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Hadrian’s Wall – the grandeur and intimacy of the Roman Empire

 

 

 

 

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The fact that most of Britain was part of the Roman Empire is one of the defining aspects of our past and nothing epitomises that episode of history more than Hadrian’s Wall.  Started in 122AD on the occasion of the visit of his to Britain it was part of Hadrian’s plan to establish fixed and defensible limits to the Roman Empire.  It is not a wall.  It is the Wall which, even if it is through a mistaken piece of translation, has given us the word in the English language.

In a nation with an ambivalent attitude today to grand public works, its ambition and scale are breath-taking.  72 miles long and built across a landscape which, even today, can still be forbidding and desolate, the Wall makes few compromises to geography in its aim to furnish the best defensive positions.  Follow the Wall today around Walltown Crags or Steel Rigg and you cannot fail to be taken back by the boldness and determination of the Roman engineers and soldiers who constructed it.

Built by the legionary soldiers of the 2nd, 6th and 20th Legions over a period of around 5 years the Wall was built of stone, except for its western reaches which, initially, were constructed from turf.  In addition to the Wall itself, the legionaries constructed a series of milecastles, a network of forts such as those which can still be seen at Housesteads, Chesters and Birdoswald and an enormous ditch or “vallum” running in parallel to the Wall.  The Wall was, by any standards, an enormous logistical exercise. By one estimate it might have taken 30,000 vehicles, 6000 oxen and 14,000 horses and mules to transport the materials required.  Its  scale is highlighted by the extent to which so many subsequent buildings in the area are constructed from stone robbed from the Wall.

The Wall was occupied for 300 years.  In the period after Hadrian the Romans tried to extend the boundary of the Empire northwards to the line of the Firth of Forth where they built the Antonine Wall as an alternative frontier defence.  It didn’t last much more than 20 years and for the rest of the life of Roman occupation they relied on the defences of Hadrian’s Wall to protect the Empire from incursions from the northern tribes of Scotland.  The Wall was garrisoned by around 9000 auxiliary troops drawn from different parts of the empire, Romanians, Spaniards, Belgians, Dutch, Germans but with their strength made up over time form more local recruits.  It is a classic image of the Roman occupation of Britain to imagine soldiers, drawn from sunnier climes in the Empire, shivering on sentry duty on the windswept Wall.

But the Wall and the forts and settlements which grew up are not just about military expediency.  As well as forbidding fortifications, the Romans were determined to bring the comforts of civilisation to the northern frontier of the Empire.  Forts such as Chesters had their bathhouse blocks; there was access to fine pottery, literature, decent wine, fine clothes and all the other accoutrements of civilised Roman life.    

 Nowhere is this more on display that at Vindolanda, a fort behind the lines of the Wall. Thanks to excavations starting in the 1970s which uncovered a fascinating series of wooden tablets, preserved in damp anaerobic conditions, recording many of the details of everyday life at the fort.  The tablets, now mainly held at the British Museum, are a unique and wonderful historical source, their everyday character making them particularly special.  The tablets cast light on many of the practical everyday features of how the Roman army went about its business and how it was supplied.  They include quotes from Vergil, an insight into how the Romans view the natives (there is a tablet which patronisingly refers to the Britons as “Britunculi” – “little Britons”), a reference to the disastrous day on which the Fort ran out of beer.   

One tablet stands out as particularly lovely.  It is an invitation sent by Claudia Severa the wife of the commander of a neighbouring fort to Sulpicia Lepidina, the wife of the Flavius Cerialis the commander at Vindolanda inviting her to a birthday party.  As well as being the oldest surviving writing by a Roman woman, it is an artefact of heartrending beauty connecting us in such an intimate way with the lives of those who have gone before us.

So when you next wonder what the Romans did for us make your way up to Hadrian’s Wall.

If you are interested in reading more about Hadrian’s Wall I would recommend for starters:

The Wall – Alastair Moffat

Life and Letters on the Roman Frontier – Alan Bowman

 

Homer’s Iliad – One thing you must read before you die

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As well as in their choice of music, I am always intrigued in the reading material which (in addition to the Bible) Desert Island Discs castaways select to take with them. It would be an important decision, needing to be something which you would be happy to read and re-read countless times. Something which, in the isolation of your solitary island, would connect you back with the wider web of humanity.

I would have little difficulty in making that choice myself. Homer’s Iliad is for me not only the earliest but perhaps the greatest works of western literature. Despite being composed over 3,500 years ago it is a timeless tale of the human condition, of our search for recognition, of our petty emotions and of our mortality.

My first introduction to the Iliad was through a radio adaptation of the story which I heard in primary school. Like countless generations before me I was captivated by the tale of a far off age and a far off war, of heroes and of Gods. The Iliad was a major reason why I chose to do Greek and Latin at A Level and at University and gave me the ambition at 17 to visit the places such as Mycenae which feature in the Iliad (it took me 30 years longer to get to Troy).

So what is it about the Iliad which makes it so good?

First it is a very special literary creation, itself wrapped in a level of mystery and mystique just like the world it describes. There has been much debate about whether it is a single literary work and the product of a single author. The consensus is that it is and that Homer, about whom we know virtually nothing for certain, was its creator, probably in the second half of the eighth century. At the same time the poem draws on much older oral poetical traditions which Homer has moulded into a single work of genius. It is intriguing to imagine whether there is a glimpse of self-portrait in the Odyssey when Homer (assuming of course that he is the author of both poems) describes the blind bard who performs in front of Odysseus at the court of King Alcinous in Phaeacia.   This is the point that our earlier traditions of storytelling translate themselves into what we would now call literature and it is staggering that at such an early point a work of such enormous psychological and emotional depth can be produced. It hardly needs to be said, in addition, that its influence on the rest of western literature has been profound.

The second factor is that it’s a cracking good story. It is the tale of the anger of Achilles, the most brilliant of the Greeks, on whose shoulders their chances of taking the city of Troy rests, but who is treated with contempt by Agamemnon, the most powerful of the Greek kings and the leader of its armies. Agamemnon forces Achilles to give up Briseis, a beautiful slave girl whom Achilles has captured and of whom he is fond. Achilles does so but, as a result, decides to retire to his tent and withdraw from the battle. In his absence the fortunes of the Greeks decline and Hector, the leader of the Trojans, is on the verge of storming the Greek ships. At this moment, Patroclus, Achilles’ friend and right hand man, pleads with Achilles to re-join the fighting. He refuses but agrees to lend his armour to Patroclus.   Patroclus rallies the Greeks but himself is killed by Hector who strips the armour. Patroclus’s death sends Achilles into an uncontrollable rage and the day after he revenges himself on Hector whom he chases round the walls of Troy before cutting him down. Priam, the old King of Troy and Hector’s father, is forced to go in disguise to Achilles’ tent and plead with him for the return of his son’s body. Seeing in Priam, a shadow of his own father, Achilles is moved eventually to pity. The Iliad finishes with Hector’s funeral, itself foreshadowing the fall of Troy.

The poem has a dramatic tightness covering a few days in the ten years of the Trojan War but using the audience’s knowledge of the eventual fate of the city to reinforce the tension of the unfolding events. The pace is fast moving, the description of warfare exciting and uncompromising, the main characters larger than life. The Iliad conveys a fearsome sense of the pressure of fate on the main protagonists, Achilles and Hector which they cannot escape. This is a heroic narrative in every sense.

But it is not without its softer moments. My favourite passage of the whole poem is the in the Sixth Book when Hector returns to Troy to upbraid his brother Paris, whose stealing of Helen has brought the Greeks to Troy in the first place, for staying out of the battle. Having done so, he meets his own wife Andromache with their infant son Astyanax. She pleads for him to stay away from the fighting but Hector is too conscious of his honour and duty to do so. Hector stoops to pick up his son who is distressed at the sight of his shiny helmet. The child’s reaction melts Hector’s resolve for a moment but he, and we, know he cannot escape his fate. It is a scene of the most unbelievable pathos.

There is a particular resonance to remembering the Iliad in this centenary year of the outbreak of the First World War. For the educated classes who took part in greater numbers in this war than any others Homer’s poetry had shaped their world view. For a second time the futility of war was enacted out in the mud of Flanders as it had been on the plains of Troy. In 2011 I fulfilled a long ambition to go to the site of Troy. Later in the year I also visited Ypres and the battlefields of Passchendaele. The resemblance of the two places, both geographically and emotionally, was striking.

Homer may not have the central place in our education which it did a hundred years ago but the Iliad is still something which everyone who is interested in literature and indeed humanity itself should read.

 

Dial 0845 4NHS * – a fond farewell to NHS Direct

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Of all the things I have worked on in my career NHS Direct is undoubtedly the thing which has touched the greatest number of lives. I remember lots of conversations which, once I had explained what I did, continued with “Oh NHS Direct….I’ve called them…..” After a nervous pause (for me) they would continue to regale their experience. Sometimes we hadn’t been up to the mark, many times we had and on some occasions NHS Direct had a really special difference for someone.

Last week NHS Direct, after 16 years of operation, took its last call. I do not want to write about the politics of why NHS Direct, despite the very positive regard it enjoyed with the public, has been replaced. 111 has many positive features in its design but I think it is worth highlighting a number of things about NHS Direct which were very special and which the NHS should not forget.

NHS Direct, in its time, was genuinely innovative. Its mobilisation at scale, in only 2 ½ years, was a significant challenge and was only achieved through the extraordinary efforts of many committed practitioners and managers. It threw together people from many different backgrounds and working across many different NHS organisations. The service was staffed by a mix of nurses (themselves from many different clinical backgrounds), health information advisers, call centre experts and the whole was greater than the sum of the parts. Such diversity was an important backdrop to delivering a ground breaking service and, for me, highlighted the contribution of new perspectives in changing service models.

It represented one of the most significant uses of IT in clinical services. Long before such systems had been adopted by other parts of the NHS, NHS Direct was using clinical decision support in real time as part of delivering clinical care. Decision support significantly enhanced the clinical safety of the service, both because it provided staff with evidence based information at the point of care, but also because it automatically documented the decisions they had taken. Together with the recording of all calls, this made NHS Direct one of the most transparent of health services. Routine use of electronic systems also opens a new world of using data to question clinical performance and NHS Direct was again at the forefront in pioneering such approaches.

While better known for its clinical work, NHS Direct played an equally major role around the development of health information and health literacy. This area rarely gets the attention it deserves from policy makers but any expectations of securing a fully engaged population in respect of the use of healthcare warrants some investment by the NHS is health literacy and self-care skills.   Self-care is not a self-disciplined restraint in the use of formally provided health care services but rather the product of collaboration with patients, and in particular those experiencing long term conditions, in building up their knowledge, skills and confidence in managing their own condition. NHS Direct made a significant contribution to this agenda through its telephone and online services and through successful offshoots such as the Birmingham Own Health project which provided a coaching based care management service for people with long term conditions.

Finally NHS Direct had a special role around health scares, whether the issues around children’s’ organs at Alder Hey, the aftermath of the 7/7 bombings or a whole range of day to day issues of concern appearing in the media NHS Direct provided a national resource for handling these in a way which took the strain away from local health services.

 The final thing which NHS Direct did well was to remain a service which was focused on listening to patients. In the end part of its difficulty was that the service model was caught between an advice service for patients and a gatekeeper role for the urgent care system. 111 as a model is clearer that it’s focus is demand management but that, potentially, has a downside. NHS Direct, at its best, treated all its callers with respect. That’s why it was liked by young parents, inevitably anxious about whether they dealing with genuine issues of concern in relation to their children’s’ health, by older people and others who weren’t sure that should be bothering the doctor, even on occasions when they had something seriously wrong with them, and by marginalised groups such as people with mental health problems who could often find the mainstream system intimidating and difficult to access. A busy shift at NHS Direct, which as a call handler, I had the privilege from time to time to do, covered an enormous range of issues. The trick was deal with all of them non-judgementally and in that way NHS Direct genuinely earned its motto “We’re here to help”. As a telephone based service, NHS Direct valued good listening skills beyond all else and I was full of admiration for how the best of its practitioners could put together crucial information about a caller’s issues by the patient way in which they listened to the verbal and non-verbal signals they elicited from callers.

NHS Direct is no more. I would be the first to admit that it didn’t get everything right but its achievements were considerable and there are things about its bold spirit of innovation and its focus on listening to patients which the NHS should ensure it does not forget.

*The origins of the NHS Direct number come from the American practice (little followed here) of using numbers on the telephone keypad to spell out a word so 0845 4647 stands for 0845 4NHS.

 

Nisi sana mens, non sanum corpus – there’s no health without mental health

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In the time I have spent working in the area of mental health few things have impressed themselves more forcibly on me than the impact of the artificial divide between physical and mental health. Institutionally the NHS has neglected the physical health needs of people with long term mental health issues and the mental health needs of people with long term physical health conditions. It has done so at enormous cost both to the individuals involved and the public purse.

In February 2012 the Centre for Mental Health and the Kings Fund published an important report Long term Conditions and Mental Health: The Cost of Co-Morbidities which set out the scale of the issue. They estimated that co-morbid mental health problems, interacting with and exacerbating physical illness, raise health care expenditure by 45% for each person. In total these extra costs account for between 12 and 18% of all NHS expenditure on long term conditions or, in cash terms, between £8 and 13 billion each year. At the same time, there is evidence that the provision of psychological interventions for this group of patients and better liaison between mental health specialists and their colleagues in acute and primary care can play a major role in reducing those extra costs.

For an NHS struggling with unprecedented financial pressures this has got to be a crucial focus for investigation and intervention and yet, so far, it only seems to be playing a marginal role in debates about integrated care and the transformation of services.

I have been very pleased that my new organisation, the Tavistock and Portman NHS Foundation Trust, has been playing an important role in developing a service model which addresses this issue. Working with local GPs in City & Hackney we have been delivering a Primary Care Psychotherapy Consultation Service which supports them in the management of patients with complex mental health and others needs which result in frequent health service use. This including patients with medically unexplained symptoms, personality disorders or other chronic mental health issues which are not currently being managed by secondary services. The service supports GPs either through case discussions and training or through brief psychological interventions.

Today we are publishing an evaluation of the service carried out by the Centre for Mental Health. This shows that the service is both achieving good outcomes for patients (75% show improvements in mental health, well-being and functioning and 55% met clinical thresholds for “recovery”) and having a significant impact in reducing the utilisation of primary and secondary care. The service saves £463 per patient in the 22 months following the start of treatment. This is against a typical cost of treatment of £1,348 per patient and in my view there would be a strong case to believe that greater savings would accrue over a longer term period in cases where the services succeeds in addressing underlying long term mental health issues.

This is not a one size fits all response to the challenge of integrating physical and mental health and there are plenty of other opportunities for mental health services to work creatively with their physical health partners to address individuals’ need in a holistic way which helps them and makes better use of health service resources. Primary care is a good place to start because many GPs already clearly understand the interrelationship of physical and mental health issues. This kind of thinking however should also be high up on the agenda of acute providers and has a good claim on resources available through the Better Care Fund.

There are many good practical and financial reasons for supporting this kind of approach. It does also raise a more fundamental need to challenge a medical paradigm which focuses on every greater specialisation and on physical health as an exclusively biological phenomenon without considering wider psychosocial factors which might impact on a patient’s life. Furthermore it highlights the current inadequacies of clinical training which mean, for instance, that is still possible for a medical trainee who does not end up as psychiatrist spending as little as 5 weeks of the undergraduate training on mental health.

As a layman it makes total intuitive sense that my physical health and wellbeing are intimately tied up with my mental state. It’s time the NHS really acknowledged that there can be no health without mental health.  

The evaluation of the City and Hackney Primary Care Psychotherapy service can be found at:

http://www.centreformentalhealth.org.uk/news/2014_complex_needs.aspx

And the greatest of these is charity

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It’s a month since I moved on from being the Chief Executive of Rethink Mental Illness. 

It was a very special experience and it feels a good time to reflect on what I learnt about the role charitable activity plays in our society and the opportunities and challenges it faces in the future. 

Charities have an enormous amount to offer both psychologically and practically in modern society.

Charities provide a sense of ambition about how the world could and should be different.  “Make poverty history” or “Together we can end cancer” are the kind of bold statements which reflect the lifeblood which motivates the best of what charities can achieve.  In our postmodern era charities have become the holding place, especially for young people, for much of the sense of hope and idealism still left in our society.  As cynicism overtakes other institutions such as religion and democratic politics it is crucial we hold onto a view of charities as positive agents of change.  Charities must jealously guard their reputation and they will be best placed to do so when they stay close to their beneficiaries. 

At their best charities reflect a different way of doing things.  Driven, fleet of foot, closer to beneficiaries, holistic in vision, the best charitable endeavour can make things happen which statutory agencies struggle with.  Not everything which charities do however is necessarily good, why should it be, but charities must get better and distinguishing between where they make a real difference and where they are less effective.  My experiences was that by their nature charities found it easy to describe their impact of what they did at an individual level, but were less skilful at quantifying at and, at times, less open, than say a commercial operation, in deciding to drop something which was not working. 

Charities have a crucial role in giving voice to the disadvantaged.  In general the media is open and respectful of what they have to say although sometimes this can overly focused on the shocking and the negative.  In recent years social media has given a new dimension to this and created a fresh and more direct opportunity for who those whom charities represent to speak directly about their experiences.  In harnessing this voice, charities are again at their best when they are non-judgemental and non-hierarchical in how they use the voice of their beneficiaries.  Effort, empathy and skill are required to ensure people who speak from personal experience on behalf of a charity are properly supported and not just seen as a “useful soundbite”.   

There has been some controversy (sometimes I feel more in the sector itself than elsewhere) about the relationship of charities to the state.  Although it has undoubtedly shrunk in the wake of public sector cuts, the last quarter of a century has seen a massive level of investment by the state in the charitable sector.  Some would argue that this has compromised the independence of the sector and it shackled its activities to models of provision defined by the State.  That is a risk which needs to be managed but by the same token that investment has enabled the sector to do far more than if it had had to rely exclusively on its own resources. 

Austerity has undoubtedly created new challenges in managing that relationship.  Charities are having to be more critical of decisions impacting on their beneficiaries.  That it is not always easy although, in my experience, most, though not all, politicians handle this in a mature way and the constituency which thinks that charities should “be seen not heard” is relatively small.

In addition while there will always a gap between what charities provide and what the state offers to all citizens as an entitlement there is a real danger when the Government pretends that the existence of charitable support is a legitimate alternative to properly funded public provision.  There was more than a hint of that message in the philosophy of Big Society which is one of the reasons why it became so unpopular in the sector.  There will inevitably be more of this to come.

There are also challenges in managing the growing professionalism of the charity sector.  Charities like other institutions need to be well run.  In general, at all levels, those who work for charities will often accept less attractive terms and conditions than they would in other walks of life but charities need talent and will need to pay to attract some of the skills they require.  They need to work on their systems of governance and ensure that they can attract Trustees with the right skills to oversee the work of major organisations.  The business must not take over from the cause but badly run organisations do no good for any cause.  The sector must be brave in correcting a naïve view of homespun small organisations.

I became a supporter for the diversity of the charity sector and the role of small and big organisations.  However, charities are at their least attractive when they are being uncharitable about their peers and when stereotypes are rolled out about different types of organisation.  Mergers sometimes have their place, as a number of parts of the sector have demonstrated, but the business logic of consolidation is to be avoided if this comes with a diminution of the essential spark and life blood of smaller organisations.  What charities must always be ready to do is work together and one of things I was most proud of when I worked in the sector was a much greater focus on collaborative working in the interest of common goals.  Much more was achieved as a result.

There is always a time to move on but I’ll miss the sector and am determined to take what it taught me into my next role.  To finish though, I want to focus on the personal level.  Above everything else charities have to offer they contain some wonderful individuals, people who often have lived through adversity themselves but whose whole response to that is to devote their time, money, energy, and will to making a difference for others.  That is why St Paul was so right to say that of the three: faith, hope and charity, charity is the greatest.

The Voice

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This isn’t a blog about my favourite Valleys Boyo.  It is a restatement of the view I have held for some time that we need to see a step change in how we place the voice of people with lived experience of mental health and other conditions at the centre of decision making in the NHS.

The reason for writing this tonight is the renewed inspiration I have gained from spending the day with well over a 100 individuals who are using secure mental health services at the Second National Service User Awards.  The Awards, organised and supported by Cygnet Healthcare, celebrate the achievements of people using secure mental health services in supporting their own recovery, helping other service users or carers and families, improving services, training staff or making a wider contribution to their community. 

I have been lucky enough to be a judge for both years of the event and it is one of the best things I have done in that time.  Across the piece the quality of entries is extremely high and they come from right across the spectrum of secure providers, including this year some from high secure services.  Individually each story is often moving when you consider the dark places which many people in secure care have come from.  Choosing winners is invidious. 

Some of the projects put forward tackled some of the most stigmatising aspects of mental health such as attitudes towards personality order and self-harm.  They demonstrated the impact which service user led training can have in helping staff understand these issues and see the person behind them.  Other schemes showed how service users can take control of their own care, chairing their own CPA meetings or developing a short hand guide to how they feel and want to be treated when they are unwell.  Many focused on how people can support their peers and share that most valuable of therapeutic processes the insight that someone has trodden the same path and come out the other end.

 

 

More than anything the awards were indicative for me of a profoundly hopeful message that recovery and co-production are beginning to take root in what many would have said would have been the most difficult environment anywhere in the NHS – that environment where individuals are derived of their liberty.

So what does my inspiring day with secure care service users have to say about the development of the voice of people who use services more widely?

Like so many issues I have been involved in recent years the rhetoric is running the right way but the reality on the ground is still very patchy.  Service user voices are more prominent but those voices are often heard too peripherally or too late.  They asked to participate in structures which are still designed around the needs of managers or clinicians and where the use of acronyms is seen as some kind of sign of authority.  The big issues are still often decided elsewhere.

So to finish why does it matter.  There are three reasons all of which were on view in the initiatives we celebrated in today’s awards.

First people with direct experience are the best placed, individually and collectively, to define and interpret what it is like to live with a long term condition.  That insight and information should be central to how health professionals are trained to do their jobs and should be crucial in the judgements they make on how best to support and help someone they are working with.  This is the secret of co-produced healthcare.

Second the views and feedback are people with direct experience of services should be central in defining what good care looks like, in judging whether the care which has been delivered meets those standards and crucially in determining the best use of resources.  In my experience, most people who use services recognise the preciousness of the resources invested in supporting them.  They don’t want to see those resources wasted in interventions which are duplicated or of no effective value.  They crucially recognise where simple resources invested sooner can save the greater costs incurred at a later date when someone gets to crisis point.

Finally the voice of those with direct experience is of immense value in supporting others who are coming to terms with the same condition or issues.  There are things which are so much easier to take in if they come from someone who has trodden the same path and peer support should be a routine intervention, not only in mental health but in other areas too.

Times are tough at present and there are immense financial challenges facing the health and social care system.   Harnessing the value of the voice of lived experience is one of the few transformatory tools at our disposal.  Let’s use it.

 

 

We must all care for young carers

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I had the pleasure of chairing a seminar last week on the issue of Young Carers.  Some excellent presenters and a great audience with a lot of enthusiasm to do something about the issue.

I’ve been aware of the issue of Young Carers for a while but the event brought some of the challenges into focus for me.

First of all the numbers.  In the last census in 2011 166,000 people in England were identified as young carers.  That is 20% more than the comparable figure in the 2001 census.  But it is also by all accounts a massive underestimate of the real picture and other surveys have suggested the numbers may be as great as 700,000.  This reflects, in many cases, the reluctance of many young people to identify themselves as carers, in particular if they are caring for someone with mental health problems or substance misuse issues.

The second is understanding the impact which caring responsibilities can have on the chances of the young people involved.  I would thoroughly recommend “Hidden from View” an excellent report produced in May 2013 by the Childrens’ Society which uses the rich data from the Longitudinal Survey of Young People in England (LSYPE) to cast a spotlight on what is happening.

The findings are stark.  While “caring responsibilities” cover a wide range of different circumstance 1 in 12 of young carers are caring for more than 15 each week.  1 in 20 are missing school because of their caring role.  Young carers are often living in homes of multiple disadvantage with the average income of families with a young carers £5000 less than those without.   Finally and most tellingly caring can have a dramatic impact on educational achievement with young carers, on average, achieving GCSE results 9 grades lower than their peers. 

The third shock relates to how little we are still doing to address this issue whether to identify young carers in the first place or provide the right level of support to them or, just as importantly, to the person they are caring for, to ensure that caring responsibilities do not become an intolerable or detrimental burden.  My sense is that, in recent years, the benefits of a growing recognition of and interest in this issue has probably been offset by the impact of the enormous financial challenges which social services and other agencies have had to face as a result of austerity.  There are beacons of good practice and some of the examples of these, whether in Leeds or Camden and Islington were part of what made last week’s event so inspiring.

What, in addition to pressure on resources, makes this issue challenging is the need for genuine multi-agency working in this area.  There are two levels to this.  The first relates to professional behaviour.  We can no longer afford clinicians or educationalists who address problems in one-dimensional terms.  Patients have families and health and social care workers need to know about them if they are to understand the best strategies for care and treatment.  Pupils also have families and teachers (and Secretaries of State for Education) need to understand that learning does not  happen in a vacuum.  The second level of course relates to budgets and to need to ensure money can be spent across organisational boundaries in the way which best deliver improved outcomes for individuals.  So what about spending some of the pupil premium on improved support for young carers?

 

 In one area the discussion was able to celebrate some important progress.  As a result of some great campaigning work by the Childrens’ Society, the Carers Trust and many other organisations the Government has committed to some important strengthening of the law in respect of the rights of young carers, amending the Children and Families Bill to give all carers under the age of 18 the right to an assessment.  We have been there before with carers’ rights of course and assessments, without subsequent access to the help required to address the needs identified, are little help.  Nonetheless this looks like an important step forward.

There is nothing new about young caring.  In the past where the family was generally the only source of help it was not uncommon for young people to have to care for parents or siblings.  In his novel “Our Mutual Friend” Dickens gives a powerful picture in the character of Jenny Wren of a Victorian young carer, herself disabled, dealing with the needs of an alcoholic  father. 

But in the 21st century we should do better.  Young carers are first and foremost young people with the hopes and opportunities of life ahead of them.  It is not right to let the burdens of inappropriate caring responsibilities stand in the way.

For an excellent inforgraphic on young carers:

 http://www.childrenssociety.org.uk/news-views/our-blog/interactive-look-young-carers-lives

 

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