Back in September, the Family Planning Association was publicly worrying about the fact we were in a recession. With something rivalling the foresight of Derren Brown, they came to the conclusion that a recession would mean NHS budget cuts, and they were frightened for the future of their service. They thought that a lack of willingness to talk about sexual health issues would lead to their services being the first to be cut. Or, as they more memorably put it, their services will be the first to be cut because

no-one will complain to the local paper about a longer wait to get their genital warts seen to.

Frankly, I don’t think they need to worry so much. Whilst, perversely, sexual health services aren’t sexy, there are much less celebrated parts of the NHS. Like those that deal with children with serious mental health problems.

Back in 2006, I wrote a polemic on here about the underfunding of Child and Adolescent Mental Health Services (CAMHS), and I guess it’s become something of a recurring theme on here. Back in 2006, services were underfunded to such an extent that 25% of the country didn’t have CAMHS crisis teams.  If, like Newt in Hollyoaks, a schizophrenic teenager wants to kill themselves, there was no-one to call to get immediate specialist help. For adults, there are dedicated teams.

We’re now in 2010, at the dawn of a brave new decade, and over the intervening years not much has really changed. Just last year, The Guardian reported how many young people were waiting almost three and a half months for specialist assessment of their mental health problems – with 75% of them having no support whatsoever in the meantime.

Compare that level of service to the sexual health drop-in clinics or the guaranteed two-week cancer wait, and you begin to see the level of neglect of CAMHS in the UK.

Child and adolescent mental health problems are the very definition of unsexy. All of us regularly see tin-rattlers and chuggers asking us to support a whole range of childhood cancer charities, or raising money for hospitals like Great Ormond Street or the soon-to-be-opened Great North Children’s Hospital – All worthy causes in their own right.

But collecting-tins for children with mental health problems are very seldom seen, not because the diseases are less common, but just because of the level of public misunderstanding of the field, and a general perception that mental health problems are unpalatable.

1 in 3 of us will have cancer at some point in our lives. Similarly, 1 in 3 of us will have a mental health problem at some point in our lives. And, thanks to the chronicity of mental health problems, 1 in every 6 people are suffering with a mental health problem right now. And 1 in 10 children have a diagnosed mental health problem.

Which of those statistics have you seen on a TV ad or bus-stop poster recently? I’m guessing only the first.

Thanks to tabloid newspaper obsession and the underactive imaginations of TV and film scriptwriters, popular conception links mental illness and criminality. Criminals and the mentally ill are one and the same to many people. Of course links exist – I’d be a fool to deny that mental health problems are rife in our prisons for example (there’s a post for another day) – but when such vast numbers of people are affected, it is hardly the case than one equals the other.

Problems of perception likely affect CAMHS even more than adult services, as I’m sure many Daily Mail readers fail to believe that mental health problems can affect children: They’re probably seen as a Guardianista cover-up for naughty kids who should be caned rather than mollycoddled. Against that background, I’d wager that many people would rather write to their local newspaper about their genital warts than about their personality disordered child.

Luckily, there are some people out there who care enough to try to change the status quo. There’s a great charity called Young Minds who recently launched a manifesto on child and adolescent mental health issues, in an attempt to influence the political classes in a General Election year with a view to tackling these issues for the long-term. To his credit, Nick Clegg of the Lib Dems seems to be broadly in support of what they’re trying to do.

But the fact remains that CAMHS are chronically underfunded, and definitely underappreciated. As things stand, CAMHS win no political votes, and so when looking for things to cut, they will likely be first in the firing line.

In this context, I hardly think the Family Planning Association needs to worry. As long as preventing teenage pregnancy remains a vote-winner, their services will be well-funded.

Perhaps one day, CAMHS will be able to enjoy that level of confidence and certainty too. For the sake of our children, I hope so.

This post is based on my contribution to Episode Two of The Pod Delusion, originally broadcast on 25th September 2009. Other topics that week included the BNP on Question Time, an undercover homeopathy sting, and the future of intellectual property rights. How could you not want to listen to the whole thing at poddelusion.co.uk?

I’ve been nostalgically browsing the site’s archives today, and flicking through the digital version of Instant Opinion.

If you remember the last general election, in which Tony Blair secured an historic third term of government for the Labour Party, you may remember that I blogged about the campaign fairly intensely. And, looking back to my post about the Budget of that year, I came across this embarrassing paragraph:

The main message that I took away from today’s events was how much better Mr Brown would be as Labour’s leader: Tony Blair’s fake emotion and anger versus Mr Brown’s real commandeering and forceful delivery, appearing to actually believe what he says? I know who I’d choose.

Jeepers, how wrong can you be?

So apologies for that. I’ll try not to write anything so crap this time around. But it may be difficult to judge the crappiness until four years hence.

Still: I guess it’s a bit reassuring to know that it’s not only ‘new media’ writers like me that mess these things up – the dead-tree press are at it too. My favourite U-turn of this year has to be Michael White’s:

A hung parliament is not going to happen – And a good thing too
– Michael White, The Guardian, 23rd November 2009

Make ready the smokeless rooms: a hung parliament is on the cards
– Michael White, The Guardian, 24th November 2009

Fabulous.

You know those bags of Rowntree’s Randoms, constantly advertised on TV? Seemingly reasonable people suddenly start spouting inappropriate words for their situation because they’ve indulged in a jelly sweet which has an unusual shape?

I’m beginning to wonder whether Gordon Brown has accidentally ingested a whole packet of the Prime Ministerial equivalent. How else can you explain the way he claims to be “pleased” and “proud” to apologise for the appalling treatment of Alan Turing, surely one of the greatest British heroes of the twentieth century? The words are simply inappropriate, as can be clearly seen by applying them to similar situations:

Mr Smith, I’m pleased to have the opportunity to apologise for your wife’s unfortunate death!

Mrs Jones, I’m proud to say that I can apologise for running over your cat!

Mr Thomas, I’m pleased and proud to apologise for your son’s death in Afghanistan!

Except, Gordon Brown wasn’t pleased and proud in the latter case. He was reportedly “devastated” about recent deaths in the country. Not angry, not apologetic, not regretful, not mourningful, not sorry, just “devastated”. Of course, not “devastated” enough to go to a military funeral, or even visit any injured soldier in hospital. Just “devastated” enough to repeatedly use the word and move on.

There are some who suspect there’s something altogether more worrying underlying Gordon Brown’s unusual responses. They claim, based on reports that he must avoid eating cheese and drinking chianti, that he is taking MAOIs, and old-fashioned kind of antidepressant.

The assertion that Gordon Brown uses MAOIs was recently made plain by Matthew Norman in the Independent, after months of hinting from Simon Heffer in the Telegraph and Matthew Parris in the Times.

The substantial problem with this theory is that virtually no-one takes MAOIs, as they’re extremely outdated and have some pretty nasty side-effects. On top of this, there are manifest reasons for avoiding cheese and chianti: A tendency for migraines, a plethora of food allergies, or a sensitivity to appearing too middle-class.

Yet whether or not he’s taking MAOIs, there are substantial rumours suggesting that Gordon Brown might be depressed. Whether or not this may impair his ability to fulfil the role of Prime Minister is debateable.

Iain Dale, for example, believes that it shouldn’t matter if Mr Brown is depressed – he deserves our compassion more than our criticism. He cites the example of Churchill, who was undoubtedly depressed but still a great Prime Minister.

I see entirely where Iain is coming from, and, for what it’s worth, I largely agree. I see no reason why depression should preclude decent Premiership.

But we live in a media-driven world that Churchill never experienced. Churchill was an alcoholic, and this may never have affected his leadership. That didn’t stop the Lib Dems overthrowing Charles Kennedy – their most charismatic leader to date – because he was a recovering alcoholic. The image wasn’t right. And if the image of a recovering alcoholic isn’t right for leader of a liberal party, how can a person with mental health problems ever be the right image for a Prime Minister?

To me, it actually doesn’t matter whether Gordon Brown is depressed or whether he fits the model image of a Prime Minister. What matters is that he’s terrible at his job. Performance must surely be judged above all else, especially for one of the country’s top jobs. And Mr Brown fails that test, and fails it miserably: From the economy, to student debt, to any one of manifest crises between which Mr Brown has lurched, it’s clear that he simply doesn’t have “The Right Stuff”.

But in today’s politics, who does? David Cameron? I suspect we might be on the verge of finding out.

Last Friday, The Pod Delusion launched. The pilot episode included a contribution from me on this subject, on which this post is based. Now go and listen to the rest!

Andy Burnham has written a piece for today’s Guardian announcing that

For Labour, it all comes down to defending the N in NHS … By contrast, the Tories are ambivalent about the role of the centre, preferring localism in health as in other areas.

It’s probably churlish of me to point out that Mr Burnham has previously espoused about the paramount important of locally, rather than natioanlly, influenced healthcare (“The hospital and Primary Care Trust must listen to patients and local people and involve them in shaping the future of the hospital” – hardly a nationalistic approach).

To point him in the direction of the Conservatives’ 45-page Green Paper on the NHS in response to his claim that “on health, Cameron doesn’t do detail” would probably be missing the point.

And let’s just ignore Mr Burnham’s complete lack of insight into the effect of his target-driven culture – Patients being moved like pawns around a hospital-sized game-board to avoid staying in one place for too long – regardless of their clinical need.

Let’s just park all of those thoughts in the vastly overpriced hospital multi-storey, and concentrate on his main point. The ‘N’.

I’m an ardant supporter of the broad principles of the NHS. I think healthcare free at the point of need is a wonderful thing. But I don’t subscribe to Andy Burnham’s ideology of a national health service with national targets to tackle national problems.

The residents of Byker have different healthcare needs to the residents of Mayfair, and the needs of the residents of Tunbridge Wells or Toxteth differ equally again. Whilst it’s true that residents in none of the above places would relish waiting more than four hours in A&E, such meaningless targets do little to disprove the inverse care law which appears to be Burnham’s prime argument for focusing on the ‘N’.

In fact, quite obviously, the most imporant bit is the ‘HS’. The country needs a Health Service that is adaptable to the needs of all. Different locales will, necessarily, have different priorities. Giving Respiratory Medicine the same priority in the North East (where lung disease is relatively common) and in Southern England (where it is rarer) would appear to me to be a failing of a nationalised system, not a benefit.

Targetting outcomes seems eminently more sensible – The respiratory services in the North-East and the South don’t need to be equitable, provided the outcome – measured in cure rate, death rate, or howsoever seems most sensible to the respiratory physicians who are far more intelligent than me – is equitable.

That’s the kind of Health Service I would like. One with an ability to respond to the local health needs of local people – not by “national standards, national pay and national accountability” – all three of which have everything to do with bureauocracy, and nothing to do with healthcare.

I’ve been intending to post for ages on the subject of patronising, irritating, and most certainly excessive Government advertising. I have found recently that it’s impossible to watch a single commercial TV programme without seeing at least one Government funded advert, whether it be for direct.gov, the road safety Think! campaign, the NHS Stop Smoking campaign, car tax renewals, Fire Kills, the Know Your Limits alcohol campaign, the ubiquitous Change4Life, the Act FAST stroke campaign, Act on CO2, the Food Imports campaign, the irritatingly clever Get On ads, or any one of the miriad campaigns the Government is funding at any one time. Listening to the radio is worse. And even Spotify has been invaded.

Government posters are everywhere – the recent slightly threatening Policing Pledge ones are spreading like a rash, but my personal favourite is the Food Standards Agency one shown here. Apparently, choosing something with fewer saturated fats helps me reduce my saturated fat intake. Well, duh.

These adverts are even invading cash machines. I’d never really noticed cash manchine adverts before – are they new? – until one had an NHS advert on it, with someone sneezing in my face.

But all of this came to a head yesterday. Whilst wandering round Eldon Square, I found no fewer than three government supported advertising stands. One was for Change4Life, there was one advertising the local NHS Walk-in Centre, and one talking about reducing CO2. All in the same shopping centre, at the same time.

This is nannyism taken to another level.

What on Earth is the cost of all of this manifest advertising? It surely must be huge.  Now no-one in their right mind would argue with some of the campaigns – fire safety is important, the Act FAST campaign is a major attempt to get people to re-think stroke, and road safety is in everyone’s interest. But there’s a difference between informing the public and forcibly ramming things down their throat.

The Conservatives have posited Government advertising as one of the big areas in which they can reduce waste. Frankly, the sooner they get the chance, the better.

Oh my!

It’s been some considerable time since I was last moved to sound this particular organ, but it appears that Labour MP Tom Harris wants to pay for me to have a car and driver to take me to and from work.

Writing in defence of ministerial cars (after Ed Vaizey suggested they be scrapped) he says:

…if you’ve just had a 12- or a 14- hour day and you’re leaving the Commons after the last vote, it’s wonderful to be able to slide into the seat of a car and relax while you’re taken home, knowing you’ll be lucky to get six hours sleep before your ministerial diary kicks in the next morning.

Well, Mr Harris, I’ll be spending at least thirteen hours at the hospital tomorrow. I’ll then sidle outside, probably feeling physically and emotionally drained, pay £7.70 for the privelege of parking at my workplace, and drive myself home. And it isn’t as if I’m the only one!

But, apparently,

…a car and driver makes life easier and … doesn’t cost that much in the grand scheme of things…

It costs £6,000,000 to run 86 ministerial cars, so I make that just shy of £69,000 per car. On my salary, Mr Harris, that is quite a lot of money. But since its peanuts to you, I’d be more than happy to let you pay!

See you tomorrow!

Several MPs, ministers, and political commentators appear to want Gordon Brown to resign as leader of the Labour Party. God knows why: These lefties seem to think that sacking Brown would be good for Labour when, in reality, it would be anything but.

Labour cannot win the next election. Barring the hugely unexpected, Labour is now by far the most damaged political party, and the Conservatives are well into an inexorable resurgence. The political wind in the country, stirred up by Big Bad Blair, is now circling Downing Street and will huff, puff, and blow down Labour’s house with surety.

Labour’s popularity is in its boots as it is, and whilst Mr Brown is hardly boosting it, it is most certainly the party which is damaged now, not the leadership, and it cannot win the next election until it has undergone a Cameronesque detoxification. And,as Carol Voderman will tell you, you can’t detoxify when under the pressure of Government.

As if that weren’t enough, governments undoubtedly live and die through economic cycles. Few governments could hope to survive the present economic downturn, and both Labour and Brown – who have previously sung so enthusiastically about how they control the economy – have dug their own graves. Taking credit for the upward economic stroke has now left their popularity careering head-first down the slippery slope of economic downturn.

Of course, Brown’s fervent support for the merger of HBOS and Lloyds TSB this week is a further mistake: He’s backing a process which he doesn’t entirely control, and any regulatory hurdles the process stumbles at will be painted as Brown losing his influence. There’s a reason why back-room deals and discussions should stay in the back room.

But still, he shouldn’t resign. Labour failing under Brown is infinitely better for the Party than Labour failing under two leaders. Labour can’t win the next general election, but with a new leader, a lick of paint, and some enthusiastic party unity, they can purge themselves back into power reasonably quickly – and that’s where minds should be focussed.

To elect another leader now and yet still lose the next election will damage the Party far more: Failure under one leader can be painted as the failure of a bad apple, fail under two consecutive leaders and the country thinks whole orchard is rotten. Allegiance is switched to pears.

Of course, such is the nature of politics, few Labour MPs genuinely care about the long-term future of the party. The career politicians in marginal seats would desperately like to keep their jobs at the next election, and see Brown as damaging the Party. They want to chuck him out to give themselves a flicker of hope of avoiding their P45 for another Parliamentary term. Frankly, they’d stand a better chance if they crossed the floor.

This Labour government is undoubtedly moribund. There are no heroes in the wings waiting to swoop in a resuscitate their chances. The only sensible thing to hope for now is a dignified death, in the hope that the rebirth can be swift.

Brown simply must not go.

Patientline Bedside System

I note with interest that Patientline, provider of controversial bedside phone-cum-television-cum-internet consoles in NHS hospitals, went into administration on Friday.

My posts on Patientline – dating back as far as 2005 – received numerous comments complaining about the overpriced nature of the system, as well as the poor customer service users received, yet I’ve always been one of the first to defend the system against criticisim of high prices: That particular problem has come as a result of poor contractual negotiations on the part of NHS Trusts countrywide.

The contracts negotiated vary from the flexible terms in which the systems are cutsomised and integrated into the hospitals IT system, to crazily imposing terms whereby the units’ screens can’t even be switched off during daylight hours. The NHS Trusts who allowed the units to be installed must have been aware that this private company was primarily interested in profits, yet allowed the installation to go ahead regardless: In some cases, through apparently give-away contracts.

The company spent hundreds of millions of pounds providing expensive equipment to patient bedsides across the country – replacing simple TVs which used to exist on wards. They then attempted to charge up to £3.50 per day for individuals to watch their souped up TVs, and charged up to 49p per minute for people to phone the units.

This represented unacceptably poor value to hospital patients – after all, who wants to pay £24.50 per week for Freeview? – and has ultimately resulted in poor value for the NHS: Essentially, patients are getting much the same service provided by the TV in the corner of the room and the portable payphone for many times the cost.

It’s easy to see the apparent advantage to NHS Trusts – able to boast about an apparent improvement in service whilst neglecting to mention the increased cost to patients – yet it’s hard to see how, at those prices, investors didn’t see Patientline’s business plan as critically flawed before it even got off the ground.

Private companies are, by definition, interested primarily in profits – not in the best interests of patients. This is the fundamental problem with PFI projects in the NHS, and that the government fails to see that time and again shows either great naivety or great incompetence. I suspect I know which.

The ghost of Patientline is rising, pheonix-like, in the form of Hospedia, who are attempting to become the monopoly provider of such services – and oversee the spread of these terminals yet further. By investing a further £12m in improved services and cutting prices, Hospedia hopes to make a go of this business. I’m not convinced it’s possible… I guess only time will tell.

» Image Credit: Patientline publicity image

Mr Brown insists that he’s been planning today’s postponement of October’s fuel duty increase for some time. Perhaps he’s a fan of this very blog, and has been planning it since May:

Every indication appears to suggest that Brown is going to give in to the current demonstrations on fuel pricing and – at the very least – further delay October’s increase in fuel duty. This will be unfortunate but necessary damage limitation, and will spin well for, ahem, ‘hard-working families’.

Indeed, as predicted, he even spun that it was a measure ‘to help families’. If only he’d listened to my earlier advice and announced it at the time of the local elections:

In his single exclusive interview, Mr Brown should have been armed with an arresting announcement – something along the lines of freezing fuel duty increases to help the poor … Pretty much anything would have moved the news cycle forward, and taken the focus away from Mr Brown and the disastrous election.

Instead, he’s decided to keep the announcement back to today, thereby achieving nothing but a pasting by those who say its another sign of the economy going down the plughole, and a good ol’ bashing by those who say it’s electioneering.

Good one, team Brown – Yet another remarkable own goal.

Cast your mind back, if you will, to 1999.

Almost a decade ago, the shiny new(ish) Labour Government decided it was important to celebrate the Millennium, and that an appropriate way to do this would be to build a nice big white tent in Greenwich.

And oh, it was a lovely white tent. So strong, it’s still there to this day. So monumental, it has its own tube station. So loved by the nation, it’s in the Eastenders title sequence.

Yet they had a problem: What to put inside the tent. Ideas were flowing, for everything from a Festival of Britain for the modern age, to a theme park. So many choices, so many options, so many decisions.

So, in the end, they went with an elephant: A big white elephant, to be precise.

Tony Blair thought the elephant and it’s dome would be “a beacon to the world”. I was more cynical: I’d not been a fan of elephants for some years, since an unfortunate collision between an elephant’s trunk and a particularly sensitive part of my anatomy.

For once, it seemed the public agreed with me, leaving the elephant unvisited and the government red-faced.

This left Tony’s team scrambling to regain any sense that they were “in touch” with the people. So, in a masterpiece of spin, they simply denied that the dome contained a white elephant. They told us it contained all sorts of fun treats, that the public would really, really like to see.

When that didn’t seem to be working, they brought in a frog to feature alongside the elephant, a strategy that brought in about six-and-a-half million visitors, yet still continued to deny the primarily elephantine contents of the dome.

“It’s great!”, they told us. “Come visit the dome and see the special treats within! It’s fun for all the family! It’s not a white elephant, it’s a rip-roaring smorgasbord of good natured wholesome British fun!”

Even once the dome closed, they still protested that the contents had been “really good”, and certainly in no-way elephant related.

That is, it seems, until last week.

In an extraordinary interview with LBC, Tessa Jowell not only admitted the existence of the white elephant, but – unbelievably – insisted that white elephants were to be banned from the Olympics, since the white elephant in the dome had been such an embarrassment for all.

Is it really fair to blame this failure of Government competence on the white elephant itself? What happened to ministerial responsibility? I’m quite sure the elephant did its best to entertain people, but was placed in a rather impossible position by this Labour Government.

And, more pertinently, why are all white elephants being tarred with the same brush and being banned from the Olympics?

I very much doubt this would happen with Indian or African elephants – no, that would be racist – but it’s perfectly fine to discriminate against the hard-working, white, middle-class elephant families of these British Isles, whilst allowing any foreign elephants to just wander into the Olympics as they see fit.

It’s absolutely sickening that the respectable white elephants of this country should be treated this way by an incompetent government. When the government starts prioritising the Olympic dreams of other country’s elephants above our own, surely the whole country is going to hell in a handcart.

It’s disgusting.

» Image Credit: Original image by Aaron Logan, modified and published under licence