Category Archives: Mental Health

HSSD Minister

Today I announced my nomination for the position of Minister of the Health and Social Services Department. In making that announcement to all deputies I sent them this letter outlining what I would seek to prioritise were I to gain the position. I feel that it is appropriate for me to publish the letter here on the website in the interest of transparency of my priorities.

I’d be equally pleased to answer any questions from the public on any matter pertaining to the role of minister of HSSD.

Dear Colleagues,

Having decided to stand for the position of minister of HSSD I thought it appropriate to share with all of you some of my views concerning the immediate future of the department. Were I to be elected I would work with the board and other departments with the aim of achieving as many of the actions below as possible whilst recognising that I would need the endorsement of the rest of the board to progress these intentions.

The PEH has been the main focus of many when talking of HSSD, but this is only one part of the department’s service offering. Mental health has gained far greater interest and attention in recent years, that is to be welcomed, but there’s scant attention given to our adult disability services for instance. Children’s services receive due close scrutiny on difficult occasions but when was the last time we heard talk of the role of the Children’s Convenor?

I’m proud that my time on the board of HSSD has been spent working closely with Mental Health and the recent organisation of Elephant Week. I’ve met every other month with carers of our Disability Services and recently attended the first meeting of the extended parent carer council, an initiative that I oversaw. I’m pleased to have been closely involved with the upcoming Sexual Health strategy, the first time we will have a strategy to deal with our high rates of teenage pregnancy and our low rates of STI diagnosis. I’ve also been diligently working with our IT department, implementing what will be a great improvement in the governance of healthcare.

The Chief Executive of the States recently circulated details of the new initiative ServiceGuernsey. Whilst I share some concern over the naming of the initiative, the principles behind it are laudable and to be welcomed. Of course in healthcare, such initiatives have long been championed under the heading of “Patient Centred Care”. HSSD is much larger than just healthcare and therefore we frequently talk of Service Users rather than patients, therefore I’d like to talk of Service User Centred Care, an equally unpalatable term, but it does describe accurately what needs to be our focus on each and every occasion, people, frequently at vulnerable points in their lives.

Some amongst you will feel that the lack of mention of finances thus far is worrying, but failure to deliver Service User Centred Care will result in similar problems, such as the current crisis that has consumed our maternity service. The cost of such failures are extensive. I will outline my thoughts on Finances later in this letter.

Maternity Service

The current crisis will be the main focus of the next board. A number of recommendations will be made by the Nursing and Midwifery Council (NMC) in their report. I’m of the opinion that a large number of the recommendations will need to be implemented without question, but for some recommendations there may be a question to ask as to the appropriate solution for a small, remote location, such as Guernsey. There’s also some questions that may need to be made as a result of Guernsey’s rather unique consultant led care with no junior doctors. This model is not unfamiliar to NHS Scotland, who have similar remote locations with a different model of healthcare delivery. I would therefore propose that the findings of the coming reports be peer reviewed by colleagues in another jurisdiction to evaluate what can reasonably be justified as not being implemented.

This is not a desire to be defensive of our services. We must recognise the failings that have occurred over a number of years and resolve to swiftly implement the findings where appropriate, but where we feel there are questions over the NMC findings we must not only act in the best interests of our population, we must also be seen to act in such a manner. A peer review allows us such an opportunity.

Part of the reason for the failings in my opinion, has been as a result of a closed environment within one of our services. This must never again be allowed to happen. I look at the partnership approach within mental health, where a number of service users call in to Albecq Ward for a discussion with service users to ensure that they receive the care that would be expected. Such visits keep our services open and transparent to the very people who’ve experienced them in the past and on occasion may need to call on the services again in the future. Specifically on Loveridge Ward, I believe there to be an association known as friends of Loveridge and I’d like to discuss a similar approach with them. We cannot rely on the medical profession alone to resolve the issues, as some of the issues are of their making.

Governance

It is evident that we cannot rely solely on the governance arrangements midwives have in place and need to improve on our internal governance arrangements. Following the incidents on Loveridge ward, the language used by the NMC and the Local Supervisory Authority (LSA) has been that of a culture. A culture of straying from procedures as being acceptable, a culture of poor relations between nurses and doctors, a culture of secrecy as a result of frequent leaks to the media. As a result of the Financial Transformation Program (FTP) two posts in the governance team were removed. We need to shore up our governance team and extend their remit, as such I would be talking about our staffing level and scope of the governance team, should they feel that an increase in staffing is necessary I would be seeking to review the staffing and skills at our disposal.

In the interim, the governance team is now looking at the individual failings in Loveridge ward and reviewing the policies across the hospital. This will give us a matrix of services areas against practice, developing a picture of where the failings lie and what actions will be necessary to tackle them.

MSG

The MSG contract will terminate in 2017 as I’m sure you’re all aware. Notice must be given in 2015 of whether the States will continue with the contract. This is an incredibly tight timeline, but given the previous reports commissioned by the department and the current crisis, I don’t believe the current contract to be a viable option. The culture of poor practice is partly borne of the current contract and the problem could be reasonably summed up in the following statement:

The Interests of the MSG are not always aligned with the interests of the PEH.

The variance of interest has already led to a culture of poor practice and the friction between senior consultants and junior nurses is detrimental to our service users.

There are different means of delivering secondary healthcare, States employed consultants, the current MSG model which could be thought of as similar to barristers in chambers, privately employed visiting consultants or a State owned company employment of all health workers. There’s also a combination of all the above that could be considered. I would seek to have a policy letter outlining the options to the States as soon as practicable, this would require a conversation with both the Social Security Department (SSD) and the Treasury and Resources Department (TRD) as the means of conducting such a review must be complementary to the benchmarking exercise that the TRD have identified in the coming budget.

Departmental Finance

The departmental budget for this year and the past two years has not been met. The proposed 2016 budget is once again lower than originally requested by the department. But whether there is an overspend or an underspend (as happened in 2011, where the significant underspend was masked by the decision of the department to undertake expenditure that should rightfully have been from TRD) the discourse is poor with only a comparison made between budget and expenditure. The context for the expenditure is simply lost and the resulting public discourse is ill informed and damaging to a department that strives to provide excellent healthcare and social care outcomes for its service users. I therefore would seek to publish quarterly financial results along with quarterly governance reporting. The number of procedures carried out in the PEH, the average length of stay, the number of hospital acquired infections, the number of service users with psychosis that we have, the number of service users with affective disorders, the number of off island complex placements and the number of off island acute placements, the number of children in our children services. When presented in that light the discourse will be greatly improved. I would therefore seek the endorsement of the States to publish such a report from the first quarter of 2015.

Capita have placed what I understand to be one of their most senior advisors to work with the HSSD for many months and have not identified any significant savings within the immediate term, even the longer term savings come with extensive caveats. This is no reason not to strive for greater savings, but the options are unpalatable. There is a fairly easy way of bringing the department back into budget and to meet a proportion of the outstanding FTP target, this would be through charging for certain services, blood tests, x-rays, parking being three obvious candidates. Jersey already employ this model in certain areas and I would seek to have a policy letter brought to the assembly as soon as practicable outlining the various charging options, but I must also state that the department may well lay the report and seek the States to reject such charging mechanisms. Neither of the previous boards this term have supported, by majority, the introduction of charging and such an outcome is conceivable of the next board.

IT

Part of the solution to the current crisis is the implementation of the EHSCR e-Prescribing module. This would tighten regulation surrounding the prescribing practices that is now overdue.

Children’s Services

The greatest risk item on the HSSD risk register remains in children’s services relating to the outdated computer system. If we are to avert another crisis we must reform the IT system and revisit working practices. This work has started, but progress is hampered by the delay in reviewing EHSCR as requested by the TRD. I know that the TRD are equally frustrated by this delay, but we must now work to release the funding and see the implementation happen as a matter of urgency.

Mental Health

Last week marked Elephant Week, an initiative to start a uniquely Guernsey week for raising awareness and tackling stigma surrounding mental health. I was the organiser of the week and brought various government departments, charitable organisations and the private sector together to deal with one of the biggest health issues we have.

The States are now working with Guernsey Mind to implement a mental health policy that should see a substantial reduction in the number of sickness days that are taken. When the Guernsey Post implemented this policy they saw a reduction of sickness days from 1,200 to 400 with 60% of that improvement seen in the first year. This is now estimated to save Guernsey Post £100,000 per annum. The opportunities for savings within the States are substantial and I believe HSSD should be at the forefront in implementing this policy.

Sexual Health

As I stated in an email to all of you recently, we need to introduce the ability to charge for contraceptive services in the Orchard Clinic. The current position of treating a Sexually Transmitted Infection (STI) and then advise service users of the need to go elsewhere for contraceptive services flies in the face of the ServiceGuernsey initiative. I believe the policy letter is written and I would therefore seek to present it to the assembly as soon as the timescales allow.

Resourcing

There are a number of promises made above, I must caveat all of them by stating that the HSSD will be tied in to a number of reviews concerning the immediate crisis in midwifery care. Throwing money at the problem won’t be a solution. The experience and knowledge of senior members will be torn between the immediate crises and the needs of benchmarking, review of healthcare and review of the MSG contract. I believe it would therefore be foolish to promise delivery of all of the above within short timescales, but I would seek to prioritise these demands with the new board and deliver to all States members a summary of the priorities and expected timescales by the end of the year.

I’d like to close by stating clearly that HSSD is facing a crisis in one part of its services. I’d suggest that what we need is experience and knowledge, when the Local Supervising Authority (LSA) described the failings as a systemic organisational failure, what the States need is someone who knows the system, understand the organisation and has a clear vision of how it needs reforming as well as the means of getting there. We also shouldn’t allow this one area to consume the board to the detriment of the rest of the department. I believe that I have the knowledge, the experience and the ability to deliver on the above and to keep all of you informed. This is not the time for us to look to an individual or a small group of five to resolve the problems, this is a time when each and every one of us need to take responsibility to the extent we can.

Thank you for your time in reading the above, should you wish to discuss any of the above or any other matter pertaining to the minister’s position on HSSD, please feel free to contact me.

Yours sincerely,

Elis Bebb.

Things to do before you die

Dying Matters

This week is Dying Matters Awareness Week, starting on the 12th May until the 18th, it aims to get people talking about death and encourages us to make provision for one of the certainties in life, its end.

As with many of these campaign weeks, the national media have been running stories to coincide with the events and I was personally surprised to read the following story on the bbc website showing that so few of us have made arrangements concerning our end of life. The details are there for anyone to read, but if I simply restate here that only 21% of respondents to a survey state that they’ve discussed their end of life arrangements, I think the problem becomes clear given that 100% will die.

Here in Guernsey there’s a wonderful campaign underway this week with the pop up shop in Smith Street taken over for the campaign and the arts commission have installed a Before I Die…. wall in the market. All geared to get people talking about, and making, end of life arrangements.

I’ve never quite felt comfortable about the term “end of life” as I always thought it was a nice way of saying “death”, but I’ve now come to realise that it’s about a lot more than the final act of death. Dying, for many people, is a process that takes time and what the campaign is asking of us is not simply to arrange our funeral and write a will, important though they might be, but to also discuss our long term care should we become incapable of making those decisions ourselves.

In the UK people may choose to write what is colloquially known as a living will, or if you’ve been watching a little too much American drama, an advance directive. This is particularly timely, as the States will be discussing a requête by Deputy Perrot (turn to page 193) when we’re finished debating the transport strategy. The requête seeks the introduction of an Enduring Power of Attorney, the ability to decide in advance of losing capacity what arrangements you’d like to put in place for that day, should it happen. This is only a small part of what is required in terms of capacity legislation, but will assist many people in determining their health care requirements in advance of losing the capacity to do so. The obvious beneficiaries will be those who go on to develop dementia, or those that suffer enduring mental health conditions that cause them to lose capacity for short periods of time.

I’m very supportive of the requête and will vote accordingly, my hope being that people will complete an Enduring Power of Attorney at the same time that they write a will, or to have the opportunity of writing one when they’ve first been diagnosed with some form of dementia. It’s important that we afford people the choice of deciding their future care needs.

An Enduring Power of Attorney would also assist HSSD in their care of people. I’m sure it will come as no surprise, now you know there’s no advanced directive available in law here, that certain care decisions become difficult for the professional carers. Doctors, nurses and social workers can find themselves in the eye of a family feud with no basis in law to fulfil what is the patient’s wishes. This is a situation we surely can’t allow to continue.
I sincerely hope the requête will be successful  and the law introduced swiftly.

On a personal note, I’m surprised people don’t talk about dying. It may be me or it may be a Welsh thing, but death is not a difficult discussion around the dinner table with the family. Well maybe not the dinner table, but I was back in Wales a couple of weeks ago and I had an evening meal with my sister and her family. After dinner the discussion moved at one point to our choices of hymns for our funerals and where we’d like to be buried. It wasn’t a depressing conversation, it was rather affirming to have such a discussion and understand why we’d both chosen our respective burial plots. It was interesting how we’d both moved from being in favour of cremation to burial. We had a good laugh about our choice of hymn and her incredulity as to how catholic I was compared to her protestant position. It was a fun evening with plenty of laughter and shows that difficult conversations can be had whilst enjoying yourself.

Having written all the above, I suppose I should also confess to being someone who hasn’t yet written a will, something that’s particularly important given that I’m in a long term relationship and haven’t married. I haven’t made proper arrangements to be an organ donor. I therefore pledge to deal with these issues this week. Hopefully a number of people will do the same, after all, if not this week, when?

The one thing we can all be sure of is dying. All of us probably know of a family that have torn themselves apart over a lack of a will. All of us probably know someone who’s had, or is currently suffering dementia, do we know if they’re receiving the care they would have wished? If you’ve attended as many funerals as I have you’ll also have seen exactly what you don’t want for your funeral and maybe some things that you do want.

Can I suggest that you give yourself a gift of ensuring you have a voice in your long term care and funeral arrangements. I’m arranging mine this week.

Seasonal Affective Dissorder

SAD

Yesterday I read a tweet from @itvchanneltv highlighting the issue of seasonal affective dissorder (SAD). It was concerning what Guernsey Mind were doing to highlight this problem. The story is available here should you wish to read it.

Last year the States of Deliberation discussed the Mental Health and Wellbeing Strategy that we would implement and it was during that debate I revealed my own mental health issue of having SAD. The speech I gave is available on my website should anyone be interested, but what I wanted to talk about in this post was my experience of SAD and how it hampered my life, career and relationships until I was diagnosed and treated.

The Mind UK Website describes SAD as follows:

Seasonal affective disorder (SAD) is a form of depression that people experience at a particular time of year or during a particular season. Most of us are affected by the change in seasons – it is normal to feel more cheerful and energetic when the sun is shining and the days are longer, or to find that you eat more or sleep longer in winter. However, if you experience SAD, the change in seasons will have a much greater effect on your mood and energy levels, and lead to symptoms of depression that have a significant impact on your day-to-day life.
Most people experience SAD during the winter. Less commonly, some people find that they experience SAD in reverse – with depressive symptoms occurring in summer.

and I would recommend anyone concerned to have a look at the rest of the website to understand what the signs of SAD are and what options are available for its treatment.

The first thing I’d like to say in relation to my own experience is that I simply didn’t think I had a problem. I displayed very erratic behaviour, frequently confrontational and in hindsight I can confirm that I was irrational. But at the time I simply thought that I was right and that the other person was wrong. I would even go so far as to justify my behaviour and refuse to listen when someone criticised.

There’s one occasion that I’d like to recount here. I was working on the IT service desk in a finance company, answering the phone and trying to resolve the problems of the company’s users. It became evident that the number of people phoning the service desk had reduced considerably, but when we did receive a call the person was either exceptionally irate or very timid. It was only when my managers discussed this with various people in the company that it became evident I was being rude and difficult when people phoned, to the point where they wouldn’t even risk phoning for assistance (for anyone working in IT, this doesn’t make for a good IT strategy).

A few examples were when people had forgotten their password, I’d ask them if they’d manage to forget their credit card pin number. When someone told me that they’d done something and it no longer works I told them that it was their fault and that they’d get lower priority because of stupidity. One person asked for different access rights to their computer, I promptly told them that it simply wasn’t possible, even if they were the MD (and it was).
I’d like to highlight these as the worst examples. I was capable of excellent work as well, taking on the most difficult members of staff and their issues and resolving them to everyone’s satisfaction. Undertaking fairly large projects successfully with good user engagement and buy in. It was this bizarre dichotomy that led to my managers failing to understand why I would be so difficult one day and so calm the next.

Without me even noticing, the problem of my attitude was affecting the IT department’s engagement with the company. There was even one occasion when I remember shouting at a member of staff in the middle of the floor, something I still cringe at when I think about it now, but at the time, as I said previously, considered this behaviour to be acceptable and rational.

This wasn’t the first time that I’d had such problems at work, but the difference on this occasion was my manager’s engagement with me about the problem. Rather than call me into an office and give me a dressing down, I was advised that they’d like me to see the Learning & Development officer. I undertook a test to assess my behaviour and then had a discussion. It was through discussing matters with him I slowly came to realise that this was irrational and destructive behaviour. I learned about Neuro Linguistic Programming (NLP) and realised that I needed to take ownership, not only for my actions, but also for the way other people perceive my actions (still working on this by the way).

It was as a result of this approach and further discussions I came to realise I had depression, but that it wasn’t constant. I saw my GP who offered anti depressants, but I thought it was worth making some lifestyle changes and exploring alternatives before starting on a course of Seroxat.

The behaviour that I displayed at this work place was no different to the behaviour I’d displayed in previous workplaces. I am known for having gone from one job to another over a period of around 13 years, some jobs lasting a year or less, with me always leaving because of annoyance. I’d wager that each and every one of my former colleagues, from a number of employers, would be able to recount a string of occasions when I was difficult, argumentative and even down right rude. The difference on this occasion was the approach of the management, they wanted to engage with me to resolve the issues rather than confront me about my issues.

I started making changes to my life, eating a more healthy diet, exercising more frequently and lowering the alcoholic intake, but that in and of itself wasn’t sufficient to deal with my health issue. I now take St John’s Wort every winter and I manage my symptoms well, I can honestly say that I don’t recognise the person I was. I’ve also learnt to recognise when I start to behave in the old way and take remedial action before things go too far. This usually starts anytime from September through to November depending on how good the summer was.

Now, when I look back, I notice that the workplace wasn’t the only place I had a problem. There were occasions at home when I would become argumentative to the point of insufferable. Getting out of bed was simply an exhausting task that I can’t really describe how awful it was. I would eat large quantities of bread and cereal craving carbohydrates and neglecting all other food groups. I would resort to alcohol on frequent occasions, feeling that having a drink somehow made me feel better about the awful day and allowing me to relax from the anxiety I felt (only to feel worse the next day). There were days when I would be racked with guilt and anxiety about something I’d said or done in the past, from the previous day spanning back to my childhood. There were occasions when I’d simply cry uncontrollably and try to lock myself away. There were the days off work with illness, both physical and sheer mental exhaustion or anguish. Finally there were the odd occasions where I simply wish I wasn’t here, had never been, those were the darkest days of all.

As I’m sure you can imagine, a lot of these behaviours made the situation worse. If you do eat badly, drink lots of alcohol and refuse to leave the house you’re likely to get worse. They allowed me to enter into a personal vicious cycle of self destruction. It also wasn’t advisable for anyone close to confront the problem since I would lash out at them as much as anyone else.

I look back and I can’t believe how bad things were. But now that I have set myself a set of rules for diet, drink, exercise and the daily dose of St John’s Wort it’s all manageable. There are the odd occasions when I notice I’ve stayed in bed too long, drank too much, eaten nothing green for a few days, have been a little argumentative or felt a welling up of emotions that result in my crying, but I recognise the problem and correct the situation. Instead of months of destructive behaviour I now have a couple of weeks a year when I don’t feel too well, but know that I’ll be fine in a few days.

In relation to my work, I know that I had a poor sickness record and that my productivity in winter was bad (to say the least). Once I started treating the issue, my sick days became virtually non existent, my productivity soared and I enjoyed the prospect of going to work again.

Given all of the above, I suppose I’m sharing this for a number of reasons.

  • Firstly I’d like to assist Guernsey Mind in highlighting this particular issue.
  • Secondly, those who may have SAD should know you can change things and manage the situation so that you enjoy life a lot more, no one should feel it acceptable to write off six months of the year for the rest of their lives, the first step is to recognise the problem.
  • Thirdly, I’d like to advise employers that if someone displays erratic behaviour, work with the person to resolve the issues, nothing could be worse than confronting the person and asking them to explain their behaviour.
    For more on this, Guernsey Mind have a wonderful training course that they offer to managers and employers to assist them in identifying and working with people who have mental health issues. Guernsey Mind are running a workshop on the 17th January next year so please contact them to book your place. When I identified my issue and treated it, my sick days became vanishingly small and my productivity soared, something every employer wishes of their staff.

The last thing that I wanted to say was sorry to all those people I worked with and had to put up with my behaviour; and a very big thank you to those managers and colleagues who helped me identify the problem and deal with it. My life now is almost unrecognisable to those years when I allowed SAD to rule my winter, that happened because of people whom I’m no longer in touch with, but to whom I’ll always be grateful.

THANK YOU

Given my reference to my taking of St John’s Wort I’d like to clarify that this works for me but may not work for everybody. I’d recommend anyone thinking of taking it to discuss it with their GP and do the research, a good place to start is the Mind UK website. I’m more than content to discuss both SAD and St John’s Wort with anyone who’d like to, but I can only offer my personal experience and direct them to the best service and research.