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Friday, July 13, 2012

BBC news piece and meeting AWP

You can see the news piece on:

http://www.bbc.co.uk/news/uk-england-bristol-18773710

Unfortunately the film clip has been removed (see previous post)

Note that neither organisations mention 'working together to carry on the provision' or 'finding a way to commission it'. Pontius Pilate meets Houdini and patients are 'collateral damage'. Both the University's and AWP's reputation have benefited from this clinic in the past at very little cost, now they are playing a game of chicken except that the disastrous outcome affects real people's lives not numbers in an end of year report.

The bit from AWP finding a solution is farcical- even experienced and caring clinicians like Dr Doran from Worcester (who was on the news item clip) need help from the clinic when stuck.

AWP's comment about what they are going to do would sit well in a Kafka novel. The mails sent to me indicate that AWP does not provide ANY real support in most of the cases. As Jade said in the interview - it is not only the medicines but also the fact that you are reviewed every six weeks by a consultant psychiatrist (and the same person - not a sequence of new people who have little understanding - my note).

So if my arithmetic is correct the intervention that has saved Jade's life and has made her able to lead a life again, would have cost about 4 hours of clinic time per year-not exactly a great deal - my calculation makes it £ 1000 to £ 2000 real expenditure depending on the estate costs. How little compared with heart surgery...

Let's imagine the same story for diabetes- hundreds of difficult to treat diabetes patients no longer have expert diabetological advice as a leading UK service run by a historical collaboration between the NHS and the University of Bristol will be closed as 'not commissioned'. Outpatient based general medical services will not see these patients as all GPs should be able to prescribe and support these patients beyond the steps outlined by NICE or their own PCTs.

It is also not surprising that AWP says that most of the people seen by the clinic don't have local mental health provision outside the clinic (as in the letter sent by them)- AWP is incapable of recognising profound distress, disability and constant suicidal thoughts as conditions in need of help. Most patients are either not looked after or told that 'nothing else' can be done.

One of you has already been dropped by secondary care in spite of being one of the few people who had an experienced and senior AWP case manager prior to his moving on.

Do write in with your story of interaction with the local NHS trust -people need to know about it. It can just be a few lines and anonymous.

Alternatively your story can be put in as a comment at the end of this post.

Try to go to the meeting on 26th July at 10 am at Callington road hospital next to Tesco.

If you cannot go send someone to represent you- let me know if you need help finding someone. Email to psychopharmcare@gmail.com ; Remember that AWP will not focus on the fact that many are either too ill to go or struggling to keep a job or a family going and therefore find it difficult to come. They will focus on the fantasy that this act (of vandalism) does not affect any people who SHOULD be in the centre of their focus. They still don't realise that their actions show that their website statements are callous hypocrisy.

Let's finish on a positive note. We have had over 1000 hits on the blog. I will need help with keeping this going as I am moving to a new job. Anyone interested- please let me know by email ; ).

Tuesday, July 10, 2012

Does any manager understand this service?


AWP took clinic out of BRI and no need to identify other suitable care- we already have it in psychopharmacology.

Here goes:

I have received an email this last week from Andy Sylvester at AWP regarding this service.  My understanding from Andy Sylvester's email is that it was a Bristol University led R&D programme and it was hosted at the BRI. AWP did try to help out by reaccommodating.  This is not a service that the PCT or AWP funds and we have not been involved in the decision to stop providing the service.

Since Andy's email I have spoken to Alison Middleton who was going to investigate this further and speak to Paula May.  This will also include identifying the patients that will be effected and how best to provide suitable care to support them.

I will keep you all updated as soon as Alison contacts me with more information.

 Kind Regards
Sally Whitley

Programme Manager Mental Health  (Interim) NHS Bristol
0117 900 2623
sally.whitley@nhs.net

A letter from a relative to Paul Miller acting CEO AWP


 
22nd June 2012

Chief Executive of AWP
Paul Miller - Acting Chief Executive
Avon and Wiltshire Mental Health Partnership NHS Trust
Jenner House,
Langley Park,
Chippenham,
SN15 1GG

Dear Mr Miller

I am writing to complain about Avon and Wiltshire Mental Health Partnership Trust’s decision to close the Psychopharmacology Clinic.

My mother is a patient of the clinic and has suffered with Manic Depression for in excess of 20 years.

My mother has been directed to every imaginable NHS and private healthcare avenue in order to access support in managing her mental health, and as a family we have lost count years ago of the number of different strategies, drugs, therapies, ‘next steps’ and doctors she has seen in this time. None of which brought her, or our family, any perceivable state of calm or quality of existence until she was able to access the support of Dr Andrea Malizia through the Psychopharmacology Clinic.

My mother continues to struggle each day of her life with depression which impacts upon every aspect of her existence. Her appointments with Dr Malizia are effectively what she lives for, a glimmer of hope within the darkness of her depression; each a small milestone for her to aim for. Each time she has an appointment, with Dr Malizia I hear her express to him “I’m safe when I come here to see you”. The clinic is her life line, in literal terms; access to some effective support which gives her the strength to keep trying new strategies presented by someone she trusts, someone whose expertise has allowed her to regain some vague minimal sense of what ‘normality’ might feel like.

My mothers treatment is far from complete, her last two appointments have seen changes to her medication and a chance to build upon what is glimmer of ‘my mum’ seen through the suffocating cloud of her depression. Her GP, although extremely supportive, has told us that she has no experience of treatment using the specialist medications prescribed through the Psychopharmacology Clinic. Without access to this specialist support and type of treatment, we doubt that my mother would be able to cope with life at all; ending her life as a result of her depression has always been a very real consideration for her that she does her best to fight against, a solution to escaping the despair she has to live with.

Please consider this letter a freedom of information request as to the consultation process undertaken by Avon and Wiltshire Mental Health Partnership Trust before taking the decision to close the Psychopharmacology Clinic. I find it abhorrent that, as a patient of the clinic, my mother had no knowledge of discussions around its closure prior to a decision being taken. The trust has a legal responsibility to undertake consultation and to complete an impact assessment before taking such a decision, and a lack of these processes would constitute illegal practice.

I would also like to request some clarification of exactly how this closure supports the aims of the trust publicized on the website. The trust claims; “Our aim is to enable and empower people to reach their potential and to live fulfilling lives through providing recovery and reablement focused services that yield positive outcomes for our service users and their carers.”

Finally, I ask you to consider how, as a trust, you would be able to justify a loss of life as a result of this closure. This appears a dramatic statement to make but, when you are close to someone who lives with severe mental health difficulties you begin to understand that, to that someone, taking your own life can seem like a practical solution to your problems.  To take away the one avenue of support that is preventing someone from taking this step, equates to switching off a life support machine – would you be able to justify doing this to a patient who had chance of recovery?

I look forward to your reply.



Yours sincerely




BBC Points West piece on psychopharmacology clinic

http://www.bbc.co.uk/iplayer/episode/b01knnxl/BBC_Points_West_09_07_2012/

From 12.30 minutes to 15.30 minutes

Aired on BBC1 on Monday 9th July

Monday, July 9, 2012

Freedom of Information response from University of Bristol

Thank you for your recent Freedom of Information request.

The University of Bristol has historically conducted its research in psychopharmacology through the provision of consultants to carry out clinical work with Avon & Wiltshire Mental Health Partnership NHS Trust (AWP), having association with and providing the administrative function for this work. Following a recent University wide redundancy exercise, the consultant who was responsible for leading the research in this area at the University was selected for redundancy.

The University has not made any decision to formally close down studies in psychopharmacology, though is aware that the departure of a clinically-active member of staff will impact on the services offered by AWP.

The University is not responsible for providing clinical services and research into psychopharmacology will continue at the University.

If you are not satisfied with the University's response to your request you may ask the University to review the response by writing to:

Director of Legal Services
Secretary's Office
University of Bristol
Senate House
Tyndall Avenue
Bristol BS8 1TH
Email: freedom-information@bristol.ac.uk

enclosing a copy of your original request and explaining your complaint.
Please include an address for correspondence. The full complaints procedure is set out at http://www.bris.ac.uk/foi/publicinfo/review.html

If you are still not satisfied with the outcome of the internal review you may also contact the Information Commissioner at:

Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
www.ico.gov.uk

Best wishes

Matt Morrison

Information Rights Officer
University of Bristol
Matthew.Morrison@bristol.ac.uk
0117 3317751 (ex.17751)

This e-mail is for the above named recipient(s) only. It may contain proprietary material, confidential information and/or be subject to legal privilege. It should not be disclosed to or used, retained or copied by, any other party. If you are not an intended recipient then please delete this e-mail and all copies and promptly inform the sender. Thank you.

Please note that in order to protect the security and working of University network and computer systems, it may be necessary to intercept, monitor, record, copy, audit, inspect and/or disclose to authorised University and law enforcement personnel any files, messages and any or all uses of the systems. The University may also be required to disclose this email as a result of a freedom of information or data protection request, or in connection with litigation.

Sunday, July 8, 2012

Professional clinical and educational views addressed to Royal College of Psychiatrists


To whom it may concern:
I am greatly concerned about the decision to close the Bristol Psychopharmacology Unit.

My learning disability patients do not directly access the clinic but I have sought the expertise of the clinicians who have run the clinic over the years. The problems addressed are the complex prescribing issues, and I am sure knowledge emanating from this unit has prevented costly assessments and admissions around Bristol (often a hidden benefit).

I hope urgent discussions about the planned closure can take place.
Yours sincerely
Dr Helen Sharrard
Consultant Psychiatrist in Learning Disability, S Glos

From the perspective of the School of psychiatry this loss will impact significantly on the training of psychiatrists & will significantly reduce an important research resource, used by many trainees over a long period. It will also mean that the concentrated expertise in dealing with difficult to manage cases will be lost in the region & we may need to refer more often to the Maudsley and other specialist centres, a great distance from the SW. Trainees may also need to gain specialist experience through placement out of the Deanery as a result.
I hope it is possible for this unit to be retained in some capacity for the future.
Yours,
Rob Macpherson, Head of School of Psychiatry, Severn Deanery.

Friday, July 6, 2012

Sounds familiar? Medication that works will be stopped...


This has been forwarded (anonymised and with permission)- this is an issue that will affect many people attending the clinic. In no other specialty would this be allowed when medicines have helped. The cost for these two is a maximum of  £ 2500 per year assuming that there are no discounts or parallel imports. What is the cost of being unable to work and not paying tax? And of being on benefits? What is the cost of despair and suicide?

Dear Dr Malizia,

Firstly let me say how horrified I am to hear of your redundancy and of the forthcoming closure of the Psychopharmacology clinic, which I'm sure has been responsible both for saving lives and restoring quality of life to many, including myself.

I received your letter asking if I wanted a review, but on a purely practical note I am unlikely to get myself out to Southmead; it may sound pathetic but it's a step too far for me, it's too far out of my 'norm', my little world.

I have a problem in that the clinic is currently prescribing me both 10 mg of Aripiprazole and 50 mg of Agomelatine daily, and I understand  that my GP will be unable to prescribe this, although I was hoping the situation might have changed with the Agomelatine?

I assume this means I will have to drop the medication, given that I am unable to get myself out to Southmead for a review, and given that the clinic is closing in Sept anyway.

So how should I best go about it? I have 5 weeks medication left; should I just half the current dosage until I run out? Is that the best way to do it?

Again, my commiserations on your redundancy. Thank you so much for all the help and care you have given me in the past, and best wishes for your future.