Received a response from Simon Waugh (SW), Board Chair, Sloven Health this afternoon. That it came by email is about the best thing I can say about it. Selectively copied in to the cc list (bypassing Katie Razzall, Newsnight and JusticeforLB headquarters).

Brief context: We had questions, Katrina Percy refused to answer them, SW answered them Sept 17 2014. In a really crap way. In such a crap way I arranged to talk with him on the phone (23.9) convinced he wasn’t really up to speed with what was happening under his watch.

The big conversation back in September? A mistake really other than the occasional droplet of insight. We’ve continually shot ourselves in the foot and made ourselves look as incompetent and uncaring as possible. Er, yep. The truth is simple. His care was not what it should have been. Yep. SW also said he’d learned to reflect about being on the receiving end of letters from him in his capacity as Board Chair and think about what it must be like to receive such a letter (does it help or does it widen the gap?). Good stuff. (Though this was in connection with sending my sis a letter meant for another patient, rather than real reflective stuff about the content and meaning of what you write).

Unfortunately, these drops were obliterated by a drill hammer communication style, clearly aided by a set of key points) that looped across the two hour conversation (LB was fab, fit and able, staff forgot he was a patient, Sloven appear crap (but ain’t really) and there are valid excuses (or cliches) for everything). Once the repetition became apparent, it was a really uncomfortable conversation.

A couple of examples of the excuses:

Sloven didn’t dive into the unit to see that the hell was going on when a “fab, fit and able” young man died unexpectedly in the bath [he died?] because the police told them not to. Mmm. Not sure about that SW. How come the CQC could just pitch up and inspect weeks later?

“Well you’re damned if you and damned if you don’t”, was the slightly tetchy non answer. Followed up by a seedy little attempt to lay the beyond appalling CQC failings as having occurred in the six weeks or so after LB died. That pesky cleaner walked out 10 days before the inspection… [at several points during this conversation I wondered if I would experience long term effects from the sickening rage it generated.]

The second example involves the other patients in STATT. SW wrote that “unfortunately” STATT patients were unable to attend LB’s funeral because of “the family’s understandable restrictions on staff attending”. Not true, I said. I explained how we wanted staff not directly related to LB’s care to bring them. Bluster bluster.. SW meant the other patients’ families thought their relatives weren’t in the right mental state to attend. Oh. Why didn’t you write that then? I asked. Puff, huff and puffenstuffen, Dr Ryan. He couldn’t possibly include every line he wanted to include in the letter. It would be impossible.

Another damned if you do and damned if you don’t situ. Clearly.

So, back to today. The emailed reply. First of all he attached the letter sent on Sept 17th for the partial cc list to read. The fudged and fake responses letter. That is pretty crap. He reiterated the fact we’ve refused to meet across two paragraphs. Yep. With regard to staff disciplinary actions apparently the final one is part-heard and will be completed shortly. Mmm. (17 Sept letter “The final hearings for the remaining investigations are scheduled to be completed in the coming weeks”. 23 Sept phone call, staff disciplines will be completed “in the next 2/3 weeks”.)  There have been no delays with the second Verita investigation and the incredibly insensitively timed email, sent on 23rd December, wasn’t sent by the Trust’s solicitor. Even though it, er, was.

Wow. Mr Waugh. That stuff about reflecting on letters sent, foot shooting and incompetence (or worse)… ? You got a bit of a waugh to go, I’m afraid.

In addition to the delay I banged on about in the previous post, I found out from NHS England this week that Sloven staff disciplinary processes are continuing. In Sloven time. On the midnight train to never never land. I’ve had this conversation several times now. It sort of sits at a junction between Tedious as fuck and Off the scale of outrageous. With a backdrop of Howl mountain.

‘What can we do?’ I asked the bearer of no news. Gnawing on the handset.
‘Nothing really’, was the answer.
‘There must be someone we can contact to say ‘This delay is unacceptable for everyone, can you do something about it?”
‘Not anymore, the only person really is the Board Chair’.

A heartsink statement given my 2 hour conversation with ‘Mr In Denial’/’Mr Kept in the Dark’ (sadly not ‘Mr Know it all’) a few months ago.  Anyway. I sucked it up, fired off a letter with the keyboard smoking, and copied it to pretty much the whole world in his hands. Including Jezza, Norm, Si, Davie B and KP too.

I was chatting to Little Sis Sam earlier and she said how outrageous it was that we’re having to do this. Yep. And how awful it must be for families who haven’t been able to meet with the various people we have. Yep. Bit of a double edged sword really, she said.

More triple edged really. If that’s possible.

1. We shouldn’t have to do it.
2. It stinks that some families have more traction than others in trying to get accountability.
3. What has actually happened?

Those wagons are firmly circled.

As the old growler sang;

Mud can make you prisoner
And the plains can bake you dry
Snow can burn your eyes
But only people make you cry…

Found out earlier the disciplinary process for the staff member we referred is delayed. Again. An extension has been granted for additional time to read through records. We referred this person in May 2013.

“I’m not being funny”, I said, on the phone, “But all this delay stuff is always on the part of the system; the Department of Health, the NHS, the CCG, the local authority. And it impacts on families who are utterly devastated. Crushed by the process. And who have nothing to answer to. We’re 20 months on from LB’s death and no accountability. Just waiting. On wait.”

How can this possibly be?

No real answer. Though very apologetic engagement.

On the bus home I read this tweet. And again my brain screamed there’s simply no excuse to delay any part of the process of accountability. It’s the absolute minimum that should be done when you’ve got something so catastrophically wrong. I can’t describe the additional pain generated as weeks, months and years go past and fuck all happens.

This established practice of embedded, accepted and unremarked upon (by those with any sniff of  power) delay needs stamping out. It’s simply inhumane.

When LB was in the unit there was a patient (one of five) who didn’t look brilliant. I only saw him/her dressed once. Most of the time we visited s/he was in a dressing gown and didn’t seem to go out much. S/he had a bit of a wry sense of humour and chatted away, like really chatted away. A bit like LB really.

I read months later that a patient died of cancer days after LB died. Eh? What? How could someone so close to the end of their life through terminal illness be in a secure unit days before their death [howl]. And why was this discussed in a document reflecting on the additional distress her/his death caused staff. No apparent consideration for other patients. Again.

In the 107 days LB was in the unit, we saw how the inmates (let’s not dress it up) connected with each other and had a sometimes uneasy, occasionally hilarious but a recognisably collective sense of being there. How the three living (remaining?) patients have dealt with the trauma they experienced during that hot, hot July, without specialist support (no post-Winterbourne View/JIP related, apparently gold plated, support here) is unimaginable. Were they able to attend this second funeral if nothing else?

I heard this week, through another dicky bird (the scourge of the candour duty obliterators) that some staff had been concerned about the wellbeing of this patient over some time. [Good]. These concerns were not really listened to. Allegedly, through the whistle blowing process, Sloven have only recently started an internal (that is, chocolate teapot jobby like) investigation into this person’s death. Over a year and a half later.

Wow. If nothing else, the shite that continues to become visible is, er, consistently, shite.

One of our campaign aims was a review into the deaths of all patients in Sloven learning disability and mental health provision since 2011. This was commissioned by David Nicholson last spring.The Death Review got off to a shaky start given nonsense about having Sloven and local CCGs on the expert advisory panel. It looks like this has been resolved but here’s hoping the review gets to the heart of the rotten core. It isn’t about number of deaths but about the response to these deaths. Not only are people denied humanity in life but also in death.

Chilling and unforgivable.