NHS spending review public consultation

Snappy title, yes? No, and not so snappy writing, either. This is one of the questions on the so-called public consultation regarding the NHS. I say so-called because, not only was it barely publicised, as you ‘ll see from this example it’s also barely comprehensible.

What views do you have on our overarching objective of improving outcomes and reducing health inequalities, including by using new measures of comparative quality for local CCG populations to complement the national outcomes measures in the NHS Outcomes Framework?
Imagine the text you need to wade through to even place that in context. Then imagine your reading capacity isn’t, say, Oxbridge level and consider your response. After 40 years ploughing through NHS documents of one sort or another and a reading capability that arguably outstrips that of many, I struggle with this and I’m probably safe in saying that the majority of people – assuming they knew about it in the first place and also how to get it – will find it impossible. The average reading age in the UK is just 10 years and this government knows that. To pitch a public consultation at this level smells of cynical exclusivity even without the failure to give it widespread publicity.
It closes today (November 23rd) but I think we should press for its conclusions to be found null and void and for an accessibly written replacement to then be made available in as many public places as possible.

Post script: a quick and dirty (via Word) analysis of reading ease places this document beyond the reach of at least 54% or the population and that is scandalous. If someone could do a better analysis, please let me know and I’ll link to it.

NHS cons reading ease




Edit 16.34. I am asking Jeremy Corbyn MP to challenge the legitimacy of this document at PMQs, to ask if it will be withdrawn in the light of its inaccessibility to so many people, and if it will subsequently be replaced by a clearer version which is both easier for most to read and with wider availability with or without internet capability.

Edit 18.12. I was sent a form to submit my question, this is the question: The NHS Spending Review consultation document was poorly publicised but worse, it is written in sophisticated and complex language which is hard to read and harder to understand for more than 50% of the UK population. Will he scrap the results as invalid on those grounds and, with advice, make widely available a replacement document written to accommodate average literacy levels?   


Control is a story of abuse.

There were many parts of Rosa that acted outside of her direct control and she would watch from somewhere above or outside while they got on with it. Most of the time they just responded to whoever was in the room, but occasionally one took the initiative and went out on a limb, so to speak. 

It draws on my professional encounters with victims and recent reports of child sexual exploitation where victims were frequently not heard and were sometimes also criminalised and returned to their abusers. Although I have written many factual reports about the impact of abuse on vulnerable people – the detachment that goes from emotional disengagement right through to almost complete disowning of a body that is experiencing repeated assaults and violations – I sometimes think fiction can get a little closer. I hope this story feels real to the people who matter.

Depression: why we have to change attitudes & tell the rabid press where to get off

It’s a grim time to have a mental health condition.  Not that it was ever easy but this week there’s been the tragedy of a lost airliner with 150 people on board, its horrific end being attributed to the wilful act of the co-pilot. He’s said to have been treated for depression, to have been signed off sick for the day in question (illness unknown), but to have torn up the note and gone to work anyway. The headlines are screaming about the killer pilot, madmen, and murderers (see Rosie Mullender’s roundup) and any chance people with depression might have had of talking openly about their situation has suddenly been drowned by a ton of ill-informed hysterical bilge.

Talking about depression is not easy because it’s misunderstood. We’ve all been a bit down at some point, a bit fed up, and we’ve bought a new dress or had a couple of pints with our mates and got over it.  But that’s not the depression that sucks you dry, spins you around until you don’t know – or care – which direction you came from or where you’re going, that bleaches the colour out of everything you enjoyed, that screams inside but leaves you silent with no words to describe what it’s doing, that turns your logic and rationality in on itself so that the desperate need to end the pain becomes a desperate need to do whatever might end the pain. For some that’s suicide, for others it’s crawling into a nihilistic hole to live in a grey world of constant white noise and lead weights for guts. Depression is tricksy, wearing different faces and slithering around definitions just out of sight, tailoring itself specially to each person it tries to suffocate. A bespoke closet of worthlessness.

Another trick depression plays is that it often makes you smile, makes you play a game alongside all the people who aren’t depressed (or that you just don’t know are depressed because, well – One in Four?), turns you into a piece of foil or tissue that looks like normal but is too thin to bear the strain of anything more substantial than a fixed, glassy-eyed grin.

So nobody knows and nobody dare tell, so nobody knows and the stereotypes persist.

The bottom line with depression is that one in four of us will experience it and here’s the trick of that – it’s interchangeable, so spotting the one in your group that you think it is, doesn’t mean you can heave a sigh of relief that it isn’t you because it could be, in time, given the right set of circumstances.

Suicides among men are rising while those among women are falling and it’s the leading cause of death among young men aged 20-34. If we scratch the surface of that, perhaps we can see that women tend to talk and to identify feelings in a way men often don’t; women are permitted to be ‘weak’ (although that has its limits where mental health is concerned) where men are supposed to be strong, and women seek help for all sorts of things more readily than men. Maybe here lies the bedrock of the isolation, confusion, fear, and despair that drives so many young men to take their own lives.

We can’t know what was going through the mind of this particular young man – whether he had planned to do what he did and engineered the situation that left him alone in the cockpit, or whether that was entirely opportunistic – but we can guess at the depth of despair that so cut him off from everything that normally matters to people; despair that drives out empathy, connection, feelings for others and that left the gap that allowed him to take so many with him.

We absolutely must make it possible to talk about mental illness the way we talk about physical illness and it’s maybe no accident that,  along with not talking, mental health has, in the UK, been disadvantaged in terms of health funding in recent years. Mental health fluctuates, it’s on a spectrum, it isn’t all or nothing, it affects every aspect of our lives and it must have parity with physical illness in order to be openly addressed. In the UK, all manner of people and agencies are working on that.  Time to Change, Grassroots Suicide Prevention are leaders in this and Matt Haig’s superb book, Reasons To Stay Alive is worth a few quid of anyone’s money. They all say the same thing – you wouldn’t blame someone with a broken leg for not walking on it, or say that a man jumping from a burning building was being selfish, or describe someone with leukaemia as lazy. When something breaks it needs fixing and it can’t be fixed unless it’s recognised and talked about without fear of a prejudicial hoohah breaking out. If suicide was the intent for this young pilot who, like many, appeared to have everything going for him and to be doing his dream job, we have to ask ourselves as a society what we could have done to help him. We can’t undo this appalling tragedy but we might just prevent another.


Some resources:

You’ve seen Grassroots and Time to Change above. Also Matt Haig’s book but I’ll shamelessly plug it again and also recommend you go to hear him as well, if you can. Meanwhile, here’s 40 mins-worth on Soundcloud.

There’s also this letter from Lisa Rodrigues, ex CEO of Sussex Partnership NHS Foundation Trust. It’s to anyone experiencing depression and recounts some of her own experience. That was a courageous coming-out for sure.

Then there’s the Men’s Mental health Forum.

And quite obviously, The Samaritans.

Men’s Movement

Rethink (mental illness)




‘Strictly Come Dancing’ – time to end the pretence?

I was not sure where to put this because the content is entertainment but the central point is honesty and how far deception can be taken in order to preserve a conceit. In the end, after Facebook, I put it both here and there.

In the UK, ‘Strictly comprises two shows – the contest night when all the participants dance and the public vote is collected, and the results show at which the dance-off between the bottom two pairs takes place. The first show goes out on Saturday night and the second goes out on the Sunday when we are led to believe it is live.

But it is not live and we all know this. It is recorded on the Saturday with different frocks and a new selection of  celebs’ mums shuffled onto the front row. The dancers themselves often give it away, sometimes the judges let slip, and an increasing number of us knows someone who has actually been. I certainly do. They were asked not to tell and I found that a little bit uncomfortable, even though, in the grand scheme of things, it seems harmless. So what if we buy into this illusion and imagine that the entire set, make-up, costumes and audience are freshly put together less than 24 hours after dismantling or sending home the last lot?

Well, I think it matters first because it’s a deceit and an unnecessary one. But I think it really matters when children become a part of the lie through illness or, as is the case just now, traumatic injury. It would have been untenable enough had Claudia Winkelman’s daughter been afflicted by a tummy bug on the Saturday which everyone (including her, presumably), had to pretend was still the case on the Sunday when she might have been perfectly well. But she was injured and the cause has to do with Halloween and candles and so the matter has become a wider and more serious one. It has brought in national news journalists whose job it is to talk about many things other than a dance programme but who are – for now at least – going along with the pretence.

At first they persisted with the line that Claudia had to miss the Sunday show ‘as well’ and latterly they have begun to talk about ‘the weekend shows’, presumably as a way of skating over the fact that being unavailable on the Saturday inevitably means being absent on what is sold to us as the Sunday. Frankly, deception on that scale goes way beyond the tiny conceit that almost certainly drove the original intention. It’s time, I think, for them to come clean; I really don’t think anyone will mind.

Samaritans Radar – serious privacy concerns raised

I first heard about SamaritansRadar yesterday (October 29th) – that it was an app, and that its function was to help identify someone, a friend, who was feeling vulnerable. Then I began to hear more concerning comments about the way in which it was being applied and how the algorithm underpinning it could not manage sarcasm. Funny? Not really; I thought it probably couldn’t handle excerpts from professional papers or books, discussion amongst professionals, for instance, about suicide and depression, and also, more amusingly, the tweets my fiction writing friends often put out to publicise their books or stories. I decided to try it out, to register and see what the process was and what filters it allowed me to apply. But there were none, it was a simple activation process that then embedded the app in my twitter account and set about monitoring all the people I follow. I know very few of them in any other context and the lack of constraints, consent, or any kind of privacy protection was alarming. I revoked its permission straight away and emailed the Samaritans with my concerns. A good idea poorly implemented? Maybe, but let’s please not drive twitter users away by well-meaning but covert surveillance.


UPDATE: 30 October

Susan Hall has written a brilliant piece expanding on mine below, and she points out that section 12 of the Data Protection Act 1998 in terms allows a data subject to send a notice to a data controller requiring it to ensure no automated decisions are taken by processing their personal data for the purposes of evaluating matters such as their conduct. It seems to me that is precisely what “Samaritans Radar” does. So I’ve sent the following to Samaritans

Dear Samaritans

This is a notice pursuant to section 12 Data Protection Act 1998. Please ensure that no decision is taken by you or on your behalf (for instance by the “Samaritans Radar” app) based solely on the processing by automatic means of my personal data for the purpose of evaluating my conduct.

Thanks, Jon Baines @bainesy1969

I’ll post here about any developments.


Samaritans have launched a Twitter App

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Suarez and biting – a perspective

This is a Facebook post (mine) I feel compelled to give blog space. I have met people who bite and it has very rarely been a premeditated or vindictive act, it has been about extreme arousal leading to an uncontrolled primitive reaction. Here’s the post:

I don’t do football and I’m not a fan of Suarez but I do know about biting behaviours like his. People are looking for explanations in terms of what provoked it but it’s most likely they’re looking in the wrong place because it isn’t rational.

In the psychology business this is called hyper-arousal and whether positive or negative – like children bursting into tears at the end of a fab party, or cats purring then grabbing your hand – it spills out and a very primitive reaction takes over. The image of Suarez sitting on the pitch afterwards with his hands in his mouth and distress on his face is also primitive – he lost it and he hadn’t intended to, in my view, because it was neither premeditated nor personal.

I thought when I saw him earlier in the week, that he was wearing a wristband and, when he bit it after an energised moment, it occurred to me that it was there for just that purpose. If so, then his difficulty has been recognised and they’re trying to manage it. This time it failed and, while I have no sympathy for those who indulge in deliberate yobbishness, I am concerned for Suarez who seems plagued by a talent yoked to over-arousal that results in this hugely objectionable behaviour.