meeting on Monday, and the PPI Forum Chair's meeting on Tuesday. For the later meeting I prepared Report on the Background and Current Sate of the Hertfordshire Mental Health Consultation. This looks at how we got where we are now, and contains some background information to make it more meaningful for people from other areas who face similar difficulties.

I am also trying to keep track of media coverage (see following entry) and have written one article for the technical press. There have been various discussions, phione calls and emails about strategy which I feel is best kept until the NHS shows its hand.

I have also spent several days "getting away" from mental health issues. Not as easy as you might think. This afternoon I walked the dog at Ashridge, and was just sitting down to a piece of cake and a cup of coffee when I was hailed by a former Community Health Council colleague, who congratulated me on my blog and expressed pleasure at the Scrutiny Committee decision. Mark you - I quite enjoy being reminded ot the crisis in such terms.

Yesterday we took my 20 month old granddaughter to Whipsnade Zoo where she really enjoyed herself as the picture shows. I almost relaxed!

I imagined the nearest tiger was called Patricia, and the two in the background were called SHAh and PeeCeeTeese. They looked very hungry and determined to get their pound of mental health flesh. Nearby an elephant called DougH was busy trampling on public opinion.

Media Coverage of the Scrutiny Committee Decision and similar matters elsewhere in the South and East

2006-05-18T21:29:00.000-07:00

PLEASE LET ME KNOW OF ANY COVERAGE [email] SO I CAN ADD IT BELOW together with a brief extract.

Health cuts referred to the minister. This in Hertfordshire (online) May 18. - The cutbacks include the closure of St Julian's acute psychiatric ward at St Albans City Hospital, which serves people of south west Hertfordshire, reductions to day services, the closure of the Direct Access Psychology Service and the closure of the Early Intervention in Psychosis Service.

MP Brands patients the victims of slash and burn plan. icBerkshire (online) May 18 - Mr Wilson said: "It's a national disgrace that this government is slashing and burning services to one of our most vulnerable groups. Mental health services are already under pressure and in Berkshire they have turned around a financial crisis in the last few years so that we have a service based on solid foundations. I cannot believe they are now being penalised for being well run."

Mental Health Protest Victory. Welwyn & Hatfield Times (online) May 24 - Committee chairman Michael Downing said: "We don't see any reason why the people of Hertfordshire should be punished when mental health and learning disability services in Herts and elsewhere have always been grossly underfunded." [see picture]

Plea from the Heart: Dad's call to prevent mental health cuts. Berkhamstead & Tring Gazette. May 24. [Front page headlines and lengthy interview with Glyn Trollope with other quotes, etc. ] Protesters against the closures and cut-backs, including members of mental health charity Mind in Dacorum and Hemel Hempstead MP Mike Penning have raised concerns that proposed cuts could see more suicides. Dacorum Borough COuncil are also concerned that more mental health patients will be made homeless. [Paper also contains articles "Top doctors lead attack on 'factory unit' surgicentre" and "Meet the Health Boss" [Public meeting, David Law, CEO, West Herts Hospitals, at Tonman House, St Albans, 7 pm, June 5 - online as "Open Up, Mr Law"]

[Not seen] - Herts Mercury.

New plea for help to health secretary. Cambridge Evening News (online) May 24 [Similar problems in an adjacent county.] "GPs and other local health professionals do not believe there is a sustainable community support structure." [Further information on the health economy in Cambridgeshire in Health chiefs in race against time., May 25]

Mental health Cuts Attacked. This is Hertfordshire [Borehamwood] (online) May 25 - David Grayson, chair of the Hertfordshire Partnership Patient and Public Involvement Forum, said: "We are very pleased the scrutiny committee have realised there are serious issues regarding the level of risk and the impact on patients. It is fairly unusual for the committee to make a referral of this kind." Mr Grayson expressed concern that a final decision could be dragged out for months but added: "The ball is in the secretary of state's court."

County Refuse Health Cuts, The Herts Advertiser 24 (online) May 25 - Sally Newton, executive member for adult care services, added: "We feel it would be a retrograde step to make cuts in mental health spending at a time when the number of people suffering mental health problems is increasing. We are really concerned about the domino effect these planned changes could have on our services. They are really big issues which need to be taken up at the highest possible level." [Also includes lengthy article Voluntary Service Fear Big Cuts in Funding.]

Anger as PCT cuts counselling service. Hounslow Guardian (online) May 25 - Criticism of the PCT's lack of consultation has also been voiced by John Hunt, co-chairman of the Patient and Public (PPI) Forum for West Middlesex Hospital and Brentford councillor Andrew Dakers. The closure of the Bics is outside the PPI Forum's remit but Mr Hunt has brought the matter to the attention of the overview and scrutiny panel.

We may have won the Battle - but we must not forget the War.

2006-05-17T23:32:00.000-07:00

OK. So the Scrutiny Committee has referred the proposed cuts to the Secretary of State.

So we can all relax and put our feet up? .... NO

The matter will go to the Secretary of State who will refer it back to local resolution and this could go on for some time. Meanwhile Hertfordshire Partnership Trust is in the middle of preparing for the cuts – and is left in a kind of limbo – it cannot go one making them, but it cannot go back either, until the issue is finally resolved. This is extremely unsatisfactory for both patients, carers and staff. It may not be practical in some cases to simply reverse changes where, for example, key staff have already found employment elsewhere.

This means that the top priority must be to ensure that things are resolved in a satisfactory manner as soon as possible to minimise further damage. The matter is confused by the fact that the Strategic Health Authority ceases to exist at the end of June, and the Primary Care Trusts cease to exist at the end of September. My suggestion is that the Alliance writes to all PCT (and SHA) chief executives, chairmen and non-executive directors (copies to MPs, Scrutiny Committee, media, etc.?) saying

The Alliance is dedicated to promoting the welfare of the mentally ill in Hertfordshire and looks forward to working with the new Primary Care Trusts to ensuing the best possible cost-effective user-oriented service in Hertfordshire
Unfortunately damage has already been done to the mental health economy because inadequate and unsafe proposals were sent out for consultation. For this reason the sooner the matter is resolved the better. It would add to the distress to patients and staff for time to be wasted in further futile attempts to show that the current proposals were both safe and cost effective, when they clearly are not. We suggest that the proposals are withdrawn in time for the final Strategic Health Authority Meeting on 26th June, and that discussion on any other changes in the mental health services in the County are deferred until the new Primary Care Trusts are appointed in October.

It is also important that the Alliance strengthens its ties, and increases its memberships and a meeting of interested parties in June (definitely before the Summer Holidays) would seem to be essential with the aim of exploring better ways of working together in the future.

We must not forget that others can benefit by what has happened – because “false economy” cuts (in terms of both patient safety and consequential damage) are happening (and in some cases have already happened) elsewhere. Information exchange is to be encouraged, and I am happy to keep this blog open – but on a topic based rather than a daily update based arrangement – with people being encouraged to add comments (currently possible but few have made comments).

There is one area which needs quick action, and this is to make a submission of evidence to the House of Commons Health Committee on the NHS Deficit before June 6th. If the cuts were going ahead ours would have been just another sob story about “how we woz robbed.” The fact that we succeeded in getting the Scrutiny Committee to accept that the cuts were inappropriate, ill-planned and unsafe makes it a far more relevant exercise. Because of my very close involvement with the key committees I think it important that I make a submission, and I am happy to make the draft available for comment and suggestions before I sent it.

Wednesday 17 May - Scrutiny Committee - We've done it !!! ### !!!

2006-05-16T22:24:00.000-07:00

Woke early - had left computer on overnight (not the first time) and it was "broke". After half an hour of abortive attempts to start it wondered if it had overheated. Switched it off for 15 minutes and I have now got on long enough to type this message and am hoping it will be working this evening when I get back from Hertford. However if this blog (and email contacts) goes silent this message may provide an explanation.

See many of you at County Hall today - and make it a good demonstration.

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The advance guard arrive for the Demonstration

(Photo by Glyn)
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I'm feeling exhausted - but it was well worth it.

The Scrutiny Committee decided to refer the £3.2 million pounds worth of cuts to the Secretary of State on the grounds that the decision to impose 5% cuts was arbitary, there was inadequate assessment of risk, the cuts were not proven to be clinically valid and the impact on users, carers and other service providers had not been properly evaluated. (I will post the formal wording when I get a copy.)

Tuesday 16 May - Strategic Health Authority Meeting - Scrutiny Committee Papers - 2 PCTs for Hertfordshire

2006-05-16T06:36:00.000-07:00

I attended the SHA meeting in St Albans this morning. Nothing exciting to report.

Total Beds & Herts overspend £107 million (after 19 million from reserves) compared with the target of £75 million. West Herts year end total comes to £51,864,000 over-spend compared with a target of £22,370,000. HPT in balance but could not hand back £1 million the SHA had hoped it would.

HPT is the only Hertfordshire Trust which is not getting an overdraft - and has to find £10 million over two years.

The Department of Health has sanctioned the failure to provide the target number of Early Intervention Teams in light of current financial restraints.

In response to a direct question John de Braux, Chief Executive of the SHA, agreed that in making cuts "Patient safety was paramount".

New PCT arrangements, including Hertfordshire, to be announced in the House of Commons at 3.30 pm today.

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Scrutiny Committee Papers are now online at http://www.hertsdirect.org/portal/eDemocracy/Civic%20Calendar/HCC/archive/Health%20Scrutiny%20Committee_13

Key document - which explains how the meeting is to be organised - with speaking times, etc., - and the key issues the Scrutiny Committee may want to raise are at

http://www.hertsdirect.org/portal/eDemocracy/Civic%20Calendar/HCC/archive/Health%20Scrutiny%20Committee_13/Item%202%20(1).doc

The papers include the JCPB paper - I think unchanged apart from an additional appendix 12 which attempts to answer some of the points raised at JCPB and includes the commissioners own assessment of rick drawn up before the submissions were received. There are also a number of written submissions.

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The Government has announced that there will be two PCT's for Hertfordshire

Monday 15 May - Notes on last Thursday's JCPB Meeting - and Speculation about the Strategic Health Authority meeting tomorrow

2006-05-15T00:18:00.000-07:00

I have now produced my notes and observations arising from the JCPB Meeting [see copy for full details]. It includes the following paragraph:

In conclusion: Because of the way the consultation arose there was a very high risk that at least the savings that could be achieved from some of the proposed cuts would proved to be over-optimistic and the risks under-estimated. It was therefore very reasonable for the Consultation Document to explicitly ask about risks and it was most improper that, a large number of responses which highlighted risks to the viability or safety of individual cuts have been ignored. The failure of the Response Document to come up with any risk assessments for the recommended cuts makes it almost impossible to monitor the effects of the cuts, or to make safe adjustments if the level of funding changes. In fact, because of the amateur approach taken there is a very real possibility that at least some of the proposed cuts are unsafe, and this has been missed because of the inadequacy of the analysis.

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Tomorrow there is a Special Meeting of the Strategic Health Authority [Agenda] which will look at the financial crisis in Bedfordshire and Hertfordshire. At first sight it is of little direct interest as the online paperwork does no more than show that the HPT is the only Trust Hertfordshire which has a financially clean bill of Health. However financial adjustments could mean that HPT is now being treated in a less favourable way to trusts which ran up large deficits. In this context a little bird has told me that the mental health cuts may be raised.

Let us look at the position from the viewpoint of the Secretary of State, Patricia Hewitt. Government action to recover the debts run up by many acute hospitals has generated bad publicity. In addition some mental health trusts such as HPT have had their budgets cut despite being in balance, even though, at least according to Louis Appleby, this was not meant to happen.

So why is the Hertfordshire position special?

Scrutiny Committees are meant to look at significant changes in NHS services and have the power to formally object - unless the changes are purely financial - and in many counties I gather the Scrutiny Committees feel pretty powerless. In Hertfordshire, because the proposed mental health cuts came immediately after the Investing in Your Mental Health proposals it was impossible to avoid a formal consultation. The consultation put a great emphasis on risks - and then the commissioners do a whitewash job by failing to consider the risks submitted by people and organizations with first hand knowledge of the areas being cut.

So on Wednesday the Hertfordshire Health Scrutiny Committee, which has already made its disquiet with the Secretary of State well-known, will be deciding whether the consultation has reached proper conclusions. Because the Response Document had demonstrably ignored risks to the inhabitants of Hertfordshire the Committee could have excellent grounds for blocking the cuts for reasons of safety which have nothing to do with finance.

If the Herts Scrutiny Committee wins this battle it will send out a message to campaigners and Scrutiny committees all over the country that they should take a good look at the risks associated with all cuts - and maybe they can win their local battles as well.

For this reason the Secretary of State and the Department of Health might be grateful if, in considering its recovery plan on Tuesday, the Beds & Herts SHA just happened to reallocate a trivial few million pounds in such a way which means that on Wednesday the Scrutiny Committee finds the mental health cuts have been cancelled and it has nothing to discuss.

OK. This is speculation - but not impossible - one must remember the devious way in which politicians think.

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Now to send out a few emails - then relax for the rest of the day, apart from attending an Alliance Strategy Meeting this evening. To the SHA meeting tomorrow and my next planned report will be tomorrow afternoon - with any news from the SHA.

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Planting a Candle

We are not sure whether it was "Plant a Tree in 73" or "Plant Some More in 74". Whichever it was Lucy put a conker in a plastic cup with some earth and it grew, and got planted in the garden. Lucy killed herself in 1985 and now, every May, we get a display of white candles to remind us of her.

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Alliance Strategy Meeting very helpful - and got some more information on QOF.

An email brings news of the new PCTs - in the form of an advert for Non-Executive Directors.

The Weekend

2006-05-13T00:20:00.000-07:00

8 am: Awake after a solid 8 hours sleep - first that long since I started this blog - helped by Temazapam which I now only use after a string of sleepless nights to help me catch up.

Overnight Craig moved my web site to a new and faster server. The email account has gone smoothly - and the new password works. The web site www.hertfordshire-genealogy.co.uk is up and running. It includes a folder which holds the mental health documents associated with this blog, so you can still access them. Only problem is that I currently cannot upload any new files. It's wonderfully helpful when your software remembers the username and passwords automatically - until things change and you have forgotten what they were!

Now for breakfast - and back to my notes on the JCPB meeting.

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10:30 - In reply to an email from Heather I highlight some of the lines of attack for the Scrutiny Meeting on Wednesday.

I think the points that will need to be covered will include.
(1) Failure to adequately consider the "risks" highlighted in the organisational submissions - particularly where these could affect the safety of users - or the ability to make the savings listed. Failure to include problems raised by HPT specialist group submissions as well as your own are important - If users, voluntary orgs and HPT staff all raise the same "serious risk" issue for a particular cut the failure of the response document to deal with this - and say what the implications are is damning.
(2) The gaps between the withdrawal of services and the establishment of any replacement.
(3) The failure to include a risk analysis associated with each cut - despite asking explicitly for details of risks. (Thank god I made a great fuss about including risks in the consultation document at the time it was being drafted. Without those questions it would be a lot harder to attack the current response.)
(4) No clear statement about how risks to users, carers, and other support organisations have been evaluated.
(5) Absolutely nothing to indicate how the changes will be monitored - or to how the standards of care expected compare with the levels of care currently provided by HPT. If the change is a disaster there is nothing in the document by which success can be judged.
(6) Of course the "Is it fair argument" needs to be made - but one sharp well informed attack would be better than everyone spending 30 seconds on this. How this is done will depend on what happens at the SHA meeting.

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Not a good afternoon and evening - took a break from drafting the notes and fell asleep - and the computer crashed at least six times - so I decided to call it a day.

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Sunday - Partly relaxation and walking the dog in the woods - and partly work on the JCPB Meeting report. Needs some editing but should be ready Monday morning.

Friday 12 May - I feel whacked ....

2006-05-12T08:09:00.000-07:00

4pm: Woke far too early - tried unsuccessfully to get back to sleep - so started drafting report of yesterday's JCPB meeting. By 11.30 I was stuck half way up a gum tree and walked the dog down the town for lunch. Combination of a good meal, the heat, the hill and general tiredness meant I stopped off at every public seat for a breather on the way back.

On my return I took one look at what I had done and junked it - and have started again - but don't expect it to appear here until tomorrow. However it will include my initial comments (on earlier blog) as an appendix, and look at the overall conduct of the meeting - and a number of specific topics.

One topic it will look at is the use of the "Quality and Outcomes Framework" (QOF) on page 30 of the response document. We were told QOF will solve the problem of getting the GPs to provide for patients when HPT services are shut down. But the QOF specifically relates to the GPs having the choice as to whether provide the extra service themselves (for which they get paid) or to get the service elsewhere. As they are now so well paid they may not want to take on extra work - particularly of the more time consuming mental health patients. But the "service elsewhere" is being withdrawn - so either the GPs are conscripted into QOF whether they want to or not - or the patients don't get treated.

I have also used my current period of being awake to dabble in a few emails. Now off to sit in the garden with the newspaper - and probably fall asleep.

And as an afterthought - I gather there could be some relevant information on finances at the SHA Board Meeting on Tuesday.

===================================================

Off to bed - having recently sent an email to "the list" commenting on Heather's email , which contained the following view of the situation:

Further to what Heather says I have a number of observations.
On her last point I am glad I have not got a vote - apart from anything else I am the only person who is entitled to sit on both the JCPB and the Scrutiny Committee because I don't have a vote. If I had a vote there would be a conflict of interest and it is very useful to have someone on the Scrutiny Committee (apart from NHS employees who are there to give evidence) who actually knows what was said at JCPB. For instance neither David Lloyd, Ken Coleman or Bob Mays will be able to speak at the Scrutiny Committee.
I think it is important to realise that there were implied options in the current consultation. It would be foolish to proceed with a "cut" if it is shown to be inappropriate because the risks to patient safety are too high, or because it was not cost effective. The consultation specifically asked to be notified of any risks associated with each cut. This is what happened in the case of Seward Lodge.
I am sure that there are two areas which will be of particular interest to the Scrutiny Committee.
One relates to the Response Document itself. This document is fatally flawed (see earlier blog) because it asks for comments on risk assessment, includes no risk assessment of the findings, and most importantly ignores all statements of possible risk made by organisations (many with very good specialist knowledge of what is going on) which made written recommendations. There is almost no honourable way that the scrutiny committee could say that the "response document" represents a properly conducted consultation.
The 5% cut issue is, in one sense completely different. The evidence given by Bob Mays at the JCPB comes from an agenda paper for the SHA relating to the current Recovery position. I have not downloaded it yet but I gather it show that the Herts Health Economy has been given a large "Control Total" (i.e. overdraft) and HPT is the only Trust not to benefit. This will be considered by the SHA Board on the 16th. I also hear that there may be a last minute AOB item "of interest". (One must remember that Professor Louis Appleby is concerned - and maybe he has found a way to pull strings.) It is not impossible that the cuts will be cancelled by the SHA on the 16th - so there will be nothing for the Scrutiny Committee to discuss on the 17th!
However, if the consultation is still on the agenda, the Scrutiny Committee will have a lot to say, especially because of the way that their request to meet the Secretary of State over the state of the Hertfordshire Health economy has been repeatedly stubbed - they would love the opportunity to formally refer a matter to her so she could not refuse taking action.

Thursday 11 May - The day of the JCPB Meeting

2006-05-11T13:08:00.000-07:00

[Report of Meeting tomorrow]

Up extra early - and as wife is away put dog in the garden and hope he will last until I return. Set out to Hertford with the aim of getting a Breakfast in County Hall before the 9 am meeting. Rush hour traffic slow and when I arrive there is no time for breakfast. Premeeting discussed how topics would be taken at the maim meeting - and it was agreed that the meeting should take as long as necessary.

Main Joint Commissioning Partnership Board started at 10 am with a useful public presence which was allowed to raise issues freely apart form some justified reprimands from the chair,when questions or observations were made which were irrelevant to the matter currently being discussed.

Shortly before 2pm there was the call for a vote and several of the Board made it clear that they were unhappy with the situation but there appeared to be no alternative but to approved the cuts as described in the consultation report. [More details tomorrow]

Rush home expecting to find the dog crossing its legs - but no - all it wanted to do was play. So I bundled him into the van and up to Wendover Woods - where I had a baked potato for a very late lunch. A short walk, make up the dog's supper and sit down with a drink of fruit juice for half an hour. Then off again to a meeting of the Board of Mind in Dacorum to report the day's activities and to discuss the implications of what is going on for the voluntary sector in Hertfordshire.

Home, a light supper, write this blog and I will be makign for bed. The report of the meeting - and the plans for the Scrutiny Committee next Wednesday can wait until tomorrow.

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Two news items about the morality of the NHS Cuts come to may attention. Archbishop Rowan Williams said the NHS must respect patients' individual needs. He warned "short-term economics" threatened to undermine that basic right, and could put vulnerable patients at particular risk. [BBC] There was also a lobby by NHS workers in which the former Health Secretary Frank Dobson said "In the interests of patients and staff, trusts do need more time to deal with their financial problems." [BBC]

My Initial Comments on the Response Document

2006-05-10T22:53:00.000-07:00

I plan to distribute the following to members of the JCPB Board this morning

I believe that the consultation report is an attempt to force through cuts which in many, if not all, cases are either unsafe or are not financially viable.
The primary purpose of the NHS is to provide help and care to those who are ill and where possible direct them on the road to recovery. In their presentation to the Health Scrutiny Committee the East & North Hospital Trust made it clear that patient safety and quality of service are of paramount importance. This report, where it mentions the risks to patients, carers, other organisations providing support for the mentally ill, and the taxpayer, does it only as an afterthought. As far as I can see the word “quality” is only mention in one place (para 7.8). Obviously quality of service has a very low priority in the way the commissioners have considered these cuts.
Also omitted is a proper assessment of the detailed submissions. Section 6 lists each of the cuts in turn, with selected quotations from people who filled in the form. In many cases there is a response to the doubts expressed. BUT WHERE ARE the quotations from the 68 organisation’s responses to the individual cuts. These responses include user and carer organisations, voluntary organisations which provide services, Patient & Public Involvement Forums, GP surgeries, and HPT staff who provide specialist services. As far as I can see all comments made by these very well informed groups about individual cuts have been ignored, even (or particularly?) where they have relevant specialist knowledge There are no quotations from their reports, and no attempt to reply to the detailed risk assessments many of them provide. So much for a properly conducted consultation of the informed public.
It should also be noted that the original consultation document asked for comments on the risks associated with EACH CUT – and in each case it should identify the risks drawn to its attention from ALL SUBMISSIONS – and assess them properly to ensure that the cut is both financially viable and safe. This has not been done (except in one case, Seward Lodge). Major risks reported to it have been totally ignored.
For instance the HPT March Assessment for the Lister Day Unit suggests that many of the patients could end up requiring in-patient treatment – and if the St Julian’s Ward closure goes ahead this could mean out of county placements. The information available to the commissioners clearly indicates that this particular cut is almost certainly a false economy – and that it could be cheaper to abort the cut rather than proceed with it. To proceed with this cut on the evidence of a quite clearly flawed consultation report would be madness.
There must also be very real doubt that the closure of St Julian’s will have the effect planned. The claimed target of 98% bed occupancy (nationally recommended 85%) demonstrates major mathematical flaws in the calculations, and the ignored responses to the consultation provide good evidence that the overall effect is likely to be much worse than predicted. Again the consultation document ignores material facts to promote cuts which are very unlikely to make the level of savings claimed.
I could go on. As far as I can see the commissioners have not followed due process in properly and transparently presenting the results of a public consultation. I believe that the furthest the JCPB can honourably go towards making any cuts is to reject the current consultation report as flawed and request that a new report is drawn up which takes a properly detailed look at the risks associated with each cut.
Chris Reynolds, 11th May 2006

Wednesday 10 May - Getting Ready for the fray - "A cut too far"

2006-05-10T06:08:00.000-07:00

The JCPB papers were emailed to me at 00.47 am but I didn't get it until just before seven and posted them here. The papers (or even the time and date of the meeting) are still not on the JCPB page at midday.

I spend a busy morning with emails, and going through the papers (printing out some) ready for tomorrow's meeting. A quick lunch-time walk with the dog and back to the preparations.

One email is relevant to what comes next. Roma drew my attention to a proposed investigation by the Parliamentary Health Committee who are to look into NHS Deficits [Press Release]. They want evidence by 6th June and I, for one, will be making a submission - and some of you may want to as well.

It is now 9.30 pm - I have got all the papers I think I need together - and prepared a one page position sheet for use tomorrow. Cleared all the urgent mental health emails (I think - perhaps there is one I missed buried 100 emails deep in my inbox). What I now need is a good night's sleep - so I am ready for the "battle" in the morning.

Just about to go to bed when I foolishly checked my email - and there is news of the proposed demonstration on the 17th (in the Watford Observer) and a report "

Joint Commissioning Partnership Board Papers for May 11

2006-05-09T23:43:00.000-07:00

JOINT COMMISSIONING PARTNERSHIP BOARD
Thursday 11 May 2006 , 10.00 am
2006-7 Savings Consultation

Cover Report
Final Response Document

Appendices
1.
CONSULTATION
2.
SUMMARY
3.
FINANCIAL CONTEXT
4.
EASY READ SUMMARY
5.
OVERVIEW OF CONSULTATION ACTIVITY
6.
TELEPHONE LOG
7.
HEALTH OVERVIEW AND SCRUTINY PAPER
8.
MEDIA COVERAGE SUMMARY
9.
HPT STAFF CONSULTATION
10.
SUMMARY OF INDIVIDUAL RESPONSES
11.
SUMMARY OF ORGANISATIONAL RESPONSES

Tuesday 9 May

2006-05-09T01:49:00.000-07:00

This morning I will be at the dentist and in the afternoon ntl will be digging up my front lawn to relay the cable which supports both my phone and broadband computer link - so it you can't contact me you will know why.

Cable reburied - and dog gets two walks.

It was suggested that the Consultation report would be emailed to me today, but had still not arrived by 9 pm! Apart from a few emails left mental health alone.

Late evening email from Charles Walker, MP. Apparently he cross swords with Patricia Hewitt over our problems in today's health debate and is hoping to raise the Hertfordshire mental health situation in the WHitsun Adjournment Debate.

Monday 8 May - More on the Scrutiny Committee

2006-05-08T02:39:00.000-07:00

A long wait to speak to someone representing NTL about my co-axial feed into the house - they say they will send an engineer sometime between noon and 6 pm - so I amay be "off the air" for both my phone and my computer for a period later today.

Snail Mail brings the agenda for the Scrutiny Committee Meeting at 1 pm in the Council Chamber, County Hall on 17th May [Agenda]

Agenda Item 1 is to looks at the consultation outcomes of the E & N Herts Hospital Trust proposals for Outpatient and Diagnostic Breast Services. The main interest on this blog is how the consultation outcomes document is presented. For instance it includes a table of "General comments submitted on consultation response form" with individual comments categorised as "Praise or thanks to clinical staff," "Criticisms of current clinical environment / support for the proposals," "Criticisms of other aspects of service" and "Other comments". It will be interesting to see if the consultations outcomes document for mental health shapes up by this standard.
Agenda Item 2 is to look at the Proposed Mental Health Service Changes 2006-7 Consultation Outcomes. The document is to follow - and will either be the document presented to the JCPB on May 10th, or an edited version of it including changes made at the JCPB meeting. Two other documents were included. One was a copy of the PowerPoint presentation given on 25th April and the other was the response of the St Albans Scrutiny Committee which met on April 27 th. This thoroughly condems the proposals and a copy of the text - and a supporting note are given here.
Agenda Item 3 is a programme report on the West Herts Hospital Trust Interim Measures (to follow). Again copies of the PowerPoint presentation of 25th April were included.

The snail mail also brought a selection of press cuttings about the mental health cuts.

Sunday 7 May - Press Release

2006-05-07T00:30:00.000-07:00

OK I was going to keep this weekend free of "mental health" issues - but suddenly realized what I had planned to do Friday afternoon - which was to circulate a media statement - which has now been written and emailed off to many key addresses.

Walked the dog - bluebells are beginning to look good in the local woods - relax during the afternoon.

In the evening I got a reminder of how unfit and overweight I have become. A phone call informs me that a friend, Malcolm Cotter, died a week ago while exploring a cave in the Mendip Hills, in Somerset. Oh for the days long ago when I was thinner and subtle enough to go caving and had the energy to do so. What really brings it home is that it was Malcolm who introduced me to caving in about 1954 - and he was 73 when he collapsed and died of a heart attack pursuing his lifelong hobby. A quick check with Google shows one obituary has already appeared and I draft another.

A relaxing weekend ??

2006-05-06T01:40:00.000-07:00

You may well ask why the green refuse bin is still awkwardly placed on the front lawn, after it was emptied on Friday, and why the van is parked on the road, rather than on the grass as usual. If you look under the bin there is a shallow depression (perhaps an inch deep) with a black line showing in the earth over a distance of about a foot. This is the supposedly "six inch deep" co-axial cable that links with my computer, telephone and TV. Do I phone my ntl emergency number and find I am off the air for several days while they repair it - or do I play safe and just leave the bin there until the consultation is over?

Rather than make a decision I take the dog for a long morning walk on the expectation that it will pour with rain this afternoon.

While out got talking over a cup of coffee. My companion turned out to have been one of the "Worried well" - of the type who will loose CMHT support. They revealed that the personal support of their CPN had played a vital role in helping them back to health - and was horrified with proposed changes.

Friday 5 May - Submission is Complete - Notifications out

2006-05-05T03:22:00.000-07:00

I have now posted the final section of the submission and have sent a dozen emails (some with long lists of recipeints) to say it is done - and that I will be trying to forget about mental health over the weekend. The only contacts still to make are with the media - but I will follow this up later today after walking the dog and having lunch.

The afternoon was going to be "consultation free" but in comes an email with some information under the Freedom of Information Act. Very interesting. One is relevant to why the PCTs might have originally (and erroneously) thought the cut of 5% was appropriate (it they thought about it at all!). The other provides a good explanation as to why the proposed cuts don't work as a group. Too late for the formal submission, but something extra to have ready for the JCPB and Scrutiny meetings.

Shortly after I get a couple of emails about the approach the Alliance should take to the Scrutiny meeting. I reply explaining my position, and outline the options open to the PCTs when they prepare the end of consultation document for the JCPB meeting - especially as the Scrutiny Committee has expressed interest in hearing from people whose objections have not been properly considered in the consultation.

Scrutiny Committee wants to hear your views

2006-05-04T15:33:00.000-07:00

Mental health service cuts slammed
04 May 2006
mailto:editorial@thecomet.net

CUTS to mental health services contradict the Government's policy to do more in the community to take pressure off hospitals, according to an MP.

Oliver Heald, MP for North East Herts, said cuts in community services, psychological services and early treatment of severe mental illness was "in direct contradiction to Government policy on early intervention and doing more in the community to take pressure off hard pressed mental health wards in hospitals".

He added: "Hertfordshire mental health sufferers and their families should not be the victims of Government financial chaos in the NHS. The Prime Minister cannot be proud of this attack on the most vulnerable in our society."

The proposed changes, by North Herts and Stevenage PCT, to Hertfordshire's mental health services will be discussed at a meeting of Hertfordshire county health scrutiny committee on May 17.

County councillor Bernard Lloyd, chairman of the county council's overview and scrutiny committee, said: "We are well aware of the financial situation facing the county's health services and the substantial savings that have to be made.

"What we must establish is whether the five per cent across the board reductions required in Hertfordshire are the best way of making these savings and whether the proposed reductions in mental health services are the right ones."

Representatives of the health service will be at the meeting on May 17 to explain the proposals and representatives of those who may be affected are invited to make verbal or written submissions giving their views.

Stevenage county councillor Michael Downing, chairman of the county health scrutiny committee, said: "Our remit is to consider whether these proposals are in the best interests of the delivery of health services across the county. If we conclude that they are not, we have the power to refer them to the Health Secretary so we want to be sure that sufficient account is taken of everyone's views.

"If people and organisations feel their views were not adequately taken into account during the decision making process, we want them to let us know."

* Those wishing to make submissions or presentations to the meeting (between three and five minutes of speaking time may be allocated) should let democratic services officer Laura Shewfelt know by phone on 01992 555565 or email laura.shewfelt@hertscc.gov.uk by next Wednesday (May 10).

Thursday 4 April - Support comes rolling in - Risk Assessments - My health

2006-05-04T02:26:00.000-07:00

9 am: Keep them coming. 15 groups have alreay agreed to support my submission. The more supporting organisations the more power to my elbow on May 11 and May 17.

12 am: Appendix 5 (risk assesments): Updates well underway and copied online - only two still need to be done - but I will be adding supporting comments all day (including the evening) from other organisations submissions (have I got yours???). Other comments will be welcome. I intend to submit the final version first thing Friday morning.

3.30 pm: All cuts now assessed in Appendix 5. May add some more quotes this evening, and final proof-read and dispatch first thing tomorrow.

Looked outside - because I have been too busy to notice some of the grass on the lawn is about 9 inches high - and the fortnightly compost collection is tomorrow morning - that should keep me away from mental health of a few hours.

Deside to put my legs up - and fall asleep in front of the TV.

Check email before retiring - and Google alerts me to important news item about the Scrutiny Committee - which I repost in this Blog.

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Over the last few days I have had a number of helpful personal supportive notes. A recent one said "And whatever happens, YOUR health must come first. If you have to choose between your health and work - YOU must always come first. Your health, your enjoyment, your well-being. The rest you delegate out to us."

Excellent advice - but mental health is more complex than that. Self belief is also important - and without self-belief one's health, enjoyment and well-being also suffers.

I was regularly bullied at school. As a result I learnt the importance of observing and understanding the enemy, and never saying anything unless you had thought about it carefully and were sure that you were right. My last school (Dartington Hall) was different. There was no bullying, and I was encouraged to question the establishment ways of thinking. This led naturally to a career in research. The problem has been that, to do my best, I need support and encouragement, and my bullying experiences meant I find it impossible to make close friends.

There have been plenty of setbacks in my life, and each time I have needed to find a way to regain self-belief. Lucy's death was bad - but I had the support of a friendly head of department, and quite a few undergraduate students who were the same age as Lucy and made it clear that they understood the injustice of what had happened. The real killer was that, before I had fully recovered, a new head of department was appointed. He was a vicious verbal bully, who picked on me. I also found myself as "piggy in the middle" between him and some of the more vulnerable students. My stress levels rocketed and gave me little option but to take early retirement and abandon my research.

I found my way back in two ways. I switched my research into local history - later providing help to people researching their family history (effectively my replacement students). I also also started helping making cups of tea for users at a local Mind drop-in and by 2001 I was the lay member on the board of the Dacorum Primary Care Group and a non-executive director of national Mind.

Belinda's death was bad enough but my mistake was to believe that I was now strong enough, and knew enough about mental health to tackle it myself. This time the "killer" was the bullying establishment. The coroner took months to reply to queries, and initially ignored evidence that contradicted the hospital evidence. He also saw nothing wrong with the coroner's officer being a policeman in the police station where Belinda had been "wrongfully" arrested. However he came good in the end - adding a formal rider of neglect to the verdict. The Buckinghamshire Mental Health Trust did not pass vital internal witness statements to the coroner until we discoverer the discrepancies ourselves - and failed to pass the inquest details to the so-called "Independent Review". The Thames Valley Police made it clear that giving a suicidal psychiatric inpatient (who was known to be terrified of the police) a piece of paper which erroneously suggested she had been charged could not conceivably be relevant to her death. This crazy view was supported on appeal - without us being shown any evidence to support the police case!

I am now fighting back. My involvement in the Investing in Your Mental Health consultation has helped a bit, as has a partial apology form the Buckinghamshire Mental Health Trust. However the challenge of the last few weeks has been a real confidence builder.

Win or loose I will take a break after May 17th and this blog will no longer be maintained on a day by day basis, if at all. I need a good break and at least a short holiday. I will not abandon my mental health interests, and I will continue to maintain my genealogy web site (but at a lower activity level). Instead I feel I now have the strength to resurrect a long abandoned research project from my past which might now be viable because of the power of the World Wide Web, and which I would like to see move forward before I die.

Wednesday 3 May - I have sent in the Sumission - but more help needed

2006-05-03T00:32:00.000-07:00

Following email discussions, and in anticipation of more, I have decided that the most effective way to go forward is for me to submit as the public representative on the Joint Commissioning Partnership Board with the "support" of a list of organisations - effectively converting the document into a petition.

I have therefore provided a title page with a short list of organisations (as examples) and where possible include a link to the organisation's web page and submission - so that we can all read each other's submissions! The opening paragraph of the body of the submission also needed rewriting - and I have replaced it with the history of my involvement in the mental health field.

And now for a break from mental health for a couple of hours. My wife has been enjoying a holoday in the New Forest and returns about mid day. There are neglected domestic duties to be done and I have to decide whether my nascent beard is to become permanent - or to vanish.

Wife arrives home early - and at least I have done the washing up - but she says "No beard!". I Walk the dog and have lunch. Then more emails. List of organisations prepared to support the submission growing and at the end of the afternoon email the submission - but will keep updating the list of supporters and also finish and submit Appendix 5.

And now to relax - a friend is coming for a light supper before we leave to hear some well known songs by members of the local Gilbert and Sullivan Society. Mental Health will be off the menu!