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 It was also agreed that new facilities should be available before old ones were withdrawn.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!

Tuesday 2 May - Submission almost ready - A submission horror story - JCPB Papers

2006-05-02T03:20:00.000-07:00

Up early (after watching snooker until it finished last night - which was a mistake)

List out the main submission and appendices, and check though for typing errors, etc. By 11 am Main submission and Appendices 1-4 seem OK - Appendix 5 is incomplete and probably will not be ready until Wednesday.

A few emails, a phone call and a problem. Our chair, who does not have access to a computer - had drafted a submission which he plans to send in as the official submission - and there clearly has been a misunderstanding. He says both should go in - and after further emails it is possible that my work might go in as a joint submission with the alliance, or at least with the support of some of the alliance members.

Walk the dog at Ashridge - bluebells just beginning to show colour - will look wonderful in about a week's time.

Phone goes. The call was for Helen who has been holidaying in the New Forest. We joke about her having a good time, and I just mention that while I have been roughing it on my own I have been busy on mental health matters. "Have you" said the voice at the other end of the line. "So have I! I have just filled in a questionnaire on behalf of the XXXX parish council. Didn't really understand most of it and we didn't have time to circulate it to most of the councillors in such a short period - especially over the holiday period. " Some of the cuts were totally outside her experience and she admitted that she didn't understand how they had evaluated risks. "But the form had come from a respectable organization - so they must have done it properly - and so I answered "YES" to all the questions about evaluating risks." I wonder how many hundreds of other forms from bodies like parish councils will be returned in a similar way. After all the question is loaded - it invites the answer "YES" and few people will answer "NO" unless they know enough to give a reason.

****!!! - left the kitchen door open and dog has had the compost bin over and there are potato peeling, etc, all over the floor.

Get an email giving details of the JCPB at County Hall at 10 am on 11th May. There will be a briefing at 9 am - and I suspect that those who can attend the briefing (I will as the only non-voting public observer) will only get the document detailing the result of the consultation at 9 am. If the paper does a proper job it will be far too long to properly read and digest in an hour and so I reply copy to all JCPB member with the following reasonable request.

Can we be assured that the complete JCPB papers will be available (presumably by email) no later than midday of 10th May so that members have time to read them and assess what they say.

The consultation document specifically asks about risks - and I know that many people claim to have found serious faults in the risk assessments. Such matters need to be thoroughly addressed in the document JCPB will be asked to approve on May 11th, and adequate reading time will be essential. If the papers cannot be made available until the morning of the 11th it would seem appropriate to consider delaying the start of the public meeting to allow adequate reading time for the Board members.

It will be interesting to see what response I get. (In fact a very quick response from the chair that if the papers were late there would be reading time.)

A quick look at David's draft proposals for a forum submission - and some emails about how to handle mine - details tomorrow morning - as I have been involved in mental health issues (including getting some petition forms signed at Ashridge) for over 15 hours.

Monday 1 May - Preparing the final submission

2006-05-01T00:49:00.000-07:00

Started editing the main submission at 8 am. You may find the following addition to the first draft of interest:

At a recent presentation to the Hertfordshire County Council Health Scrutiny Committee the North & East Herts Hospital Trust explained the way they were hoping to remedy the current financial problems. They made it clear that quality of care and patient safety were of paramount importance. Financial cuts were only being considered where the integrity of the public service could be maintained.

There is no equivalent clear cut declaration in the current consultation – and the only reference to any possible deterioration in patient safety is that “areas of extreme immediate risk can be avoided.” The meaning of “extreme immediate risk” is not defined but is presumably more serious than “high risk” which is defined in the Summary and Guidance on Completing Risk Assessment Form to include fatalities. This is in line with the absence of any mention of in any increase in suicide risk in areas where such an increase could reasonable be expected. To make matters worse there is no clear indication about how the quality of service will be maintained (or to what levels it will fall) or how any patient-safe replacement services (if they exist) will be provided and funded. People attending public meetings are very frightened (and rightly so) when questions on this subject get an answer which is little more than “we don’t know yet – we were hoping you would be able to make suggestions.” If members of the consultation team have no idea how the quality and safety of the service is to be maintained any risk analysis relating to patient safety can be little better than fiction – and if the consultation team understood mental illness they would realise that their unprofessional approach to quality and safety issues was bound to cause many patients and their carers to panic.

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

11.15 am I have now posted what is close to what I hope is close to the final version of the Herts Parts PPI Forum Submission. Now off to walk the dog and a quick lunch - and I hope to add in some (or all) of the draft appendices in the afternoon.

4.20 pm - enjoyed walk and lunch, bluebells just starting to show colour. Appendix 1, 2 and 4 now attached to main submission. Will take another break and have Appendix 3 ready by about 6pm, with partial draft of Appendix 5 sometime in the evening.

Sunday 30 May - Are the Cuts Fair? Draft Risks for Cuts

2006-04-30T03:17:00.000-07:00

I have now posted a draft of the section looking at the reasons why the application of the cuts to HPT are inappropriate. While this will go as part of the Herts Parts PPI Forum submission, the consultation did not ask the question and what I have produced is a framework for arguing the matter at the Scrutiny Committee on 17th May.

I have also started work on a cut by cut risk analysis, and will try an get it posted by first thing Monday Morning. In particular I am looking for gaps in the additional "risk anaylsis" document that has been produced, looking for risks which the consultation team have failed to consider. (Their assumption seems to be that if we haven't yet worked out a good way to do something with no funding that the risks can be ignored!)
=====
Have been on the computer for about 8 hours today, working on the Herts Parts PPI Forum submission. The appendix on the risk analysis of the cuts is in skeleton form (many boxes still to be filled in). However I am posting it now because:

It contains some important information on how those carrying out the consultation are planning to ignore risks to users, carers, etc, including suicide. (Things that affect individuals are not valid risks!)
It contains my response to these tactics - but any suggestions to strengthen the case would be helpful
It contains my risk analysis on several of the cuts.
It contains quotes from other organisations's submissions - email me a copy of your submission and I may include a quote.
Time is running out - priority tomorrow must be to finish the body of the submission, to send out on Tuesday, and if necessary the appendicies will be emailed on Wednesday.

Saturday 28 April - Councillors on JCPB

2006-04-29T02:32:00.000-07:00

I went a little quite yesterday - in part trying to draft someting on the 5% for our forum submission, and to share, and in part - I am afraid relaxing watchin snooker. I have also realised that some ordinary matters have been left unattended - and I am now rushing to the Post Office (with the dog) to get a motor vehicle licence before I go illegal!

Will definitely have some more information to post later today.

===============================
Following a request from Heather I give details of the Hertfordshire County Councillors who I expect to be at the JCPB on 11th May.

David Beatty Absent for last meeting, don't remember him saying anything earthshattering at previous meeting.

Ken Colman Former Chair of HPT (in its earlier West Herts form), now Vice-chair of Dacorum PCT - so has "conflict of interest" - it was his action that led to the temporary hold on St Julian's closure. Dispite conflict can possibly be swayed. On Health Scrutiny but will withdraw because of his role on JCPB.

David Lloyd - Vice-chairman - Has Adult Care Services Portfolio on HCC - so anything that suggest increasing load on ACS particularly relevant. Attends some health scruitny meetings because of his ACS interests.

Bob Mays - New boy- very hot about NHS waffle and - replaces Michael Downing (Chair of Heath Scrutiny) who resigned because being on the JCPB meant he could not speak out on Scrutiny. - Hopefully Michael will be able to act as chair on 17th May because he will not have been party to any decision at JCPB on 11th May.

=========

Sent a number of emails and finished the 5% cuts draft - but will post it tomorrow after I have slept on it.

Will need to draw up a plan for what I have to do between now and 3rd May - as I feel I am running out of time.

Friday 28 May - A Sobering Thought for the Day

2006-04-27T23:05:00.000-07:00

Last night's meeting at St Albans had an interesting effect. At each public meeting I have attended over the last few weeks, the PCT representatives have become more and more apologetic and the public more effectively vocal. While it might not be justified, I go to bed happy and relaxed for the first time in weeks. Tonight I am not haunted by the vision of my desperately mentally ill daughter Lucy looking at me through the grill of a stinking cockroach-infested strip cell in the psychiatric basement of Holloway Prison because the Health Authority (in 1984) was determined to save money on their mental health budget. Instead I just drift off to sleep.

There is a thump as I roll over and the book I had been reading falls to the floor. Not a thought of my other daughter Belinda dying in an under-funded psychiatric ward that was so badly managed that the Coroner added a formal rider of "Neglect". I simply return to an unworried dreamless sleep.

I wake at about six. Do I think about the family whose wage-earning alcoholic husband and father has been denied specialist treatment because so-called public servants are afraid to publicly speak out and tell Patricia Hewitt that in Hertfordshire mental health is more important than providing people with a choice of hospitals to treat their in-growing toenails. Am I empathising with the carer who is worried that their seriously ill son is to return home prematurely because St Julia's Ward is to close. Am I concerned because the withdrawal of early intervention in psychosis will mean that someone may be treated too late, and join the sad ranks of those who never work for life because of mental illness.

Unusually, this morning such thoughts never cross my waking mind. Instead - and why I do not know - I wake to the nightmare of a high-powered American bomb going off in a deep underground shelter full of civilians in Baghdad. Oh well. That's life in the modern world - no wonder mental health problems are on the increase.

Thursday 27 April - Scrutiny Notes now complete - >>> RED RISKS for bed cuts <<<

2006-04-27T02:09:00.000-07:00

I have now completed my notes on the Scrutiny Committee Meeting to include reports on the hospitals - and added links to the agenda papers and a powerpoint presentation. I have also added links to three "new" documents relating to risks associated with the Mental Health consultaion which I got by following up information from the meeting. (I will be commenting on the major risks they have not included later).

It is interesting that the hospitals can carry debts over to 2007/8 - but that HPT cannot - despite repeated statements that all trusts are being treated equally!!!

I have decided that I haven't time to convert document formats because a small number of people have limited software on your computers - free software which will allow mircosoft office files, inculding word documents and PowerPoint presentations is available from www.openoffice.org

I broke a "relaxation rule" and took some papers with me on my lunch-time dog walk. I have now taken the PCT's "Guidance on Completint Risk Assessment Form" and applied it to my analysis of the financial viability of the bed cuts. Result - plenty of Reds (High Risk) , plenty of Ambers, "Significant Risk) no Greens (Moderate or low risk). For "draft 3" - probably the final version see Response to St Julian's Ward Closures.

Email alerts on the above - then I need to relax with the dog again before going to an evening meeting in St Albans.

The meeting of the St Albans Borough Health Scrutiny Committee was interesting - as I was invited to sit at the table - and was given ten minutes to speak. Basically no-one considered that the cuts were appropriate - and the committee agreed to say so loudly up to te Secretary of State level.

And now to bed - I need a good night's sleep.

Wednesday April 26 - Draft Scrutiny Notes

2006-04-26T02:42:00.000-07:00

Up early - sent notes off to Mind in Dacorum - some emails and phone calls - darft notes on yesterday's scrutiny committee. For mental Health matters see draft at [word - now updated/pdf - draft only] - other information will be added later.

BBC interview went well - for World at One on Friday.

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

Stress is a funny thing - and I switched into what is best described as "protective mode" during the afternoon - and rather than fight it watched snooker - and took the first sleeping tablet for months in the hope of a good night's sleep. Part of the problem is that my wife has left for a holiday in the New Forest with some friends and I find it harder to control stress levels when I am on my own.

Hopefully will be back in operational status tomorrow - as I have more material to post to this blog, etc.

Tuesday 25th April - News from Scrutiny Committee

2006-04-25T10:01:00.000-07:00

Up early to drive to Hertford - traffic not too bad by the back route I took- radio reported 25 minutes queues on my normal route due to road works. Arrived early enough to have breakfast at County Hall before beginning of meeting.

Scrutiny Committee started at 10 am and continued till just after 1 pm. I will draft some notes, either this evening or tomorrow morning, but the key points were:

It was agreed that the mental health consultation was, in general, going as had been agreed at the previous Scrutiny Committee.
Because of the late date of some public meetings (Bishops Stortford on 2nd May, Consultation ends 3 May) late submissions would be considered up to 8th May. My recommendations are that everyone should try to get things in by 3rd May, particularly if you are planning submitting a letter or report, rather than just form filling.
The Joint Commissioning Partnership Board will meet on 11th May
The Scrutiny Committee to discuss the results of the consultation will be on 17th May - provisionally at 1 pm (with the pre-meeting for councilors at 10 am). BUT ...
The next item on the agenda was the reconfiguration proposals for the West Herts Hospital. Having failed to provide adequate information for this meeting (par for the course for this trust) David Law effectively invited himself to the 17th May Scrutiny Committee by including a slide in his presentation. ...
After the meeting I had a word with Michael Downing (Chair of Scrutiny) to point out that, with the 1 pm start the mental health business (especially if controversial) could take up virtually all afternoon - and there may not be time for the West Herts Hospital business (always controversial and time consuming) as well.

Drive home - pick up dog - Wendover Woods for a late lunch - light rain so dog gets very short walk - home and read emails.

FILE FORMATS

Mostly routine - but two messages from the same person - one states he cannot read word files. The other asked for my comments on two files in a format unknown to me - so I have no idea what they say. Following an earlier message from someone else I spent an hour or so converting all the word files addressable from the Correspondence page into pdf files and added a pdf link. In future if I get a file in word format I will post in it in both word and pdf formats and give readers the choice.

For instance the Herts Parts PPI Forum draft can now be read in [word/pdf] format. (I will be updating this, or at least the appendixes, probably tomorrow, but some far have had three responses - one questions the wording in one place - the other two felt it clearly makes the points that need to be made ...)

Now supper - and then some notes for guidance on the Mind in Dacorum submission. However fall asleep so abandon everything until tomorrow - apart from replying to one email.

Monday, 24th April - Draft Forum Response - Letters from DoH and HPT - Bed number statistics

2006-04-24T01:44:00.000-07:00

Wake up. Switched on radio. Royal College of Nurses commenting on the cuts and saying how the mentally ill and elderly are loosing out. That's fine. Patricia Hewitt quoted on how well the NHS is doing. Adrenelin levels rocket and I have an asthma attack (fortunately only mild).

After breakfast return to the draft forum report and complete the final section. As yet it has not been seen, much less approved by fellow Forum members - but time is running out and others may benefit by seeing how I suggest the matter be tackled. In particular it is important we all work together - and if enough of you let me have copies of your submissions we can add a reference to ours, to show that we are all working together with a common goal.

DRAFT HPT PPI FORUM SUBMISSION

Now to send out some emails to let everyone know it is there.

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

Next I am off to Hertford for the pre-meeting for the Health Scrutiny Committee tomorrow. Decide to go cross-country because of major road works on my normal route - but get there on time.

Health Scrutiny Committee meetings involve the NHS representatives presenting papers, and answering questions put by the county councillor members and five nominated PPI Forum members. The pre-meeting briefings are very useful as it allows key questions to be discussed in advance, and advice given about what options are open to the committee if the answers are unsatisfactory. There are three items on tomorrow's agenda which relate to the current health crisis.

A report on the progress on the mental health consultation. I will report on what happens tomorrow - but today's meeting suggested one additional question about the consultation process I may want to ask.
Pre-consultation update on the East & North Herts Hospital Trust
Press Release (yet again no proper paperwork) from the West Herts Hospital Trust

As I have been reporting on these meetings to the meeting of PPI Forum Chairs, my report tomorrow will include some information on the last two items.

At an earlier Health Scrutiny Committee meeting the Councillors decided to write to the Secretary of State requesting a meeting to discuss the Hertfordshire Health crisis. No reply was recieved because, when asked, the Depatment of Health said it had never arrived. It was sent again and a reply has now been received refusing a meeting from someone who did not have a job title (perhaps they are the office cleaner????). I doubt that the County Councillors will let this matter rest.

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

Drive home, shopping on the way, walk the dog, have supper and local at my emails at 7 pm. Things are hotting up - about 20 messages to attend to.

Simon des Forges supplied four documents (large, broadband recommended to download) for addition to this site.

Letter from the Department of Health of 20th April which effectively says the mental health cuts are none of the DOH business because “it is right that decisions about the local configuration of services should be taken locally, where the health needs of the local population are best understood.”

Letter from Bill Macintyre and Anne Marwick of HPT which is probably as helpful as possible, bearing in mind that it not politic for one trust to be overtly critical of the trusts which provide the money for the services.

Capacity Modelling of In-patient Mental Health Services in Bedfordshire and Hertfordshire (March 2005) and Capacity Modelling of Adult (working age) In-patient Mental Health Services in Bedfordshire and Hertfordshire (April 2005). These were reports commissioned for Investing in Your Mental Health. I have not had time to digest them, but they make it clear that the National Service Framework recommends a bed occupancy of 85% (to allow for statistical variations) while the consultation is aiming for a totally impractical 98%.

A quick glance also revealed some interesting facts about what would commonly be called “revolving door” patients. It says “In Hertfordshire they have on average 2.7 admissions, occupying 78 bed days and 26% of all Occupied Bed Days.” This figure is much higher than would expect on their comparator basis and any calculation of bed numbers which does not allow for such semi-residents of the wards will be seriously flawed. [It would be interesting to know whether a significant number of these patients were a legacy from Hill End.] – My page on Bed Numbers will need revising but for the time being I have simply flagged it with the above notes.

Other emails related to my draft, the progress with the petition, arrangements for the Radio 4 programme and the St Albans Borough Health Scrutiny Committee, and the Mind in Dacorum submission. There was also a helpful note from Carol on the effects of the various cuts.

9 pm - and I need to be up early tomorrow for the Health Scrutiny Committee in Hertford - so no more tonight.

Sunday 23 April

2006-04-23T04:15:00.000-07:00

A big job today - I am writing this at midday and have spent the last three hours preparing a draft for the response by the Herts Parts PPI Forum. About halfway through so time for a break to walk the dog and have lunch in the cafe by the monument at Ashridge. (see picture).

A couple of hours later and back to the grind and by six the main text is 90% complete, although appendicies need to be written. I decide to call it a day and check through early tomorrow morning . If OK I will then send out the draft for comment, etc. including to people who may find it useful when drafting their own submission.

Saturday 22nd April - Herts Funding levels

2006-04-22T00:05:00.000-07:00

Mental Health and other health topics are getting a good coverage in the local press and on checking the morning emails my daily google news mailing for "Mental Health" and "Hertfordshire" came up with eight references.The most useful was the following from the Borehamwood & Elstree Times

NHS spending £400 less per head than in London: Less money is spent per head on NHS patients in Hertfordshire and Bedfordshire than in London or the national average, new figures have revealed. The spending figures, which came to light after a parliamentary question from Hertsmere MP James Clappison, show that an average of £1,059 is spent on patients within the Bedfordshire and Hertfordshire Strategic Health Authority (SHA) compared to an average of £1,434 per head in London and £1,228 in England. Mr Clappison said: "We receive a much smaller share of health funding than other parts of the country. We have got to live within our means but our means are much smaller compared to London."

The online paper also includes 'Devastating mental health service cuts' which reports the recent public meeting at Borehamwood in some detail including opposition from GPs: It is feared that planned cuts could affect care services run from the Elstree Way Clinic in Elstree Way, Borehamwood, which is funded by HPT and provides specialist care to children with behaviour disorders. At a public meeting in Borehamwood on Wednesday night GPs expressed concern over the threat to these services, particularly as Borehamwood suffers from high levels of deprivation and child poverty. Because of the additional pressures on voluntary organisations and carers Leah Bretton, from East Hertsmere MIND, said I get three of four telephone calls a week from users, carers and psychiatrists wanting us to provide counselling services which we are not in a position to provide. "I am really worried about the impact these cuts could have on service users, increasing their suffering and that of their families." Although funding for the drop-in centre will not be cut, Ms Bretton fears the additional workload could force it to axe services. "We are going to continue to struggle to fund the day service and if we don't get the funding we may have to start looking at closing groups in Borehamwood," she said.

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

During the morning I dropped into three social events and over cups of coffee chatted about the mental health situation. I came across one case of stress due to cancer in the family - which is the type of case which is likely to loose support and which is discussed in the Macmillan Nurses report mentioned earlier.

Apart from attending to a few emails I decided to take the dog for a good walk - and to relax. As someone who would be categoriezed as the "worried well" by the authors of the consultation I must keep my stress levels under control.

Friday 21st April - Updated St Julian's Response

2006-04-21T04:00:00.000-07:00

I roll over in bed - my bleary eyes try and focus on the clock 6.33 am - normally I am up by now but I think I will rest a bit longer today. I blink and see that it actually says 8.33 and the van should already be in the garage for its MOT test. This consultation is playing havoc with my sleep patterns.

Returning from the garage I get a phone call from Radio 4 and mark the date of 26th April in my diary. They will be interviewing other people the same day, including a GP who is prepared to speak out against the cuts. I then get busy updating my St Julian Notes - posting them on line at midday. Next to email details of the revised St Julian's notes, and the HPT assessment to all interested parties, and am delighted to see that the HPT assessment has already been picked up from my blog by the Alliance. I therefore decide to break for lunch and a dog walk, and do the rest of the emails this afternoon.

Checking my snail-mail I get the outstanding papers for the Scrutiny Committee on 25th April. The Mental Health items was mentioned earlier on this blog - and if you have any points you want me to consider raising relating to the conduct of the consultation (not the content) please let me know ASAP. One "late" paper is a Progress report on the Interim Service Configuration for the East & North Herts Hospitals. The other was no more than a copy of the Press release by the West Herts Hospital Trust on 12th April. The proposals are that the Hospital Interim Reconfiguration Proposals will be presented to the Health Scrutiny Committee on 8th June - so should not be on the agenda for the meeting on 17th May relating to the mental health consultation.

In the evening I prepared and dispatched emails to most interested parties I am in contact with to make sure they know about this website, and to alert them to the latest developments. I particularly asked the chairs of other Forums to keep me informed of any developments that could usefully be shared.

Other points from my emails, etc.:

The Hansard report of the adjournment Debate is best read on Charles Walker's web site at http://www.charleswalker.org/search/article.php?id=152. One point I had missed is that the mental health cuts for HPT represent 30% of the total cuts on all mental health trusts.

Plans for the Alliance's demonstration are going ahead.

It is now clear that Radio 4 is to interview a number of people about the cuts next week.

It is becoming increasingly clear, from public meetings where the PCTs have presented the consultation, that they have little idea how they will handle the patients that are being "passed back" to them by HPT. They clearly hoped to get practical (no cost) suggestions from the audiences. While they claim in the consultation document that they have assessed the risks, they don't have an operational plan, and it is impossible to assess the risks if you don't have a model of what will happen.

Night All.

Thursday 20th April - Freedom Of Information - HPT's own assessment >>> ESSENTIAL <<<

2006-04-20T00:48:00.000-07:00

Near panic - I start checking mail and there is a momentary power cut. Everything restarts except the computer ... No access to email, my files, links to key documents on the web, my calendar, etc. ... If I have to get the local computer shop to fix it it could take a couple of days ... Could it be the fuse ... New fuze works !!! ... but check and so does the old one ??? ... this is mad ... I must calm down.

Plan out the day - there is in informal Herts Parts PPI Forum at Hatfield (sandwiches from 12.30) and the public Dacorum PPI Forum at Berkhamsted 19.00. I also need to walk the dog and do some shopping. I need to find the agenda papers for the lunch-time meeting (but don't panic if I can't find them) and there should be time to check through recent emails without my stress levels going too high. Anything else will be a bonus.

Emails include several making suggestions about my St Julian's draft notes - but I will delay updating until tomorrow. Simon provided me with the link to yesterday's Hansard which ends with the transcript of the adjournment debate on Mental Health.

A seminar "which aims to indentify the major health issues facing the public of Hertfordshire and to assess whether the statutory services are working effectively to deal with these" is being planned for 30th June. It is for County Councillors and members of the Health Scrutiny Committee only - and will undoubtedly look at all aspects of health. It could well be useful to let your county councillor know your views prior to the meeting to encourage them to attend.

Taking a few minutes break I dozed off, and had to rush to Hatfield, with the dog in the van, in order to get to the Herts Parts PPI Forum where the present situation over the consultation was laid and I agreed to produce some documentation and attend another meeting. There was some usefuk feedback about how horrified and disillusioned the HPT staff were. Then back home an a quick walk in the woods with the dog.

My emails contained some most important information obtained under the Freedom of Information Act from HPT. The first is a report from Bill Macintyre which details HPT's assessment of each of the cuts - and most of the entries are devastating. Everyone preparing a response to the consultation should read this document, and will find some useful ammunition for whichever of the cuts they consider important. The other is a shorter general assessment by Anne Marwick which was sent out with the report and includes the following:

The Trust found that as a result of this process it was possible to identify that there would be additional pressures in a number of areas including primary care and, potentially, out of county placements, which were vital pieces of information both for the immediate and future mitigation of potential problems.

This is not offered as a comprehensive risk assessment. Nor is it an individual risk assessment for users or carers. Rather it is a working document which informs decision-making, monitoring and mitigation of problem areas as identified.

....

After a short break I left for the Dacorum PPI Forum meeting, where I spoke about the consultation (in lieu of Julie Atree who was ill) and was delighted to find that they were strongly in favour of oposing the cuts. Then back home and look at a few more emails.

One commented on the need for users and carers to get together and I responded "To use descriptive words such as "user" and "carer", "male" and "female", "young" and "old", or "white" and "coloured" to try and divide people up into disparate groups is often counter productive. As far as I am concerned we are all people with needs, hopes and fears. Drawing artificial boundaries between groups of people can be unhelpful. Of course we should all work together - and remember that these words are only words. The problems lie with the people who see these words as battle lines."

Good Night all - The day has been exhausting and I need some sleep.

Wednesday 19th April - Comments on St Julian's, Adjournment Debate, and BBC interest

2006-04-19T06:28:00.000-07:00

Having drafted some notes on the reasons why the consultation is seriously flawed over the way it handles the St Julian's closure I decided to rework it into a lengthy reply to that section of the consultation. It is now available in draft form online. It is lengthy and I will probably submit it at the weekend (after incorporating any comments) as a separate part of my submission. I don't expect anyone to copy it - but it might give you some ideas of of things you may want to object to in other parts of the consultation.

I was just about to go off for a late lunch walk with the dog when the phone rang. Radio 4 is interested in what is going wrong with mental health in Hertfordshire and a reporter had found my blog! This may be triggered by the Early day motion in the Houses of Parliament this evening, and we spoke for half an hour.

I was delayed on the dog walk and returned just in time to here the Adjournment Debate which I think started early - as Charles Walker MP was already up and speaking - but I don't think I missed more than about a minute. I think he presented the case very well, particularly with regards to carers, and there were a couple of helpful interventions by two other Herts MPs.

Rosie Winterton gave the usual congratulatory statements praising the NHS staff in Hertfordshire, and particularly in the Hertfordshire Partnership Trust. She quoted from the Alliance letter relating to the provision of community services, psychological services and early intervention and, apparently referring to the Direct Access Psychology, said how important the service was, and how glad she was to see that the consultation proposed to invest Â£300,000 in the service. [You could have blown me down with a feather - but she definitely enthusiastically considered the consultation was handing out money!] Most of the rest was pretty predictable - using undisputed improvements since 2001 to "prove" we never had it so good. She quoted the February JCPB meeting as authorizing the consultation - without saying that the JCPB had no say in the 5% cut - and of course everyone must work to eliminate the Hertfordshire deficit.

Tuesday 18th April

2006-04-17T21:09:00.000-07:00

I wake early and log on briefly to see if there was any relevant News. The Independant online had an article "I'm not drinking. I'm just self-medicating" and other sources covered the same news - a report by the Mental Health Foundation which could be quotable to cover the alcohol (and CMHT?) cutbacks. The report is due to appear on their site later today.

Another news story which broke at the end of last week was "Suicide rate falls to new low". The full report "National Suicide Prevention Strategy for England - Annual Report on Progress 2005" is available online.

I really have a sleep problem because after writing the above I had breakfast, sat in a comfortable arm chair and dozed for most of the morning. In the afternoon I drafted some notes on the unreliability of the bed calculations for the closure of St Julian's Ward, identifying a significant number of effects of the changes which will push up the number of people needing beds. Basically the people who drew up the document were totally ignorant of elementary queuing theory, and to try and run anything at 98% bed occupancy when there are so many uncertainties is a recipie for both human and financial disaster. Will finish and post tomorrow (If I don't fall asleep at the keyboard.

Easter Weekend - I Relax and mainly forget mental health

2006-04-17T20:43:00.000-07:00

Saturday: My normal relaxation (after walking the dog) is running a web site, www.hertfordshire-genealogy.co.uk, to help people find out about their Hertfordshire Ancestors. This has been somewhat neglected over the last few weeks, so this morning I decided to post a joint April/May newsletter there, postponing the next newsletter to the beginning of June. I had planned to update some more information files but felt tired and decided I had been overdoing it so relaxed.

Easter Sunday had been planned as a day of relaxation and I left it that way - with a dog walk in the morning and a trip to London to visit my son and see our 18 months old granddaughter and be thrilled by her rapidly progressing language skills.

I had two task scheduled for Bank Holiday Monday morning . The first was a family history task involving downloading quite large images over the internet. The computer crashed about a dozen times and in disgust I switched it off and didn't scan some letters from the local paper I had planned to post on this site. In the afternoon we visited old friends and in addition the normal chat we discussed the current consultation . They mentioned that they had been talking to a GP who said that GPs were going to find the changes hard work, because they had come to rely on the CMHT. Because of the availability of specialist support for the patients the GPS had become comparatively deskilled managing such tasks and the reduction of such services would be a shock. There was also news which could suggest how the cutbacks might affect some users.

Friday 14th April - Why the Cuts must be stopped - A Tragic Tale

2006-04-14T11:52:00.000-07:00

Today I walked through the woods on the Ashridge Estate with Franki. To him it was just another walk but to me it brought memories flooding back as when the children were young we often picnicked here. Today would have been Belinda's 40th birthday but she killed herself in a Buckinghamshire mental hospital 5 years ago, at Easter, on her birthday, and her ashes are scattered among the trees. Franki was her dog. I am afraid I had to stop and have a good cry.

Why am I telling you this now?

Because it demonstrates the costs of failing to adequately support the mentally ill. The Sorry Tale of Lucy & Belinda starts in 1984 when the Oxford Regional Health Authority had found an unofficial way of reducing its mental health bill by "diverting" patients into Holloway prison. The courts got fed up with this and in October 1984 there was a "test" case when a girl called Wendy was given life imprisonment for a trivial offence, and this caused the Court of Appeal to remind the the Health Authority that it had a duty of care ...

Four days before Wendy was sentenced another seriously disturbed young woman, Lucy, was arrested and after a "medical" was deemed to be "not mentally ill" and was remanded in Holloway Prison.

Lucy was my daughter, and The Sorry Tale of Lucy & Belinda describes what happened to her, the effects it had on the family, and how what had happened led to the death of Lucy's sister, Belinda.

A few years ago I did an estimation of the cost to society including the NHS, Adult Care, Social Security, Home Office costs (Police, Courts, Coroner, etc.), the Exchequer (loss of tax income), etc. The total came to about £2 million for one "money-saving" diagnosis in a police station.

While some may argue that this is an extreme case, just one or two such cases could completely swamp any of the proposed cuts in the consultation - and as thousands of people are affected by the cuts it is reasonable to assume that there will be several extreme cases, and hundreds of other less expensive, but still costly cases to set against the claimed savings in the cuts.

Thursday 13th April - IMPORTANT -SCRUTINY COMMITTEE AGENDA

2006-04-13T02:39:00.000-07:00

The first thing this morning was to write a personal letter to the Secretary of State based on her saying "The way the NHS has been run for nearly 60 years is that areas that have overspent, and some have done it for a very long time, have not had enough incentive to make themselves more effective because they have known they will be bailed out by areas that were under spending." I point out that one of the areas of the NHS which has been doing the bailing out is mental health ....

Then a phone call to my GP for a repeat prescription. I mentioned the words "mental health" and he said he was very unhappy about the effect of the proposed cuts.

HEALTH SCRUTINY COMMITTEE

The post brought several items and the key item was the Agenda of the Health Scrutiny Committee at 10.00 a.m. on 25th April. The key extracts are:

Scrutiny of the final decision will take place at a special meeting of the Health Scrutiny Committee on the 17th May 2006, the purpose of this item being for the committee to consider whether it wishes to exercise its statutory powers in respect of the consultation process.

The meeting will only consider the conduct of the consultation - not its content.

Some concerns have been expressed at the close proximity to the 3 May deadline of some of the later public meetings, particularly that in Bishops Stortford on the afternoon of 2 May. . The Committee may therefore wish to seek assurance that there will be some flexibility in the deadline to take account of late submissions.

At the meeting on 17 May the Scrutiny Committee will consider "Evidence from organisations who responded to the consultation process focussing on where concerns have not been addressed."

This means that the main organisations objecting to the cuts will have an opportunity to speak (and/or present papers?) if they feel that their objections are not addressed in the final consultation report.

[There was no mention about whether the 5% would be raised at the 17th May meeting.]

Other items on the agenda (these papers not yet available) relate to the acute hospitals.

There will be a private briefing for county councillors and PPI Forum representatives on the afternoon of Monday 24th and if there are any matters of particular concern about the way the consultation is conducted it is best if you make your views known to a county councillor on the Health Scrutiny Committee (or a PPI Forum member, including me) before then

I also got notification that there will be an additional Board Meeting of Dacorum PCT at 1 p.m. 16 May, at Boxmoor Playhouse, 72 St Johns Road, Boxmoor, to consider the 2006/7 budget and financial recovery plan, which had to be deferred because of the late changes in the Payment by Results tariff. Other items include a copy of the open letter about the cuts being sent out by the Herts Parts PPI Forum.

I was delighted to get a comment posted on this blog from a worried GP who is very concerned about the damage that will be done to patients by the cuts. He writes: Good luck and don't take no for an answer. This is rationing beyond what is reasonable or safe. Any patients or their relatives who feel that they will be harmed by these intended reduction in services need to remind themselves that the Secretary of State for health has the ultimate duty of care towards you. This govt also hates bad publicity. So please put pen to paper.

A break for lunch and a walk with the dog on my return I have an opportunity to catch up on the news. The cuts to the West Herts Hospitals make the headlines - and it is interesting to note that the hospitals have until 2010 to clear their debt. We clearly need to ask (1) why HPT has to make all the savings in one year and (2) if the hospital is allowed to spread its debt over several years, will HPT be expected to continue to subsidize it?

The Gazette publishes another letter on the mental health cuts and its editorial about the hospital could also apply to our situation:

We are told staggering debts of £28.6 million have to be tackled and current overspending is running at the rate of more than £l million a month but the suspicion must be that this latest attack on Hemel Hospital is just another symptom of riding roughshod over the views of patients. There will be no winners. Staff working in inadequate buildings and plunged into a pit of low morale as they are expected to work even harder as their numbers fall are not a good prescription for giving patients the quality of health care they deserve.

I am now closing this blog for the day. In about an hour I am off to Hatfield for a meeting - and I will leave reporting on that until tomorrow.

[Cartoon from this week's Private Eye.]

Wednesday 12th April

2006-04-12T02:30:00.000-07:00

I decided to spend the first part of the morning away from mental health - and answered about half a dozen emails relating to my family history site at www.hertfordshire-genealogy.co.uk. While typing away Patricia was interviewed about the latest announcements about staff redundancies - including the West Herts Hospitals. Much of what she said was in line with earlier interviews - but included a very clear statement that suggested the trusts which catered for deprived people, which were in balance, should not have to cut back to bail out overspending trusts. She may well have been meaning the North/South divide. Does anyone have an accurate transcript of a minister making such a statement which could be unambiguously applied to the Hertfordshire mental health situation.

For much of the day I worked on the response to the letter from Felicity Cox, of Dacorum PCT, relating to risks associated with the patients who will no longer get treatment from HPT. I organized my comments under four main headings - each with a number of key points - which some of you may find useful in preparing your own submissions to the consultation.

So what resources are being made available within PCTs to "replace" the services?
Mental Health involves a network of different organizations working closely together. How far have they been consulted, and have the relevant financial implications been adequately considered?
What are the opinions of the professionals and users?
Why should we trust the statements in the consultation document?

There has also been a flurry of emails, the most important being a circular letter from the Alliance to GPs, with an associated poster. Another provides details so that I can attend the Welwyn/Hatfield PCT Forum in public tomorrow evening (6.30 pm at the Wellfield Trust Room, Birchwood Sports Centre, Longmead Road, Hatfield) where the cuts will be on the agenda.

Simon kindly provided me with a link to a Guardian article "Hewitt sticks to her guns as problems grow" which includes the words "She insisted trusts currently in deficit would have to cut their own costs next year, and could no longer rely on being bailed out by trusts in surplus." As a result my task for this evening is to write a deliberately very short letter to Patricia Hewitt concentrating on the point that underfunded and under privilledged areas of the NHS includes NHS mental health trusts.

Tuesday 11th April - Including letter to Tony Blair from The Alliance

2006-04-11T03:44:00.000-07:00

Emailed copies of my JCPB notes to various interested parties and then scanned Felicity Cox's reply to my letter on risks. The key issue - which is not made clear in the consultation documents, is that there are two distinct types of change. One is internal to HPT and the other is the transfer of responsibility for the patients from HPT to the Primary Care Trusts. The risks I was concerned about, and still am concerned about, relate to the ability of the Primary Care Trusts to manage. I will reply later today, but for the moment I am off to a Mind Meeting Place and a hospital appointment in Hemel Hempstead.

At Hemel I turned up at St Mary's Hall, for the Mind Meeting Place, and met a number of old friends. There was a good turnout and there was a rock and roll band, Lithium, for entertainment led by Bob Houlston (who I met online yesterday). I had a number of interesting chats including one with someone who had attended one of our Forum meetings as a member of the public.

There was one bit of sad news. For very many years Mind in Dacorum has held what was originally called a drop-in in a church hall at lunch time on Tuesdays. When I first got involved in 1991 I sometimes helped at the Baptists' Church in Marlowes, and later it moved to St Mary's Hall. Because of the need for voluntary sector charities to economise, today was the last meeting in that venue. The next Tuesday Meeting Place will be at the Mind offices in Leighton Buzzard Road - which unfortunately is smaller - putting a lower limit on the number of users who can attend.

On my return I find a number of emails. Simon has sent round a copy of the letter "The Alliance" has sent the Prime Minister. Heather circulates a number of documents - including my JCPB notes and wrote:

One point to add: at the Strategic Comm Group meeting on 21st March 06, I queried the necessity to make a 5% cut at all, and not for example, a 2% cut whilst making savings elsewhere in further 'internal efficiencies' and 'service reconfigurations' before any service reductions. The reply given me was that this was not negotiable although from documents handed out that day (see attached financial context), it seemed reasonable to at least look again at the initial calculations ie. not repay the 6.5% in 'debt repayment', but repay less, stagger the loan and reduce services less....

I would agree with Chris Reynolds and Bob May that this initial 'apparently' fixed sum of 5% is definitely worth challenging as the cuts stem from there. It not how I would have chosen to attribute my budget.

Another email confirms the Joint Commissioning Partnership Board meeting to consider the result of the consultation will be at 10.00 am on 11th May. The date of 17th May for the Scrutiny Committee has not yet been confirmed. Yet more emails dealt with the possible organisation of a demonstration.

In the evening the news breaks that the West Herts Hospital trust is to loose 500 jobs [BBC news Item].

Monday 10th April - Key notes on JCPB Meeting

2006-04-10T00:19:00.000-07:00

At last I have finished my notes on the JCPB meeting of 6th May. They raise many issues - for instance they clarify the responsibility for the 5% cuts, and attempts to railroad the consultation through without considering the risks. The recent decision about contracts for drugs and alcohol treatment suggests that there may be no room for excellent local voluntary sector services in future. In addition the JCPB funded Carers in Hertfordshire report "Family Carers' Views on the Future Provision of Family Support Services in Hertfordshire" provides plenty of quotable quotes as to the risks to carers as a result of the cuts.

Last night I discovered that the reason I had got no comments on this Blog was that I hadn't switched the facility on. This morning I find Bob Houlston had added a comment - and I have now visited his excellent web site "Mental Health Survival Guide - Dacorum & St Albans UK". The site not only gives good advice, but also illustrates the difficulties service users have to overcome - and hence may provide ideas for fighting the proposed cuts.

After taking the dog for the normal lunchtime walk I forgot to go to the Mind meeting place I usually attend, and spent most of the afternoon trying to edit a text and not getting it right (hopefully for tomorrow). One of the problems was that Windows crashed several times and as stress was building up decided to call it a day and take the dog for another walk round Tring Reservoirs.

Sunday 9th April

2006-04-09T15:31:00.000-07:00

I slept late, having taken a sleeping tablet, the first for ages, as my stress levels had been too high to get to sleep. On waking I checked my emails and had one from a genealogy contact which showed how carers are exploited by the services down under:

Dear Chris, I wish you all the best with your fight for mental health improvements. The same happens in Australia. My brother is bi-polar, he lives with mum, my dad died recently & Roger has gone into a manic phase. My mum is 82 and the mental health people are quite happy to have her look after him rather than hospitalise him & get him back to a stable state. My mum is being intimidated, bullied & he is overbearing, taking what he wants & ruling the roost. She doesn't need this at a time that her husband has passed on but he is her baby & she puts up with it. Mental Health here should be doing something but they don't.

GOOD LUCK, you go get them Chris

Before I had time to have breakfast I got a phone call. There had been a change of plans and I bundled the dog into the van, and headed off round the M25 for an informal family meeting. While there we were all entertained by my granddaughter Hanaa (18 months) whose language skills are well advanced for her age. Mental health problems were happily forgotten.

On returning home in the afternoon the plans for a quiet dog walk were thwarted by crowds of people (I had forgotten that there was an open day in the woods), no room in the cafe, and the start of a snowstorm. Feeling frustrated I decided that a quiet evening would do me more good than another "Mental Health Crisis" session at the keyboard.

So good night and see you all tomorrow.

Saturday 8th April

2006-04-08T01:40:00.000-07:00

My normal online relaxation is running the web site www.hertfordshire-genealogy.co.uk which is designed to help people research their Hertfordshire Ancestors. Since starting this Blog the site has been neglected, and emails requesting help and advice have started to mount up. My first task this morning to post warning messages about delays on the site and to send a circular email to all the outstanding messages in my genealogy mailbox. (BTW - some of you may have already noticed that many of the pages linked to this blog are "hosted" by my genealogy web site, at least on a temporary basis.) I check with Craig, who hosts the Genealogy web site and he offers to set up a special mental health web site if it is decided to continue this after the end of the consultation.

Google emails me with Concern over mental health cuts, a report of a meeting of the Hertsmere Patient & Public Involvement Forum, published in the online version of the Borehamwood & Elstree Times.

The post brings a letter from the Dacorum PCT in reply to mine of 31st March (I will post tomorrow) and on walking the dog drop in to a coffee morning at a local church to let them know about the mental health crisis. The dog goes to sleep in disgust as I spend a long time talking to a worried mother with a mentally ill son. I tell her about the special changes affecting the mental health service in Tring and suddenly realise that I do not know what is happening to people who lives in Tring - but have their GP in Buckinghamshire. I email a contact in HPT to find out.

In the afternoon I draft my notes of the JCPB meeting - taking a break to watch the Grand National. A good supper - and I fall asleep in a chair - so decide to keep clear of the computer (apart from finishing today's blog) and will finish the JCPB notes tomorrow.

Friday 7th April - Reports of important meetings

2006-04-06T23:37:00.000-07:00

After yesterday's round of meetings I have three meetings to write up, and other electronic paperwork to attend to - and having slept badly started at about 6 am with some Press Reports.

The Gazette, which comes out in two editions - one for Hemel Hempstead and the other covering Berkhamsted & Tring, had six items relevant to the cuts or NHS changes. Mental Health cutbacks could kill was based on a Mind in Dacorum press release. The consultation repeatedly suggests that the voluntary sector could help care for people whose specialist mental health care has been axed and Support halved for voluntary groups describes the cutbacks in funding by the Hertfordshire County Council. Consultation cuts included highly disturbed children and adolescents - and the care of mentally ill young adults is always a problem. Cuts leave homeless out in the cold describes how financial cuts mean Herts Young Homeless Group are having to drastically reduces their services in Dacorum.

The Gazette also reports that the national emergency care support team [who job is to care about money] is to help the West Herts Hospital Trust [the cause of a significant part on the local NHS debt] put in place a recovery plan. Another article criticises the enforced merger of the Ambulance Trust and there is discussion about the borough council decision to give planning permission to the new Surgicentre.

Next came the job of upndating the calendar of events - adding the dates of the Joint Commissioning Partnership Board meeting to consider the result of the consultation, on the 11th May, and the Herts County Council Scrutiny Committee which will probably be on the 17th May. I have also provisionally added the dates of the various PCT Patient and Public Investment Forums during and shortly after the period of the consultation. Then a phone call with a very interested journalist, and two requests for information under the Freedom of Information Act.

And now to the main matter of the day. I have edited and posted my report of the public presentation of the consultation by the Dacorum PCT on the 5th. It would be nice if all areas could work to get something like 50 attendees and my notes could help people to prepare questions.

I then drafted and posted my report on the Joint Beds/Herts/Luton Health Scrutiny Committee - including dates of the forthcoming NHS changes - and the final agreement on Investing in your mental health and the joint level.

Feeling tired I looked at the Watford Observer, which I got when I took the dog for a walk. 'Without the service I would not have the life I have now' relates to the proposed cuts while Funding withdrawal will sever 'vital link' describes the forthcoming closure of an information service for the disabled.

My report on the Joint Commissioning Partnership Boad will follow tomorrow.

Thursday 6th April - JCPB and other meetings

2006-04-06T11:13:00.000-07:00

What a day - woke early and found three news articles in our local paper relating to financial cuts for health. Then into the van and of to Hertford - with a stop at Hatfield Tesco's for breakfast and a final check through the days papers.

10 am and I am in Committee Room C in County Hall for a pre-meeting briefing of the Beds, Herts and Luton Joint Health Scrutiny Committee - with the meeting opening to the public at 10.30 - the subjects being discussed including the Investing in Your Mental Health. At 12.30 I joined a workshop type lunch session on the way that mental health services might be organisms in future, then to Committee Room B for 2 pm. The long and sometimes noisy Joint Commissioning Partnership Board Meeting included sessions on the closure of St Julians ward, and the conduct of the consultation - and after informal talks with various people set off home at 4.30 pm.

At home I found a dozen new emails of which four related to mental health and will be dealt with tomorrow. One from someone who had found this site and wanted to help with the campaigning. In addition my wife had written two messages on the notepad by the phone. I will phone the journalist tomorrow but the one from a member of a PCT PPI Forum required an immediate phoned response.

A quick supper and a few minutes relaxing - and I am off to a meeting of carers to bring them up to date on the cuts and the consultation. I won't be returning until after 10 pm - so reports on the meeting will have to wait until Friday.

Wednesday 5th April

2006-04-05T00:03:00.000-07:00

Up early and at 7 am the phone went - and a few minutes later I was being interviewed on Three counties Radio. Seemed to go well and was able to briefly mention some of the cuts, the fact that the audience of about 50 were unanimous in their opposition, and the fact that people should attend the meetings to be held after Easter. The cuts were mentioned several times later on the programme and part of the interview was re-broadcast at 9 am.

During the programme there was another interview, of someone from Macmillan Nurses. The problem is that many people who have been diagnosed with cancer become depressed and find there is no one to talk to. The speaker said that there were 11,000 cases a year in Hertfordshire, and about half of them had difficulties coping with the emotional aspects of the disease. He gave an example of Bob, who was getting divorced, and who had lost his job because he could not cope with the stress of living with the disease. Nobody on the programme linked the cases - but this is exactly the type of case which will be hit by the cutbacks in the CMHT - and many people with other devastating medical diagnoses do not have the benefit of Macmillan Nurses.

I followed this up an there is a press release on a new report (published today) entitles worried Sick - the emotional impact of cancer, on www.macmillan.org.uk. The following extract comes from the press release:

The report found that almost a third of people with cancer (32%) said that their relationships are put under ÂenormousÂ strain and over a quarter (26%) said they experienced real difficulties in their relationships with their partner as a result of their cancer diagnosis. A quarter (25%) of these people (7% of people with cancer surveyed) said that they had broken up with their partner as a result of their cancer and four in ten (43%) people living with cancer said that their sex life had suffered because they had cancer.

They could make a useful contact for the petition (as would some of the other hospices) and while I was thinking about it Simon sent an email giving details of the online petition - and I add the link to the side bar.

I then get down to writing up a report on yesterday's meeting, and send a draft round by email in case anyone thinks I have left something important out. Will post final version on tomorrow (if I have time).

While preparing the report I note that the last public meeting gives the people of Bishops Stortford who attend the meeting two hours to read the consultation document, prepare a reply, check it with their colleagues (if they are replying on behalf of aorganizationon) and post it. Send email to query if this is "proper" to County Hall.

I grab a quick sandwich for a late lunch and take the dog for a walk along the Wendover Arm of the Grand Union Canal to "escape" from mental health - only to end up talking to another dog walker about the limitations of the mental health services in Buckinghamshire. Return home and my wife hands me 22 petition cards she had got signed at a Lenten lunch associated with the local church. Some more emails - including listing out enclosures for tomorrow's meetings, and a long phone call.

I have now been up "thinking Mental health" for nearly 12 hours - and still have to check through the papers for tomorrow's meetings - starting at 10 am on the other side of the county. I need a break and there will be no more updates of this blog tonight.

Tuesday, 4th April - Public Consultation Meeting

2006-04-04T06:33:00.000-07:00

Today is the first day at which the NHS hold a special meeting to put their views to the public - at 6 pm at Boxmoor. The "action group" of organizations has been contacting people to see if they can attend and I send out a number of emails to let people know that this site is in existence. The media are showing interest and immediately after a half hour talk with a reporter from the Watford Observer I get a phone call from Three Counties Radio to arrange an interview at 7 am tomorrow, about the meeting this evening.

Somewhat disappointing was an email from Professor Louis Appleby. Back in 1984 he wrote a review of a TV programme which featured the inappropriate imprisonment, and death, of my seriously mentally ill daughter Lucy. Following the death of my other daughter Belinda while in psychiatric care in 2001 (after having been "wrongfully arrested" in the same police station as Lucy) I was invited to comment on one of his reports on suicide prevention. In connection with the current financial crisis he writes:

Thank you for taking the trouble to write, and for the valuable information. It sounds as if someone has said to you that I was unaware of the problems in Hertfordshire when I paid my visit a few weeks ago. This is not correct, though of course I have not had all the details. In fact, I and my DH colleagues have been in regular contact with key people in Hertfordshire over the last few weeks. Your information is useful to us in conducting these discussions. I have also had a recent letter from Bill Macintyre, Chief Executive of the trust, following my earlier discussions with him. I should emphasize that we are doing what we can to make sure that local organizations achieve financial balance and at the same time continue to make progress on key policy developments.

It is interesting that when he spoke at a meeting in Hertfordshire in March he painted a rosy view of the situation in Hertfordshire - and when a questioner pointed out that the situation in the county had no resemblance to reality the audience burst into applause. In his current reply to me he ignores the fact that rather than continuing to make progress, things are actually going backward.

Another interesting email was from Simon des Forges, project worker for the Hertfordshire based service user involvement charity Viewpoint. He has written an article We must all fight the mental health cuts on www.psychhminded.co.uk (an online site for all who work in psychology, psychiatry and mental health) [direct link to article] - The article is well worth a read - and I may well add a comment.

Other emails give details of the mental health consultation to be held on 18th April (2-4 pm) at Park Lounge, Welwyn Garden City - or provide copies of NHS documents which I could not find on the appropriate web sites.

Now to take a break from the keyboard - and get ready to attend this evening's meeting. ...

There was a good turn out of about 50 to the Dacorum PCT public meeting on the consultation. A presentation was given of the changes, and Glyn was invited to respond, and he couldn't find a good thing to says about the cuts or they way they were presented. There was a short "workshop session" to allow people to talk among themselves and there was then a question and answer session. None of the questioners supported any aspect of the proposals, and few, if any were satisfied with the replies they got. After the meeting there was a chance to talk to other people there, and as a result I have such a list of things to do tomorrow (including a report on the meeting) that I am cancelling my trip to Hertford.

Report for 3rd April

2006-04-03T03:42:00.000-07:00

I was interested to see the news about the NHS Bank. - and wonder if this is a way of minimising the damage by spreading the debt over several years. (As the debt is not HPT's it would be nice if the acute hospitals or the PCTs paid the extortionate interest.)

Have added two letters relating to the risks to patients and the services in general. The first was sent by mental health professionals working in HPT in February and seems to have been ignored in drawing up the "risk assessments" in the consultation document. The second is trying to find out why the Dacorum Primary Care Trust thinks the risks are much less serious than the Hertfordshire Partnership Trust.

Off to lunch - and to walk the dog (seen here in his younger days).

Feeling better after a brisk walk, a snack, and a visit to a Mind "meeting place" and a chat with some service users I return to my computer. There is a request for information about what the Patient & Public Involvement Forum was doing that needed an immediate reply, and Mind in Dacorum has issued a Press release. Another email brings news of another consultation meeting, this tme at Ware on April 25. This means that at least five of the public meetings will be in the last 6 days of the consultation - suggesting that there could be a large number of responses arriving in the last few days.

Report for 2nd April

2006-04-03T00:54:00.000-07:00

I have decided to reorganised this Blog - as there is a lot of information that needs to go online. This is being posted elsewhere and the blog will serve as an index to it - and a report on progress.

Today's work has been set up a calendar of meetings with links to the web pages containing the relevant documentation, and information on the organisations concerned and a separate list summarising the organisations concerned and how you can find out who to contact.

Tomorrow I will post some information on the background to the cuts and why they seem grossly unfair, togehter with some key correspondence.

The Nature of the Crisis

2006-03-17T13:47:00.000-08:00

The Hertfordshire Partnership Trust provides mental health and specialist learning disability services in Hertfordshire. These services are commissioned by the Primary Care Trusts and due to serious overspending, mainly by the acute hospitals the total health debt in Hertfordshire and Bedfordshire now totals about £115 million pounds.

None of this debt is due to the Hertfordshire Partnership Trust but it is being asked to drastically reduce services to pay for excessive expenditure elsewhere. Some of these cuts are subject to a consultation which finishes on May 3.

I have been involved with mental health provision in Hertfordshire for many years, as a trustee for Mind in Dacorum (and for a time as a trustee for National Mind), as a member of the North West Herts Community Health Council, and currently as vice-chair of the Herts Parts Patient & Public Involvement Forum. In this role I represent the Forum (and hence the public) as an official observer at the public meetings of the following bodies:

Hertfordshire Partnership Trust Board

Joint Commissioning Partnership Board

Hertfordshire County Council Health Scrutiny Committee

These bodies all play an important role in the current crisis situation, and as I have speaking rights at these meetings it is important that I know the views of the people of Hertfordshire.

This blog - and the associated web pages are to keep everyone informed about what is going on, to provide patient and public oriented advice to those who wish to respond to the current consultation. and allow you to contact me to express your views.

Chris Reynolds

mental.health@codil.co.uk