Yesterday the Health Secretary, Jeremy Hunt, declared that would-be nurses should spend a year doing hands-on care, working directly with health care assistants, in order to be eligible for funded nursing degrees. Today it occurs to me that large sections of the population may be labouring under the misapprehension that student nurses currently spend their whole three years sitting in classrooms. So let me join the queue of people who have already pointed out that, absolutely, they do not. In order to register, students are required to spend half of their time working directly in practice. This point, plus others, was very well-made by the University of Southampton student (whose name I cannot remember, unfortunately) who was interviewed on this matter on yesterday’s BBC News. Bearing in mind that nursing degrees are lengthy affairs (the terms are much longer than those followed by students of most other disciplines), the amount of time learners spend doing care work is already significant.
Month: March 2013
Writing for publication
Some promising news today from the assistant editor of a journal a colleague and I sent a jointly authored paper to last year. It’s taken a while for them to be sent, but we’ve now received peer review comments. They’re detailed and considered, and we’ve got work to do, but I’m optimistic the reviewers like our paper enough for it to make the cut (at some futue point) and get into print.
It would be tempting fate to say more at this juncture (like giving the identity of my esteemed collaborator, the name of the journal or what the paper is about), so I’ll resist. Suffice to say that the receipt of an editor’s email with an update on a submitted manuscript is always a moment of excitement and anxiety, in equal measure. It’s a big deal getting something into press in this job, and invitations to revise and resubmit (or even better, correspondence indicating that a journal will accept something ‘as is’) are always welcome.
Of course, editors also say ‘no thanks’, and I can confirm that I’ve had my share of being on the receiving end of emails of this type. At this point thick-skinned tenacity is key. I’ll perhaps sulk a little and protest to loved ones, friends and colleagues, but then I have to get on with it and do what’s necessary before offering my article to a new journal. I once had to submit versions of a paper to something like five journals, one after another, before one was willing to accept it. It was either ‘too social science-y’, or not ‘social science-y’ enough, depending on where I sent it.
Selecting students of nursing
During my recent visit to the Netherlands I learned that universities there are obliged to offer places to applicants provided that the formal entry requirements are met. So, for applicants to nursing courses, there are no selection events: no interviews, no assessments of aptitude or attitude, no tests in numeracy or literacy. Here in the UK, the NMC (our regulatory body) requires that offers of places on nursing degrees are only extended after face-to-face selections have taken place. The NMC asks that interviews include assessments of motivation, and of reasons for choice of intended field of practice (adult, mental health, children or learning disability). Would-be students are also invited to demonstrate their understanding of the work of nurses. An interesting difference in approaches, I thought.
Visiting the Netherlands
Michael Coffey and I have just returned from a four day trip to the Netherlands, an event supported with funding from the Mental Health Research Network Cymru. We were there to share and develop research ideas with the impressive Dr Bauke Koekkoek and colleagues, and to learn about the Dutch mental health system. Bauke, a mental health nurse, is Associate Professor of Social Psychiatry and Mental Health in the Hogeschool van Arnhem en Nijmegen (HAN) University of Applied Sciences, and is interested (amongst other things) in matching the needs of people with mental health difficulties with services. You can read more about Bauke’s work in his inaugural lecture.
Bauke did a great job organising a full schedule of activities for our three working days away. Well done, Dutch train and bus companies, for delivering Michael and me to our various destinations in timely fashion. We were, though, reminded during our trip that it is the bicycle which remains the vehicle of choice for many Netherlanders.
We had the chance to meet with academics, practitioners and service users during our travels across Utrecht, Arnhem and Nijmegen. Our thanks to everyone who gave their time and who shared their expertise so generously: Dr Arjan Braam; Mark van Veen; the Kompas team at Pro Persona‘s Wolfheze site; Dr Ad Kaasenbrood and his colleagues in the Arnhem Functional Assertive Outreach Team (and particularly Vincent and Riska, who Michael and I spent Tuesday morning with); the Arnhem FACT Team service users who welcomed us into their homes; the HAN Social Psychiatry and Mental Health Nursing research group; and Hein, Rob and Leon who teach at HAN and have interests in developing international links.
The Social Psychiatry and Mental Health Nursing research group, who we met on Tuesday afternoon, are a capable and accomplished team. Their MATCH Project is supported by a significant grant, and Bauke and his collaborators have done exceptionally well in using this as a springboard for further, associated, studies. Examples include PhDs investigating the effectiveness of therapies, and a planned ethnographic examination focusing on discharge (and non-discharge) of people from community care.
It was good to hear people present and discuss their ideas, and in a spirit of collegiality Michael and I had the chance to share our interests and plans. I took the chance to talk about my research in a general sense, using as a prop this set of slides embedded below:
Interesting to learn during our time away was the system of preparing mental health nurses in the Netherlands. Yesterday, for example, we met Rob Keukens who runs HAN’s part-time, 18 month, post-qualification social psychiatric nursing programme. This is the nearest thing to what here, in the UK, we would describe as a post-registration course for community mental health nurses (CMHNs). For those interested, Bauke has described and analysed the Dutch CMHN profession in this paper.
The principal purpose of our trip was to further our research connections, and for Bauke, Michael and me to spend time putting our heads together to develop new research ideas. We know we’ll need to involve others, and target funding streams sympathetic to international research proposals which set out to create new knowledge to improve mental health and well-being and the organisation of mental health services.
More on all this to follow in due course, I am sure.
Disinvesting in mental health?
Writing for The Guardian’s Healthcare Professionals Network this week, David Brindle reports that spending on mental health care in England has fallen for the second year in a row. He references unpublished figures disclosed last week to the House of Commons Health Committee, along with the 2011-12 National Survey of Investment in Adult Mental Health Services which appeared last August, and from which I have clipped these first two headline findings:
The key figure here is the bit I have circled in red: that, in real terms, investment in mental health services in England in 2011-12 reduced by 1%. Last summer The Guardian reported the publication of this finding under the banner of mental health spending having fallen for the first time in 10 years, and if I am understanding David Brindle’s latest article correctly evidence of further cuts has been gathered since. Elsewhere in this piece Dr Hugh Griffiths, the Department of Health’s National Clinical Director for Mental Health, is quoted as having told the Health Committee last week of being ‘disturbed’ by reports of cutbacks to services in some English regions.
Meanwhile, via this piece in The Telegraph I see that the former coalition government Care Minister and LibDem MP Paul Burstow is heading up an independent Mental Health Commission with the liberal think-tank CentreForum. The Commission’s task is to ‘examine the state of mental health care provision in England’. This is a task made all the more urgent in the light of the finding, also contained in last August’s National Survey, of a £29.3 million reduction in investment in crisis resolution, assertive outreach and early intervention services.
All this paints a very bleak picture indeed. Reductions in funding and in services threaten to roll back the investments made in dedicated mental health care in the years following the publication, in England in 1999, of the National Service Framework for Mental Health. New Labour acted at tremendous speed in prioritising the mental health field. When in government Labour took action to develop community care through the creation of new types of services. It changed the law, put resources into improving access to psychological therapies and rewrote professional role boundaries. Some of the specifics were contentious, sure, but I for one did not doubt that the challenges of improving mental health and developing services were finally being taken seriously. In fact, Michael Coffey and I wrote about this period of policymaking in our wicked problems paper (which can be downloaded here). In this we urged careful consideration of the cumulative impact of policy actions, and the perils of trying to change everything in a complex system of health and social care all at the same time. But needless to say we made no case for cuts, which is what is evidently taking place around large parts of the country now.
As it happens, I can’t immediately find a Welsh equivalent for the Department of Health’s National Survey for England. If it’s out there, perhaps someone can point me in the right direction? It would be good to know the trends for investment in mental health services here in Wales. More generally, now I come to think of it, I want to learn more of the prospects for the future of the mental health system in this part of the UK now that the Welsh Government has a new Health Minister in Professor Mark Drakeford. The Minister is a Cardiff University Professor of Social Policy and Applied Social Sciences, and it will be interesting to see how future policy and services shape up under his direction.
Involving People, and watching football
Another started-on-the-train post, the length of which reflects (more or less) the length of my journey home.
Yesterday took in a trip to the Cardiff City Stadium for two, entirely unrelated, happenings. First was the annual event of Involving People, the organisation which works across Wales to promote public and service user participation in health and social care research. I’ve had contact with the Involving People team in connection with COCAPP, and the folk there are really very good. Yesterday’s event was excellent, too, and I learned plenty about public engagement from the earliest generation of research ideas onwards.
Following a short-ish break and a chance to catch up on work emails over a coffee, my return trip to the stadium was to watch Cardiff City put in a rather jittery performance against a visiting Leicester side looking to press their own promotion credentials. An at-the-death goal from the Bluebirds’ Rudy Gestede got the draw. Well done that man.
Hello again, trainers
Great to have been running again this morning, with my pal Simon. We chose a relatively flat route, taking us down the Penrhos Cutting and along the Taff Trail heading towards Pontypridd. It’s only been a week or so since I last got out, but I sure felt creaky.
To illustrate this event on this blog I might have uploaded a photograph or two of South Wales’ hills and trails, or even a piccie taken en route. These options are far too obvious. Instead I have elected to include a picture of my trainers, sitting proudly post-run on a staircase. Thank you, shoes, and I apologise if you deserve a more accomplished runner than me as your owner.
The COCAPP crew, and MHNAUK comes to Cardiff
Yesterday’s COCAPP meeting in Cardiff was both productive and fun. It was lovely to welcome those members of the London contingent able to make the trip, and I extend my apologies (again, and for the last time!) to those I conspired to keep waiting in a darkened corridor before turning up with a room key.
COCAPP is an exciting research project to be involved in, and pretty soon it will have its own blog. I’ll then add links from here for those who are interested. Briefly summarised, this is an England and Wales cross-national investigation into mental health care planning and coordination, and into the relationships between these processes and recovery and personalisation. It’s funded by the NIHR Health Services and Delivery Research Programme, and has lots of distinct elements: about which more will follow, I guess, once the dedicated project blog is up. For now, here’s a photo of yesterday’s assembled COCAPPers (where from left to right there’s Aled, Jitka, Alan (COCAPP’s chief investigator), Sally, me and Michael. We very much missed Alison and Jennifer and their wise contributions, and when we’re all in one place I imagine we’ll take another, and more complete, photo.
Yesterday evening was the traditional social involving food and drink with fellow members of Mental Health Nurse Academics UK, ahead of today’s meeting proper. As Cardiff hosted we got to select the venues, and I hope everyone who was able to make it enjoyed the selection of fine ales and wines, and indeed the general ambience, at The Rummer Tavern. Likewise the food at The Mango House.
MHNAUK’s first meeting of 2013 was a good ‘un. Jen French talked about mental health strategy in Wales, and Ian Hulatt updated us on the Willis Commission. Eschewing the usual format of host universities presenting their research and teaching activities in the morning, Michael Coffey (in the photo above, and MHNAUK chair) and Joy Duxbury (newly elected vice chair) invited reflections and discussion on the aims and purpose of the group, and on the character of research in mental health nursing and what can be done to nurture it. There was some lively discussion in the two groups (facilitated by Linda Cooper and Len Bowers respectively) which convened to talk to these areas. It occurred to me unhelpfully after the event that we might have taken a MHNAUK photo, including the 35 or so members participating today: not least as MHNAUK, like COCAPP, is collectively thinking of increasing its presence via a blog.
Work aside, running has taken a big back seat this week, what with one thing and another. Must get out soon!
End of the working day train blog
Here’s a quick post from the train heading home. At least there are plenty of seats to be had at this time of the evening, but missing a train can mean a fair wait until the next arrives. Anyway: this morning’s teleconference with the evidence synthesis team confirmed how much we’ve achieved so far in this project. This is a review in the area of ‘risk’ for young people using inpatient mental health services. I’m very much appreciating the design we’re using, which revolves around two reviewing stages. Following an initial scoping, representatives from the wider stakeholder field have the chance to shape the priorities for our second, in-depth, review phase.
Today has also brought some MSc-related work, and a chance to meet with pre-registration postgraduate students to talk about dissertations and research approvals. Tomorrow’s COCAPP team meeting is all planned for, and then it’s onwards to Mental Health Nurse Academics with a meal in the evening and the big meet-up of the clans on Friday. Goodness me, it’s all happening.
Cardiff hosting, and NPNR news
This is the week that both Mental Health Nurse Academics and the COCAPP team come to Cardiff. MHNAUK’s meeting on Friday will take place in the Council Chamber in the Main Building, which is really rather grand. Visiting COCAPPers can look forward to a more everyday venue for our Thursday meet-up. This will be in Eastgate House (which is where I’m based).
Other news of note in the world of mental health nursing education and research is the impending move of this autumn’s Network for Psychiatric Nursing Research conference from Oxford to Warwick. The annual NPNR bash has taken place in Oxford pretty much since it was launched in the 1990s. I gather from my Twitter-using pals who sit on the scientific and organising committees that we can expect a relocation for an event scheduled, this year, for September 5th and 6th. It occurs to me that Warwick University is well-placed for delegates travelling from all parts of the UK, and indeed from around the world.
Ben Hannigan's blog 