Category Archives: Discrimination

This is reproduced with permission from OurNHS openDemocracy 

The sharp recent increase in reported hate crime – the worst rise on record – is linked to the EU Referendum, according to Mark Hamilton, head of the National Police Chiefs’ Council. He said last week “Some people took that as a licence to behave in a racist or other discriminatory way.”

The imagery and language on immigration used by Nigel Farage, Boris Johnson, Michael Gove and others has made the unspeakable acceptable.

This is raises several big challenges for the NHS.

The NHS would collapse overnight without the contribution of EU and Black and minority ethnic workers. Anyone who thinks otherwise is living in cloud cuckoo land – including any minister who thinks the immigration status of these staff should be a bargaining chip in EU negotiations.

There are 110,000 EU workers in our health and care system. Ten per cent of our doctors, and more than 20,000 NHS nurses, are from another EU country. Well over 200,000 staff in the NHS (a third of doctors and a fifth of nurses and midwives) are from Black and Minority Ethnic backgrounds. The NHS is the largest employer of Black and Minority Ethnic staff in the UK.

EU staff by nationality by NHS trust

EU staff by nationality by NHS trust and CCG

Source: Health and Social Care Information Centre, NHS Hospital & Community Health Service (HCHS) Workforce Statistics, as at 31 March 2016; and House of Lords Library

But racism in Britain has deep roots. A generation of Irish nurses were poorly treated. The MacPherson Report demonstrated how deeply race discrimination had become embedded in the culture of public services.

Staff are discriminated against in appointments, in disciplinary action, in bullying, are less well treated when they raise concerns, wait longer to be promoted, and do less well on discretionary pay. The evidence is clear from NHS workforce data and staff survey data consistently show that BME – but until recently, concerns were greeted with wilful blindness.

The NHS has a poor track record in tackling other forms of discrimination, too. Disabled staff and LGBT staff suffer high levels of bullying, for example. Women are still seriously under-represented in more senior posts.

Yet the evidence is now clear that discrimination, and especially discrimination against BME staff, impacts adversely on patient experience and care.

Most race discrimination in the NHS is subtle. It is well hidden, or the unintended consequence of stereotypes, bias and a culture where injustice is difficult to challenge. Understanding individual experiences is crucial. Often black and minority ethnic staff bottle up their response because to sharing it is seen as unsafe and threatening – both for them and for those who hold power at team, division, profession and organisational level.

More overt racism

But the toxicity of the Referendum campaign has now helped legitimise more overt forms of racism.

Racist graffiti has appeared on NHS premises.

We’ve heard anecdotally of an increase in patients wanting to only see a white, ‘British’ member of staff.

Patients demanding healthcare from a healthcare worker of a particular ethnicity has been unusual in the NHS.

But it happens. Some 17 years ago one London primary care trust felt it necessary to agree a policy that, should families demand to see a white health visitor or district nurse on a home visit as some had, then that request would be refused, and advice and care would then only be available from a Health Centre where that request would be refused again. Two years ago, Dr Nadeem Moghal described how the parents of a child in a hospital where he used to work refused to have any doctors caring for their child who were other than white. He said: “the clinical director concluded that because of the nature of the disease and the clinical need of the patient, the parents request would be enabled”. In other words, the hospital would uphold the parents’ request. And until a board level inquiry reversed the decision, which the parents eventually agree to abide by, care was organised so that only a white British doctor attended to the child.His article rightly referred to Macpherson’s definition of institutional racism

“The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.”

Days after the Referendum result, a Leicester Musculoskeletal Radiologist Dr Ali Abbasi ‏tweeted “@drmaliabbasi Last night a Sikh radiographer colleague of mine was told by a patient “shouldn’t you be on a plane back to Pakistan? we voted you out”. 

Sometimes these issues are not easy to tackle. When my dad’s care home called us some years ago to say he had racially insulted a member of staff we were astonished. He was a life-long opponent of discrimination in all its forms. His dementia had first caused him to start swearing, something he had never done in his entire life, and then this. We spoke at length with dad, and repeatedly, explained it was not acceptable and must stop. It did. To this day I still cannot understand what happened.

Sometimes the racism is overt and violent. Last year a patient who subjected two healthcare assistants to racial and homophobic abuse was fined, after a prosecution brought by NHS Protect’s Legal Protection Unit (LPU), after the police stated that they were unwilling to take further action. (The LPU advises health bodies on a wide range of sanctions that can be taken against those who assault, harass and abuse NHS workers).  

In 2013, recorded racist verbal and physical attacks against those working in the NHS were on the rise, according to a Freedom of Information request by BBC radio 5 Live. Their investigation found that; the number of such attacks in the NHS had risen 65% since 2008 with a total of 567 racist incidents, though I suspect there may be significant under reporting.

The large-scale 2015 NHS staff survey (and previous years’ surveys are similar) shows that White and BME staff were equally likely to experience harassment, bullying or abuse from patients, relatives or the public in last 12 months, but BME staff were more likely (25%) to report experiencing harassment, bullying or abuse from staff in the previous 12 months compared to white staff (22%).

BME staff were more likely (14%) to experience physical violence from patients, relatives or the public in last 12 months than White staff (12%) and more likely (3%) to report experiencing physical violence from staff in last 12 months than white staff (1%).  

The survey figures show that in fact BME staff are more likely to experience harassment, abuse, bullying and violence from fellow staff than they are from the public. And any bullying of staff impacts on patient care, making effective teamwork hard and making staff more reluctant to raise concerns or admit mistakes.

The risk of the post EU Referendum toxicity is that discrimination may rise despite the fact that NHS employers, on the whole, were quick to react to Brexit, understanding the risk of alienating their workforces.  

Some suggestions

The ringing of bells by the Leave campaign and the wringing of hands by the Remain supporters does nothing to prevent the potential undermining of EU and BME staff within the NHS.

Since 2015 the mandatory Workforce Race Equality Standard has produced data that validates the belief of injustice and the pain already experienced by many BME staff. And the Standard has obliged (or helped) organisations to hold a mirror to themselves and requires organisation to improve the treatment of their BME staff.

So here are a few suggestions for anyone in managerial, governance or leadership roles in the NHS. Good trusts have already actioned some of these points.

  1. All staff should be informed about the evidence of the positive contribution that EU and BME staff make to the NHS. All managers should be informed and confident to tackle the issue, and trade unions must be involved. A good start would be this excellent blog on EU staff.
  2. Create a safe space for discussion but not for tolerating racism. Allow staff to raise difficult issues and ask questions troubling them, in a way that effectively challenges prejudice.  Leaders should meet EU staff and BME staff directly affected, as the best ones already have, to listen to their concerns and their ideas for responding to this challenge – and offer practical support.
  3. Underline the principle of zero tolerance for racist behaviour of any kind, whether from patients or staff. This may not always be easy – for example where unwell patients are abusive – but think through how to respond in line with the principle of zero tolerance, including whether patients can choose to be treated by white staff.
  4. Strongly encourage staff to formally report all instances of bullying, abuse, harassment or violence (from whatever source) as a health and safety incident (for example, using Datix) as well as through the HR department. Make clear that anyone seeking to prevent such reporting, or retaliating when staff do, will face disciplinary charges. Managers must model the behaviour they expect of others.
  5. Be proactive. Use staff survey data to identify hot spots of bullying, violence, and discrimination working with unions and staff networks to intervene proactively. Undertake full (not just sample) surveys to better understand such patterns.
  6. Bear in mind that there is extensive evidence of the less positive experiences of BME patients (and indeed other minority groups such as LGBT patients) and the NHS needs to ensure that is not worsened by the current climate too.
  7. Learn how the best organisations how they are tackling these issues – staff survey data will give a clue but beware tick box approaches focused solely on policies, procedures and training. Ensure there is a dedicated member of staff, working with unions and staff networks, who concerned staff can contact. Take advice from NHS Protect when necessary.
  8. Check out current advice to employers on what else they can do to support staff from the EU.
  9. Recognise that the current environment makes it even more important to engage fully with the NHS Workforce Race Equality Standard whose principles of fair treatment for all can be easily applied to EU staff. Tackling discrimination against BME (and EU) staff requires a determined effort to change workplace culture – something that will benefit all staff and all patients.
  10. Support calls for adequate funding for the NHS. An underfunded NHS, with growing queues for care and treatment, encourages some to blame “foreign” NHS users even if the contribution of “foreigners” to the NHS both as staff and as taxpayers outweighs their so-called “burden”.  

The legacy of hostility to immigrants, and lies about NHS funding, which helped deliver the vote to Leave the EU can be turned around. Don Berwick rightly said

At its core, the NHS remains a world-leading example of commitment to health and health care as a human right – the endeavour of a whole society to ensure that all people in their time of need are supported, cared for, and healed.”

The collective effort of a hundred and more different nationalities within the NHS to care for our population is a living riposte to xenophobia. The NHS demonstrates, more clearly than anything else can, the positive contribution that staff – from all nationalities and all backgrounds – make to the national good.

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NHS England’s – and as a consequence, the Government’s – refusal to commission Pre-Exposure Prophylaxis (PrEP) is as short-sighted as it is stupid. Around seventeen people in the UK are newly diagnosed with HIV every single day, and we have available to us a drug, Truvada, which has been shown to reduce the risk of contracting HIV by between 90 and 99 per cent. In a large international study, those gay men that took at least four doses a week saw 96 per cent fewer infections. A UK study saw a figure of around 86 per cent. Whichever figure you accept, it’s a significant impact in ending the transmission of HIV, and the closest thing we currently have to a cure.

Now I accept Truvada is not cheap – I hate talking about healthcare in purely economic costs (it’s people’s lives we are really talking about here) but even in crude economics, the lifetime costs of treating somebody with HIV could reach around £380,000. By limiting PrEP prescription to those most at risk of contracting HIV, we could drastically reduce the number of infections and the associated lifetime costs.

Now the Government claims that the cost may have to be absorbed by existing local authority public health budgets – which have been slashed repeatedly by the very same Government. And that causes an additional issue: assuming councils did this, ALL of the costs of prescribing PrEP would fall to local authorities, whereas the NHS would be the beneficiary of ALL of the financial savings in hospital treatment, care and lifetime treatment no-longer being necessary. The Local Government Association has rightly called the decision an “attempt to create a new and unfunded burden on local authorities.” And some local authorities would clearly have to devote far more resources than others – authorities such as Manchester and Brighton & Hove, and other similar areas with large LGBT, MSM or African BAME communities, would almost certainly have to spend more than other councils.

The Labour Party has consistently called on the Government to reconsider this counterintuitive position. In my Urgent Question to the Public Health Minister, I made the point that the Health Secretary could delegate the power to commission PrEP to NHS England via Section 7a of the NHS Act 2006, but that this would need to be accompanied by appropriate funding. This, in our view, proves that the Government has made nothing more than a political decision, and is hiding behind legal advice.

The UK was once a world leader in the fight against the HIV epidemic, and yet now it’s lagging behind other countries in Europe. Offering PrEP to people at risk of infection would help us to significantly turn the tide in this fight. It is time for the Government to use its section 7a powers and put this situation right.

 

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I landed at Heathrow on 26th January 1991 with three pounds in my pocket and a turban on my head. In my head were Oxford spires, Bertie Wooster, Pink Floyd, Sir Humphrey Appleby from Yes, Minister and the Marylebone Cricket Club—as well as a firm conviction that I would feel at home. I was heading for Hounslow in west London to get some cash from a family friend before going to the General Medical Council (GMC) offices near Great Portland Street to register, and finally to Lincoln to start work as a junior doctor. At Heathrow, I asked an elderly lady how to get to Hounslow, admitting that I only had £3. “Don’t worry love, you will get there and still have change left for a drink.” Paradise: where women you have never met call you “love.”

The GMC office was tricky to find. Outside the tube station, I asked directions from a group of youngsters who snarled: “Fuck off.” Disheartened, I turned to a man rushing somewhere. He looked at my creased paper with the GMC address and phone number, rang the number on his brick-sized mobile phone to find out where it was and walked me to the front door.

Lincoln was trickier still. Flat, everyone white, and not a turban or dark skin in sight. Walking back the first evening from a corner shop, I was stopped by three young men. Tattooed and aggressive, they wanted to know if I was aware that their country and my country were at war. They thought I was Iraqi. They were in no mood for lessons in geography, religion or culture; my pleading that I was a Sikh from India was of no interest. As they started to push and shove me, a group of women across the road came over. They were nursing students and one of them had seen me earlier that day trying to find my way round the hospital accommodation. One of them shooed the guys off with language that would do a seasoned sailor proud. I was close to tears. She took me to her flat, made me the most welcoming cup of tea I have ever had, and said: “Don’t mind those dickheads, love.” Love, again

I was bewildered. This was not the England I thought I knew. My ancestors came from a small clan of Kashmiri Brahmins who converted to Sikhism in the 18th century. Indian Kashmir has now almost been cleansed of its non-Muslim population; my clan, a successful minority in Kashmir, has been without a home for three decades. I was lucky; I grew up in Delhi. I was training to be surgeon and living a recklessly indulgent life till Indira Gandhi’s assassination in 1984. In the aftermath, I joined groups seeking justice for the Sikhs. By 1990, it was clear that there would be no justice.

I decided to leave India and found a job as a charity worker in Ethiopia. Three weeks before I was to leave, a work opportunity arose from England, as a psychiatry trainee in the East Midlands. Confronted with a dilemma, I invited friends over and opened a bottle of Indian Scotch. After several drinks a friend suggested: “Why don’t you stop over in England to see how it is? After all, England is on the way to Ethiopia.”

After arriving in Lincoln, I became exquisitely sensitive to racism. My antennae twitched at every perceived slight and humiliation, even when, in retrospect, some incidents had benign and often slightly comic explanations. I remember being asked to attend to an elderly lady who wanted to leave an inpatient ward against medical advice. As I approached the ward, she was standing by the door arguing with a nurse. She looked at me and said: “Look, my taxi is here.” Having examined her, I told her I was going to detain her under the Mental Health Act. She was incredulous: “How can it be right that you can come to my country and stop me from leaving?” I explained that I was simply doing my clinical duty as required by law. She asked which law it was and which party had been in government when it was passed. I said it was the 1983 Mental Health Act and although I was not certain, I thought the Tories had been in power. “Bloody Tories” she exclaimed, still struggling to accept that someone like me could override her will. In her world, people like me were taxi drivers or corner shop owners. Was she driven by racist or malicious intent? I don’t think so. Racism would be an easy charge, but doesn’t explain everything.

In those early years, I could easily find examples of pervasive and pernicious racism within society and in the NHS. A consultant I worked with told me that I must return to my country after completing my training, since there were “too many of your kind” in the UK already. I witnessed subtle prejudices and downright discrimination against ethnic minority candidates in exams and interview panels. In what was then the NHS merit award system, I noticed how white consultants locked themselves in closed committees and handed out financial rewards to each other, ignoring their often equally worthy non-white colleagues. A London medical school had a systematic way of excluding applications from non-white and female candidates, based on name recognition. At a party, a slightly drunk female colleague accused me of “building mosques in the UK” and having “four wives back home.” When I explained that I was a Sikh, not a Muslim, she said: “Of course you are going to deny being a Muslim.”

Yet my everyday life was not an accumulation of disagreeable experiences. The racist events stand out not because these were common, but because these sharply contrasted with everyday life among the friendly, decent, scrupulously fair and unfailingly polite population that makes up the bulk of Britain. I quickly made friends, learnt to love ales, started attending concerts by my teenage rock heroes. I also worked out the hidden intricacies of English as spoken by the English. In a meeting, if your view was considered “interesting,” it meant you might be right. “Very interesting” implied that you were obviously barmy. When the English called you “Sir,” they were distancing themselves. When they were amusingly rude, you were one of them. I was lucky I worked with people who were accustomed to working with ethnic minorities on an equal basis. I suspect my experiences would not have been the same in a different class and professional setting.

So how racist is Britain? The answer depends on one’s reference point. Compared with a utopian society of flawless human beings, Britain undoubtedly harbours some people with racist prejudice. Compared with human societies as they exist in the real world, Britain is one of the most tolerant and welcoming nations in the world. Had I moved from New Delhi to Chennai, Kolkata or Hyderabad, I would have faced discrimination based on language, culture and geography. Tribal affiliations are part of being human. And many countries, including those from which most migrants originate, have a shameful record of discrimination and human rights violations. India regularly experiences large-scale violence, often triggered by trivial religious or political disputes. A Muslim man was recently lynched because it was suspected that he had beef in his house. The UK should not be judged by India’s standards. It is also not right to expect the UK to live up to an unrealistic standard, where every individual is non-racist, and where everyone has the right to be offended by a subjective interpretation of someone else’s words; where history has to be washed clean of racist impurities; and where white culture is a homogenous monolith that subjects an equally homogenous minority group to its malevolent intent.
Swaran Singh wearing his hair down and a "fiendish leather jacket"

Swaran Singh wearing his hair down and a “fiendish leather jacket” 

Everything to do with race cannot be always attributed to racism. Some years back there were serious suggestions that ethnic minority patients should only be seen by ethnically matched clinicians—apartheid within the NHS. This followed evidence that ethnic minorities were more likely to be diagnosed with a serious mental disorder, and were more likely to be detained under the Mental Health Act. There is robust evidence that the reasons for higher rates of mental illness and detention lie with the socio-economic disadvantages experienced by some minority groups, including societal marginalisation and discrimination, but these factors are outside the control of the NHS. Under pressure from anti-racist groups, successive governments have accepted the charge that mental health services are “institutionally racist,” and have spent hundreds of millions of pounds on race equality—as if sending psychiatrists on cultural sensitivity training courses would improve the social disadvantage of minority communities. (Ironically, the one part of the NHS with disproportionately large numbers of ethnic minority staff is mental health care.) No one would say GPs were racist because they diagnose higher rates of coronary artery disease in people from the Asian subcontinent or hypertension in those of Afro-Caribbean origin. The remedy for such ethnic differences in health lies in implementing social change that reduces exposure to risk factors for heart disease and high blood pressure, not in blaming doctors. But such is the power of the racism charge that politicians are forced to act before they have had time to think.

In my first year in the UK, a white woman with post-mastectomy depression refused to see me because she felt that someone from my “culture” would not be able to understand her. I wrote to her asking to meet up before she decided whether I could help or not. She did, and we had a successful therapeutic relationship. White patients cannot demand that only a white doctor sees them. If as an ethnic minority patient, I demand that an ethnically matched clinician should see me, I am saying to my white friends: I am equal to you, but you are not equal to me. Our shared humanity and the commonality of human suffering, pain and loss should allow us to understand the influences of culture without demanding that patients from minority ethnic groups be treated in a fundamentally different way.

I led research, commissioned by the Department of Health, to understand the experiences of ethnic minorities seeking help (The Enrich Project.) In our research, we asked black and Asian communities whether they want to be seen by someone from their own background. No one asked for it; everyone said that they don’t care about the ethnic origin of the clinician as long as the clinician was competent and treated them with respect and dignity.

When we meet another human being, each one of us makes the same spontaneous, automatic, instantaneous and involuntary judgements about them: male or female, adult or child, my tribe or not my tribe. These are evolutionary responses designed to assess threat. Is the other person a potential friend, foe or mate? Tribal costumes and decorations are primarily designed to confirm “us versus them” status. Hence the importance in all societies of visible markers of difference. There is a famous saying in anthropology: “in some ways we are like everyone else, in some ways we are like some other people, in some ways we are like no one else.” Between our common humanity and individual uniqueness is the separation of our tribe.

Race and ethnicity are just one way of dividing us, and in my experience, class is a deeper dividing line in British society than ethnicity. Many such divisions can be overcome by commonalities of language, values, traditions, food and social networks. We need shared symbols. Witness how debates about the niqab are so difficult and disconcerting. In a free society, the state has no business telling people how to dress, and yet dress that creates a complete visual barrier between people not only emphasises difference, it can also seem a rejection of shared social norms. While I would never dream of asking a patient to change the way they dress, I know that I would struggle to conduct a mental state examination or engage in psychotherapy with a person in full niqab since I would have no access to the non-verbal cues that are so important in the therapeutic encounter. Governments have a much trickier job balancing individual freedom with social cohesion. I wonder how British society would react if traditional Digambar Jains, some of whom live naked, were to demand the freedom to live true to their faith in this country.

There are disadvantages in considering racism as a sufficient explanation for all ethnic differences everywhere. We found in our Enrich project that for the same poor experience of care, white families would blame “poor services” while black families would blame “racist services.” If the problem is formulated erroneously, wrong remedies are applied, which risk exacerbating rather than alleviating the problem. On 19th September 1990, Rajiv Goswami, a 20-year-old from Delhi University, set himself on fire in a public place in New Delhi in protest against the government’s plan to increase the compulsory quota for lower castes, from school placements to senior government jobs. Within a few days, 150 young people attempted suicide in protest, often in public places. I interviewed 22 of them, six of whom subsequently died. None had a serious mental illness. But each had experienced reverse caste discrimination, either directly or against a family member. They were upper caste but poor. By assuming that caste was the only source of disadvantage, the government intervention was discriminating against people for whom being upper caste had conferred no advantage. Today, in the UK, white working-class boys have the greatest attainment gap in education. No one speaks up for them, since they are not an ethnic or racial minority. Would anyone consider the hugely successful East African Gujaratis in Leicester an oppressed group? Race is not the only, or even the biggest, barrier to success in the UK.

In 25 years of living here, I have seen Britain make huge and positive strides towards equality and against racism. The kind of racism I experienced in my early years is increasingly rare, although there is a worrying recent increase in hate crimes in some parts of our society. No mainstream politician in Britain would make the kind of statements routinely heard from Eastern European leaders. Although it is difficult to be sure, I suspect very few people, certainly among the younger generation, harbour the kind of naked prejudice that was apparently common in the 1970s. This is a cause for celebration, even as one has to guard against complacency.

I now tell new arrivals to the UK that it is easy to integrate into British society. Get a dog and strangers will start talking to you while walking in the park. Go to the pub, even if you don’t drink. Spend Sunday pottering in your local garden centre. Encourage your children to participate in host culture and traditions. You will make many friends in Britain. British people are more than happy to meet you halfway, but you have to make a start too—you have to walk towards them, not walk away and isolate yourself with your own kind. For culture is not an impermeable barrier between people that, if breached, inevitably leads to conflict. Our common humanity transcends our tribal loyalties.

Two years after I arrived, I had to apply to the GMC for full registration, which required a positive reference from each consultant I had ever worked with. I got the references, including from the consultant who had wanted me to leave the UK. He could have easily wrecked my chances of staying in the UK, but didn’t. I asked him why he had given me a positive reference. He said that he had been unable to lie. I can call him a racist, or I can acknowledge that even when he could have hidden behind the anonymity of the GMC process, his basic decency and sense of fairness won out. A quarter of a century in the UK has only confirmed for me that most people I meet are decent, kind, fair and free from racism.

We must not deny, ignore or excuse our tendency to stereotype and our unwitting prejudices against people not like us. I remember many years ago leaving a rock concert in an area that was supposedly home to far-right extremist groups. I decided to take a cab rather than walk home. It was about 2am, I had my long hair down and was wearing a fiendish black leather jacket. I saw a large shaven-headed white young man getting some cash out. I hesitated. We looked at each other. I had no choice but to approach the cash point. As I got behind him, he looked at me and said pleadingly: “You are not going to mug me, are you?” I burst out laughing, in relief and astonishment, that he was scared of me. There we were, each trapped in our own prejudices, and finding the other threatening.

We know the world only through a narrow perspective—our personal past and our current understanding of the world. We cannot see the world afresh every moment. To claim to be colour blind or prejudice free is to lie to oneself. We all have prejudices. In a decent society, the best we can do is to be aware of these and try our best not to let them influence our judgment. By and large, most Britons, from all ethnic and racial groups, try their best.

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Psychiatry has always lagged behind general medicine and governments be they Labour, Liberal or Conservative have consistently failed to address the disparity. But mental health affects one in four of our populations and can cost the country in many ways. The cost of psychiatric services is just a small part, mental health problems can damage physical health, can limit a person’s capacity to work, can affect the health of relatives and can place a burden on the police, the courts and prison service. So why then as a country are we neglecting a health problem that affects so many and costs so much?

Throughout our society mental health is the elephant in the room. The effect of stigma and discrimination should not be underestimated. It can leave sufferers frightened to ask for help, scared to tell friends and family, ashamed of their illness and ashamed of their history. To be quite honest most people should know from reading that tackling stigma and discrimination has to be a priority if health outcomes are to be improved.

But the fact that discussing mental health is such a taboo leaves mental health being brushed continually under the carpet. Perhaps then it’s not surprising that the increasingly vociferous body of NHS campaigners have barely touched upon the damage that has been inflicted upon psychiatric services by David Cameron’s government.

Our politicians are elected to serve the people and govern according to the wishes of the people. So until the people start speaking up and saying that mental health needs investing in, it simply won’t happen. If tackling stigma and discrimination did nothing more that open up conversations about mental health and make it sociably acceptable to talk about then that would be huge.

Starting that conversation is crucial to improving outcomes for those affected by mental health but also crucial in encouraging campaigners to call for better services. It should not be something that a person has to hide away for fear of being rejected by their community. It should not be something that a person has to hide from potential employers. But it is.

Yes we have laws against discrimination. But they are close to meaningless for the many people who have a history of mental illness and have to fight against discrimination in everything they do. People with mental illness are often lacking in self-confidence and they are not going to be fighting back when the services they rely on are withdrawn. And they won’t fight back against government policies such as welfare cuts that make life hard. They really do need other people to stand up for them.

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Frances O’Grady, General Secretary of the TUC hundreds of prominent people  and politicians from all major parties, call for the autumn statement to ensure that mental health is treated on a par with physical health (requiring much greater investment). Ten areas of concern are set out. The conclusion is that those experiencing mental ill health “suffer discrimination in our publicly funded NHS.”

The call is timely and the breadth of support is welcome evidence of a higher level of public understanding of the crisis in mental health. The benefits to society of early and effective intervention (reflected in people being able to continue in employment or education) are rightly argued. The benefits to the individuals and their families are equally critical.

Discrimination against people with mental health issues has been around since time immemorial, but awareness has grown recently reflected in the increasing numbers of high profile figures who have spoken out about their own experiences.

Unfortunately, this awareness has coincided with a worsening of the numbers affected. This results from a combination of developments . The cuts in NHS mental health provision stand out as the sharp end of the problem. Less accepted are the causes. Mental ill health has a multitude of causes, but unions have highlighted the negative impacts of stress at work resulting from cuts, redundancies, restructuring, increased workloads, pay restraint and in-work poverty, zero-hours contracts and casualisation. Some early intervention solutions were identified at a TUC seminar in February (read the report) but the case studies presented there painted a bleak picture of the problems. While better NHS care is vital, preventative action is better. But that depends in part on changes to wider government policies.

Those not in work fare little differently but people’s experience of the benefits system can also be a source of stress. The charity Mind has just published its finding that people receiving Employment Support Allowance (ESA) are “more likely to be punished than helped into work” by a factor of three, and that 83% of those on the Work Programme said the experience had made their mental health worse.

The letter recognises disparate impacts on some communities, with a disproportionate over-representation for African-Caribbean and African communities needing adult services. The analysis could be extended. The Equality and Human Rights Commission report “Is Britain Fairer” (published last week) added in the vulnerability especially of young lesbian, gay, bisexual and trans people to mental ill health and a heightened risk of suicide: despite the real advances in acceptance of LGB and T people this statistic is raw proof that the job is far from done.

Stigma continues to be associated with mental health. It means that most people are unwilling to admit to it – especially in the workplace where they know they risk losing their job and struggling to be re-employed in a discriminating employment market. Let us campaign for equality for mental health in the NHS but recognise that wider changes are needed if the numbers needing NHS treatment are to be brought down in the first place.

First published on the TUC blog

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Britain’s Black communities experience poorer health along with access to health and social care compared to the general population. There is a link between social deprivation, poverty, housing, education and cultural behaviour and norms engaging with health professionals. There is also clear evidence that racism and discrimination that can affect a person’s health status.

The combination of health inequalities and racial inequalities has the following impact:

  • Rates of detention under the Mental Health Act are higher than average for Black Caribbean and Black African compared to the rest of the population
  • Prevalence of stroke 70 per cent higher than the average
  • We are six times more likely to develop diabetes
  • Black men and women have higher incidence of cancer such as prostate, oral, stomach, and liver. There is also clear evidence of reported poor experience of cancer care treatment and support
  • Insufficient support for young people accessing mental health and counselling services.

Black staff since World War II have played a key role in the development of the NHS from its creation in 1948.  The NHS is the largest employer in the UK with over has 1.3 million staff, thus making this also the biggest employer for Black people working across a whole range of disciplines and professions. However recent research undertaken by the RCN show that black nurses are more likely to bullied and put on disciplinary compared to their white peers.

Despite attempts efforts to increase representation of black staff at senior management and board level constant restructuring of the NHS has made matters worse. A report by Middlesex University called ‘Snowy White Peaks‘ further highlights the nature of racism in the NHS on board representation and poor patient experience from black communities.

We need a race equality strategy and a commitment by the Secretary State for Health and senior leaders in health and social care to work in partnership with service users, carers and the wider community to deliver on the following manifesto:

  •  Secretary of State for Health and Chief Medical Officer to develop a BME health and social race equality action plan with resources
  • Establish clear target and indicators on tackling racial and health inequalities for Health & Well Being Boards
  • Continue ring fence budgets from Public Health England, CCGS and Health and Well Being Boards to fund community led social marketing and health awareness programmes targeting BME communities
  • Development of cultural specific counselling and trauma conflicts services
  • Ongoing support of patient and community engagement in making health and social care service accountable
  • Development of supported housing projects for people with mental health and learning disabilities
  • Introduction of a national screening programme targeting black men and women for cancer
  • Develop quotas and target to increase senior management and non-executive board representation
  • Prevent further marketisation of the NHS but encourage development of BME led organisations as partners working in the support and delivering services
  • Introduction of a race equality strategy to tackling health inequalities with a focus on mental health, dementia, cancer, diabetes and women’s health
  • Development of a national action plan for BME elders exploring housing and social care packages including development of retirement homes in the Africa and Caribbean.

We need a new agenda and political commitment to ensure the health and wellbeing of black people is being considered seriously as voters, tax payer and contributors to the economy.

A major transformation in policy and services development is now required in the next period of Parliament to put race back on the agenda.

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Over the past several years there has been a growing political consensus and convergence by the mainstream political parties in a shared perspective in how to tackle issue mental health and the poor health outcomes experienced service user and their carers from health and care services in a number of areas:

  • Parity of esteem recognising that physical and mental should be the same (but disagreement by the parties regarding cuts in mental health services)
  • Need to improve child and adolescent mental health services
  • Waiting times targets for appointments for access to psychological services
  • Ongoing support for Time to Change the national social marketing campaign in tackling stigma and discrimination
  • Importance of public health interventions for mental wellbeing
  • Current approach in the development and funding of Improving Access to Psychological Therapy services
  • Crisis care and greater partnership between police and mental health services professionals.

However, there is one clear absence by all the political parties: the issue of race. This raises fundamental questions such as why is race equality off the political agenda? How can black mental health issues can be part of the parity of esteem?

The challenge we have in 2015 is that current mental health policy and services are failing to meet the needs not just of black community but other minority communities like the Irish, South East Asian, Chinese, Turkish and Kurdish, along with women and the LGBTI (lesbian, gay, bisexual, transgender and intersex) community.

The recent Care Quality Commission (CQC) annual monitoring report of the Mental Health Act, which has also incorporated the learning since the inception of the Act in 1985, further highlighted the over-representation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Orders (CTOs) in the psychiatric system. The CQC has also revised the code of practice that recognises issues around race equality as part of wider perspectives and principles of human rights.

But we have had 30 years of piecemeal race equality training, strategies, pledges and indicator sets that have failed to shift the agenda, much to the dismay of many service users, frontline staff, senior system leaders, activists and politicians. This further adds to the malaise and perception that ‘BAME [Black and Minority Ethnic] and black mental health’ is an intractable issue that is impossible to address again reflecting the demise of the Delivering Race Equality programme in 2010.

In the meantime, new trends in psychosis and mental ill health are emerging within BAME communities, and which current austerity measures will only serve to exacerbate, as the marginalised are pushed to the extremes in all aspects of their lives. Thus we need to create a new agenda by exploring structural racism in society and its impact on services by coming to terms with many of these historical inequalities in order to create the right conditions around reconciliation and trust between service users and the leaders of mainstream institutions that have the potential to transform policy making and service development.

Since the demise of the Delivering Race Equality strategy under the last Labour government and with the coalition at times adopting a ‘colour blind’ approach to race and health this reflects lack of political will and/or energy to do this.

This is sadly being mirrored by the marginalisation of servicer user and grassroots networks, activists and campaigners in policy and service change along with impact of cuts in funding of BAME-led voluntary sector. The only exceptions has been the development over the past five years of National Service User Survivor Network, which has created a space and opportunities for BAME service users to influence national policy, and campaigns led by the families of Sean Rigg, Christopher Alder and Black Mental Health UK, which are now part of the wider international campaign of Black Lives Matter.

However, in the past several months there has a growing recognition that the issue of race equality cannot be avoided any further. The government has given further funding to Time to Change in exploring issues around stigma for BAME communities in mental health. For instance, the 300 Voice project is targeting young black men in Birmingham. The Home Office Minister, Theresa May is leading work around examining the issue of deaths in custody and crisis intervention and also Charles Walker, Tory MP and former chair of the All Party Group for Mental Health has been a welcome ally in championing race equality and mental health along with sharing his own experiences of mental ill health.

This has created an environment for parliamentarians to be open about their experiences. Former Labour spin doctor Alistair Campbell in his forthcoming book recommends all MPs should consult a psychiatrist on a regular basis for support to manage their stress levels.

The Liberal Democrats were in many ways the driving force through first Paul Burstow and then Norman Lamb in developing government mental health policy. This was reflected in the membership of the Ministerial Advisory Group and the Equalities Group on mental health which advises the government on mental health policy. In addition, the Lib Dem think-tank Centre Forum Mental Health Commission, which was chaired by Burstow, launched its report called The Pursuit of Happiness in July 2014. The report recognised that more work is required to tackle issues on race equality as part of a national wellbeing programme around self-care and recovery.

With regards to Labour, Ed Miliband’s Independent Taskforce launched its report in January, The Mentally Healthy Society, that could form the basis of a mental health strategy for a future Labour government.

The report has more than 40 recommendations covering a range of issues from children, education, employment, housing, early intervention and equalities. The Taskforce report makes a specific recommendation for race equality: “The previous government’s action plan on BAME mental health, Delivering Race Equality, ended in 2010 and has not been renewed or replaced. We want to see a renewed focus and leadership on tackling race inequality in mental health services for both young people and adults…. the Department of Health should develop a new national strategy to tackle race inequality in mental health services, including on workforce development and leadership, and improve outcomes for BAME communities. It must be clear about what indicators will be used to measure progress, and what success will look like. This should include a national framework through which commissioners and providers at local level can be held more accountable for developing and delivering their own plans to achieve this.”

The report recommendations, if delivered, would make a difference to all communities and especially to the black community. This is a major achievement, which backed up Ed Miliband’s pledge in tackling race inequality issues in a recent interview with The Voice newspaper at an event organised by Operation Black Vote during Black History Month in 2014.

I hope that race equality will still be on the agenda along with resources, action plan and clear lines of accountability by Minsters and system leaders.

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In January Ed Miliband’s Independent Taskforce led by Sir Stephen O’Brien launched its report completed a report called The Mentally Healthy Society this will form the basis of a mental health strategy for a future Labour government.

The report has over 40 recommendations covering a wide range of issues from children, education, employment, housing, early intervention, equalities. Ed Miliband made some specific commitments drawn from the report as a key election pledges:

  • to increase the proportion of the mental health budget spent on child and adolescent mental health services
  • to ensure that in future all teachers have training in mental health
  • in government, to set out a strategy and timetable to implement a 28-day waiting-time target for access to talking therapies for both adults and children, and to ensure that all childr​en can have access to school-based counselling if they need it.

The Taskforce report makes a specific recommendation for race equality:

“The previous government’s action plan on BAME mental health, Delivering Race Equality, ended in 2010 and has not been renewed or replaced. We want to see a renewed focus and leadership on tackling race inequality in mental health services for both young people and adults…. The Department of Health should develop a new national strategy to tackle race inequality in mental health services, including on workforce development and leadership, and improve outcomes for BAME communities. It must be clear about what indicators will be used to measure progress, and what success will look like. This should include a national framework through which commissioners and providers at local level can be held more accountable for developing and delivering their own plans to achieve this.”

The report recommendations if delivered by a Labour government will make a difference to all communities and especially to the black community. This is a major achievement which was back up Ed Miliband’s pledge in tackling race inequality issues in a recent interview with The Voice Newspaper and also speaking at event organised by Operation Black Vote during Black History Month in 2014.

However to make this recommendation a reality we need a national equalities health and emotional wellbeing strategy as part of an wider government affirmation action plan. This strategy would be cross governmental but supported by an independent advisory body with a Minister reporting to Parliament. The Advisory body would be representatives from a whole range of stakeholders such as community representatives reflecting the diversity of the black community, politicians, policy makers, faith, academics, professional bodies, trade unions and clinicians. This strategy would have a distinctive action plan for BAME mental health learning the lessons from Labour’s last plan- Delivering Race Equality Strategy (2007-2010). The action plan needs to far reaching with real resources and clear links of accountability to system partners and players. This programme of work needs to holistic and creative in approach to build trusts and co-production between the community and the mainstream stakeholders.

The recent Care Quality Commission (CQC) annual monitoring report of the Mental Health Act which has also incorporated the learning since the inception of the Act in 1985 further highlighted the over representation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Order in the psychiatric system. The CQC have revised the code of practice which recognise issues around race equality as part of wider perspectives and principles of human rights.

Labour is the only party to make a commitment to race equality and mental health. Chuka Ummna and Sadiq Khan will be both launching Labour’s BAME Manifesto during the General Election campaign which highlight the importance of why BAME voters need to support Labour to victory in May 2015.

First published on Labour List

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Stigma and discrimination in mental health – What an enormous subject to talk about but also such   an important subject to talk about.

I will talk as somebody who has been through the mental health system and come out the other end.  I have known the best and worst of mental health care and it is a subject that I feel passionately about.  Unfortunately I often feel I cannot disclose my past to anyone.  Not because I am ashamed but because of stigma and discrimination.

It is also very poorly understood.  We live in a society where most people assume that if they are unhappy, stressed or angry there are practical steps they can take to alleviate their feelings.  When somebody is mentally ill this is not entirely the case.

But our society finds that hard to understand so we judge the mentally ill and make statements like:  “You need to pull yourself together” or “Find something you can do that you enjoy” or “Listen to some nice music and relax”.  A person with mental illness will hear many such statements and know that they are in some way being blamed for their suffering.  This in itself can make the person’s suffering increase.

Mental illness is often a very long drawn out situation.  Nobody gets depressed for just a week.

Many people who have chronic illness will start to feel they are defined by their illness.  I have felt it myself and have seen it in others where the mental illness becomes your identity.  You are the depressive or you are the schizophrenic.

When society puts the blame on you for your illness or failure to recover then the subconscious understand that your illness is your fault and an inadequacy on your behalf.  If that illness is your identity then it can easily be translated to a feeling of “I am inadequate as a person”.

Mental illness is hard to be around.  Family and friends will find you difficult, unpredictable, complicated and perhaps socially unacceptable.  There is a level of fear, the unknown is something people find frightening.  The normal way of interacting with a person will have unexpected reactions from a mentally ill person.  I can understand why my friends and family found me difficult to be around and were never quite sure of how to relate to me.

Discrimination often happens when a person appears different, they may have a different coloured skin, have a different gender, sexual orientation or religion.  Discrimination happens because many people have some anxiety or difficulty in understanding the differences.  Being different is the reason why a psychiatric patient is discriminated against.

We may have laws about discrimination, but a person with psychiatric problems cannot go to the police because they feel shunned by friends and family.  If they don’t get a job they can’t prove it was because of their illness and an employer is not likely to say that is why they have been rejected from the job they wanted.

One thing that puzzled me throughout my illness was the way many people failed to understand that I had needs that were relative to managing my illness but also had all the same needs as everyone else.

People need to have a level of self- respect and also feel respect from the people around them.  There is no reason why a mental health patient is any different.  Without the respect from others a person can find it hard to have their own self-respect.  Without self-respect why would a person feel they deserve a decent life?

Recovery from mental illness will usually require the intervention of others but it will also require the collaboration of the patient.  All too often psychiatric patents, including myself, will feel that they are not worthy of recovery and fail to collaborate in their treatment.

This government produced a document titled No Health Without Mental Health.  It outlined a number of aims for mental health care in this country, but reducing stigma and discrimination was not listed.

I do believe that we make the work of the psychiatric services very difficult when we refuse to address stigma and discrimination as something that hinders recovery.

I believe that if stigma and discrimination was to be addressed the problem of mental illness in our society could be reduced.  Figures show that 1 in 4 of us will now suffer from mental illness at some point in our lives.  All of them will have friends and families who will also be affected.  Our country spends money on treatment, and at times the justice system in dealing with mental illness.  At the same time the country is supporting people who are left unable to work.  Mental illness is frightening and painful for the patient and can impact on physical health.  It would pay everyone if we could do our best to help people recover.

I believe that there needs to be a task force set up to examine stigma and discrimination and find the steps we could take to reduce it.   Survivors of the mental health system, relatives and friends of sufferers and mental health professionals would all be needed to work alongside any politicians if such a group was set up.

I have spoken to many people about the subject of stigma and discrimination in mental health and found it astonishing how little people can understand without having experienced it.  This is why I feel it is imperative for people who have been through mental illness or been around mental illness to be involved in finding a solution in this country.

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Disabled people generally, and those in receipt of social security payments in particular, have been at the harsh end of this government’s policies and rhetoric. It is disgraceful that the most vulnerable are being asked to shoulder the lion’s share of the cuts.

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Labour MPs rightly hold a mirror up to this government and its record – their cuts, their bedroom tax, their war of words – but too often those are stories not in the first person, they are stories of others. Disabled people need to speak for themselves and have a place in the cockpit of the nation. The situation is about to get worse as David Blunkett stands down in 2015. And although Anne Begg is a huge asset to Parliament, which disabled people will be joining her and replacing Blunkett?

Tuesday’s National Executive Committee (NEC) equalities committee, and later the ‘org sub’, will be debating what Labour can do to better support disabled people seeking public office, especially those who want to stand for Parliament. The growing acceptance that our processes are not only expensive and timely, but exclusionary for some of the very voices that we should have on Labour’s benches, has led to a debate at the top of the party on the issue.

For those disabled people who want to go for selection, they face great challenges. Mark Cooper, disability campaigner, shed light this:

“I often am asked why aren’t there more disabled people in political office. The answer is a complicated one with factors such as the fact that not all selection meetings are in accessible venues or they think the campaign would be too exhausting for them. The underlying cause of it all, though, is that political parties are not accessible to disabled people and others. By access I do not mean physical access but I mean access to understanding what a party stands for. This is important because if a person does not relate to a party’s views then they will not join it and then possibly put themselves forward for selection to be a candidate.”

In the last year of the Labour government, Harriet Harman, as Minister for Women and Equality commissioned the Speaker’s Conference on Parliamentary Representation to look at many of these issues. In her submission she wrote:

“Disabled people are also held back from participating in civic life by time pressures. A study by the Office of Disability Issues showed that ten per cent of disabled people mentioned at least one attitudinal barrier to them getting more involved in clubs, groups and the local community. In addition, nine per cent of disabled people said that issues related to access prevented them from getting more involved, including transport or travel problems.”

Following the speaker’s conference in 2009-10, the Access to Elected Office for Disabled People Fund was created. They give bursaries to aspiring candidates of between £250 and £40,000 to help with the ‘additional disability-related costs’ of party selection processes.

While it is a huge step forward there are considerable problems with the fund. First, as it refers to on the front page of its website,  the ‘fund is a limited pot’. The public good of Parliament reflecting the very people it says it represents makes it worth extra money for this important cause, even when money is as tight as it is now. The Labour Party should commit to doing this when elected next May.

Second, the disabled person granted support has to meet the agreed costs upfront and claim back the money from the fund at a future date. This can be a considerable barrier for many disabled people seeking selection. Expecting disabled people, whether dependent on benefits or not, to have the accumulated funds and cash flow to not only cover the costs of selection, let alone the additional costs, is in too many cases just unacceptable.

There is a really easy solution to this. The Labour Party should act on behalf of the disabled applicant and step in the help their cash flow. The party can claim back these costs –  as a third party provider – from the Access to Elected Office for Disabled People Fund itself. This would cost the Labour party nothing but do a huge service to our disabled members afforded the opportunity to get additional funds but unable to make the initial outlay. Regional offices would be well places to provide these services.

In addition, the Labour Party should lobby the Speaker of the House of Commons and those who administer the Access to Elected Office for Disabled People Fund for further changes to the working of the fund.

Finally, the fund should develop a direct relationship with each of the political parties and their respective disability groups like the Labour Party Disabled Members’ Group. The fund’s advisory committee is made up from those with an ‘expertise in a range of disability and electoral issues. The members of the panel are independent and do not represent the views of any political party or organisation.’ A direct dialogue, if not a reference group made up of the political parties themselves, could improve the service and nature of the fund considerably.

There are also problems closer to home. Direct discrimination from our own members is much too common. It is a hard truth but we have to face up to it. The comments, coded or otherwise, have no place in the party of equality. Dealing with these issues is not easy – if they were it would have already been sorted. With real urgency, the Labour Party should work with the Labour Women’s Network, BAME Labour, LGBT Labour and the Labour Party Disabled Members’ Group to develop complaints procedures that deals swiftly and appropriately with allegations of sexism, racism, homophobia or discrimination against people with disabilities.

For too long action has been promised but results have been lacking. This week is the chance for this NEC to start to correct that. The next NEC has an obligation to follow this through and take it further.

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This article was first published by Open Democracy

The new Immigration Bill introduces hefty charges for migrants to use the NHS. It is a costly, wrong-headed insult to the migrants on whom the NHS has always relied.

My father was an immigrant. He came to London at the age of 10 from Bombay in 1927. Having trained as a doctor at Barts in the years running up to the Second World War, when war broke out, he joined the Royal Army Medical Corps. In the immediate post war years, he campaigned for Nye Bevan, helping win the argument amongst GPs that we should set up an NHS, and that it should be free for all. He spent the rest of his working life as a GP in Plumstead giving back what he had been given by this country.But if he had arrived today, if the current Immigration Bill goes through, he would have no entitlement to use the NHS he was going to spent his whole life serving.
Dr Roointon Boomla

Dr Roointon Boomla

Home Office ministers Theresa May and Mark Harper are responding to UKIP’s dog whistle. They talk tendentiously of the UK having “a national health service, not an international health service”. They propose charges of between £200 and £400 a year for all migrant workers, right up until they achieve permanent residence status in the UK. This takes at least five years. Ministers create the spectre of health and benefit tourists, illegal immigrants and spongers, to justify an attack on migrants. Mark Harper writes he will “clamp down on those from overseas who try to abuse our public services”.What is the cost of this abuse of the NHS, this problem that the new Immigration Bill is meant to solve? Last year the NHS says it spent £33 million treating foreign nationals. This is 0.03%, three hundredths of one percent, of the total NHS budget of £110 billion. To put it another way, just two hours of the annual NHS spending per year. This £33m compares with the £16.3 billion migrants and visitors contribute to the UK economy.Migrants form a large proportion of those working in health and social care. Many work at little above the minimum wage. These are the people Theresa May wishes to charge because she feels they do not already contribute to our country. And at the top end of the wage spectrum, one in three hospital consultants was trained overseas. We have a government that is parasitic on medical school training in countries much poorer than ours, but rather than say we are indebted to India, Pakistan, Nigeria and Egypt, it proposing a double robbery by introducing these charges.The harm is not simply financial. Charges will deter people from seeking treatment. If only those with their papers in order and who have paid their annual fees can register with the NHS, there will be a pool of the impoverished who dare not seek medical treatment when they are ill. This will undo years of work getting marginalised people to come forward for HIV testing. As a GP myself I know that stopping people coming to see me for routine care of their asthma will only result in those same people presenting in crisis and at greater expense in A&E. As Diane Abbott correctly points out, stigmatising foreigners accessing the NHS creates a public health risk. What price xenophobia?

But also we need to think how this will be enforced. To ensure visitors to the UK have paid their health tax, GPs will be forced to check ID and immigration status on all those who register on their lists.

Nye Bevan, the architect of the NHS, considered these issues. He named those who called for charges for foreign visitors “ill informed” or “deliberately mischievous”.

“How do we distinguish a visitor from a British citizen?” he wrote. “Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats, both must be classified. What began as an attempt to keep the Health Service for ourselves would become a nuisance to everybody.”

It is GPs who are likely to carry the burden of this policing. And I am certainly not prepared for my surgery staff to become the enforcement agency of the Home Office. For this to work, it is clear there would need to be a link up between NHS computer systems and those of the Home Office. This is sure to undermine confidence in the confidentiality of computerised patient records.

My father is now 96. He worked for the Royal Army Medical Corp and then the NHS from his early 20s till the age of 70. What right does immigration minister Mark Harper have to say those following in his footsteps do not contribute enough and are out to “abuse our public services”?

As Nye Bevan concluded on the same issue:

“The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine.”

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Recent research shows that 10% of the world’s population are unable to afford the prescription lenses that they need for a healthy vision. The World Health Organisation and The Centre for Vision in the Developing World both report shocking figures, which not only affects personal health for those who are visually impaired, but poses public safety risks as well as educational issues for the future.

Short-sightedness is not only a problem for public safety when it comes to operating vehicles and machinery, but it is also an encumbrance on the world’s educational bodies, with visual impairment affecting one in 20 preschool children and affecting one in four school children. The common problem is that the child, the child’s parents and school teachers are unaware of the problem.

Whilst most families in the UK can afford to provide the right eye care for children, delaying or avoiding treatment is all too common due during a tough financial climate.

Additionally, research from a globally renowned corporate eye care company and Drive Safe tells us that one in three commuting drivers in Britain are visually impaired and drive without the aid of prescription glasses or contact lenses, meaning that one in three would fail an eye test, breaking the law.

Prescription Glasses at Lower Prices

Whilst the growing number of visually impaired people without the means of funding glasses causes continued concern for The World Health Organisation, there are retailers working to provide a much better product offer which can be obtainable for the less affluent.

Online retailers have become the convenient and more cost effective answer for visual impairments in the UK, with many offering a simple web service that allows easy ordering and fast delivery of prescription glasses.

E-commerce platforms are able to provide retailers with lower overheads than a high street store, meaning that high prices can be a thing of the past.

Despite the growing e-commerce world, the problem continues to persist on a vast scale. Prescription glasses are often unaffordable, forcing hundreds of millions of people to carry on with poor vision. Although online price wars and low overheads are creating a more affordable market for anyone who is short  sighted, long sighted or visually impaired, in a tough economic climate where the recession is still very much affecting the poorest areas of the UK and other countries, eye health is not a number one priority.

Eye Health Improves Quality of Life

As we know, visual impairments not only affect health but they can be dangerous when considering the daily need for driving – and the educational and economic issues are damaging for future development.

Moreover, having access to the correct eye health and being able to get help from an optician, can dramatically improve standards of living and quality of life. Prescription lenses can help with everyday tasks such as reading, writing and using a computer as well as giving people confidence in the workplace – or children confidence in a school environment.

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