You know when something just ‘don’t look right’.

It’d been parked there for several days.

A big brooding, black BMW… on the pavement. Mums with buggies stepping into the road. Dog walkers, in an act of reprisal, encouraged their pooches to cock a leg against the alloy wheels.

It took three days. Eventually the constabulary turned up… in a Skoda.

Two young officers had a poke around. Yup, the Beemer was nicked.

It was interesting to talk to them. Both in their 30’s. Stab-vests, handcuffs, telescopic truncheon, pouches, pockets and pepper spray. 

Not exactly Dixon of Dock Green. More, Robo-Cop of Docklands. 

It’s not often you get to see a real policemen, these days. Not in this neck of the woods… despite it being the London Borough with the highest crime rate.

I had an ulterior motive. I steered the conversation to the Met’ and the Mental Health Act. Real-time research.

From Tuesday the Commissioner’s men and women started withdrawing their support to the NHS on mental health call-outs… except where there’s a threat to life.

‘Was it really a problem?’

‘Yes…’ came the unequivocal reply. Followed by a litany of stories, first hand experiences and anecdotes. Whole shifts, marooned in A&E whilst the NHS struggled to deal with some poor soul.

Patients detained under the Mental Health Act wait with police officers for an average of 12 hours before receiving medical care. 

This will be cut to one hour under the new plans. One million hours of police time to be saved, every year. 

Is it a problem? I would have thought so.

Nevertheless, NHSE’s October, MH Board papers (para 24) give a cheery and optimistic report;

‘…more people than ever before… receive NHS support for their mental health… five million patients accessing care in 2022/23, an increase of more than one million in five years…supported by an extra £2.3bn a year…

... to expand its mental health offer.’

Where does the word ‘offer’ fit into the lexicon of care? 

Proffer, suggest, propound, bid… there are over one hundred synonyms for ‘offer’ none of them come close to service, care, compassion, access or even ‘more’.

‘Expanding an offer’ is nothing like 'doing our best to look after more people’. 

Policing has gone the way of Robo-Cop, please don’t let the NHS to go the way of the supermarket; special offer. ‘Fast check-out for six symptoms or more’. This week’s offer; speedy-boarding… into an ambulance.

Noooo!  

Three months ago the Common’s Public Accounts Committee reported on mental health services.

For me, comparing the Commons Report with he Board papers the reality looks very different.

Headlines; 

• Staff shortages holding back MH services from improving and expanding
• MH bed occupancy is well over 95%. In practical terms, choc-a-bloc. 
• Lack of definition on how to treat MH services with equal priority as physical services… twelve years after goal was announced.
• Staff vacancy rates in acute inpatient MH services are approximately 20% or more. 
• Of 29 ICBs surveyed by NAO, only four said they had all or most of the data they needed to assess patient and user experiences… none of them in relation to patient outcomes.

The NHSE board report breezes on;

‘With potential new treatments for Alzheimer’s disease on the horizon, we are stepping up and accelerating preparation for potential rollout.’

Really? A new drug, Lecanemab shows promise but is not approved by NICE and may (note, may) be available on the NHS in 2025.

The MH workforce increased by 22% overall, but varied greatly for different staff groups. More therapists, fewer for doctors and nurses.

Over the same period, referrals to services increased by a whopping 44%.

The increase in staff, outstripped by the rise in demand for services.

There’s a trap, waiting for all senior management and Boards to fall into…

... the reality between between work imagined and work done, work prescribed and work disclosed… 

… how people think that work is done and how work is actually done are two different things.

The concept emerged in the ‘40s, from safety-ergonomics and has gone on to be developed and used in safety critical industries, of which health-care is one. 

Work imagined by the Board.

Work actually done at the sharp-end. 

Work reported and work reported on...

… and work where you know something 'just don’t look right'.