Guidance for commissioners of services for people with medically unexplained symptoms - 2017

I Googled joint commissioning panel and seemed only to find mental health. So it looks to me that this is not one of several government based committees as part of the health service. It talks of 'inspiring' commissioning. It says it is a collaboration between 17 organisations - Royal Colleges and charities.

So I get the strong impression that this is an independent lobbying group that has taken upon itself the job of advising health care providers. As such it seems sinister. One of the organisations is the New Savoy Partnership:
'The New Savoy Partnership is a unique coalition of organizations that came together in 2007 to persuade government to recognize the value of psychological therapies provided free on the NHS.'

So not exactly unbiased.

 

There is no official relationship between the NHS and the Royal Colleges, which are independent professional organisations. So there is nothing 'official' about this body.

I think in the UK we re used to a dividing line between welfare state public organisations and commerce. That dividing line has been eroded and it is now the official policy of the government that it no longer exists. This puts us in a situation rather similar to Soviet Russia in 1989. A socialist system is mixed freely with commercial interest. The result is probably worse than a purely commerce-drive system as in the USA. Commerce can parasitise the public purse without anyone realising it.

 

Chaired by Jeremy Clarke, presumably the one who is at the LSE Centre for Philosophy of Natural and Social Science and who says:

"My research at LSE is part of a progressive inter-disciplinary project led by Nancy Cartwright looking at how evidence can be used to make better predictions for outcomes (Cartwright, 2013). Myself and Professor Cartwright, with Katherine Furman, are working on specific problems for policy makers looking to help people with depression back to work: how to intervene most usefully in a complex human social situation? Evaluation methodologies that privilege only RCT-derived interventions have tended to miss outcomes that matter to these clients and have also undervalued the proper place for complex, objective clinical judgment

http://www.lse.ac.uk/CPNSS/research/currentIndividualResearchInitiatives/jeremy-clarke.aspx

 

That sounds very much like pseudo-rigourology.
It seems absolutely clear that this is a pressure group with an emotional agenda. The worst sort of do-gooding.

 

I wonder whether the choice of name (New Savoy) is determined by the wish to imply a taste for a lavish, expense account lifestyle, (which might be shared with those commissioning services) or a Gilbert and Sullivan sense of humour.

Perhaps the second would be more appropriate for the depressed, unemployed.

 

It looks to me like they are trying to put even more illnesses into the MUS category:

"On average, 52% of patients accessing outpatient services have MUS, with the highest rates relating to gynaecology clinics (66%) and the lowest rate (37%) relating to dental service"

"The risks or associated factors for MUS include being female, younger in age, and currently employed" - actually the table they use to show the breakdown of MUS referrals in outpatient clinics says 57% women, 42% men - I don't think that is statistically in favour of being female?

" MUS may be caused by physiological disturbance, emotional problems or pathological conditions which have not yet been diagnosed .... In severe cases of MUS, there is overlap with personality disorder...Consequently, many people with MUS have complex presentations caused or exacerbated by co-morbid mental health problems such as anxiety, depression or personality disorders...There should be a positive emphasis on ‘function’, rather than a focus on ‘cure’"

these were all from page 6

Page 7 - the internet is bad! "However, quite often misinformation and inaccurate advice, provided either by health professionals or other sources patients have accessed, such as the internet, can make it difficult for doctors to know what to do in cases of MUS."
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While they do mention physical disorders they are normally in conjunction with co-morbid psychological ones.

This looks to me to be a type of bridging paper which introduces even more areas (Dentistry, Respiratory, Rheumatology, Gynaecology, Neurology, Gastroenterology, Cardiology) to the MUS bucket. There is a case study on using psychotherapy for MUS conditions without mentioning which ones. Then making it seem that using psychotherapy led to cost savings - "Detailed information on health service use was collected for a sample of 282 patients treated by the PCPCS. Based on this data, it is estimated that treatment by the PCPCS reduced the costs of NHS service use by £463 per patient in the 22 months following the start of treatment. Savings in primary care accounted for 34% of this total (mainly fewer GP consultations) and savings in secondary care for 66% (fewer A&E and outpatient attendances and inpatient stays)."

In the perfect setting it recommends- "biopsychosocial assessment and treatment on wards and in dedicated MUS outpatient clinics.... The hospital MUS service will redirect patients from the emergency department, expedite discharges from medical and surgical wards, and offer effective interventions. These activities should help avoid unnecessary medical investigations and interventions, reduce length of hospital stays, and prevent frequent referrals and readmission"

It is actually a really scary document that seems to be a five year plan to get MUS services (provided by specially trained people!) integrated into the NHS to help reduce A&E admissions etc and take away the burden from the local authorities. It relates all of this to mental health.

It talks about special clinics etc and using biopsychosocial methods - I wonder who would need to be engaged to provide this, and how much money would be needed for their services!!

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I really wonder how they explain the logic of all so called psychiatric conditions. Do they consider them to be medically explained or medically unexplained. If they are are all medically unexplained as seems to be the logic from their own position just what they hell do they get paid for.

The other thing is how exactly do they make revenue from this approach are they separate corporate entities that contract to the NHS?

Why wouldn't the NHS just employ its own blue cardigan brigade on minimum wage, it seems a monkey could declare someone medically unexplained and then just ignore them.

It would be interesting to find out a cost per person charged to the NHS by outside contractors if this is already happening or a proposed cost.

 

On the positive side, this policy will fail quickly and spectacularly as soon as it kills a few people.

On the negative side, this policy will kill people before it's admitted to be a failure.

 

'The hospital MUS service will redirect patients from the emergency department, expedite discharges from medical and surgical wards, and offer effective interventions.'

This is a sick joke.

 

No. Its a medically unexplained joke.

Self fulfilling. The effective intervention is the expedited discharge.

 

Except officially no one is sick, so its a medically unexplained joke!

Exactly what are they going to do, go around the A and E, yelling "bring out your unexplained", then dump them into a taxi with a bill?

 

Its shocking really it will make people terrified to go to hospital once they have been "warned".

 

I'm so glad this wasn't in place when I went to the Walk in Clinic at St Thomas' Hospital with abdominal pain and constipation! They'd have sent me straight to MUS services without finding out I have diverticulosis, and at the time diverticulitis with sky high CRP which they gave me a course of antibiotics for. I see from the MUS guide that "IBS" (which is what I thought I had) is included (see P6). So to have that and ME I wouldn't have stood a chance!

Plus what will WHO say about ME being in 2 places at once? Those hoops have been jumped through already.

 

The CBT/MUS paradigm is sowing the seeds of its own extinction, just like psychoanalysis did with its ridiculously exaggerated claims in the 60's. Being successful and expanding into more and more areas of medicine also means that more people get the chance to see what this paradigm really produces. Which is magical thinking, poor science, incorrect and simplistic views such as "stress hormones", "bad thoughts making people sick", little in the way of good results, and much in the way of bad results.

 

Its also a bit laughable that they think people with "MUS" are taken seriously in hospital anyway to the extent that they would be bed blocking.

Surely the next stage must be to identify all of the "medically unexplained" on a national register and block them from leaving their house incase they attempt to attend a hospital or GPs.

Perhaps they could all be given ASBOs and ankle bracelets.

 

What records of death from this will be collected? My guess is none. A lot of people would have to die, or inconvenient people who are noticeable would have to die, before deaths would even begin to be a scandal. The UK establishment is quite skilled at ignoring deaths when it wants to, and battles for justice can take decades.
This has to be fought hard now.

This government has ignored the UN report on how it treats disabled people so I expect that ignoring WHO as well would be easy.

 

I hope you are right, but I'm cynical.

 

I think we will eventually see an uprising by patients hurt by it, and doctors that can't stand seeing medicine being increasingly taken over by this nonsense. Unfortunately psychogenic views are still popular in medicine but there is a limit to everything.

There may also be unexpected allies in the form of human rights organizations. The WHO already harshly criticized the UK for its treatment of disabled.

The threshold for voicing dissent also decreases with every new study reporting abnormalities that don't fit into the BPS model, and with every big name researcher and organization that expresses support. I think the BPS school has deliberately tried to make it difficult for outsiders to join patients in voicing dissent. They know that widespread dissent can easily put an end to their plans. For now it's mostly patients that are voicing dissent but we are clearly going into the direction of ME/CFS becoming more socially accepted.