Another fine mess!
Two years after promising to abolish at the last moment and without warning or March to the Rally in the Geraldine Mary them, the government has now reinvented consultation, the reform proposal was Harmsworth Park at the Imperial War the community health council. dropped and replaced in the final NHS Museum. Plan with the single statement of intent to Speaking during the Lords debate on The abolish CHCs. The government has published a draft NHS Reform and Healthcare Professions Mental Health Bill that, if enacted, will be Bill health minister Lord Hunt said that This provoked a huge backlash, and not the biggest change in mental health the new PCT Patients’ Forums will now: just from the opposition parties, and the legislation for 20 government was forced to put abolition on enable people locally to express hold while it enacted the Health and their views about health matters; Social Care Act. After the Election, and with CHC abolition this time in the monitor and review local Labour Party’s election manifesto, the services; proposal appeared in the NHS Reform and National Poet… employ staff to commission or Healthcare Professions Bill. Again, provide independent support to however, opposition was wide ranging help individuals to make a because the structures intended to replace Some challenges for Primary Care complaint; Trusts… CHCs were neither independent nor work to empower their local integrated, and they were also population to express their views incomprehensible. Innovations in Primary Care… about health issues that matter to them; and Following fierce all-party opposition in Better care for refugees and asylum offer a one-stop service by the House of Lords, ably supported by seekers in providing advice and David Hinchliffe MP and Linda Perham information to the public about MP amongst others in the Commons, the London… public involvement and government’s compromise to transfer the complaints processes. bulk of the CHC role and responsibilities Now we are Ninety!…. to the PCT Patients’ Forums was finally In other words, they will offer all the accepted. The State Medical Service services that CHCs currently provide. Scheme… Unfortunately, because there will be many It has taken two years to reach this more PCT Patients’ Forums than CHCs, unsatisfactory state, and the new A few reasons for advocating a but with no extra money, the new Forums arrangements will be far less effective and State Medical Service… will be even more under resourced for robust than reformed CHCs. In the their work than the CHCS were. And the process the government has also managed new blueprint for the PCT Patients’ to alienate many of its natural supporters, A Diamond Jubilee and a Forums remit could well overlap, lost the services of many talented CHC Centenary…. duplicate or even conflict with the local staff and members, and demoralised those authority health scrutiny and overview members and staff who remain. Had the OBITUARY: Dr. D. Elizabeth role. original proposals for CHC reform been Hilliard (Bunbury)… progressed, the mechanisms for effective When the government was working on public and patient participation in health Forthcoming SHA Meetings….. The NHS Plan, the intention then was not care would already be up and running. to abolish but to reform CHCs, and the SHA CONFERENCE: involving Secretary of State of the day, Frank patients and the public in Dobson MP, was robust in his support for healthcare…. reformed CHCs. CHCs were to be reduced in number and would cover a greater catchment area. They would have Fringe meetings at Labour Party more staff and more resources. Their Annual Conference Councils would be reduced from the 2002 ….. present 24 members of assorted provenance to a more manageable eight. Mental Health Alliance These eight members would be selected Branch contacts…… through a stringent recruitment process, March and would be chosen for their commitment and ability effectively to and Rally represent the public interest in their local NHS.
CONTENTS
RIGHTS NOT COMPULSION
Saturday 14 September 2002
These reformed CHCs would complement the other proposals for patient and public Gather at 12 noon in Whitehall Place, involvement in The NHS Plan, and the reforms were well thought out. However, London SW1.
Socialist Health Association 22 Blair Road Manchester
also “out” as a manic-depressive. Through There are also some implicit her poems about psychiatry in a wide contradictions in the requirement for sense Carol hopes to inform a larger PCTs to meet national targets and the new Tel: 0870-013-0065 audience and help to create a kinder and NHS Plan responsibility to reflect local admin@sochealth.co.uk better understanding of mental ill-health. needs and priorities. National targets do She was reappointed as the SHA’s not necessarily reflect local priorities, and National Poet at this year’s annual general a balance must be struck between any meeting, and has sent us some new conflicting demands. Editor: Judith Blakeman poems, some of which appear in this edition of Socialism & Health. Public health issues will play a key part in The views expressed in this journal improving the health of the PCT’s local population, and the ability of a PCT to are not necessarily those of the Those with Mental develop its public health role to suit local SHA needs is dependent on having the right Health Problems years. It will affect everyone who uses staff. It may also be appropriate for mental health services, their carers, and neighbouring PCTs serving similar those who provide services. The effects Those with mental health problems communities to share some specialist will be felt for many years. Include public health staff. Deluded, demented, depressed, There has been widespread criticisms of Drug-addicted, alcoholic, In addition, the PCT’s responsibility for the draft Bill, and the Mental Health Food disordered, hyper, very hyper, health improvement must be delivered in Alliance (and others) are determined to Under-active, withdrawn, too extrovert close liaison with other local strategic change it. The best of the proposals – Too angry, never angry, unable to grieve bodies, and the PCT may have to such as rights to advocacy and a new Valium-addicted, psychopathic, contribute to the Local Strategic tribunal system – must be retained, but Unemployed, sexually-abused, Partnerships of more than one local there must be changes to the parts that Over-religious, traumatised, abused, authority. However, local authorities could see far more people subjected to Can’t cope, still can’t cope, ante-natal, themselves may have differing local compulsory treatment. What the Bill lacks Isolated, over-worked, peri-menopausal, priorities and capacities, and the PCT is any right for people to receive the Disorganised, still can’t cope, must ensure that its local authorities mental health services they need. Semi-orphaned, poverty stricken, themselves are fully aware of their own Homesick, and hysterical. responsibility for the health of their The Mental Health Alliance is a coalition populations. of organisations established to comment Is that Everyone? on the draft Bill. The Alliance is calling for rights, not compulsion, including:
M16 8NS
a reduction in the use of
Carol Batton
11 April 2002 compulsory powers; an individual right to assessment _____________________________ of needs, and to have those needs met; statutory enforcement for advance directives; Some challenges for a law that takes account of people’s capacity to make their Primary Care Trusts own treatment decisions; adequate safeguards governing A PCT board member writes . . . treatment without consent.
For more information see: www.mentalhealthalliance.org.uk e-mail to mha@mind.org.uk or telephone 020-8215-2323
_______________________
NATIONAL POET Carol Batton is one of the most prolific and popular poets in Manchester. She is
Capacity issues
PCTs must have the management and staff capacity to deal with their enlarged responsibilities and to liaise effectively in partnership working with other members of the local health economy – including neighbouring PCTs, acute hospital trusts, the ambulance service, the mental health trust, and social services departments. Additionally, they must develop effective partnerships with the wider local community, such as local branches of unions and health professional bodies, With the introduction of Strategic Health voluntary sector and community groups, Authorities, primary care trusts (PCTs) and service users. have new responsibilities, enhanced roles and an involvement in the widest spectrum of health care across broad The patient experience areas. One new and fundamental PCT responsibility is to improve the overall health of its population, but without the In seeking to develop better primary ability to influence all the determinants of health care in the 21st Century, it can be a very complex process disentangling the that population’s health. many strands that contribute to health care, and delivering quality care in new ways means that the experiences of the Contradictions patient will crucial. New developments and innovations in health care provision
must be designed with user involvement high quality primary health care with from an early stage, and to achieve this, enthusiasm and commitment. staff time and resources must be available.
Innovations in Primary Care
My grandfather was a tomato. But in between They’ve added a gene, And now I’m a bastard Soya bean.
The expertise of health professionals, no Carol Batton matter how proficient they are at their job, can be negated if the patient’s perception PCTs now have the opportunity to is one of individuals with no time to listen experiment and innovate in the way that 16 February 1999 and explain what is happening. A patient’s local primary health care is delivered. An SHA member has drawn our attention to journey through one episode of health care can achieve a good medical result, the Access to Primary Care project while also being a frustrating experience initiated by the Somerset Coast PCT, as Better Care for an example. if effective communication and understanding is not shared between the Refugees and Asylum This project aims to improve patients’ out health professionals and the patient. of surgery opening hours contact with a Seekers in London It is important, too, to remember that staff variety of health care services. Patients need to make one telephone call, their and their families are also users of the The first resource pack for health care service, but involving staff in decision- conditions will be assessed, and they will workers who care for refugees and asylum be advised and/or directed to the most making means top level support for time seekers in London was launched recently appropriate service, such as an on-call GP, out for meetings and discussions, as well by the London Directorate of Health and as administrative support. If the NHS is the local ambulance service, the minor Social Care. serious about effective staff involvement injuries unit, a community nursing at all levels, it must recognise that there is service, or a community hospital. If the problem is less urgent the patient will be Meeting the health needs of refugee and a cost element. referred to his/her own GP’s surgery the asylum seekers in the UK: an information and resource pack for following morning. health workers is a handbook providing Patient participation The Advice Line gives advice on common comprehensive information to help illnesses and injury self-care, providing improve the health care offered to refugee Members of community health councils advice also on general health questions as and asylum seekers in London. It was written by Dr. Angela Burnett and (CHCs) and the successor Patients’ Forum well as more serious complaints. The Yohannes Fassil, both of whom have nurse staffing the advice line is supported members must also be involved. These extensive experience of working in the by an on-call local GP, who will be individuals may be “expert patients” or available for treatment and medication if health service, and both of whom have a they may be “informed citizens”. personal interest in refugees and asylum However, care must be taken to reduce required. seekers. the danger of the patient who is focussed on a single issue or who has an axe to Many additional services are available Refugees and asylum seekers arrive in the grind becoming too involved in a one through this innovative out of hours dimensional way. service. These include the minor injury UK seeking help. They may have suffered unit and minor illness clinic at the local traumas that the host population cannot The use of juries or health panels to assesscommunity hospital, extended cover from begin to imagine. Around 85% of community reactions to health issues may community nursing teams, and nurse led refugees and asylum seekers who enter also be very useful. It is usual to find that telephone triage and advice during the out the UK settle in London. Some have need of hours period. Care is also provided by of special care and resources. However, every health organisation has some the Rapid Response Vehicle in addition to they often miss out on appropriate health contact with patients and users in both informal and structured ways. The PCT the regular emergency vehicles. The rapid care because of the lack of guidance and advice available to healthcare workers. response vehicle is staffed by a local should thus identify and co-ordinate existing involvement, identify gaps and paramedic, and is fully equipped to This resource pack provides a good respond to any emergency call. develop ways to fill them, and engage understanding of how to meet their needs. with them in ways that are appropriate for It is user-friendly and provides the local community. Socialism & Health would like to hear information and lists of useful contacts. It from PCT Board members and others is designed to be read either in full, or to about any local innovations and be used as a reference point. The pack examples of good practice that they Major new challenges provides an array of useful tools and wish to share with a wider audience. information designed to help GPs and health centres provide the best possible The Shifting the Balance of Power agenda healthcare for refugees and asylum TOMATO therefore sets major new challenges for seekers. PCTs. For their part, the PCTs must embrace these challenges and develop new and innovative ways of delivering
My grandma was a tomato
Asylum seekers and refugees are entitled Carol Batton to NHS care. However, difficulties can arise through, for example, trying to July 2000 understand their health problems. Access to an interpreter or translation service is vital. The resource pack provides help on this, and much more. It will be updated Relax regularly on the Internet, and is now available through the Department of Health website. Relax ... The Department of Health has also commissioned the Refugee Council to produce a resource pack for NHS and social services staff on the health and social care needs of asylum seekers who are dispersed through the National Asylum Support Service. At the time of writing this was not yet available, but is expected shortly.
There is absolutely Nothing the Psychiatrist can do! So take off your Slippers, forgive Yourself, and cry! Carol Batton _____________________________
The State Medical Service Scheme A summary of the 1912 paper by J. E. Esslemont MB In 1912 a key debate amongst “Medical men” (sic) was the organisation of the profession. Three possible models were being debated:
1. a “State Medical Service in
2.
which the bulk of the profession will become a branch of the Civil Service”; “a Public Medical Service organised by the profession itself”; and practice that remains “as purely private as possible”.
3. The London resource pack is available at www.doh.gov.uk, Now we are Ninety! and details of the Refugee Mr. Esslemont comes down firmly on the Council pack in preparation can side of a State Medical Service, albeit one be obtained from Alison Beedie A brief foray into the archives of that is compatible with and working side on 020-7210-4985 or Michael Socialism & Health reveals an interesting by side with private practice for “well-toSwaffield at the Specialist Health letter from the late Dr. Elizabeth Bunbury. do individuals”. He felt that the country’s In it she says that some of the founders of medical service would be improved by Services Directorate on 0113- the Socialist Medical Association (SMA) closer affiliation with government, and 254-5002. always regarded the State Medical that government would be improved by
The Tranquilliser A Tranquilliser is painful; But you must take it; It calms the Doctor.
Carol Batton, August 2001
Friends I have friends. Therefore I am “socially included”.
Service Association (SMSA), founded in closer affiliation with the medical 1912, as the precursor of the Socialist profession. He drew attention to six Medical Association. The SMSA was a benefits. non-party organisation, although it was heavily influenced by the Fabian Society.
Research
Sadly, reference to Dr. David Stark Murray’s definitive history of the SMA/SHA Why a National Health The first is research, and Esslemont notes Service? indicates that we cannot truly that the country is falling way behind regard the birth of the SHA as 1912, since Germany in making strides in science and in 1930 the SMSA very briefly ran industry. In Great Britain, provision for alongside the newly formed SMA. research work depended chiefly on “the However, there was continuity in capricious support of private personnel, since the first President of the beneficence”. The list of preventable SMA – Mr. Somerville Hastings, at that diseases was short, and that of time MP for Reading and subsequently unpreventable ones very long. for Barking, was also the President of the Furthermore, what little research that was SMSA. In that dual role he recognised undertaken was not being collected, that the SMA was the organisation of the classified and disseminated. future, and consequently the SMSA withered on the vine.
Preventive treatment
Within our archive, two SMSA pamphlets survive – The State Medical Service Next comes preventive treatment. Issues Scheme, a paper read before the that needed to be addressed included “bad Bournemouth Division of the British housing, bad drainage, tainted milk, Medical Association on Wednesday 2 October 1912 by J. E. Esslemont MB, and unhealthy trades, segregation of infectious diseases and the like” – a list that remains A Few Reasons for Advocating a State familiar to this day. The role of an Medical Service, author unknown. efficient public health service, allied to
efficient research, would be swiftly to the utmost assistance of voluntary charity, transfer the list of “unpreventable” are unable to provide for their own diseases to the list of “preventable” adequate treatment” and that it would diseases, and thence to the list of “pay the State to look after the health of “prevented” diseases. Chief amongst the poor”. Practitioners should therefore A Few Reasons for these was tuberculosis, “a wicked waste “welcome the advent of the State into the Advocating a State of life . . . going on unheeded and field of general practice” so long as unchecked”. We forget what a scourge satisfactory financial arrangements were that disease was until very recently in this in place. In effect, Esslemont is promoting Medical Service country, and we should note with concern a salaried GP service which would be its return as a manifestation of poverty remunerated “partly by salary and partly This 1912 SMSA pamphlet presents and homelessness. by capitation fees”, and would include thirteen good reasons for advocating the even such benefits as “a course of postcreation of a State Medical Service. These graduate study on full pay”. include:
A State Board of Health
Hospitals
The next need was the establishment of a The State Medical Service would promote State Board of Health composed of a great increase in the number of leading members of the medical hospitals, with a “much larger number of profession and with a President of Cabinetmedical men than at present”. These rank, acting as both an advisory and an would over time be brought into the administrative body. It would receive National Scheme and be “used for research reports, make recommendations consultative, operative and therapeutic to government on public health matters work at the request of . . . the patient’s and other legislation and it should be able, own doctor”. Each district or town would when necessary, to “demand the also have its own Central Medical Depot, expenditure of millions for public health including pathology and laboratories, a with the same assurance as the Admiralty medical library, district nurses and a drug asks for Dreadnoughts”! and dispensing department.
the waste of medical resources
generated by competition and overlapping functions between the various branches of the medical profession; the need to free medical men and women “from such distasteful and incongruous work as the assessing and collecting of fees for services rendered”; the need to establish the medical profession firmly as a scientific calling; the need for large scale spending on investigations into the prevention and cure of disease; the unequal distribution of doctors that left “a very considerable portion of the poorer class with no proper medical supervision”; the reform of a hospital system that was at the mercy of uncertain and inadequate voluntary charity and not keeping pace with modern scientific methods; the lack of opportunity for practitioners to refresh their knowledge and become acquainted with modern methods and practice; the need to guarantee every medical practitioner an adequate and certain salary, gradual promotion and a generous pension.
Its administrative role would be wide ranging, including examinations for Promotion admission to the profession, supervision and control of the work of all branches of the medical, dental, nursing and Finally, Esslemont considers the pharmaceutical professions, the promotion (or career prospects) of his administration of all hospitals, asylums, medical men, believing that “too much nursing homes, sanatoria and other consideration is given to seniority and medication institutions, and the promotion social status and too little to keenness and of research. Esslemont speculated that ability, the result being that enterprise and eventually, through this Board, the originality are discouraged, and the medical profession could come “to exert service attracts the wrong class of men”. an influence in the affairs of State The State Medical Service would move commensurate with that which the legal the “round men in square holes, or feeble profession, the Church, the Army and men in powerful positions” in favour of Navy exert now” and that “considerations “fitness for work”, letting “the best man of health, heredity, and the improvement win, no matter what his age or his origin”. of the race . . . will at last receive serious attention”. Esslemont sought to re-assure the members of the Bournemouth BMA that he was not proposing a cut and dried The ordinary practitioner scheme but merely highlighting the need for a new scheme, stressing in particular the roles of research, prevention and The role of the ordinary practitioner in hospital administration that the BMA in How far the NHS has overcome these shortcomings and achieved the objectives the State Medical Service would also be 1912 did not consider part of its remit. addressed. Practitioners in those days felt He argued that while medical attendance laid out so clearly in 1912 is still a matter that their work was being encroached and medicine had their places, there was a for debate in 2002! _____________________________ upon by the public health officer, the fundamental need to devise “a plan or schools medical officer, the hospital, organisation which shall cover the whole sanatorium and “one public institution field of medical work and deal with the A Diamond Jubilee after another” and that far greater problem of the Nation’s Health in a encroachments were coming. Esslemont scientific and statesmanlike fashion”. and a Centenary! notes that “the poorer classes, even with
Hospital out of the post war debris, 11.00 a.m. to 3.00 p.m. Nevertheless, in some respects we may planting cherry trees and turning the Wesley’s Chapel, Old Street, garden into a haven for bees as well as a lay claim to being 90 years old and, London EC1. although we will celebrate 75 years of the calm and pleasant space for the patients of the Hospital. SMA/SHA in 2005, we could perhaps also consider celebrating the Centenary of the first demands for a national health She and her husband also established a Saturday 14 September care service in 2012. children’s zoo there for the benefit of Liverpool Branch Meeting _____________________________ children who otherwise had little contact National Policy Forum with animals.
OBITUARY Dr. D. Elizabeth Hilliard (Bunbury)
On their retirement to Bath, she and her husband fostered a number of museums and she continued to develop beautiful gardens. She was also instrumental in the restoration of the ruined Lansdown Tower, beside which her ashes were scattered, joining those of her father and her late husband.
7.00 p.m. Liverpool TUC 24 Hardman Street, Liverpool L1 9AX Saturday 21 September
West of England Branch Meeting National Policy Forum with Doug Dr. Bunbury, the widow of Dr. Leslie When Elizabeth Bunbury retired in 1950 th Hilliard, died in her 98 year on 10 June as Hon. Secretary of the SMA, Somerville Naysmith MP 2001. 9.30 a.m. to 12.30 p.m. Hastings paid her and her husband the following tribute: Gatehouse Centre, Hareclive Road, She was the only child of missionaries, Hartcliffe, Bristol BS13 born in Hong Kong in 1903. She started her medical training in 1921 at the Royal Free Hospital Medical School, and decided to specialise in mental illness once she had qualified.
“it is not only for what they have done that Elizabeth and Leslie deserve the respect and affection of us all, it is for what they have been and are – the best of friends and colleagues, always ready to listen always ready to help.
Saturday 28 September
Manchester Branch Meeting National Policy Forum She met and married Dr. Hilliard in 1936 11.00 a.m. to 1.00 p.m. while they were both at the Maudsley It is because they have put above all else Hospital, and throughout their 60 years the welfare of the organisation they have 22 Blair Road, Manchester M16 together their partnership extended to all so well served and because they have 8NS their activities in a manner reminiscent of maintained in it the true spirit of socialism Beatrice and Sidney Webb. that we revere and respect them.”. After the Second World War, Dr. Bunbury worked to rehabilitate patients damaged by war service and also with the survivors of the Japanese POW camps. She and her husband were by then very active members of the Socialist Medical Association. Both were on Central Council and were members of the SMA group known as “The Buniards”, playing a leading and consistent role in the demand for a National Health Service. They also campaigned avidly to humanise the treatment of mental illnesses. Elizabeth Bunbury was for many years the editor of Medicine Today and Tomorrow and its successor journal, Socialism & Health. She was also Honorary Secretary of the SMA for five years until 1950.
Saturday 16 November
FORTHCOMING SHA MEETINGS Saturday 7 September Scottish Branch Meeting National Policy Forum 11 a.m. to 2.00 p.m. Edinburgh City Chambers, Edinburgh Saturday 14 September
Dr. Bunbury was fascinated by plants, nature and gardening. After the War she created a garden at the Tooting Bec
London National Policy Forum and SHA Central Council
SHA Central Council with David Hinchliffe MP 11.00 to 2.30 p.m. Wakefield (To be confirmed) ________________________
SHA CONFERENCE
admin@sochealth.co.uk
Canter I seek to take a canter by the Seas of Time I ride the shore’s bright edge at the very tide For all we can see from saddle can be ours ‘til dyin’
Involving Patients and If I fall off horses, I cannot keep from the Public in the cryin’ And that is always why I cried; I seek to take a canter by the Seas of NHS Time. Friday 29 November 2002 10.00 a.m. to 4.00 p.m. London Voluntary Sector Resource Centre 356 Holloway Road, London N7 6PA Speakers include: David Gilbert Head of Patient and Public Involvement, Commission for Health Improvement Peter Walsh Director, Association of CHCs of England & Wales
It can hurt to ride a horse – The going’s never fine (at night), But from the higher saddles – God can hardly hide. All we can see from saddle can be ours ‘til dyin’ I never fall off, (You never hear me cryin’); Though I am lyin’ I never canter fast – Because it’s hard to ride . . . I’m only cantering within a Sea of Time – I’d trot, if Time were .longer than my life. I’m trying to go further, and see things not mine. Sometimes I feel that nothing has ever died – For all we can se from saddle can be ours ‘til dyin’
Christine Hogg Both Love and Leaf – the world can shine Department of Health Transition divine, Advisory Board Both I and nature, both like bride and Pauline Quennell Manchester University Dr. Iain Chalmers TO BOOK YOUR PLACE CONTACT
brother; I seek to canter by the Sea of Time; For all we can see from saddle is ours ‘til dyin’ Even though we’re crying. Carol Batton 6 June 2002 _____________________________
CONTACT THE SHA
Martin Rathfelder Socialist Health Association 22 Blair Road Manchester M16 8NS
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