Friday, 15 January 2016

Long time no post - something of an update.

This morning, whilst searching in vain for an old asset register (rock and roll), I came across a blog I wrote in response to being asked by my boss at the then West and South Yorkshire and Bassetlaw Commissioning Support Unit, or WSYBCSU as it was more commonly but hardly less easily pronounceably referred to.  The CSU was one of the many enormous changes implemented by the Tory-Liberal coalition government.  Spin on to the end if you want to know how that worked out.

Job Security is a Redundant Concept?


A bitter pill is still a pill

A Blog Pitch by Andrew Stimpson – Health & Justice Lead WSYBCSU

In 2011 I was made redundant from a post within the NHS.  It was a bewildering and disorientating experience, and the wound was not salved in any way by the earnest, but rather ineffectual consultations that punctuated the process.

The redundancy followed a three year spell working regionally on Offender Health issues, never the most glamorous of fields, but nevertheless extremely rewarding.  Prior to this I had spent six years of my life working in Her Majesty’s Prison Hull, a classic Victorian pile populated by shady reprobates, oddballs and misfits.  It also houses prisoners.  I could classify those six years in a number of different ways but essentially, they were the best six years of my working life.  Quite apart from the social life, which was admittedly fabulous, it afforded me an incredible opportunity after a number of years flirting with other careers and flitting from job to job.

It enabled me to effect real change.

Prison nursing at the time was generally operated ‘in-house’ by Her Majesty’s Prison Service (HMPS) and delivered by a combination of nurses and Health Care Officers (HCOs, some also trained nurses).  It was, in many ways, the nursing equivalent of the Wild West, complete with swaggering cowboys and brawling drunks.  There were also prisoners.

The case is well made today for the prevalence of complex conditions, multiple co-morbidities, mental health and substance misuse issues amongst offenders, and it astonishes me to this day how effectively many of these conditions were managed in an extremely restrictive and poorly equipped environment.  That said, many mistakes were made and many problems existed within the systems of care thanks to outmoded concepts and attitudes amongst the Healthcare Team.  The prison is a demanding, high pressure environment and emotional burnout was a common problem. A stubborn unwillingness to adapt to change in some quarters contributed to low morale and further poor practice,  leading many of the ‘old hands’ to leave the job once the NHS took charge of health provision within the prison and introduced new-fangled concepts like ‘clinical governance’ and ‘hand washing’.

Ironically (perhaps) the HCOs, some of whom had traded in nursing uniforms for prison officer garb, were the most skilled, compassionate and caring individuals in the team.  They were a far cry from the stick wielding ‘prison warder’ image, although they could certainly wield the stick when merited.  Recently NHS England, in response to Francis, unveiled The 6 Cs ( in an attempt to educate the nursing profession that it has some obligations to patients.  In my experience these prison officers were as caring, compassionate, competent, communicative, courageous and committed as any clinical practitioner I have ever worked with in my longish career.  They responded extremely well to new ideas and saw myself, and another colleague who arrived at the same time, as a breath of fresh air, which never goes amiss in an establishment that generally smells like a combination of ash trays, teenagers’ trainers and poorly maintained toilets.  Together we instigated a culture of care and recovery that, for a golden 18 months, saw real improvements in a number of areas.

I moved on from HMP Hull in 2008 and took a role with the Yorkshire and Humber Offender Health Team, broadening my experience base and working with police, courts and probation services on responding to the Bradley Consultation, and subsequently implementing the recommendations of the Bradley Report.

The Bradley Report was a useful tool.  It cemented a lot of things that, although we knew already,  gave real drive and impetus to a change movement that was sadly derailed by the wholesale changes instigated when the current government was elected.
Swings and roundabouts.

Following two and a half years in the wilderness I returned to offender health (courtesy of the CSU), now rebadged as Health & Justice (not to be mistaken with the 1969 All-British Wrestling Tag Team Champions).  Unsurprisingly the same issues remain...
  • High rates of mental ill-health in offenders
  • Variable standards of care in criminal justice settings
  • A lack of cohesion in commissioning services for offenders
  • Prisons still smell like old cabbages

On a positive note however I have been able to revisit my old stomping ground and conduct meaningful work around health care in prisons.  I have even been able to catch up with old colleagues and bear witness to the tremendous developments that have taken place in HMP Hull’s Healthcare Department in my absence.  Many of those old colleagues remain some of the most skilled and capable carers of people it has ever been my pleasure to witness.  The reasons why that should be the case could be debated at length but, thinking back to those 6Cs, in some ways it appalls me that we need to spell out in massive letters to nurses that they should be caring and compassionate.  In my mind, they are core tenets of the very vocation that prospective nurses seek to undertake, yet often seem more likely to be demonstrated by non-clinicians such as nursing assistants and HCOs, thanks to the relentless procedural and task orientated drift of nursing focus over the years (another debate there perhaps).

Of course there are other reasons why the 6Cs become threatened in practice.  In a prison for example, as in an A&E department on a Saturday night, repeated barrages of verbal abuse and the occasional physical assault tend to sap even the gentlest of spirits.  More broadly however we now occupy a space where nothing is a given and public sector jobs are no longer the sure deal they once were.  It isn’t only the prospect of impending cuts, redundancies and rationalisations that cause considerable anxiety to the work force, but the prospect of next year’s and the year after that and so on.  TUPE issues, relocations, management restructures, downgrading, re-profiling, applying for our own posts... all are possibilities. 

The CSU itself is, like all other providers, a reflection of its work force in macrocosm.  It will effectively be reapplying for its own job, only dozens of times per year, and those of us that occupy the spaces between the machinery are manning treadmills to keep it running. 

Being made redundant once, from a job that would have been described many years ago as ‘safe as a bank’ (pun very much intended), had the unforeseen benefit of making me somewhat philosophical about the prospect of undergoing the same process once again.  Last time my colleagues and I had no power to alter our destiny, and despite being a high performing team we were simply pushed over a cliff. 

This time is different. 

In joining the CSU we all went down the rabbit hole. 

We can choose one of two pills.

Choose wisely.

As it happens it didn't matter which pill we chose.  The CSU model was largely disastrous, with most falling by the wayside or being subsumed into even larger organisations.  In the case of WSYBCSU, it merged with NYHCSU to become YHCS.  None of that matters other than to say it never got any better and ultimately failed, despite the best efforts of us drones, because it was operated by morons.  Reading this back though I can relate to the sense of guarded optimism I felt when writing it, because I still feel that way three or so years on. Now we have a fully blue blooded Tory government, the NHS is collapsing in a mire of willfully created debt and doctors are going on strike, yet the bulk of the rank and file believe in their vocation and in the NHS as a concept.

That's somewhat encouraging I suppose.