Just doing a bit of reading, the talk of NHS reorganisation having whetted my appetite for a bit of health geekery. I'm mainly trying to get my head around the purchaser provider split in NHS and what that means. Here's @mellojonny from 2011 (Pre Lansley) abetternhs.net/2011/01/18/com…
This by Mick Timmins is great "choice and competition in health seem to work best when there is a growing rather than a shrinking market – and, despite its relative protection, health has been a shrinking market since 2010" kingsfund.org.uk/blog/2017/06/c…
*Nick, not Mick
So, there was thirty year vision that what would improve the NHS and/or healthcare was the ability for organisations within the NHS to 'buy' (commission) services from organisations of their choice. Patients would make rational decisions and so would NHS organisations, logic went
Rational decisions in times of plenty are different from rational decisions in times of growing scarcity. When you haven't much money, it's a rational decision to spend less of it, or to act in other ways that mean you will have more of it. That's not always good for health, that

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More from @MarkOneinFour

14 Feb
Some of you will probably know I'm currently grieving. It's a month since my fantastic sister died. I've been thinking a lot about loss, progress and reckoning and coming to terms, both personally and as a society. And I've been wondering: how will we remember the pandemic dead?
The UK is filled with memorials to the dead of wars, of disasters, of lifeboat crews and atrocities. We are a landscape haunted by attempts to remember the brave and the innocent. Villages, towns, businesses, communities: all grouped together to pay for plaques, statues, gardens
I have a terror that in our desire to get 'back to normal' we will forget those lost and things lost during the current pandemic. There's not an enemy they were overcome by; not a single flashpoint of tragedy. Those lost to the pandemic are an uncomfortable reminder of failure
Read 21 tweets
12 Feb
Thinking about health and social care integration. Some people think you need reorganisation to remove silos. But, thing is, people like silos. And things not working in partnership often result from one partner not wanting to, or being in a position to do, what the other wants
I think reorganisation of health and social care always tilts toward 'reorganisation of social care so the NHS works better' and very seldom 'reorganisation of NHS so social care works better'. Social care isn't just an element of local authority work that enables the NHS
I kepp thinking of the grand utopian dream of end-to-end health and social care, all together under one notional organisational roof like Toys R Us and thinking: it is a utopian dream and it's also one that people didn't really like the closer it was to reality
Read 6 tweets
8 Feb
Actually, one thing I have been doing during lockdown is really indulging in 'this looks like that' & 'that sounds like this'. What I mean is kind of grazing and burrowing into visual or auditory things. Exploring without going anywhere by jumping from book to book, song to song
Really, consciously tickling my visual and auditory palate by finding things that feel new or which belong with each other by theme, production, sound or, I dunno, shared feeling of jouissance. An example: old pre-internet photobooks on niche subjects with that kodachrome hue
It's like really spending enough time in a landscape that you can see the history of the topography, uncover the old paths, see what links things that otherwise seem unconnected. Seeing the contour lines of culture and human ideas between previously singular seeming things
Read 4 tweets
8 Feb
Things I've done for my #mentalhealth during lockdown include: having a cup of tea; making space to do things just for me; getting on with some stuff that means a lot to me; looking out of the window; not kicking my own arse for things I've not done during a national crisis
I've not written a book. Or found a new hobby. Or learned a language. I've mostly been concentrating on just having a day to day life with small pleasures and tiny doses of awe and wonder. I feel like too many people think of activity as medicine against being mental
I can't give you any tips. Why should I be able to? I don't know you. I don't know what helps you to feel like your life is going OK. Having people to talk to is important to me. It mightn't be to you. Having something interesting to think about is important to me. You may differ
Read 13 tweets
4 Feb
Another year, another time to #TimetoTalk day. This year I'd like to talk about mess and discomfort. One element of stigma is feeling like you carry a story and history that will never be understood and never be possible to integrate with the lives and stories of everyone else
If there's a #TimetoTalk day, there should also be a #timetolisten day. And listening means learning to live with stories that discomfort, stories that trail off, stories that ask questions you can't answer. Mental ill-health is a fucking mess to live with.
The experiences people share around mental ill-health will not conform to your wider narrative expectations. The job of making our stories make sense that we have who live through them is not the same job that a person listening has. #timetotalk isn't about you
Read 8 tweets
3 Feb
Worth looking at trending topic 'CAMHS' (Child and Adolescent Mental Health Services) right now. We aren't providing good service to everyone who needs it. We're often providing a weird service to people who do because CAMHS gets blown about by cultural ideas about mental health
Yes, I know people don't really share much about healthcare experiences that went well, but people's experiences of CAMHS that are being shared present CAMHS as contextless set of unexplained events where things happen for no reasons instead of a place of help and support.
With CAMHS wider cultural winds are like "We need to give children/ young people every support they need for their mental health unless we don't. We don't medicalise distress, unless we do, but we might not again, keep you on yr toes. If you don't want service, you can have it."
Read 6 tweets

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