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How to profit from NHS-funded torture and neglect

Started by Zetetic, May 23, 2019, 07:49:21 PM

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José

Quote from: touchingcloth on September 09, 2019, 12:41:49 AM
What's the most profit someone has made from this?

enough to buy multiple luxury/sports cars and a palatial five bedroom house.

touchingcloth

Quote from: José on September 09, 2019, 12:45:26 AM
enough to buy multiple luxury/sports cars and a palatial five bedroom house.

Cool, do you have any tips? I've made a ton off of forex and I'm looking for my next big deal now.


touchingcloth


Dex Sawash


Zetetic

Quote from: touchingcloth on September 09, 2019, 12:47:46 AM
Cool, do you have any tips?
Secure children's services. English commissioners don't seem to care in the slightest what happens to their kids as they're shuttled around the country, the market is at best an oligopoly in much of the UK, and the margins seem to be pretty great if you don't give a shit.

earl_sleek

Quote from: José on September 09, 2019, 12:36:54 AM
they usually recruit their staff through the jobcentre, jobseekers are browbeaten into taking this kind of work with the threat of sanctioning.

I'm a service manager in the care sector and in my experience, people who've been sent our way by the jobcentre don't even show up. The jobcentre doesn't seem to have any way to check if they've attended or not, only if they got an interview. Regardless, I certainly wouldn't employ anyone I thought wasn't suitable, but with care/support work being low paid and low status recruitment is very difficult, and getting worse. 

I'm fortunate that I work for a nonprofit, and have spent most of my social care career in nonprofits. The exception is my last employer, who were pretty bad - they allowed a neighouring home to go from Needs Improvement to Inadequate over the course of a year without any action from senior management, took on placements that were totally unsuitable and were just basically all about the money. They left me with a firm belief that it's immoral and inefficient to run care services for profit.

Zetetic

CQC has just marked down a bunch of Cygnet and Priory hospitals, which is remarkable given what they'll call Outstanding.

RCPsych writing to Matt Hancock.

HSJ reporting that the market for private providers in MH and LD continues to look set to grow.

greenman

Quote from: Quote on May 24, 2019, 10:28:49 PM
To be clear, I don't want to say that slapping residents around and mentally torturing them is in any way part of the system. At least, I fucking hope it isn't.

Sorry if that wasn't there I didn't mean it in that respect, I mean "culture" in terms of shifting services to lowest bidder private companies.

Zetetic

Hints of something terrible in NI relating to LD. No details, no press yet.

Zetetic

Chief Exec of Cygnet Healthcare was paid just shy of £1m in 2019.

Zetetic

Spend continuing to increase. There's a dogshit Guardian article which, as usual, treats this as a uniquely English phenomenon because doing otherwise would require doing some work.



The daughter of an acquaintance - someone who I encountered via this issue - died on the 20th April, in a private unit, having spent the last 8 years in such units. She would have been 30 in October.

TrenterPercenter

https://www.theguardian.com/commentisfree/2022/apr/26/shocking-stories-mental-health-england-2bn-a-year-private-hospitals

Seems relevant to your thread @Zetetic though I'm not really with this idea that there is a political move to obliterate longterm care (that is just silly).

Zetetic

Quote from: Zetetic on April 24, 2022, 11:57:30 PMThere's a dogshit Guardian article which, as usual, treats this as a uniquely English phenomenon because doing otherwise would require doing some work.

TrenterPercenter

QuoteAnother worker tells me of a child patient with a history of being abused who fell off a waiting list because their working mother had missed a call from mental health services. One of their female patients who suffered abuse from her parents and then partners has suicidal tendencies, they say, but waiting lists mean having to wait months to get an assessment, and then another 18 months before getting help. One mother of a suicidal teenage boy was made to put in a referral to child and adolescent mental health services in writing, told there would be two weeks until an urgent appointment was possible, and felt there was no choice but to take him to a chaotically busy A&E department. "My son feels his life isn't worth bothering with, and feels even more hopeless," she tells me. If you speak to anyone who has been through our struggling mental health system, you'll hear the term "waiting lists" comes up again and again.

This is basically my work.  It's all to do with underfunding but directing all of your funding to inpatient care does not solve this, you need early intervention and assertive outreach and you need to integrate stepped models of care into community settings. 

There is no contradiction between these things adequate funding should be available it is as @Zetetic has pointed out nothing that is unique to the UK it is a longstanding international problem.

TrenterPercenter

Quote from: Zetetic on April 26, 2022, 09:29:04 AMsome obsessive rant about Wales not being mentioned

Yes well you can't disagree with considered arguments like this.


I honestly thought you were considering the international crisis in mental health but I should have realised.

Zetetic

Quote from: TrenterPercenter on April 26, 2022, 09:25:28 AMthough I'm not really with this idea that there is a political move to obliterate longterm care (that is just silly).
Whether or not it's "silly" as an actual objective, the ideological stance is widespread.

The most common response - by far - to the Guardian article (and to very similar figures that I've obtained and shared with certain groups in my part of the UK) amongst activist professionals, mental health think tanks, third sector etc., is "well this just shows how right we are about the need to invest in community services/psychosocially health early years/early intervention/prevention". A conviction that the choice is between warehousing people in artificial hells or wiping out the need for long-term inpatient care. (Edit: LOL, which, of course, you've happily parroted.)

Yes, I'm sure, if pushed, these people would generally concede that some people will always need long-term care - but that's largely disconnected from their advocacy.

There are a small number of people - generally psychiatrists - who will make noise about there being an actual 'bed crisis' in mental health and not pretend that we'll disappear it any time soon, in this place, with a focus on demand.

These are often dismissed, not entirely inaccurately mind you, as being too enthralled with medicalisation. A more serious engagement would interrogate what resources you need to go along with "beds" to make inpatient settings less hell-ish and less medicalised... but of course one of the implications of that would be that we can't keep trying to drain resources out of care for the seriously unwell.

TrenterPercenter

Quote from: Zetetic on April 26, 2022, 09:46:32 AMThere are a small number of people - generally psychiatrists - who will make noise about there being an actual 'bed crisis' in mental health and not pretend that we'll disappear it any time soon, in this place, with a focus on demand.

Ah I did suspect this.  Finally we've got to the bottom of things.

We can have proper discussion about psychiatrists and medical models if you like now you've owned up to your actual position?

Zetetic

Quote from: TrenterPercenter on April 26, 2022, 09:45:12 AMYes well you can't disagree with considered arguments like this.
I think you're just being unpleasant.

The article has been followed up with a column from Owen Jones, also making out the problem to be a uniquely English one.

I note that the main response from people who don't fall into the activist/think tank/third sector bucket is "Tory privatisation!!!". I will hold my hands up and admit I do find this upsetting when we have a Labour government here doing exactly the same thing to near enough exactly the same degree.

QuoteI honestly thought you were considering the international crisis in mental health but I should have realised.
A starting point might be to consider more than one nation, of course.

TrenterPercenter

Quote from: Zetetic on April 26, 2022, 09:51:47 AMI think you're just being unpleasant.

I note that the main response from people who don't fall into the activist/think tank/third sector bucket is "Tory privatisation!!!". I will hold my hands up and admit I do find this upsetting when we have a Labour government here doing exactly the same thing to near enough exactly the same degree.

I dunno Z you are generally the one that is unpleasant on this topic.  It's not just the Labour government in Wales and the Tories in England it is an international problem that has been going on for a long-time.  That should show you that this isn't just some political decision on one nations government but a global inability to meet treatment needs - there is serious discussion to be had here on why that is.

Zetetic

Quote from: TrenterPercenter on April 26, 2022, 09:50:19 AMWe can have proper discussion about psychiatrists and medical models if you like now you've owned up to your actual position?
I don't think I've ever been at all covert about my 'actual position'.

We should do everything we can to reduce the incidence of serious mental 'illness'. I scare-quote 'illness' because I'm not attached a medical model - if you want, we can reframe this as the incidence of people with forms of emotional regulation or cognition that render them unable to function in our society and liable to extreme distress or hurting others.

A lot of that is "early intervention and assertive outreach and ... stepped models of care into community settings" - no argument. Some of it changing society to enable a more diverse set of people to function in it - some of that is fairly directly about attitudes, some of it is about material conditions.

At the same time 1) that's not going to happen and 2) even if it did, it's a generation or two before we really see massive reductions in demand for care of the seriously 'ill' of a kind that it's extremely difficult to deliver it dispersed over a 'community' without an incomprehensibly huge workforce. (Edit: Setting aside other issues like societal demands for particular kinds of risk management. I wonder if we're likely to see something not a million miles away from a 'carnage in the community' scandal at some point, which won't do anyone any good.)

The implication of that is, we are going to need varieties of inpatient care for decades to come and we need to resource this properly. We need enough staff in these places to be able to consistently engage people with meaningful activities and social contact, rather than the smallest possible number to semi-reliably hamfistedly manage risk from hour-to-hour. I don't think this is a particularly 'medical' position - quite the opposite. (If you like don't even call them hospitals. Do a Trieste and call them 'community centre beds'.)

As part of that we need to stop dumping people outside of the NHS, often away from where they (and their families and friends) live. This is a way of further stretching out the already thin strand of responsibility for these people, and makes it easier to ignore how shit we have made their situations.




Zetetic

Quote from: TrenterPercenter on April 26, 2022, 10:00:26 AMThat should show you that this isn't just some political decision on one nations government but a global inability to meet treatment needs
Ultimately this comes down to making excuses for governments in the UK, who have major influence over - for example - the workforce supply here. Yes, there are multiple international workforce crises - but that doesn't actually mean that the Westminster government can't radically alter the availability of e.g. LD nursing staff in the UK by 2026.

Quotethere is serious discussion to be had here on why that is.
Feel free to start this.

TrenterPercenter

#82
Quote from: Zetetic on April 26, 2022, 10:06:18 AMI don't think I've ever been at all covert about my 'actual position'.

Perhaps but you have tendency to overplay medication and underplay talking therapies.  We'll move on but there is of course lots of problems with psychiatry and the medical model approach to mental health that needs to be addressed if going down that avenue, easy when it is always a conversation about the failures of community care.

QuoteWe should do everything we can to reduce the incidence of serious mental 'illness'. I scare-quote 'illness' because I'm not attached a medical model - if you want, we can reframe this as the incidence of people with forms of emotional regulation or cognition that render them unable to function in our society and liable to extreme distress or hurting others.

No one is ultimately bothered about whether you say illness, disorder or problem, people develop or acquire serious mental illnesses over their lives with the majority of them occurring prior to 25.  Emotional regulation is a feature of the trajectory to illness, we can see 'illness' as the crisis point and eventual breakdown of someones functioning.  It isn't either or it is both.  Mental health rarely (unless organic or acquired) just suddenly appears, it isn't a pathogen you can then apply some chemical to that kills it.

I say this because, you keep mixing up long-term care and prevention in some ridiculous assertion that they are in competition with each other, arguing because of budgets they are (which is a bit like saying cancer prevention is in competition with cancer treatment).  If you want to champion long-term care, a worthy and important thing to do, then I would absolutely stop grinding your axe about early intervention and community care as from anyone that understands this area it does nothing but make you look a bit unhinged about it.

Of course inpatient long-term care is important, I've never, ever in over 20 years of working with several different mental health trusts, a shed load of third sector providers and specialists across higher Ed ever  heard anyone ever say that it isn't?!  You want to prevent the develop of serious mental illnesses just like you want to prevent the develop of serious cancer that is all there is to it - we don't have even close to the infrastructure to do this at present not that early intervention doesn't work.

QuoteA lot of that is "early intervention and assertive outreach and ... stepped models of care into community settings" - no argument. Some of it changing society to enable a more diverse set of people to function in it - some of that is fairly directly about attitudes, some of it is about material conditions.

OK good. So what are we arguing about then.....oh wait when you said no argument you meant these arguments below

QuoteAt the same time 1) that's not going to happen

Again, a sterling argument.  Well guess I can do this also Z proper funding for the treatment gap isn't going to happen either, in fact we've already been through this, it is the basis of the treatment gap not the result of it.

Quoteeven if it did, it's a generation or two before we really see massive reductions in demand for care of the seriously 'ill' of a kind that it's extremely difficult to deliver it dispersed over a 'community' without an incomprehensibly huge workforce.

Ah so it could, progress I suspect.  You can't just exaggerate aspects of healthcare like this of course no system will be perfect and this is absolutely incredible considering you are advocating things that amounts to previous failed models of inpatient care (nice asylums) and meds (plenty of people out their sedated out of their lives needlessly because they can't get adequate community care that we are conveniently forgetting).  I'm not going to go into the work I do here but there are solutions, that is why integrating care is important in articles you call dogshit.  Regardless what on earth are you talking about anyway, we can reduce demand in 20 years or what? What on earth is the other option fund and collect seriously ill people in Neo-asylums how does that reduce demand? Again it comes back to this incredible lie that there is some contradiction between longterm care funding and community care - atleast we could consider the vast amount of service users that don't want to go to inpatient care and want to remain independent with support in the community.

QuoteThe implication of that is, we are going to need varieties of inpatient care for decades to come and we need to resource this properly. We need enough staff in these places to be able to consistently engage people with meaningful activities and social contact, rather than the smallest possible number to semi-reliably hamfistedly manage risk from hour-to-hour. I don't think this is a particularly 'medical' position - quite the opposite.

As part of that we need to stop dumping people outside of the NHS, often away from where they (and their families and friends) live. This is a way of further stretching out the already thin strand of responsibility for these people, and makes it easier to ignore how shit we have made their situations.

Perhaps to achieve we need to consider the whole picture and stop picking fights with sections of the service.  Like I say I've never known anyone other that rightwing arseholes with a desire to make money from sedating people and people with stigmatised attitudes to people with MH approach this issue in the way you do (I'm not saying you are either of these, in fact I'm sure you aren't I've just not seen it before outside of these groups).  Of course you need staff across the whole system, you need to prevent serious MH conditions developing and you need adequate care settings for when this goes wrong.

TrenterPercenter

Quote from: Zetetic on April 26, 2022, 10:13:43 AMUltimately this comes down to making excuses for governments in the UK, who have major influence over - for example - the workforce supply here. Yes, there are multiple international workforce crises - but that doesn't actually mean that the Westminster government can't radically alter the availability of e.g. LD nursing staff in the UK by 2026.

LD if you are talking (as I think) about intellectual disability (we use that term now as LD means different things to different people) is a somewhat different area that doesn't strictly apply to early intervention in terms of ID, though it does it terms of their mental health.

Zetetic

#84
Quote from: TrenterPercenter on April 26, 2022, 10:51:05 AMintellectual disability (we use that term now as LD means different things to different people)
This sort of shit from you to try to win authority points or something is quite irritating, particularly when you're wrong in a way that's obvious to anyone vaguely familiar with a topic.

"Learning disabilities" remains in much wider use in the UK, not least amongst people with learning disabilities themselves - and even it wasn't, "learning disabilities" is the relevant term in the context of the LD nursing workforce (given professional registration terminology).

Zetetic

QuoteI say this because, you keep mixing up long-term care and prevention in some ridiculous assertion that they are in competition with each other, arguing because of budgets they are (which is a bit like saying cancer prevention is in competition with cancer treatment).

It would be like that if cancer prevention meaningfully competed with cancer treatment at any point - but since they're overwhelming funded from separate pots and usually different organisations, require different workforces and so on, it's not really very much like it all.

Zetetic

By contrast, getting to the end of the first actual page of content in England's "Implementing the Five Year Forward View" document (for example) makes it exceedingly clear that "releasing savings" from within the health system is a fundamental part of the transformation being demanded, and the cash it requires.

This comes back to - I think - that you and I might see that this competition for resources is unnecessary and a consequence of ideological commitment to overall underfunding. I think we are on the same page there.

However, that doesn't change the prevailing ideological stance, and the common assumptions bound up with that.

Zetetic

QuotePerhaps but you have tendency to overplay medication and underplay talking therapies.
I don't think this is true, other than if you're referring to thing I may have said regarding "what people can reasonably get out of their GPs before the heat death of the universe".

(For what it's worth, I literally had a conversation with my GP last week - where all I wanted was a sick note - and the upshot of our shared decision making was that there was no point referring me to either of the talking therapies services available, in large part because they were fucked for the foreseeable future by the mismatch between capacity and demand.)

I've emphasised extremely clearly that the thing we need more than anything else inpatient settings is time for meaningful activities and social interaction. (Which, I appreciate is not identical to "talking therapies" but it is not "overplaying medication" either.) If you like I can add "because the alternative is often chemical restraint" (well, and then often physical and mechanical restraint...).

TrenterPercenter

Quote from: Zetetic on April 26, 2022, 11:03:27 AMThis sort of shit from you to try to win authority points or something is quite irritating, particularly when you're wrong in a way that's obvious to anyone vaguely familiar with a topic.

"Learning disabilities" remains in much wider use in the UK, not least amongst people with learning disabilities themselves - and even it wasn't, "learning disabilities" is the relevant term in the context of the LD nursing workforce (given professional registration terminology).

?? You are seeing things that are not there Z.  I'm not disagreeing with the fact it remains in wider use I'm just trying to discern what you meant because LD an abbreviation could mean learning disability or learning difficulty (two different things in your mainstream usage) and across the pond these meanings are reversed.

I work with specialists in the area that prefer to use the term "intellectual disability" now because of this problem, I wanted to differentiate who you are talking about because it is very relevant to issue of early intervention - that is is all.

TrenterPercenter

Quote from: Zetetic on April 26, 2022, 11:09:11 AMIt would be like that if cancer prevention meaningfully competed with cancer treatment at any point - but since they're overwhelming funded from separate pots and usually different organisations, require different workforces and so on, it's not really very much like it all.

Sorry it is.  It doesn't matter about funding pots that is a distraction to the point I was making.  They are not in competition with each other, they are complimentary to each other, people treating cancer (regardless of who is funding them) recognise the importance of early treatment.

This is the sophistry you engage with in the absence of you dealing with this very simple and important aspect.