Another weird week (ending 19 March) in the ‘not-so independent’ Public Investigation into Southern Health NHS Foundation Trust: a complete absence of service user/family/carer witnesses and no robust challenges by Panel Members.
Terms of Reference (“TORs”):
Before asking questions, ‘independent’ Panel Member, Dr Durkin asserted that the Panel’s role was to look at the current and future – not the past. This is an alarming departure from the TORs, which state that the Panel would consider:
“The extent to which the Trust has implemented recommendations from previous reviews and investigations and where further improvements can be made.”
“The supervision structure that has been in place since 2011 by the Clinical
Commissioning Group [“WHCCG”] … and how it has been exercised towards the Trust in relation to complaints and investigations, and of any planned changes in the light of public concerns.”
The key previous inquiry was the Mazars Review [January 2016]. Dr Durkin, did you not notice that 2011 and 2016 are not the current or the future! Could your refusal to address the past relate to your role as NHS National Director of Patient Safety [2012- 2017]? Surely not!
There are countless adages on this subject too – from the 14th to the 21st century:
“The past resembles gthe future more than one drop of water resembles another.” Ibn Khaldun [1332-1406].
“In order to plan your future wisely, it is necessary that you understand and appreciate your past.” Jo Coudert [1923-2015].
Employed by WHCCG since 2011 so ideal for the Panel to question about the supervision structure in place since 2011 as per the TORs. They failed to do so after Dr Durkin’s intervention.
She made several questionable claims: for example the Trust engaging more with families and service users; an improvement plan in place since 2016; and that the Trust had acheived its targets on care plan standards. No doubt unwittingly, she identified the difference between policies/plans and outcomes. She went on to say that 80% of carers didn’t know about care plans and others didn’t think they were worth the paper they are written on – yet the Trust is allegedly meeting its targets!
She had never seen some reports; could not answer key questions; and has no data to show discharge planning from secondary care had improved – she just ‘believed’ it. CRASH’s Freedom of Information Requests suggest that s.117 after-care¹ is a shambles.
She admitted that Southern Health is not as good as other Trusts on communicating with patients, families and carers, “Until you find the right people, which is difficult.”
Steven Hales, Deputy Chair/Lay Member Working in Partnership Committee (“WIP“)
Mr Pascoe started by emphasising that the Panel was especially interested in improvements in the last year, i.e. forget the TORs again!
Steven made some surprising assertions, which were at best exaggerated and at worst inconsistent with reality, for example about service user/family/carer involvement.
He engaged in his fair share of service user/family/carer blame, claiming that some complainants will never be satisfied and the priority should be how complainants are dealt with now. Again, forget the past! He claimed it was a communication problem to reach out to those who really hurt to convince them that things are different. He talked of advertising, public relations and leaflets. This is pure spin.
The answer is easy. TALK TO THOSE WHO HURT (the Trust has contact details) and remember, THE CUSTOMERS IS ALWAYS RIGHT.
Most customers, who are now hurting, could have been satisfied if the post-2017 regime had not brought to an end co-operation with the Forum for Justice and Accountability at Southern Health (“the Forum”) and later with the breaved family group (set up by Alan Yates as Interim Chair). Initially, we were consulted and decribed as ‘critical friends’ of the Trust.
Indeed the Pascoe Investigation might have been avoided if, after Alan Yates left, the new regime had not brutally ended co-operation with the bereaved family group and ‘kicked the Forum into touch’. Could this be because the Chair and both CEOs are fearful of the members’ combined expertise and their robustness in challenging the Board. Surely not!
Notably, Stephen said one governor normally attends WIP meetings. ONLY ONE?
He claimed Southern Health is not the same as it used to be and that it is safer now. He would not hesitate to refer his friends and families to the Trust. All talk and no evidence.
Amelia Abbott, Carers Strategy Project Officer/Triangle of Care Project Lead
Joining 9 months ago, Amelia made a refreshing change – a Southern Health official with genuine enthusiasm for her role; keen to make improvements; and with an impressive grasp of the Triangle of Care (“TOC”).
She was unafraid to expose the Trust’s continuing shortcomings. For example, the Forum have been recommending the TOC since 2016, and despite the Trust’s deadly failings in family liason exposed at two Inquests just 3 months apart, Amelia admitted that the Trust hasn’t achieved Stage 1 accreditation 5 years later. The Forum could make significant contributions to assist – if only we were allowed to do so. For example:
We contacted the two experts named by the Trust, Prof. Dimash Bhugra and Prof. Sir Simon Wessely. They agreed that section 98 of the IMHA could be used in UK as ‘best practice’ without changing UK law:
“S.98 (1): When a PMI² is discharged into the community or to a different mental health unit or a new psychiatrist takes over, the existing psychiatrist must consult the PMI, the nominated representative and the relevant family member or carer. (2): The existing psychiatrist will, in consultation with the persons referred to in s.98(1), ensure a plan is developed as to how treatment of services are to be provided.”
We also found useful guidance in the World Health Organisation Rule Book.
Simples! TOC and Care Planning improved in one go – if the policy is strictly applied. Yet has this been implemented? We doubt it – we continue to see failings in care when inpatients are discharged or transferred between hospitals and/or Consultants.
Amelia made useful observations on TOC training. At first, she saw an average of only 6 staff on courses but this is increasing: her next course is full. Even more enlightening (if unsurprising) is that she typically saw nurses and allied health professionals – but only occasionally Consultants and doctors. She agreed that better data is needed on this.
Beth Ford, Service User Involvement Facilitator
Beth is to be commended for disclosing her autism and mental ill-health but, having asserted that the Panel (as a result of her autism) would only hear the truth, she made two seriously misleading statements, perhaps unwittingly.
- She claimed there were no Out-of-Area Placements. If this were true, why would Southern Health invest £3.3m on two new mental health wards with a total bed capacity of 28. The target opening date is Summer 2021. One ward is specifically to “Provide mental health support to women in a bid to prevent the need for treatment outside Hampshire.” Marchood Priory is still receiving NHS-funded patients too.
- She denied that the Trust is responsible for 111 services – a half-truth: Dr Broughton set up a specialist 111 team manned by Southern Health staff but based at the 111 call centre. We know this after supporting a service user in a complaint about 111.
She made a number of other dubious assertions. For example:
- To talk with as many service users, carers, families as possible to gather feedback.
- Before 2019 (when she joined) she would not be treated by the Trust. Now she would. To misquote Mandy Rice-Davies, “Well, she would say that, wouldn’t she?”
- There has been a major culture shift at Southern Health since she joined.
However, most alarming revelation was the description of her day-to-day activities. She alleged to have: all-points access to Trust units; unsupervised access to patients and their records; free reign to upbraid Southern Health’s clinical staff and others; and authority to resolve complaints on the spot. She also claims to barge into Directors’ offices on a whim and admits to occasional use of inappropriate language in doing so.
Beth – ‘Robo Cop‘ of Southern Health?
However, the NHS includes as common signs of autism – finding it hard to understand what others are thinking or feeling and seeming blunt, rude or not interested in others without meaning to.
Indeed, we believe there are serious risks in an autistic person carrying out this role unsupervised – including a risk to the person doing so. Indeed, is this not a role for Board and Divisional Directors?
Two observers could not believe their ears – despite their combined business experience, including Quality Improvement, they had never seen such a bizarre management structure.
Even allowing for her disability, if Southern Health’s Board truly believes this attitude and modus operandi will encourage service users, families, carers and staff to speak up truthfully, they are sadly mistaken – living in Cloud Cuckoo Land one might say!³
Again, all Beth’s evidence related to the alleged improvements since 2019. She did say, without a hint of irony, that she felt some NHS staff were intimidating people! She made other interesting points, which require further research, relating for example to complaints handling, use of generic email addresses and unpaid service user volunteers.
Two ex-Public Governors summed up Southern Health’s management structure succinctly.
“All the plans are bolt-ons – find a problem and form another committee with little oversight. You can’t buy a Land Rover and turn it into a F1 racng car by buying and bolting on extras.”🙁
“I’m getting the hang of their modus operandi. Let one CEO move on, and blame him for everything if convenient! (They didn’t seem as bold to blame that woman [Katrina Pecy] when she led the Trust!) I’m quite perturbed at Lynne, because [redacted for legal reasons]. I believe a lot is being done to undo the good work of public involvement and holding to account during these Covid times. I would not be surprised that there will be lots of scandals afterwards.” 🙁
In short, transformation of Southern Health is a long, long and very dusty ol’ road.
With apologies to Jerry Jeff Walker
¹ Section 117 of The Mental Health Act 1983 (as amended) makes Local Authority Social Services and CCGs entirely responsible for aftercare.
² PMI – patient with mental illness.
³ Cloud Cuckoo Land: a state of absurdly over-optimistic fantasy. As in, “Anyone who believes that these plans will be effective is living in cloud cuckoo land”.