Heavenly Haven

Leaving the house, I felt that something wasn't quite right as I cycled off to the station. I discovered, when I got there and looked at the indicator board, what it was: I hadn't reset my alarm after yesterday's early start - and was an hour early. Undeterred, I had pleasantly quiet trains to Paddington, over which the sun was rising.

Maybe I should get up at this time every day, I briefly thought. 'Briefly' because I remember an old mentor and colleague telling me how he always got up at 4am and did two or three hours' writing before he got ready for work. He has written some excellent textbooks as a result, but I'm afraid I just value my life in the land of nod too much to even contemplate it.

Liverpool Street station was easy: the machine spat the ticket out as soon as I put Jo's code in, and the train to Colchester was a bit quaint: old-fashioned bouncing-up-and-down-seats with lots of tables. I wasn't sure about the upholstery - bright blue cushions with a flying pigs motif - but they're not as bad as the most recent Great Western assault on our eyeballs: lurid purple with shocking pink squiggles. Their graphic designer must have been luvved-up on ecstacy at some laser show when he came up with that one. But the guard (as they have started to call them again on SW Trains now, instead of the horribly corporate 'train manager') DID manage to show some sympathetic discretion when I was on a train too early for my ticket. So maybe I was wrong in what I wrote in yesterday morning's post: but I'll keep an eye on it and report it back to you.

Colchester is a new place to me, and an extra hour meant time for a cycle ride round the town centre - quite a graceful place, with some interesting higgeldy-piggeldy streets with names like 'Sir Isaac's Walk'. But if you think Essex is all flat - then think again if you intend to cycle from the station to the High Street: it was a bit strenuous for my ageing cardiorespiratory system - but at least I made it to the top without the indignity of having to get off and push.

Arriving at the Haven is like rolling up to a rather large well-kept and nicely proportioned suburban house in an affluent part of the Home Counties, which I suppose is exactly what it is. But it certainly wasn't like having an appointment to do a formal review of a mental health facility. The first to greet me was Meg, their part-time and slightly arthritic PAT Labrador; next we were introduced to the slightly spooky white cat with beautiful green eyes, that seems to have left home and adopted her new family, as only cats can. Then lots of people, and the business of the day began.

One of the questions I'm asking at every 'Innovation Centre' is what picture they would like put on this blog, that they are proud of. The good people of The Haven had many homely objects to choose from, and some willing human volunteers - but they soon arrived at consensus that it should be their embroidered banner, which hangs in the main living/group room:

As before, if anybody reading this was there for the meetings - please say something below.
It will all be quiet for a few days now, as our next outing isn't until Aylesbury next Tuesday.

CANDI floss

The first thing that slightly flummoxed us about site visit number two was that we were expecting it to be up near 'Camden', or perhaps 'Islington' - as we have always known it as the 'Camden and Islington project'. But when we looked up the postcode, it was slap bang in the middle of Bloomsbury - just off Russell Square, in the midst of London University. We didn't quite believe this, so rang everybody we could think of who had or might have been there - but they were all switched through to voicemail. Who said the era of long lunches is over? So we went off to the address which corresponded to the postcode we had, which in fact it turned out to be right - because we later learned that the borough of Camden and Islington (and the PCT boundaries) went as far south as the northern edge of the council area of the City of Westminster, and Westminster PCT .

As the sun had come out  (or had we come out of the SUN?), we thought a race across London would be quite a good idea to keep us sharp. It was going to be Top Gear-style: Sue on the bus, Lisa on the tube and me on the Brompton bike. Unfortunately, it didn't quite work like that, as Sue and Lisa decided that they'd rather go on the tube together, and by the time I got to the end of Wandsworth Common and looked at the map I decided that it was FAR too far to cycle, on a cold day when I was expected to turn up looking reasonably composed and suitably smart, so it was the Northern Line for me too.

Unfortunately, we made a bit of a boob with this one - we hadn't made it clear enough that we wanted to talk with service users as well as senior staff. So we are going to need to schedule in a second visit, to see the service user gang. But it's probably just as well, because it is quite a complex project - particularly how it has developed and changed since it started - so we had a very useful and detailed discussion to understand just how it all works. We probably would have been half in the dark, if we had tried to fit in everything else we wanted to. So watch out here for the second visitation, which will probably be in March.

But we didn't want to fail in our mission to take the obligatory photo, so we took two. The first is of the lobby, which we thought was rather elegant and uncluttered; the second is of a filing cabinet. How boring could a photo be? Well, if you look above the filing cabinet - you will see what we colloquially know as 'Frankie's Wedding Cake' precisely amended to show the PD services that exist in Camden & Islington (and Bloomsbury).

A civilized entrance lobby

An interesting chart in the office

So that's it for day one. Tomorrow, off to deepest Essex.

Here comes the SUN

OK, Clapham Junction wasn't all that bad, and they're trying to improve it by having jazzy lifts to all the platforms, and it WAS quite easy to find the right train to Balham. And Balham itself was quite interesting - a retro-tube station on the corner, with Californian traffic lights. And rows and rows of decent solid victorian houses on the dawm cycle ride to the hospital, where I was met by somebody I have never seen in my life before - but offered a cup of tea and comfy room to watch the SUN come up (forgive the pun).

The meetings went to plan - firstly in a consulting room in a converted nurses home and then in a converted ancient ward from the days when Springfield used to be the County Asylum for South West London.

Now, as one of the purposes of this magical mystery tour of the country is for 'getting the message out there'. So just what is 'the message', and why use a blog as part of it? The problem is a bit of a Catch-22: we won't know just what the message is until we have been round everywhere, and we won't know how best to use the blog until we have talked to everybody about it.

In our minds, the message is something like 'people around the country, in these different innovation centres, which used to be called PD pilots, have done some extraordinary work in completely new ways, involving all levels of the system, and it needs to be taken seriously'. At least that's the message we're starting out with; we are collecting mountains of data to back it up as we go round, and it might end up quite different.

The medium is quite another aspect. The one definite thing is going to be a rigorous report which will analyse, summarise and communicate everything we gather on our travels, and suitable parts of it will be put through various channels that are available to us at the Department of Health. The rest will 'emerge' as the process develops - and it is the softer, more varied and less concrete. Again, we have started off with some 'ground level' ideas - but will modify them as we go. One rather nice one that came up this afternoon is that we will take a photo at each site, and post it on the blog for each entry. What we have already decided to do with Ann, our web supremo for the national PD website, is to offer each site a web page there for 'official information', and to offer each service user group we meet a page for whatever artistic and creative things that they want to put there (like poems, drawings, paintings, photos, videos, sound clips or pdf documents). If the service already has a good website that they are quite happy with (for example, on their NHS Trust's server), then we will just put a link to it from the national site. If they don't already have an 'official' website, or want to use some pages more flexibly than their organisation's policies allow - we will be happy to host it. Or if they want to stay completely quiet about what they are doing - we'll leave them alone (but we hope not many will choose this option). But if people want to use our national PD website in other ways, we will try to help.

Our very helpful focus group at SW London SUN wanted their photo on the blog - though not everybody in the group wanted to be in it - so here it is.

Can we ask that they do us a small favour: could each of you, when you see your picture here, just add a few words to the 'comments' about what the day was like for you? You don't need to identify yourself in any way if you don't want to. Thanks!

Next - off on the Northern Line to the other side of the river... (People who don't know London might not understand the enormous significance of this!)

Triple Whammy

Triple Whammy

[Image] Dawn over SW11 It's not nice having to get up for the first train of the morning, especially when the next one, an hour later, would only make you five minutes late - but sometimes things are more important than an hour's extra sleep. How Jim Naughtie and Euan Davies do it, and sound so normal as well, is truly impressive.

This morning the first thing to hit my ear drums was their jolly banter about the weather - how it just hasn't stopped raining all night in London, which is just where I'm about to go to, with my folding bike - and having just left my rain cape at the hospital yesterday. Ho hum.

Dawn over SW11

Clapham Junction is arguably the second most alienating railway station in Britain, though it'll need to do a lot of work to catch up with Birminham New Street. Of course, the whole network is trying very hard to do serious alienation at the moment: with their robotic communications, insistence that we're 'customers' rather than 'passengers', and training their previously nice and friendly staff - usually 'railwaymen' and 'railwaywomen' to the core - to fear treating those 'customers' as fellow human beings and ever being able to exercise flexibility or discretion. At least we've got that 'UK Train Times' app that seems to be able to do seriously useful things - like knowing which platforms trains are going from before the station staff do, and taking you home without the need for any intervening thought. Who needs to talk to a human being any more?

It may even be a quadruple whammy, as there is also the 'Sarf London' factor - which makes a train journey to somewhere like Balham, then a cycle ride to Springfields Hospital feel a bit like an expedition to the source of the Nile or the Star Wars space cafe. Just why does North London seem so much more understandable and easier to get to - with tubes going nearly everywhere, and places that you have at least heard of?

It's never too late.

Just where do we start?

We should have been doing this nine years ago, when the government started to realise that there was a pretty big mental health problem out there that most NHS services aren't set up to deal with. An awful lot has happened in the last nine years, and this feels more like the end than the beginning. We're in such austere times, with limits on funding, with it feeling almost impossible to start anything new, and with many aspects of all our lives getting more harsh and severe. The national PD programme, which has done all sorts of things in the last nine years, is going to finish in March 2011 - and this blog, plus the website that goes with it, might be all that's left by April.

However, we're not going to get morose and glum here -  though we won't be putting a shiny corporate gloss on everything either. Most people in the PD movement will be experiencing at least some aspects of the national gloom at the moment, and we don't want to minimise that. Many good things that happened, and positive developments that are still happening. We hope that this blog, and the processes going on behind it, will help to link people up and build on the positive developments. Maybe a long shot - but we're going to try our best!

To get up to speed, let's do a good things/bad things list - about everything that has happened in this field since 'No Longer a Diagnosis of Exclusion' came out at the end of 2002.

Bad things

• Henderson Hospital and Main House closed: no NHS provider now has residential beds for adult non-forensic PD (what we call 'Tier 4 provision').
• The new government-funded pilot services (see below, good things) only cover 9% of the population.
• With so many NHS changes, nobody knows whether they are coming or going - and the general institutional response is harsher management control and less space for grass roots creativity.
• The new training (KUF - Knowledge and Understanding Framework) is very very difficult to get going in this environment, even with the decent funding from the government that it is getting.
• Recession and cuts, cuts, cuts. 
• For service users, considerable fear about being forced into work; for clinicians, a worry that the benefits system will fail to recognise their mental disorder, and so make them more unwell.

Good things 

• Eleven new pilot projects started in 2004 - and all of them are still going strong. The 'final clinical review' of them all will be the main preoccupation of this blog from now until March.
• Many others - number unknowable - have also started since then in the 'mainstream' NHS. We're going to start tracking them down and including them on the national website in April.
• Lots of other pilots and new ideas have also been developed in prisons and secure units (though they are not going to feature in this blog)
• Inspirational and attitude-changing training being set up across the country (KUF - but also see the down-side in 'bad things', above) 
• Useful NICE guidelines (BPD and ASPD) which aren't over-prescriptive, were published in January 2009
• Roadshows throughout the country to disseminate the 'Recognising Complexity' guidance for commissioners (mental health and others) were very well supported.
• Exceptional energy and enthusiasm has come from the PD service user (aka 'experts by experience') movement, represented by organisations such as Emergence (nationally) and STARS (in the Thames Valley). But probably many more around the country that we don't know about yet (So please respond to this blog if you are one of them!)
• A 'First National Congress' at the ICC in Birmingham in November 2009 to celebrate all the innovation and creativity: opened by Lord Victor Adebowale and hosted by the BBC's Mark Easton.

That's enough to start with.
Next posting expected when we're on the round-England journey, starting on Tuesday.
Here's the map of where we're off to:

PDB