Unsweet Sixteen.

Tags

#7DaysofAction, #justiceforallthedudes, (un)accountability, adult LD services, institutions, learning disability, The ATU Scandal, true stories

Today’s SevenDaysOfAction post, “16 Years”, asks us to put ourselves in the shoes of Tony Hickmott, who has spent 16 years, from age 24 to 40, in an ATU, and think about what we ourselves accomplished in those 16 years.

Between my 24th and 40th birthdays, I:

• Finished my postgraduate degree
• Worked for five different employers, then began working from home
• Sang in a dozen different opera productions
• Bought a flat, sold it, bought a house, sold it, moved to another one
• Travelled in Europe, Asia and South America
• Attended the weddings of many friends and the christenings of their babies
• Attended one family funeral and one friend’s funeral
• Got married and had two children
• Began a further postgraduate qualification
• Made many friends and hosted them as guests in my own home
• Spent at least one weekend a month walking in the wild places of Britain
• Went to plays, concerts, the cinema, firework displays, fairs, ceilidhs, restaurants, dinners and parties
• Went to bed in the wee small hours rather oftener than I probably should have

And

• Left not one permanent footprint on the sands of time, without regretting a single minute of it.

Tony Hickmott hasn’t left a mark on history either.  In his case, it’s been because he’s been locked up, for no crime, without hope of appeal or reprieve, in near-solitary confinement, as a publicly-funded patient of a privately-run Assessment and Treatment Unit.

Sixteen bitter years.

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Common Trials: The Coordination Conundrum.

Tags

institutions, learning disability, medication, mothers, NHS

I’ve just spent 2 hours making phone calls to a dozen different people, trying to make sure that G will be safe during an upcoming hospital admission.  My phone line must be white-hot by now and it’s a good thing we have hard floors, or I’d have worn the carpet down to the canvas, pacing back and forth.  I have to stand and pace when I’m making this sort of phone-call; I need to keep my energy levels high in the face of incomprehension, it’s-not-my-job, and we-don’t-do-that.  Because I understand all too well what may happen – and what is likely to happen – if I don’t persuade people to see things from “just Mum’s” viewpoint, it becomes my job, and I have to do that.  All the while, there is a constant worry at the back of my mind, that if I rub someone up the wrong way, I may end up tarred with the ‘inappropriate involvement’ brush from paintpots like this recent case (where censure was warranted) and #LBInquest (12.14 onwards) (where it most definitely was not).

It is, as they say on Facebook, complicated.  Specialisation applies to administrative as well as clinical staff.  The admissions team schedules theatre slots, but you have to speak to the ward about bed spaces and to the departmental teams about staff complement.  The procedure that G is about to have is normally ‘day case’, but G’s complex interlocking medical conditions mean a three-day stay for pre-op stabilisation and post-op observation.  In turn, that means that the surgical team need to co-ordinate with respiratory and gastro, that an HDU bed must be booked, that the anaesthetics team need to be reminded that they have been warned of the extra wrinkles.

It’s very obvious from the letter advising me of the provisional admission date, that none of this has got through to the admissions team.  It’s a standard day-case admission letter, and if I felt inclined thus to waste my time, I could go through it furiously underlining every other word and muttering, “Wrong,” “Nope,” “Ain’t happening,” “In your dreams and my nightmares, sunshine”.

Instead, I burn through my phone bill, a deliberate smile on my face to help me pour bouncy-walk-induced positive energy down the line, talking to clerks, secretaries, nurses and answerphones, to get the whole thing orchestrated.  Each time, I repeat all the name, rank and serial number information with enthusiasm, as if I couldn’t possibly think of anything else I’d prefer to do on a summer morning.  I sympathise with technology glitches, make jokes, throw in a compliment here and fulsome thanks there.  I note numbers, names, who has agreed to do what.

Now, I have to wait and see (and maybe make a few follow-up phone calls in a week or 10 days).  I did all this four months ago, only for the procedure to be cancelled at the last minute.  It was scheduled for February half term and too many staff were away, taking winter holidays with their kids.  Of course staff need a work-life balance, their children deserve holidays, and I hope every last one of them had a thoroughly enjoyable time.

It’s just …. well, some of us get to go ski-ing.  And some of us feel we are permanently skating on thin ice.

Four Hours With Franklin.

Tags

appropriate vocabulary, autism, institutions, kindness, learning disability

Now that E is away at University and unlikely to be occupying his room for more than a couple of weeks at a time, the children’s Papa – a tidy soul to the core – has ambitions to turn the space a little more guest-friendly, by turfing out some of E’s more juvenile possessions.  The practicalities of this aspiration have in the first instance fallen to me. To anyone who knows me, it will be no revelation to be told that I am absolutely useless at throwing things away.

How do I know whether E is still attached to the Lego star-cruiser that he so laboriously constructed eight years ago and which has been poised for takeoff from the top shelf of the bookcase ever since?  I dare not even touch it, lest I accidentally dismantle one of its delicate protrusions and put myself permanently in the dog-house.  Ditto the Airfix, the sporting trophies, the Warhammer sets.

“Just go through the books, then”, said P.  Nope.  While P sees a rummage through bookshelves as an chance to winnow out any that haven’t been read for a while, I see it as an invitation to reacquaint myself with old friends.  One doesn’t put old friends out the door.  From The Very Hungry Caterpillar to The Tale of Samuel Whiskers, to Wolf Brother, to Smith, to The Hunger Games, to King Hereafter, E’s bookshelves are a coded chronicle of his life with us, and each of them is still a darn good read.  So having pulled all the books off the shelves and replaced them, I settled down, slightly guilty, very exasperated, and in need of cheering up and soothing, with a couple from his mid-primary-school stage: Mij Kelly‘s Forty-Eight Hours With Franklin and Franklin Falls Apart.

The thing with good books, I find, is that on re-reading, you come across bits that resonate as new, because you have changed in the interim.  I first read Three Men In A Boat in my very late teens, on a Scotland-to-London train, disrupting the entire carriage with honks and snorts of mirthful recognition at the posing, mock-heroics and ineptitude of the young-adult heroes.  Twenty years later, with the benefit of knowing my brother’s personality-plus Jack Russell, I read it again and was convulsed by the contributions to expedition-packing – long-forgotten – of Montmorency the terrier.

Re-reading Franklin, the adventures of an accidentally-animated shop dummy, I laughed again, as I expected to, but I also began to see another layer that didn’t appear to me ten or twelve years ago.  Franklin, born into the world of humans as a six-foot baby, has no understanding of people or how things work, which leads him to repeated close shaves with law-enforcement.  He doesn’t talk, although he learns to repeat sounds, words and phrases that he hears.  He is literal-minded.  Asked to lend a hand, he does what any sensible shop-dummy would do: unscrews one of his at the wrist and passes it over.  He relies heavily on his flesh-and-blood siblings, Gertie and Joe, to protect him from the consequences of his unwittingly disastrous actions. They understand, from a knowledge of his past, what his probable intentions are and what his apparently out-of-context repetitions of stock phrases mean.  They know that when he says, “Ow, ow, ow, motorbike stars”, he means his legs are hurting and “Body no Perkins, body cow”, means actions were stupid (like the cows) but not malicious (like Mr. Perkins).

Well-meaning adults, such as Joe and Gertie’s parents, don’t quite get this, at least not until they have spent time with Franklin and begun learning to understand him.  And even then, the parents get it wrong, initially thinking only of how presenting papers on Franklin to international conferences will enhance their standing as scientists.  Strangers, pardonably, think Franklin is weird or rude when he addresses them as ‘Podgy’.  They aren’t to know this is his attempt at complimenting them for being a ‘prodigy’.  And some strangers, learning just how different Franklin is, see him as an opportunity for money-making: as a freak-show exhibit; as a subject for containment and study; as a tabloid newspaper headline.  In pursuit of their own aims, they ignore or dismiss Franklin’s rights to bodily integrity, autonomy and self-determination.

Echolalia, language differences and communication difficulties.  Incomprehension of the world around him.  Reliance on others’ attunement.  At risk of exploitation and/or incarceration.  Not quite human.  Sounds very familiar, doesn’t it?

Perhaps that’s why there was never a third Franklin book.  Perhaps, having created her living mannequin and seen him evolve, maybe without her realising it, into someone who looks very like an adult with learning disabilities and autism, Kelly just couldn’t imagine a future for him.

P.S. The Franklin books are long out of print, but occasionally resurface second-hand.
They are available together as an e-book called The Franklin Files.

Here Come The Girls.

Tags

#justiceforallthedudes, care in the community, independent living, institutions, kindness, Local Authorities, NHS

Six weeks ago, I was wondering, “where are the girls?”.  A couple have emerged onto social media since.  Although neither is in exactly the same situation as the lads who featured in The ATU Scandal #7DaysofAction, I am noticing same old themes of waiting until a situation turns into a crisis, counterproductive provision, failures to keep safe, the dangers and indifference of total institutions, isolation, the powerlessness of loving families, the difficulties of leaving an ATU, financial skewing that makes it advantageous for mental-health provision to hang on to people and disincentivises Local Authorities from bringing them home, and terrible, all-pervading, stress and fear for inmates and families alike.

Sophie doesn’t have a learning disability, as far as I am aware, but she does have bipolar disorder.  She is currently in St. Andrew’s hospital in Northampton.  This hospital, a very large one headquartered on the old Northampton ‘lunatic asylum‘ site, is not actually part of the NHS; it is a private institution with charitable status that bids for NHS contracts.  Sophie’s family, who live in Middlesex, have concluded that the hospital is not suitable for Sophie.  According to the petition for her transfer, it’s making her life and her family’s life hell.  The family have tried everything they can think of to get her home, but “nothing works”.  Her family believe she is treated badly where she is and is not kept safe.  Sophie has managed to self harm on many occasions, sometimes very seriously.  Her family are ‘desperate’ to have her closer to home so that they can support her.  They say: “Sophie is 21, she is a beautiful, caring, lovely young lady who just wants to be with her family.  She suffers with bipolar but she is not a criminal, so she should not be locked away like a prisoner.  To be honest, prisoners have a better quality of life than Sophie does in St. Andrew’s.  She doesn’t receive basic human rights and is not kept safe.  We need her closer to her loving family.”

The second young lady is not in an ATU – yet.  Her name is Emily, she is 19 and profoundly disabled by her autism and learning disabilities.  She needs 24-hour, 3:1 care.  For the last few years, she has been living in a residential school with visits to her parents’ home in Shropshire, but in less than three weeks, when term ends, she will have aged out of the school system.  So far, she doesn’t have anyplace else to live either, despite her family’s long-running and increasingly frantic efforts to find her a home of her own with proper supports.

They have been through all the hoopla of trying to secure her a liveable income (which was initially denied) and a house.  They have been asking their Local Authority and Social Work departments for help and support, which has been in very short supply and seems mostly to have consisted of ‘signposting’ to providers.  Wrong boxes were ticked by official form-fillers, meaning that Emily has missed out on some potentially suitable houses.  Those which were offered are all unsuitable for one reason or another – too far from family, too small, too insecure.  The only currently empty property which, according to Emily’s swathe of professional therapeutic and medical reports, is suitable, is said to be in leasehold limbo between the Council and the Housing Association.  Apparently, it will not be made available to Emily anyway, because it is earmarked for adults returning from ATUs.  But if Emily doesn’t have somewhere of her own to live in two-and-a-half weeks’ time, she will end up in an ATU.  Her family have been told that, absent a home of her own, there will be no other options.

Let’s just think about that for a minute.  Emily’s education, health and social care professionals have known for nearly two decades that Emily will always need care and support.  Her 18th and 19th birthdays can have come as a surprise to no-one.  Yet there has been no forward planning for the end of her schooldays.  Unless someone does something very soon, Emily will be placed in a facility intended for (a) assessments (which have already been done – exhaustively), and (b) treatment (which she doesn’t need and which can’t help her since she has autism, not a mental illness).  She will be in uncongenial surroundings that will be very likely to exacerbate her difficulties with making sense of the world, and she probably will be subject to the forensic, carrot-and-stick, behaviour-modification-restraint-and-heavy-medication regimes that have left too many dudes in a terrible state; and the prospects of which have Emily’s mother in agonies of terrified apprehension.

Yesterday, whilst her father was travelling to visit yet another far-flung shoebox property remote from Emily’s family and home town, the car encountered a pothole that has left it inoperable due to suspension problems.  It’s not the only thing that is breaking down.  If Emily ends up in psychiatric care, I fear her Mum may just be driven to join her, as the strain is very obviously getting to within a whisker of being too much for her.

*****

*****

Picnics, PBs and politics.

Tags

(un)accountability, institutions

Yet more grim news from #JusticeforLB.  Tim Smart, the ‘Interim Chair’ parachuted in by NHSI to sort out Southern Health, is doing a fair old impression of someone bucking for a change of name to Tim (Possibly-)Nice-but-Dim, as he seizes the first opportunity to fail to engage with the public.  Deeply disappointing.

Meanwhile, Mark Neary is struggling (again) with bureaucratic stupidity at all levels of government, in his quest to ensure that Steven can do perfectly ordinary things like go swimming.  He’s also struggling with ‘experts by non-experience‘ who insist, in quite spectacular displays of non-person-centredness and ignorance of non-directiveness and in the face of all the evidence, that he ‘should’ be having a good experience of Personal Budgets (PBs) and Direct Payments.  He isn’t.

It reminds me of an argument I had with my tutor about political philosophies.  We were reading a series of novels that included Le Rouge et Le Noir, La Faute de l’Abbé Mouret and L’Espoir and got into a big stushie about secularism, anticlericalism, and Communism (amongst other things).  The tutor argued that Communism was a secular political philosophy.  I argued that it was an anticlerical religion because it had articles of faith, such as the required belief in the historical inevitability of dictatorship of the proletariat; a millenarian postulate, if ever there was one.  We eventually agreed that any system would work, provided everyone in it was of perfect good-will; but that since people are without exception imperfect, no system could work flawlessly.  We also agreed that in practical terms, neither theocracy nor Soviet Communism were very appealing.

And the same applies to Foundation Trusts and Personal Budgets and other things like Education, Health and Care Plans.  They are not necessarily either good or bad things in and of themselves, but like all theoretical constructs, are, in the real world, just (and only) as good as their implementation.  In turn, implementation is generally as good as the people responsible for it.  It’s no good saying that the service structure is excellent if the services themselves are execrable and delivered or run by the malicious, the hidebound or the simply uninterested.

Whatever system you’re engaging with, you’d better hope, or pray, to whatever entities you think may influence the outcome, that you get good people controlling things.

And meantime, be prepared to shovel shite.

I.Can’t.Even.

Tags

#justiceforLB, (un)accountability, Connor Sparrowhawk, institutions, learning disability, NHS, preventable deaths, Sloven Health

This latest #JusticeforLB development is almost beyond comment.  It does, however, throw into sharp relief the siege mentality obviously operating within Southern Health; and speaks volumes about Sloven culture and the messages purposefully circulated within, and outwith, the organisation.

The transcript below comes from a message left on LB’s mother’s office answerphone from someone claiming to work for Sloven.  It doesn’t much matter whether the caller is a member of management, a lower-ranking staff-member, or just an unconnected crank; she has obviously absorbed and internalised an execrable attitude to LB and to his mother, and feels justified in spewing it out.  A toxic attitude that aligns precisely with Sloven’s dealings with LB and his family, all through the more-than-three-years since LB was admitted to STATT.

And Sloven’s response?  Of a piece with their previous form, and with the call.

Sloven are not setting up an enquiry, actively seeking the culprit and requiring staff to disclose information.  They’re not even setting up an internal enquiry and asking for all available information.  Oh no.  They will, apparently, set up a ‘full internal investigation’, if and when they receive ‘any information’ in response to their ‘urging’.

Pathetic.  As always.

 – – – – –

Good morning, hello. Hi, I believe this is a message for Dr. Sara Ryan, um, I’ve been seeing on the media about your son, your poor son that died under the care of Southern Health.  I work for Southern Health and I’m, it, it’s awful that you’ve lost him, I’m so sorry that you have done, um, ’s tragic, and … I hope you find some closure after the report, the, um, issue of the GMB … CQC report today, but I do think you are being reall- very vindictive.  I think you are a vindictive cow.  On TV all the time, ummm, slating the NHS Southern Health.  With your intelligence background, you know, as much as anybody else knows, that Southern Health only took over those units in Oxfordshire recentl-, you know, the recent months before your son died.  You know, with your background, it takes a while to make changes in anywhere, and I think now you’ve just become a bitch and you want some attention, but you are vindictive, you are unpleasant, and you are a nasty cow.

This message was recorded at 9.33am on Friday April 29th.  To save this message press 1.  <beep> To-  Message saved.

– – – – –

Reparations and Resignations.

Tags

#justiceforallthedudes, #justiceforLB, (un)accountability, institutions, Local Authorities, Sloven Health

After several days of carefully-worded prevarications, the Prime Minister has finally had to admit that in claiming he had nothing to do with offshore tax havens, he was in pants-on-fire territory.

Media coverage appears to agree that not coming clean at the earliest opportunity was a particularly stupid move. “It’s never the offence, it’s always the cover-up“, says one headline.  Cameron doesn’t appear to have helped himself by sounding plummily and defensively irritated when being questioned.

Worse than merely causing offence, or laying himself open to the most caustic ridicule, it also leaves the PM under ongoing suspicion that there may well be more revelations to come.

It’s not that he participated in legally permissible, if morally questionable, financial dealings.  It’s that he didn’t tell the truth when asked.  Even if he didn’t outright lie, he was evasive and shifty.  The public are not daft.  They can spot shiftiness when they see it; while for the media, a squirm is catnip and the scent of a buried bone: all the incentive they need to keep on digging. Cameron’s failure of candour is what has led to calls today for his resignation; for many, he has forfeited the level of public trust considered necessary for him to continue in office.  He could confess every little peccadillo he’s ever committed, and still people would wonder if there were more.

In the same newsfeed as the multiple pictures of the beleaguered PM, came this report, on how the Oregon State University has changed the way it handles sexual assault cases linked to the college or its students.  In 1998, Brenda Tracy was gang-raped by four men including two U of O students on sports scholarships.  Despite the accused men’s admissions, the investigation was mishandled and dropped.  But in late 2014, after sports journalist John Canzano wrote a piece on the incident, the president of the University, Ed Ray, contacted Ms. Tracy to apologise.  Ray had only joined Oregon State in 2003, five years after the assault.  Ms Tracy considered his apology genuine and is now working with the University to improve its approach to the problem of sexual violence by or towards students.  In contrast, Kristin Samuelson and Laura Hanson, who were also badly treated by the University following student-linked rapes, are still without proper apologies or closure.  Both were discouraged from reporting the rapes, and Hanson later discovered that the University had taken possession of her supposedly confidential counselling records without her permission.

Back in the BC days (Before Children), I worked at one time for a Local Authority, and every election day (which was most years, as our councillors retired by thirds rather than in one fell swoop), I would end up in a school or community hall with an electoral register, some rickety plywood booths and some very battered black tin boxes, as Presiding Officer of a polling station.  The duty was mostly mind-numbingly and bum-numbingly tedious, and often foot-numbingly cold as well, but on this particular day, the station was in the community hall of an old people’s home, so it was at least warm.  I arrived at 6.30, set up the booths, the tables and the notices, and nipped through to the loos, which were opposite the day-room.  They were nicely kitted out with modern fittings, and discreet stacks of incontinence supplies in each cubicle.  However, when I next paid a visit around elevenses, there was a large blob of shit in the middle of the floor, with a trail of smaller blobs leading to one of the cubicles.  I went to find the day manager, who thanked me and said it would be dealt with.  At lunchtime, around 2pm, the blobs were still there, each dried to a darker crustiness on top.  I spoke to the manager again.  “It’ll be dealt with!”, she said, sharply.  But by 5pm, the shit was still there – only someone had trodden in it, and a trail of stinking footprints and zimmer-frame skid-marks led back across the corridor carpet towards the day-room.  This time, the manager was nowhere to be found, and although I mentioned it to someone in a uniform dress, the smears and lumps were still in evidence when I paid a final visit at 10pm before taking the boxes to the count.

The following morning, I went to find a colleague on Community Care to ask if there was anything that could be done.  “It’s not about it being unpleasant for me,” I explained, feeling close to tears.  “It’s that if they are that way in front of outsiders, what are they like to the people who can’t get away?  I wouldn’t want my Granny or Grandad in a place where nobody cares if shit gets tracked all over, and I don’t think it’s acceptable for anybody else’s Granny or Grandad, either.”  My colleague hugged me.  “Don’t you worry, I’ll see to it.”

A few days later, I was accosted by the Electoral Registration Officer.  “What do you think you’re doing, complaining about E House’s treatment of residents?  That’s none of your business.  The manager’s threatening not to let me have the hall for elections in future.”  I suggested that we could take it to the Chief Executive, as Returning Officer.  The ERO declined; we both knew which way that would go.

One of my responsibilities at the Council was Ombudsman cases.  Underlying causes of complaints were routine, even trivial matters; what got them taken up by the Ombudsman was maladministration: a failure to ‘do it right’, often compounded by an obstinate refusal to recognise that the aggrieved had just cause for complaint, and frequently aggravated by attempts to blame the complainer for ‘causing’ the situation complained of.

One of the earliest cases in the files concerned a disabled tenant of municipal housing, who had been asking to have repairs and renovations to her home accorded a higher priority, as her condition was being worsened by the current conditions in the house.  The housing officer seemed to have treated the request with extreme jobsworthiness, interpreting any discretion in the housing regulations to mean, “although we could accede to your request, we don’t absolutely have to, – so we won’t”.  It was not until the tenant, after over two years of patient pleading, went to the Ombudsman, that an officer from the Council actually went round to see the state of the place, which, as it turned out, was shocking.

The officer’s report outlined the work to be done, with costs and timescales, detailed the considerable extra costs the tenant had incurred as a result of having to live in an unsuitable property and outlined the weekly amount needed to cover her living expenses in alternative accommodation until such time as the work was finished.  The Chief Executive’s handwritten note in reply was brief. “DO IT. Start NOW. I want a weekly update.”  A further, typed, letter to the tenant apologised fully for the specific failings of the Council, explained the arrangements proposed to remedy them and asked for the tenant, if she agreed, to telephone her approval to the Chief Exec’s office so that delays could be kept to a minimum.  It also requested permission for the Chief Executive to visit the  tenant once the works were done, so that he could satisfy himself that everything had been sorted out.

The final document in the case-file stated that the reporting officer had visited the tenant after the Ombudsman’s case had been closed.  The tenant had had no further problems, was fully satisfied with the way her case had been handled. The officer added, somewhat smarmily, that the tenant had had a number of complimentary things to say about ‘a certain Chief Executive’, for having visited to present her with in-person apologies from the Council, a cheque reimbursing her previous expenditure and flowers and chocolates to accompany a ‘New Home’ card.

That was the Chief.  He was a wily political operator and undoubtedly autocratic, but his fundamental concern – above his staff and beyond the councillors – was the people, whether as a collective, as small groups, or as individuals, whom the Council was there to serve.  I liked and admired him and was very sorry when, a few years later, the Council found itself mired in a scandal whose origins predated his appointment; and, after it all ended in the inevitable disaster, he felt obliged to resign.  Although the causes of the scandal were nothing to do with him, he had been unable to make it go away, and he recognised that someone else needed to take over in order to allow a fresh start with a clean slate.  Like Ed Ray, the Chief accepted that although he had had no power over what had gone wrong, he did have the power to help right it for the future, and he took the necessary action, however unpleasant it was for himself.

The original administrators dealing with Brenda Tracy, and with the Council tenant, were incapable of seeing that they had got things wrong, and badly.  In both cases, there needed to be a change of administration before the people affected by the wrongdoing could be satisfied that they would get redress.

It’s a pity a scandal and an outrage that the current Chief Executive and Board of Southern Health can’t see that they need to go for exactly the same reasons.  They are part of the problem, so they can never be part of any satisfactory solution.  However many times they repeat, “We have made changes”, the people affected by their failings will not, cannot, have confidence in these pronouncements, as long as they are spoken by the same old faces that have already proved themselves untrustworthy and two-faced.

For people to have any confidence in Southern Health, Katrina and the Sloves need to resign. Now.

The Ministry of Tragic.

Tags

assessment, fiction, institutions

Good morning, Ms. Parsley, and welcome to St. Mungo’s Mental Elf Hospital Trust.  Perhaps you’d like to tell us a bit about yourself?

“My name is Citrina Parsley and as you know, I’m applying for the post of Witch in Chief.  I always wanted to work in the Elf Service – my father was a Healer and my mother was a Fizz-Tickle Therapist – so after doing my degree at Hogwets College of Bitchcraft and Bollockry, I applied to Nollege College, to do a course in Wizmanagement (Healery).  In the holidays, I got myself an internship in the Department of Stealth.  Well, the Department of Stealth and Total Obscurity, it was, then, and after that I had two years on the Ministry of Tragic’s MsManagement training programme.

“Then I spent five years Pottering around various projects while wearing a badge that I had Charmed to display a variety of fancy-sounding titles, before skipping overseas to hone my msmanagment skills somewhere nice and remote.  Here, I had overladyship and msmanagement of all magical and non-magical operations within the coven: goading two dozen disciplines to deliver enchanting sorceries for pea-Knuts. My work saw a vast increase in the numbers of victims of magical misfortunes arriving at our door, so I arranged for the construction of a monstrous maze to manage patient flows and stymie new arrivals.  I also planned new buildings and worked with the stoneraisers, the Chief Wizard and Healers to plan the new Almshouse (including futurology and service transmogrification) for the agreed amount of Galleons.

When I came back, I did a year as a Sorcery consultant – working with all the top Adminwizards of the Almshouses and Covens in my area to source saucers – and then I landed a plum role at St. Werburgh & St. Walstans, redisorganising the entire establishment of what were acknowledged as the most disorganised dungeons in the country.  By means of Polyjuice Potion, I impersonated the Chief Wizard both internally and externally during this period.  I led and managed all the magical disciplines, properties and accoutrements, plus conjuring, transmogrification, sorcery development and Paracelcian msmanagement.  I created a new management clique in each area, to control conveyance and transmogrification through staff capacitation alongside implicit imponderables.

“My next move was to community magimedicine – providing the vanguardium leviosa for thousands in the magical community and msmanaging millions of Galleons.  I stuck that for over three years until a better opportunity came up in the Hufflepuff Herbology Foundation Trust, which in turn led to me to the position of Witch-in-Chief at Slytherin Fountain Elf Trust, where I’ve been for the last five years.”

Thank you for that.  Is there anything else you would like to tell us?

“I was awarded Witch Weekly’s Most Charming Coiffure of the Year.”

You’ve brought your academic certificates with you but we’re having a little trouble with this Gothick printing on the Hogwets diploma – does it say your degree was in Healing?

“No.”

Oh.  Definitely not Potioneering – is it Herbalism?

“No.”

Could you help us out a little, here, Ms. Parsley? 

“Leylines.”

Leylines?  Leylines.  Well, that’s, er, certainly an unusual route into the Healing sphere.  With a Healer father and a Fizz-Tickle therapist mother, it might have been expected that you would have studied Healing or a related discipline yourself, rather than geomancy?

“Well, of course you’re a Healer, aren’t you Doctor Flssstfckmnst?  I know all about you, He Who Cannot Be Pronounced.  Just like my father, all, ‘You’ll never amount to anything, Citrina, if you don’t get straight O grades. Can’t study Healing with E’s, you know.  They may call them Exceeds Expectations but I call them not good Enough.’  Even when he didn’t say it, I knew he meant it.”

Would you like a tissue, Ms. Parsley?  Well, if Healing wasn’t for you, did you not consider one of the auxiliary professions?  Herbologism, say, or Potioneering or Fizz-Tickle Therapy like your mother?

“What, and have Dad snarking at me the way he did at my Mum?  No thanks.  Anyway, I showed him.  So what if I only got A’s?  My grades were Acceptable rather than Outstanding, but who wants to be an outlier?  My degree may be in leylines, but I’ve had literally hundreds of Healers working for me, and if I felt like it, I could make ’em widdle their drawers with fear; I had the power to hire, fire, or petrify.  Haha!  How do you like them apples, Dr. Daddio?  And once I’m Witch in Chief here, you’ll say, How High?, Mr. Boring Chairman, when I say Jump, or I’ll turn you into a frog!”

Fascinating.  Tell me, Ms. Parsley, do you really think you are here for a job?  Don’t you remember you were brought here suffering from self-induced Delusionaria Grandiosa and this is your admission interview?

“I’m admitting nothing.  And I’m not staying here if I’m not going to be in charge!”

Come, come, Ms. Parsley, you’ll find your time here will be much easier if you just resign yourself to undergoing treatment.

“I’m not resigning.”

***

Lessons Learned.

Tags

#107days, #AdsThePoet, #IamThomas, #justiceforLB, #justiceforNico, autism, cerebral palsy, Down syndrome, institutions, mothers

Exam fever has descended on our house, for the second year in a row.  Maybe I’m on the brink of senility, but I don’t remember exams being this big of a deal when I was at school.  You went to lessons, did your homework, did timed single questions every month or so, sat mocks in January, kept pegging away at practice papers, and then stocked up on hay fever preventatives and treatments before the real thing in June.  And, of course, you got a year off from public examinations between your GCEs and your A Levels.

The consequence for schools of public examinations three years on the trot seems to be that there has been very little time in each year for consolidation of knowledge.  Eldest has been galloping through the various AS syllabi right up to the end of this week, and now he goes on study leave.  Er, what?  In effect, by the time he gets to his A2s he will have lost half a term’s teaching from his A-Level courses, compared with the length of time his father and I each had.

Still, his GCSE’s have taught him how to revise methodically, and he has been busy since Christmas condensing his notes down on to file-cards – a different colour for each subject, with coloured spots on them to code for topics – and then expanding them up again.  I don’t think I acquired that sort of skill until I was at University – and even then I only used it for subjects such as law or history, where facts trumped flair.  For language and literature, I just seemed to absorb the books, and, faced with a choice of questions, never had much trouble finding something on which to hold forth in a manner pleasing to the examiners for the length of a forty-five- or sixty-minute essay.

One of my courses was twentieth-century French ‘literature of ideas’: mostly mid-twentieth-century existentialism.  I adored the ambiguities of Camus; enjoyed, in an arms-length kind of way, the waspishness of Sartre (though I could have done without the stodgy density of L’Etre et le Néant); mulled over de Beauvoir alongside the shelf-full of 1970’s feminist texts that my Hall room-mate was only too delighted to lend to me; and laughed out loud at Roland Barthes’ nostalgically lyrical descriptions of wooden toys.  A man who could seriously write, ‘le bois ne blesse pas’ (wood does not hurt), was a man who, in my opinion, stood in great need of the salutary experience of being on the receiving end of an alphabet brick flung with malice, force and accuracy by a younger sibling.  Evidently Barthes’ brother was gentler than mine were, or perhaps, being junior by twelve years, young Michel had been too awed at the brick-flinging stage by the teenage Roland to subject him to these projectile assaults.  But I appreciated M. Barthes’ description and dissection of the then-latest Citroen car, the DS – a bubble of glass and sleek enamel, floating on hydropneumatic self-levelling suspension, which was such an idol that its name was pronounced ‘déesse’, or ‘goddess’.

Unfortunately, it wasn’t enough to read the books; we had also to grapple with the philosophical concepts behind them: Camus’ Absurd; Sartre’s phenomenological ontology; de Beauvoir’s Other; Barthes’ semiology.

On the day of my Final in this particular subject, I had somehow managed to set my alarm-clock an hour early, and having risen, bathed and breakfasted before I discovered my mistake, I decided not to go back to bed – I didn’t fancy getting undressed and having a second bath before re-dressing – and instead did some last-minute cramming on Mythologies.  I’d already memorised a number of quotations, but in his last piece of the book, a mid-length essay called ‘The Myth, Today’, Barthes helpfully provided a little table of levels and degrees of meaning, which I now copied out several times.  Two hours later, in the exam hall, I was faced with a question on semiology that begged for a neatly plotted table to support my disquisition on the evolution of sound into symbol into mythic significance.  I duly sketched it out, wrote my five hundred words, did the other questions required, went home and thought no more about it.  Months later, my tutor pounced on me at the faculty post-graduation sherry reception and told me how the examiners had been particularly impressed by my grasp of semiology in my Barthes essay.

I didn’t tell her about my last-minute cramming, or that I could no longer remember anything much about semiology beyond the notion that ‘things can be more than they seem’ and the general outline (but not the content) of the ‘Myth Today’ table.  University had also taught me the wisdom of accepting a compliment gracefully and of not digging unnecessary holes beneath my own feet.  I smiled, and thanked her, and moved on.  The lessons in social graces I had not only learned, but practised and internalised; the Barthes, alas, had been learned, but not remembered.

That, I think, is the problem with the ‘lessons learned’ from Winterbourne View, from Stafford, from twenty, thirty, forty years of horrified discovery.  Each time, the lessons to be drawn have been so obvious that even the most wilfully ignorant could not dismiss them.  Each time, the atrocities have been roundly denounced, the promises to learn sonorously delivered.  Each time, it is claimed that the lessons have been learned; and each time it has become painfully evident that if they ever were learned, they have not been properly remembered.

Such lessons have to be learned collectively, at the organisational level, so that they become part of the organisation’s automatic reflexes.  Otherwise, the learning dissipates, as individual staff-members leave the service and their replacements are not imbued with the same knowledge.  In an organisation like a hospital, the loss of knowledge can be startlingly rapid.  While a core of staff may be long-term employees, many health professionals need to keep moving on to new posts in order to foster their careers, while many non-medical staff may also be in short-term jobs.  Staff turnover across the NHS has been calculated to be of the order of 25% per annum.  That’s a very rapid attrition of any unembedded learning.

Services need to organise themselves so that they don’t just learn: they retain and transmit what they have learned, so that future versions of themselves know that people with epilepsy don’t get left alone in the bath; that people with very high care needs and a risk of aspiration are not, at their most vulnerable and precarious times, made to share the attention of a lone staff-member with three other similarly disabled people; that people whose mothers are worried about their significant chest infection need to see a doctor as soon as possible; that having a GCS of 3 just now doesn’t mean that you have never had, and never will have, a higher score.

Learning a lesson is useless if you don’t remember it.

Selective Hearing and Elective Mutism.

Tags

#107days, (un)accountability, High Ordeals, institutions, NHS

This week’s #107daysofaction has been about listening – or not – to families. Katherine Runswick-Cole blogged on Bettelheim and mother-blaming, Sara Ryan on speaking up for your family member, and Mark Neary gave us another chilling portrait of institutional deafness.  I’ve had similar concerns going round in my head for months and months now.

An acquaintance, whose child receives 1:1 health worker support in school to manage a life-threatening medical condition, last year gave permission for one-off participation in an educational activity which the child does not routinely access. The school’s trained risk assessor, with health-risk assessment input from the healthcare worker, devised a safe way of delivering the activity to the child on that occasion, using 3:1 support.

The healthcare worker was subsequently disciplined by the Trust for not preventing the activity.  Healthcare managers visited the parent at home and tried to get agreement that proper parental permission had not been given for the activity.  The parent repeatedly asserted that permission was in fact given, but felt that the managers’ attitude and language implied the parent was lying to protect a worker to whom the family had become ‘too close’.  The managers then declared that even if given, the permission was invalid because it was in an improper format and from a parent insufficiently informed to understand the ramifications.  The parent was incensed:  “Are they trying to say I was too ignorant to give permission, or just too stupid?”

What seems to have riled the heid high yins of the Trust, is that an ‘unqualified’ parent and a lowly healthcare assistant trespassed on their fiefdom by daring to take part in decision-making with school staff, but without deferring to, and involving, the almighty expertise of the health management.  Things which tend to support the idea that management took a hissy fit include the conduct of the disciplinary investigation and the disciplinary panel.  An ‘independent’ member of management – i.e. a manager out of the worker’s direct line of reporting – was charged with investigating and reporting on the incident, but:

– Did not follow agreed procedure;
– Did not consider the legal and practical responsibilities of, and limitations on, the health worker in school;
– Failed to seek evidence from the school staff and school management;
– Did not refer to, never mind place any weight on, the parent’s responses to the managers;
– Cited the one clause in the worker’s contract that could be construed as requiring supervisory oversight during risk-assessment, while ignoring several others that mandated routine independent risk-assessment and joint working with education staff;
– Ignored the provisions of the child’s care plan, which required the worker to risk-assess;
– Accepted, without any supporting evidence, management assertions that there was a risk referral system (there wasn’t, and never had been);
– Refused to accept, despite supporting evidence, that permission had been given and suitable risk-mitigation put in place;
– Took no account of customary practice; and
– Did not seek to check that delegation, training and supervision had been set up and delivered as claimed by management (they weren’t, and hadn’t been for some time).

In spite of all its faults and omissions, the worker was found on the basis of the investigation report to have committed gross misconduct and the severest sanctions were applied.

The worker, together with the Union representative, did huge amounts of work to find evidence to refute the allegations.  Some of the school’s other healthcare workers had been interviewed by the investigator.  All mentioned that the worker was known to have a high reputation, but each agreed, with some or with marked reluctance, that the worker’s conduct might be blameworthy in the scenario as described by the interviewer.  When the Union rep contacted the co-workers to ask if they would be prepared to give evidence in person about the qualities of the worker and their understanding of the scenario, they all refused.  All seemed to be fearful about what might happen to them if they spoke up.  The Union rep then contacted the parent, and on hearing what was happening, the parent volunteered to act as witness for worker, to state that valid permission had been given for the activity.  The Union rep – also a Trust employee – subsequently mentioned having been the recipient of pointed remarks from managers on the subject of being overzealous in trying to find staff witnesses, although according to the rep, no pressure to appear had been put on anyone – they had merely been asked, and any refusals accepted at face value.

At the hearing, the parent was told, dismissively, by member of the disciplinary panel that even valid parental permission and school risk-assessments or management plans did not override the health worker’s duty to determine suitable activities and prevent ‘unsuitable’ ones.  The parent was stunned and asked the panel, “When did Trust personnel take over my responsibilities?  When did my child become a looked-after child?”  The only response was huffing and eye-rolling.  The school staff who had also volunteered to come, as witnesses to the risk-assessment procedure, seem to have been similarly rudely treated; apparently there was much fury and a few tears of outrage in the anteroom after evidence had been given.

In the end, it was the school’s risk assessment trainer – a very senior healthcare professional who is now an independent consultant to settings that care for children with complex medical needs, and who, like the education staff, had volunteered as a witness – who gave the evidence for the worker that tore to shreds the allegations, the management’s supposed superior risk-assessment capability, and the way the healthcare workers were managed and (un)supported when working with the child in school.

Once all the substantive allegations had been disposed of, the management seriously considered changing the accusation and disciplining the worker for ‘risking the Trust’s reputation’.  The parent threatened to go to Press and allow the public to judge precisely who had put Trust’s reputation at risk, pointing out that it was the child who had been at significant risk, and from the actions of the Trust, not the worker.  After disciplinary proceedings were begun, and the worker removed from duty, the parent had been left without trained cover for lengthy periods of time and on several occasions had had to stay awake to the point of dangerous exhaustion, in order to provide the round-the-clock observation and care that the child must have.

After all this malarkey, family is now so distrustful of health service management that it is embarking on the personal budget route for the child’s future care. And an excellent healthcare worker – the most capable, conscientious and trustworthy, says the parent, of all who have ever cared for the child; one who cares not just for, but about the child – has been off work for the best part of a year.

I wonder if that ‘not just for, but about’ is the nub of the problem.  ‘Caring for’ is a professional activity: seen as regulated, neutral, dispassionate, cerebral, theoretically-based, rational, considered and orderly.  ‘Caring about’ is unprofessional: therefore unregulated, involved, emotional, visceral, practically-based, instinctive, reactive and messy.  It can’t be reduced to spreadsheets and tick-boxes, it can’t be fitted in to predetermined slots.  It spills over, like life, like laughter.  It doesn’t respect professional pomposity and it threatens professional power.

As such, it is dangerous for professionals to listen to the voices of those who ‘care about’ – mostly, but not exclusively, family – unless they are prepared to give up their power and thereby risk their professional status and, potentially, the income that derives from it.  Even worse is to suggest that other professionals besides one’s self should listen, as that threatens whole swathes of professionalism.  The safe thing to do, professionally, in a status-defined field of work, is generally to keep schtum oneself, and suppress anybody else who looks ready to speak.

Selective hearing and elective mutism work fine as defences for power, until power comes up against someone who has so little of it that they have no stake, no interest in maintaining the power structure and are happy to kick the supports away.  Striving to maintain the appearance of power then becomes less a method of defence and more one of shooting yourself in the foot.

The parent in the story above is going to walk away from the power-game with the budget-ball, leaving a reduced service that will probably, eventually, need a reduced number of managers.

The health worker was so pulverised by the spitefulness of the way the disciplinary was handled, and the threat that over a decade’s dedicated work would be utterly obliterated by what was basically managerial arse-covering, that all the energy and thought that had previously gone into work was redirected to building a defence case, with results that must be deeply uncomfortable for all in the Trust hierarchy.  What’s more, when that worker is back in post, it is pounds to pennies that they are not only going to do everything by the book, but they are going to allow zero leeway for management to do things other than by the book.  In future, says the parent, that worker is going to be stamping, hard, on any toe that comes even a fraction out of line.

The school staff are not answerable to the Trust, and resented the implied attempt to impugn their conduct in their own areas of professional responsibility.  It was the school that initially alerted the risk-assessment consultant, by calling them in to double-check that education staff had in fact done things properly.  The consultant wasn’t prepared to have their training smeared-by-implication either, so volunteered for witness duty.  Although a health professional, the consultant now works outwith the NHS, so had no inhibitions of loyalty to the Trust to prevent them from doing a thorough demolition job on the execrable management case.

Everybody knows that sooner or later, the tactic of sticking one’s fingers in one’s ears and humming loudly is bound to fail.  Eventually, the elective deaf-mute will have to listen, and have to answer for their actions.  Much better to start off by listening carefully, so that you actually hear what is being communicated; and by speaking up whenever (but only if) you’ve got something worth saying.