Tag Archives: being

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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Medicine treats women as entirely passive – being ‘told’ about HRT is par for the course

Buck up, ladies of a certain vintage! There is marvellous news. “Women told hormone replacement therapy does not lead to early death,” reads the headline in the Times. That’s women “told”, you see. I do not know why any women were worried about the increased risk of breast cancer, heart disease and stroke except that, well, we were told to be. Now scientists more or less agree that the benefits – protection against fracture for lower bone-density, against diabetes and endometrial cancer – cancel out the risks. So pump it up, if that’s your bag.

When I got to the age where I was offered HRT I was completely mystified by the conversations around it. It’s terrible! It’s wonderful! It saves your life and your skin. Suddenly, there was a world of women handing round the names of private doctors like dealers; doctors who offered bioidenticals said to be better than the bog-standard HRT on the NHS.

It wasn’t for me, though now I wonder. What bothered me at the time was the idea that ageing is an illness that must be treated; that our depleted oestrogen has to be restored in order for us to function properly as feminine. Clearly I did not suffer in the way I have seen some women suffer. The insomnia was bad but I quite liked feeling angry all the time, alongside the sense of dropping out of the part of life where one’s drive is seen as inherently about mating.

I wondered what I was becoming, for menopause is a form of transition, an everyday one. Still it’s embarrassing to talk about it all, because age is embarrassing and women’s bodies are frankly weird. We live in a culture where the highest compliments are not “Well done on that Nobel prize”, but, “You’ve lost weight”, and, “You don’t look your age”. This is an unfortunate thing for the middle-aged bon viveur.

But that women’s lives may be put at risk – or that as individuals we may assess those risks, while a medical establishment addresses us as entirely passive – is par for the course. It starts in puberty when girls go to the doctors and are told that the solution to their pain (cysts, fibroids, endometriosis) is either pregnancy or the pill. Thus begins a life on a combination of artificial hormones. Pills for ever until you hit the HRT jackpot.

Along the way, women who do not feel OK may be going to doctors for years complaining of pain before being diagnosed. The new advice on endometriosis is: “Listen to women”. Yes, really. And if you do listen to women you will hear story after story of women not getting the right treatment for years and then women beating themselves up for not giving birth the right way or not finding breast-feeding easy and feeling both that their bodies were all wrong but that nobody was listening to them.

I used to think one of the successes of feminism was in encouraging women to make active choices around contraception and childbirth. My mother, after all, was sterilised against her will while under general anaesthetic, the permission given by her then-husband. He was very much “then” after that, I can tell you.

By the time I had my first child, more than 30 years ago, I still had to fight not to have labour induced, but I had a sense that my generation would demand that the rights of individual women be taken into consideration.

This was because the body was firmly at the centre of feminist debate and many women benefitted from that debate whether they considered themselves feminist or not. The proverbial birthplan did not come about by accident.

But what has gone on in the meantime? Sure, progress has been made, but I do not know a woman who hasn’t been patronised by a doctor or been made to feel that she should not complain.

At the same time I was being offered HRT or antidepressants, I was in A&E with one of my daughters, then 19 and in terrible pain. My entire reproductive life flashed before me as she was having an internal scan and the consultant said: “Mummy, come behind the curtain and see your daughter’s lovely eggs. Don’t worry, you will be a grandma after all.” Yes, my daughter gave me permission to tell you this story as we were both mortified by it. Her value was that she could reproduce; mine was that I had done so.

This is still the way much of the medical establishment addresses us; the reality of having a female body with its periods and malfunctions and fluctuating hormones, its hair and its blood and its pain.

From young women brushed off in doctors’ surgeries to women in their 50s being “told” whether we can have HRT or not, it never stops. Listen to women: such a simple thing to do. I can’t wait for it to start.

Medicine treats women as entirely passive – being ‘told’ about HRT is par for the course

Buck up, ladies of a certain vintage! There is marvellous news. “Women told hormone replacement therapy does not lead to early death,” reads the headline in the Times. That’s women “told”, you see. I do not know why any women were worried about the increased risk of breast cancer, heart disease and stroke except that, well, we were told to be. Now scientists more or less agree that the benefits – protection against fracture for lower bone-density, against diabetes and endometrial cancer – cancel out the risks. So pump it up, if that’s your bag.

When I got to the age where I was offered HRT I was completely mystified by the conversations around it. It’s terrible! It’s wonderful! It saves your life and your skin. Suddenly, there was a world of women handing round the names of private doctors like dealers; doctors who offered bioidenticals said to be better than the bog-standard HRT on the NHS.

It wasn’t for me, though now I wonder. What bothered me at the time was the idea that ageing is an illness that must be treated; that our depleted oestrogen has to be restored in order for us to function properly as feminine. Clearly I did not suffer in the way I have seen some women suffer. The insomnia was bad but I quite liked feeling angry all the time, alongside the sense of dropping out of the part of life where one’s drive is seen as inherently about mating.

I wondered what I was becoming, for menopause is a form of transition, an everyday one. Still it’s embarrassing to talk about it all, because age is embarrassing and women’s bodies are frankly weird. We live in a culture where the highest compliments are not “Well done on that Nobel prize”, but, “You’ve lost weight”, and, “You don’t look your age”. This is an unfortunate thing for the middle-aged bon viveur.

But that women’s lives may be put at risk – or that as individuals we may assess those risks, while a medical establishment addresses us as entirely passive – is par for the course. It starts in puberty when girls go to the doctors and are told that the solution to their pain (cysts, fibroids, endometriosis) is either pregnancy or the pill. Thus begins a life on a combination of artificial hormones. Pills for ever until you hit the HRT jackpot.

Along the way, women who do not feel OK may be going to doctors for years complaining of pain before being diagnosed. The new advice on endometriosis is: “Listen to women”. Yes, really. And if you do listen to women you will hear story after story of women not getting the right treatment for years and then women beating themselves up for not giving birth the right way or not finding breast-feeding easy and feeling both that their bodies were all wrong but that nobody was listening to them.

I used to think one of the successes of feminism was in encouraging women to make active choices around contraception and childbirth. My mother, after all, was sterilised against her will while under general anaesthetic, the permission given by her then-husband. He was very much “then” after that, I can tell you.

By the time I had my first child, more than 30 years ago, I still had to fight not to have labour induced, but I had a sense that my generation would demand that the rights of individual women be taken into consideration.

This was because the body was firmly at the centre of feminist debate and many women benefitted from that debate whether they considered themselves feminist or not. The proverbial birthplan did not come about by accident.

But what has gone on in the meantime? Sure, progress has been made, but I do not know a woman who hasn’t been patronised by a doctor or been made to feel that she should not complain.

At the same time I was being offered HRT or antidepressants, I was in A&E with one of my daughters, then 19 and in terrible pain. My entire reproductive life flashed before me as she was having an internal scan and the consultant said: “Mummy, come behind the curtain and see your daughter’s lovely eggs. Don’t worry, you will be a grandma after all.” Yes, my daughter gave me permission to tell you this story as we were both mortified by it. Her value was that she could reproduce; mine was that I had done so.

This is still the way much of the medical establishment addresses us; the reality of having a female body with its periods and malfunctions and fluctuating hormones, its hair and its blood and its pain.

From young women brushed off in doctors’ surgeries to women in their 50s being “told” whether we can have HRT or not, it never stops. Listen to women: such a simple thing to do. I can’t wait for it to start.

‘It’s like being reborn’: inside the care home opening its doors to toddlers

A crescendo of nursery rhymes is not what you’d expect to hear in an care home for older people, but arriving at Nightingale House in south London, you can hear the children before you can see them.

“Isn’t it fantastic? It’s the highlight of my week,” says 89-year-old Fay Garcia, while bouncing baby Sasha on her knee. “It’s like being reborn.”

Garcia never had children but is one of the regulars at the baby and toddler group. It’s been running since January in preparation for the new nursery, which opened this week.

The Apples and Honey Nightingale nursery, run by founder Judith Ish-Horowicz, is the first of its kind in the UK. The concept of intergenerational care began in 1976 when a nursery school and a care home were combined in Tokyo. Since then, there have been successful schemes across Europe, Australia and the US. In Singapore, the government has committed £1.7bn to initiatives to improve ageing in the country, including 10 new intergenerational housing developments.

Combining care for older and young people has economic benefits for care homes, and health benefits for their residents.


Combining care for older and young people has economic benefits for care homes, and health benefits for their residents. Photograph: Barbara Evripidou/Channel 4

The UK is still catching up with the idea, says Stephen Burke, director of United for All Ages. For seven years, the development agency has worked with a range of organisations – including local authorities, housing providers, care homes and community centres – to encourage them to think more broadly about opportunities for combining care.

Interest is growing. Burke expects the UK’s first housing development for students and older residents (as seen in the Netherlands) to launch soon, and representatives from Torbay council in Devon will travel to the US this autumn to see examples of best practice. Nurseries are run near to care homes in cities such as Chichester and Edinburgh, but Apples and Honey is the first to run a nursery within a care home itself, with joint activities for the children and residents including exercising, reading, cooking and eating meals.

“[It’s] about bringing people together,” says Burke. “By getting people talking to each other, you break down some of the barriers and challenge some of the stereotypes [particularly around ageism, dementia and other conditions affecting older people]. We see this having benefits for all generations.”

Ish-Horowicz came up with the idea many years ago after bringing children from her first nursery in Wimbledon to visit Nightingale House each term. The new nursery, housed in the care home’s refurbished maintenance block, has 30 places for two- to four-year-olds and a number of spots reserved for the children of care home staff.

“Everyone I’ve spoken to loves the idea,” says Ish-Horowicz. The Ofsted registration process went smoothly, although there were issues finding insurance: “We had to explain to them that we weren’t going to leave the children in the care of the residents (or the other way around), and they didn’t all need to be DBS checked,” she says.

Ish-Horowicz’s proposal came when the home was reassessing its own approach to care, says Simon Pedzisi, director of care services at Nightingale House, who had consulted students of medicine, occupational therapy and nursing for new ideas.

“Our average age on admission is 90, so we have to think in an innovative way about activities,” says Pedzisi. “[Care] has to be more meaningful, deeper and measurable. It’s about social interaction because that’s what older people really [need].”

In Channel 4’s Old People’s Homes for 4 Year Olds, residents of Bristol-based St Monica Trust were found to have improved mood, mobility and memory after spending six weeks with children.


In Channel 4’s Old People’s Homes for 4 Year Olds, residents of Bristol-based St Monica Trust were found to have improved mood, mobility and memory after spending six weeks with children. Photograph: Barbara Evripidou/Channel 4

When care for older people faces staff shortages, funding cuts and estimates that another 71,000 care home places will be needed by 2025, it’s understandable that innovation is in short supply. But Pedzisi insists that any extra money needed to support the nursery will be well spent.

There can be economic benefits for care homes considering sharing their sites, says Burke, including gaining additional rent and sharing administrative, ground maintenance and catering costs. Co-location can also improve recruitment and retention of staff, who take advantage of flexible on-site childcare or find satisfaction in the increased variety in their roles.


It’s about learning through generations and caring about each other. This kind of thing can change the community

Judith Ish-Horowicz

The health benefits of alleviating residents’ social isolation may also lead to savings elsewhere. “If people are well stimulated and live meaningful lives, they’re going to eat well. They’re then at less risk of dehydration and falling, therefore you’ll lower the risk of hospital admission,” says Pedzisi.

Increased social interaction is linked to a reduced risk of disease in elderly people, which was recently highlighted in Channel 4’s Old People’s Homes for 4 Year Olds documentary. Eleven residents of Bristol-based St Monica Trust were found to have improved moods, mobility and memory after spending six weeks with children. The trust has since committed to adding a full-time nursery to one of its residential care homes, playgrounds at a number of other sites, and is developing a new retirement village.

“We’ve always done intergenerational activities, but we wanted evidence so we could roll out wider programmes,” says David Williams, the trust’s chief executive. “It has created a buzz and a feeling that we can do things differently. It’s also had an impact on our staff. If you’re working in an organisation you feel is [making a difference], you want to be part of that innovation.”

As Apples and Honey Nightingale welcomes its first class of nursery children, Ish-Horowicz is optimistic for the future of intergenerational care. “There’s such a positive feel around this; you know it’s going to work,” she says. “It’s about learning through generations and caring about each other. This kind of thing can change society and the community.”

Join the Social Care Network for comment, analysis and job opportunities direct to your inbox. Follow us @GdnSocialCare and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to socialcare@theguardian.com.

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.

‘It’s like being reborn’: inside the care home opening its doors to toddlers

A crescendo of nursery rhymes is not what you’d expect to hear in an care home for older people, but arriving at Nightingale House in south London, you can hear the children before you can see them.

“Isn’t it fantastic? It’s the highlight of my week,” says 89-year-old Fay Garcia, while bouncing baby Sasha on her knee. “It’s like being reborn.”

Garcia never had children but is one of the regulars at the baby and toddler group. It’s been running since January in preparation for the new nursery, which opened this week.

The Apples and Honey Nightingale nursery, run by founder Judith Ish-Horowicz, is the first of its kind in the UK. The concept of intergenerational care began in 1976 when a nursery school and a care home were combined in Tokyo. Since then, there have been successful schemes across Europe, Australia and the US. In Singapore, the government has committed £1.7bn to initiatives to improve ageing in the country, including 10 new intergenerational housing developments.

Combining care for older and young people has economic benefits for care homes, and health benefits for their residents.


Combining care for older and young people has economic benefits for care homes, and health benefits for their residents. Photograph: Barbara Evripidou/Channel 4

The UK is still catching up with the idea, says Stephen Burke, director of United for All Ages. For seven years, the development agency has worked with a range of organisations – including local authorities, housing providers, care homes and community centres – to encourage them to think more broadly about opportunities for combining care.

Interest is growing. Burke expects the UK’s first housing development for students and older residents (as seen in the Netherlands) to launch soon, and representatives from Torbay council in Devon will travel to the US this autumn to see examples of best practice. Nurseries are run near to care homes in cities such as Chichester and Edinburgh, but Apples and Honey is the first to run a nursery within a care home itself, with joint activities for the children and residents including exercising, reading, cooking and eating meals.

“[It’s] about bringing people together,” says Burke. “By getting people talking to each other, you break down some of the barriers and challenge some of the stereotypes [particularly around ageism, dementia and other conditions affecting older people]. We see this having benefits for all generations.”

Ish-Horowicz came up with the idea many years ago after bringing children from her first nursery in Wimbledon to visit Nightingale House each term. The new nursery, housed in the care home’s refurbished maintenance block, has 30 places for two- to four-year-olds and a number of spots reserved for the children of care home staff.

“Everyone I’ve spoken to loves the idea,” says Ish-Horowicz. The Ofsted registration process went smoothly, although there were issues finding insurance: “We had to explain to them that we weren’t going to leave the children in the care of the residents (or the other way around), and they didn’t all need to be DBS checked,” she says.

Ish-Horowicz’s proposal came when the home was reassessing its own approach to care, says Simon Pedzisi, director of care services at Nightingale House, who had consulted students of medicine, occupational therapy and nursing for new ideas.

“Our average age on admission is 90, so we have to think in an innovative way about activities,” says Pedzisi. “[Care] has to be more meaningful, deeper and measurable. It’s about social interaction because that’s what older people really [need].”

In Channel 4’s Old People’s Homes for 4 Year Olds, residents of Bristol-based St Monica Trust were found to have improved mood, mobility and memory after spending six weeks with children.


In Channel 4’s Old People’s Homes for 4 Year Olds, residents of Bristol-based St Monica Trust were found to have improved mood, mobility and memory after spending six weeks with children. Photograph: Barbara Evripidou/Channel 4

When care for older people faces staff shortages, funding cuts and estimates that another 71,000 care home places will be needed by 2025, it’s understandable that innovation is in short supply. But Pedzisi insists that any extra money needed to support the nursery will be well spent.

There can be economic benefits for care homes considering sharing their sites, says Burke, including gaining additional rent and sharing administrative, ground maintenance and catering costs. Co-location can also improve recruitment and retention of staff, who take advantage of flexible on-site childcare or find satisfaction in the increased variety in their roles.


It’s about learning through generations and caring about each other. This kind of thing can change the community

Judith Ish-Horowicz

The health benefits of alleviating residents’ social isolation may also lead to savings elsewhere. “If people are well stimulated and live meaningful lives, they’re going to eat well. They’re then at less risk of dehydration and falling, therefore you’ll lower the risk of hospital admission,” says Pedzisi.

Increased social interaction is linked to a reduced risk of disease in elderly people, which was recently highlighted in Channel 4’s Old People’s Homes for 4 Year Olds documentary. Eleven residents of Bristol-based St Monica Trust were found to have improved moods, mobility and memory after spending six weeks with children. The trust has since committed to adding a full-time nursery to one of its residential care homes, playgrounds at a number of other sites, and is developing a new retirement village.

“We’ve always done intergenerational activities, but we wanted evidence so we could roll out wider programmes,” says David Williams, the trust’s chief executive. “It has created a buzz and a feeling that we can do things differently. It’s also had an impact on our staff. If you’re working in an organisation you feel is [making a difference], you want to be part of that innovation.”

As Apples and Honey Nightingale welcomes its first class of nursery children, Ish-Horowicz is optimistic for the future of intergenerational care. “There’s such a positive feel around this; you know it’s going to work,” she says. “It’s about learning through generations and caring about each other. This kind of thing can change society and the community.”

Join the Social Care Network for comment, analysis and job opportunities direct to your inbox. Follow us @GdnSocialCare and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to socialcare@theguardian.com.

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.

Wellbeing in schools is being tossed aside in favour of exam elitism | Letter

Last Thursday my clever 16-year-old daughter Rachel should have been getting her GCSE results. A picture taken at her school happens to illustrate one of your articles online; I recognise the children. But Rachel is not there.

Your coverage of the new GCSEs has rightly highlighted the error of focusing again on the brightest, most academic children, while doing a disservice to all of us by neglecting those who can excel at vocational qualifications.

But only one of your articles (‘We were guinea pigs, but it was OK’, 24 August) talked about the extra stress and higher expectations created by the exams. The toll exacted on my family was extreme: Rachel took her own life in January, with school stress a major contributory factor. Her story is at antidepaware.co.uk/losing-rachel

As a nation we are facing a crisis in teenage mental health. At the same time, teachers are struggling with their own stress, the spectre of the league tables ever-present.

Your editorial (25 August) says that, although misprioritised, “the reforms are good ones”. I would dispute this. Who are they really for? Is the ability to distinguish between very clever and very, very clever – a 7, 8 or 9 – really of use?

The government talks about the new 1-9 exams being a gold standard helping the UK to compete in a global workplace. I’d say this is claptrap, given the less practical, more old-fashioned nature of new curriculum. And do the new grades really help employers pick the best 16-year-olds? The ability to succeed exceptionally at an academic exam (with no coursework component) is in any case a poor method of selecting candidates for the too-scarce vocational traineeships and apprenticeships.

Does it help sixth forms decide who to accept? Well, possibly, and time will tell how many sixth forms set the entry bar as high as a 8 or 9 – hopefully not many. What it definitely will do, though, is add another, more socially divisive way to measure school success (how many 9s?) and enable elite universities to distinguish between top-scoring pupils with scant regard for social and economic factors – or for an adolescent’s development between 16 and 18.

I spent a lot of time trying to persuade my sick daughter that getting the top marks didn’t really matter; that an A was good enough, that her mental health was more important. I failed in this. I know other parents who had the same discussion with their children.

Perhaps I failed because it was clear to Rachel that it wasn’t true. Despite government mental health commitments, the reality is that combating stress, improving mental health and supporting wellbeing in our school system are being tossed aside in favour of elitism.
Sarah Finke
London

Papyrus, a UK charity that provides confidential support and advice to young people who are feeling suicidal, can be contacted on 0800 068 41 41, or by texting 07786 209 697 or emailing pat@papyrus-uk.org; also in the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.

Wellbeing in schools is being tossed aside in favour of exam elitism | Letter

Last Thursday my clever 16-year-old daughter Rachel should have been getting her GCSE results. A picture taken at her school happens to illustrate one of your articles online; I recognise the children. But Rachel is not there.

Your coverage of the new GCSEs has rightly highlighted the error of focusing again on the brightest, most academic children, while doing a disservice to all of us by neglecting those who can excel at vocational qualifications.

But only one of your articles (‘We were guinea pigs, but it was OK’, 24 August) talked about the extra stress and higher expectations created by the exams. The toll exacted on my family was extreme: Rachel took her own life in January, with school stress a major contributory factor. Her story is at antidepaware.co.uk/losing-rachel

As a nation we are facing a crisis in teenage mental health. At the same time, teachers are struggling with their own stress, the spectre of the league tables ever-present.

Your editorial (25 August) says that, although misprioritised, “the reforms are good ones”. I would dispute this. Who are they really for? Is the ability to distinguish between very clever and very, very clever – a 7, 8 or 9 – really of use?

The government talks about the new 1-9 exams being a gold standard helping the UK to compete in a global workplace. I’d say this is claptrap, given the less practical, more old-fashioned nature of new curriculum. And do the new grades really help employers pick the best 16-year-olds? The ability to succeed exceptionally at an academic exam (with no coursework component) is in any case a poor method of selecting candidates for the too-scarce vocational traineeships and apprenticeships.

Does it help sixth forms decide who to accept? Well, possibly, and time will tell how many sixth forms set the entry bar as high as a 8 or 9 – hopefully not many. What it definitely will do, though, is add another, more socially divisive way to measure school success (how many 9s?) and enable elite universities to distinguish between top-scoring pupils with scant regard for social and economic factors – or for an adolescent’s development between 16 and 18.

I spent a lot of time trying to persuade my sick daughter that getting the top marks didn’t really matter; that an A was good enough, that her mental health was more important. I failed in this. I know other parents who had the same discussion with their children.

Perhaps I failed because it was clear to Rachel that it wasn’t true. Despite government mental health commitments, the reality is that combating stress, improving mental health and supporting wellbeing in our school system are being tossed aside in favour of elitism.
Sarah Finke
London

Papyrus, a UK charity that provides confidential support and advice to young people who are feeling suicidal, can be contacted on 0800 068 41 41, or by texting 07786 209 697 or emailing pat@papyrus-uk.org; also in the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.

Wellbeing in schools is being tossed aside in favour of exam elitism | Letter

Last Thursday my clever 16-year-old daughter Rachel should have been getting her GCSE results. A picture taken at her school happens to illustrate one of your articles online; I recognise the children. But Rachel is not there.

Your coverage of the new GCSEs has rightly highlighted the error of focusing again on the brightest, most academic children, while doing a disservice to all of us by neglecting those who can excel at vocational qualifications.

But only one of your articles (‘We were guinea pigs, but it was OK’, 24 August) talked about the extra stress and higher expectations created by the exams. The toll exacted on my family was extreme: Rachel took her own life in January, with school stress a major contributory factor. Her story is at antidepaware.co.uk/losing-rachel

As a nation we are facing a crisis in teenage mental health. At the same time, teachers are struggling with their own stress, the spectre of the league tables ever-present.

Your editorial (25 August) says that, although misprioritised, “the reforms are good ones”. I would dispute this. Who are they really for? Is the ability to distinguish between very clever and very, very clever – a 7, 8 or 9 – really of use?

The government talks about the new 1-9 exams being a gold standard helping the UK to compete in a global workplace. I’d say this is claptrap, given the less practical, more old-fashioned nature of new curriculum. And do the new grades really help employers pick the best 16-year-olds? The ability to succeed exceptionally at an academic exam (with no coursework component) is in any case a poor method of selecting candidates for the too-scarce vocational traineeships and apprenticeships.

Does it help sixth forms decide who to accept? Well, possibly, and time will tell how many sixth forms set the entry bar as high as a 8 or 9 – hopefully not many. What it definitely will do, though, is add another, more socially divisive way to measure school success (how many 9s?) and enable elite universities to distinguish between top-scoring pupils with scant regard for social and economic factors – or for an adolescent’s development between 16 and 18.

I spent a lot of time trying to persuade my sick daughter that getting the top marks didn’t really matter; that an A was good enough, that her mental health was more important. I failed in this. I know other parents who had the same discussion with their children.

Perhaps I failed because it was clear to Rachel that it wasn’t true. Despite government mental health commitments, the reality is that combating stress, improving mental health and supporting wellbeing in our school system are being tossed aside in favour of elitism.
Sarah Finke
London

Papyrus, a UK charity that provides confidential support and advice to young people who are feeling suicidal, can be contacted on 0800 068 41 41, or by texting 07786 209 697 or emailing pat@papyrus-uk.org; also in the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.

General practice is being ground down so that private providers can take over

“A GP, eh? Well I guess there are worse things you could do.”

That was the only careers advice I got in my final year at medical school.

The Royal College of General Practitioners (RCGP) has previously raised awareness of bad mouthing of GPs during medical school training.

The college highlighted the fact that many consultants teaching in medical schools talk about general practice as a second-rate career option to hospital medicine and that this is one of the reasons we are short of GPs.

I’ve no doubt that bad press does nothing to improve recruitment to our ranks, but the pressures on the family doctor service, which has led to the closure of dozens of practices across the country, has also played its part in making general practice less attractive to medical graduates.

GP surgeries are not part of the NHS in the way hospitals are. Most surgeries are still small businesses. In most cases the doctors own or rent their premises, they employ and pay their own staff and have all the usual responsibilities of running a business in addition to their work as doctors.

What many patients do not realise is how much general practice is being squeezed at both ends at the moment. Income for general practice is falling in real terms year-on-year, while the costs of running a practice are spiralling out of control.

Furthermore, 90% of all patient contacts in the NHS occur in general practice and in 2017-18 we were predicted to receive 7.29% of the NHS budget – general practice is exceptionally good value for taxpayers’ money. The RCGP is currently campaigning for general practice to receive 11% of the NHS budget.

All GPs have to pay for medical indemnity insurance out of their own pocket. Due to rising litigation the cost of this has been rising by as much as 25% per year. Personally, my indemnity insurance is over £10,000 per year. For comparison, 16 years ago I was paying around £1,700 indemnity costs per year and my income was higher than now.

I have met doctors who just do out-of-hours work (deemed more risky) who pay almost double this. Out-of-hours shifts are unfilled in many parts of the country due, in part, to the enormous cost of indemnity insurance making it economically unviable for many doctors.

All GPs are now forced to undergo annual appraisal and five-yearly relicensing (revalidation). We are expected to undertake 50 hours of educational activity per year, write this up and reflect on it in addition to undertaking patient satisfaction surveys, audits, review of significant events and complex cases and attending local clinical commissioning group meetings. In the last 12 months I spent the equivalent of two working weeks fulfilling these tasks. One can argue about the benefits of annual appraisal, but those two weeks were time that I could not spend on patient care.

Surgeries are now obliged to undergo regular inspections by the Care Quality Commission and must pay thousands of pounds for the privilege. Preparation for these inspections is as stressful and time consuming as a school preparing for an Ofsted visit.

The aim of these measures can only be to grind down the current model of general practice until it fails and large private providers can be brought in to take over. Otherwise there is no other conceivable reason why any government would put so much additional strain on such a necessary and already beleaguered service.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

General practice is being ground down so that private providers can take over

“A GP, eh? Well I guess there are worse things you could do.”

That was the only careers advice I got in my final year at medical school.

The Royal College of General Practitioners (RCGP) has previously raised awareness of bad mouthing of GPs during medical school training.

The college highlighted the fact that many consultants teaching in medical schools talk about general practice as a second-rate career option to hospital medicine and that this is one of the reasons we are short of GPs.

I’ve no doubt that bad press does nothing to improve recruitment to our ranks, but the pressures on the family doctor service, which has led to the closure of dozens of practices across the country, has also played its part in making general practice less attractive to medical graduates.

GP surgeries are not part of the NHS in the way hospitals are. Most surgeries are still small businesses. In most cases the doctors own or rent their premises, they employ and pay their own staff and have all the usual responsibilities of running a business in addition to their work as doctors.

What many patients do not realise is how much general practice is being squeezed at both ends at the moment. Income for general practice is falling in real terms year-on-year, while the costs of running a practice are spiralling out of control.

Furthermore, 90% of all patient contacts in the NHS occur in general practice and in 2017-18 we were predicted to receive 7.29% of the NHS budget – general practice is exceptionally good value for taxpayers’ money. The RCGP is currently campaigning for general practice to receive 11% of the NHS budget.

All GPs have to pay for medical indemnity insurance out of their own pocket. Due to rising litigation the cost of this has been rising by as much as 25% per year. Personally, my indemnity insurance is over £10,000 per year. For comparison, 16 years ago I was paying around £1,700 indemnity costs per year and my income was higher than now.

I have met doctors who just do out-of-hours work (deemed more risky) who pay almost double this. Out-of-hours shifts are unfilled in many parts of the country due, in part, to the enormous cost of indemnity insurance making it economically unviable for many doctors.

All GPs are now forced to undergo annual appraisal and five-yearly relicensing (revalidation). We are expected to undertake 50 hours of educational activity per year, write this up and reflect on it in addition to undertaking patient satisfaction surveys, audits, review of significant events and complex cases and attending local clinical commissioning group meetings. In the last 12 months I spent the equivalent of two working weeks fulfilling these tasks. One can argue about the benefits of annual appraisal, but those two weeks were time that I could not spend on patient care.

Surgeries are now obliged to undergo regular inspections by the Care Quality Commission and must pay thousands of pounds for the privilege. Preparation for these inspections is as stressful and time consuming as a school preparing for an Ofsted visit.

The aim of these measures can only be to grind down the current model of general practice until it fails and large private providers can be brought in to take over. Otherwise there is no other conceivable reason why any government would put so much additional strain on such a necessary and already beleaguered service.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.