Ok. Here’s the gig. Rich and I (and others I know) are genuinely puzzled/baffled at the mo. This is a bit of a lengthy post but worth a careful read. If you have time, I’d also recommend reading today’s #107days post where Sally Donavon talks about related issues. The question is at the end and it would be great if professionals could try to set aside their bureaucratic goggles and think about this in purely human terms.
First, a summary of issues and actions:
- Abuse at Winterbourne View exposed in 2011. Action: fancy (concordat) talk, no real action
- In Oxfordshire, learning disability services provided by Sloven, jointly commissioned by the Clinical Commissioning Group (CCG) and Local Authority (LA), are known to be poor since 2011. Action: ineffectual meithering, cosying down together
- LB drowned unsupervised in the bath. Action: (attempted) carpet sweeping
- Independent report by Verita concludes there was opportunity and knowledge to prevent LB’s death. Action: unclear
- Three failed CQC inspections in Oxon. Cherry picking lowlights; denial of basic healthcare standards, patients forced to shower without shower curtains and use a mobile toilet in staff view; illegal deprivations of liberty; lack of basic staff training/therapeutic environment/hygiene/battery in defibrillator/record keeping; out of date medication and oxygen; inadequate staffing levels; inadequate (dangerous) premises. Action: enforcement warnings
- Monitor investigate and find various potential breaches of Slovens licence including due diligence around their takeover of the Ridgeway Partnership in November 2012, knowing there were issues and not addressing them. Action: enforcement action
Now I ain’t no rocket scientist but it seems pretty obvious to me that 2. and 6. directly contributed to LB’s death and I’m not sure how the Sloves can repair this breach in due diligence eighteen months on. It also seems glaringly obvious that there’s no proportionate relationship between what happened and what’s been done in the 10 months since LB died.
Yesterday, Sloven Chief Exec (of the Year/Health Services Journal (HSJ) inspirational leader), Katrina Percy, spoke on local television/radio. She seems to have swallowed a brand new chapter from the Sloven jargon manual (probably inspired by Bill Mumford’s new involvement in sorting out Oxon provision) which focuses on a shift to community based services. The problem (now), other than the ‘buildings’ (?), is that ‘the right staff’ are working ‘in the wrong place’ (inpatient rather than community settings). Worryingly, the new line seems to be that all problems will be solved by shutting the units and ditching the patients in the community where staff, who couldn’t give a fuck before, will transform into engaged, informed, motivated and caring workers.
Her response to 2-6 above is; ‘it’s not about [staff] neglecting patients but about not operating in the most modern way that they need to‘. Eh? Oh my giddy aunt. Not neglect? The most modern way?? What definition of ‘inspirational’ were you using at HSJ Towers??
She insists she wants to listen to the people of Oxon (cue Dambusters again) and hear what they have to say about services…
Climbing back down from the glitzy and glamorous world of awards and inspirational leadership, and sidestepping the whole modern/neglect thorny issue, here’s a tiny glimpse of current life for a few dudes/families in Oxfordshire:
- One of LB’s classmates has been living outside of Oxfordshire for over two years since he was sectioned at the age of 15. His parents travel to see him every other weekend in Newcastle.
- A second classmate’s first ‘adult/transition’ appointment with the Sloves a month or so ago was so poorly handled/ill prepared for by a Sloven psychiatrist (who was involved with LB) that his family made an official complaint.
- The family of a third young man who died in August 2012 have not been given a copy of the Sloven internal investigation into his death. Allegedly it would be too distressing. The inquest into his death has been delayed to allow more evidence to be gathered.
So, what we’d like to genuinely ask the Slovens, the CCG, the local authority, the CQC, NHS England, the Department of Health, Monitor (anyone really) is:
Given 1-6 above, can someone tell us clearly and precisely what would have to happen within health and social care provision to generate a response that is proportionate, swift and meaningful?
It not the full answer ,but teaching diversity to every school child , would be a small , but good long term idea. Professionals who work within the community should have to pass ( with distinction ) an exam in diversity , Learning to respect a person first ,then their condition / situation. a close second Bitchiness in a caring work environment should be an instant sackable offence. On going training for staff,at all levels.is a must.
I agree, as you say it’s only part of the answer, but vitally important I think.
“They” will carry on because they have “Judicial Discretion”, so all the criticism in the world is not going to shake them. The more flack they get the more it reinforces their position. The answer is legal enforcement and a punishment, a limitless fine or imprisonment similar to the HSE for corporate manslaughter and they must be in their position to serve us. It will take a continued relentless struggle to achieve this but we can do it and it will be worth it in the end so don’t vote for any political party that doesn’t agree to these terms.(They are the head of the snake)
I have seen truly good and person-centred care. Admittedly not in an “assessment centre”, but for adults with very complex needs, including profound multiple learning difficulties + complex medical conditions (including poorly controlled epilepsy). The sticking point? It didn’t come cheap. We were told that the care package for my brother was “the most expensive in the county”. Well, maybe, but it was also the package that met his needs (nearly). We and his (small, charitable) service provider were very picky about who cared for him. There are quite a few “carers” and “nurses” out there who care more about an easy life than providing the care that is needed. But there are people, if you look for them, who are wonderful and prepared to go the extra mile to make a difference. They exist, and if they are nurtured in an environment where person-centred care and respect is the norm, then those attitudes flourish. Of course, the opposite is true – put one of these people in an environment where staff aren’t supported, where people’s dignity isn’t respected, and where even basic safety isn’t maintained, and they will struggle to provide good care. The environment and culture matter.
I don’t know how you fix a broken culture. But you have to start by recognising that it’s broken, and that “lowest common denominator” funding usually results in “lowest common denominator” quality.
Sadly, I agree with Sue. There are countless individuals who work at the coal face, with ever reducing budgets. Flagging up concerns and quality issues on a daily basis. You get what you pay for and it’s depressing but I believe that the public sector is terminally ill. My colleagues are committed, and work long hours often in their own time to make sure people as as safe as possible. Until more resources are allocated the situation will get worse.
There seems to be a plentiful supply of ‘managers’ prepared to sell their souls to the devil rather than speak out and reject inadequate services. It sometimes feel like a battle everyday.
Ive written about Martin before hehas a complex epilepsy Lennox Gastaut syndrome. He is now 38. When he was 20 he and his mates and the parents decided tomove from the lovely boarding school for young people with epilepsy to the NSE Chalfont St. Peter this was 1996. Martin travelled alone by train to our home in Solihull. By 2000 the NSE had lost so much money they ceased to function and Martin moved to Croydon. In 2003 Croydon home gave him notice, and he was moved to a god forsaken village in Kent. Then back to the NSE Chalfont in 2003 (illegally sectioned at this time), then in 2006 taken to the Court of Protection and moved to a Ridgway Trust psychiatric unit in Aylesbury, and from there to a mental health unit in Cardiff under a Court Order of June 2008. Another order 2011 said he had to remain there. Owing to these orders he has not been assessed for capacity since 2007. The Court appointed a visitor who saw him yesterday to assess his capacity. I will be 80 this year, I had a hip replacement in 2009, then a brokenwrist and then a broken shoulder. The doctor who assessed Martin yesterday asked him WHY HIS MOTHER COULDNT TRAVEL TO VISIT HIM. This is where I cried. He is only allowed home for one afternoon every six weeks, and the carer isn’t allowed to talk to me about Martin. Fees for the home in Cardiff £2,400 a week.
It is shocking to hear of people being treated like parcels. How can anyone create a home and friendships if they are moved about the country? How can families and friends maintain links with their loved ones? Too much rhetoric and not enough genuine commitment to supporting people in their lives. And money pours into to the system to be spent on what?
I have worked in the field of mental health for over 30 years and things are getting worse IMO.
This made me cry too Shirley. How awful for you and Martin over such a long period of time. It’s barbaric and graphically illustrates the complete disregard ‘professionals’ have. Deeply, deeply distressing. Though more fuel for the fight. This is simply unacceptable. x
What IS this not allowed to talk to a parent? Where does that come from?
As an able-bodied adult with full capacity I would have the right to say I did not want information passed to my family. But who is deciding that that part of adulthood applies, but so many others can be ignored? This has never happened to me – but I would be beside myself if it was.
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Martin’s brothers e mail to SS March 2013.” Iam not at all happy with the review notes, actually I am rather shocked. I find nearly everything in the review is not for Martin but against him.Furthermore I hope that during our telephone conversation it came through that Martin needs people around him who are helping him and not against him”