Tag Archives: crisis

NHS chief tells ministers: face up to the pay crisis

Ministers should address mounting disquiet among NHS staff about pay and recruitment if the health service is to avoid a full-blown staffing crisis, the head of the official body that represents hospital trusts and mental health services says today.

The stark warning from Niall Dickson, chief executive of the NHS Confederation, comes as GP leaders predict that 2,000 European-born doctors could leave the country because of uncertainty about their status caused by Brexit, with disastrous consequences for patient care.

Writing on theguardian.com, Dickson says nurses who complain about pay increases being capped at 1% – meaning they suffer real terms decreases– “have a point” and suggests the government think again about the effects of stagnating pay on morale and rates of staff retention.

“There may now be a case for looking again at pay,” he writes. “Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”

The intervention by the confederation, whose chairman is former Tory health secretary Stephen Dorrell, is significant on an issue as sensitive as pay rates for NHS workers.

Last weekend, the Royal College of Nursing announced that nearly four out of five of its members (78%) who had taken part in a consultative vote backed a walkout in protest over pay while 91% favoured industrial action short of a strike.

Dickson says the RCN should not resort to any form of action that would harm patients but highlights rising vacancy rates as evidence of a problem that must be addressed. Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, he says. Specialities such as psychiatry face a constant struggle to fill training places and the number of child and adolescent, and old-age psychiatry posts. has declined.

Parts of the country, Dickson says, are finding it “almost impossible” to entice GPs, while some hospitals are being propped up by doctors in training because they can’t fill consultants’ posts.

The Royal College of GPs, the professional body for family doctors, says today that the manpower problems will be exacerbated as GPs from EU countries return home, because of Brexit. A total of 2,137 GPs in surgeries across Britain are from countries in the European Economic Area: the other 27 EU members plus Switzerland, Norway and Iceland.

Dr Helen Stokes-Lampard, chair of the RCGP, said: “We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable.

“Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”

The RCGP wants the next government to stem the potential outflow of EU national GPs by guaranteeing their future status. Ministers should add family doctors to the migration advisory committee’s shortage occupation list, as happened several years ago with nurses, to make it easier to recruit GPs, it argues.

The British Medical Association claimed last week that general practice “is on the brink of collapse” because it is “several thousand GPs short”, and that family doctors are buckling under an “avalanche of work”.

Research published last week by NHS Improvement warned of “future supply problems” in many parts of England in which large proportions of GPs are over 55 and thus likely to retire in the next few years, including Kent and Medway (24.2%) and Somerset (24%).

Jonathan Ashworth, shadow health secretary for Labour – which has said it will end the pay cap for public sectors workers – said: “The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging … to guarantee the rights of EU citizens working in our health and care system.”

A Conservative spokesman said only that: “Our manifesto said explicitly that we will make it a priority in negotiations with the EU that the 140,000 health and care staff from EU countries can carry on making their vital contribution.”

NHS chief tells ministers: face up to the pay crisis

Ministers should address mounting disquiet among NHS staff about pay and recruitment if the health service is to avoid a full-blown staffing crisis, the head of the official body that represents hospital trusts and mental health services says today.

The stark warning from Niall Dickson, chief executive of the NHS Confederation, comes as GP leaders predict that 2,000 European-born doctors could leave the country because of uncertainty about their status caused by Brexit, with disastrous consequences for patient care.

Writing on theguardian.com, Dickson says nurses who complain about pay increases being capped at 1% – meaning they suffer real terms decreases– “have a point” and suggests the government think again about the effects of stagnating pay on morale and rates of staff retention.

“There may now be a case for looking again at pay,” he writes. “Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”

The intervention by the confederation, whose chairman is former Tory health secretary Stephen Dorrell, is significant on an issue as sensitive as pay rates for NHS workers.

Last weekend, the Royal College of Nursing announced that nearly four out of five of its members (78%) who had taken part in a consultative vote backed a walkout in protest over pay while 91% favoured industrial action short of a strike.

Dickson says the RCN should not resort to any form of action that would harm patients but highlights rising vacancy rates as evidence of a problem that must be addressed. Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, he says. Specialities such as psychiatry face a constant struggle to fill training places and the number of child and adolescent, and old-age psychiatry posts. has declined.

Parts of the country, Dickson says, are finding it “almost impossible” to entice GPs, while some hospitals are being propped up by doctors in training because they can’t fill consultants’ posts.

The Royal College of GPs, the professional body for family doctors, says today that the manpower problems will be exacerbated as GPs from EU countries return home, because of Brexit. A total of 2,137 GPs in surgeries across Britain are from countries in the European Economic Area: the other 27 EU members plus Switzerland, Norway and Iceland.

Dr Helen Stokes-Lampard, chair of the RCGP, said: “We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable.

“Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”

The RCGP wants the next government to stem the potential outflow of EU national GPs by guaranteeing their future status. Ministers should add family doctors to the migration advisory committee’s shortage occupation list, as happened several years ago with nurses, to make it easier to recruit GPs, it argues.

The British Medical Association claimed last week that general practice “is on the brink of collapse” because it is “several thousand GPs short”, and that family doctors are buckling under an “avalanche of work”.

Research published last week by NHS Improvement warned of “future supply problems” in many parts of England in which large proportions of GPs are over 55 and thus likely to retire in the next few years, including Kent and Medway (24.2%) and Somerset (24%).

Jonathan Ashworth, shadow health secretary for Labour – which has said it will end the pay cap for public sectors workers – said: “The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging … to guarantee the rights of EU citizens working in our health and care system.”

A Conservative spokesman said only that: “Our manifesto said explicitly that we will make it a priority in negotiations with the EU that the 140,000 health and care staff from EU countries can carry on making their vital contribution.”

NHS chief tells ministers: face up to the pay crisis

Ministers should address mounting disquiet among NHS staff about pay and recruitment if the health service is to avoid a full-blown staffing crisis, the head of the official body that represents hospital trusts and mental health services says today.

The stark warning from Niall Dickson, chief executive of the NHS Confederation, comes as GP leaders predict that 2,000 European-born doctors could leave the country because of uncertainty about their status caused by Brexit, with disastrous consequences for patient care.

Writing on theguardian.com, Dickson says nurses who complain about pay increases being capped at 1% – meaning they suffer real terms decreases– “have a point” and suggests the government think again about the effects of stagnating pay on morale and rates of staff retention.

“There may now be a case for looking again at pay,” he writes. “Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”

The intervention by the confederation, whose chairman is former Tory health secretary Stephen Dorrell, is significant on an issue as sensitive as pay rates for NHS workers.

Last weekend, the Royal College of Nursing announced that nearly four out of five of its members (78%) who had taken part in a consultative vote backed a walkout in protest over pay while 91% favoured industrial action short of a strike.

Dickson says the RCN should not resort to any form of action that would harm patients but highlights rising vacancy rates as evidence of a problem that must be addressed. Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, he says. Specialities such as psychiatry face a constant struggle to fill training places and the number of child and adolescent, and old-age psychiatry posts. has declined.

Parts of the country, Dickson says, are finding it “almost impossible” to entice GPs, while some hospitals are being propped up by doctors in training because they can’t fill consultants’ posts.

The Royal College of GPs, the professional body for family doctors, says today that the manpower problems will be exacerbated as GPs from EU countries return home, because of Brexit. A total of 2,137 GPs in surgeries across Britain are from countries in the European Economic Area: the other 27 EU members plus Switzerland, Norway and Iceland.

Dr Helen Stokes-Lampard, chair of the RCGP, said: “We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable.

“Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”

The RCGP wants the next government to stem the potential outflow of EU national GPs by guaranteeing their future status. Ministers should add family doctors to the migration advisory committee’s shortage occupation list, as happened several years ago with nurses, to make it easier to recruit GPs, it argues.

The British Medical Association claimed last week that general practice “is on the brink of collapse” because it is “several thousand GPs short”, and that family doctors are buckling under an “avalanche of work”.

Research published last week by NHS Improvement warned of “future supply problems” in many parts of England in which large proportions of GPs are over 55 and thus likely to retire in the next few years, including Kent and Medway (24.2%) and Somerset (24%).

Jonathan Ashworth, shadow health secretary for Labour – which has said it will end the pay cap for public sectors workers – said: “The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging … to guarantee the rights of EU citizens working in our health and care system.”

A Conservative spokesman said only that: “Our manifesto said explicitly that we will make it a priority in negotiations with the EU that the 140,000 health and care staff from EU countries can carry on making their vital contribution.”

GP recruitment crisis intensifies as vacancies soar to 12.2%

Vacancies for GPs are at their highest ever level, research suggests.

A survey of 860 GPs for Pulse, a news magazine for general practitioners, found 12.2% of positions were currently vacant – up from 11.7% at the same time last year and from 2.1% in 2011, when Pulse started collecting the data.

The findings show 158 GPs (18%) have been unsuccessful in filling a vacancy in the past 12 months. In that period, the average time taken to recruit a GP partner has risen from 6.6 months to 7.4.

Pulse said some practices were having to hire non-GPs to fill the gaps, while others had closed after failing to recruit a GP partner.

A report from the Commons public accounts committee in April found there had been “no progress” in the previous year on increasing the number of GPs, despite a government target to recruit 5,000 more by 2020. The report said the number had actually fallen, from 34,592 full-time equivalent doctors in September 2015 to 34,495 in September 2016.

MPs said more trainees needed to be recruited and that existing GPs should be encouraged to stay on.

Prof Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said of Pulse’s findings: “We know that practices across the country are finding it really difficult to recruit GPs to fill vacant posts, and the degree to which this problem has increased over the last six years is staggering.

“In the most severe cases, not being able to recruit has forced practices to close, and this can be a devastating experience for the patients and staff affected, and the wider NHS.”

Stokes-Lampard added: “At present, UK general practice does not have sufficient resources to deliver the care and services necessary to meet our patients’ changing needs, meaning that GPs and our teams are working under intense pressures, which are simply unsustainable.

“Workload in general practice is escalating – it has increased 16% over the last seven years, according to the latest research – yet investment in our service has steadily declined over the last decade and the number of GPs has not risen in step with patient demand … This must be addressed as a matter of urgency.”

How schools are dealing with the crisis in children’s mental health

It could easily be a child’s bedroom. In the centre is a large mat, while a selection of dolls and soft toys line the walls. It is hard to believe that this nurture point in Plaistow, east London, aimed at helping children deal with their emotional problems, was once a school staff room.

Youngsters aged five to 11 can drop in three days a week and speak to a trained counsellor from the charity Place2Be. But as well as worries over friendships, bullying or problems at home, headteacher Paul Harris reveals that a growing number of children are suffering from anxiety as a result of Brexit and the election of Donald Trump.

Fortunately, pupils at Curwen primary and its sister school, Kensington primary in Manor Park, can speak to a counsellor before their problems become overwhelming.

The lunchtime drop-in – known as Place2Talk – is part of a package of support services offered by the charity, which includes one-to-one counselling and play therapy for children suffering from more serious mental health issues.

Working with 282 primaries and 50 secondaries, the charity provides early intervention support in schools to children who are troubled and unhappy.

The charity is not the only one working with schools. The Art Room charity supports five- to 16-year-olds who are experiencing emotional and behavioural difficulties.

There are eight Art Rooms in schools in Oxfordshire, London and Edinburgh, supporting 500 children a week by offering art as therapy to increase their self-esteem, self-confidence and independence.

It is this kind of partnership that Theresa May, the prime minister, said in January that she wanted to see more of. She said then that one of her priorities was children’s mental health, which has long been recognised as in crisis.

Statistics show that one in 10 children – or an average three children in every classroom – has a diagnosable mental health problem, and that 75% of mental illness in adults has its roots in childhood.

The prime minister said, before the election was announced, that she wanted every secondary school to be offered mental health first aid training, as well as new ways introduced to strengthen links between schools and NHS staff alongside more online support services for children and young people. May’s recognition of the crisis in children and adolescent mental health has been welcomed. But headteachers say that cuts of £3bn to school budgets threaten existing in-school care and want mental health funding ringfenced.

Harris, who is also executive head of three other primaries in the London borough of Newham, says the proposed school funding cuts mean losing the service of 17 teaching staff: “I believe support needs to start young in primary schools to build resilience before children go on to secondary.

“Cash needs to be earmarked for this from health budgets, otherwise we will lose this vital service.”

Celine Bickerdike: ‘Teachers had to believe you had a problem before you could access the school’s services’

Celine Bickerdike


Celine Bickerdike is a young champion for the mental health charity Time to Change

Celine Bickerdike, 19, is an apprentice in Leeds and has secured a university place to study history. She has had anxiety and depression since aged 12. But it was five years before she sought professional help.

“My first experience of being judged because of having a mental health problem was when some girls took my antidepressants from my bag and started reading out the side-effects in front of everyone. They humiliated me. How can people be so cruel?

“There was some school mental health support, but teachers had to believe you had a problem before you could access it. Most of my teachers thought I was OK – one even said that I was stressed because I wasn’t working hard enough. I broke down during my mocks, which was when my history teachers, who I was really close to, told me to go and see a doctor.

“I put an enormous amount of pressure on myself to get the grades I needed for university. I was anxious about the future – and failure.

“I didn’t get into the university I wanted and this really took its toll. I felt completely lost. All my friends were at university. I had gone from having a promising future to being on job seeker’s allowance.

“I think initially, my parents didn’t take my mental health problems seriously; they thought it was just ‘hormones’. I’d always been a bit of a worrier so they assumed that my problems were small because of that.

“Nowadays I find it easier to talk to people about my mental health because I’m more confident and don’t doubt my condition as much. People’s conditions should be believed as soon as they develop so that it’s easier to prevent them worsening like mine did.”

‘Shattering stigma starts with simple conversations’: tackling the child mental health crisis

Public concern around child and adolescent mental health is at an all-time high. The prime minister, Theresa May announced in January her intention to better identify and help the growing number of young people in schools who are at risk of developing mental health issues. Prince Harry and the Duke and Duchess of Cambridge, meanwhile, are using their profiles to convince the public that “shattering stigma on mental health starts with simple conversations”.

And yet, despite growing awareness of the issue, child and adolescent mental health services (Camhs) are under an increasing amount of pressure. Healthcare professionals bemoan a lack of resources and staff while the health secretary, Jeremy Hunt, has described Camhs as the “biggest single area of weakness of NHS provision”.

What are some of the issues facing children and young people today? What problems are services confronted with? What examples of best practice are there and how can the health, education and social care sectors provide better mental healthcare for children and young people? These were some of the questions addressed by experts in mental health at a roundtable discussion, chaired by the Guardian’s health policy editor Denis Campbell and supported by online counselling service XenZone.

“For children, there are so many messages about what to be, what to look like, how you should present yourself to the world. It’s 24/7 and social media judges most things,” said Anne Longfield OBE, children’s commissioner for England. “There’s anxiety around exams, schools and increasingly linear expectations. That all builds up.”

Sarah Hulyer, an activist from YoungMinds, the young people’s mental health charity, agreed that exams and stress are part of the problem. She also talked about the considerable effect of social media on young people’s mental health. “I think social media is negative in several ways in that your public life never ends. You’re always being watched,” she said.

Hulyer pointed out that social media can glamorise mental health problems and emphasised how important it is to start a conversation about mental health at a young age. “A lot of young people learn about mental health in the media, but often the only things talked about are anxiety and depression,” she said. “Young people don’t know [the range of] problems there are until they’ve had them explained to them.”

Attendees also discussed the problems facing services. Norman Lamb, Liberal Democrat MP and former mental health minister, said: “We’re faced with a dysfunctional system with awful access, which leads to people taking their own lives. We’re not going to solve the whole problem if we focus on the system giving treatment. It has to be about prevention and a fundamental shift of emphasis.”

Most agreed that there were significant problems facing the Camhs workforce. “We do not have an available workforce with sufficient morale to deal with the problem,” said Dr Bernadka Dubicka, consultant child and adolescent psychiatrist and chair-elect of the child and adolescent faculty, Royal College of Psychiatrists. She believes there are vast numbers of children and adolescents who could have been helped before they were referred to Camhs.

Sean Duggan, chief executive of the Mental Health Network at the NHS Confederation, claimed that the importance of child and adolescent mental health has not been properly recognised in the sustainability and transformation plans (STPs) that have been drafted to improve health and care in England. “STPs are here to stay and are a vehicle for setting priorities,” he said, adding that child and adolescent mental health is an urgent priority that needs to be addressed.

Although many around the table underlined the role that schools can play in reducing mental health problems among pupils, Malcolm Trobe CBE, general secretary for the Association of School and College Leaders, pointed out that there is a gap between what schools can deal with and their access to external support.

“Teachers have workload pressures – they just don’t have the time [to offer additional support],” he said. But he also asked where children with mental health problems were going to get that extra support: “We’ve got to move from talking about it to actually doing something. Health and education departments have got to work together so we have a strategic view of this.”

While the majority of those in attendance bemoaned the state of child and adolescent mental health services in the UK, Dr Matt Muijen, adviser in international mental health, painted a different picture. “There’s an unusual publicity about poor mental health in England. That creates demand,” he said.

“When you look at the supply side, you have remarkably good standards. There is no separate budget for child mental health but you’re the second highest funder of mental health services after the Netherlands. As a proportion of the health budget, you are by far the highest.” He went on to criticise local authorities for their inability to commission services, adding: “I always feel like health services in England are constantly changing, with a total lack of stability with no one quite knowing what they’re expected to do.”

Given the huge demand on services, attendees agreed that action was needed and floated possible solutions and examples of best practice. Elaine Bousfield, founder and chair of XenZone, suggested a digital approach could help, as long as it is tied into the wider health and social care system.

Bousfield spoke about XenZone’s online counselling and emotional wellbeing platform for children and young people. It’s used by them to talk to someone – generally for one to three sessions. “The beauty is they’re not then ruminating and adding to their anxiety,” she said. “Quite often young people don’t know what’s going on. They just feel terrible and they might not know why. They need a space where they can talk about that.”

Hulyer said a large part of the solution lies in the digital world, as that is how young people communicate. She said young people have a despondent view of Camhs and don’t believe that services will ever be there for them. She stressed the importance of learning about mental health at school and how it should be part of the curriculum. “You learn about physical health, so you should learn about resilience; how to deal with stress.” Hulyer also said that parents need support and talked about a helpline set up by YoungMinds that they can call for information and advice.

Dr Emma Blake, paediatric mental health consultant and chair of the Child Mental Health Committee at the Royal College of Paediatrics and Child Health, also highlighted MindEd, an online service for adults designed to provide help with, and information on, child and adolescent mental health.

Lamb and Duggan, meanwhile, cited some areas of the country where services are working well to tackle child and adolescent mental health. In Oxfordshire, mental health professionals go into schools every week and work with teachers to increase their understanding. Lamb said they had seen a drop in referrals to Camhs because they are intervening much earlier.

In Northamptonshire, a referral management centre was developed in 2015, which includes a consultation line open to young people and families, a texting service offered by school nurses, online chat for young people to talk to a mental health professional, self-referral, a children’s crisis home treatment team and two adolescent in-patient wards. Duggan also highlighted a new programme at Sussex Partnership NHS foundation trust – the Discovery College.

The concept is based on the existing recovery college, which involves free courses developed and delivered by health professionals. The discovery college applies the same principles for children and young people. It involves free courses for 13- to 20-year-olds, providing knowledge and skills to maintain and manage mental health.

Despite these positive schemes, there is still frustration over the lack of action relative to the tone of the conversation around child mental health.

During his time in government, Lamb produced a blueprint for mental health services, Future in Mind, which brought together a number of key proposals. Two years on, the government is now producing a green paper on the same subject. “This is an excuse to carry on talking rather than doing,” he said. “I’ve said to the health secretary to create incentives around the country to make urgent progress. The green paper can provide some value, but we need to do what we said we were going to do.”

At the table

Denis Campbell (Chair)
Health policy editor, the Guardian

Anne Longfield OBE
Children’s commissioner for England

Noman Lamb MP
Liberal Democrat health spokesman

Prof Miranda Wolpert MBE
Director, Evidence Based Practice Unit, UCL and Anna Freud Centre

Dr Emma Blake
Chair, Child Mental Health Committee, Royal College of Paediatrics and Child Health

Dr Bernadka Dubicka
Chair-elect, Child and Adolescent Faculty, Royal College of Psychiatrists

Sean Duggan
Chief executive, Mental Health Network, NHS Confederation

Elaine Bousfield
Founder and chair, XenZone

Sarah Hulyer
Activist, YoungMinds

Tony Hunter
Chief executive, Social Care Institute for Excellence

Dr Matt Muijen
Adviser in international mental health

Charlotte Ramsden
Chair, Health, Care and Additional Needs Policy Committee, ADCS

Prof Helen Stokes-Lampard
Chair, Royal College of General Practitioners

Malcolm Trobe CBE
General secretary (interim), Association of School and College Leaders

Signs of hope in the prison mental health crisis

Mental health problems in the prison population have long been a matter of concern. Suicide rates in prisons in England and Wales are at an all-time high; a record 119 people killed themselves in 2016 – an increase of 29 on the previous year, according to figures from the Ministry of Justice. The rise in prison suicides has been accompanied by a 23% increase in incidents of self-harm, to a total of 37,784.

“It’s a huge issue because lots of people in prison have mental health problems,” says Dr Steffan Davies, consultant forensic psychiatrist and co-chair of the Community Diversion and Prison Psychiatry Network at the Royal College of Psychiatrists. A study by the Prison Reform Trust found that 72% of male and 70% of female prisoners experience two or more diagnosable mental health disorders. Research by the National Institute for Health and Care Excellence found that 7% of male and 14% of female prisoners have a psychotic disorder – 14 and 23 times the level in the general population respectively.

The situation looks set to get worse. In recent years, staff numbers have dropped significantly, budgets and staff training have been cut, the prison population has more than doubled, and the introduction and rising use of new psychoactive substances has contributed to increasing violence.

Jacob Tas, chief executive of the social justice charity Nacro, says: “The overcrowded prison environment is likely to worsen existing mental health problems that are often the key drivers for offenders to commit further crimes or become violent while in prison.”

Davies adds: “It does feel like things are getting worse and I’m hearing it’s hard to recruit people to prison mental health services. People are leaving, and quite a few find it an extremely stressful environment to work in.”

While the general outlook is bleak, projects such as the self-management training programme at HMP & YOI Parc, Bridgend, south Wales, hold out some hope. Developed as a partnership between the Mental Health Foundation and G4S, and funded by Big Lottery Fund Cymru, the aim was to improve prisoners’ mental health through self-management and peer support.

The programme was delivered between September 2013 and December 2016, and involved two to three hours’ training one day a week for four weeks. Up to 10 participants could attend. Training included positive thinking, goal setting and problem-solving.

Fifty prisoners filled in the Warwick-Edinburgh mental wellbeing scale at the start of the course and a month after its completion: the mean score showed a significant increase in the prisoners’ wellbeing.

Lauren Chakkalackal, senior research officer at the Mental Health Foundation, says: “A number of positive stories came from the project. It was an opportunity for people to feel listened to and express how they were feeling.

“A group of prisoners produced resources to better support the mental health needs of new prisoners. The prisoners themselves took ownership of that group.”

Plans are afoot to develop similar models in other prisons and the project is being redesigned to support older prisoners and young offenders.

Amsterdam’s solution to the obesity crisis: no fruit juice and enough sleep

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The city is successfully fighting fat by promoting tap water in its schools, along with healthy cooking classes and a ban on fast food sponsorship

The city of Amsterdam is leading the world in ending the obesity epidemic, thanks to a radical and wide-reaching programme which is getting results even among the poorest communities that are hardest to reach.

Better known for tulips and bicycles, Amsterdam has the highest rate of obesity in the Netherlands, with a fifth of its children overweight and at risk of future health problems.

Related: For children’s health, the government has to treat sugar like cigarettes | Gary Taubes

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My teenage cousin is having a crisis, but her mother won’t get her the help she needs

My cousin is 16, and apparently going through a crisis. She hates college, skips classes and has spoken to my grandmother often of hating her life and not enjoying anything any more. My grandmother is in bits about this and has tried to talk to my cousin’s mother, her daughter, about getting her some help. However, my aunt’s response has been, “She’s not going to turn out mental like the rest of you people.” (Other members of the family, including me and my grandmother, have had mental health problems.)

My cousin enjoys watching videos and playing video games, but her parents have banned them and see them as an example of her laziness. She is not sleeping either, so her constant exhaustion is taken as yet more evidence of laziness.

What terrifies me is that this is what my mother did to me, and I can only see it getting worse. When I began self-harming in my teens, my mum also banned me from my one hobby, screamed at me when I had a panic attack and slapped me when she found out I had self-harmed.

I had problems with substance abuse and dropped out of school. I moved away from home as soon as I could.

I am now in my mid-20s, and not close to anyone in my family apart from my grandmother. I have now moved somewhere else and, although I don’t see my parents, I am in contact with them. I haven’t seen my cousin for a few years and have no contact details for her. Anyway, I am not sure how, “Hi, I know we haven’t spoken in years but you remind me of me” would go down. I am trying to help my grandmother find a way to talk to my aunt in a manner that won’t enrage her, but my grandmother is a very non-confrontational person and, as much as she is trying to help my cousin, having to confront my aunt has only resulted in my grandmother being screamed at and threatened with losing contact with her grandchild.

I don’t know how to help my grandmother or my cousin, but I feel as if I have to do something, or history may repeat itself.

That you have come so far from a very toxic and unsupportive environment is incredible and a real credit to your strength of character.

It is great that you are so caring about your cousin and grandmother, but I think there is a lot of over-identifying going on. Your cousin doesn’t sound as if she is in a great place, but the facts pertaining to her were thin. The rest of your letter was about your experiences within the family and your fears of what might happen. I am not trying to minimise how you feel, or what is happening in the slightest – but the key is to separate the different strands so you can work on the right bits at the right time.

I consulted Stuart Hannah, a child and adolescent psychotherapist (childpsychotherapy.org.uk), who said: “The news about your cousin is filtered through your grandmother, via her daughter [your aunt].”

News filtered through people who have their own agenda or narratives can get distorted and then there is less likelihood of anyone getting the help and support that is right for them.

I disagree that it is not worth contacting your cousin: I think you should get in touch. Sure, if you go in there with “you remind me of me” that may not be conducive to further communication. But if you make a different sort of contact, more of a general “hi”, and see what happens, that may be really helpful to her in time (don’t expect miracles straight away). After all, you are not that much older than her, a mere decade, and you share a grandmother. There should be lots of other things to talk about so she feels she has someone to talk to if she feels like it – so it’s about her agenda, not anyone else’s.

It sounds as if you have a lot of issues you haven’t dealt with yourself and I wonder if you have some support (apart from your grandmother). If you do, you could come at this situation with less of your own baggage and would be better able to support your grandmother.

I don’t know what the conversations with your grandmother are like, but Hannah counsels: “How can you offer [your grandmother] something different? Something that isn’t judgmental or blaming [that she seems to get from her daughter]. You can listen from a neutral place. Don’t go down the slagging-off route [if you do], and suspend judgment of family members. If you can hear your grandmother’s experience, that may in turn help her listen to her daughter.”

Being empathic is great – however, if we over-identify with a situation (and both you and your grandmother might be), then the danger is, when we hear about something similar we can start to overlay our own experiences on to this new situation. This stops us seeing what is really going, and it imbues everything with extra emotion.

I think, given everything you have said, there is an element of trying to save your younger self, and that’s laudable, but there is a limit to how much you can do. You may also find this website helpful:

Youngminds.org.uk

Your problems solved

Contact Annalisa Barbieri, The Guardian, Kings Place, 90 York Way, London N1 9GU, or email annalisa.barbieri@mac.com. Annalisa regrets she cannot enter into personal correspondence.

Follow Annalisa on Twitter @AnnalisaB

Crisis looms for social policy agenda as Brexit preoccupies Whitehall

Ever since Theresa May set out her vision to govern for everyone and not just the privileged few last July, those in the charity sector who work to reduce poverty and inequality have waited patiently. Campbell Robb, the chief executive of the Joseph Rowntree Foundation, was one of many charity leaders who hoped for progress. He wanted to see a revamp of the government’s much-criticised “troubled families” programme, a £1bn scheme set up by David Cameron in 2011 and billed as the Tories’ flagship social policy initiative.

But when the Department for Communities and Local Government issued its first annual report on the programme , the charity sector was hugely disappointed. Robb described the document that emerged as “thin” and a “testament to the vacuum” that exists where we need to see “big political and social change”. It was barely noted in the media, which focused instead on a range of austerity-driven changes to the tax and benefit system, announced originally by George Osborne, which came into effect at the beginning of the new tax year. The changes hit the poorest hardest, while helping millions of the better off. The view increasingly held by thinktanks, and across the public sector, is that May’s government – even if well intentioned in wanting to reduce inequality and enhance opportunity for all – is too distracted and too constrained by the state of the public finances to do so.

“There is a danger that Brexit could suck the oxygen out of attempts to implement a sweeping programme of social and economic reform that is badly needed at home,” Robb said.

Even within parts of the Tory party, MPs and others worry that Brexit is now the only show in Whitehall, one so all-consuming, so draining of civil service and ministerial energies that everything else – the May agenda included – is on the back burner.

“David Cameron came into office with a new social vision of Conservatism and promptly sacrificed it on the altar of austerity,” says Phillip Blond, director of the ResPublica thinktank. “It is vital Theresa May does not let her one-nation Conservatism experience a similar sacrifice at the behest of Brexit. The trouble with Brexit is that those who voted against the EU as a proxy for globalisation and its general destruction of working-class security, risk finding May’s ‘global Britain’ to be far, far worse for them.”

Ryan Shorthouse, director of the liberal conservative thinktank Bright Blue, says he always suspected Brexit would syphon the energy out of Whitehall and voted against it partly for that reason: “A persuasive argument for voting Remain, I thought, was the lengthy and disproportionate focus that would be required of politicians and policy-makers to undertake the process of Brexit, which is indeed what we are now experiencing. There are other important and pressing issues that urgently require deeper thinking and discussion: the affordability and quality of social care, the upskilling of those on the lowest incomes, the financial sustainability of the NHS, and decarbonising our economy.” The green agenda, once central to May’s predecessor, hardly registers these days.

When the financial crisis broke in 2008, Nick Pearce, now professor of public policy at the University of Bath, was in charge of the No 10 policy unit under Gordon Brown. “It was the biggest economic shock the UK had faced since the second world war,” he says. But it did not preoccupy every government department as Brexit does. “It was largely dealt with by the prime minister, his advisers, the chancellor and Treasury officials, and the Bank of England. It was not like Brexit. Most of Whitehall now has Brexit at the top of the in-tray.”

It has already been decided that the next Queen’s Speech will be dominated by Brexit-related bills. Ministers have been told to limit their bids for domestic legislation so the way is clear for parliament to focus on the “great repeal bill”, which will incorporate the mass of EU law into UK law, and on other Brexit-related bills including one on immigration. A recent report by the National Audit Office says the civil service has already created more than 1,000 extra roles in the two new Brexit departments – for International Trade and for Exiting the EU.

‘Lego bricks and boiled eggs’: the three Brexiteers explain everything

And that is just the start, as the search for trade experts – outsourced over the last four decades to Brussels – intensifies. Many civil servants have shifted from domestic roles to Brexit posts in a huge, destabilising, but necessary, reconfiguration of Whitehall. Jeremy Heywood, the cabinet secretary, has described the task of managing his Brexit troops in Whitehall as “the biggest, most complex challenge facing the civil service in our peacetime history”. The NAO says new skills have to be learnt and found – a process which inevitably means less use of expertise gathered over decades by senior mandarins.


The poorest third of households are faring even worse than they did after the 2008 crash

The Resolution Foundation

Its report says: “Departments which have had large amounts of EU-derived funding and legislation, for example, will need legal, economic and sector experts to deal with the implications of leaving the European Union, and will have to do so using their remaining staff while also seeking to achieve pre-existing priorities.” Lord Kerslake, a former head of the civil service, says it is entirely right that the focus is on delivering a successful Brexit, but he fears problems will develop down the line in unrelated but vitally important areas as eyes are taken off the ball. “Nobody has quite got the measure of this because of the dominance of Brexit,” Kerslake says.

“Of course there is a need to equip government for Brexit but there is also a need to carry on with the rest of the business of government. There is a risk for the government in this: that things that would have surfaced through being debated and being challenged in normal times will now not surface early, and not until they become crises.”

Angel of the North


The Angel of the North statue. The fate of English devolution – formerly a priority – is in question. Photograph: Christopher Thomond for the Guardian

Emma Norris, programme director at the Institute for Government, says the repercussions are already being felt on issues of critical importance. “After trailing a big decision on airports, a parliamentary vote on Heathrow was pushed to late 2017. Key social reform policies in education have been delayed too, like the national funding formula, which was originally due to be implemented this year, but will be delivered at least 12 months late.

“The fate of English devolution – formerly a major priority – is also in question. Adult social care and hospitals are being pushed to breaking point and, in the case of prisons, beyond it. Ambitions to reduce demand, make better use of technology and find new ways of working have yet to be realised. Without action, within the next two years the government could face a disastrous combination of failing public services and breached spending controls against the backdrop of Brexit.”

She adds: “Even the prime minister’s personal priorities are moving slowly. David Cameron’s life chances strategy was scrapped in favour of a new focus on social mobility. But many of the details of this are yet to come and, as the Social Mobility Commission recently reported, inequality is rising.”

The Resolution Foundation maintains that the need to address stagnating living standards and rising inequality is “the non-Brexit challenge of this parliament”. It points out that typical incomes are set to grow by 3% over this parliament – barely any faster than during the Blair/Brown Labour governments, which coincided with the financial crisis and its aftermath. The thinktank says May’s priority, the “just managing families”, are doing worst of all, with the poorest third of households faring even worse than they did after the 2008 crash. This, it predicts, means we are heading for the “biggest rise in inequality since Margaret Thatcher was in Downing Street”.

Pearce points out that Brexit will also skew spending priorities, creating new pressures on finite resources for a government struggling to keep public finances on a tight rein. “Economic priorities – such as R&D, skills and infrastructure spending – will get higher priority in public spending. Brexit will also create powerful new lobbies, such as farmers, universities and key business sectors, who will be arguing for funding to replace lost European Union resources. These lobbies will find themselves competing with the public services that have lost most from austerity, such as social care. And they will also be up against a neo-Thatcherite wing of the Conservative party that wants to use Brexit to cut corporate taxes and public spending even further.”

Torsten Bell, the Resolution Foundation director, says May cannot afford to overlook problems at home as she conducts her Brexit battles with the EU. “The living standards outlook is bleak and risks giving us the inequality rises of the 1980s, without the feelgood factor of rising incomes. But it can and should change. After all, Theresa May knows her record will be judged as much on the Britain she builds as the Brexit she delivers.”