INTRO: [00:00:00] Stories, labels, Misconceptions NHS remains a blessing Created in 1948 We want it to remain great A podcast where we share our stories Explore solutions in all their glories They say it's broken, but it's not done With your host Val Barrett, Dr. Jeremy Anderson

Val: Welcome to Stories, Labels and Misconceptions with Val Barrett. 

DR Jeremy: Dr. Jeremy Anderson. I was thinking back to one of our episodes where we talked about housing and prescribing home heating.

DR Jeremy: As a way of trying to keep people out of hospital. And I thought that was really innovative. And what that's really done is it's reframed the idea of. Like a welfare benefit, [00:01:00] and it's calling it a, like a medical prescription. And so essentially you're reframing, you're reconceptualising this intervention to try to solve a problem.

DR Jeremy: And I thought that was brilliant. Really insightful. And it's something that psychologists do all the time. So when I work with patients, one of the main ways that we work with people to help with something like their mood or their anxiety is what we call cognitive reframing.

DR Jeremy: We're reframing what we think about a thing. For example, if somebody, goes for a job interview and they don't get the job. Yeah. And their first thought is I'm such a loser. No one wants to hire me. I'll never get a job.

Val: Or I didn't get it because I'm a woman or look a certain way.

DR Jeremy: Yeah. What's wrong with that? It might be true, one of the problems with those statements is they're too certain. So maybe reframe it as, I don't really know the answer. It could be any one of these many [00:02:00] things.

DR Jeremy: when you come up with multiple explanations, And acknowledge you don't really know you're a little less certain that the really bad one, the I'm a loser. I'll never get a job. You're a little less certain that's true. 

Val: But remember, I told you before about the actress, Susan Sarandon. 

DR Jeremy: Yeah.

Val: Whenever she went for an audition and she never got it, she went out and celebrated because if you don't get something, it then leaves the door open for you to get something better. She wasn't meant to be there. That's how she dealt with it. 

DR Jeremy: Exactly.

Val: Yeah.

DR Jeremy: So if you focus on the negative, that brings you down.

DR Jeremy: If you notice every negative is a trade off potentially opening a door, You've reframed the idea and that helps your mood. And it's psychologists deal, do reframing to help individuals, but it seems like you can do reframing on larger, societal problems.

DR Jeremy: There's a profession now I've just hired a couple of people who [00:03:00] are what are called social prescribers. So this is actually reframing. Roles. It's medicalizing and there's a bit of, I suppose there's a bit of controversy about that. There's some things you wouldn't want to always like over medicalize or because there's a risk of stigmatizing.

DR Jeremy: Mental illness is a good example. In some ways, I suppose it's helpful to talk about something as a mental illness. Rather than I don't know if the alternative is possession by evil spirits. For a long time, I can't remember the last time this happened, people conceived before we knew what epilepsy was.

Val: Yeah. 

DR Jeremy: Was conceived as, you're possessed by the devil. We're going to bore a hole into your skull to let the evil spirits out.

Val: Okay.

DR Jeremy: So epilepsy was an illness that was in need of a re-framing as a medical illness. Reframing these issues can be helpful.

DR Jeremy: And so this example of home heating was one of reframing an issue. [00:04:00] In a medical way that kind of opens us up to new solutions and this whole profession or vocation of social prescribing is a way of interacting with people, reframing it as a health intervention. And I was also thinking about my own research.

DR Jeremy: I think I've told you before, my research was looking at anger provocation and one of the things I did was cross-cultural examinations of how people from different cultures manage their anger. 

Val: Yeah. 

DR Jeremy: One thing some cultures promote is this idea of cognitive reframing. Someone does something that really pisses you off. And you can't do anything about it. If somebody, a business rips you off, they take your money and it's a fly by night kind of thing. And they close up shop and you never see them again. 

Val: Yeah. 

DR Jeremy: Your money's gone. You can't do anything about it. You're furiously angry. How can you reframe that? To feel better. this is something we do all the [00:05:00] time. I wonder if other problems in our society, many of which we've talked about on this podcast are intractable issues, but if we thought about them in a different way, would that open us up to new solutions 

Val: When we did our series on inequalities, we know that there are many factors that impact on that, whether it's housing education, employment. All those issues. Whether it's mental health, physical health, emotional, everything leads directly at the door of the NHS. 

DR Jeremy: Exactly 

Val: we know the NHS is struggling a lot. And I like the way This new secretary of state of health is going. He's actually look at reframing. I don't know if they've used that word, but there was an article and I heard it on the news let's look at [00:06:00] mental health. 

DR Jeremy: Sure. 

Val: Mental health itself.

DR Jeremy: Yeah, in some ways, that's a reframing as well. 

Val: The NHS spending on antidepressants. During the pandemic, it rose by 139 million. And that's a lot. 

DR Jeremy: Yes, 

Val: are trials underway. To see if comedy on prescription can improve mental health and reduce NHS costs. 

DR Jeremy: Fantastic.

Val: I'm glad they're trying something different. 

DR Jeremy: Absolutely. At an individual level I often advise my patients to, watch a stand up comic, go on YouTube there's lots of comedy there. Have a laugh.

Val: Do you know what is strange? When lockdown happened, I used to look at pictures of puppies, kittens, nature. Because I live in a flat. I had no garden. 

DR Jeremy: Yeah. 

Val: [00:07:00] I noticed how I felt after I looked at those pictures. I felt better. Happy. I love comedy. We watch a lot of comedy and I try and stay upbeat. There are times when I'm down, but I know what I need to do to change my mood, so this comedy prescription, the trials, when did it start in February we know one size doesn't fit all. We have GPs give prescriptions for gyms. 

DR Jeremy: Okay. 

Val: And we know exercise raises endorphins?

DR Jeremy: Yes, 

Val: swimming. I'm part of active life because of my age. I do water aerobics. I don't need to pay. There are things you can do, but if your depression is in a way where you can't even get through the front door. Do you see what I mean? 

DR Jeremy: Yeah. 

Val: It's all well and [00:08:00] good having these things. where you have to leave your home to go to another place. But we've also got to think of things that people can access online first. 

DR Jeremy: Oh, yeah. As a first step. And I think what's great about comedy, in the context of reframing, if you watch a comedian tell a joke, 

Val: Yeah, 

DR Jeremy: Reframing. It's all about reframing, with a comedian they set you up. There's misdirection. You think they're going one way and what makes the joke funny is they go a different way. So they're every joke, they're constantly flipping, they're reframing the way we're thinking about something, obviously in a funny way and it's making us laugh.

DR Jeremy: But I think the benefit is not just the fact that people are having a laugh, which is good. But just subtly suggesting to people that there's more than one way to think about a thing, right? That's enormously helpful, clinically speaking. 

Val: But it's easier to write a prescription. They [00:09:00] say one in five adults are on antidepressants. 

DR Jeremy: Yes. 

Val: That's a lot. 

DR Jeremy: Yeah. 

Val: What does that say about society? 

DR Jeremy: I think, like I was saying before, a lot of mental illnesses used to be framed as a religious or an evil spirit kind of thing. Then we reframed it as a medical thing.

DR Jeremy: We called it mental illness. We've reframed it again as mental health. But still we've we've medicalized it and so now we're treating it with medical treatments and, reframing it again as things like, it can be treated with exercise comedy woodworking or walking through nature or something.

DR Jeremy: Yeah. 

Val: Yeah. 

DR Jeremy: It's about changing it up getting back to the way we feel and make our way in the world it's about life. 

Val: Sometimes life is shit. Life could be bad through no fault of our own [00:10:00] some children are born into the worst conditions. You can't help who your parents are where you live. I think we need to reframe education. Haven't you noticed education hasn't really changed? 

DR Jeremy: No, not 

Val: really. Cause I look back and think okay, it's great. Algebra and all that

Val: I don't think I've used them. School needs to prepare you for the real world, it's not doing that. It's saying you can. Pass an exam you can add up, spell, write in sentences, speak a little French 

DR Jeremy: think if we think of it just a bit more broad, the way we do it. You show up in the morning at a specific time a bell rings, go to class, go to the next class everybody, goes to lunch at the same time. Comes back at the same time. What are we training people to do? We're training people to go to a factory reliably at the same [00:11:00] time, right?

Val: But don't forget when you leave education and get a job, you have to turn up on time. 

DR Jeremy: Yes, you 

Val: So if you're working that kind of job, yes. Yes. But you have to. So in a way, it's getting them to understand about being on time. If there's a uniform wearing that uniform. 

DR Jeremy: That's another great example. Like uniforms used to be more common. There's still Schools that have uniforms.

Val: We wear them here. This country does. 

DR Jeremy: But a lot of jobs used to have a uniform.

Val: Depending on what kind of job it is. Don't forget in the office, you wouldn't turn up in scruffy jeans. And an unkept t-shirt. . So in a sense, wherever you work, there is a way to look, a way to present yourself. Whether everybody is wearing the exact same color or the exact same clothes, it doesn't matter. What separates you from. Going [00:12:00] out on the town with your friends to go into work is your clothing. 

DR Jeremy: Yes. 

Val: Dress for business.

DR Jeremy: Yes. So there's some changes. With education, we might want to think about, one thing people have talked about is that we don't teach people to write in cursive script anymore. Exactly. Why would you do that? If in your life, you're not going to be writing a letter, you're typing on a keyboard at a screen. Why do you need to learn to do that? 

Val: Schools need to change, dying breed, but some people do. The older generation still write their Christmas cards.

DR Jeremy: Yes. We just, we don't teach people like there's actually generations of children now that don't know how to read cursive script, because they didn't learn writing or calligraphy or, they're not using like a quill in a little jar of ink or something like that.

Val: I loved my fountain pen. 

DR Jeremy: Yeah. 

Val: When I was at school, you'd have your jar of ink. 

DR Jeremy: Yeah. 

Val: And you draw back the [00:13:00] ink and put it and I loved writing with a fountain pen. I'm sure there's people who don't know what a fountain pen is. I didn't use a quill. 

DR Jeremy: Yeah. 

Val: But a fountain pen,

DR Jeremy: yeah, 

Val: you can still buy them. 

DR Jeremy: Yeah, 

Val: We've lost that artistry, the art of writing, some people still write 

DR Jeremy: Some people do. We won't write it off. 

Val: Yeah. 

DR Jeremy: Reframing is something that can be very helpful. Should we go through some examples?

Val: Go on. 

DR Jeremy: If we think about the issue of homelessness, right? 

Val: Yeah. 

DR Jeremy: People not having a place to live, right? What's the typical way we think about someone who's homeless 

Val: don't want a home. 

DR Jeremy: Yeah, they don't want a home yeah,

Val: you're on the street because you want to be on the streets. 

DR Jeremy: Yeah. Or they've made bad choices. Yeah. 

Val: Or you're a drug addict. An alcoholic. 

DR Jeremy: Yeah. 

Val: Where we know family breakdown, loss of job income. There are people living in their cars. 

DR Jeremy: Yeah. [00:14:00] 

Val: Go into swimming baths, using the facilities and then going to work. So not all of them are unemployed. 

DR Jeremy: Yeah. So if we were going to reframe that, what would we do? We could think about living in a society that doesn't have Reliable housing, The housing stock in the country, maybe there isn't enough or it's not affordable. 

Val: There's a lot of homes that are derelict, lying there empty because councils are not invested in doing them up. So there are empty properties there. 

DR Jeremy: Yeah. We have structures, but they're not fit to live in.

Val: But then as you're talking about this, recently on the news, there are protests going on that immigrants are being put up in hotels around the country. 

DR Jeremy: Yes. 

Val: And what seems to be said is that if they can do that, they should [00:15:00] house the homeless first. Not just at Christmas, because if they could do it through COVID, and they did it, I think it was in Windsor, when one of the royal weddings was going on, because they don't want tourists seeing homeless, it's not that this government cannot do it.

DR Jeremy: Yeah. Yeah. 

Val: They can do it. 

DR Jeremy: Yeah. 

Val: It's getting all the resources a person needs because some may be suffering from trauma. 

DR Jeremy: Yeah. 

Val: Addiction. or depression, whatever it is, that person will carry it from the street into that home. A lot of them can't cope being confined into it.

Val: And I don't know I was watching a show many years ago a wealthy couple, I think this was in the States, brought a home for a homeless couple. And they brought them a nice bed. Do you know they couldn't sleep on the bed? Their bodies. Weren't [00:16:00] used to it. Oh yeah. They were sleeping on the floor.

Val: Yeah. Sometimes it is a shock to the system when you've lived on the street for so long. Like how you talked about before when people are on alert and their blood pressure is constantly high. . So can you imagine when you're living on the streets of downtown LA

DR Jeremy: Yeah. 

Val: Your blood pressure is probably never coming down because you're constantly on alert. 

DR Jeremy: Absolutely.

Val: Yeah. 

DR Jeremy: Yeah. 

Val: It's not as easy, as people think. Get that person, pack them up. There's a nice home. Bye. 

DR Jeremy: Yeah. 

Val: Not easy. So many factors how are they going to pay rent? support themselves? Do they have a support system? What do they need to enable them to stay in that home and get a job, get a [00:17:00] bank account? Because if you're homeless, I don't know if you can have a bank account now. I don't know if it's changed. All these things we have, we take for granted, doing online banking and all these things. Some people, don't know how to do it. They've been on the street for so 

DR Jeremy: long. And you raise a good point, right? There's an area for reframing, we live in a world where the system makes it difficult if you haven't got it all lined up. How do you get a bank account if you don't have a home like an address.

DR Jeremy: But how do you rent a flat if you don't have a bank account? So you get stuck because you don't have everything lined up. So you can't get a 

Val: job. You need an address. You need a bank account. There goes the catch 22. You're living in a circle.

Val: I want to get a job. I'm qualified I may not have anywhere to live. You may look at me like I've got no skills, but guess what? I used to be a manager this happened to me [00:18:00] for no fault of my own, but I can't get a job because I don't have a home and I can't get a bank account and it just goes on and on.

DR Jeremy: So maybe the reframing in that case is thinking about, we need to build some flexibility into the system. We need to build other options. Because there's people who just, for whatever reason. They're outside of that loop. They can't get into it. Yeah. Another thing I was thinking about one of the mandatory trainings that I go through is about preventing or dealing with radicalization.

DR Jeremy: This sort of anti terrorism kind of stuff. And there's been a reframing of that from like a criminality anti terrorism kind of thing to a a safeguarding for vulnerable individuals. We framed it more as a social or even a medical a safeguarding issue, so there's people who are vulnerable, who are hurting, who have suffered something and [00:19:00] they're victims of being manipulated into extreme ideologies, 

Val: right? 

DR Jeremy: They get manipulated and exploited, to commit acts of terror. 

Val: Yeah. 

DR Jeremy: A big part of the prevention program has been to help healthcare professionals like myself recognize when people are at risk of victimization and report them to adult safeguarding for intervention.

Val: Do you target one particular group? 

DR Jeremy: You notice there are specific groups. It's not one particular group. 

Val: Yeah. 

DR Jeremy: But there's different kinds of radicals. Not everybody's radical in the same way on the same topic, right? If you notice that somebody is at risk. And expressing kind of antisocial abuse.

Val: One second as we're talking and I'm looking at my TV screen. There's a homeless carpenter. 

DR Jeremy: Yeah. 

Val: On the news. And he has a profession. 

DR Jeremy: [00:20:00] Yep.

Val: I can't hear his story because we are recording this, but I can see him, and it's sad. Yeah. It really is. Yeah. How and you can understand why. For whatever reason, people want to add reasons why people protest. I think I'm hoping. People wouldn't be so angry if the country put its citizens first. It's weird that you can have so many homeless people and homeless Families in bed and breakfast. There was a family, I think in Lambeth where toilets didn't work and they had to use a carrier bag.

DR Jeremy: Yeah. 

Val: Really? In England, Great Britain, the United Kingdom. We have a monarch. We are part of the [00:21:00] Commonwealth. We have the head of the Commonwealth. And you have your people defecating in a carrier bag. 

DR Jeremy: Yeah. 

Val: While they are living inside a home. 

DR Jeremy: Yeah. 

Val: It doesn't make sense. And then they look at other countries and have the cheek to call them third world or shit holes. 

DR Jeremy: We assume a lack of indoor plumbing was from another century. 

Val: Yeah. 

DR Jeremy: We're talking about the present day.

Val: Exactly. Exactly. Yeah. So sorry to interrupt.

DR Jeremy: Some other examples the knife crime going on. Yes. So how are we typically reframing this as just criminals?

Val: Yes, 

DR Jeremy: people committing crimes. 

Val: Yeah. 

DR Jeremy: Okay. 

Val: It is a crime. 

DR Jeremy: It's a crime.

DR Jeremy: It's been difficult to address. How could we reframe it? 

Val: It hasn't been difficult. Scotland used to be the capital for knife crime in the EU. 

DR Jeremy: How did they deal with that? And what 

Val: they did, they they [00:22:00] adopted a public health approach.

DR Jeremy: Exactly. They reframed it.

Val: Viewing violence as a preventable disease. And significantly reduced. Knife crime. Perfect example, right? 

Val: The argument is that I've heard from different commentators is that Scotland, the people that committed the knife crime were dominantly white male. In London, it's dominantly young black men.

DR Jeremy: Okay. 

Val: So if you see that something has worked somewhere else, this is the point of having trials. 

DR Jeremy: Yeah, 

Val: of doing something and if it works, you think you would roll it over and do it somewhere else. They haven't. So one can assume it's because the only difference between the Scotland knife crime epidemic and the knife crime [00:23:00] epidemic in London are the differences in ethnicity. That's it. It's still knife crime at the end of the day. So why Scotland can do that and our government cannot do it here? , They're doing comedy for people who are on antidepressants or who are depressed. Fine. So they are reframing things and doing things differently. With the knife crime.

Val: It's already been done. And the results have been really good. Scotland was really bad. And the results have been really positive. So you think to yourself, why not here? Because I'm sure they've got something there to do with drugs, where there's somewhere where they go. . . And it's managed. I remember watching a [00:24:00] program Scotland does a lot of things differently. 

DR Jeremy: . I think they do. Reframing it as a public health problem and the positive impact it's had. Is a good example? If we've got a positive example, we should be rolling it out. In other places, similar to this we've talked a little bit already but the idea of drug abuse, right? If somebody's got a drug problem and we're calling it, they're abusing the drug. That's really focusing on the individual making bad choices. 

Val: Yeah. Yeah.

DR Jeremy: And that's one way of framing it. But if we were to reframe it more as a medical condition we can offer treatment rather than jail. 

Val: Is that a medical condition? 

DR Jeremy: Yeah, I would say alcoholism.

Val: No, but We reframe it as a medical condition 

DR Jeremy: because 

Val: we know with alcohol, is it liver disease? Kidney? Which one is it? Liver? 

DR Jeremy: It causes a whole bunch of problems, mostly liver, 

Val: yeah. So we know that there is a , direct result, cost to [00:25:00] the NHS, waiting for an organ blah, blah, blah. So I don't know if it is reframed. as a health condition. But let me tell you about the Scotland scheme and what they focused on. Sure. So the key element of the public health approach was treating violence as a disease. 

DR Jeremy: Okay. 

Val: They focus on prevention. There was a multi agency collaboration targeting root causes And an example of some of the initiatives were no knives, better lives. There was a community initiative to reduce violence and a navigator program. 

DR Jeremy: Yeah. 

Val: The homicide rate in Scotland more than halved. 

DR Jeremy: Yeah,

Val: since 2004, I find this. So this is old news, but there was a [00:26:00] 50 percent reduction in violent offending. That's huge. 

DR Jeremy: Absolutely. And I think that's a great example, of reframing violence as a disease. Violence isn't a disease. You could frame it as a disease. 

Val: Yeah. 

DR Jeremy: And they're getting these positive results, right? There's certain people who will hear what we're talking about and get a bit queasy, like this doesn't seem right.

DR Jeremy: Like you're just playing with words and making mischief. I think there's probably some validity to that criticism, we don't want to just pretend that if we change the word that will magically solve the problem.

Val: But what the words did was allow them to focus on it differently.

DR Jeremy: Exactly. . 

Val: So instead of looking at it as a crime, locking them up and throwing away the key. 

DR Jeremy: Yes. 

Val: They treated it like they would have treated any disease. 

DR Jeremy: Yeah. 

Val: And it brought a better outcome. Yes. So words do matter because the words [00:27:00] then tell us how we're going to treat said issue.

DR Jeremy: And that's the key. The second step is the key if you change the word and nothing else changes. That doesn't do anything, it's about the word you change it to changing the behavior and how we treat it. That's important 

Val: yeah. 

DR Jeremy: And I think, some other concerns about it is oftentimes this reframing is taking responsibility or blame. Away from individuals and putting the onus more on the system. So I think for some people there's a concern. What about personal responsibility, right? If you're to go back to knife crime or something, right? There's an idea like, people, individuals just shouldn't be running around with knives, stabbing people, right? And aren't those individuals responsible, if we call this a disease, are we failing to hold individuals accountable? 

Val: I don't know. 

DR Jeremy: Does it let people off the hook?

Val: It does if you don't do anything if you're not [00:28:00] treating the symptom and the cause. There's a cause and effect to everything. 

DR Jeremy: Yeah, 

Val: We know that if you live in a house with damp mold, the effect is you're going to get sick. You're going to get ill.

Val: So we know that when you use a knife on someone, the likelihood is that person is going to die. you're going to get locked away in prison.

DR Jeremy: What did you say with what they did in Glasgow? There was a 50 percent reduction in crime. 

Val: That's what he said when I found the information. 

DR Jeremy: So if you've got a 50 percent reduction. Isn't that good enough? Even if it did enough, even if there was a lack of personal accountability because we treat it as a disease rather than a crime, we've got a 50 percent reduction. Isn't that good? 

Val: We don't know if in any of these programs and these initiatives. There's room for people to take accountability. We don't know that because they could be, if they're calling one no [00:29:00] knives, better lives, there's got to be accountability because if you want to change someone as a psychologist, that person has to be honest first.

DR Jeremy: Yes. 

Val: You've got to admit. What you've done because all that person isn't going to change so it's about reframing, not just, it's about reframing them as well, if that's the right word to use with a human being, but it's showing them a better way of life, a better way to live. 

DR Jeremy: Yes. Sometimes It helps to take away this idea of personal blame we inappropriately think people are to blame when they're really not, so if we use the example that we've talked about in this podcast many times, the concept of the bed blocker, we're saying, there's all these mounting costs in the NHS.

DR Jeremy: And it's all because there's these bed blockers, these people who shouldn't be in hospital, but they [00:30:00] are right. So what if we reframe that issue rather than blaming individuals, right? Calling them bed blockers and saying they're to blame for these problems in the NHS. What if we looked at it more like traffic congestion there's flow through the system. And people are getting stuck, where's the bottleneck in the system? 

DR Jeremy: Think about it. I was recently traveling in Canada on one of the islands and had to, Go to the airport. I got off the ferry terminal and was driving to the airport in an Uber. And like the way this ferry terminal was set, there were like six lanes of traffic all feeding into one lane.

Val: Yeah. 

DR Jeremy: Okay, sure. I could blame the car in front of me for not being able to move.

Val: But then he's actually in the car in front but 

DR Jeremy: he's, but it's not like he can move because there's a car in front of him. The problem is there's a bottleneck too many lanes feeding into too few lanes. So if you wanted to change that problem. You would stop trying to [00:31:00] blame the other cars for being there. . But rather what do we do to increase the number of lanes at the bottleneck.

Val: We've always said words that governments use are always to put the blame, on the person. If there's no social care. Is that my problem? It is. It ends up being my problem, but I'm not the reason, for us not having any social care.

Val: I read the other day, a person was on a hospital bed for 18 months, 18 months of dinners, 18 months of free accommodation. And, because of social care, imagine the money they spent on that one bed. Because we talked about this before. And this is what I hate that they don't do.

Val: Imagine the money spent on that bed. That money could have been spent in social care. That bed would have been freed, but they just like that money's for that money's for that. No it's it, the NHS and the [00:32:00] social, it should be one. That's so it's not the fact that it's where they allocated that money because she had to be fed.

DR Jeremy: Yes. 

Val: She was housed because you're on a bed. Not paying rent. 

DR Jeremy: Yeah. 

Val: You're being looked after. You'd be more careful there. There are nurses doctors she's got rent for free. That's money. She's got a bed. She's got nurses on tap. 

DR Jeremy: Yeah. 

Val: She got food. She got everything she needed. And then, the cost of NHS bed was over a thousand. Or a couple thousand. 

DR Jeremy: Yeah. 

Val: Was that a week or a day? I can't remember.

DR Jeremy: Somewhere between 700 and a thousand pounds a night. 

Val: Yeah. 

DR Jeremy: Yeah. 

Val: So 18 months, what is that in 18 months?

DR Jeremy: That's, come on. Let's try, come on. What is it? 500,000 pounds? 

Val: 18 times what? 

DR Jeremy: If we said it was 1000 times 18 [00:33:00] months is 365 times 1. 

Val: Lord, 

DR Jeremy: right? 

Val: Yeah, 

DR Jeremy: that's 1000. So I think that's half a million pounds. If that was given to housing or social care, we could house and feed somebody. And pay their heat for a lot less than half a million pounds, right? Because 

Val: a community nurse could have visited. Makes no sense. 

DR Jeremy: So I think that's a perfect example. One way of framing it that highlights personal responsibility inappropriately, in my view, would be to say, this is a scammer.

DR Jeremy: This is a fraudster. But we've got a perverse incentive, right? People who can't afford to house themselves or feed themselves and they're finding ways in the system that they can survive. And it's inappropriate because it's costing a lot more for them to come into hospital. But they wouldn't be doing that if the system was different. 

Val: Yeah. So we know that through all the chats that we've had on the podcast that [00:34:00] the main focus should be social care. It has to be. They have no option. 

DR Jeremy: Yeah. 

Val: Because we're in August. It's the first of August today. And what about three months plus away from flu season?

Val: Let's see how they handle this. As usual, it's going to be a shock that winter's here. Oh my God, it's here. Really? Giving up the flu jabs. Oh my God. The NHS were overwhelmed again. From the summer they should be looking at, okay, you don't need to be here, but what can we do to get you out?

Val: What do we need to do to get you out of this bed and home? Right now there should be an empty ward somewhere or open up the nightingales. For winter. Because the sad thing [00:35:00] is, this is England, Great Britain, the United Kingdom, where we have a reigning monarch. We shouldn't have anybody, especially elderly people, lying on trolleys. Waiting for a corridor nurse. 

Val: And then have the cheek to call another country third world we shouldn't be doing that. We have no right to look down on noses. Other countries considering the mess that we're in at times that we have a system that is probably envied in a lot of countries, a system where that we get ill and the ambulance calls. They're not resuscitating using give us your credit card.

DR Jeremy: Yeah. 

Val: You've gone, then when you get to the ward Nobody's asking you, [00:36:00] give us your credit card. We are fortunate Yeah. At this moment in time to have a system the way we do, in order to preserve it the way it is for the next generation.

DR Jeremy: Yes. 

DR Jeremy: We need to reframe how we view health. Look at the words we use, who we choose to blame for their illnesses or the things Unfortunate things that impact on their lives where they need support. It might be me tomorrow.

DR Jeremy: It might be you we shouldn't look down on anyone. We don't know what they've gone through. Don't know their pain. But one thing I know is that we should have a system that we still have today. That's been here. Since 1948. I should know that. It's in the rap. I should know [00:37:00] that. It's so embarrassing. Since 1948. I won't do the rapping. 75 years. Yeah. 

Val: We want it. And I know it may be a stretch. We want it to last another 75 years. 

Val: When they say, what's the jewel in the crown? We don't literally mean the crown on someone's head. This should be it.

Val: We need to look at better ways of maintaining it. Yeah. Because it's alright for those that can go to private doctors or whatever, but they have to remember. When you go to a private hospital, as a pregnant woman and give birth, you must remember there's no A& E, there's no emergency there. Anything goes wrong, they take you straight to the nearest NHS.

Val: People should remember that. When people go abroad to get plastic surgery done, they come back, anything goes wrong, they go straight to the NHS. 

DR Jeremy: Yeah. 

Val: No matter how bad the [00:38:00] outcomes are in some hospitals the NHS is where people end up, whether they start in private care.

Val: They end up in the NHS to clear up the mess they've paid for privately. We shouldn't, for the time being, look how much money they spent opening these nightingales and it wasn't used, we said they could have gone to the universities Get the medical students that are there on their last year.

Val: Get the nurses on their last years. Get them, it should have been when COVID happened. They should have put the country on a war footing and on a war footing. They forget what happened in the war. Every hand on deck, women were turning into engineers. 

DR Jeremy: That's, reframing saying, okay we've got this disease. Let's put ourselves on a war footing, that's framing it. As something other than a disease, [00:39:00] to mobilize resources to deal with this problem.

Val: Yeah, because there were so many, delivery trucks, all those would have been used to rush supplies up and down the country. Oh, PPE. And this is why when you change to a war footing, you use all those resources that you might not use every day when it comes to the NHS, so there's things that they could have done. But as I say, when it happened, I said, get golden brown. Get brains onto it. 

DR Jeremy: Yeah. So I wonder if it would make sense to think about another example of reframing. This is something we've talked about before. The notion of maternal mortality disparities by ethnicity, that is we've said it before. Black women in the UK and the U. S. are significantly more likely to die during or shortly after childbirth compared to white women. 

Val: Yes, 

DR Jeremy: disparity persists, even after controlling for things like income, education and health [00:40:00] access. There are some ways of framing or reframing this that maybe are not helpful.

Val: Yeah, 

DR Jeremy: if you think it's only the system that, it's about racism and neglect that can oversimplify things, alienate people. In the system or imply that the people there are full of malice or incompetence, right?

DR Jeremy: There's other problematic ways of reframing it. If you're just going to blame the victims focusing on stuff like, these people in these groups, they make bad choices or bad health choices, or they're, they're eating the wrong food or they're, whatever it is.

DR Jeremy: That's there's an issue of personal responsibility, but maybe the shifting the blame to the individual is unfair in this case. It erases, 

Val: why is it my fault for being black? No, 

DR Jeremy: Not to be black but

Val: If you're going to say if, the blame is going to be shifted to me, 

DR Jeremy: I meant is if you said, okay, people in this community, they, they eat a lot of fat or sugar or something like that. They're making bad choices. [00:41:00] Okay. Yes. In one sense, that's true, but a lot of sugar, of course, so bloody hell, but it's not 

Val: specific to one group. 

DR Jeremy: No, it's not. But I guess what I'm saying is even if you could point to a difference, there's one group that does it more than another. There may be system level reasons for why they do that.

Val: But then that doesn't, then your argument changes when we look at obesity, because obesity, you could be any ethnicity and you have a lot of sugar. do you see what I mean? 

DR Jeremy: Could, but but there are, even if we look at obesity by country, right? There's certain countries that just have.

DR Jeremy: A lot more obesity than others. So us is the prime example. UK is not far behind, but you, us is super high obesity. Have 

DR Jeremy: fantastic. But right. But if, if you're living in the U S versus living in, I don't know, Vietnam, right?

DR Jeremy: There's a whole different system there that's contributing to what you put in your mouth, right? So there is a system level factor that we need to not ignore, right? Of course. And there's also things that we don't want to, when we reframe something, we [00:42:00] don't want to reframe it in a vague way where we just say it's complex.

DR Jeremy: Yes, it is complex, but let's actually let's think about it. Let's think about more specific examples, right? So there is trying to figure out what the factors are, how they interact and what we do about it. So if. If we wanted to go back to like different maternal death rates, right?

DR Jeremy: We could reframe it not as in these problematic ways, but really just saying we need clinical attunement, right? That is the clinical services we provide need to be attuned or calibrated. to the needs of the people they're serving, right? 

Val: But isn't it supposed to? 

DR Jeremy: It is supposed to, right?

DR Jeremy: But we need to think about the problem as a lack of attunement, right? So it may just be that the differences in death rates are because the system we have isn't appropriately attuned to the specific needs in that group, right? So there may be health conditions that are more common in some groups compared to others.

DR Jeremy: And we have a system that doesn't recognize that it doesn't serve. There's now an [00:43:00] underserved group and they're experiencing in this case, higher rates of death, right? 

Val: West streeting is doing another report on maternal women, black women in.

DR Jeremy: Of course there's a report. 

Val: Yes.

Val: Look reports delay. We're not doing, but we're looking as if we are doing, but there have been so many reports. I don't want another report. I will try my best never to read another report, but I know I will. 

DR Jeremy: Yeah. 

Val: Curiosity, because all it is, it's going to be a cut and paste from all the other reports because there's nothing new. Do you see what, do you see what I mean? There's nothing new until an alien comes and we have to look at how we treat aliens in the NHS. There's nothing new. 

DR Jeremy: Yeah, 

Val: that just isn't save your money, save the time and just implement. The recommendations on other reports, because we know when you do reports, recommendations are made.[00:44:00] 

Val: You don't like them. You don't implement them. What is the bloody point? It's a waste of time. And all that does is make the public think, Oh, they're going to do something that the bloody well not. Okay. I'm on a rant. 

DR Jeremy: Okay, 

Val: we're going to bring this to an end because I shouldn't have even mentioned reports that really that's done it for me.

Val: Yeah, I'm going to have to reframe that. 

DR Jeremy: Yeah we can reframe. 

Val: I'm gonna have to do me. I did. 

DR Jeremy: Yeah. 

Val: Okay. We've chatted enough today. Let's do our stories, labels, and misconceptions. Because we haven't done that for a while, Dr. J. 

DR Jeremy: Sure, sure. 

Val: Okay. So the story we know is we looked at examples of reframing.

Val: So it changing someone's view or outcome, blah, blah, blah. So What's your label? Do you have a label in any of the stories? 

DR Jeremy: I think the label really, we're talking about the kinds of negative labels that get put onto people like bedlocker, for example, right? That in some sense it's true, but it's not really true.

DR Jeremy: It's not the full picture, right? It, and it [00:45:00] inappropriately blames people. There's a misconception there. It, it inappropriately blames people for being there. 

Val: Oh, that was short. 

Val: Okay. I was ready for some long ting. 

DR Jeremy: There's the misconception that, you know that people are to blame for their problems. But the truth is actually much of the time it's the system or society that we live in that is structured. In a way that doesn't meet people's needs.

DR Jeremy: And the way to fix these seemingly intractable problems is to actually make a system level change. 

Val: The label is that. Homeless people they're all addicts. 

DR Jeremy: Yeah. 

Val: Just that they have no home. So that's the misconception is that everyone on the street doesn't have a job. 

DR Jeremy: Yeah. 

Val: When they do, they just don't have a 

DR Jeremy: home. Maybe there's a label in there. Like we might think of someone who's homeless or not working as like economists call this the free rider problem, right?

DR Jeremy: It's the idea that in any society, there's people who contribute, And then there's people who don't, the free riders, the people who are just happy to just glide along on the [00:46:00] work of other people. They call 

Val: them scroungers here. 

DR Jeremy: Scroungers. And I think that's a misconception of many of the people that, that are, yes, they are on benefits or they may be homeless or they may be.

DR Jeremy: Not working and paying taxes at the moment, but it's not because they're happy to be doing that, right? It's that we live in a world that it doesn't allow them to do that. There's barriers in place that prevent them from doing it. And honestly, as I look forward at the workplace with the advent of AI, this is a whole other episode to talk about.

DR Jeremy: I think we're all going to be free riders at some point. 

Val: There are already, there's a lot of people that work, but because the wages are low, there's some employers don't want to pay a good wage. 

DR Jeremy: Yeah. 

Val: They also get benefits to top up their wage. Not everyone on benefits is unemployed. 

DR Jeremy: Yeah. 

Val: It's not like that. 

DR Jeremy: Yeah. I think people do want to work. And if they're not working or sorry, if they are working, they probably want to work more or get paid [00:47:00] more. 

Val: Okay. So we know that reframing isn't a trick. It's a tool. I like any tool. No comment. Dr. Jeremy. 

DR Jeremy: Is that another joke, Phil?

Val: I thought you were going to say something. Oh, like any tool. It depends how you use it. 

DR Jeremy: Yes. 

Val: I might add. Oh God, it's getting worse.

Val: So I'd just like to say thanks for listening. Oh dear. 

DR Jeremy: Yes. We need to just listen to some comedy just to get some tips. 

Val: See words make you laugh. 

DR Jeremy: Yeah, 

Val: I just read the word tool

Val: That's it. Just the one word. And I'm oh dear, my eyes. Anyway, I have enjoyed today. 

DR Jeremy: Me too. 

Val: Glad I've Dr. Jeremy back by my side on screen. 

DR Jeremy: Yep. 

Val: Looking handsome. 

DR Jeremy: Thank you, Bill. 

Val: That's another laughter. 

DR Jeremy: Yes. 

Val: Anyway, guys, thanks for listening. And if you think differently, let us know, connect with us, leave messages of support, whatever it takes.

Val: And yeah. Do [00:48:00] you want to have the last word Dr. J? No, that's okay. No, you're doing great. You just have. 

DR Jeremy: Yep. 

Val: You just have. Okay. You've just spoken. Exactly. So that's the last word. Go on. That's the last 

DR Jeremy: word. Thanks, Val. 

Val: All right. Bye. 

DR Jeremy: Bye bye. 

Val: Oh, fuck. Go!