Category Archives: Rheumatoid Arthritis

Hospital bosses forced to chant ‘we can do this’ over A&E targets

Hospital bosses were forced to chant “we can do this” by a senior NHS official in an effort to improve their accident and emergency performance in advance of what doctors have warned will be a tough winter for the NHS.

Hospital trust chief executives say they were left feeling “bullied, patronised and humiliated” by the incident last week at a meeting attended by Jeremy Hunt, the health secretary, and Simon Stevens, the head of the NHS in England.

The leaders of about 60 trusts which NHS national bodies deemed to have the worst record on meeting the politically important four-hour A&E treatment target were called into a meeting held in London on Monday 18 September.

Chief executives present say that they were divided into four regional groups, covering the south and north of England, London, and the Midlands and east of the country, each of which held a separate session with a senior NHS England official.

Paul Watson, NHS England’s regional director for the Midlands and east of England, then encouraged those in the group he was leading to chant “we can do it” as part of a renewed effort to improve their A&E performance. Hunt and Stevens are not thought to have been at that session; nor was Jim Mackie, chief executive of health service regulator NHS Improvement, who jointly convened the meeting with Hunt and Stevens.

One chief executive said: “It was awful – the worst meeting I’ve been at in my entire career. Watson said: ‘Do you want the 40-slide version of our message or the four-word version?’ Everyone wanted the four-word version, obviously.

“He then said ‘I want you to all chant ‘we…can…do…this’. It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.”

According to the Health Service Journal, which revealed what had happened at the meeting, Watson told trust bosses that they were initially chanting too quietly and that they should chant the slogan again but louder, and “take the roof off” with the noise.

Watson’s use of the tactic has prompted complaints from within the NHS that the chanting was “Bob the Builder for NHS leaders”, after the children’s TV character Bob the Builder with his “Can we fix this? Yes we can” catchphrase. Another HSJ reader posted a comment on its website saying: “More akin to North Korea than the NHS”.

Anger and ridicule directed at Watson have prompted him to apologise for and explain his behaviour in messages he posted on the HSJ website since it published the story.

“If anyone found my session on Monday inappropriate in any way then I can only apologise – it was meant as light relief rather than brainwashing,” said Watson.

“As I said at Monday’s event, this can be done. If that seems cheesy or patronising then so be it but it does have the merit of being true – Paul”, he added.

He also repeated his claim that inadequate A&E performance endangered patients’ safety.

“It’s good to let off steam but let’s remember what’s at stake here: 1 Urgent care is the most basic service the NHS provides; 2 A badly run, crowded ED [emergency department] is a miserable experience for our patients; 3 These patients are often frail, elderly and frightened as well as very ill; 4 A crowded ED can be dangerous.”

If other trusts could provide excellent A&E services despite the rising demand for care, why could the 60 represented at the meeting not do that, he asked. He also angered trust bosses by saying that “the biggest single determinant of whether a struggling service is turned round is the confidence, optimism and determination of local leadership to do this and follow it through”.

The Guardian has approached NHS England and the Department of Health for comment.

Hospital bosses forced to chant ‘we can do this’ over A&E targets

Hospital bosses were forced to chant “we can do this” by a senior NHS official in an effort to improve their accident and emergency performance in advance of what doctors have warned will be a tough winter for the NHS.

Hospital trust chief executives say they were left feeling “bullied, patronised and humiliated” by the incident last week at a meeting attended by Jeremy Hunt, the health secretary, and Simon Stevens, the head of the NHS in England.

The leaders of about 60 trusts which NHS national bodies deemed to have the worst record on meeting the politically important four-hour A&E treatment target were called into a meeting held in London on Monday 18 September.

Chief executives present say that they were divided into four regional groups, covering the south and north of England, London, and the Midlands and east of the country, each of which held a separate session with a senior NHS England official.

Paul Watson, NHS England’s regional director for the Midlands and east of England, then encouraged those in the group he was leading to chant “we can do it” as part of a renewed effort to improve their A&E performance. Hunt and Stevens are not thought to have been at that session; nor was Jim Mackie, chief executive of health service regulator NHS Improvement, who jointly convened the meeting with Hunt and Stevens.

One chief executive said: “It was awful – the worst meeting I’ve been at in my entire career. Watson said: ‘Do you want the 40-slide version of our message or the four-word version?’ Everyone wanted the four-word version, obviously.

“He then said ‘I want you to all chant ‘we…can…do…this’. It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.”

According to the Health Service Journal, which revealed what had happened at the meeting, Watson told trust bosses that they were initially chanting too quietly and that they should chant the slogan again but louder, and “take the roof off” with the noise.

Watson’s use of the tactic has prompted complaints from within the NHS that the chanting was “Bob the Builder for NHS leaders”, after the children’s TV character Bob the Builder with his “Can we fix this? Yes we can” catchphrase. Another HSJ reader posted a comment on its website saying: “More akin to North Korea than the NHS”.

Anger and ridicule directed at Watson have prompted him to apologise for and explain his behaviour in messages he posted on the HSJ website since it published the story.

“If anyone found my session on Monday inappropriate in any way then I can only apologise – it was meant as light relief rather than brainwashing,” said Watson.

“As I said at Monday’s event, this can be done. If that seems cheesy or patronising then so be it but it does have the merit of being true – Paul”, he added.

He also repeated his claim that inadequate A&E performance endangered patients’ safety.

“It’s good to let off steam but let’s remember what’s at stake here: 1 Urgent care is the most basic service the NHS provides; 2 A badly run, crowded ED [emergency department] is a miserable experience for our patients; 3 These patients are often frail, elderly and frightened as well as very ill; 4 A crowded ED can be dangerous.”

If other trusts could provide excellent A&E services despite the rising demand for care, why could the 60 represented at the meeting not do that, he asked. He also angered trust bosses by saying that “the biggest single determinant of whether a struggling service is turned round is the confidence, optimism and determination of local leadership to do this and follow it through”.

The Guardian has approached NHS England and the Department of Health for comment.

Hospital bosses forced to chant ‘we can do this’ over A&E targets

Hospital bosses were forced to chant “we can do this” by a senior NHS official in an effort to improve their accident and emergency performance in advance of what doctors have warned will be a tough winter for the NHS.

Hospital trust chief executives say they were left feeling “bullied, patronised and humiliated” by the incident last week at a meeting attended by Jeremy Hunt, the health secretary, and Simon Stevens, the head of the NHS in England.

The leaders of about 60 trusts which NHS national bodies deemed to have the worst record on meeting the politically important four-hour A&E treatment target were called into a meeting held in London on Monday 18 September.

Chief executives present say that they were divided into four regional groups, covering the south and north of England, London, and the Midlands and east of the country, each of which held a separate session with a senior NHS England official.

Paul Watson, NHS England’s regional director for the Midlands and east of England, then encouraged those in the group he was leading to chant “we can do it” as part of a renewed effort to improve their A&E performance. Hunt and Stevens are not thought to have been at that session; nor was Jim Mackie, chief executive of health service regulator NHS Improvement, who jointly convened the meeting with Hunt and Stevens.

One chief executive said: “It was awful – the worst meeting I’ve been at in my entire career. Watson said: ‘Do you want the 40-slide version of our message or the four-word version?’ Everyone wanted the four-word version, obviously.

“He then said ‘I want you to all chant ‘we…can…do…this’. It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.”

According to the Health Service Journal, which revealed what had happened at the meeting, Watson told trust bosses that they were initially chanting too quietly and that they should chant the slogan again but louder, and “take the roof off” with the noise.

Watson’s use of the tactic has prompted complaints from within the NHS that the chanting was “Bob the Builder for NHS leaders”, after the children’s TV character Bob the Builder with his “Can we fix this? Yes we can” catchphrase. Another HSJ reader posted a comment on its website saying: “More akin to North Korea than the NHS”.

Anger and ridicule directed at Watson have prompted him to apologise for and explain his behaviour in messages he posted on the HSJ website since it published the story.

“If anyone found my session on Monday inappropriate in any way then I can only apologise – it was meant as light relief rather than brainwashing,” said Watson.

“As I said at Monday’s event, this can be done. If that seems cheesy or patronising then so be it but it does have the merit of being true – Paul”, he added.

He also repeated his claim that inadequate A&E performance endangered patients’ safety.

“It’s good to let off steam but let’s remember what’s at stake here: 1 Urgent care is the most basic service the NHS provides; 2 A badly run, crowded ED [emergency department] is a miserable experience for our patients; 3 These patients are often frail, elderly and frightened as well as very ill; 4 A crowded ED can be dangerous.”

If other trusts could provide excellent A&E services despite the rising demand for care, why could the 60 represented at the meeting not do that, he asked. He also angered trust bosses by saying that “the biggest single determinant of whether a struggling service is turned round is the confidence, optimism and determination of local leadership to do this and follow it through”.

The Guardian has approached NHS England and the Department of Health for comment.

Parts of UK identified as high risk areas for Lyme disease

The south of England and the Scottish Highlands have been earmarked as high risk areas for Lyme disease.

The National Institute for Health and Care Excellence (Nice) said some areas appear to have higher prevalence of infected ticks which cause the disease. But the health body said prevalence data is incomplete as it called for a large study into the condition in the UK.

Better information on incidence, presenting clinical features, management and outcome of Lyme disease both in hospitals and GP services will mean that services can be tailored to suit those infected, Nice said.

It is estimated that there are 2,000 to 3,000 new cases of Lyme disease in England and Wales each year.

But Nice said this could be an underestimation because there is no requirement for GPs or hospital clinicians to report the number of cases.

A new draft guideline from Nice states: “Infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete.

“Particularly high-risk areas are the south of England and Scottish Highlands but infection can occur in many areas.”

It has also set out a series of recommendations on how the condition can be assessed and treated.

These include: diagnosing people who present with a distinctive rash – often described as looking like a bullseye on a dart board – without needing to refer them for further tests.

A typical lyme rash, spot looks like a bull’s eye ona dart board


A typical lyme rash, spot looks like a bullseye ona dart board. Photograph: anakopa/Getty Images/iStockphoto

Medics have also been urged not to rule out Lyme disease if a person who has symptoms of the disease is unsure whether they have been bitten by a tick.

Antibiotics should be used to treat the condition but if symptoms persist after treatment, a GP should consider a referral to a specialist, the guideline adds.

“Lyme disease may be difficult to diagnose as people can have common and unspecific symptoms, like a headache or fever, and they may not notice or remember a tick bite,” said Saul Faust, professor of paediatric immunology and infectious diseases at the University of Southampton.

“Our draft guidance will give GPs and hospital doctors clear advice on how to diagnose if they think Lyme disease is a possibility,” said Faust who also chairs the guideline committee.

It emerged in August that former England rugby captain Matt Dawson underwent heart surgery after being bitten by a tick in a London park.

The 44-year-old developed feverish symptoms after visiting the park early last year and was later diagnosed with Lyme disease, he told the BBC.

Dawson is now free of the disease, having undergone multiple heart operations and endured 18 months of treatment.

The bacterial infection, caused by infected ticks, can lead to conditions such as meningitis or heart failure if left untreated.

Ticks can be found in woodland and heath areas. The tiny spider-like creatures, which can carry the bacteria responsible for the disease, are found throughout the UK and in other parts of Europe and North America.

Areas known to have a particularly high population of ticks include: Exmoor, the New Forest and other rural areas of Hampshire, the South Downs, parts of Wiltshire and Berkshire, parts of Surrey and West Sussex, Thetford Forest in Norfolk, the Lake District, the North York Moors and the Scottish Highlands.

Not everyone who gets bitten by a tick will be infected with Lyme disease, as only a small proportion carry the bacteria which causes the condition.

I’m reinventing mental health care by putting patients in charge

A feeling of powerlessness dominated my experience of mental health services. And this feeling was at its worst when I was sectioned. Sectioning replicated aspects of the traumatic experience that initially caused my suicidal crisis. I felt trapped, captive and utterly out of control. I couldn’t escape. .

The limited control I had over my interactions with mental health professionals also had a negative impact on me. In the psychiatrist-patient relationship, the power lies with the psychiatrist. And in the community, mental health teams decided how often I would be seen, what kind of care I would receive and when the care would end. Each of these things made me feel vulnerable.

In the summer of 2012 I started to speak of my plans to set up Suicide Crisis, a centre to provide an alternative type of mental health care. However, many people were sceptical because I was a recently discharged psychiatric patient.

The traumatic experience I went through was profoundly damaging and distressing. Remarkably, though, I think it changed me into the kind of person who was able to overcome the many barriers to setting up the crisis service. I developed a determination and a tenacity, which I didn’t have before.

It’s entirely possible that someone can be both a psychiatric patient and a competent professional. But sometimes I’ve felt that people find this difficult to understand. In the four-and-a-half years we’ve been providing services, we’ve never had a suicide of a client under our care.

Our work has received national attention in the last 18 months. We have given oral evidence about our crisis centre to the health select committee and presented to the National Suicide Prevention Strategy Advisory Group, which is run by the government adviser on suicide. We are approached regularly by NHS professionals and commissioners, who refer to our centre as an example of best practice.

Perhaps society can start to think of people with experience of mental illness as having valuable knowledge of what works and what doesn’t, which helps them succeed in this field. There are times when my lived experience is as important as my formal training. I have a deep understanding of what it is like to be in crisis.

My experience has even helped when assessing clients’ suicide risks, as in the case of Aidan*, a patient at the centre. Aidan had been very depressed, then one day he came to his appointment with us and seemed very happy, almost euphoric. I recognised that sense of exhilaration, which a person may feel when they have made a decision to end their life, because I experienced that same euphoria myself in 2012. I recall it as a very intense experience, where all my senses were heightened. I was sure I would soon be leaving this world and could appreciate every aspect of it in what I thought were my remaining hours.

Aidan’s risk was clearly high, and we provided intensive support to ensure his survival. I immediately contacted NHS services so they could assess whether he needed to be sectioned. He wasn’t sectioned, but the NHS crisis team kept in contact with him that night.

After that, he asked us to support him and we saw him on a daily basis. We kept in regular contact with his mental health team and he continued to see them every week.

My experience of feeling disempowered when using mental health services is the reason we ensure our clients have a greater degree of control. They decide how often they see us, what kind of care they receive and when they are ready to leave us. Our male clients say they find this particularly helpful. They can feel especially vulnerable when they seek help; putting them in control helps to counteract this.

Early on we took the decision to employ an advising psychiatrist and other advising clinicians. They have expertise that we don’t. They advise us on individual client cases, which can be complex. And they helped us create links with the local mental health service.

However, the ethos of the charity and the way our service is set up and run are all from a lived experience perspective.

We are in regular contact with local mental health services because we are often helping the same people. Clients often feel able to tell us things they may not feel able to disclose to their mental health team. In such cases, we are keen to share that information, with the client’s permission.

The power balance between patients and mental health professionals has effectively been reinvented in our organisation. “You’re my boss,” our advising psychiatrist tells me. However, I prefer to see it as a levelling of power, a greater equality. We all have huge respect for each other’s different strengths and abilities. We all learn from each other.

*Identifying details have been changed

Joy Hibbins is founder and chief executive of Suicide Crisis

  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

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Women in the greatest need are being let down by a lack of local support

Nobody ever turned up to a substance misuse clinic in need of support solely for substance misuse, says Pip Williams, who spent 26 years living with alcohol and drug dependency. At the same time, she grappled with mental health issues, an abusive relationship, homelessness and periods of losing her children to care.

“When you’re a woman with multiple issues you face a choice: we have to deal with what’s killing us first – is it substance misuse or is it domestic violence,” she explains. “Support for those things can only be accessed in silos; there needs to be a place where woman can get holistic help for it all – and before they reach crisis.”

Now in recovery, Williams has gone on to found a support network for pregnant women at risk of having children with foetal alcohol spectrum disorders. She has contributed to Mapping the Maze, a report by Against Violence and Abuse (AVA) and Agenda, the alliance for women and girls at risk. The report highlights the confusing and fragmented nature of provision in local authorities across England and Wales – with some areas having a range of services for women, and others having none at all.

Gathered through FOI requests, here are some of the report’s most troubling findings:

Women are bounced between services

Only 19 out of 173 local authority areas in England and Wales have services for women that address all the following issues: substance misuse, mental health, homelessness, offending and complex needs. Nine areashad no evidence of any of these services for women whatsoever.

The vast majority of services available across England and Wales address single issues – so women are bounced between services, having to repeat their stories multiple times and are often unable to get the help they need.

Support with substance misuse isn’t tailored to women

Women make up around a third of people accessing drug treatment services – with that figure increasing to nearly 40% for alcohol services, according to the National Drug Treatment Monitoring System.

But only just shy of half of all local authority areas in England have support services specifically for women experiencing substance misuse, according to the Mapping the Maze report. In Wales only 22.7% of authorities are home to localised support of this kind.

Substance misuse midwives accounted for more than a third of substance misuse services found, feeding into a wider finding that more than a quarter of all support for women facing multiple disadvantage is for pregnant women or those with a young baby.

Women are commonly invited to join a weekly women’s group, housed within a generic substance misuse service. The report argues that this tends to be an add-on rather than at the core of formal recovery programmes, with one woman interviewed for the report saying she felt these groups were “something to tick a box rather than something [organisations] are committed to”.

The report also notes that it is disappointing that only only ten of the 129 residential rehabilitation services listed on Public Health England’s website are solely for women.

Resistance to providing gender-specific mental health support

The report notes that 104 English local authorities and five Welsh unitary authorities providesupport for women experiencing mental health problems, with the voluntary sector playing a huge role in delivering these services.

More than half (55%) of mental health support identified in the report was aimed at pregnant women and new mothers.

Anecdotally, providing gender specific support for women who don’t fall under maternity or perinatal is met with “notable resistance” from several clinical commissioning groups. A typical response was that “all commissioned services are for men and women equally”.

Donna Covey, director of AVA, would like to see a change in mindset. “We know that delivering the same service for everyone doesn’t deliver equality of outcomes,” she explains. “To be effective, services needs to be trauma-informed and women specific. Central government needs to take the lead in making sure that these women get the support they need to rebuild their lives.”

Mapping the maze

AVA and Agenda have created an interactive map, pinpointing where specialist support is available for women affected by substance use, mental ill-health, homelessness and offending. It will also help to identify gaps in provision, and both organisations are encouraging voluntary organisations, commissioners and public service professionals to use the map as a resource.

Covey says many local authority commissioners have a poor understanding of what women experiencing multiple disadvantage want and need and don’t appreciate the importance of women-specific services.

The report makes a number of recommendations for commissioners and other professionals to address this, including:

  • Speak to women with lived experience and directly involve them in the commissioning process.
  • Promote a trauma-informed culture. Recognise that many women experiencing multiple disadvantage will also have experienced gender-based violence.
  • Be gender aware – specialist services are generally more effective than generic ones – and know that provision of specialist women’s services does not breach the Equality Act 2010.
  • Build longevity and flexibility into tenders. Helping women with complex lives in unlikely to fit neatly within short-term targets.
  • Practice joint commissioning and commission across localities. Commissioners should also ask bidders to demonstrate how they will ensure ease of access to services.

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Why we are hard wired to watch pornography | Daniel Glaser

The launch of David Simon’s new series The Deuce (starting on 26 September), has thrust pornography back into the spotlight. One of the most famous neuroscientific discoveries of the last decade probably plays a role.

This is the finding of a ‘mirror neuron’ in the cortex of a macaque monkey, so named because it fires both when the monkey sees an action and when it performs it – ‘mirroring’ behaviour it witnesses.

Cells in the human brain have been shown to exhibit similar behaviour. Dancers use their knowledge of movement to help them see it: to understand and enjoy it more. The implications for pornography are clear. Without such a system in the brain, explaining why people find watching sex arousing is difficult.

There have been a few studies demonstrating a correlation between mirror-system activation and erections in men, but it’s largely escaped systematic study. It’s hard to believe that this use has evolutionary significance, although some studies have shown that male monkeys will give up a certain amount of fruit juice to look at pictures of female monkeys’ bottoms.

Dr Daniel Glaser is director of Science Gallery at King’s College London

Working to prevent avoidable sight loss | Letters

The 250 people who will start to lose their sight today (Specsavers/RNIB figures) may never know that half of all sight loss is avoidable. National Eye Health Week (18-24 September) aims to address this by promoting regular eye tests for everyone, including those with good vision.

Recent research by the British Ophthalmological Surveillance Unit found that patients are suffering permanent and severe visual loss due to health service delays. Accordingly, until 29 September, an all-party parliamentary group on eye health and visual impairment has asked for evidence from interested parties including patients and families about how best to address the issue of overstretched NHS eye clinics.

The most common cause of blindness in the UK is age-related macular degeneration (AMD), which isolates and handicaps many thousands of sufferers. Yet I, and many others, have had very successful treatment for dry AMD, contrary to recent media reports discrediting the Hubble or EyeMax implants, currently being submitted to Nice for approval. If adopted, this would be the first NHS operation capable of helping all stages of AMD through a fast, painless procedure similar to a normal cataract operation.
Elizabeth Lenton (retired GP)
Plymouth

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Mental health trust pays damages over man’s death in tower block fire

A mental health trust has paid out damages over the case of a man with bipolar disorder and a history of lighting fires who was trapped in a blaze at his cluttered tower block flat.

Bob Crane, 61, a well-known character in the Stokes Croft area of Bristol, had been cooking on open fires at his seventh-floor council flat for more than a year because his electricity had been cut off.

Concerns were repeatedly raised that Crane was putting himself and his neighbours at risk, but he died of smoke inhalation and carbon monoxide poisoning after his cooking fire got out of control.

Crane’s son, Alex, told the Guardian his father was treated as an antisocial nuisance rather than a vulnerable man with a serious untreated mental illness, and criticised agencies involved for failing to work in a joined-up way to keep him and other residents safe.

He said: “No one was prepared to take the lead. There was no coordinated effort. It was all very haphazard though it should have been obvious there was a serious danger to life. Too many heads were buried in the sand. It was all but inevitable that my dad would die in a fire, and it is a miracle that no one else was killed.”

Alex, an English teacher now living in Vietnam, said he had tried to look after his father. He said: “My dad and I were very close. I looked after him for my whole adult life until the strain became too much and I placed my trust in the Avon and Wiltshire mental health partnership (AWP) and Bristol city council to keep him safe.”

Crane was diagnosed with bipolar disorder in 1985 and was detained under the Mental Health Act on a number of occasions. In 2012 Crane stopped taking medication and, because he refused to acknowledge he was ill and rejected help, was discharged from mental health services.

In May 2013 the electricity supply to Crane’s flat was cut off and he began to light fires to cook and heat water. Firefighters were called four times to reports of smoke and flames at the flat.

Crane was served with an injunction prohibiting him from lighting fires in or near his tower block, Carolina House, in June 2014. He did not stop and the following month a nurse who had visited wrote that his flat was a “major fire hazard” and if there was a blaze there was a “high risk” he and his neighbours would not be able to escape.

A mural that appeared in Stokes Croft that was dedicated to Bob Crane.
A mural dedicated to Bob Crane that appeared in Stokes Croft. Photograph: Steve Morris for the Guardian

Crane died following a fire in September 2014. A report from the fire and rescue service concluded: “The most probable cause was the deliberate ignition of flammable materials such as paper or wood for the purpose of cooking or heating water.”

An inquest ruled that Crane’s death was accidental and a serious case review that investigated how agencies including AWP and the city council handled the case raised concerns about joint working practices. It said there had been a failure to understand that Crane’s antisocial behaviour was a symptom of the deterioration of his mental health.

Alex Crane brought a claim for damages against AWP and the city council, arguing they had violated his father’s right to life under the European convention on human rights. While not accepting that it was liable or negligent, AWP settled and the claim against the council has been discontinued.

Alex Crane said his father was an eccentric but well-liked character in Stokes Croft, a neighbourhood famed across the globe for its street art. Three murals appeared in the neighbourhood dedicated to Crane following the fatal fire.

He said: “My dad was a very interesting character, outgoing and sociable. He made everyone laugh and he had lots of friends. He also had an anti-authoritarian streak, which sometimes ended in confrontation with people he perceived to be the establishment.”

Alex Crane said he did not believe professionals understood his father’s illness. “He always presented as articulate even when he was completely out of touch with reality.”

He also expressed concern at the funding available for mental health services. “There is a shameful lack of resources. I’ve been involved in this [his father’s case] since I was 13 and I’ve seen mental health services get considerably worse. The availability of beds, of time with professionals has gone down and down.

“Ultimately, my dad’s case illustrates the dangers of expecting under-funded, under-trained and under-staffed public services to care for mentally ill people in the community.”

Alex Crane’s lawyer, Gus Silverman, of solicitors Irwin Mitchell, said more should have been done to help Crane. He said: “It is extremely concerning that Bob was allowed to continue living on the seventh floor of a high-rise block when the authorities knew that he was regularly lighting fires, living without electricity and suffering from a serious untreated mental illness.”

A spokesperson for AWP said: “Although the trust was not liable or negligent we made a financial settlement. This was a complex issue involving multiple agencies and after taking legal advice and considering a range of factors we determined that a payment with no admission of liability would be the best outcome for the taxpayer.

“We would like to reiterate our condolences to the family and friends of Mr Crane for their loss.”

A Bristol city council spokesperson said: “We were extremely saddened and concerned about Mr Crane’s death. This tragic incident resulted in a review of our practices and we worked closely with the Bristol safeguarding adults board to help develop a new policy around self-neglect, which all partners now follow.”

Body’s ‘bad fat’ could be altered to combat obesity, say scientists

“Bad fat” could be made to turn over a new leaf and combat obesity by blocking a specific protein, scientists have discovered.

Most fat in the body is unhealthy “white” tissue deposited around the waist, hips and thighs. But smaller amounts of energy-hungry “brown” fat are also found around the neck and shoulders. Brown fat generates heat by burning up excess calories.

Now scientists experimenting on lab mice have found a way to transform white fat into “beige” fat – a healthier halfway stage also capable of reducing weight gain.

Dr Irfan Lodhi, from Washington University School of Medicine in the US, said: “Our goal is to find a way to treat or prevent obesity. “Our research suggests that by targeting a protein in white fat, we can convert bad fat into a type of fat that fights obesity.”

Beige fat was discovered in adults in 2015 and shown to function in a similar way to brown fat. Lodhi’s team found that blocking a protein called PexRAP caused white fat in mice to be converted to beige fat that burned calories.

The discovery, published in the journal Cell Reports, raises the prospect of more effective treatments for obesity and diabetes. The next step will be to find a safe way of blocking PexRAP in white fat cells in humans.

Lodhi said: “The challenge will be finding safe ways to do that without causing a person to overheat or develop a fever, but drug developers now have a good target.”