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Episode 3 with Mark Pattinson
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We are joined by Mark Pattinson, CEO of CareADHD, to talk about innovation in running ADHD services, right to choose and the future of ADHD care.
We also welcome a new presenter to the team, Jamie Gordon!
That's it for this week. More soon!
Recommended
Transcript
Introduction and Personal Journeys
00:00:08
Speaker
Hello, welcome to the ADHD UK podcast. My name is Max Davey. I'm Lauren Jennings. And I'm Jamie Gordon. Ah, another voice has appeared. Yes, listeners, we're spoiling you.
00:00:22
Speaker
Not with the episodes, obviously, because it's been a while, but with presenters. So we have a new member of the team. So ja I think first first order of business, Jamie, will you introduce yourselves to the thronging masses of our audience? Absolutely. So my name is Jamie Gordon. I'm an ambassador for ADHD UK. I'm on the lead ambassador team and I am based in Reading. You can probably tell from my accent that I am from Glasgow.
00:00:52
Speaker
Oh, ah no, I was joking. You haven't got a classic Reading at accent at all. it's much your your Your accent is is much too much too melodious for Reading. ah um um And can i so you're somebody who has ADHD yourself, Jamie.
00:01:12
Speaker
Yes. and but Can you tell us a little bit more about that and sort of how long you've been diagnosed and what your kind of no experience of it has been so far, briefly? Yeah, no, absolutely. um Well, i' I don't know, can anybody sort of say their experience briefly, particularly people with ADHD? ah I don't know. But like, um so, yeah, I mean, I was diagnosed with ADHD in I think it was about 2020. And I'll tell you, and It was actually like it was three months from when I spoke to my GP until I got an NHS diagnosis. I mean, you know, that's actually quite remarkable. But where the where the issue started for me is when I moved to Reading. That was where the problem sort of started. I had an NHS diagnosis, but it was really difficult to get it sort of transferred over to Reading. Basically, I waited on a waiting list for two years for what they called a medication review, but actually it was it was just a diagnosis. and
00:02:19
Speaker
um At that point, I sort of realised we are wasting so many resources on, you know, children going to adult services, people moving from one end of the country to the other. um And i just thought it was really inefficient. I was on the ADHD UK Facebook support group all the time. i was noticing that so many people had so many different issues.
00:02:44
Speaker
And yeah, that was it. I thought I need to become ah an ambassador. that I need to do something about this. Yeah, fantastic. um And we're you're very welcome. and And one of the things that you're going to do and one of the things that your kind of arrival has has facilitated for us is a separate feed for ambassadors to tell their stories. So Lauren, do you want to jump in and talk about that a little bit?
00:03:08
Speaker
Yeah, absolutely. So and as you may or may not know, and there is over 100 ambassadors in our group um and every single one has a different story um and different perspectives and different things to bring to the podcast. So we're really looking forward to bringing ambassadors onto the podcast to share their stories and their experiences.
00:03:31
Speaker
And of course, ah one of things I forgot at the beginning is happy Pride Month, everybody. oh yeah. um And relevant to that, you've got some some Pride content coming up.
00:03:42
Speaker
Yes. So we'll have two of our incredible ambassadors on the podcast to speak during Pride Month. So that will go out this June. Fantastic. Fantastic. Fly the flag. Fly all the flags. um um And... um So the other thing I thought was interesting from what you were saying, Jamie,
00:04:03
Speaker
is actually no sorry let me just go back because there will now be an ADHD ambassador podcast feed we will link to it when it's out it might not be out this week it might be out it might take a couple of weeks but next as soon as it's out it will be in the um the the show notes but just just keep an hour out an eye out if you're particularly interested in lived experience around ADHD it would be a great ah great sort of massive stories. It'll be a great kind of um source of inspiration, I'm sure, for every for everybody in in the community. So I'm very excited to to be a listener to those because it's you um um I've got plenty on my plate doing doing that doing the um the main
Interview with Mark Pattinson
00:04:50
Speaker
show. um
00:04:53
Speaker
Speaking of, it's very relevant, I think, Jamie, that you um talked about the inefficiency of the NHS. I think as it is since as an NHS. I mean, I'm not offended as an NHS clinician, obviously, but we talked to Mark Pattinson and Mark left the and NHS to for to to found care ADHD,
00:05:17
Speaker
um a provider which runs through what's called a right to choose contract with the NHS. um And I don't want to spoil it because he's he really is very good at introducing it himself. But we're going to run today's and episode. the The bulk of today's episode is going to be an interview with with Mark. Lauren, and I know you can listen carefully to that one and and and kind of have have your thoughts. Do you want to say anything before the interview or should we leave it till after?
00:05:45
Speaker
I think it's a brilliant episode and I think everyone should be looking forward to listening. All right, fantastic. Well, without further ado, let's get on with the episode.
00:05:58
Speaker
Right, so we welcome to the ADHD UK pod, Mark Pattinson, founder and CEO of Care ADHD. Welcome, Mark. Thank you for having me, Max.
00:06:10
Speaker
but it's It's a great pleasure. um Mark and I have had some dealings via ADHD UK but i think it's I think it's great to have somebody who's well tell you tell your own story and then I think it will become obvious why I'm excited to have you on.
00:06:23
Speaker
what What is care ADHD and how did you end up founding and founding it and and you know what what's your story really? Brilliant. Thank you. So my my story and is relatively simple, really. i'm ah I'm a nurse by background. I've worked in the and NHS for the for last 15 years.
00:06:43
Speaker
I had the the privilege and of working up from a staff nurse through to ward manager, matron, clinical nurse lead, and I finished my and NHS career, I guess you could say it like that, as a service director. and for mental health um services in South East London.
00:07:05
Speaker
um I think my time in the NHS um was very, very special. um I talk very, very fondly of it. I think there were some some personal frustrations um at at transformation and I wanted the opportunity to see if care could be delivered um in in a slightly different way. So I um i founded Care ADHD. um It was created to address the significant unmet need for those people looking for an ADHD assessment. And and i made a number of commitments. I wanted to, and first I wanted to offer additional capacity to the NHS. and I wanted to make sure that those people that use our service and had an exceptional time. um great patient outcomes.
00:08:02
Speaker
I wanted to create an environment for clinicians um where they would thrive and encouraged to, I guess, push the boundaries um in the way that care is delivered. And ultimately, Max, I wanted it to save the NHS money.
00:08:16
Speaker
um because i thought if we could save the nhs money it would enable um the nhs to reinvest it in in other areas so i think that's where i that's where i think it's it's really important to get a get a bit in the weeds here how because essentially what you're saying you're saying ah you're leaving the and nhs you're going to set up another provider how does that save the nhs money just for people who don't know how it works Yeah, of course. So i and so it in the NHS, whether you come to an independent provider under Right to Choose or or the NHS...
00:08:56
Speaker
The money that's used to create those services comes from the taxpayer. um Now, my experience, my own personal experience within within the and NHS was that we were we were receiving um funding and we couldn't see enough patients. So patients, and depending on what part of the country you're in, some are waiting in um nine, 12 months, some are waiting five, six, seven, seven years.
00:09:26
Speaker
you um And I knew how much it was costing me as a service director to put a patient through an ADHD pathway.
00:09:37
Speaker
um And I believe that there were ways of supporting patients through the pathway, using technology um and other innovations that would mean we could stretch the taxpayers' money, see more people for for for less.
00:09:58
Speaker
I also knew that there was a variety of different contracts out there. Some were paying a lot more, some were paying a lot a lot less. and so we opted to go towards a um an ICB that had a contract which was less than other areas. So when we see patients, and whether you're from Manchester or Cornwall, we charge the and NHS um the the least amount of money possible.
00:10:29
Speaker
So how do you would, so I think there's lots to unpack from that. And we'll talk, we'll talk a bit later about what right to choose means in case people are kind of, what's that? But what you're essentially saying is with taxpayer money, you can get more bang for the buck, as it were. You can get for each a pound, you can get more ADHD care out of each pound.
00:10:54
Speaker
How do you do that? So introduce... introduce and um I was gonna say workflows, but and for the sake of this conversation, we've we've introduced technology um which reduces the administrative burden.
00:11:12
Speaker
and So clinicians are spending more time with patients offering high class um assessments. You have to remember, as a nurse, I would spend more time as a nurse writing up an assessment than actually doing the assessment itself.
00:11:31
Speaker
um And so we've looked at the pathway, we've looked at NICE, we've looked at the pathway and and we've been able to build and parts of the pathway that can be automated so we can we can move patients through at a quicker rate than what we could do previously. can you Can you give me an example of something that you've automated that would be a manual process in the NHS?
00:11:56
Speaker
Of and booking someone in for an assessment, for example. um So in the NHS, we would um we would need to wait for somebody to start work in the morning and before a patient could be contacted. We we automate that process. um We also automate and report writing. So if I was writing up an assessment, it could take me an hour and half, two hours to to capture the conversation. We've now got... um
00:12:30
Speaker
AI technology, which allows us to to streamline that that that process a lot quicker. and We also send out digital communication. So we don't necessarily post letters. We can we can email. um And and and these these small things then add up um um you know in ah in ah in a great way.
00:12:55
Speaker
And so the obvious question is, and I say this as an as a clinical lead for an ADHD, NHS, ADHD service. Gosh, there's a lot of acronyms flying around, but I think we're probably all right. um But to as someone who runs an NHS service, why doesn't the NHS do these innovations?
Challenges and Policies in ADHD Assessment
00:13:18
Speaker
That's a really... so This isn't a video podcast, but mark my Mark's face there was priceless. But but you've you've alluded to your own personal frustrations. Yeah.
00:13:31
Speaker
I think sometimes it's it's really it's really difficult in in certain environments, Max. I think um i think there's risk there are some incredible clinicians um and operational leads in the NHS.
00:13:45
Speaker
I think trying to move away from the way that you've worked for many, many years is is really difficult. um I think there's less incentive sometimes yeah to do it. um i mean, we're we're able to um financially compensate clinicians better than what I could as a service director. um and And I think there's there's a lot of um historical ways of working, um which is very, very difficult to to move away from. One of the...
00:14:22
Speaker
one of the best feelings that i've had moving out and there's not there's not many of them believe it or not i do miss my time in the nhs but one of the things that i have really enjoyed is the ability to find different solutions to problems which i wasn't always able to do for for one reason or another in the and nhs um and and i don't have the same constraints as what i what i once did oh So let's go back to what your um how your system works, because I think there might be some people listening who don't really who've heard of Right to Choose and don't really understand it. Is it private? Is it not? Blah, blah, blah. how what does
00:15:05
Speaker
How does it work? How does Right to Choose work and how is it paid for? So... um So right to choose exists. um it's ah It's obviously, it's it's a policy. um And the think that the first thing that we should say is it's a policy that should be absolutely celebrated. um It is a policy that gives people the right to choose where their care is delivered.
00:15:34
Speaker
And this there's certain elements that an independent provider has to go through to be able to offer right to choose. So and so the most obvious one is we have to have a contract with the and NHS to provide a service. Now, once we've got that contract with the and NHS, we are then able to open our doors to to anybody in England who would like an ADHD assessment. So an ICB, an integrated care board, will and advertise a contract and what they will say is, we need an in we need a provider, it doesn't have to be independent, it could be the NHS, we but we need a provider to provide a set of services. So for example, we have a large number of contracts now with a variety of different and integrated care boards. And they say, we need you to be able to assess people. and we need you to be able to follow these and
00:16:32
Speaker
um these these these rules, these these services. And if you do that, then um people can choose to have their care delivered by you. So we deliver the same um same assessment, same treatment, same support as what an NHS provider would but we are known as as as an independent provider. So you could technically go into your GP, ask for an ADHD referral.
00:16:58
Speaker
You can pick um a number of providers that have got contracts and you can be referred to us. and we have And we have systems hooked up to primary care, which allows a GP to go on their system and send a referral off and to us. Now, I think what's important to remember is right to choose is is funded by the taxpayer. The same way that the NHS receives its money, its funding, we also receive funding um through the same same mechanics, if you like.
00:17:32
Speaker
And so ah if a listener, if someone was listening and they were interested in an assessment, they could just go to their GP and ask for right to choose. Yes, yes. And then the GP would have to make sure that it's clinically appropriate. um And if they if they believe it is clinically appropriate, then they will do the referral. The referral will come through to us. You will be onboarding onto our system. And then your journey, your episode of care will start with us.
00:18:00
Speaker
Yeah, so that that clinically appropriate bit is a really important one. And just to clear to be clear, again, for the listeners' benefit, that applies to children and adults. Is that right? Yes. Yeah, that's right.
00:18:13
Speaker
So ah there's a few things to say about that. One is, of course, as you might be aware, some some GPs are a bit resistant to and right to choose to making these referrals. What would be your advice either to GPs or to people who are thinking about or not a right to choose referral? And do you understand that reticence? Do you understand that resistance?
00:18:37
Speaker
Yeah. i i understand that and there's variation. and There's variation in the independence. It's the same way as there's variation with with any healthcare provider.
00:18:51
Speaker
um And i understand that there has been and articles and in the newspaper shining a light on on on some providers where care maybe hasn't been to the standard that we would hope so I do understand that unfortunately um you can be tarnished with the same brush um and it's a shame uh but but that's unfortunately the position that we are in I think I think what frustrates me a little bit Max is is um
00:19:27
Speaker
particularly within this country, we think about the independent sector and we think that it's a negative place to be. And in actual fact, I've just spent the last 15 years as a nurse in the NHS. We've got chief medical officer who sat on a board for many years in the and NHS. We've got hundreds of clinicians that have spent time in the NHS and in the independent sector. and i think what's really, really important is how we demonstrate um the level of quality through through assurance, through oversight, through the same i high clinical and expectations that the and NHS has. We are regulated the same way as what the NHS is, as you as you know. and In some respects, there's ah there's a there's a bigger spotlight shining on us. so
00:20:17
Speaker
do get a bit frustrated if I'm honest. I think to myself, you know, when I was a service director in the NHS, you know, nobody would bat an eyelid. as ah As a CEO in the independent sector, there's there's bigger scrutiny.
00:20:31
Speaker
In some ways, I see it. In some ways, I think
00:20:36
Speaker
It may be an unfair challenge. So I think there are some fair and unfair challenges to the right to choose model. I think I mean, I think one of the challenges that i still hear from NHS clinicians is that right to choose is diverting funds that otherwise would go to core NHS services. What's your response to that?
00:21:00
Speaker
um I don't see why um somebody struggling um with symptoms associated with ADHD, umt I don't understand why um that person would be, um I guess, ah subjected to that level of challenge. um I think um ADHD, autism services, ND pathways, um i think the opportunity to help somebody in their hour of need, their time of need, um who who are struggling, be that relationships, work, productivity, um
00:21:41
Speaker
I'm not sure where the line is with with core mental health services. i think um we need to find a um ah more efficient way um of commissioning.
00:21:54
Speaker
um i think we need to challenge the way that services have been commissioned. um And I think Whether you're struggling and need ND support or struggling and you're in a crisis or you need perinatal services or an inpatient stay, um I think it's very, very difficult to say we should have this service, but not that not that service.
00:22:21
Speaker
Yes, I see what you mean, because if you're going to have an ADHD service, it needs to be paid for and you provide for ADHD services. in and of itself, better value for that. So you can, if you have a certain amount of money in your local area to spend on mental health as a whole, you get more ADHD per thousand pounds or whatever, a you know, yeah um from ADHD than typically you would from a mainstream and NHS service.
Complex Cases and Integrated Care
00:22:48
Speaker
And I, you know, ah i completely i accept that because i've I've seen your figures. I can't, it's very hard to argue with that. um
00:22:57
Speaker
I suppose the other the other kind of strain of potential, it's not even a criticism, it's a question. And it's something I wonder about as well. Because sometimes you can get somebody in and the question is very simple. Do they have ADHD or not? And that's that's their main problem. And they need they need a diagnosis or are not diagnosis and they need treatment or not treatment. And that's sort of great.
00:23:19
Speaker
That feels to me like exactly what a standalone ADHD service is for. ah You know where i'm going with this, of course. um Because a lot of the kids, I mean, I say kids because I work in a children's service, but a lot of people, their ADHD is enmeshed in a much broader set of difficulties, often quite complex difficulties. And that is both a diagnostic puzzle.
00:23:48
Speaker
So you may have somebody who could be ADHD, but also autistic. I haven't actually asked you yet if you do ah both assess them both at the same time, but that's an example of a complication or somebody whose potential ADHD symptoms may also be as a result of traumatic events and you know current exposure to domestic ah abuse or whatever. um And also...
00:24:16
Speaker
so that So that creates a a diagnostic problem, but also a problem of treatment planning, which needs to be done, which I would argue, perhaps, is best done in an integrated way across the whole person's whole situation, not just isolated to ADHD.
00:24:32
Speaker
So I think that's a bit more of a nuanced challenge. um And I just wondered what you thought about that.
00:24:39
Speaker
i think it's fair I think it's a really fair challenge. um I think and this one, it's really important, it's sensitive. Clearly, ADHD, autism can overlap, particularly in children and adolescents. What we um what we strive to do is is involve parents or carers.
00:25:00
Speaker
We have a process whereby we work very closely and to get input from from schools and educational institutions and and we look carefully at the functional impact. So it's not for me or for us, it's it's not just about symptoms. and And importantly, we also spend time thinking about what else could explain the the presentation. you You touched on an example there where you it could be trauma related. so um The goal isn't about speed in any of this, it's about accuracy and it's about safety um and it's about you potentially ruling out um other the and the diagnoses. So yeah we we have a fantastic clinical team. very highly skilled, led by ah Dr Chris Abbott, who's a children's consultant psychiatrist. And and just just to touch on the last bit there, Max, in terms of fragmented services, you're absolutely right. And I think most...
00:25:59
Speaker
independent providers and are craving that closer working relationship with the NHS. I don't think any private independent provider wants to work in isolation.
00:26:12
Speaker
I do believe that. I think it's in the best interest of the individual for us to be able to all wrap around, whether that's NHS, social care or the independent sector. I think that's that's laudable. and Do you find it easy for your individual clinicians to work with local CAMHS or local mental health services?
00:26:33
Speaker
i ah my My experience is that when you reach out to it be a CMHT CAMHS service, yeah the the NHS is is full of of of caring, compassionate clinicians and who who want to work in the best interest of the individual. the same way as the clinicians within the independent sector. um Sometimes there are pressures with with primary care um for reasons that we're all aware of um and what I would say is if there's ever a situation where a a GP for whatever reason does not want to enter shared care then we would continue to see that that that young person, that adolescent or that adult on an ongoing basis.
00:27:17
Speaker
do they often refute they Do they often say that they don't want to join Shared Care? This is this is a very common complaint on our Facebook groups. um um and me So we've got really good working relationships with a lot of GPs. and We are seeing more that don't want to enter into Shared Care. um And ah whether you agree or disagree, I think for us it's ah it's about...
00:27:44
Speaker
If the answer's no, how do we continue to wrap around that individual so they don't slip through the net or the crack? Yeah, yeah. And and I think it just just as a bit of a public service broadcast, if a GP says no, there's not much you can do about it, as in my experience. they just they're just they They're not obliged, partly because they're not really NHS employees. They're kind of contractors to the NHS, just to bear that in mind. Yeah, yeah. I yeah ah don't want this to be a sort of kind of, I don't want this to segue into an anti-GP segment, but they are contractors,
00:28:22
Speaker
They are small business owners, and so they have their own business to protect, um which is absolutely fine. um What sometimes frustrates me is when they dress up them protecting their business as them protecting the NHS, because those are two different things.
00:28:38
Speaker
Anyway. I'm going to stop before I get myself in trouble. And that was me talking and not Mark, just to be absolutely clear. It was definitely Max. ah um Yes, but it is a bit frustrating. um So how are you meeting...
Future of ADHD Services
00:28:54
Speaker
Because you set yourself up as a cheaper and more efficient and arguably more... window An alternative with a better...
00:29:05
Speaker
ah patient experience are you not absolutely flooded with demand are you not completely overwhelmed and we've we've um we've seen more people being referred um we've we've scaled safely and i've been really proud with the way that um we've scaled um i think i've got more more assurance, more oversight in this in this space than what I've had in a lot of other spaces in my time as a um yeah as ah as as ah as a lead.
00:29:35
Speaker
um and And what I would say is that we are... able to support, we're able to to work with the NHS, we're working um um hand-in hand in hand. We do have some very, very good working relationships with primary care. um and And so far, we've been able to attract enough um and of clinicians to be able to offer enough clinical capacity to be able see people.
00:30:07
Speaker
And I suppose that's partly to do with the fact that you are able to attract clinicians that perhaps um with a a more attractive package is probably but one way of putting it We are able to, and i think my I think attracting clinicians in this space is easier than I've had it in in in the NHS. yeah um I think we we work really hard to make people um i'll give people their that flexibility um in terms of when when they choose to work. um and And we're able to incentivize people in a way that I was never able to do in the NHS.
00:30:47
Speaker
yeah Yeah, absolutely. um ah You'll be glad to know we're nearly there. So do you think that Right to Choose is hit is in for the long run? is it Is it part of the solution to the ADHD crisis?
00:31:06
Speaker
am i think I think it's one part of the solution, Max. I think, um and this may not be a popular view, um i think whether you are an independent sector or whether you're in the NHS, if you're being funded to deliver a service and for whatever reason you are unable to deliver that service, then I think we need to look at what we are commissioning.
00:31:29
Speaker
um and um And that's not a, you know, that's not a ah slate towards the NHS or the independent sector. But healthcare care in in in in this country needs to be, and it needs to be both the NHS and the independent sector. The end the NHS does some phenomenal work. um and And I have had some incredible years there. It can't do everything.
00:31:58
Speaker
And we're seeing the fact that it can't do everything. And I believe that there is there is technology and ways of working out there. I'm not even sure that most of the public realise, you know, in terms of how we can move people through a pathway. at a safe pace that meets patients' needs, that means that clinicians can work in a safe, enjoyable environment. So i think right to choose, and yeah clearly it's a phenomenal policy, and i think we should I really do mean that. We should celebrate the fact that people in this country have the ability to self-commission services that would improve their health.
00:32:42
Speaker
i'm Do I think it'd be around forever? i'm I'm not sure if it'll be around forever. I think commissioning will evolve. um But I think as part of that, I think we need to look at who we are commissioning, what are the standards that they are offering, um and what is the cost?
00:32:58
Speaker
and Because clearly there isn't a bottomless pit of money. we need to make sure that there's high quality services at a most affordable and price.
00:33:10
Speaker
So I suppose my last question is what your hope what are your hopes for the future of care ADHD or of ADHD, the ADHD landscape more broadly? I think the care ADHD and we want to be partners to the and NHS. and yeah We want to be partners to primary care and we want to continue to offer very high quality services um in terms of ADHD and care and support. i and i hope that we that we can get to a position where those people that need support, care, assessment, treatment, coaching, psychology, and medication, whatever it might be, and I hope that care is is able to be delivered
00:33:56
Speaker
high quality and and most cost effective so that more people can receive the care and support they need. If we can support more people, Max, it means they can get back to the quality of life that they want. It means people can be more productive. They can have better relationships. They can contribute more. You know, we should be we should be praising the people that come forward asking for help.
00:34:19
Speaker
Yeah, absolutely. And not not not rolling our eyes and going, oh, another one. Yeah, but absolutely. Absolutely. and and for And for those people that aren't comfortable and confident for whatever reason, you know, let's keep talking about it.
00:34:32
Speaker
You know, let's let's celebrate the fact that more people are coming forward who need care and support than ever before. And they're doing that because in this country, we are reducing the stigma around um receiving that that that support. So, you know, long may that continue.
00:34:49
Speaker
I suppose I'm going to do one cut supplementary question because one of the things the big things that's happening at the moment is a sort of inquiry into overdiagnosis where a lot of the noise has been around potential overdiagnosis of ADHD.
00:35:03
Speaker
Do you think we have an overdiagnosis problem? And if so, what should we do about it I don't think there's overdiagnosis problem. I don't think there's any evidence whatsoever to suggest that prevalence has increased. And I think what we've done in this country is we've said it's okay to come forward.
00:35:21
Speaker
And I think if you say to people over and over again, it's okay to come forward, guess what's going to happen? People are going to come forward. Let's celebrate it. Yeah. Yeah. Good. Well, that was an easy answer to, I completely, i mean, that's factually correct answer to this question, but it's worth it's worth hammering away. there is no idea There is no over-diagnosis crisis at a population level.
00:35:43
Speaker
in ADHD in this country. It doesn't exist. It's a myth. Right. Good. Mark, is there anything else you'd like to tell our listeners before we yeah let you go? and I want to say thank you. Thank you for listening. and I think when when you hear about care ADHD, please know that people are trying really, really hard to improve services, to grow services. We won't always get it right. um And if we don't get it right all the time, we learn, um we develop, but we have a group of people here that that really do care.
00:36:17
Speaker
um So just want to say big thank you, Max, for for giving us the opportunity to have this conversation. No problem all. You were on my list even before I was approached by your people.
00:36:28
Speaker
All right. Thank you. Thanks very much.
00:36:38
Speaker
And like I said in the beginning, I think that was a brilliant episode. ah Shared care is something that ambassadors in particular have actually been speaking about over the past few months. And and the part around shared care and explaining the NHS contractors and small business owners was interesting.
00:36:54
Speaker
I hope that this episode reaches a lot of people because I really do feel like it will make a great impact. I also really like the comment made around if we can support more people, it means that they can get back to the quality of life that they want.
00:37:07
Speaker
That in itself was a great statement, I believe. What do you think, Max? Yeah, I think quality of life is why we do the job, really. um i think it's it's funny, isn't it? I do a lot of talks around the evidence base around ADHD treatment, and I think for a long time we focused on does this medication reduce hyperactivity? Does it make your concentration better in lab you know in lab experiments?
00:37:37
Speaker
And there's actually relatively little about the impact of different treatments and management and management strategies on quality of life. It's something that's missing. um And we certainly know about the quality of life in ADHD untreated and that it's not great. um But but i think I think that's absolutely right. I think it should be more of a focus both for...
00:38:03
Speaker
research but also as a target for you know as as as a target for commissioning you should be demonstrating quality of life um improvements although that is a difficult thing to actually it's quite a difficult thing to actually demonstrate but but but it we should be trying oh absolutely another thing that was said on on the podcast as well about debunking overdiagnosis at the end that was a really good way to end the podcast i feel but it's also very true because i know myself from sort of seeing social media, or even to having conversations with people about over diagnosis and ADHD and actually debunking that from my own lived experience, let alone it come from from this podcast as well was was actually really impactful.
00:38:45
Speaker
I think it's a really important way. And I think we should keep hammering at home. i think it's really kind of disgraceful, the seniority of figures, and I'm not going to name anyone specifically,
00:39:01
Speaker
who have been peddling the and the overdiagnosis myth. um i I think we know categorically that there is no systematic overdiagnosis in the UK. So the number of diagnoses made in the UK is not excessive. Now, are there particular individuals who may benefit from a different diagnosis and who've got an ADHD diagnosis? Yes, that will always happen. Equally, there are lots of individuals who have a different diagnosis who would benefit more from an ADHD diagnosis. Guess what, guys? That's medicine. that's
00:39:39
Speaker
You don't always get it right all the time. um you know The same is true of any medical condition. There are people who ought to have a diagnosis who don't and who have a diagnosis who perhaps would be better off being thought about in a different way.
00:39:55
Speaker
I don't understand why ADHD is the one condition where this is frontnet front page news, where it is literally something that happens in the whole of medicine. Definitely. And it's that, you know, there's this over diagnosis conversation, but it's because we've been under diagnosed and underrepresented for so long that now it's coming to the surface. really believe that.
00:40:16
Speaker
it It comes from, i think it comes part, it's really interesting to know why it is that the over-diagnosis myth has become so easy, you know, how why the media and the political class have been so susceptible to it. And I think it's a rapid rise. I think it's quite bound up with identity. And I think there's a bit of a backlash against identity.
00:40:40
Speaker
Generally people identifying themselves, partly to do with gender and, and, and as well that related to that um don't get me onto that um because then from down again anyway um uh but but i and i think it's also to do with a sort of um because it's a behavior it's a behavioral slash mental health thing there's a little bit of of um kind of residual just buck up just pull you just you know pull put Pull your socks up.
00:41:11
Speaker
I was trying to think of what i should people should be pulling up, and with all sorts of very unfortunate things that i didn't say. My goodness me, that was a close-run thing. Pull your socks up. um There's a bit of that attitude still around there in the media. Pull your socks down.
00:41:28
Speaker
Put your socks up. You know that phrase. It's a phrase. It's a thing. yeah Thank you. It's me. right, fine. um That's the thing you should pull up. Nothing else. um
00:41:40
Speaker
um So, ah yeah. Did that answer your question as well as well as make you laugh in a way that's going to make it difficult for you to to continue this discussion? No, it's actually... Oh, it's quite funny. No, I totally agree. And ah sometimes I think as well, with something that's not physical, if it's hidden, like hidden disability, for example, just because you can't see it doesn't mean it's not there. And it's it's very much...
00:42:08
Speaker
been the case and it and it's why I think a lot of the time these sort myths do do happen is because it's not physically visible but you know it doesn't mean like I say that it's not there and it doesn't it mean that you know we when we have these conversations like the one that we've had in this you had in this podcast and the one we're having right now it it really does make the invisible visible but we have so much more work to do still Yeah, and i but i think I think the fact that it's an invisible disability or invisible difference is important because it makes it easier for the misdiagnosis, the overdiagnosis myth to to sort of take root.
00:42:45
Speaker
And also there is there is a greyness about, there is a fuzziness around the edges of the diagnosis. There's no question about that. um As there are in a lot of medical diagnoses. In fact, most medical diagnoses have no clear cut off.
00:42:59
Speaker
um or if there is a clear cut off, it's arbitrarily defined by doctors. So, you know, fine. Yes, there's a fuzziness there, but big deal. that that That's meds. Again, that's meds.
00:43:11
Speaker
And this is the thing as well, where there's comorbidities involved as well. So two things can be true at the same time. very much know that, like an ADHD, for example, when there's when there's two... I don't want to say the word conditions is kind of don't like the word conditions, but difference, you know, that that's another thing, that's another layer as well. And how it impacts an individual's life can be completely different from how it impacts and another individual's life because of different factors. So there is a lot of things to think about.
00:43:39
Speaker
Yeah, and I think what Mark, I think Mark's got a very good understanding ah ah of all of that and and and a sort of understanding a kind of quite a wide view at least in in theory of of of of individuals i think the difficulty that the these providers have is that they're paid to do one thing which is done which is diagnose adhd and there's lots of other stuff they could be doing with patients but that is the thing that they're paid to do so there's always this tension of yes you want to be holistic you want to treat the whole person but actually what you're being paid to do is to treat and diagnose one condition so so that that's something that i think he he did a very good job of kind of
00:44:18
Speaker
thinking through ah in the interview but it is something that I think about um because ultimately we all want to be treated as an individual but at the same time the most efficient thing for the health service is to essentially have a kind of conveyor belt of diagnosis and treatment there is that tension and I don't think you can make it go away 100% um eighty percent and it's as well when when you've got and when you're going through the shared care process you know look like i think was mentioned the The budget around accessing medication for those that that want to take the medication route can be extortionate. And you know getting that shared care access is really important to so many.
00:44:59
Speaker
Yeah, no. Well, I think we could have a whole episode about shared care. um I don't know who we would interview. um But yes, that may be something that we haven't got time to get into today. know a few guys, to be honest. We'll go offline and see if we can get that. But I think the whole thing about shared care is, ah yeah, it's ah it's ah it's ah it's a big mess.
00:45:23
Speaker
um Yeah. Yeah. All right. Well, um Jamie's still here. um yes been listening in you've been taking notes don't what you've been writing down I'm dodling digitally doodling doodling we're very much approve of doodling i'm i am um cru the thing I crusade about is that children should be allowed to doodle 100% essential that they ah be allowed to doodle but that put that on a t-shirt um great so um anyway like any any last words from anyone before we wrap up today's episode
00:45:59
Speaker
I just thought the the podcast was brilliant. I really did. um I'm really looking forward to listening to it. Jamie, of course, has not listened to you yet. That is a very good point, Jamie. Why would I allow yourself to jump into that? That would be great. I'm sure it's great, though. I'm sure it's great.
00:46:23
Speaker
I can't wait. I can't wait. I think we're just going to knock this one in the head. We will come back as ah the smooth and professional team that we are now, well-oiled machine. But for now, from me, Max Davey. Jimmy Gordon.
00:46:42
Speaker
Yeah. Goodbye.