Covid Companions

Cute Labrador dog with stethoscope as veterinarian on light blue backgroundWhere have the last two months gone since our previous post?

Covid-19 has exposed an enormous gap between (on the one hand) the medical expertise, competence and empathy of doctors, nurses and other staff ‘on the front line’ and (on the other hand), the shortage of leadership skills within the NHS. So, let’s look at three heart warming stories involving our furry friends.

Medical Detection Dogs

covid_dog_norman_350px

 

Jasper

One of six dogs who could lead the way for dogs to be used to identify travellers entering the country infected with Covid-19 the virus or to be deployed in other public spaces.

© Medical Detection Dogs

 

A UK trial has begun to see if specialist medical sniffer dogs can detect coronavirus in humans. The dogs are trained already by the charity Medical Detection Dogs to detect odours of certain cancers, malaria and Parkinson’s disease. Read more→

These diseases have their own unique odour: the charity believes medical detection dogs can be trained to detect COVID-19 too and that this could be an important part of the efforts to overcome this epidemic. Read more→

A dog’s incredible sense of smell is thanks to the complex structure of its nose, which contains over 300 million scent receptors, compared to 5 million in a human. Thus, they have an incredible ability to detect odours, and are the best biosensors known to man, which, combined with dogs’ ability to learn makes them perfect for detection dog.

Many of us will have encountered sniffer dogs at airports, where they are commonly used to detect explosives, drugs and agricultural products with high levels of accuracy.

With £500,000 of government funding, the first phase of the trial is being led by London School of Hygiene & Tropical Medicine, along with the charity and Durham University.

To donate and help the charity continue its life-saving work click here→. To assist as a volunteer, including fundraising, puppy socialising and fostering, click here→.

Llama with Envy-inducing Eyelashes[Original Source: New York Times 06.05.20]

Who would have thought that a llama called Winter with, “Envy-inducing eyelashes” could be important in the fight against Covid-19?

Llama Winter

Winter

Living on a farm run by Ghent University, Winter participated in virus studies involving SARS & MERS. Her antibodies staved off those viruses so scientists from The University of Texas, The National Institutes of Health and Ghent University’s Vlaams Institute for Biotechnology postulated that the same antibodies could also neutralize the virus that caused Covid-19. They were right, and published results on 5 May 2020 in the journal Cell.

© Tim Coppens

 

The researchers are hopeful the antibody can eventually be used as a prophylactic, by injecting someone, such as a health care worker who is not yet infected, to protect them from the virus. While the treatment’s protection would be immediate, its effects wouldn’t be permanent, lasting only a month or two without additional injections.

This approach is at least several months away, but the researchers are moving toward clinical trials. Additional studies may also be needed to verify the safety of injecting a llama’s antibodies into humans.

Vets & nurses needed for NHS hospital wards” [Original Source: Vet Times 03.04.20]

In April, Hampshire Hospitals NHS Foundation Trust reached out to animal health colleagues for assistance with clinical care for critical care 3045267_vetwithdog_324492and acute medical patients.

The role (described as a ‘bedside support worker’) includes tasks such as monitoring temperature, pulse and respiration; blood pressure and oxygen saturation; as well as venepuncture and venous cannulation, “If trained and assessed as competent to do so”.

 

Health Service Journal also reported that Torbay and S. Devon Foundation Trust had recruited 150 vets and veterinary nurses to enrol as, “Respiratory assistants” to act as the “eyes and ears” of the ICU medics. A trust spokeswoman said that veterinary staff have valuable skills to support our staff caring for patients with respiratory problems.”

Vet Times reported that, within 48 hours, 4,000 vets, veterinary nurses and students had signed up and that Dr Jo Hillard, who developed the idea, was in contact with about 50 Trusts – including in London, Wales, Liverpool, Birmingham, Nottingham and Norfolk.

An Acute Manager commented on HSJ’s article:

“It’s all hands to the pumps. If all staff are working flat out and need help I think asking people with medical and surgical training is a good idea (probably safer too).”

Elsewhere, a retired Consultant Anaesthetist wrote:

“Humans often successfully help others in an emergency, so the idea that having a formal education in a field closely related to the emergency might impair the chance of success seems bizarre” and more contentiously, “If a human is in the throes of a medical emergency, many vets might do a better job than many medical doctors, depending on the type of problem [paraphrased].”

14319741_s¹ News sources:

There have been many occasions when compelling, and often bizarre stories have arisen during the pandemic.

 

 

Handling the pandemic has been characterised throughout by delays, wilful ignorance, dumbness, statistical gymnastics, cronyism and contradictions by government and NHS leaders. For this reason, almost as soon as we identify an interesting subject, contradictory information has appeared with indecent haste.

For this reason, CRASH recommends the following information sources for regular updates on Covid-19.

The New York Times: normally available on subscription, NYT is providing free access to global news and guidance on coronavirus. It issues a daily update by email with the latest developments and expert advice about prevention and treatment. Register here→.

Cell Press: anopen access‘ platform for communicating life and physical science to the global research community and beyond, with a Coronavirus Resource Hub here→.

Vet Times: largely for the veterinary profession, it is a partly an open access platform with a Coronavirus hub here→, which contains other public interest articles too. 

Health Service Journal: always a ‘must read’ for professionals, leaders and anyone with an interest in health and social care, access to coronavirus-related articles is free here for registered users. Normally HSJ is available on subscription only, although registered users can access five free articles per month. 

Meanwhile, we continue to monitor Southern Health NHS Foundation Trust.

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.

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

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/

Counting sprouts

13126964 - fresh green brussels sprouts isolated on white backgroundBizarrely, it is alleged that Southern Health is recommending COUNTING VEGETABLES as a therapy for depression. Being the festive season, sprouts should be readily to hand!

Sarah Ghafoor had suffered with depression for around 20 years and had previously made attempts to take her life. However, during an Inquest into her death, her family alleged she had been told by mental health professionals to COUNT VEGETABLESwhen she felt overwhelmed by her son, Ben’s death.

Sarah was prescribed a cocktail of anti-depressants and was seen by mental health staff at Southern Health as she struggled to cope with Ben’s death. She made three attempts to take her own life after his death on March, 12 2018. Her daughter-in-law told the Court Sarah had just wanted ‘someone to help’ but had been let down by Southern Health:

“She needed someone she could phone, not someone who told her to count vegetables – her son had died.

“I called Southern Health begging for help and they were horrific to me on the phone. If there were like that to me, how would she have felt?”

Read more here→

Another of Southern Health’s bright ideas for therapy (this time in conjunction with Southampton City Council) is CLEANING COUNCIL HOUSES. This came about after we proposed two proven outdoor therapies, to which a CMHT Manager responded:

Girl Plumb Dirty Toilet

 

“I thought about the supported housing projects in Southampton and many [with] no cleaning services. I was wondering if we could work together with Employment support to engage individuals in recovery to do some of this work.” 

 

 

 

So CLEANING COUNCIL HOUSES is apparently good for patients’ self-esteem. Cleaners we know laughed at the thought – it is more likely to have the opposite effect. Also, if patients have understanding employers, who allowed them time to recover from mental illness and the employers discover their employees are doing cleaning work for the Council, they will assume the patients are fit to return to work – if only to clean their workplace. I also suspect Southampton Council’s motives – cheap (or free?) labour. Sounds more like modern slavery to me! I wonder if they get paid at all? 

Now for ideas for open-air therapy proposed to Southern Health by CRASH:

BEACH CLEANING

Beach Cleaning

 

Not our original idea, but we were extremely impressed by Marine Biologist, Emily Stevenson, who appeared on Sky News on 22 September 2018 to promote her Beach Guardian initiative in Cornwall to tackle the scourge of plastic on our shores. Business owner Rob Stevenson and his  daughter Emily set up Beach Guardian originally in 2017.

 

Rob and Emily soon recognised that the region’s mental health was also in crisis with time off work due to mental health issues doubling in the past year, to the point where NHS figures show that Cornwall has seen one of the biggest increases in the country. Rob and Emily saw a way of addressing both problems with Beach Guardian. Read more→

And what’s more, CRASH received a potential offer of external funding for this therapy.

WALKING WITH ALPACAS

KONICA MINOLTA DIGITAL CAMERA

 

Or if fresh air on the beach doesn’t suit – go into the New Forest and walk with Alpacas. Read more here at footnote² →.

 

 

 

So which do you think is more beneficial to mental health patients?

Walk in the forest and on the beach – or counting sprouts and cleaning Council Houses!

Operation Scorch

 

Fire and flames.

Can you help detectives investigating the rape of a teenager in Southampton?

On Sunday, 2 December 2018, an 18-year-old woman was assaulted between 11pm and 11.50pm in Riverside Park just off of Woodmill Lane, Southampton.  Her name cannot be revealed for legal reasons. Read more here→.

So why, you may ask, it this relevant to Southern Health? Unforgivably, there is an alleged rapist at large as a result of its failure to report the alleged rape of a patient.

The Inquest into the death of Ellie Brabant, revealed that she returned to Antelope House, alleging she had been raped. Southern Health failed to report the allegation to the police.  CRASH believes the police would like to eliminate Ellie’s alleged rapist from their inquiries into the latest incident. It is only a possibility but such inquiries might also lead belatedly to an investigation into Ellie’s alleged rapist.

The Coroner’s Regulation 28 Prevention of Future Deaths Report on Ellie’s death identified this. The report by the charity Inquest records also that Southern Health:

  • Contaminated the scene of Ellie’s death by allowing her room to be cleaned before the police had finished their work.
  • Withheld a key document from the Coroner¹, Counsel for the family, and (to his great embarrassment) Counsel for the Trust. The Coroner’s diligence led to this being remedied on the last day of hearing verbal evidence: the document was key. 

Even more alarmingly sources close to Hampshire Constabulary inform us that Southern Health did not make a police report even after receiving the Coroner’s report.

Therefore, if you have any information, material or CCTV footage that can help in either incident, please dial 101 quoting Operation Scorch (Crime Number 44180450724). You can email postmaster@hampshire.pnn.police.uk too using these references We are sure it will be well-received. Please read on for more details.

Police Rape Map

 

For the assault on Sunday, 2 December 2018, the police have issued the route they believe the man they are hunting may have taken. Larger image here.

If any readers were in this area on 2 December and/or have any other information, they should contact the police.

 

 

The Coroner’s Regulation 28 Report and the charity Inquest’s report on Ellie Brabant says much about alleged improvements at Southern Health.

Even in the era of Katrina ‘Teflon’ Percy, I don’t recall, for example:

  • An informal patient telling clinical staff she had been raped, whilst away from the unit, and the Trust (?) not reporting it to the police. ***
  • An informal patient allowed to continue taking leave when she was returning high on drugs and/or drink and admitting to prostituting herself to raise the money.
  • The Trust (?) failing to secure the scene of an unexpected death before the police had finished their work. ***

I do recall late disclosure of evidence being criticised by a Coroner but, on this occasion, it was only the diligence of the Coroner, who discovered evidence on the last day of hearing, that the Trust had withheld a vital document. ***

22032231 - grumpy old judge in extreme wide angle closeup with hammer and wig*** Does failing to report alleged rape; failing to secure the scene; and withholding a key document from a Coroner, fulfil CPS Charging Standards for Perverting the Course of Justice² or Misconduct in Public Ofice³?

 

The charging decision is made by the police, working with the Crown Prosecutor. But, everyone can form an opinion⁴ using the information and links in footnotes 2 & 3. 

Finally, a reminder that BBC South Today’s report on the Inquest, is available here→.  

And for those who came to the Southern Health saga late, the BBC documentary ‘Broken Trust’ is now available too – here→.

¹ Senior Coroner, Mr Grahame A Short

² Perverting the Course of Justice is a common law offence committed when an accused:
does an act or series of acts; which has or have a tendency to pervert; and which is or are intended to pervert; the course of public justice. The course of justice starts when:
an event has occurred, from which it can reasonably be expected that an investigation will follow. The Trust knows there will be an Inquest and a police inquiry after an unexpected death so the question of reasonable expectation does not even arise. 

³ Misconduct in Public Office is a common law offence, which is committed when: a public officer acting as such; wilfully neglects to perform his duty and/or wilfully misconducts himself; to such a degree as to amount to an abuse of the public’s trust in the office holder; without reasonable excuse or justification. It normally includes elements of dishonesty, concealment and cover-up. It is often used when an alternative offence does not give the Court adequate sentencing powers.

DISCLAIMER – facts around the incidents described in this post are attributed (as shown) to the Coroner and Hampshire Police. Related observations are opinion only and should not be interpreted as implying any misconduct on the part of any individual persons or persons. That is a matter for the CPS, police and/or relevant Regulators.    

Equality – the Indian Way

Panoramic view of Taj Mahal at sunset

India beat England – and not just at cricket.

On 12 April 2017, we referred to The Indian Lunacy Act 1912 and a paper, summarising the history of mental health legislation in Britain extending back 172 years. We noted the word, ‘Lunacy’ was not replaced in Indian Law until The Mental Health Bill 1986.

Now, in the field (pun unintended) of mental health, leading academics¹, write of the new Indian Mental Healthcare Act 2017  (“IMHA):

“In theory, the IMHA is a highly progressive piece of legislation, especially when compared to legislation in other jurisdictions subject to similar analysis.

“Overall, it is likely that India’s new mental health legislation will impact on more individuals than any other piece of mental health legislation in the world”

They found India’s compliance with the World Health Organisation’s ‘Resource Book on Mental Health, Human Rights & Legislation’ (“WHO-RB”) standards generally good and more compliant with these standards than legislation of Eire or England & Wales. 

In particular, they claim that the UK Mental Health Act inadequately addresses the fundamental rights of voluntary patients, vulnerable patient groups, emergency treatments and economic and social rights.

So let’s look at some important sections of the IMHA [paraphrased] in comparison with UK legislation:

S.18(1) and (2): Every person has the right to access mental health care treatment and services run or funded by Government which are affordable, of good quality, in sufficient quantity, available nearby, and without any discrimination.”

Are our mental health services of sufficient quality and quantity and always available locally? Clearly not. 

S.19(1): A patient with mental illness (“PMI”) has the right to live in the community and be part of and not segregated from society.”

Are UK Community Mental Health Teams (including Crisis Teams) adequate for this to be a realistic objective? Clearly not.

S.20(2): PMIs shall be protected from cruel, inhuman or degrading treatment and have the right to live in a safe and hygienic living environment, proper sanitation and facilities for leisure, recreation, education, religious practices and privacy.”

In the UK, the availability of a safe environment and adequate facilities, free from inhuman and degrading treatment, cannot be guaranteed. See also s.97(1) below. 

S.21(1): Every person with mental illness shall be treated as equal to persons with physical illness in the provision of all healthcare.”

Speaking on 10 October 2013, Norman Lamb MP said it all: 

“There is an institutional bias against mental health within the NHS.” (Read full speech here→.) 

Some politicians do tell the truth!

“S.21(4): Every insurer shall make provision for treatment of mental illness on the same basis as is available for treatment of physical illness.”

If UK insurers had to cover mental illness on the same basis as physical illness, it would relieve the pressure on NHS mental health services considerably.  

S.27(1): PMIs are entitled to receive free legal services to exercise his/her rights available under the Act.”

In UK, non-means tested legal aid is available only whilst a PMI is detained under a section. Otherwise a PMI, who wishes to take legal action, must fund it themselves, even if breaches of mental health legislation have life-changing consequences. 

S.97(1): Seclusion and solitary confinement is totally banned and physical restraint is to be used sparingly, when absolutely needed, and deemed the least restrictive method.”

The young woman, behind barSeclusion and solitary confinement are not unusual in the UK: ask Bethany, 17, who has autism and extreme anxiety; has been locked in a seclusion room for almost two years; and is fed through hatches. Her father had to fight off Walsall Council’s bid for a gagging order stopping him from speaking out about his daughter’s treatment. Read more here→

 

Straight Jacket reduced

 

Physical restraint (including ‘face down’ restraint) has increased in recent years with reports of PMIs being fed through hatches in seclusion, forcibly injected with powerful drugs to sedate them, and violently restrained by up to six adults. Read more here→

 

S.98 (1): When a PMI 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.” 

How many Inquests identify lack of adequate care plans as a contributor to suicide when PMIs are discharged? How many PMIs and families complain about lack of consultation before discharge; transfer between units and/or a change in Consultant Psychiatrist? 

Regarding family involvement, it is worth noting that WHO-RB specifies:

“Two occasions exist when the family and carers are automatically involved; these are: when planning discharge and in the case of a person found wandering in the community.”

Incorporating this into the Mental Health Act would put an end to Trusts using data protection legislation as an excuse not to involve the family at key stages. 

S.108: Any person who contravenes any provision of the IMPA (or related rules and regulations) is liable to imprisonment for up to six months or a fine of up to 10,000 rupees [£110³] or both for the first offence and imprisonment for up to two years or a fine of up to five lakh rupees [£5,500³] or both.

We believe it oppressive to incorporate criminal law against individual clinicians in the Mental Health Act. There are sufficient sanctions in UK law (including common law) to cover serious cases, such as manslaughter, false imprisonment and Misconduct in Public Office. Other aspects of professional misconduct are for Regulators to determine. 

The difficulty is that the police are reluctant to investigate medical professionals (save in the most blatant cases, such as Dr Shipman) and UK Regulators are insufficiently robust to hold medical professionals to account. 

“S.109: Where an offence is committed by a company or organisation, every person who, at the time the offence was committed, was in-charge of and responsible to the company as well as the company shall be deemed guilty … and be punished accordingly.”  

At Southern Health (and probably elsewhere) we know the difficulty (some may say impossibility) in holding Trust Directors to account. For this reason, we believe there are benefits of incorporating a clause based on S.109 of the IMHA into the Mental Health Act.

Reservations

Of course, there are common barriers to full implementation of the IMHA, including inter alia funding, staffing, public health priorities and stigma, which cast a shadow on the new legislation. But then, don’t these barriers apply in UK too?

Also, adequate diagnosis of mental illness is essential for high quality mental healthcare, as is the need for high level clinical training and judgement for accurate diagnosis. In UK, it is evident that accurate diagnosis and effectiveness of training is patchy, and revalidation and regulation of psychiatrists is poor.  

But overall, Duffy and Kelly¹ conclude:

India realistic waving flag vector illustration. National countr“Other countries revising their legislation would undoubtedly benefit from studying India’s constructive, pragmatic and enlightened approach to this matter.”

 

 

¹  Richard M. Duffy and Brendan D. Kelly

² International Journal of Mental Health Systems

³ Exchange rates on 26 November 2018