Who is it that has the drink problem in Scotland?

During the course of this week, two pieces of government spin emerged from the bowels [or should that be kidneys?] of Victoria Quay.

Statistics released today [26th June] by NHS National Services Scotland show that in 2011-12, 97,830 ‘Alcohol Brief Interventions’ (ABIs) were carried out – 60 per cent above the target of 61,081 interventions - and that every health board exceeded its target.  This is a marked increase from 2010-11 when over 88,000 ABIs were delivered.Alcohol Brief Interventions are used for patients in the NHS when it is clear they may be drinking above sensible guidelines and alcohol may be a factor in their ill-health.  ABIs typically take the form of a short discussion with a health professional to talk about their drinking, the benefits of cutting down and, if necessary, further advice or support.

Nothing like a bit of government health jargon to get you scratching your head and reaching for a refill to your pint or your wine glass.

Why the clunky grammar of 'Alcohol Brief Interventions' ?  Who really speaks like that ?
Why was there a target of 61,080 and 1 ?  Who did they have in mind for that 1 ?  Are our health civil servants so on top of things that they can set targets with that degree of refinement ?  They must know exactly how much we drink, what street we live on, and how we voted in the last election.  They probably do know just how many angels can be made to dance on the head of a pin.  Spooky stuff. 
Why 'brief'
Does the 'intervention' take place in the pub?
It doesn't mention anything about 'safe' interventions ?  Can you get pregnant as a result or even contract sexually transmitted diseases [or diseases of the willie, as Billy Connolly used to say]?  
Will the health professional respect me in the morning after ?
Will the same health professional provide me with a 'morning after' pill ?
Or will it have to be a different health professional ?

So many questions, so many decisions.  It makes you reach for the glass ....

And that is before you realise that almost 100,000 people received grammatically incorrect and condom-less interventions from a health professional - and we haven't a clue what the effect was.  Not a clue.  Check the press release yourself.  What you will find is that the Cabinet Secretary is chuffed to share that our government has spent £196 million since 2008 on tackling alcohol problems - and not a sniff of a data set which says X number of people have reduced their intake as a result or that our NHS is now saving £Y million a year as a result.  Something tells me that the NHS in Scotland has got a spending problem to match the  booze problem in Scotland - it pisses away almost £200 million in 4 years and can't tell us what difference, if any, it has made.

The day before, our glorious leaders issued yet another orgasmic press release on how Scotland was tackling its other problem that dare not speak its name - sectarianism.  Six communities in Scotland [none of them in Morningside or Bearsden, oh no, they don't do sectarianism in suburbia] are to share from a funding pot of £230,000.  So, on average we have been spending £50 million a year on tackling problem drinking.  On tackling bigotry, sectarianism, religious discrimination, and religious hate crime, we will spend less than 1/200th of that.

Next time you are on a night out, celebrating the simple reality that you are still in paid work that achieves things which can be measured and which makes other people's lives better, when you get to the end, pre-kebab, stage and you are having a woozy wee in the toilets, or even behind a bush on the way home, and trying to keep your shoes dry, just remember that you are doing on a very small scale what the government health minister has been doing for the last 4 years, but with her having a much bigger kitty.

Fear and loathing for the dispossessed

Last year, two people decided that the grind of poverty, the lack of a positive welfare support system in the UK, and the increasingly shrill demonising of anyone who relied on state benefits, was too much and killed themselves.  It was and remains a heartbreaking and harrowing story.  It has not left me, and it comes into my conscious mind at all sorts of times, especially when I am able to make some of the choices they were not able to make.

I blogged about Helen and Mark Mullins in November last year.  Remind yourself of the story here.

 'I think the system is very unkind ....You have
those who have the power to do this to you and
 those of us who don't have the power to resist
 it' - Mark Mullins

I have this morning carried out a quick Google search to see if I could find out what has happened since last October.  To find out if there has been an inquest.  To find out if we have managed to recover our collective sense of decency.  To find out if we are still in thrall to the fear and loathing inspired by the coalition government's policies.

I was unable to find anything other than the many reports and blogs filed last October and November.

At the same time, this morning's media has been overflowing with comment, analysis and gasps of amazement at the latest arrogance to emerge from the cesspits of the UK banking sector.  Barclays bank has been exposed as having been playing seriously silly buggers, fiddling and massaging interest rates, to make themselves look good, ensure obscene bonuses continue to be paid, and help Chief Executive Bob Diamond to continue to pull down a £multimillion salary.  The bank has been 'fined' [guess who will really pay that].  No-one has been fired or resigned.

.. a Prime Minister who actively demonises the
dispossessed in our society and seeks to strip
away what little shreds of dignity they have left
 - David Cameron, Bullingdon Club photo, back 
row, second from left

I believe there is a direct link between the factors which led Helen and Mark Mullins to kill themselves and such as the arrogance of Barclays, the self-centredness of the all too many tax dodgers like Jimmy Carr, the amnesia of Rupert Murdoch and his many acolytes, and a Prime Minister who actively demonises the dispossessed in our society and seeks to strip away what little shreds of dignity they still have left.

Many more people will die, quietly, causing little fuss, and with their remaining shreds of dignity scraped away by the insatiable and vulture-like greed of those who already have more than enough.  Unless those of us still living, still holding on to some shred of dignity, some sense of decency, keep the memory of Helen and Mark Mullins alive in our actions, our words and our deeds.

In the heat of the #Twitter night

Some of you will know about Twitter.  Others won't.  That's OK.  If you want to know about it and read some of my musings on it, read my timeline and profile.
It is a fascinating place.  Where else can you exchange brief [no more than 140 character long] views with Krishnan Guru-Murthy, offer a response to some of Kenny Farquharson's tweets as editor of Scotland on Sunday, and then take time to prompt Nicola Sturgeon to do her job as Cabinet Secretary with responsibility for equalities and get Equal Pay sorted for women working in Scotland's NHS.
Twitter allows public bodies and government to self-promote their own agendas.
It also allows for intolerance to emerge, with some examples of racism being expressed.  There are even instances of 'stalking' [known as 'trolling'] taking place.  The police can and do investigate abuse wherever it takes place, including Twitter.
One of the features of Twitter is that you 'follow' people.  You agree to be alerted any time they post something on Twitter.  If you look at my profile [or anyone else] you can see who I follow, and you can see who follows me.
I realised recently that I had not read any 'tweets' from Nicola Sturgeon.  Her tweets ranged far and wide and included a lot on her work as a constituency MSP.  I invariably responded to her tweets with a reminder that she still had to deliver equal pay for women working in our NHS.  When I checked recently on her lack of tweeting, I found that I had been 'blocked' [you can do that, it is a bit like the school playground and deciding that you are not talking to someone].  I can only conclude that my reminders on equal pay became tiresome to the Cabinet Secretary and she decided to block me from her Twitter timeline.  
At the same time I also realised I had not read any tweets from Scottish Government.  They use Twitter to tell you where the First Minister is and what superhero efforts he is making on behalf of Scotland.  Things like forcing himself to go to Los Angeles for 4 days to watch a movie and persuade US business people to invest in Scotland.  I enjoy taking a sharp pin to the inflated and pompous tweets from government and try to remind them of some of the realities citizens face every day.  Again, I have checked and found that the 'shovel ready' tweets from the spinners at St Andrew's House have 'blocked' me from the stuff which drips from their shovels on Twitter.  It appears my pins have been too sharp too often.

It is at times like this I feel I have just been 'blocked' by Chief Gillespie from Sparta.

Democracy - for hearing people only

Part of the fun in TV programmes like Channel 4 news bulletin is in watching the attempts by those delivering sub-titles to convey what is being said by whom and when - all in a sometimes rapid-fire environment.  I 'watch' TV with sub-titling 'on' because I am hearing impaired, and there are a lot of deaf and hearing impaired people in this country [10 million some estimate] who rely on sub-titling and/or signing to be able to be up to date with news and current affairs.
The quality of sub-titling across the main TV channels is variable, especially when the programmes being watched are live.  No matter, it allows deaf/hearing impaired people to be almost as well informed about current affairs as hearing people, and enables and empowers us to use that informed state to contribute to and influence the debates, a lot of which affect us.
Those of you who are keen fans of my blogging will also know I am active on Twitter.  Twitter is without barriers for deaf/hearing impaired people, and enables rapid, up-to-the-minute exchanges on breaking news [of all kinds] and, in some cases, even influences and shapes national politics.  An example of this is the regular flurry of comment and feedback on Prime Minister's Question Time in the House of Commons.  This generates a huge volume of traffic on Twitter, and a lot of it comes from people who are watching it broadcast on parliamentary TV [in Westminster and First Minister's Questions in Holyrood].
That doesn't work for me.  When I log on to parliamentary TV [in either London or Edinburgh] I can't access sub-titling.  Neither parliament TV channel offers sub-titling.
When I asked why, I was offered a variety of reasons - including costs - and it was suggested that either Hansard or the Official Report provided the information I was looking for.  Indeed, both documents do provide a comprehensive written record of proceedings - several days after the event.
So, if I want to follow debates in either parliament and act quickly on what might be said during debates or evidence sessions at Committees, I am prohibited from doing so - because I am hearing impaired and my parliaments are not routinely accessible to me and around 10 million other people.
If governments can cut deaf/hearing impaired people out of the heart of democratic debate, who is next? 

NHS a haven for bullies

Some of you will be aware that in recent months, Nicola Sturgeon was forced to face up to the fact that the NHS in Scotland was not working as it should.  NHS Lothian was found to have been fiddling waiting list figures.  This was not a 'victimless crime'.  People were being denied treatment they needed.  All in order to meet targets set by Nicola Sturgeon.

Part of the underlying cause in this mess is that the Cabinet Secretary for Health, Nicola Sturgeon, refuses to put in place robust central systems which give her instant access to audited performance data from NHS Boards on a range of critical areas of work.  For instance, Nicola could not tell you what the gender pay gap is just now across the NHS in Scotland.  She would have to write to all the NHS Boards and ask them to supply the information, then get one of her staff to put all 22 reports onto one spreadsheet and work out the answer.  But that issue is for another blog.

Back to the waiting list fiddling.  Back to the organised, institutional cheating of patients out of their right to being fairly treated, and not just in the medical sense, but also in the sense of basic human decency.  Back to our NHS, where the government has used up lots of Parliamentary time to push through a Patients Rights Act, which ensures in the fine print at the end of the Act that none of the 'rights' are enforceable in the courts.

In March 2012, PriceWaterhouseCoopers [PWC] presented a report to Scottish Government, 'Review of Aspects of Waiting Times Management at NHS Lothian'.  28 pages of dry, let's not scare the horses, comfortable and comforting jargon.  The verdict ?  In the words of the report - "In considering the multiple evidence sources, it is apparent that the management and processes for waiting times at NHS Lothian have been sub optimal."  I love that - sub-optimal.  The kind of language you can safely use in front of your granny.  Not sure the patients cheated out of their treatment would agree that phrasing was accurate.

In considering the multiple evidence sources, it is apparent that the management and processes for waiting times at NHS Lothian have been sub optimal 

Another report into the wider issues on the management culture at NHS Lothian was published in May 2012.  Translated ?  The PWC report found evidence of bullying and Nicola Sturgeon asked for another report into that.  This report was also written in that careful language one commonly encounters in the NHS.  It did manage to say - "Furthermore and more significantly the alleged inappropriate behaviours have endured and gone unchallenged or become accepted."  Translated ?  There was/is a bullying culture in NHS Lothian and one of the consequences was the fiddling of waiting times because the real picture was bad news senior managers did not want the Board to know about.

OK. Caught fiddling.  Caught bullying.  What does Nicola do ?  She said "I want to be clear that there is no place in any part of the NHS for a management style or culture of this type and it will not be tolerated."  She went on "I have now asked Dr Charles Winstanley [NHS Lothian Board Chairperson] to produce a single integrated action plan which will bring together the improvements required in waiting time information reporting, governance and culture.”

Translated ?  She asks the same Board members [appointed by her] who sat there while all this fiddling and bullying was going on under their noses to undertake the Augean stable cleaning.  Bit like asking Fred Goodwin and other 'sub-optimal' bankers to fix the banking crisis they created and guide us out of the recession.  Baffled, bewildered and bemused by her 'thinking', I asked the Cabinet Secretary why she was not considering her own position, given she had to take some responsibility for appointing a Board which had been unable to impose effective governance which would have avoided the fiddling and the bullying.  I also asked what she was doing to protect the staff who had been bullied and who were still being bullied.

The response I got was breathtaking in its attempt to do a Marie Antoinette [albeit with that Weegie accent and head-butting nod used by the Cabinet Secretary in interviews] over the issues.  Nicola said : "The results of the 2010 national staff survey indicated that less than 1.5% of NHS Lothian staff reported incidents of bullying or harassment. It would, therefore, have been difficult to conclude from the staff survey results that a culture of bullying existed. There is no indication from the 2010 national staff survey result that there is a wider culture of bullying across NHSScotland."   She had also decided, not unusually, to ignore most of my direct questions.  I have gone back to her along the following lines.

You say that there is no indication that there is a bullying culture in the NHS Scotland, citing the staff survey. Two things. Surveys are not the best tool with which to pick up bullying, as few NHS staff believe it is worth completing that or any other survey to ascertain staff experiences in this regard as they have no trust that their views will receive proper attention or action.  Your response concedes this very point on Lothian's results, and yet you now know that bullying exists in Lothian.

Secondly, the report on the bullying culture in NHS Lothian did put it into a context of how it compared to the rest of the NHS [as evidenced by the staff survey results] and found that there was no marked variation between NHS Lothian and the rest of the NHS.  It follows that if there is a bullying culture in NHS Lothian there is a strong likelihood that there is such a culture across the rest of the NHS.  You cannot concede on the one hand that the staff survey did not reveal the bullying found in NHS Lothian and then cite the same staff survey results as providing no indication that there is bullying across the rest of the NHS. 

Staff in the NHS will be filled with despair at this quality of analysis by the Cabinet Secretary.  Other than a flawed if not lazy analysis by the Cabinet Secretary, the response sets out in a lot of detail the many processes NHS Scotland has for tackling bullying.  Process itself will never change behaviours.  Glossy brochures, posters, leaflets and sound-bites will not change the culture of the NHS.  That apart, unless there is some kind of quality assurance around the various efforts being made to ‘tackle’ bullying, linked to monitoring over time of how staff perceive any change in bullying behaviours, it is all a waste of time and is on a par with much of the equalities work done in NHS Scotland where for example it still cannot provide robust data on whether BME or disabled people get access to the same quality of health services as non-BME and non-disabled people.  There are myriad processes across the NHS which suggest much activity on equality, but little or no evidence that any change is being made or discrimination is being eliminated.  So too is it with NHS Scotland’s limited value work on bullying.

Aside from that, my reading and re-reading of your response finds that you have ignored, avoided, or mislaid the core and direct questions I asked in my email of 15th May. This seems a tad discourteous, and I would courteously invite you to respond directly to these, and urgently.  These were :

Why have you as Cabinet Secretary, who has lead responsibility for creating the management culture in the NHS at the most senior levels, not accepted responsibility in any way for what has been uncovered and why have you not decided that your resignation would be the most appropriate and honourable action?

Given the Board members in NHS Lothian were all appointed by you, and that the governance arrangements at NHS Lothian failed to work in uncovering and dealing with the bullying culture, why is it that the Board is not being sacked and new, untainted, Board appointments being made?

Given the adverse impact on the patient experience as a result of the fiddling of waiting time guarantees, what confidence can and should patients have that the bullying culture has not also impacted on the quality of patient services in other parts of the NHS?

Given the report found no basis for believing that the bullying in NHS Lothian was unique to the NHS in Scotland, what radical and meaningful action is being taken to identify and eliminate bullying across the entire NHS?

And finally but no less importantly, why have you as Cabinet Secretary not required NHS Lothian to investigate the number of staff who have been dismissed or who have resigned from NHS Lothian employment as a direct result of the bullying culture and look at options for reinstatement of those staff or, at worst, appropriate levels of financial compensation being awarded to them?

The Cabinet Secretary needs to deal with the lives of those who have been bullied out of work in the NHS.  Ignoring it won't make it go away.  Ignoring it will mean that the culture uncovered will not change.  If you want to push the Cabinet Secretary into doing something real on bullying in our NHS, send her a tweet via this button.   Tweet to @NicolaSturgeon

They fuck you up, those NHS Boards do - with a nod to Philip Larkin

Just as you get to the end of the real news section of a broadsheet and you want to skip the classifieds, public notices, court circulars [why can't they be square?], lonely hearts, and announcements and get to the sports sections, something snares your eye.
It could be anything.  This time, for me, in early May 2012, it was a notice, barely the size of two postage stamps and probably using 8pt type size, and advising that the Board of NHS Health Scotland was due to meet later that month.  Anyone interested in attending should phone a named NHS Health Scotland staffer on a landline phone number.

That's what snagged my eye, and my mind.

And it is what pissed me off from the get go.

Two things you need to know.  I am hearing impaired.  Been losing my hearing since I was a 5 year old [just a few years ago].  Now I have no hearing on the right and seriously little left in the left.  Using landline phones does not always work for me.  Sometimes on a good day it does, other times it is as if I am in deep space and light years away.

The other thing is that NHS Health Scotland hosts a £million a year unit of staff dedicated to making sure the whole NHS in Scotland is accessible to all, complies with the Equality Act 2010 and the related specific equality duties.  Previous NHS Scotland Chief Executives have set the goal for the NHS to be more than compliant and to go beyond that and be exemplary.  Deaf and hearing impaired people have not suddenly sprung up like mushrooms.  The barriers to them being involved in the mainstream of society have been around for centuries.  Inviting us to contact public bodies has long been known to require more than a landline phone number.

I entered into an email based dialogue with the Chief Executive and his staff, starting off from the premise that NHS Health Scotland were discriminating against deaf and hearing impaired people and that given the needs of this community are not new or recent, there was something structurally, culturally and institutionally discriminatory at the heart of how NHS Health Scotland goes about its business.

They said it was not 'deliberate'.  They said they would change the notices in future to include an email address.  They said they would overhaul their processes and guidance on a meeting check-list.  They said they would 'note' a number of suggestions I had made.

Despairing of this bureaucratic attempt to construct and hide behind a smokescreen, I tried once more.

I suggested that whether or not the act of discrimination was deliberate was of no consequence and is certainly no defence in law. I questioned any signs of a real awareness in NHS Health Scotland that discrimination exists, that is deep rooted in the organisation and its staff, and is not something which can be removed simply by amending process. I pointed out that the process was, in the form of the check-list, already there – it was the staff who did not use it. Simply and only adding to process will not eliminate the discrimination.

I also pointed out - ‘noting’ my comments on impact assessment and ‘bearing my observations in mind’ signals no real or urgent commitment to eliminating the discrimination I have identified, and the NHS Health Scotland equalities cupboard is not only bare but cobwebbed when it comes to ideas and action to tackle the institutional discrimination in the organisation through its people as opposed to tinkering with process. It is deeply disappointing to realise that.

I remain entirely dissatisfied with the attempts of NHS Health Scotland to deal with the core issues I have raised and indeed some of the original questions remain unanswered. In light of that sustained failure there is little point in formally complaining for two reasons – firstly, there is no sense offered that NHS Health Scotland welcomes change required to eliminate discrimination. Secondly, the invitation to consider a formal complaint was made in the complete absence of guidance from NHS Health Scotland on precisely what process would be followed in handling any such complaint. The message is quite clear – I would be wasting my time.

I concluded - I am formally requesting NHS Health Scotland to take into account as evidence the substance of my representations on discrimination in how Board meetings are organised and that the principles involved in that failure of NHS Health Scotland should be addressed as part of the setting of Equality Outcomes required of NHS Health Scotland in complying with the specific equality duties. I formally request notification from NHS Health Scotland if it decides not to set an Equality Outcome which will deal with and evidence removal of the forms of discrimination I have identified.

At no time in all of this did NHS Health Scotland indicate that it understands it discriminates, that it accepts that it discriminates, that it will openly admit that it discriminates, or that it even cares that it discriminates.  All of these corporate mindsets are required before you can do real work in eliminating discrimination.  If you think it is OK to make deaf or BME people drink from a different water tap than that used by hearing or non-BME people, then you are unlikely to be able to work out how to end that discrimination.  If you are looking to the national NHS equalities resource in Scotland to deliver equalities, it looks as if deaf people are going to be born, live and die before the NHS mainstreams disability equality in the most simple of situations.