Knife Attacks – Whose Crime Is It?

I find myself staring at the screen, unable to comprehend how utterly devastating it must be as a parent, to have a police officer knock on your door in the early hours of the morning, to be told that your darling child has been stabbed to death. My heart weeps for the senseless loss of life, young lives stolen away in this rising tide of violence. I know what it is like to break truly awful news to people and their families and my heart goes out to the police officers on the beat or the clinicians in the Emergency Department, who have to break the terrible news to the parents and the siblings, that so suddenly, a bright shining light in their lives, has been extinguished.

 

Knife attacks are a crime, there is no denying that, but the burden of guilt is not so easily apportioned. We are seeing an exponential rise of it in our streets, with a 93% increase in recent years across England, whilst in Scotland, they have seen a 64% decrease over a similar timeframe. We need to examine what has gone on in that time and ask some very uncomfortable questions. We also need to call people to account for decisions which have been made, despite knowing the evidence, and  we desperately need a ‘whole systems’ approach to tackling this epidemic.

 

The Primeminister has stated that “knife crime” is not linked to a decrease in policing numbers. The police chiefs disagree. The truth is, that it’s not only the police who have disappeared off our streets (and these are community police officers, who knew their communities well and were respected and trusted – it takes years to build up those kind of relationships) – we’ve had a perfect cocktail of cuts right across the board which is directly attributable to the mess we are now in. Ongoing austerity, which is a political choice, has also led to the closure of youth centres, more young people than ever excluded from school, (who then have a 200 times higher chance of being groomed into violent gangs) and massive cuts to public health and local government, meaning many preventative schemes have disappeared. When policy fails, it has to be called out and challenged. Everyone with a brain knows that prevention is better than cure. And for those who have lost loved ones, there is now no comfort – this could have been prevented, but has been allowed to escalate at such an alarming rate because we do not have a form of politics or leadership that listens to what is really going on in our communities, but continues to drive through ideological changes without thinking through the consequences. This is unacceptable.

 

When Heidi Allen MP came to Morecambe, she heard the testimony of my friend, Daniel, who grew up in some really tough circumstances, forced into a gang culture in order to help put food on the table and prevent harm coming to his family. Tears streamed down her face as she heard his powerful account of what it meant for him as a young person, to have his youth centre closed, his local high school closed and being told he was not a priority when he was street homeless. She told us that she had not realised the layers to the poverty that many are experiencing across England. And this is how the (perhaps) unintended consequences of remote policy decisions affect ordinary people in droves across the UK. When school budgets are cut and mental health teams are cut and social care provision is cut and youth centres are cut, children and young people from home environments which are already struggling to make ends meet, already processing significant trauma and adversity, fall prey to gangs and criminal networks who use them and abuse them for their gains across county lines.

 

And yet in Scotland, we are seeing an altogether different picture emerging, because they saw this problem 10 years ago and decided to make a difference by dealing with complex living systems, rather than tinkering clumsily with mechanistic thinking. So it is high time that England ate some humble pie and learnt from our Celtic friends.

 

Scotland, unlike the English, are not delaying on taking a serious approach to Adverse Childhood Experiences, hoping to become the first fully trauma informed nation in the world. They have taken a public health, holistic approach to the knife crime problems in Glasgow and then spread the learning across the nation, rather than making devastating cuts to their PH budgets. What they have done isn’t rocket science – it’s plain, public health common sense. They have chosen not to criminalise, label and stigmatise young people (something the hostile environment rhetoric seems to do). They have refused to see it as a race problem – because it isn’t (but some in our press in particular, and some members of the government have stirred up this nonsense anyway) and they have invested in early and effective youth intervention programmes, amongst other things.

 

One of things my work has taught me to do, is suspend my judgements of those who we would automatically and ordinarily point the finger at, the supposed perpetrators of a crime, and really listen to the truth. The truth here is complex and I’m not saying that people who commit violent acts do not need to face the consequences of their actions. They do. But what I am saying is that we need restorative justice in our communities that breaks this horrendous cycle. We also need to recognise that there has been terrible violence done to our most vulnerable children and young people across England by a series of political decisions. The government has failed those it should have protected. In my line of work, those kind of errors would lead to massive learning events and the dismissal of those who had failed in their leadership. Perhaps people have such little faith in the political system we have because there is seemingly such little accountability. Now is not the time for silly political defence of failure. Now is the time for humility, repentance and a genuine turning of the hearts of the fathers and mothers in the nation to the rising generation, far too many of whom are no longer with us.

 

 

 

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Solutions for the NHS Workforce Crisis

This week, the Kingsfund, one of the most respected think-tanks on health and social care in the UK declared that the current NHS staffing levels are becoming a ‘national emergency’.

 

The latest figures have been published by the regulator, NHS Improvement, for the April to June period.

 

They showed:

  11.8% of nurse posts were not filled – a shortage of nearly 42,000

  9.3% of doctor posts were vacant – a shortage of 11,500

  Overall, 9.2% of all posts were not filled – a shortage of nearly 108,000

 

NHS vacancies a ‘national emergency’

 

This is having a profound impact on staff who are working in the NHS now, with low morale, high stress levels, increasing mental health problems and people leaving the profession (either to go over seas, where pay and work-life balance is considerably better) or retire early. 

 

Increasing the number of doctors, nurses and midwives (all with considerable debt, mind you!), by 25% over the next 5 years is welcome, but it doesn’t solve the problem now, and it is unlikely to be enough, even then!

 

But, let’s take a solutions focussed approach. What can we do now? I think there are a few things we need to consider:

 

  1. I can understand how frustrating it is for the public to find that waits are longer to receive much needed care. When we’re anxious or worried about our own heath or that of a loved one, we are understandably at a position of higher stress. However, this staffing crisis is not of the making of the nurses, doctors and other health professionals who work long hours every day to provide the best health care they can. So, it’s really important that as a country, we treat our NHS staff with kindness, gratitude and respect. The current abuse of NHS staff is making the job even harder and really making people not want to come to work. And that means we also need to make complaints in a way that is perhaps a bit more compassionate or understanding towards people who are working under high stress situations. It is important that we learn from mistakes, but complaints have a huge impact on staff and can hugely affect their confidence, even when they are dealt with in a very compassionate way by those in leadership. 
  2. We need to ensure that we use our appointments appropriately. Yes – sometimes, we have to wait a while to see our GP, but if we get better in the mean time, we really don’t need to be keeping the appointment! And missing appointments costs us all so much time and energy and makes those waiting lists ever longer. If we value our health system, we need to either keep appointments, or take responsibility to cancel them.
  3. We need to take an urgent look at the working day of our NHS staff and work out how we build more health and wellbeing breaks into their days. We need staff to have space to connect, keep learning, be active, be mindful and take appropriate breaks. This means senior leadership teams getting the culture right, when the pressure is on and the stakes are high. 
  4. We need to get smarter with digital and enable patients to make better and more informed choices about their own care and treatment, with better access to their notes. In this way, we waste less time and empower people to become greater experts in the conditions with which they live everyday. There are great examples of where this is happening already. It isn’t rocket science and can be rolled out quite easily. It’s good to see some announcements about this from the new health secretary Matt Hancock MP, but we need to make sure the deals and the products are the right ones. It’s also vital, when it comes to digital solutions that Matt Hancock listens to his colleague and chair of the health select committee, Dr Sarah Wollaston MP, in being careful what he promotes and prioritises.
  5. We need to be thinking NOW about the kind of workforce we are going to need in the next 2-3, and 5-10 years and we need to get the training and expectations right now! There is no point designing our future workforce based on our current needs. Rather, we need expert predictive analysis of the kind of future workforce we will need, in line with the ‘10 year plan’ and begin to grow that workforce now. If it’s healthcoaches we need to work alongside GP practices, then let’s get them ready, if it’s community focussed nursing teams, then let’s adjust the training programmes. This kind is vital and must influence what happens next.
  6. We need to stop putting pressure on NHS staff to deliver that which is currently undeliverable without causing significant stress to an already overstretched workforce. By this I mean centrally driven schemes, such as the intended roll out of GPs working 8-8, 7 days a week. Maybe it’s an aspiration for the future if we can sufficiently reimagine the workforce, but it’s not a priority now and isn’t the answer to the problems we’re facing.
  7. We need to stop the cutting of social care in local governments, and ensure that central funding flows to where it needs to be, to ensure the allied support services are present in local communities to work alongside NHS colleagues in getting the right care in the right place at the right time. This is the single biggest cause of our long ED waits and our problems with delayed discharges from hospital. It isn’t rocket science. It’s the reality of cuts to our social care provision, which have been too deep and this needs to be reversed.

 

Personally, although it is an option, I feel uncomfortable about a ‘recruitment drive’ from overseas, as it is very de-stabilising to health care systems in more deprived parts of the world when we do that. I think there are some win-win initiative we could develop pretty quickly that could also form part of our international development strategy.

 

In summary, we need to treat our NHS staff with kindness, look after their wellbeing, use our services appropriately, use digital technology with wisdom and not for political gain, redesign and start building the workforce of the future now, stop undeliverable initiatives and ensure the right funding and provision of services through social care which means central government funding back into local government. It won’t solve everything, but it will go along way towards giving us a more sustainable future to the NHS.

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What Every Northerner Should Know About the North/South Health Gap

Tweet Everybody knows about the Gender Pay Gap – it’s well publicised and very much in the public domain for discussion – and too right! – How is this even still an issue? It it is quite simply wrong that women should earn less than men, any time, any place, end of discussion.   Well the [Continue Reading …]

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