Category: Other

Making Hay

Hay Festival 2015

I’m back from the annual week-long trip to the Welsh Marches, taking in an eclectic mix of speakers at both the Hay and the newer How the Light Gets In festivals. The first of these has grown in size to the extent that, for some years, it has been located out-of-town in a field of marquees. I remember visiting when events took place in the local primary school. The second, much smaller, festival makes use of the Globe building supplemented with tents across two sites.

There was plenty on offer related to the field of mental health. Andrew Scull used images to support a tour through mental health services across time, and Mark Salter gave a lively account of the limits of biology. Richard Bentall, Dinesh Bhugra and Simon Baron-Cohen debated categorisation and diagnosis, concluding (in largely consensual style) that what we need is more public mental health, peer support and respect. David Healy continued his critique of the pharma industry.

This year the weather was kind, which always makes a difference. Travelling further north for a day, deep into Powys, took us to the Elan Valley and a fine walk in the hills.

Caban Coch dam
Carn Gafallt

Back at the festivals, I’m always impressed when natural scientists are able to convey difficult concepts in ways which are understandable to lay audiences. This is not easy, I would have thought, when the working language is that of mathematics. On this occasion I took the time to listen to a discussion on the physics of black holes, and was glad that I did.

Next week sees me back at work, with a new office giving views over Cardiff towards the Bristol Channel. Here’s a photo taken just before I headed off for my week away. Look hard enough and you can, just about, make out the sea.

Office view: Cardiff, then the Bristol Channel, and Somerset in the far distance

Spring election, and the politics of mental health

It hasn’t always been like this, but mental health is something which politicians now talk about. In the run-up to next week’s general election mental health has even featured in public appeals to voters. The Liberal Democrats have particularly campaigned in this area, and in their manifesto promise £500 million per year for better mental health, and specifically make a case for investing in research. Labour talk about giving mental health the same priority as physical health, and the Conservatives say pretty much the same. Reviewing all the main parties’ manifesto promises for evidence of concrete plans for post-election improvements to mental health care, over on his blogsite the Psychodiagnosticator observes ‘that many of them were so vague as to amount to no promise at all‘. I think he has a point.

Possibly the broad manifestos produced in the run-up to a general election are not the places to look for fully worked-up blueprints of what future mental health policy across the UK might look like. Perhaps, more accurately, we should not think about ‘UK policy’ in this context at all. Members of Parliament elected to Westminster next week, from amongst whom a new government will be formed, will have authority to directly shape services in England only. Health and social care remain areas over which devolved authorities have jurisdiction, and for a ballot delivering a government with the power to pronounce on mental health care here in Wales we must look to the National Assembly elections to be held in 2016. I’ve indicated before that mental health policy here is different from that in England, and indeed from other countries in the UK. Consider again the case of the Mental Health (Wales) Measure. This is a piece of legislation for Wales alone, mandating for care and treatment plans, care coordinators, access to advocates in hospital and the right of reassessment within secondary mental health services following discharge. It was introduced in the face of some strong, pre-legislative, criticism from at least one senior law academic (Phil Fennell) who in 2010 began his submission to the National Assembly by saying,

The gist of my submission to the Committee is that this measure, although well-intentioned, is cumbersome, unduly complex, and will lead to a delay in providing services which ought to have been available already to service users and their families in Wales under the National Service Framework for Adult Mental Health and the Care Programme Approach.

Five years on the Measure has not only passed into law, but been subjected to a round of post-legislative scrutiny by the National Assembly’s Health and Social Care Committee (see my post here), to which the Welsh Government has now responded. With data from across both England and Wales, COCAPP (and in the future, COCAPP-A) will have something to say about how care planning and care coordination are actually being done, and readers will be able to draw their own conclusions on the extent to which changes in the law trigger changes to everyday practice. And, whilst we’re in policy comparison mode, for a view from Scotland try Paul Cairney. He argues that divergence in mental health policy across the UK, exemplified by contrasting English and Scottish experiences of reforming the law, reflect differences in both the substance of policy and in policymaking style.

In all of this I am, again, reminded of the wicked problems facing all policymakers who seek to intervene in the mental health field. Whatever direction it takes, future policy will be open to contest and will surely trigger waves of consequences.

An evening on the Taff Trail

A brief post with no bearing on work matters whatsoever. Yesterday evening, in the two hours before sunset (which was just after 9pm), a perfect opportunity was presented to take in the simple pleasures of walking the Taff Trail. This is one of the places I also like to run, though for the last few weeks I’ve been nursing a sore Achilles and have, therefore, been resisting.

This part of the world is criss-crossed with disused railway lines, harking back to South Wales’ industrial heritage. Check out the photo here, which was taken yesterday on the flat, mile-long, stretch leading from the Penrhos Cutting to the bottom of the steep hill which climbs above Castell Coch.

This second photo was taken on the same stretch looking towards Craig yr Allt, which remains one of my most favourite places of all.

Bank holiday time off

Nice to have had a few days off, and to have properly escaped the tyranny of a computer with a permanent internet connection. Apart from the odd work-ish tweet this really has been a long weekend away from the routine. There’s been plenty of cheering for a team of teenage footballers, and a squeezed-in walk along a south coast (of England) sea front. I’ve also rediscovered the joys of holidaying in close proximity to thousands of others, and the pleasures of school-style food. Such fun, but always good to be home.

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

Today's trainersGreat 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.

Acronyms and initialisms abounding

Now we’ve completed our IRAS form and been to REC, its onwards to NIHR CSP and NISCHR PCU. Hopefully the SSI we give to R&D will be OK, and once we’ve been adopted by the CRN and CRC we’ll get help from a CSO or two.

So that’s all clear then, right? Apart from ‘OK’, which I presume needs no introduction, these are acronyms and initialisms associated with the process of applying for approval to conduct research in the NHS, and getting help to recruit participants and generate data once permission has been secured. I could add that, in the case of COCAPP, we’re making these applications because we’re interested in the CPA and CTPs, and that we should probably make links with a CLAHRC, an AHSP and keep in with the RRG. And did I mention the MNM we’ve already started? You don’t know about MNM? Then read the papers coming out of RAMESES.

Of course, in writing all this I am wilfully and rather mischievously seeking to confuse. The point, though, is that words matter. Shortcuts and abbreviations can save the time of people who are already in the know, but can present an impenetrable thicket to the outsider. Perhaps the process of navigating NHS research approvals should be described using only the commonest 1,000 words in the English language.


Getting back to it

IMG_1414A quick post following a half-term break. Cornwall proved to be a fine place to spend last week. It is, truly, a most beautiful part of the country. Here’s a photo of the beach at St Ives to prove it.

Now it’s back to it. This week I’m working on two projects, and in the case of one will hope, by Friday, to be clearer on local arrangements for making payments to service user researchers. There’s some work to be done on preparing NHS R&D applications, too. Over the next week or so I also need to put some time aside to respond to Cardiff University’s consultation on the reorganisation of schools within the College of Biomedical and Life Sciences. The idea has been formally proposed that the School of Nursing and Midwifery Studies (where I work) and the School of Healthcare Studies (home to the academic occupational therapists, physiotherapists, radiographers and operating department practitioners) might merge. A move of this type has been on the cards for some time, so no surprises there.

Remarkable stuff, snow

IMG_1393As an aside, with no bearing whatsoever on my last post describing what I do using only the commonest words in the English language, here are two photographs revealing what snow is capable of.

IMG_1394These were taken over the weekend, deep inside Fforest Fawr. The branch of this tree has entirely split, presumably under the weight of accumulated snowflakes. Parts of the Taff Trail, and certainly the Penrhos Cutting, were littered with branches (and indeed, whole trees) brought to the ground in this way. The second photograph is of the branch, collapsed following the break.

I can’t quite recall seeing this kind of thing happening during previous snowfalls. What’s different, I’m wondering? Unusually sticky snow, perhaps?

What I do at work, described using only the commonest 1,000 words in the English language

Via a link in a tweet from @bengoldacre I came across the Bad Science (and now Bad Pharma) author’s secondary (!) blog, and this page in particular. Here, Ben describes how randomised controlled trials work, using the English language’s commonest 1,000 words.

The idea of making complex things simple in this way comes from Randall Munroe at, who produced the wonderful graphic I’ve reproduced here (with his permission) of how the Saturn V rocket works. Called Up Goer Five, the supporting text (as you can see for yourselves) explains things ‘using only the ten hundred words people use the most often’.

So that anyone can have a go at making difficult stuff understandable in this way, a text editor has now sprung up at In goes your explanation, and if you happen to use a word from outside of the list of 1,000 commonest you’ll get a message telling you that it is not permitted. Such fun. You can also tell others of your efforts through Twitter using the #upgoerfive hashtag.

Yesterday and today I’ve been using this online tool to chip away at a description of what I do at work. It turns out that an awful lot of the words I’m fondest of fall outside of the list of those permitted. Examples include ‘process’, ‘system’, ‘nurse’, ‘health’, ‘complex’ and ‘organise’.

Anyway, here’s my effort:

For over 60 years people in this part of the world have believed that those who are sick should be looked after, without having to pay for their care at the time they need it. So to make sure there are always people around to do the job of caring, and to make sure there are places to go when we’re sick, everyone who works gives some of their money to pay for doctors, hospitals and so on. The important thing is that if you’re sick you should get the help you need, no matter how much money you have (or don’t have). I think this is a great way of doing things, and so do lots of other people.

But what do we mean by being sick, and what type of care is best? Some people have problems like their hearts not working in the way they should, or other bits of their bodies going wrong. But there are also people who have problems with how they think, feel or act when they are with others. They can get very sad, scared and worried. They can get confused, and/or hear things which aren’t really there. Families and friends get concerned when these things happen, but don’t always know what best to do. As it happens, we don’t completely know what causes these kinds of problem. It may be because something is wrong in the body, and/or it might be because bad stuff happens to people which makes them sad.

Maybe one day we’ll know much more about what causes people to be sick in these ways, and be able to help them more or even stop their problems happening in the first place. But for now, and I guess always, we need people who spend their time looking after those who get very sad, or worried, or confused, or who hear things which aren’t there. This is serious and important work, and there are lots of different types of people who do it. Those who do it as a job can be found in teams both in, and out of, hospitals. In truth, how these people and the teams they work in fit together can be really confusing. Nothing ever stands still, as new ways of getting stuff done appear.

So here’s what I do. I trained to look after people who have problems with thinking, feeling and acting and now I help to train others in this field. I also study people who do this kind of caring work, the teams they work in and what it’s like to be someone getting help. I do this because it’s important to find out how the different parts (the people, the teams) fit together, and to learn how caring work can be done in different, and maybe better, ways. Working with friends with the same interests I have used a number of approaches to study these things. I have sat with people and asked them questions about the work they do. I have read what people write about the care work they have done, and have watched people doing their day-to-day jobs. I have asked about the care work that people (like family and friends) do, and for which no-one is paid. I have asked people to tell me what it is like to get help from people in different jobs, and what it is like to have care across different teams over time. I have given people pieces of paper with questions about what they think and feel, and asked them to return their answers for us to read and study.

What have I found? The work that people do is changed by where and when they do it, and by who else is around. So you and I might think we know about the work that people in caring jobs do, but it turns out that there are lots of different ways of getting stuff done. Jobs change over time, and sometimes people do not agree who should do what. In teams, people sometimes do work which has to be done because there is no-one else to do it. I happen to think this is interesting and important, for lots of reasons. One reason is that if we don’t know what types of work people will end up doing, how do we know how best to train students? I have also found that a lot of caring work is hidden, because it is done by people who are not paid and/or who are on the edges. This is especially so in the case of people living in their own homes, and who get help from care teams which are placed outside of hospitals. Everyone thinks of doctors, but who remembers the work done by the person living next door? The way the different bits (the people, the teams) fit together means that those who are in need sometimes have problems getting the right help at the right time. And, when new teams appear, I have found that these can do great work but at the same time cause new problems to pop up somewhere else. This is because everything is joined to everything else. From studies completed with friends some years ago, I have also found that doing caring work is not easy. People who do it can get to feel very worn out.

Here is some new stuff I’m doing now. With friends I’m going to look at how people plan care, and what this means for the person who needs help. I’m also about to start a new study where we will read about young people in hospital, and how those who care for them keep them safe.