Mouth one way, belly ‘nother way


Old Australian Aboriginal description of a hypocrite:

Mouth one way, belly ‘nother way.

SH Notice2




Which brings us to a sign spotted at Southern Health NHS Foundation Trust’s HQ recently.







This from a Trust:

  • Whose Chair is accused of intimidating a patient’s representative at a Council of Governors meeting to the extent that the patient felt too intimidated to stay to ask an important question relating to his ‘care’. Read more→
  • Whose CEO is accused inter alia, of damaging patients’ health and discrimination under section 1 of the Disability Discrimination Act 1995 (as amended).

SH Notice1


How can Southern Health staff be expected change the way they think and act about mental health if their Chair and CEO set such a great example!


Dormitory Wards


Another of Southern Health’s dark secrets was revealed recently. It is 14th in a list of English mental health Trusts with highest number of dormitory wards and beds. Details→¹

Lunatic Asylums come to mind!


And, in respect of out of area placements (“OAPs”), where families have to travel afar to visit their loved ones, Southern Health NHS Foundation Trust was exposed recently as 7th on the list of mental health Trust having the highest number of inappropriate OAP’s². Whilst these are ‘inappropriate’, the definition of an OAP is:

“The patient is being admitted to an inpatient unit with another provider.”  

This reflects the fact that, whereas inappropriate OAPs affect patients and their families, all OAPs have financial implications. Southern Health admitted: 

“The £1.1m deficit remains broadly the same as the previous month and
continues to be attributed mainly to out of area placements.”

It appears that Southern Health is massaging OAP figures by excluding contracted beds with Solent NHS Trust (6) and The Priory Southampton (10) from OAP figures because, “These beds are within our catchment area…” What part of HM Government’s ‘Out of area placements decision tree‘ does Southern Health directors not understand.

Whilst it is great for patents and families to have OAPs within Southern Health’s catchment area (especially those lucky enough to be admitted to The Priory), the affect on the Trust’s deficit remains. 

To adapt a well-known adage attributed to Benjamin Disraeli, in our opinion:

“Southern Health is an organised hypocrisy.”

And, for balance, patients can be guilty of hypocrisy too. I suspect the person who returned £250.00+ of medication to a local pharmacist claims the NHS is underfunded.

Wasted Scrips


In 2017-18, there were 11,619 community pharmacists in England.³

11, 619 x £250 = £2.9 million 



And that’s just one patient at one pharmacy. Apparently, a significant percentage arises from patients’ ticking every box on a Repeat Prescription form rather than tick just the items they need – and GPs do not cross-check diligently

A report by the Department of Health estimates that unused medicines cost the NHS around £300 million every year, with an estimated £110 million worth of medicine returned to pharmacies, £90 million worth of unused prescriptions being stored in homes and £50 million worth of medicines disposed of by Care Homes. 


¹ Source: Health Service Journal

² An inappropriate OAP: when a patient is treated out of their local area. [Media Office, NHS England and NHS Improvement – 26 June 2019]


Bored Meetings & Peter Drucker

Failed BusinessCRASH sat recently through two interminable Southern Health NHS Foundation Trust meetings – a Board Meeting on 14 May and a Council of Governors Meeting (“CoG”) on 28 May 2019: meetings which previously took place on the same day of the month. Result?

  • Fewer governors attend Board Meetings to judge how Non-executive Directors hold Executive Directors to account: that’s the Governors’ job! Just one there on 14 May.
  • Fewer members of the public attend both meetings to pose challenging questions.

This was entirely predictable: many governors and members of the public have full time jobs and other commitments. Most find it easier to dedicate one day a month to Southern Health rather than two three-quarter days (including travelling).

Also, details of the CoG were not published until it was too late to file advanced questions so only two members of the public attended. Even some staff at Trust HQ did not know about it until the day of the meeting.”



CRASH was one member of the public present at the CoG: the other (mentally unwell person) with a question to ask at the end, left half-way through feeling intimidated by the Chairman of Governors attempt to intimidate CRASH.

Naturally, the Lead Governor kept shtum, doing nothing to ‘protect’ the public.



The Japanese MD, Nagatomo-san, who pulled CRASH up the slippery ladder at Kawasaki without  much resistance!), was a disciple of legendary business guru Peter Drucker. Four of us got one of his books for Christmas – not an easy read so we can’t recall much!  A bottle of Faustino I Gran Reserva Rioja would have been preferred.

However, coincidentally last week, we came across a quote attributed to Drucker:

“Culture eats strategy for breakfast.”

Also the words were used and embellished in an article about the NHS in ‘The Journal of the Royal Society for Medicine’ headlined “Understanding organizational culture in reforming the National Health Service: it includes (amongst other robust statements) the following comment by a US hospital CEO about culture needed to transform the NHS:

“Culture eats strategy for breakfast, every day, every time”

The whole article by Prof. Huw T. O. Davies BA MA MSc PhD Hon MFPHM¹, published in November 2001, is compelling reading for those attempting to transform NHS Trusts. Read more here→

Yet Southern Health’s motto appears to be:

‘Strategies eat culture for breakfast, every day, every time.’

CRASH’s peers share our cynicism and came up with further variations :

“Strategies eat culture for breakfast meetings, every day, every time.” 

“Meetings eat everything, every day, every time.” 

Or (unrelated):

“We exist to talk about stuff, not to really do anything.”

To test the theory, CRASH carried out a word count on the papers of a random Southern Health Board Meeting using the search facility:

Strategy 61 plus strategies 5 = 66.

Culture 11 (no plural) plus cultural 2 = 13.

If  one analyses (or drills down as the NHS prefers to say) the results for culture, the figures are even more enlightening. Of the 13:

  •  3 are attributed to guests at the meeting.
  •  6 appear in the Trust’s risk assessments – because, “There is a risk that we fail to develop and maintain a culture….” or similar.
  • Only 4 are attributed to comments by Directors.

Most telling is this extract from the papers:

The Trust has liaised with other Trusts who have successfully implemented violence reduction initiatives and found that: setting targets for reduction does not work and promotes under reporting of incidents initiatives not supported by a quality improvement methodology will not be sustained in the long term as they do not embed and support cultural change.

This may seem a bit like gobbledegook but, if our interpretation is correct, it is somewhat bizarre that Southern Health, an organisation trying to introduce Total Quality Management, seems more interested in strategies than culture.

Low angle view of cricket umpire signalling six runs against blue sky


One could say of Southern Health NHS Foundation Trust:

“Strategy hits culture for six every day, every time




Southern Health claims to be improving community services yet the Basingstoke ‘Gazette‘ reports that it is scrapping the majority of drop-in clinics in Basingstoke for young Mums and babies!” Read more here→


We all know that babies are at the most vulnerable stage of their lives – so scrapping the majority of drop-in clinics really is a great idea, Nick, especially when the Trust  website and notepaper bear a logo claiming to put, “Patients & people first.” And the ‘Our Vision and Values‘ page of the website claims it as a core values.



A decision made by bean counters? Surely not.



Which gives us a great opportunity to close by paraphrasing Drucker again.



“Money eats patients for breakfast, every day, every time”



Back in the 1970/80s, little did we know that Drucker would be so useful 40 years’ later!When will Southern Health NHS Foundation Trust transform its culture?


¹ Honorary Member, Faculty of Public Health Medicine