United Kingdom: Oxford Health NHS Foundation Trust; Oxford University Hospitals ME/CFS service

Posts moved from the general thread about UK ME clinics

job ad
Clinical Psychologist - CFS & Renal
Oxford University NHS Foundation Trust
The post holder will provide a highly specialist clinical psychology service to patients who access the Myalgic Encaphalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Service (0.5wte) and Renal and Transplant Service (0.5wte).
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The OUH Clinical Health Psychology department is a well-established team that supports a wide range of specialities across the acute hospital Trust.

The team has close academic links with the University of Oxford through the Clinical Psychology training programme and other research groups across the Medical Sciences Division.
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    • To communicate effectively, empathically and clearly with team members and other medical professionals regarding psychological or medical matters which will regularly be highly complicated (such as explanation of multi-faceted clinical formulations including psychological principles, medical factors, personal and family psychological factors, and the implications of these), highly emotionally charged (such as eliciting/discussing experiences of trauma or childhood abuse), and which may require managing difficulties in understanding (such as cognitive deficits, or unconscious denial of psychological conflicts), or overcoming communication difficulties with patient who are hostile, antagonistic, highly anxious or psychotic.
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    • In carrying out the duties of the post, to cope with and manage challenging behaviour at times, including verbal abuse and risk of physical aggression (for example from people with behavioural problems or enduring mental illness).
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Job Advert (jobs.nhs.uk)
 
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Sly Saint said:
job ad
Clinical Psychologist - CFS & Renal
Oxford University NHS Foundation Trust




Job Advert (jobs.nhs.uk)
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How does ME get bundled with renal/transplant medicine? Actually, let me guess..nowhere else for it to go?

But, what a horror job ad, when applied to ME patients. All the worst tropes wheeled out about us;

To communicate effectively, empathically and clearly with team members and other medical professionals regarding psychological or medical matters which will regularly be highly complicated (such as explanation of multi-faceted clinical formulations including psychological principles, medical factors, personal and family psychological factors, and the implications of these), highly emotionally charged (such as eliciting/discussing experiences of trauma or childhood abuse), and which may require managing difficulties in understanding (such as cognitive deficits, or unconscious denial of psychological conflicts), or overcoming communication difficulties with patient who are hostile, antagonistic, highly anxious or psychotic.
 
Fainbrog said:
highly emotionally charged (such as eliciting/discussing experiences of trauma or childhood abuse), and which may require managing difficulties in understanding (such as cognitive deficits, or unconscious denial of psychological conflicts), or overcoming communication difficulties with patient who are hostile, antagonistic, highly anxious or psychotic.
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yes, well, one wonders why a patient might be hostile or highly anxious... perhaps because it is inappropriate , nay abusive, to start asking people about whether they have a history of sexual abuse. Nobody should be asked about this - its none of their ruddy business to be 'eliciting it'. Nobody should ever be pressured into divulging such things! Someone prying into that will provoke healthy defensiveness which then gets read as antagonism.

And thats assuming there IS a history of trauma!

Same for 'unconscious denial of psychological conflicts' - that'll be 'disagreeing with the therapist' then, since they are always right!

And i speak as someone who has had a fantastic experience of therapy. Sadly however most of the psychologists i met i wouldnt feel emotionally safe even having a chat with.
 
Just having a look at the Oxford services in relation to this advert. At OUH (there is another one) it is run by clinical psychologist anyway, with 2+ psych and a physio. https://www.ouh.nhs.uk/chronic-fatigue/treatment/

It says that their approach is in line with 'the Nice guideline' (and links at least to the 2021 one) and BACME guide to therapy in ME/CFS

I think that this document - and indeed others in BACME's archive page ( https://bacme.info/library/management_guides/ ), which seems to have quite a lot of materials I wasn't aware they've been building up - needs to be looked at carefully by us and probably charities too. It's nonsense like this that makes me think a clear out is needed, because it doesn't matter how good the communication of pwme and scientists is then it feels there is deliberate misinterpreation and hear what they like tactics which is plain unprofessional and harmful. And it has been long enough

https://bacme.info/wp-content/uploads/2022/08/BACME-ME_CFS-Guide-to-Therapy-2022.pdf

An example from an intro section:
Therapy is designed to work with all the above processes described in the pragmatic model. The aim of a rehabilitation plan is to regulate bodily systems and to begin to desensitise a heightened level of sensory processing inside the body by doing a small amount (a baseline) of activity and achieving a better balance of rest in all areas of activity in daily life. Having achieved this, the challenge may be to then build up activity gently over time thereby reeducating the body and increasing tolerance for activities.
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I find the manipulation of the term 'baseline' particularly unforgivable and manipulative given that is a safety limit for pwme not to be exceeded - and is being pushed as a starting point. So deliberately sewing miscommunication in a document and demonstrates utter not understanding pwme or having spoken to any proper ones if they are doing that with such terms.

To me the overall still thick-headed just rewriting the pathetic storytelling 'in place of science' (when it is supposed to science-led, this is not - it's 'fill in the gaps with a little ditty to jolly the children what you are doing isn't harmful) is just the old 'sign of madness of not being able to stop just repeating the same harmful thing over and over again because you won't see the harm'. The irony and the arrogance therefore that poor sane pwme will get such people 'doing therapy'. I guess they have to be harmed in huge numbers of ways through this - I mean can you imagine being surrounded by people telling you something that won't help will 'recover you' by a fervent fool who says you are the deluded one if you state calm sense? - for the delusion of the staff to be propped up.

And it really can't be justified as 'good mental health' for the staff, given they might feel happier but is propping up that delusion, and pointing out all sorts of distracting places to look for false labels to try and claim your false reality where 'it must be the patient with secret hidden something as to why it all doesn't add up' really healthy no? I don't know who wrote it but it is rantings of denial and someone trying to justifying why south is north hidden under pretend 'models' and is worrying that such staff or training is dumped on any patients. Why do pwme need to bear the burden of making problem staff or trainers feel there is a place for their distorted reality? It's been enough years of it and never was their responsibility to be in that pantomime for them so that they can pretend it all makes sense.
 
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hmm just to follow-on I've look at the PEM document for BACME ( https://bacme.info/wp-content/uploads/2022/05/BACME-Post-Exertional-Malaise.pdf ) and even that includes the same old tired not accurately nuanced bits:

Things like the following just show a lack of seriousness or really getting it properly:

If you begin to notice a sustained improvement in your symptoms and are having more good days than bad days, gradually increase your activity levels, paying attention to any negative effects or triggers that may cause a PEM episode.

• If an increase in your activity levels does trigger a PEM episode, do not be discouraged. Wait until you feel a bit better, then try a smaller increase in your activity level.
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Avoiding all activity and spending long periods of time lying down can cause additional problems due to loss of muscle strength and fitness and make it more likely for you to experience an increase in fatigue when you try to do something. If your fatigue has become so severe that you are spending much of the day in bed, ask your GP for specialist support.
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which to me just sounds like they've tweaked the trope of 'lying in bed all day' and the old 2007 guideline, rather than looking to start from 2021 in getting the illness that is including PEM/PESE as a cardinal feature.

The aim is to reduce the number and severity of episodes of PEM by balancing rest and activity. This is referred to as Pacing.
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Nope that is their interpretation of what they want to offer - treating PEM involves understanding you have a limit/threshold - their understanding of PEM in this document makes it very clear they don't get it is a limit for the day, week and it is ongoing like that. They clearly think it is about 'not exceeding in one go' and aren't they so clever to help the thicko CFS people to break it down so they can achieve as much.

When the illness of ME/CFS is actually that even when you try and do that, and try and 'push the boundaries by running the line to triggering a flat out crash to maximise productivity' like they are suggesting - well that is when I would end up in the worst relapses and have permanent deterioration.

But hey simplify so you can give out toshy info to those who will give out info to pwme. I hate this attitude that has been spread by some people as the new 'clever thing to do' where you take a problem and instead of facing reality and being a problem-solver you think tha you simplifying it to something it isn't ie willfully misunderstanding for your own convenience is a 'skill' rather than a fundamental incompetence that makes whatever you do based on that underlying flwed cornerstone incompetent also. How do you tackle getting through to someone who lives in that mindset where they think nuance and accuracy is a dirty word/attitude 'because the listener would have to expend energy hearing something properly'?

I'm sorry but I despair with these lazy rehashes because all that was needed for a PEM document was that they described it accurately and instead its pages of denial and weedling. You can only explain and put down in Nice guidelines things so many times before it is reasonable to expect 'can't/won't change spots' to be the valid conclusion, this is from a link which says 'last updated Jan 2023' (document written August 2021)
 
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bobbler said:
It says that their approach is in line with 'the Nice guideline' (and links at least to the 2021 one) and BACME guide to therapy in ME/CFS
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BACME is not an authority of any type here. They flaunt their defiance of the NICE guidelines, while pretending to follow them, but will pretend that somehow this lobby group of commercial therapists is an authority worth citing.

Good grief this profession...
 
OK I've now looked at the other Oxford service 'Oxford Health' which is for those moderate and severe: https://www.oxfordhealth.nhs.uk/me-and-cfs/your-care/

Here is their treatments section:

Once the diagnosis is confirmed, recommendations are made for the best course of action based on the your particular circumstances, taking into account your needs and preferences. The service offers:

  • individualised, person-centred programmes that aim to sustain or gradually extend, if possible, the person’s physical, emotional and cognitive capacity.
  • support in managing the physical and emotional impact of symptoms (as recommended by NICE)
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This is a reversal of what is supposed to be happening. Where is the bit about someone's health, rather than performance. But that perhaps says it all about both the paradigm and the staffing of clinics?

Talk about frankly manipulating the guideline process - which really ABSOLUTELY said that CBT was only if someone had grief etc, I just think the whole CBT part needs to be removed from the Nice guideline, because that industry and profession and sector [EDIT: particularly the one that wants to get involved with illnesses and psychologise them, and yes sadly that is now a large amount of those only trained in CBT or from the psychiatric ie not full-gamut scientific psychology looking at the situational first therapists] cannot be professional [EDIT: they clearly don't want to hand over to real scientists and medics for the illness and real psychologists who will get themselves up to speed on the illness and situation for any situational psychological damage caused, much of it by them]. And it never had a place other than being polite, given for other illnesses people could link to say 'if other comorbidities'.

And both this and the OUH seem to rely on 'anonymous testimonials' - of course we don't know given past issues with many services using correct diagnostic criteria (and the fact this was obviously called fatigue/ME service) whether it is from those who actually even had ME/CFS

“I had severe ME/CFS for 18 years. I couldn’t think clearly or walk more than a few steps and I was housebound for long periods. I lost my career and had minimal contact with family and friends.

“Things changed, though, after I was referred to Oxfordshire Chronic Fatigue/ME Service. The therapist taught me ways to manage the pain and other symptoms. Soon I was able to walk a little more, read a book, and be taken out for coffee. I gradually improved in all respects and am now completely recovered.

“I’m immensely grateful for the help I received. It literally changed my life. In fact, it gave me a whole new life, and a bright future to look forward to.”
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I'm not keen on the following section being pretty cagey about what background the 'team' is from, surely it is just BASIC and about consent and rights that someone should be honest and open about who they are and what they intend to do so why 'practitioner' and 'therapists' but not specifics?:

Who is in the team?
The Oxfordshire ME/CFS Service comprises of a highly specialised practitioner/clinical lead and two specialist ME/CFS therapists

We can also refer people to clinicians at Talking Space Plus for a programme cognitive behaviour therapy (CBT).
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I note the referrals page: https://www.oxfordhealth.nhs.uk/me-and-cfs/referrals/
dated Dec 2021, so post guideline, and they've had all the freedom in the world to update this.

Says:

(Please note: The OUH service offers cognitive behavioural therapy (CBT) and support with exercise with a Specialist Physiotherapist should this be appropriate for you.)
 
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The contact person for the job advert on the NHS site Clinical Psychologist - CFS & Renal Oxford University NHS Foundation Trust), is part of Michael Sharpe's Oxford University NHS Foundation Trust Psychological Medicine Team see link below

'For questions about the job, contact:
Principal Clinical Psychologist Dr Annabel Haldane (CFS)'
https://www.jobs.nhs.uk/candidate/jobadvert/C9321-23-1809



Oxford University Hospitals NHS Foundation Trust
PSYCHOLOGICAL MEDICINE CLINICAL SERVICE

Trust Lead for Psychological Medicine
Michael Sharpe

Clinical Psychologist
Annabel Haldane

https://www.ouh.nhs.uk/services/departments/psychological-medicine/clinical-service.aspx
 
Fainbrog said:
How does ME get bundled with renal/transplant medicine? Actually, let me guess..nowhere else for it to go?

But, what a horror job ad, when applied to ME patients. All the worst tropes wheeled out about us;

To communicate effectively, empathically and clearly with team members and other medical professionals regarding psychological or medical matters which will regularly be highly complicated (such as explanation of multi-faceted clinical formulations including psychological principles, medical factors, personal and family psychological factors, and the implications of these), highly emotionally charged (such as eliciting/discussing experiences of trauma or childhood abuse), and which may require managing difficulties in understanding (such as cognitive deficits, or unconscious denial of psychological conflicts), or overcoming communication difficulties with patient who are hostile, antagonistic, highly anxious or psychotic.
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ME Association has written to the trust.

https://meassociation.org.uk/2023/0...st-about-inaccurate-and-offensive-job-advert/

Sorry if this has since been shared my brain isn’t functioning enough to read all the posts on this thread..
 
Someone on Twitter pointed out that the "Trust Lead" position is held by Michael Sharpe. The page lists Dr Annabel Haldane (CFS) which is the contact person in the job advert.

https://www.ouh.nhs.uk/services/departments/psychological-medicine/clinical-service.aspx

Could it be that this service has recurring problems with "hostile" and "antagonistic" patients because of its own negative attitudes towards patients? Or maybe patients don't much like being told they have subconscious emotional conflicts because they recognize it as pseudoscience? Or they don't like being given harmful treatments?
 
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"Could it be that this service has recurring problems with "hostile" and "antagonistic" patients because of its own negative attitudes towards patients? Or maybe patients don't much like being told they have subconscious emotional conflicts because they recognize it as pseudoscience? Or they don't like being given harmful treatments?"


Unlikely. The job ad is a repeat of a similar vacancy ad for a Liverpool University Hospital some years ago which was very similarly worded, almost word for word. That Liverpool ad framed ME patients as hostile, emotionally volatile, disturbed and potentially dangerous. The Oxford ad is almost a facsimile.

I think the job ad is a smear campaign in it's own right. The ad pre-emptively positions ME patients as disturbed and potentially dangerous - it incites a negative attitude towards the patients from clinic staff.
 
Lou B Lou said:
The latest deceptive language manipulation used to disguise GET/Graded Activity is to frame exercise as rebuilding your stamina.


Oxford Health NHS Foundation Trust

Treatments

'.... Starting with some gentle, regular, activities you can gradually begin to rebuild your stamina.'

https://www.oxfordhealth.nhs.uk/me-and-cfs/treatments/
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Just same deluded stuff - how can the same people be able to involved in anything that takes pwme as patients when two years down the line they (the staff) still can’t think straight as exampled by utterly cannot get their head round how opposite snd false beliefs their thinking is - they werent ‘slightly wrong or off’, and these people just show signs of being utterly stuck in delusion-land with writing this and then when you point it out the ‘nope still no penny drop, you’ve just changed the synonyms didn’t you’ pulling teeth nonsense.
 
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Hoopoe said:
Someone on Twitter pointed out that the "Trust Lead" position is held by Michael Sharpe. The page lists Dr Annabel Haldane (CFS) which is the contact person in the job advert.

https://www.ouh.nhs.uk/services/departments/psychological-medicine/clinical-service.aspx

Could it be that this service has recurring problems with "hostile" and "antagonistic" patients because of its own negative attitudes towards patients? Or maybe patients don't much like being told they have subconscious emotional conflicts because they recognize it as pseudoscience? Or they don't like being given harmful treatments?
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Let’s remember the extreme words such individuals use to describe patients or their actions for what turned out to be eg putting in a FOI request or wanting to provide critique or feedback to an article or research as per other illness patients would be perceived as entitled and following normal protocol.

Something doesn’t actually need to have any examples or truth behind it for it to be claimed if the power differential is great but I can imagine the implications of what someone could get labelled with, or done to them, under certain depts and powers - which shouldn't be 'linked to' or 'suggested as likely' just because someone has me/cfs - would make someone terrified too.


This feels like the same major issues of conflict of interest at the micro-level, as well as macro-leve to influence this happenning a lot at that level, and is very serious. At the end of the day this advert is propaganda for those who read it but also direction for those who do the job and primes how a narrative will be interpreted for any poor individuals who might end up there?

And so it feels like some individuals might be in these situations 'sitting ducks' to an epistemic risk [leading to risk of many other types of harm in this context] caused by 'well one of us has to have false beliefs and I've already confirmed in writing that as long as I get to choose it isn't going to be me'. So seeing certain narratives being suggesed even in recruitment - so if a normal reaction occurs to insensitive behaviour towards them they've been misled to believe it is actually 'just that that disease makes you hostile' is pretty significant as to whether the old services are looking to improve their staff and attitudes.

If it happened that someone got told they were antagonistic or 'in denial' just for disagreeing then how would such patients not find it hard to deny or brush off such false suggestions, as that being done to anyone would be shocking and frightening - and they would be right to be frightened/feel threatened by it. Particularly when they were probably understandably worried about the risk of going there in the first place so someone might claim that as a symptom rather than caused by the service.

I think what I'm saying is that: if as a test a number of normal people walked in to 'mystery shop', who had no issues with ME/CFS or mental health (but did know what would be harmful vs not re guideline), has this advert created a situation where even those people - if carrying a label or suggestion of ME/CFS - could ever walk out without having perceived as any of the labels in the ad, no matter how they actually acted? Because it seems no win and to paint instructions that would escalate to one end alone.

Which feels like the safeguarding issue I always thought existed.

And what service that would call itself psych anything wouldn't be understanding of such worries they will cause and factor in it is their behaviour that will need to be exemplar to avoid causing this. Is there any process that would preserve their safety or could reassure them?

when you think about how any wariness in those with ME is very likely due to harm caused by old guidelines and surrounding propaganda of false beliefs there is a huge discussion needed here. Surely in logic-land, the least appropriate situation is to have those who did that in charge of the same patients and with no oversight to stop them seeing this as/claiming ‘they need to deal with their trauma’ (as if it came from anywhere else but the reality they do not want to acknowledge).

And the only thing worse than that is if those same people also had confirmed they not only weren't going to change or listen, but will battle to return it to the status quo or worse. Oh and that they blame patients for it ever having changed at all.


And there has been no risk assessment or checks for this - where someone’s issues could be due to how they’ve been treated by similar professionals (who might not want to admit that cause). And no plan for the poor souls who do need/want psychology but need and deserve the absolute opposite kind with people who will be safe for them and not in denial. It feels inappropriate the more I look at this.

This is a dept/niche that is allowed to make subjective diagnoses then use these very numbers to make poor inferential claims that are used to prime more of the same e.g.like the FND 'second most common diagnosis/x% of your patients will have this and they'll look like y demographic'. Such writing in an advert could surely influence any second opinion before they even saw the patient even if one were offered.



I’m trying to think of an equivalent situation or scandal and if those hurt would be put back into such a power differential uner the same people. With no acknolwedgement of the awkwardness that would need to be encumbent on the staff member to manage their behaviour to avoid, and no oversight or safeguards, or even promises/signs of change or intention to. And with this type of priming likely to incite misinterpretation and antagonism towards them for which blame is to be lumbered on the unsuspecting person who merely walked in the door. It almost feels so bad I'd use the phrase 'stitching up'.
 
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Trish said:
Can this be raised in the responses to the government consultation?
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Maybe alongside other publicly available examples. There are very nasty presentations out there that very clearly paint a false and bigoted version of us. And of course SMILE's "the bastards don't want to get better". Fiona Fox calling us Nazis. No shortage of that, and very much worth raising.

The decades-long smear campaign can definitely be used against them. There is so much of it, for years they went too far because it was all so easy for them. I'd also use the tribunal scolding the PACE researchers over accusations they admitted were false, showing how little of what they say can be taken at face value, they even lie to tribunals, expecting to be simply allowed to. And how a few irreverent-but-accurate tweets do not in any way amount to harassment, despite explicit accusations smearing us all to an international audience.
 
Out of interest I just Goog1ed socia1 work job adverts, where the professiona1 wou1d be working with very troub1ed individua1s and fami1ies. None of the adverts used offensive 1anguage. Instead they simp1y referred to the app1icant being ab1e to work with 'individua1s with comp1ex needs' or 'fami1ies who present with a variety of needs' etc.

The same is true of adverts for schoo1 jobs, even though (for examp1e) as a teacher my daughter has to dea1 with serious safeguarding issues, chi1dren at risk of crimina1 exp1oitation, fami1ies invo1ved in county 1ines, young peop1e with severe menta1 or physica1 hea1th prob1ems, 1earning difficu1ties etc. - a11 on a dai1y basis. But as a professiona1 she'd never use inf1amatory 1anguage to describe these young peop1e or their fami1ies, not even in informa1 conversations.

These NHS ME/CFS job adverts are tru1y offensive and shocking.
 
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