Yes indeed the NHS has a poor record on mental health.  But the examination question here is whether the NHS is generally a better arrangement for health service organisation and delivery than a market based / private capital dominated approach.  The failures of the NHS in mental health reflect a) the use of the wrong model for such support (not simply reducible to the medical model, but underpinned by an individualising, faulty machine paradigm that for all its partial  insights leads inexorably to victim blaming alienated care) and b) the wider, societal discrimination, stigmatisation of people who suffer mental distress (or whatever equivalent term you prefer).  It is probably  the 2 together that makes it so difficult to make real improvements.

I wouldn't want to take the mistakes and imperfections of the NHS, in this field or any other, as evidence that socialised health services are somehow inferior to the alternatives (Bismarkian social insurance  - currently being touted for social care, or privatised, marketised, inadequately funded health care a la USA - and look at the steady stream of NHS managers and policy makers going across he Atlantic to find out how to so it better!).

The discourse is, and must be 'NHS good' because of the very real threats to a healthcare system based on the principles spelled out in the the initiating post in this thread.  But yes it also needs strengthening - it is flawed as much by the compromises made in setting it up (no democratic control, too much power to one group of technicians - also called medics) as by anything inherent to it.  One way to begin to address the very real flaws is by working to make practice and policy in the NHS more democratic - as individual practitioners, as citizens, patients, carers, and community psychologists too.  Democracy in the consulting room and democracy in planning and managing health services.

Finally, I do have a problem with social enterprise (notwithstanding the valuable work done by some - we live in a world of contradictions).  Why is a neoliberal regime promoting them?  I'm all for worker and user co-ops in the context of moving from a private system to a socialised one, but I believe they are being used as a stalking horse in a move in the other direction.  In Manchester the public bus company was bought out by the workers - great a worker run company!  They were bought up by Stagecoach.  Already one PCT is moving to set itself up as a social enterprise - why?  The NHS is/was a 'social enterprise'.


Wendy Franks wrote:
[log in to unmask]" type="cite">
Hi David (and all)
 
Thanks for your response, and the friendly terms in which you presented it. As you know, I appreciate your critical voice here on the list, and am aware that your comments avoid personal criticism, but present a critique of ideas and positions.
 
I'm glad you brought up the issue of critiquing the NHS and the notion of how difficult it can be to counter the prevailing discourse of 'NHS: good'. What I said below, was that most of the founding principles would be hard to dispute, ie: those Annie referred to:
Comprehensiveness, Universality, Free of Charge, Equality. In fact, I had some doubts when I was thinking about the question of whether the NHS should be comprehensive - ie: a statutory health service providing services, through professionals taking up an expert position on elements of life and community needs that may be better met in other ways. Of course, there are times when I definitely want a service from an expert, for example, when I fall down and rupture my spleen, and it needs taking out or I'll bleed to death, that kind of thing. I don't mean to suggest that the NHS is only good for medical emergencies, but I do think that what the NHS provides should be as open for discussion as how, or anything else. I know that we focus a lot on mental health on this list, but of course community psychology also has a legitimate focus on the material aspects of life that contribute to community well-being such as poverty, housing, and physical health.
 
As several people on the list will know, I'm taking some time out from working in the NHS, for a range of reasons, but at least partially because I found aspects of my working environment to be doing me more harm than good. I'm still finding ways of making sense of my experience, and have not reached a clear conclusion. As an NHS worker, I have been very aware of the ways in which NHS systems can enable the development of toxic environments for all kinds of people, including providers and users of the services. As such, I welcome a critical perspective.
 
But even in saying all this, I also value the idea of free universal health care, as an NHS service user as well as a service provider. Most of all, what I wanted to put across was my support for creating an opportunity to discuss further, and to consider how to present a challenge to the changes that are currently happening in turning the NHS from a public service model into a market based model.
 
Hope some of the above makes sense, as I’m writing in haste. Unfortunately, I go away tomorrow, and won’t have time to add much further to the debate for a while, but will be interested to see where it goes from here.
 
All the best,
 
Wendy

David Fryer <[log in to unmask]> wrote:
Hi Wendy,
 
Thanks for contributing to discussion although you have a lot on your plate at the moment.
 
As you know and I know (but others might not) you and I agree on lots, we discuss matters in a friendly way off list when we can and we can disagree on things without seeing that as disrespectful or destructive, so this reply is meant in the spirit of promoting critique and not personal disagreement:
 
I would like to suggest that we avoid defaulting to a taken-for-granted assumption that, although there is oppression as well as emancipation in practice in the NHS, the NHS is beyond critique in principle and assuming that if we developed a collective stand on the NHS 'in principle' it would necessarily be positive stand. There is massive public support for the NHS and it seems almost sacrilegious to question whether the NHS is a 'good thing'. The near taboo in many progressive quarters of any questioning of whether the NHS is a 'good thing' in principle, the dominance of the 'NHS is good' discourse, and the scarcity of progressive counter discourses are surely reasons for critical scepticism about whose interests the NHS really serves, its relative value to various classes, how it functions in terms of governmentality, its role in the reproduction of the labour side of the means of production, etc?
 
Difficult issues but this is of course a community psychology discussion list
 
David

 
From: The UK Community Psychology Discussion List on behalf of Wendy Franks
Sent: Fri 18/07/2008 23:17
To: [log in to unmask]
Subject: Re: 60th anniversary NHS: community psychology manifesto

Hello all,
 
Just a quick email, as I'm between various demands that are taking up a lot of my energy at the moment... but I felt it was important to respond to this.
 
I think it's worth distinguishing between the founding principles of the NHS (most of which I think would be hard to dispute), and the practices that have evolved within parts of the NHS, which David has referred to below. When I was working in adult mental health, I encountered a lot of examples of oppressive practices, and this is not the NHS activity that I want to support. I also saw some good examples of positive practice, even bordering on the emancipatory at times, if you can imagine! The founding principles of the NHS extend beyond mental health, into the broad range of health services that we all use, and the service as it was initially designed does appear to be undergoing a serious degree of erosion and stealthy (sometimes not so stealthy) privatisation.
 
I would personally welcome an opportunity at Edinburgh to consider how to focus our energies on making a stand to mark the 60th anniversary. A couple of thoughts initially come to mind:
 
1. work with other groups, such as Keep Our NHS Public: http://www.keepournhspublic.com/index.php
Perhaps inviting someone to help us to think together at the Edinburgh conference, if space can be made for it there? Maybe we need some outside help to guide us in learning how to be more effectively engaged, in terms of lobbying/politics (we do seem to hit a dead end time and again)?
 
2. formulate a Community Psychology response to the Department of Health's NHS consultation which claims to consult on the 'proposed NHS Constitution published today, marking 60 years of the NHS, is about safeguarding its core principles and values for the next generation' http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085814
The consultation runs until 17 October, so we could look at this at the conference too? I'm not always optimistic about how meaningful are consultations like this... but it's a possible opportunity.
 
Unfortunately I will be away for most of the next month, and not able to work on this personally, but would hope to have space to be involved nearer to the conference.
 
Wendy
 


David Fryer <[log in to unmask]> wrote:
but . . .  whatever one thinks of the progressive founding principles as articulated below (and personally even though they are increasingly rhetorical than actual, I think a lot of them), I would not want to forget that the NHS is a central part of an apparatus which in practice delivers, for many, oppressive practices and is contested by survivors of psychiatry, mad pride, activist groups like SUG (the Seroxat User Group), Reachout and other emancipatory  anti-psychiatry movements, that it is within the NHS that problematic individualistic psychologistic  'interventions' (like CBT for unemployed people) are widely delivered by clinical psychologists, that the NHS is central to the psy complex governmentality critiqued by Rose, Parker etc. and the medical model of disability critiqued by disabled people's movements. This is not to deny there are progressive aspects of the NHS in principle which should be supported and developed but to also emphasise that there are oppressive aspects of the NHS in practice which should be contested and diminished by community and critical psychologists.
David
 

From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Diamond Bob
Sent: 18 July 2008 16:27
To: [log in to unmask]
Subject: Re: 60th anniversary NHS: community psychology manifesto

Thanks for this Annie and to Mark’s comments. I agree whole heartedly with recognising and giving our support to the principles that the NHS was founded upon. It does feel increasingly threatened by the corporatisation and semi-independent status of Foundation Trusts. Not to mention the half-baked notions of choice which ultimately seems to me to be about more choice for some at the expense of no choice (dare I say it possibly no service) for others.
 
What to do about it? I’m less clear about. Letters to the papers are one thing and I think they have their place but is this what we’re thinking about this time? Perhaps something more substantial like the community psychology statement from the birmingham meeting linked to the 60th anniversary. Apologies if I’ve overlooked things here.
 
Bob Diamond
 
From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Annie Mitchell
Sent: 06 July 2008 15:22
To: [log in to unmask]
Subject: [COMMUNITYPSYCHUK] 60th anniversary NHS: community psychology manifesto
 
 
 
 
Hi All,
 
It is the 60th anniversary of the NHS. I am startled to realise that I have worked for it for nearly half its existence! Supporting the public sector is one of 4 core principles put together in the Birmingham Manifesto by a group of UK community psychologists a couple of years ago, attached.; Mark Burton put the manifesto statements  together for us. Mark wrote this about the NHS:
 
*The National Health Service in the UK, established by the 1948 Labour government with the
following founding principles: Comprehensiveness - a service covering and meeting all
kinds of health care needs - from infancy to old age, not just for physical illness (mental
health and wellness), preventative and curative. Universality - a service of uniform quality
for all - on the basis of citizenship rather than either ability to pay or insurance scheme
parameters. Free of charge - it would be paid for by the state (on the basis of redistributive
taxation – a principle since eroded). Equality - those with more resources (educational,
money, etc) would get no better a service than those who were less advantaged. Since
people do not have equal health care needs, the point is to have access on the basis of
need and not any factor irrelevant to need (see www.dhrsa.org.uk).
 
Be good of we could continue to think about ways in which as a group we could disseminate/ act on the Birmingham  Manifesto; I know that there will be opportunities to think about this do so at the forthcoming September conference in Edinburgh.
 
 
Annie
 
 
Annie Mitchell
 
Clinical Director,
Doctorate in Clinical Psychology,
School of Applied Psychosocial Studies,
Faculty of Health and Social Work,
University of Plymouth,
Peninsula Allied Health Collaboration,
Derriford Road,
Plymouth,
Devon
PL6 8BH
 
 
Phone  Programme Administrators:
Jane Murch, Emma Hellingsworth
01752 233786
 
Please note I  work 3 days per week:
usually Monday, Tuesday & either Wednesday or Thursday.
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Academic Excellence at the Heart of Scotland.
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