Category Archives: Stress Management

UK’s new air pollution strategy ‘hugely disappointing’, says Labour

A new clean air strategy published by the UK government has been criticised as “hugely disappointing” by the Labour party. Other groups said it did little to tackle the dirty diesel vehicles that are the main source of toxic air in urban areas.

The new strategy, announced on Tuesday by environment secretary, Michael Gove, aims to crack down on a wide range of pollutants. These include particulates from wet wood and coal burning in homes, ammonia emissions from farms and dust from vehicle tyres and brakes.

Ministers also want to give provide personalised pollution alerts to people and give local authorities new powers to cut pollution, all subject to public consultation.

The government said the new action would reduce the costs of air pollution to society by an estimated £1bn every year by 2020. The health costs of toxic air are currently estimated at £20bn a year, by the Royal College of Physicians and the Royal College of Paediatrics and Child Health.

The new clean air strategy is a response to an EU directive on cutting harmful emissions. An air quality plan, published in July 2017, is related to a separate EU directive on cleaner air. The latter plan was condemned as “woefully inadequate” by city leaders and “inexcusable” by doctors, and was ruled illegally poor in February, the third such high court defeat for ministers.

On Thursday, the government suffered another legal blow, with the UK referred to Europe’s highest court over its failure to tackle nitrogen dioxide pollution, which mostly comes from diesel vehicles.

Gove said: “Air quality has improved significantly since 2010 but 60 years on from the historic Clean Air Act a clear truth remains – air pollution is making people ill, shortening lives and damaging our economy and environment.

“This is why we are launching this clean air strategy, backed up with new primary legislation,” he said. “It sets out the comprehensive action required across all parts of government to improve air quality.”

The health secretary, Jeremy Hunt, said: “Air pollution is contributing to a national health crisis. We have a responsibility to stop this issue at source. Today’s [strategy] does just that, taking a giant step towards cleaning up our air for good.”

However, Sue Hayman, the shadow environment secretary, said: “It’s hugely disappointing that despite being dragged through the courts time and again on its inadequate air quality plans, the government is dragging its feet by announcing yet another consultation.” She said Gove had issued more than 25 consultations since the 2017 general election, but none had yet produced new laws.

James Thornton, the CEO of the environmental lawyers ClientEarth who have defeated ministers three times in court, said: “Road transport is still the main source of illegal air pollution in our towns and cities. We need a national network of clean air zones (CAZs) to take the most polluting vehicles out of the most polluted areas.”

The government’s own research shows CAZs, in which cars are deterred from city centres by pollution charges, are by far the most effective solution to air pollution. But ministers refused to make them compulsory, instead making them a voluntary and last-resort option for local authorities.

Greenpeace and the British Lung Foundation both backed the call for CAZs. Paul Morozzo, at Greenpeace, also said proposed new powers for local government looked like ministers passing the buck: “It looks like local authorities are being handed responsibility without the clarity on where the resources will come from.”

Details of the government’s new proposals were not available. But on domestic wood and coal burning it said it would legislate to ensure “only the cleanest domestic fuels” will be on sale. This may include wood bearing the “Ready to Burn” logo which indicates low moisture content. Wood and coal burning in homes contributes almost 40% of emissions of small particulate pollution, PM2.5, which is especially damaging to health.

Ammonia from manure and fertilisers on fields blows into cities and is a significant contributor to particle pollution. Ministers want to require farmers to invest in better slurry control and fertiliser application, perhaps supported by grants from a revised farm subsidy scheme.

Particulate pollution is below EU limits in most parts of the UK, but it is above the stricter World Health Organization limits for 90% of the population. The government has now set a goal to halve the number of people living in such areas by 2025. Another action to help achieve this is “working with international partners to research and develop new standards” for tyres and brakes that shed fewer particles.

Poorest and brightest girls more likely to be depressed – UK study

Brighter girls and girls from poorer families are more likely to be depressed by the time they enter adolescence, according to a study triggering fresh concern about soaring rates of teenage mental illness.

The government-funded research identified the two groups as being most at risk of displaying high symptoms of depression at the age of 14. In contrast, more intelligent boys and boys from the most deprived backgrounds appear not to suffer from the mental troubles that affect their female peers, the academics discovered.

The findings are based on detailed questionnaires filled in by 9,553 boys and girls aged 14 across the UK as part of the Millennium Cohort Study (MCS), which is tracking the progress of people born in 2000 into adulthood.

They add to growing evidence that teenage girls are particularly vulnerable to mental health difficulties. NHS figures show there were sharp increases between 2005/06 and 2015/16 in the number of girls under 18 admitted to hospital in England because they had self-harmed by cutting (up 285%), poisoning (42%) or hanging themselves (331%).

The researchers, led by Dr Praveetha Patalay, also found that being overweight, a history of being bullied and not getting on with peers were the three most common causes of depression in boys and girls aged 14. Their previous finding, that 24% of 14-year-old girls and 9% of boys that age were depressed, stirred widespread debate last year.

Dr Nihara Krause, a consultant clinical psychologist, said the findings about brighter and poorer girls were worrying, given the known links between depression and self-harm, and self-harm and risk of suicide.

“Some children who are depressed will self-harm. Some people say that physical pain is easier to tolerate than emotional pain,” she said. “What’s very concerning, in those who are depressed, is the link with suicide, because more and more studies show that self-harm is a predictor of suicide. Someone who self-harms is more likely to try to take their own life, especially if they are depressed. So these new findings are a concern from that point of view.”

Patalay said girls from families in the bottom two quintiles of household income were 7.5% more likely to be depressed at 14 than girls from the highest income families, but the same pattern was not found in boys.

Cleverer girls also had a significantly higher risk of having high depressive symptoms at 14, she said, and she was doing further research to calculate that risk more precisely among those with “higher childhood cognitive scores”.

Krause said: “Part of it could be that [brighter girls] have a ‘hyper brain’, a more active brain, which often means they have a much higher emotional reaction to things and they are constantly overthinking things.

“For example, if there’s a friendship situation that might be a concern to them, children of higher intelligence might think about all sorts of reasons why this situation has developed and get stressed about it.”

She pinpointed pressure on children to succeed at school – from their parents, schools and themselves – and competition for university places and jobs as a key cause of anxiety and depression in teenagers. In addition, some bright pupils are pushed too much, and those children can develop academically but be less adept at forming friendships, she suggested.

Children of either sex who have been bullied are 5.5% more likely to be depressed at 14, and boys or girls who do not get on well with their peers are 1.5% more likely to exhibit depressive symptoms.

The researchers also found that overweight boys and girls were 5% more likely to be depressed. This has prompted speculation as to whether the huge recent increase in childhood obesity is helping to drive what experts say is a growing mental health crisis in young people.

“We found a substantial link between being overweight and being depressed. Rates of overweight and mental ill-health are increasing in childhood, and they both have enormous consequences through our lives. Tackling these two health issues should be a public health priority,” Patalay said.

Emla Fitzsimons, a co-author of the findings and director of the MCS, said: “The study highlights a sharp increase in mental health problems among girls between ages 11 and 14. We certainly need to be looking at how the use of social media and cyberbullying may affect girls and boys differently.”

Dr Nick Waggett, chief executive of the Association of Child Psychotherapists, said it was unhelpful to highlight bright or poor girls as being at particular risk “when we already now there is a significant burden of mental illness in children and young people, including adolescent girls, and that there is a substantial shortfall in specialist services for them.”

Claire Murdoch, NHS England’s national mental health director, said: “After decades in the shadows, children’s mental health is finally in the spotlight, with more young people seeking help and years of unmet need being addressed. The NHS has responded, with 70,000 more young people set to get help, £1.4bn of extra funding and eating disorder and perinatal mental health services covering the whole country.

“But if the NHS is to meet fully the scale of the challenge then government, schools and councils need to work with us and our patients over the long-term.”

I wanted to find out how my baby died. Instead I got dishonesty and hostility | James Titcombe

In November 2008 my nine-day-old son, Joshua, died in truly terrible circumstances, as a consequence of failures in his care at Furness general hospital, part of the University Hospitals of Morecambe Bay NHS foundation trust. Joshua’s death instantly turned my life upside down. But as I began to seek answers as to what exactly happened and why, nothing could have prepared me for the years of dishonesty, obfuscation and, at times, outright hostility that followed.

Critical records of Joshua’s care went missing, statements from staff were dishonest, investigations were superficial, the organisations that should have been taking action to ensure the maternity services at Morecambe Bay were safe instead acted to reassure each other that everything was OK.

In March 2015 an independent investigation, chaired by Dr Bill Kirkup, was published. The report found that there was a “lethal mix” of failures at the maternity unit where Joshua was born. The first opportunity the trust had to identify that things were starting to go badly wrong was the tragic death of a baby girl in 2004, yet this was effectively covered up. The family weren’t told the truth, and unsafe care at the unit continued. Between 2004 and 2013, 11 babies and one mother died avoidably.

Throughout this period, the Nursing and Midwifery Council (NMC), the regulator responsible for protecting the public by ensuring nurses and midwifes practise safely, appeared to take little action. In relation to Joshua’s care, the last hearings only took place in 2017, some eight years after Joshua’s death. Yesterday, a long awaited report from the Professional Standards Authority (PSA) finally provided some answers as to why. The report makes difficult and sad reading for me [full report here].

The PSA describes concerns about the evidence it was able to obtain from the NMC to assist its review. We are told that the standard of record-keeping was “very poor”, and that information relevant to the review wasn’t included in the NMC’s case files. The report recounts in heartbreaking detail the experience of many Morecambe Bay families who contacted the NMC. A clear pattern emerges of an organisation placing little onus on what these families were saying, and in some cases simply dismissing people’s concerns with little or no consideration.

In April 2012, Cumbria police met the NMC to given them a detailed list of cases at Furness general hospital about which they had significant worries. But the NMC took no action “for almost two years”. While this was ongoing, midwives under investigation continued to practise, and in some cases were involved in subsequent serious incidents involving avoidable harm and death.

It would be unrealistic to expect any large and complex organisation to get everything right all of the time, but any organisation with such an important public protection role must be open and transparent when things go wrong, so that the organisation can learn and improve and maintain public confidence and trust.

But the report highlights the continued failure of the NMC to be open, honest and transparent about its own actions, pointing to its misleading responses to families and the secretary of state, its failure to disclose external reports looking at learning from cases, and its failure to be open and transparent with information requests.

These are damning conclusions, and highlight an urgent need for change in the leadership and culture of the organisation.

But the response from the NMC this week can only be described as woefully inadequate. On Monday, Jackie Smith, the chief executive, announced her resignation but in doing so made no mention of the problems highlighted by the report, and instead spoke of her pride in all that the NMC had achieved. On Wednesday, the NMC did not put forward a single person to respond to media interview requests. There were, however, dozens of retweeted positive messages about the former chief executive on her own Twitter feed.

In addition, along with other families, I have received an impersonal and hollow letter from the NMC, along with some emails that the NMC should have disclosed to me following a personal data request from me (which they spent £240,000 responding to), but didn’t. One of the emails was between two NMC staff discussing visiting me in Cumbria in 2016 to take a statement about Joshua’s death. Upon seeing my surname the first person writes: “Is it wrong that my default position was to snigger at that name?”; “It’s not wrong it’s totally appropriate,” came the response.

These comments are puerile and silly, but also indicative of an organisational culture that has lost sight of its purpose, and the patients, mothers and babies it exists to protect.

The culture of an organisation stems from the action and behaviour of the people at the top. The response from the NMC so far, highlights an urgent and pressing need for change so it can properly do its job of protecting patients.

James Titcombe works for Patient Safety Learning

Bev Humphrey: ‘The underfunding of the NHS is almost conspiratorial’

Mental health has a hell of a lot to teach the acute sector,” says Bev Humphrey, the outgoing chief executive of the Greater Manchester mental health NHS foundation trust. “It needs to sit up and listen.”

Humphrey believes that truly integrated mental health teams – involving psychiatrists, psychologists, mental health nurses, social workers, speech therapists, occupational therapists and dietitians – that provide services around the clock are the way forward across the NHS. “We have crisis intervention teams working 24/7, helping to reduce the pressure on inpatient beds. If you had that for older people, you would have fewer emergency admissions to hospital.”

Although Humphrey wants more integration on the frontline, she does not think that health and social care organisations should merge. “What makes me incredibly nervous is any talk about integrating commissioning and funding of services,” she says. “If the funding is shared between clinical commissioning groups and local authorities – when I see that those same local authorities have had to decimate their adult and children’s social care services due to cuts – why would I want to merge? It would be like getting into bed with a bankrupt brother.”

Humphrey is particularly scathing about how council cuts are impacting on substance misuse services. “In the north-west, alone, we have seen cuts of 30%-40% to addiction services in the last five years,” she says. “Services are tendered every three years on a hamster-wheel basis. Treating addiction is very complex – it relies on good relationships with health, prisons, the police, housing, social services, the voluntary sector and schools. They take time to build up. When services are re-tendered it can smash those relationships.”

Humphrey also worries about the state of mental health services in prisons. “The way they have been procured by NHS England is woeful,” she says. “They need to be much more strategically planned. But there is no joined-up strategy across the NHS and the criminal justice sector. Prison health services need to be intelligently commissioned and not procured in the same way as the NHS buys office pens. And commissioners need to stop taking money out of these services.”

Much of the pressure on mental health services is exacerbated by charities going under, says Humphrey. “An awful lot of voluntary organisations locally have gone to the wire or had their grants cut.” So, GMMH has introduced a wellbeing fund, which gives £500,000 a year to community groups to run local mental health and substance misuse projects in Manchester.

Humphrey leaves GMMH after steering its creation in January 2017, when Greater Manchester West mental health NHS foundation trust, where she was chief executive, took over Manchester mental health and social care trust, which had provided community and inpatient services in the city centre. Her responsibilities and budget almost doubled to nearly 5,000 staff and an income of £300m. Earlier this year, the new trust’s leadership was rated “outstanding”, along with its substance misuse services, by inspectors for the Care Quality Commission. Overall, it rated GMMH as “good” overall, with substance misuse services and the trust’s leadership deemed “outstanding”. And t. Three-quarters of patients with a first episode of psychosis begin treatment within two weeks, well above the target of 50%. Waiting times from referral to treatment are coming down, although they are some way off hitting national targets. There have also been financial improvements. “We have saved £3.2m in management and corporate function costs in one year, and these savings are being directly reinvested in frontline staff such as community psychiatric nurses, psychologists and social workers,” she says.

Humphrey, 57, has enjoyed a 35‑year career in the NHS after developing a keen interest as a teenager when she spent a lot of time doing her homework in hospital corridors while her mother was ill. She got a place on the NHS graduate training scheme and never looked back. “I did everything from working in the hospital laundry to assisting with hip replacements in theatres. It teaches you how complex the NHS is and how interdependent everything is. I was hooked.”

Humphrey believes the health service is now close to breaking point and that government policy is to blame. “The chronic underfunding of the NHS is almost conspiratorial,” she says. “The way it has been starved of money for the last seven years is scandalous. We haven’t got to this decade to find everyone is suddenly iller. I fear the government will turn around in a few years and say, ‘Look, we have given you money and it hasn’t worked – we need a new system.’ I am concerned this would lead to a compulsory insurance model.” It would create a two-tier system, she feels. “The NHS is not only a very efficient service, it’s also clinically excellent. If we move away from that [a service that is free at the point of need] there’s no going back. What you would end up with is very poor quality services for the poorest and those who need it most.”

Humphrey is clear that improving recruitment and retention of employees is critical to GMMH’s success. She has voluntarily introduced the living wage, the first NHS organisation in the north-west to do so. All staff earn at least £8.75 an hour. The move has seen pay rises for 522 staff, including the trust’s nursing assistants, healthcare support workers, porters, receptionists, drivers and administrative staff. “It was a no-brainer,” says Humphrey. Introducing the living wage cost around £2m. “I took quite a lot of flak for that, but we had healthcare assistants in secure mental health units being paid less than they could earn at Tesco. I was clear – how could we afford not to do it? Not paying the living wage would have been unethical.”

Curriculum vitae

Age: 57.

Family: Married, with one daughter from a previous marriage and two stepdaughters.

Lives: Barrowford, Lancashire.

Education: Holly Lodge comprehensive school, Liverpool; University of Liverpool (BA literature and language); University of Manchester (MA economics).

Career: 2017-18: chief executive, Greater Manchester mental health NHS foundation trust; 2006-17: chief executive, Greater Manchester West mental health NHS foundation trust; 2004-06: chief executive, the Walton Centre NHS trust for neurosciences; 2002-04: director of performance, Cumbria and Lancashire strategic health authority; 2000-02: director of specialist services commissioning, Lancashire and South Cumbria; 1995-2000: director of strategic planning and commissioning, East Lancashire health authority; 1992-95: director of planning and contracting, East Lancashire health authority; 1991-92: children’s services manager, Burnley health care NHS trust; 1988-91: district services manager, Burnley, Pendle and Rossendale health authority; 1985-88: deputy hospital manager, St John’s hospital, Chelmsford; 1983-85: national management trainee, Mersey regional health authority.

Interests: Mountaineering, fell-walking, photography, swimming, poetry.

Failure to act against ‘dangerous’ midwives resulted in deaths – report

Babies and mothers died after a health regulator failed to act against midwives suspected of providing dangerously poor care, despite the police raising concerns about their conduct, a damning report has concluded.

The Nursing and Midwifery Council (NMC) did nothing for two years about information supplied by Cumbria police on maternity staff at Furness general hospital, an inquiry found.

The NMC’s failure to instigate disciplinary proceedings against midwives at the hospital allowed them to carry on practising when they represented a danger to pregnant women and their offspring, according to the Professional Standards Authority (PSA).

Up to 19 babies and mothers died at the hospital between 2004 and 2012 as a result of mistakes by staff of its maternity unit, in one of the biggest patient care scandals involving an NHS trust in England.

A previous inquiry into the deaths concluded that 13 of the infants and women would have lived if they had received better care. The scandal involved six neonatal deaths, 10 stillbirths and three deaths of mothers at the hospital, which is one of five run by Morecambe Bay hospitals NHS foundation trust.

The PSA’s review of the NMC’s handling of the scandal was commissioned by the health secretary, Jeremy Hunt. Cumbria police told the review: “We were really concerned that reports of the same midwives [of whom] we had the cases sitting in front of us were still practising at the hospital.”

The PSA, which supervises medical regulators, found that the NMC was not prompted to do anything by the police reports, despite their seriousness.

“In our view there was scope for the NMC to investigate the wider fitness to practise of the midwives concerned and the police expected them to do so at the time the information was sent,” the 80-page report says. “We saw no evidence that the NMC considered doing so. This was an opportunity missed, given that some of the midwives identified by the police were subsequently involved in adverse events at [Furness general hospital].”

The NMC has admitted that its handling of cases involving midwives from the trust was unacceptable and has said it is “truly sorry”. Jackie Smith, the regulator’s chief executive since 2012, announced her resignation on Monday.

Bill Kirkup, who led the inquiry into the scandal that reported in 2015, has criticised the NMC’s “lamentable failure” over its decision to clear two midwives of misconduct relating to the death in 2008 of Joshua Titcombe. He died nine days after his birth after midwives failed to spot he had a serious infection.

In a scathing joint statement, Joshua’s father, James Titcombe, and two other bereaved parents, Liza Brady and Carl Hendrickson, said the report exposed “the truly shocking scale of the NMC’s failure to respond properly to the serious concerns and detailed information provided to them”.

They said: “We were particularly horrified that even when Cumbria police directly raised significant issues, the NMC effectively ignored the information for almost two years. Whilst this was going on, serious incidents involving registrants [midwives] under investigation continued, meaning lives were undoubtedly put at risk. Avoidable tragedies continued to happen that could well have been prevented.”

They also slated the NMC for being “defensive, legalistic and in some cases grossly misleading in their responses to families and others” and for its “culture of denial and reputational management”.

The PSA’s report also reveals that the NMC mishandled its dealings with bereaved families, had very poor record-keeping and did not pass on to the PSA material that the latter’s inquiry team then found elsewhere.

Smith, the outgoing chief executive, said: “Since 2014 we’ve made significant changes to improve the way we work and as the report recognises, we’re now a very different organisation. The changes we’ve made put vulnerable witnesses and families affected by failings in care at the heart of our work. But we know that there is much more to do.”

Failure to act against ‘dangerous’ midwives resulted in deaths – report

Babies and mothers died after a health regulator failed to act against midwives suspected of providing dangerously poor care, despite the police raising concerns about their conduct, a damning report has concluded.

The Nursing and Midwifery Council (NMC) did nothing for two years about information supplied by Cumbria police on maternity staff at Furness general hospital, an inquiry found.

The NMC’s failure to instigate disciplinary proceedings against midwives at the hospital allowed them to carry on practising when they represented a danger to pregnant women and their offspring, according to the Professional Standards Authority (PSA).

Up to 19 babies and mothers died at the hospital between 2004 and 2012 as a result of mistakes by staff of its maternity unit, in one of the biggest patient care scandals involving an NHS trust in England.

A previous inquiry into the deaths concluded that 13 of the infants and women would have lived if they had received better care. The scandal involved six neonatal deaths, 10 stillbirths and three deaths of mothers at the hospital, which is one of five run by Morecambe Bay hospitals NHS foundation trust.

The PSA’s review of the NMC’s handling of the scandal was commissioned by the health secretary, Jeremy Hunt. Cumbria police told the review: “We were really concerned that reports of the same midwives [of whom] we had the cases sitting in front of us were still practising at the hospital.”

The PSA, which supervises medical regulators, found that the NMC was not prompted to do anything by the police reports, despite their seriousness.

“In our view there was scope for the NMC to investigate the wider fitness to practise of the midwives concerned and the police expected them to do so at the time the information was sent,” the 80-page report says. “We saw no evidence that the NMC considered doing so. This was an opportunity missed, given that some of the midwives identified by the police were subsequently involved in adverse events at [Furness general hospital].”

The NMC has admitted that its handling of cases involving midwives from the trust was unacceptable and has said it is “truly sorry”. Jackie Smith, the regulator’s chief executive since 2012, announced her resignation on Monday.

Bill Kirkup, who led the inquiry into the scandal that reported in 2015, has criticised the NMC’s “lamentable failure” over its decision to clear two midwives of misconduct relating to the death in 2008 of Joshua Titcombe. He died nine days after his birth after midwives failed to spot he had a serious infection.

In a scathing joint statement, Joshua’s father, James Titcombe, and two other bereaved parents, Liza Brady and Carl Hendrickson, said the report exposed “the truly shocking scale of the NMC’s failure to respond properly to the serious concerns and detailed information provided to them”.

They said: “We were particularly horrified that even when Cumbria police directly raised significant issues, the NMC effectively ignored the information for almost two years. Whilst this was going on, serious incidents involving registrants [midwives] under investigation continued, meaning lives were undoubtedly put at risk. Avoidable tragedies continued to happen that could well have been prevented.”

They also slated the NMC for being “defensive, legalistic and in some cases grossly misleading in their responses to families and others” and for its “culture of denial and reputational management”.

The PSA’s report also reveals that the NMC mishandled its dealings with bereaved families, had very poor record-keeping and did not pass on to the PSA material that the latter’s inquiry team then found elsewhere.

Smith, the outgoing chief executive, said: “Since 2014 we’ve made significant changes to improve the way we work and as the report recognises, we’re now a very different organisation. The changes we’ve made put vulnerable witnesses and families affected by failings in care at the heart of our work. But we know that there is much more to do.”

Nurses falling ill after inhaling spice fumes in prisons, says union

Nurses treating prisoners who have fallen ill after smoking the psychoactive drug spice are suffering adverse effects to their own health after inhaling fumes, the nursing union has said.

The Royal College of Nursing (RCN) says that under current guidance its members are expected to enter cells before smoke has cleared. As a result they are reporting to the union that they are suffering the effects of inhaling the substance for hours following exposure, with some unable to drive home after their shift, it says.

In at least one case, a nurse was taken to A&E by ambulance after being knocked unconscious by the psychoactive fumes.

One nurse, speaking on condition of anonymity, said: “Recently we’ve had to give medical care to over 50 people [who have been smoking spice] in one week. Walking back after attending to a patient, I’ve suddenly felt dizzy, nauseous – it’s almost like the world has zoomed out.

“It’s really bizarre. I’ve sat in my car in the carpark for 50 minutes after work so I feel confident enough to drive. We’re all worried about driving in case it’s not safe or we get stopped and it shows in our system.”

Use of psychoactive substances is widespread in UK jails and the Prison Officers Association has previously warned about the impact on its members. Last month, Tees, Esk & Wear Valleys NHS foundation trust withdrew nursing staff from Holme House prison in County Durham due to the risk posed by spice.

The RCN has written to the head of the prison service (HMPPS) demanding more is done to protect nurses from the effects of the drug.

Janet Davies, the RCN chief executive and general secretary, said: “As dedicated health professionals, prison nursing staff are expected to offer high quality care, but they should not be expected to put their own wellbeing on the line to deliver it.”

The union argues that HMPPS guidance fails to distinguish between the longer-term issue of secondhand tobacco smoke and the “serious and acute issue” of exposure to spice.

The guidance also outlines a duty “to intervene to protect a prisoner(s) or member of staff in danger of immediate harm in a cell where smoke or fumes has not yet cleared”.

The RCN says such a requirement is unacceptable for healthcare staff, given that emergency responders are advised, under Resuscitation Council guidelines, to ensure their own safety before treating casualties.

NHS spends almost £1.5bn a year on temporary nursing staff – report

The NHS is spending almost £1.5bn a year on temporary nursing staff to cope with shortages, research has found.

The NHS has a shortfall of 40,000 nurses in England, according to the Royal College of Nursing. A report from the Open University, Tackling the nursing shortage, argues that the £1.46bn being spent on temporary staffing to plug the gaps could pay for 66,000 qualified registered nurses.

NHS trusts paid for an additional 79m hours of registered nurses’ time at a premium rate in 2017, which is 61% above the hourly rate of a newly qualified registered nurse in full-time employment. If existing gaps were permanently filled, trusts could save as much as £560m a year, the report states.

“Relying on temporary nurses to plug gaps is just sticking a plaster over the problem, and costs considerably more than if vacancies were filled permanently,” said Jan Draper, professor of nursing at the Open University.

“The sector is facing challenging times. We know that poor retention and low recruitment results in inefficiencies and ultimately puts patient care at risk, so it’s vital that we look to a more strategic and sustainable approach.”

Janet Davies, general secretary of the Royal College of Nursing, said the report exposed the “utter false economy” in NHS staffing. “Short-sightedness in recent years has left tens of thousands of unfilled nurse jobs, to the severe detriment of patient care,” she said.

“Workforce planning has been ineffective and dictated by the state of finances, not the needs of patients. It is further proof that cost-cutting plans saved no money at all and – instead – increased agency costs, recruitment fees and the sickness absence bill through rising stress.”

Retention of nursing staff has become a significant problem for the NHS. Seven in 10 newly qualified nurses quit their NHS trust within a year of qualification, with some moving to other trusts away from where they trained.

The study found 34% of registered nurses were unhappy in their role, with 35% thinking of leaving their job if things did not improve. Meanwhile, the number of applications to study nursing at university have fallen by about a third since the introduction of student loans for nursing degrees, said the report.

The Brexit vote has also contributed to a growing recruitment crisis. Since the referendum there has been a 28% increase in the number of EU nurses leaving Britain, which could exacerbate the problem, said the report. Overseas applications for nursing roles has fallen by 87% in the past 12 months.

The study suggests that offering more flexible training, including distance learning, could help the problem, and urges a more consistent use of newly introduced degree apprenticeships.

Action, not more reports, needed to tackle student mental health | Ketters

The Universities UK report Minding Our Future highlights what those of us who work with students have known for many years (Call for urgent action to improve mental health services for students, 11 May). Mental health services are not integrated, and they do not always follow the person if he or she relocates, assuming that services are available for younger people and that they are able to access them. 

Governments of all political persuasion express their commitment to reform, and their deep regret and sorrow when life is lost, or serious harm occurs. Such expressions are of little if any comfort to those in need of support and services. Nor do they provide any strength to families and friends who lose loved ones. At what point did we decide that support for vulnerable young people was not a priority? When did we decide that the politics of austerity and outsourcing were more important than their lives and wellbeing?

Please, no more reports telling us what we already know. As the fifth strongest economy in the world, the provision of well-funded, integrated and personalised mental health support services for all generations is achievable. Until we commit to such a policy, we will continue to read tragic stories of suicide and self-harm.
Professor John Williams
Professor of law, Aberystwyth University

Your report rightly draws attention to the enormous problem of providing appropriate support to students experiencing periods of mental distress. I ask myself: “What happened?” In 1999, when I worked in HE, the heads of university counselling services produced the report Degrees of Disturbance: the new agenda; the impact of increasing levels of psychological disturbance among students in higher education, which was taken very seriously by the Committee of Vice-chancellors and Principals (now Universities UK).

The report addressed the very same issues as Minding Our Future. Many institutions took this seriously. They introduced mental health awareness training for staff at all levels and recommended urgent expansion of counselling and support services. I was involved at the Open University in developing and delivering some of this training over the following few years. Last week’s report makes depressing reading. Things seemed to be improving at the beginning of the century. The deterioration in student support services must reflect the massive change in social priorities that has occurred, alongside huge financial austerity pressures on education, health and social services, under the Tory governments since 2010. There is an urgent need to halt the damage.
Chris Youle
Winchester

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Action, not more reports, needed to tackle student mental health | Ketters

The Universities UK report Minding Our Future highlights what those of us who work with students have known for many years (Call for urgent action to improve mental health services for students, 11 May). Mental health services are not integrated, and they do not always follow the person if he or she relocates, assuming that services are available for younger people and that they are able to access them. 

Governments of all political persuasion express their commitment to reform, and their deep regret and sorrow when life is lost, or serious harm occurs. Such expressions are of little if any comfort to those in need of support and services. Nor do they provide any strength to families and friends who lose loved ones. At what point did we decide that support for vulnerable young people was not a priority? When did we decide that the politics of austerity and outsourcing were more important than their lives and wellbeing?

Please, no more reports telling us what we already know. As the fifth strongest economy in the world, the provision of well-funded, integrated and personalised mental health support services for all generations is achievable. Until we commit to such a policy, we will continue to read tragic stories of suicide and self-harm.
Professor John Williams
Professor of law, Aberystwyth University

Your report rightly draws attention to the enormous problem of providing appropriate support to students experiencing periods of mental distress. I ask myself: “What happened?” In 1999, when I worked in HE, the heads of university counselling services produced the report Degrees of Disturbance: the new agenda; the impact of increasing levels of psychological disturbance among students in higher education, which was taken very seriously by the Committee of Vice-chancellors and Principals (now Universities UK).

The report addressed the very same issues as Minding Our Future. Many institutions took this seriously. They introduced mental health awareness training for staff at all levels and recommended urgent expansion of counselling and support services. I was involved at the Open University in developing and delivering some of this training over the following few years. Last week’s report makes depressing reading. Things seemed to be improving at the beginning of the century. The deterioration in student support services must reflect the massive change in social priorities that has occurred, alongside huge financial austerity pressures on education, health and social services, under the Tory governments since 2010. There is an urgent need to halt the damage.
Chris Youle
Winchester

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters