Prisoners with serious mental health problems face urgent treatment delays

Almost 75% of prisoners are facing delays in being transferred to NHS hospitals to receive urgent treatment for serious mental health problems.

Prisoners in England who need to spend time as an inpatient in a mental health unit are meant to be taken there within 14 days of doctors admitting them. But new official figures show that barely one in four of the prisoners who received such care last year were transferred within the supposed maximum two weeks.

Labour MP Luciana Berger, who obtained the figures through a parliamentary question, warned that the already fragile mental health of prisoners needing hospital care could be badly affected by them being denied speedy care.

“In the outside world we would never expect someone to wait as long as two weeks to get appropriate care, and we know that prisoners are at much higher risk,” she said. “With every day that goes by their condition is likely to worsen, so the delay will have a hugely detrimental impact on their mental health.”

Figures released by the Department of Health show that 412 prisoners were transferred to hospital from jails in England within 14 days during 2015-16, or 26.5% of the total. However, far more – 1,141 (73.5%) – had to endure delays of longer than that, health minister Nicola Blackwood confirmed.

“This ubiquitous failure would never be tolerated in the outside world,”, Berger will tell MPs on Wednesday, in a Commons debate she has secured on suicide and self-harm in English jails.

Berger, the president of the Labour Campaign for Mental Health, said she did not know if there was a causal link between the delays and the record number of suicides – 119 – that occurred in English prisons during 2016. “It is likely to be a contributing factor, but it is just another issue, among many, which paints a very bleak picture of the inadequate support provided to people experiencing mental illness in our prisons,” she said.

2016 also saw a record number of incidents of self-harm in jail – 37,784 in all, up from 7,000 on the previous year.

In community settings, detentions under the Mental Health Act often take just a few hours. But the process takes longer with prisoners. Those who are due to be transferred wait temporarily in their jail’s hospital wing but, Berger added, those units are not equipped to give prisoners with serious mental health problems the proper care they need.

Berger will use the debate to accuse ministers of presiding over a “shocking and shameful rise in suicide and self-harm” in jails. “Most prison psychiatrists don’t feel able to deliver a basic level of care,” she will say. “Mental health services in prisons are at breaking point.”

The Ministry of Justice declined to comment directly on the figures. A government spokeswoman said: “We are committed to making prisons places of safety and reform and giving prisoners the support and treatment they need to help turn their lives around.

“All prisons have established procedures in place to identify, manage and help prisoners with mental health issues. Increased support is now available to those at risk of self-harm or suicide, especially in the first 24 hours, and we have invested in mental health awareness training for staff.”

Prisoners with serious mental health problems face urgent treatment delays

Why are there so few male nurses?

Efforts to promote gender equality in workplaces of all kinds may be widespread, but the number of men in nursing remains stubbornly low. Last year just 11.4% of registered nurses in the UK were male, according to figures from the Nursing & Midwifery Council – only a marginal increase from five years earlier, when they made up 11% of the workforce.

And the proportion of nursing students in the UK who are men hasn’t shifted either, according to the Higher Education Statistics Agency: in 2016 it stood at 11.6%, compared with 11.5% a decade earlier.

“It’s disappointing,” says Janet Davies, chief executive of the Royal College of Nursing, “because we’ve promoted nursing for men. I think it’s good to match the balance in the communities we’re working for. And also we don’t want to lose those people who would make fantastic nurses.”

She believes continued stereotyping about what a nurse looks like is partly to blame – despite the presence of male nurse characters in TV dramas. “When people think of a nurse perhaps they do think of a woman. Some of the details don’t help – the term matron is weird – but it’s about the job, and in my experience men take it in their stride and work with it.”

Davies questions whether it is the work itself that doesn’t attract men, or whether other factors are to blame: “Is it something about people being conditioned at school? Is it suggested by careers officers? It isn’t the best paid job in the world and I think people do look at salary and feel perhaps they want more than that.” And yet once men are working as nurses, Davies says, the role is accepted by the vast majority of people. “I don’t think anybody bats an eyelid anymore,” she says.

At Queen’s University Belfast, a campaign to increase the number of male nursing students that includes targeting all-boys schools – which are more common in Northern Ireland – has prompted a rise from 6% three years ago to 10% today.

Prof Donna Fitzsimons, head of the university’s school of nursing and midwifery, says: “Nursing is all about the empathy and caring that people show, but those traits are not exclusively female and it’s very important for patients that we have diversity on all levels.”

Paediatrics is one field where that’s especially apparent, Fitzsimons says. “Boys, in particular, can find it hard to relate to women at times. Sometimes a male nurse can really bring out a side of a child that helps to lift their mood and allows them to feel more comfortable in a hospital setting.”

The department now tests nurse applicants in five-minute simulated clinical scenarios, as well as interviewing them. “Men seem to have benefited from that exercise,” says Fitzsimons. “Men might find it harder to put into words their caring and compassionate qualities, but can demonstrate them more easily.”

Davies believes that strong role models and encouraging school-age children to think about nursing as a career are key. “It really is a superb job,” she says, “and men are fabulous nurses.”

‘It’s now more recognised that men can do the job in the same way fathers can parent’

I made my mind up that I wanted to be a nurse when I was 14 or 15. My mum’s a care assistant so, subconsciously, that influenced me quite a bit. I did work experience in a school for children with learning disabilities, where a lot of the pupils had epilepsy, and that inspired me too. I knew I wanted to be in a caring profession.

I received a little bit of teasing from my friends, but no one ever questioned why I was doing it. And once I started my training they became more and more interested. That’s always been the case.

I’ve been a nurse most of my working life, so being outnumbered by female colleagues is what I’m used to; I don’t really notice it. Earlier in my career I had a few comments where patients seemed to have expected that the nurse caring for them was going to be a woman, but men were already becoming more commonplace in the profession when I qualified.

Now I’m in a more senior role, patients occasionally assume I’m a doctor if I’m addressing a complaint or helping them with an issue. I correct them, but I don’t challenge them as to why they think that – it wouldn’t be very useful for the caring relationship. And it doesn’t bother me. Occasionally a female patient has preferred to have a female nurse look after her care needs and that’s understandable, especially with elderly patients.

When I was a ward manager, or sister, I did get some people saying: “Shouldn’t you be a brother?” But, actually, no one has ever commented on the fact that I’m a matron and a man. I’ve worked on shifts where it’s been predominantly male nurses, and a lot of the wards I’ve worked on have had a good balance of men and women. It’s now more recognised that men can do the job, in the same way that fathers are getting more involved looking after children.

Once you see a nurse in action giving you excellent care – that’s when the gender disappears.

Dan Wicks, 38, cardiology matron at Guy’s and St Thomas’ NHS foundation trust

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Why are there so few male nurses?

Labour’s failure on the NHS is prolonging this health crisis | Polly Toynbee

Remember Mavis Skeet? In 2000 the 74-year-old led the news for weeks when her operation for cancer of the oesophagus was cancelled four times, until it became inoperable and she died. Liam Fox, then shadow health secretary, exclaimed: “This is not an isolated case. The NHS is not coping!”

When does a rumbling NHS crisis erupt into a volcanic political eruption? Labour’s miserable failure to “weaponise” the NHS into a winner in Copeland makes it worth looking back.

Mrs Skeet was the tipping point for Labour. The worst flu epidemic in a decade blew away Tony Blair’s pre-election “waiting lists cut” pledge. Instead Labour stuck to a draconian Tory budget, but this one case sent Blair into the TV studios promising to match average EU spending – and Labour did. The best NHS decade followed: 7% annual budget increases saw waiting times plummet, as heart and cancer results improved.

Margaret Thatcher’s eruption came in 1987 with the NHS squeezed dry. Babies died waiting for operations at the Birmingham Children’s Heart hospital. Through gritted teeth, the NHS “safe in our hands”, she bunged it £100m and punished it with the internal market.

In this latest seismological era, political vulcanologists can’t predict exactly when the top will blow. With its lowest ever funding rises, its hardest years are still to come, despite soaring numbers of the old, hospital admissions up by 31%, and 22% more A&E patients since 2010. Staff shortages follow cuts in nurse training and worsening GP and specialist recruitment. Even if extra is found for social care, the National Audit Office suggests it won’t stem the flow of patients into hospitals.

Are things bad enough yet? The British Medical Association reports that 15,000 hospital beds have been cut in the past six years. The Royal College of Surgeons protests at cancer operations being cancelled. Ambulances frequently stack up outside hospitals. Look at all that molten lava bubbling away.

Mavis Skeet’s death in 2000 became a tipping point for the NHS under Labour. Her operation for cancer of the oesophagus was cancelled four times. Photograph: PA

Ahead of next week’s budget, Theresa May pretends the NHS has an extra £10bn – at loggerheads with Simon Stevens, the head of NHS England, who publicly disputes it. What forces a U-turn? Before it was deaths, but already two patients have died on Worcester Royal hospital trolleys, one after a 35-hour wait. Coroners have protested to the health secretary, Jeremy Hunt, after two recent deaths due to lack of intensive care beds: the case of Teresa Dennett, who died from a stroke, and Mary Muldowney, who died after a brain haemorrhage.

The war zone of A&E has featured nightly on BBC news, with a graphic documentary series on the controlled mayhem in barely coping hospitals. When is enough enough? Not quite yet, it seems. The government has been lucky, with no flu epidemic in any recent winters or any Arctic freeze-over. With beds at full capacity, it would only take a mild outbreak to tip over the NHS.

The pressure-cooker is finance: monumental debts swell by millions a month as hospitals receive absurdly frantic threats if they don’t cut back. In December they were told to free beds by cancelling operations, causing longer waiting times and lost revenue from missed operations. Look at King’s College hospital, in south London: its chair, Bob Kerslake, calls official finances “kidology”. Ordered to make a surplus this year, King’s can’t avoid a £2m loss – yet the punishment is a cut in funds, sending its deficit to £30m, and an instruction to make a £26m surplus next year: this is mirage accounting, mirrored everywhere.

So far these debts are Hunt’s and chancellor Philip Hammond’s problem: what do patients care? But if the Treasury really means to recoup the money, plus the £22bn in savings it demands of the NHS by 2020, then Vesuvius will blow. Wards and units will close, staff will be laid off, the chaos will be unprecedented. It can’t happen.

When the government is forced, kicking and screaming, to pay up, who will it blame? It will call the NHS “unsustainable” and “a bottomless pit”. (Hammond already has.) Yet more “reforms” and re-disorganisations will be hurled at it: payment for services, top-up insurance and tax rebates for private payers will resurface. The government will ignore the UK’s fall in the EU spending scale since 2010, and is now sixth out of the G7 countries, with fewer beds, doctors and nurses per capita.

Who has the political heft and credibility to defend it? Fear of Labour’s NHS moral hegemony kept Thatcher, John Major and David Cameron in check. No longer. Labour thought the NHS was its big bazooka in Copeland, where a maternity unit is under threat. But the naked desperation of Labour’s “Babies will die!” leaflets shot the very last bolt in Jeremy Corbyn’s arsenal. Each time he raises the NHS at prime minister’s questions his feeble attempt at “weaponising” sounds pathetically opportunist: May bats him away with balderdash statistics he is too incompetent to refute.

This has never happened before: polls find May more trusted than Corbyn to run the NHS by 45% to 35%. Far worse, Labour’s failure to counter the right’s message has left more people blaming the NHS crisis on migrants and patients’ bad lifestyles than Tory underfunding or rising numbers of older people. As ever the Mail and the rest carry endless NHS tourism or obese wastrel stories – but Labour has always had to fight twice as hard to get a hearing for the facts on the NHS.

Whoever follows Corbyn will now find it ferociously hard to regain that lost NHS ground. By 1997, hammering away in opposition, Labour had made the threadbare NHS the top issue and owned it. Hard-won economic credibility earned it the trust to run the NHS better. Now Ben Page of Ipsos Mori finds the NHS the second issue after Brexit, but Labour doesn’t own it, or anything else: Corbyn falls behind on everything, with every demographic, so even Labour voters prefer May.

Because the NHS crisis has so far exploded in debt rather than closures, most people’s experience is not yet bad enough to reach tipping point. Page says satisfaction is down on 2010, but not rock bottom, with always a long lag in perception. A third would pay more tax for the NHS, but the rest want savings by denying obese people and migrants.

Austerity has entered the nation’s blood stream: Page finds most people still think it necessary – despite the reckless tax cuts ahead. Banging on about “austerity” without specifics gets Labour nowhere. May’s own polling and her Copeland result tell her this – but hubris is her greatest peril. There may be no opposition, but if she and her chancellor really try to squeeze the gargantuan debt out of the NHS, all hell will break loose anyway.

Labour’s failure on the NHS is prolonging this health crisis | Polly Toynbee

Eggs lose free-range status on Pancake Day

On Shrove Tuesday, the biggest egg-buying day of the year, UK consumers are being warned that eggs branded as free range have actually been laid by housed hens because of emergency measures to combat the spread of bird flu.

All free-range egg boxes will carry a sticker explaining that the box contains “eggs laid by hens temporarily housed in barns for their welfare”.

But consumers, who will be stocking up on eggs to make pancakes on Tuesday, will still be charged a premium for free-range eggs.

The UK consumes an estimated 52m eggs on Pancake Day, more than double the normal rate. About half the eggs sold in supermarkets are usually free range.

On 6 December poultry farmers were ordered to house their flocks to protect the UK from a virulent outbreak of avian flu.

The stickers are being introduced because, under EU rules, if hens have been housed for more than 12 weeks they cannot be sold as free range.

Andrew Opie, the director of food policy at the British Retail Consortium, said: “What we will start to see is stickers appearing on boxes of eggs to indicate that the hens that have produced those eggs are no longer free range. The likelihood is that all egg boxes will be stickered.”

Asked by BBC Radio 4’s Farming Today programme whether prices would fall as a result, he said: “We would hope that customers would recognise that this is a challenge beyond the control of the farmers themselves and will continue to support British free range farmers through this difficult time.”

There have been several confirmed outbreaks of the H5N8 strain of avian flu this year, including on farms in Northumberland, Suffolk, Lancashire and Lincolnshire.

About 20% of egg producers have flocks in areas classed as a high risk of contagion. From Wednesday, the restrictions will begin to be eased.

All farmers in the high-risk areas will be required to continue to house birds. Those outside the area will be allowed to let birds out, but many are expected to continue to house their flocks as a precaution.

The UK consumes an estimated 52m eggs on Pancake Day. Photograph: Alamy

The H5N8 strain of bird flu poses no risk to humans. The British Free Range Egg Producers Association said birds were not being be kept in battery farm conditions.

It said: “While free-range egg farmers would prefer their birds to be outside, they also wouldn’t want to risk the health of their birds. Their sheds have plenty of room for the birds to move around freely and include scratching areas so birds can still display their natural instinctive behaviour.

“Farmers have also put in additional stimulants like footballs, cabbages and even Christmas trees to keep the birds happy.”

It added eggs “will still taste great and will have been laid by birds who were allowed outside before 6 December, and that will be allowed outside again as soon as it is safe”.

Opie said: “We expect more farmers to be bringing hens indoors than might be anticipated from those higher risk areas that have been identified by Defra [the Department for Environment, Food and Rural Affairs].

“That’s a genuine concern from farmers to prevent the virus entering their flocks and destroying their livelihood. We anticipate that all eggs will be stickered for that reason.”

Eggs lose free-range status on Pancake Day

"Nursing makes all the difference in healthcare": how the job has changed

It’s 30 years since Trevor Clay challenged his fellow nurses to rise up and make their voices heard. The profession had been “remarkably insular”, he wrote, and to its lasting cost had taken little heed of the social, political and economic forces that shaped its practice.

Clay, the charismatic leader of the Royal College of Nursing (RCN) during its period of explosive growth in the 1980s, argued that nursing’s great strength – its overriding focus on the needs of the patient – was at the same time its great weakness. “Too many nurses take that suppression of their individual feelings on a daily basis into political life,” he said. “Nursing is perhaps the most unassertive profession in the UK.”

Three decades after Clay made that claim, it’s timely to revisit it. If he was still alive today, would he be satisfied or still frustrated at the standing of nursing in the UK?

Nurses are certainly not the handmaidens of any other profession

Janet Davies

He would certainly find the profession’s agenda changed – or, more to the point, extended. The three core issues he identified as pay, education and advancing the nurse’s role remain valid. But events and trends have added three more: staffing levels and the mix of qualified and support workers; nursing’s response to the changing healthcare agenda; and the recurring accusation that the profession has somehow lost its soul.

The Mid Staffs scandal, which exposed alarming attitudes and practice on the part of some nurses, and the inquiry into fatally poor standards of infection control at the Vale of Leven hospital in Dunbartonshire, Scotland, have unquestionably scarred nursing’s reputation.

Janet Davies, the present chief executive and general secretary of the RCN, argues that care quality, staffing levels and skills mix are inextricably linked. Mid Staffs was as much about insufficient numbers of qualified practitioners as about lack of compassion, she says, and she worries that understaffing – with almost every hospital reportedly now falling short of targets for qualified staff – may be causing “compassion fatigue”.

“Compassion is the absolute essence of nursing, but being one of two nurses with 15 or 20 highly dependent patients is hardly conducive to doing your job in the most compassionate way,” she says.

Compassion was one of the “six Cs” at the heart of the last nursing strategy, led by Prof Jane Cummings, England’s chief nursing officer. That was an approach explicitly designed to help restore the profession’s pride in the wake of Mid Staffs. Her new strategy, launched last summer, shifts the focus to 10 commitments to challenge unwarranted variation in outcomes for patients, their experiences and use of resources.

This represents, in part, a recogniton that nursing must adapt to the new reality of healthcare, with the emphasis shifting away from treating illness towards preventing it, strengthening public health and supporting 15 million people living with long-term conditions.

At the same time, the profession must deal with the implications of Brexit – for recruitment from the rest of the EU – and the likelihood of continued severe pay restraint for the rest of this decade. There is also a raft of workforce reforms coming into effect in England this year, including the end of training bursaries and the removal of a cap on intakes at universities.

The reforms have sparked controversy and nurse leaders have faced criticism for failing to take a clear and united position. Peter Carter, Davies’s immediate predecessor, who is broadly in support of the changes while remaining cautious about the effect of ending bursaries, says: “The profession doesn’t really have a coherent take on these initiatives, but they could ameliorate the shortfall in numbers coming into the profession.”

Davies defends the RCN’s scepticism about the reforms – not least because of the strain they will heap on an already struggling NHS – and insists that the profession overall is in good shape. Since Clay’s era, she points out, it has become graduate-only entry, has adopted three-yearly revalidation and has greatly enhanced its research base. “Skilled nursing is the one thing that really makes a difference in healthcare,” she says. “We’ve always known that, but now we can show it.”

With the advent of a new nursing degree apprenticeship route to complement increased university intakes – as well as the option of becoming a nursing associate – the profession should have no shortage of new blood.

But has nursing found an assertive voice? “Nurses today have much more of a role in the taking of key decisions,” says Davies. “They are certainly not the handmaidens of any other profession.”

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"Nursing makes all the difference in healthcare": how the job has changed

What impact will Brexit have on nursing?

The NHS faces a severe nursing shortage. An ageing population has pushed up demand, while an ageing nursing workforce – with one in three nurses set to retire in the next 10 years – is reducing supply. The shortage is particularly acute in mental health, with specialist nurse numbers falling more than 10% in the past five years.

And the Brexit vote may make it even worse. A July 2016 Institute for Employment Studies (IES) report reveals about 4.5% of NHS nurses in 2015 were from EU countries excluding Ireland, a steep rise from the 1% of 2009. In some trusts in London and the east of England, the proportion is as high as 20%.

Nurses who have been here more than five years will be eligible to remain. But what will happen to the others? Helen McKenna, senior policy adviser at the King’s Fund thinktank, believes that the government “urgently needs to clarify its position on the status of nationals who are already here in the UK working in health and social care roles”. While the prime minister has said she would like to guarantee the rights of EU citizens already living here, that is by no means certain. McKenna says: “Her position is likely to be dependent on reciprocal agreements for UK citizens living elsewhere in Europe.”

Rachel Marangozov, IES senior research fellow and report co-author, notes that the uncertainty and perceived hostility towards migrants may put some EU nurses off: “What are you going to say? ‘Come and work in London or the east of England – we can’t guarantee your future status, but come and work for us.’ It’s a very difficult sell.”

Janet Davies, Royal College of Nursing chief executive and general secretary, says that nurses from the “wider” EU are already losing interest in coming here and warns: “It’s to be expected as an immediate reaction, but what we don’t know is whether it’s a trend that will be sustained and become a serious problem.”

Both Marangozov and McKenna think the problem could be partially addressed by naming nurses as a priority occupation. But it may be difficult, says Marangozov, to devise a set of criteria that would allow in nurses but not other occupations in shortage areas.

An alternative is to ramp up recruitment from outside the EU. This will also need a change in policy, but, according to Marangozov, the very reason recruitment from EU countries has increased so dramatically is because of tighter immigration controls on countries outside the EU. The only realistic solution, she argues, is better workforce planning at a national level. Given the global shortage of nurses, dependence on immigrant nurses can only be a temporary measure: “We just rely on them as a stopgap because nobody has bothered to plan these issues in the workforce properly.”

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What impact will Brexit have on nursing?

British people unaware of pollution levels in the air they breathe – study

People across the UK are underestimating the impact of the air pollution crisis in their local areas, according to a new survey.

Almost two thirds of respondents said they were concerned about the issue of air pollution, but only one in 10 said they thought the air they breathe is bad.

Last week the Guardian revealed that there are 802 educational institutions in the capital where pupils as young as three are being exposed to illegal levels of air pollution that can cause serious long term health problems.

And government statistics show 38 our of 43 UK “air quality zones” breach legal limits for air pollution.

Friends of the Earth, which carried out the latest survey, said that despite the growing evidence many people – particularly outside London – were still unaware of the dangers of air pollution.

“With only 1 in 10 British adults rating their air quality as poor despite swaths of the country breaking legal limits for air pollution, it seems the message about the scale and danger of air pollution isn’t getting through,” said Oliver Hayes, a Friends of the Earth air pollution campaigner.

“Often you can’t see it or smell it, but it’s there – and air pollution is risking the health of an entire generation of children.”

To coincide with the findings Friends of the Earth has launched what it says will be the “biggest ever citizen science air pollution experiment”. People can apply to the charity for clean air kits, enabling them to test the air quality where they live, and FoE will provide tips on how to avoid air pollution and what people can do to help support the campaign for clean air.

Hayes said: “Our clean air kits help people to find out about the air quality in the places they care about most: on the street where they live, where they work, where their children go to school and at the heart of their communities.

“The results will help us build up a localised picture of the state of our nation’s air to really bring home why everyone, from individuals to businesses and politicians, must do all they can to make the air we breathe safer.”

Air pollution is linked to heart disease, lung cancer, worsening asthma and poor lung development in children and leads to the premature deaths of around 40,000 people every year in the UK.

The Friends of the Earth report coincided with a separate study for the Greater London Authority which found a much higher awareness of air pollution in the capital.

It found that nine out of 10 people in London believe air pollution is at crisis levels and two thirds describe air quality in their local area as bad.

It also found that every London borough has recorded illegally high levels of air pollution in the last two years.

Hayes said: “Whilst Londoners are starting to understand the air pollution crisis, in part due to welcome attention from politicians and the media, outside of the capital it’s a very different story.”

Friends of the Earth said it hoped thousands of people will join in the charity’s experiment so it can create a comprehensive national air pollution picture. It said the data generated will feed into a national map which will help create a “state of the nation” report on air pollution.

British people unaware of pollution levels in the air they breathe – study