Covid-19

airplane taking off icon

 

Although this blog relates to mental health, Coronavirus (Covid-19) affects us all.

Whilst we profess no medical expertise, there is a wealth of information available. Therefore, we quote reliable sources in an attempt to clarify certain issues. This World Health Organisation chart compares the symptoms of Coronavirus, Cold & Flu.

89791403_10157190557311593_4340322756236148736_nNB: symptoms vary between individuals, so the WHO’s ‘rough guide’ is no substitute for a full examination and diagnosis by a medical professional.

Realities

  1.  Don’t be confused by use of ‘coronavirus’ and ‘COVID-19’. Coronaviruses are a large family of viruses which may cause illness in animals or humans. The most recently discovered coronavirus causes coronavirus disease COVID-19.
  2. Most people who become infected experience mild illness and recover, although it can be more severe for others.
  3. Wash your hands frequently; regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. Read more ‘common sense’ precautions here.

Two people bowing and greeting each other before business meeting4. Most estimates of the incubation period for COVID-19 range from 1-14 days, most commonly around five days.

5. With advisories about personal contact, is the Thai Wai not the most civilised greeting?

 

Myths

  1. Antibiotics work against viruses. NO – they only work on bacterial infections. COVID-19 is caused by a virus, so antibiotics do not work. They should not be used as a means of prevention or treatment of COVID-19.
  2.  COVID-19 is more deadly than SARS. NOSARS was more deadly but much less infectious. There have been no outbreaks of SARS in the world since 2003.
  3. I must wear a facemask. NO if you are not ill or looking after someone who is ill, you are wasting a mask. Disposable face masks can only be used once.
  4. It is simple to use a facemask. NO there are recognised protocols for when to use a facemask; how to put on, use, take off and dispose of masks. Click here for details.

There are more myth-busters here→.

“Don’t panic” [Corporal Jones, Dad’s Army]

We now turn to consequences, which bring out the worst in human behaviour.

blue-3

 

At a supermarket yesterday, we thought W.W. III had started!  And there is no logic to the items being stock-piled. Vast empty shelves for loo-rolls (despite diarrhoea being only a rare symptom) but plentiful tissues (critical to safeguarding others from getting sick) .

 

 

20314344 - dog with a bag of cold water on his head

 

Golden Labrador pups must be having a world of fun in some households until they get sick. (Other brands are available!) 

 

 

“The pits of the world! Vultures! Trash!” [John Mcenroe]

We have seen women flighting over loo-rolls in a Sydney supermarket but here are two true stories of people in UK, who really are ‘reaching for the bottom’ [pun intended].

Smiling male doctor and nurse with guns isolated on white

One of our nieces is a senior hospital nurse: visitors/patients are stealing full hand-gel dispensers .

She talks of having an armed-guard when next receiving a delivery.

 

 

Very_Angry_Emoji

Our supermarket has two boxes for customers to gift items to foodbanks and vulnerable people generally. A kind-hearted person left some loo-rolls – only for another customer to nick them!

 

 

Girl Plumb Dirty Toilet

 

NO WORDS – and no punishment – she’d nick the loo-rolls!

 

 

 

¹ There has been one instance of a dog being infected in Hong Kong.

HASC Chickens

“Where are Southern Health’s Chief Executive or the Chair of Governors?”

So asked Cllr David Harrison at a meeting of Hampshire County Council’s Health & Social Care Sub-Committee (“HASC”) on 4 March 2020, when members were asked to not only consider the latest CQC report but also The Pascoe Report.

family portrait poultry chicken, red rooster bright yellow littl

With huge respect to Monty Python – Cleese, Barker & Corbett, “Class System” Skit 1966

The Committee heard deputations about Southern Health NHS Foundation Trust from three members of the public totalling about 25 minutes. The full text of the deputations is available here→.

The only Southern Health employee present during the deputations was Southern Health’s infamous spin doctor, he who acted in an unbecoming and disrespectful manner after the Inquest into the death of Ellie Brabant: BBC South Today report here→.

Readers may have realised already that the CEO, Dr Broughton and Chair, Ms Hunt chickened out. Instead, they sent along a frit Chief Nurse, Paula Hull to ‘face the music’. Her frankly amateurish presentation was in distinct contrast to the re-assuring, confident and professional presentation to HASC by Southampton General Hospital.

It appears Paula is being ‘used’ by the Board for unpleasant jobs – one could have some sympathy for her if it were not for the fact that she would not look any of us in the face!

After Paula’s Report (available here), Cllr Alan Dowden urged members to take action:

“It worries me. We are the select committee and we must do something.” 

Whilst Cllr Mike Thornton stressed that some of the CQC’s ‘must do‘ actions were so obvious that it shouldn’t have needed the CQC to point them out. For example

Biohazard Infectious Waste Safety Sign. Black on orange safety s“Ensure consistency in the disposal of clinical waste in line with policy on handling and disposal of healthcare waste.”

It beggars believe that any hospital does not have consistency in disposing of clinical waste!

 

Others common sense issues in the report, which do not need clinical expertise, include:

  • Ensure all patients have access to a clinical psychologist and psychological therapies.
  • Ensure staff record their decision-making when carrying out mental capacity assessments and ensure staff have a sound understanding of the Mental Capacity Act 2005.
  • Ensure there is a patient alarm system on all older people’s wards, which enables patients and visitors to alert staff to their need for urgent support.
  • Ensure all patients in the crisis service have holistic, person-centred care and a crisis plan in their records. Records must be clear, up-to-date and recorded consistently in the electronic record.
  • Ensure the physical environment of the health-based places of safety are fit for purpose and meet the requirements of the Mental Health Act Code of Practice 8.
  • Ensure the Trust meets its legal obligations in the health-based places of safety.

There was also an important contribution by Cllr Marge Harvey, who has personal experience of unsatisfactory service by Southern Health.

Coincidentally, Health Service Journal reported recently that Simon Stevens might give unearned incentive cash to mental health sector. However, a reader asserts that psychiatry has encouraged ‘mission creep’ of the mental health agenda in a classic example of provider capture and went on to comment:

Before there is any more money, the sector must define what is and is not mental health, how one counts it and how outcomes should be measured. At the moment vast chunks of what is best termed ‘the human condition’ are labelled as MH in the pursuit of various secondary gains. 

Young woman talking with psychologist

Perhaps if Southern Health targeted budgets on psychologists and therapies, it would prevent ‘the human condition’ tipping over to serious mental ill-health. In parallel , it would reduce costs of prescribed drugs; reduce Psychiatrists’ workload; and improve bed availability for those who need it.

 

And finally, one of the ‘should do’ actions prescribed by the CQC is:

  • Ensure there is clear senior oversight of the service, particularly the health-based places of safety.

In the light of these and other ‘must do’ and ‘should do’ actions, it seems bizarre that the CQC rates Southern Health as ‘Good’ in 16 of 18 domains. For example:

  •  How can the ‘safe’ domain be ‘GOOD’ when consistency of clinical waste disposal is  sloppy [pun intended!] and the Trust implicitly is not meeting its legal obligations in health-based places of safety.
  • How can the ‘well-led’ domain be ‘GOOD’ when, aside from the upside-down management structure, there is lack of clear senior oversight of the service, particularly health-based places of safety.

Truly deplorable and unacceptable saga

These are the words of Nigel Pascoe QC in the Pascoe Report on Southern Health NHS Foundation Trust, which is available here→.

Legs of a snowboarder stuck in snow

An upside down, head in the sand snow management structure is illustrated here too.

Our previous post is relevant to the Pascoe Report too. Crucially, Mr Pascoe concludes:

“The long and complex process of the review of this Final Report has brought home to me just how wide the gulf still is between the family members and the Trust. I have sought to express a fair and balanced independent view, whilst continuing to receive sharply opposed submissions. The reality is that deep distrust remains. It is no part of this Report to assess the degree of reputational damage that this Trust has sustained by their actions and failures towards these families. But I retain the hope that an independent limited Public Investigation at least has the potential to change the narrative of a very troubled story.”

In short, Mr Pascoe recommends a two-stage Public Investigation – the first into the death of one patient and the second effectively an investigation into the Trust’s current performance in limited respects. 

Unfortunately, it appears Southern Health’s CEO, Dr Nick Broughton still does not get it (or does not want to get it). He continues to offend bereaved families by implying that, as these are historical cases, he bears no responsibility for the anxiety and stress caused, i.e. a ‘not me guv’ approach.

This was demonstrated when, at the instigation of a bereaved mother, the Portsmouth News changed its article on the Pascoe Report to add to the mother’s comments. 

“Dr Broughton had a real opportunity to resolve our cases but for whatever reason chose another route. His distancing himself from the Trust’s failures to investigate is offensive.”

CRASH’s opinion about Dr Broughton’s sanctimonious and insensitive comments on BBC South Today and in the social and printed media is:

“The bereaved families and I are already concerned by Dr Broughton’s attempt to distance himself on the grounds that the original incidents were historical. He showed no recognition that he could have resolved the issues in the last two years without the need for NHS England to commission Mr Pascoe, no doubt at great cost to the taxpayer.

“The Bereaved Family Group was set up originally by the excellent second Interim Chair, Alan Yates. Rather than conclude the process, Dr Broughton chose to put the bereaved families through two more years of unnecessary distress – and of course Mr Pascoe’s work is still ongoing, whilst Dr Broughton goes on to pastures new.”

Reverting to the CQC Report, it has become evident that one claim is fatally flawed – and, worse still, the CQC knew it was fatally flawed:

“The leadership team had engaged proactively with a number of families who had previously not received the appropriate level of care, consideration and investigation into their loved one’s deaths or poor experience of care (under a previous leadership regime).

“Each family worked with a senior member of the trust’s leadership team…. In late 2018, the trust sought the assistance of NHS Improvement to help address the outstanding concerns of five families….”

13163377 - piglets at trough eatingThis is hogwash: Alistair Campbell would be proud it! It is (at best) a half-truth or (at worst) a terminological inexactitude and (more worryingly) the CQC knows it. 

 

Firstly, it implies the Trust willingly, “Sought assistance” from NHSI. In truth, they only did so at the behest of the bereaved families because relationships had broken down.

More seriously, a meeting in December 2018 was a conspiracy between the Trust, NHS England and the CQC to silence the families, not help them. A bereaved father writes:

“Understanding the barriers to progress to be wider health system issues we [his wife, another bereaved father and a supporter] were instrumental in establishing a meeting between Dr Broughton and Ms Hunt of the Trust, Dr Lelliott [CQC] and Professor Kendall of NHSE in December 2018. The stated purpose of the meeting was to explore what these barriers were and attempt to find ways around them. In effect we were committing to continuing to work with the board in our own time and at our expense in order to gain assurance that lessons were being learned and real improvements in service made.

“Sadly, the meeting did not go to plan. We were treated with utter contempt by Professor Kendall and Dr Lelliott and essentially told to go away and mind our own business. Ms Hunt did appeal to us to act as critical friends of the Trust, an offer I personally accepted on the spot, only to be rudely rejected by Dr Broughton. That is where my direct engagement with the Trust ceased [bold added].”

The father submitted evidence to the recent CQC inspection, including a reminder of this event. Yet the CQC still had the audacity to publish, what it knew was false statement.

Duck looking for food in a lake

It shows an upside-down management structure too: the CEO over-rides decisions of the Chair! The Chair cannot control her CEO. This does not characterise what the CQC claims to be a well-led regime.

 

So Dr Broughton continues to add to this, “Very troubled story” – but then he’s already jumped ship. The timeline suggests he first saw a draft of the Pascoe Report in or before November 2019. At the same time, he would have known about the CQC’s over-flattering report. He leaves in May – six months later (possibly a contractual notice period).Nick B

So – November 2019, a good time to apply for another job, Nick!

Surely not.

 

Care[less] Quality Commission

124487987_sInitially, this post was planned to challenge the accuracy of the latest Care Quality Commission Inspection Report on Southern Health NHS Foundation Trust and the flattering media reports, which followed, such as in ‘The Oxford Mail’→

However, sources close to the NHS have informed CRASH that an independent report by leading Counsel will shortly be published by NHS England or NHS Improvement and that this report will in itself disabuse the CQC of many of the claims it made about the Trust.

The report was circulated today – but withdrawn within an hour – not before it had been leaked anonymously. However, in fairness to those involved, we will not comment until it is republished. Instead, we will let the CQC’s recent record speak for itself. Readers can decide, which of the categories in the above image apply.

In November 2019, the Joint Parliamentary Committee on Human Rights (“JCHR”) published its 2nd Report (2019 session). The JCHR heavily criticised CQC inspections an, at chapter 7, point 157 of the report concluded of the CQC:

“A regulator which gets it wrong is worse than no regulator at all.”

Also, the JCHR also concluded at chapter 7, points 123 to 157, (amongst other things):

1. The CQC, as regulator, should be a, “Bulwark” against human rights abuses of those detained in mental health hospitals. Its ability to protect patients against human rights abuses is, “Impaired” and, “Urgent reform” of its approach and processes is, “Essential”.

2. Concerns raised by patients and family members about treatment must be recognised by the CQC as constituting evidence and acted upon.

3. A review of the system which currently allows a service to be rated as, ‘Good’ overall even when individual aspects, such as safety, may have a lower rating.

The JCHR’s inquiry was triggered in May 2019 when BBC Panorama exposed serious abuse and mistreatment of vulnerable adults at Whorlton Hall. The CQC’s then-deputy chief inspector of hospitals, Dr Paul Lelliott told Panorama:

“On this occasion it is quite clear that we did not pick up the abuse that was happening.”

Health Service Journal analysis also showed that, after the Whorlton Hall scandal, the CQC down-graded six mental health hospitals to, “Inadequate, just months after describing them as either, “Good” or, “Outstanding”!

The CQC also rated Norfolk and Suffolk Foundation Trust, “Requires improvement” for whether services were safe, responsive, effective and well-led and, “Good” for whether services were caring. But Healthwatch Suffolk said there was:

A disparity between what the trust reports, the outcome of this inspection and the experiences of service users and carers”.

And the local service users’ champion said it had noticed: 

“Very little improvement in peoples’ recorded feedback”.

Sick Bag 2

And what happened to Dr Paul Lelliott after all this. Why, of course, early retirement to go travelling, financed no doubt by a healthy pension pot, and a gong in the New Year’s Honours List.

Pass the sick bag!

 

However, the evidence suggests these criticisms can be levelled at the CQC’s latest inspection report on Southern Health, despite the appointment of a new Deputy Chief Inspector Mental Health & Community Services, Dr Kevin Cleary. CRASH knows that Dr Cleary and his inspectors had evidence, which they clearly ignored. Wilful blindness?

Moreover, as recently as 21 January 2020, ‘The Times’ reported that, during an audit, the CQC found, “Duplicate material” in 78 reports, with identical quotations from patients or sections of evidence pasted into reports on different institutions. As a result, the CQC has decided to carry out several re-inspections. Read more here→

In all the circumstances, the CQC report on Southern Heath, which (in our opinion) deflects the truth and contains terminological inexactitudes¹ should be treated with a huge bucket of salt.

We await the new report but it begs the question – did Dr Nick Broughton jump ship before the truth was out?

On an entirely different subject, Sir Keir Starmer MP told BBC News:

“I know from running a big organisation that, if you’re going to change the values and the culture of the organisation, you’ve got to do it from the top down”

No-one doubts there are dedicated and caring staff working at the coal face in Southern Health. What the ‘new leadership’ has failed to demonstrate is a good culture at the top.

The leadership could also learn from The Military Leader², who wrote under the heading ‘Systems that Strangle‘:

“Teams and their members take fewer risks and stop fighting for new insight when they have processes to protect them. It’s not intentional, it’s a function of our innate propensity to seek homeostasis…a comfortable, predictable environment.”

Yet all we see at Southern Health are lots of systems, planning, strategies, consultations and meetings but no change in culture!

Broken Trust

In short, CRASH is not alone in believing  Southern Health remains, what the BBC termed, a, ‘Broken Trust.’

The CQC should be downgrading Southern Health just as it has downgraded six others.

 

¹ Terminological inexactitude [Winston Churchill  1906 and (unsurprisingly) William Rees-Mogg 2018!]

² The book, ‘The Military Leader’ is available from Amazon and other bookshops. With more than 20 years of combat-tested leadership experience, Andrew Steadman knows what it takes to build teams and grow leaders. Drawing from his highly successful career as an Army Infantry officer, he wrote ‘The Military Leader’ to be a foundational leader development resource for leaders of all professions.

A reviewer on Amazon comments:

“An excellent book on leadership! The lessons and techniques can be used by leaders in all industries and organizations.”

Having read the book, this comment applies especially to leadership in the NHS.

Planning to Fail

dav© James Whitworth¹

In February this year, Dr Nick Broughton, CEO of Southern Health NHS Foundation Trust produced a Briefing Paper, effectively an Action Plan to reduce the number of Out of Area Placements (“OAPs”)² to circa. 20 before the end of 2019. It is already well off target.

It incuded a colour-coded graph, which we have updated from later Board Papers:

  •  Red – actual OAPs by month to December 2018.
  •  Blue – projection to March 2020 with full effects of Southern Health’s actions.
  •  Green – projection to March 2020 with full effects & housing available for patients ready for discharge.
  • Purple – actual OAPs to September 2019 and the October trend. Off the scale in August 2019! 

OAP Graph - Copy

How can the public have confidence in the management when a plan they prepare in February goes so spectacularly off target so quickly?

But Southern Health’s November Board Papers state that the Trust’s block contract for OAPs at the Marchwood Priory has been increased to 17 until March 2020 and it is currently negotiating with Elysium Healthcare for the provision of 5 female PICU³ beds in Newbury, Berkshire. (Actually, it appears to be in Thatcham!)

With the contract with Solent NHS Trust for 6 beds, the contracted total OAPs will be 28.

That’s over twice the projected figure even without extra-contractual beds! And the year to date spend of £4.8m (to Augst-end ) compares to a budgeted figure of £2.7m.

BUT BEWARE is skulduggery afoot? 

Ominous notes in Southern Health’s November Board Papers suggest that OAPs to The Marchwood Priory and Solent NHS Trust will be excluded from the future overall  total of OAPs figures. What’s more, this allegedly conforms to NHS England guidance. 

Yet, the Department of Health publishes a very simple decision tree, ‘How to decide whether an admission is an OAP.’ It states unequivocally that an OAP includes when:

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

FLOWCHART

 

Perhaps both Southern Health’s and NHS England’s CEOs are attempting to minimise the bad news ending up on the Secretary of State’s desk. They should reflect on the words of Life Coach, Lindsey Ellison:

 

“When you cheat on yourself, it’s the ultimate betrayal. It means you don’t value who you are. You don’t respect your boundaries. You think you’re aren’t good enough.”

We complimented Dr Broughton for his comments after Mr Justice Stuart-Smith’s sentencing in R v Southern Health NHS Foundation Trust so we should also compare his performance with undertakings he gave and his comments about engagement with campaigners. We reflect on the very positive comments he made then about members of The Forum for Justice, Accountability & Equality at Southern Health and others.:

Crucial to these and other improvements is the contribution from many families and individuals dedicated to bringing about change. Whether working alongside us, or indeed as campaigning activists, their courage, dignity and insight is making a difference and deserves recognition.”

Now the honeymoon period is over, he treats CRASH and other members of the Forum with open hostility  if we dare challenge him.

Fake News neon sign vector. Breaking News Design template neon sign, light banner, neon signboard, nightly bright advertising, light inscription. Vector illustration

 

We do not intend to make a political point but we nearly choked on https://www.suellabraverman.co.uk/a statement by  quirky New Forest East MP, Rt. Hon. Dr Julian Lewis in a recent election flyer:

“Julian continues to campaign on , and monitor, such major local issues as mental health acute beds, community hospitals and the future of Dibden Bay.” 

Oh really? Whilst Dr Lewis was prominent in campaigning against bed closures in 2012 [Hansard 18 Apr 2012 : Column 79WH], the latest OAP figures suggest that, whatever effort (if any) he has made to this end, has been ineffectual.

Later [Hansard 8 June 2016 : Column 149WH], Dr Lewis contributed only reluctantly:

“I hesitated to contribute to this debate because I have not been involved in the
cause of the current crisis, which is about the deaths of patients being
insufficiently explained.” 

And when the excellent Suella Braverman MP sent a letter to Dr Broughton, counter-signed by other Hampshire MPs, Dr Lewis’s signature was notable by its absence.

In short, Dr Lewis worries about his own agenda but, “Hesitates” when deaths are not properly explained. Can he not see the link between bed shortages and patient deaths?

thank-you-2

 

 

Special thanks to James Whitworth¹ for allowing use of his cartoon on a complimentary basis.

 

 

Footnotes:

¹ Whitworth cartoons regularly appear in national newspapers as well as a wide variety of magazines including Private Eye and Prospect. He is a nationally syndicated cartoonist with daily topical cartoons appearing in newspapers from Edinburgh to Portsmouth. He also provides bespoke illustrations for Business, Marketing, Presentations & Publications.

View examples of Whitworth cartoons here:  several reference the NHS including one directly relevant to Out of Area Placements, i.e. bed occupancy.

² OAPs can be split into two categories – appropriate and inappropriate.

  • ‘Appropriate OAPs’ occur if a patient is admitted to an inpatient unit with another provider but in the same geographical area.
  • ‘Inappropriate OAPs’ occur if a patient is admitted to an inpatient unit with another provider outside of the geographical area.

Whilst appropriate OAPs are generally acceptable (arguably better) for patients and their families, the affect on Southern Health’s finances are the same.

³ PICU – Psychiatric Intensive Care Unit

Broken Willow

Fallen willow tree on the bank of a riverA recent Ipsos Mori survey on Hampshire GP surgeries revealed that residents least happy with GPs overall were those Fareham & Gosport Clinical Commissioning Group’s area, where the average satisfaction for surgeries was 75% – below Hampshire and national averages.

Top of the class in Hampshire is Petersfield’s West Meon Surgery with a 99% satisfaction rating. In summary of Hampshire surgeries’ ratings:

  •  35.5% achieved 90% and above.
  •  38.7% achieved 80-89%
  • 16.1% achieved 70-79%
  •  5.4% achieved 60-69%

Where was The Willow Group? 90th out of 93 – 4th from bottom at a miserable 59%.

The full table is available here→ .

So why is The Willow Group (a network of GP surgeries in Gosport that had caused problems for patients in the past, from “dodgy phone lines” to being unable to get an appointment) relevant to a blog relating to Southern Health NHS Foundation Trust?

Hidden away in a corner of The Willow Group’s web site:

“We are part of Southern Health NHS Foundation Trust.

Apparently, other GPs in the area were flooded with so many people wanting to change their practice that patients have been banned from doing so. In December 2018, it was reported that over 2,100 patients had transferred practices, putting a strain on the system. Two of eight practices in the town had already had to close their registration lists, as they struggled to cope with increasing numbers. Some residents believe that many transfers had been away from the Willow Group – Read more here→.

One has to ask why Southern Health – the ‘Broken Trust‘, with long-standing unresolved issues in its core specialism of mental health and learning disabilities – wants the added burden of a troublesome GP Practice Group.

Question Mark 2

 

Would it not be in everyone’s interest for Southern Health to dispose of the Willow Group to concentrate on its core business?

On the NHS ‘Reviews and Ratings‘ web site, the Willow Group is rated only two stars.  Comments here include [partly abbrev.]:

 

 

 

Emoticon face with symbols on mouth

 

“Receptionist rude and unhelpful, no dignity or respect for elderly patients.

“Visited in August 2019. Posted on 14 August 2019.”

 

“Every time I try to phone, I get put in a queue whilst I wait for my ‘care navigator’ … get bored and just go to surgery. Sometimes with a sick child strapped in a buggy, to cancel their jabs that week because, and this will tickle you, I don’t want to waste anyone’s time. Today’s debacle was the usual ‘you are P8 in the queue so I set about housework knowing this was going to be a long one. I got down to P3, the house was immaculate by now, when the phone just rung off. End of. Called back, P9. No way. I just wanted to book some jabs for my son. That’s all. 20 years ago it was a phone call and job done in 2 minutes tops. Visited in June 2019. Posted on 13 June 2019.”

“Left the surgery in tears!! The Dr I saw was very rude and made me feel like a failure!! I actually left his room in tears and the chemist arranged for someone to pick me up because I was so upset. Disgraceful considering I’m also depressed. Visited in May 2019. Posted on 19 June 2019.”

“My wife called surgery as requested was given an instruction that she would be called back with[in] 48 hours. Nothing heard from surgery. Called again and yet again told she would be contacted – still in pain still waiting for a reply. This service is disgraceful and needs fixing. So much for the promises of improvement given.
Visited in February 2019. Posted on 28 February 2019.”

Additional comments here, including the ‘Big Shoes’ story.  Interestingly, this website suggests that, in the Willow Group, out of 62 stories told, none have led to changes.

lack of freedom

 

THE BIG SHOE STORY

Patient told by GP to buy bigger shoe!

 

“Partner just undergone complex surgery on foot which could have been avoided if doctors/staff had acted much sooner. She rarely visited a surgery but few years ago a foot began to swell and toe distended to one side. She visited Waterside only to be told by the GP to buy bigger shoe. This is the absolute truth! She came away appalled & dejected … the surgery should hang it’s head in shame.”

“For nearly 5 weeks I have been desperately trying for an appointment for a medical examination to renew my commercial drivers’ licence. I have been promised call backs, emails and nobody has contacted me to set up a time. My licence will expire in a couple of weeks and I will lose my job, but the Willow Group do not care. It is impossible to get through to speak to someone. On the times I have been into the surgeries to try and get the situation resolved, I am told by the reception staff that they don’t usually work there and they are not sure how it works…. They are going to cost me my job. As far as I can see, the Willow Group needs to get some staff that know what’s going on. At the moment, they are not fit for purpose.”

Divas!

Young beautiful woman in red dress looking to blue sea and fiery sunset

“‘Diva’ doctors threaten patient care.”¹

We have reported on the culture in the NHS previously here→ – and elsewhere.

New research commissioned by no less that the General Medical Council has identified five problematic subcultures amongst doctors in leadership roles:¹ 

Diva subcultures – powerful and successful professionals are not held to account for inappropriate behaviour. Left unchecked, divas become viewed as untouchable, and colleagues accommodate them and work around them.”

It was easy to find an image of a female diva but it is likely that are outnumbered easily by male divas. The other four subcultures are harder to illustrate! 

Shouting to a womanFactional subcultures – disagreement becomes endemic, and the team starts to organise itself around conflict. Those in dispute look for support and loyalty from colleagues, and staff may seek to avoid working with those on the ‘other side’.”

 

WILD GEESE

Patronage subcultures – arise around influential leaders who have social capital in the form of specialist knowledge, professional connections, high status, respect and access to resources.”

 

Embattled 4

Embattled subcultures – where resource has been inadequate, and unequal to demand, practitioners eventually become overwhelmed. They feel besieged by the unmet need they see in patients, and may show signs of chronic stress such as short temper, anxiety and burnout.

 

The silhouette of a lonely man

Insular subcultures – some units become isolated from the cultural mainstream of a larger organisation, resulting in professional practice or standards of care that deviate from what is expected. The isolation can be geographical or psychological.”

And of course these subcultures aren’t mutually exclusive. They may often co-exist alongside one another in the same organisation.¹ 

The full GMC Research Paper by Dr Suzanne Shale is available here→²

We believe that some of these features could be applied equally to many in NHS leadership roles, not just doctors.

I struggle to categorise Southern Health NHS Foundation Trust and may be able to identify features of all five subcultures. For now, from personal experience, we know that there are divas, who are not held to account for inappropriate behaviour and already consider themselves untouchable.

Would anyone like to suggest the subcultures that exist at Southern Health! If so please use the reply facility here→

Sources:

¹ Health Service Journal: article by Annabelle Collins with comments by readers here→ . (Please note that the full article and comments are available by subscription only.)

² General Medical Council.

Mouth one way, belly ‘nother way

Uluru

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. 

Footnotes:

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]

³ https://www.statista.com/statistics/418071/community-pharmacies-in-england/

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.”

Shtum

 

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.

CRASH WILL NOT BE GAGGED

 

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

 

14319741_s

 

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.

10928364_s

 

A decision made by bean counters? Surely not.

 

 

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

Drucker-portrait

 

“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?

Footnote:

¹ Honorary Member, Faculty of Public Health Medicine

 

The Secretary of State’s Desk

Woman businesswoman under stress missing her deadlines

 

“The rational response of an appointed NHS CEO is not necessarily to improve the long-term performance of the hospital, but instead to minimize the amount of bad news that ends up on the Secretary of State’s desk.”

 

 

This is just one conclusion to academic research,  ‘The Impact of CEOs in the Public Sector: Evidence from the English NHS‘ published by the Harvard Business School.

The paper, available here, authored by leading academics Dr Katharina Janke
(Lancaster University), Prof. Carol Propper (Imperial College & University of Bristol) and Prof. Raffaella Sadun (Harvard Business School) is supported by detailed, statistical analysis, which mere mortals would not pretend to understand.

The conclusions are enlightening and should be essential reading for the Secretary of State for Health & Social Care, his Junior Ministers and officials, along with the Boards of NHS Improvement and the Care Quality Commission.  Essentially:

“We find little evidence of CEOs being systematically able to change the performance of these organizations. We also do not find evidence that a change in CEO brings about an improvement (or even just a change) in performance.”

The paper proffers two possible explanations [abbreviated and paraphrased]:

“Lack of CEO effects is consistent with top managers chasing political goals, not policies that might improve hospital performance. The rational response of an appointed CEO is not always to improve long-term performance, but to minimize the bad news landing on the Secretary of State’s desk: this may explain why there is a CEO effect in remuneration, unassociated with observed performance, but with receiving public honours. The political nature of the NHS may lead to negative sorting (reluctance of high performers to seek CEO appointments). 

“Hospitals are large complex organizations, in which highly trained (and hard to monitor) individuals run separate, interconnected production processes. Top Management may find it difficult to engage in co-ordination and getting a large number of actors, who traditionally have not worked together, to work co-operatively. A possible interpretation of our finding is that the organizational inertia of a large hospital is often too strong for a CEO to impact performance.”

These conclusions are remarkably similar to expert (unscientific) analysis of Southern Health’s recent reply to a letter from Suella Braverman MP to the Secretary of State. A press release and Southern Health’s response are available here→.

The expert analysis is here→.  The similarities with the conclusions of the Harvard Business School paper are clear. For example [abbreviated and paraphrased]:

“I am also mindful that there is a political and PR exercise at play here.

“[Directors] have forgotten that the letter was addressed to the SoS. They address the points made as though it were directed to them as criticism and write what I feel is a very defensive letter. A better approach would have been to build on what was said and commit to what they could do with £5m to invest in the areas identified, or indeed suggest where the outcome could be improved by investing it differently. They simply don’t see this opportunity; they see this as a threat to their position and authority. Clear arrogance on their part I would suggest in that they know best. 

“They are dismissive about the points on GP training and the deployment of Medical Examiners essentially saying its someone else’s job to deal with those. Everyone is aware these are not Trust specific issues, indeed the work requires all parties to play their part and work as a team. Saying it’s for someone else to do is very much old school “pass the parcel” mentality which indicates there is much more to do to change the culture.

“Overall, the response doesn’t say a lot. It’s all aspirational. Very little is tangible in terms of specific results that can be expected to be seen by a specific time. 

“The first two pages of the [Trust’s]  reply are all spin and waffle. It tells us very little about what the customer can expect by way of improvements. It tells us there’s a new board, a focus on training staff in a QI methodology, a focus on improving patient and carer engagement, a new organisation structure and an improved culture. No detail as to what this will mean to the customer.  

Regarding the second explanation, we know Southern Health is a large complex organization, in which hard to monitor individuals who run separate, interconnected production processes. It is difficult to engage in co-ordination and getting a large number of staff , who traditionally did not work together, to work co-operatively. As we have said before, transforming an NHS Trust is more difficult than turning around an ocean liner.

When will the Secretary of State’s desk look like that of Russian Tsar Nicholas II in his office in Livadia Palace, Crimea – 4 family photo’s, 6 sheets of paper and a large tome?

figure of tsar Nicholas II in Livadia Palace

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