Random Investigations

I’ve been following the NMC fitness to practice hearing into the conduct of the nurse from Winterbourne View who broke the jaw of one of the patients. The outcome was so utterly depressing as the panel decided that the nurse was able to continue practicing in the nursing field. Steve Scown from Dimensions has written a cracking post on the subject:

What is the point of the Nursing and Midwifery Council?

There are two other ongoing investigations by professional bodies as well. Next week sees the resumption of the GMC hearing into Dr Valerie Murphy, the responsible clinician for Connor Sparrowhawk. The way the hearing has gone so far, it is impossible to predict what the outcome might be.

Last week also saw the HCPC held a hearing into the conduct of the social worker, Linda Fraser. Ms Fraser had been found by the Judge in a Family care proceedings case to have altered care records to present the parents in the case in a worse light and to have lied about the matter in court. She is still working in the same role. Once again, the evidence at the HCPC hearing has been so removed from the court ruling that the outcome could go any way.

All these case has taken me back to the time Steven was assaulted by one of the shift leaders when he was in the Unit. I thought it then, and I feel even more certain about it now – any investigation into an assault, or even worse, a death of a learning disabled person is completely random. Despite armies of professional bodies, safeguarding agencies, the police, the matter can be investigated or totally shut down. It’s the toss of a coin. A positive outcome relies more on luck than process.

The day Steven was assaulted, he was lucky. (I can’t believe I’ve just wrote that). The shift leader turned up for work. From the evidence in his trial, it seemed likely that he was hungover from the night before. Steven was in the garden with two agency staff waiting for the shift leader before they could go out. The agency staff had no agency at all and couldn’t do anything without the say so of the shift leader. I imagine it was pretty tense in that garden. The shift leader appeared in the garden with a cup of coffee. Steven asked him when they were going out. The shift leader didn’t respond. At some point, Steven hit the shift leader on the arm. The shift leader kicked Steven three times and threw the coffee over him.

Here’s the lucky bit. The two agency staff had integrity. They phoned their manager and told her what they’d just witnessed. Another stroke of luck was that the manager was unable to contact the social worker nor the manager of the unit, so phoned the police. That meant the police arrived before any shutdown had started to happen. The shift leader and the chap he was taking over from had started the cover up and already got Steven out of his wet clothes but they couldn’t hide the cuts and bruises on his leg. Fortunately, the agency staff witnessed all this and weren’t prepared to keep quiet.

I didn’t know any of this until later that day. The social worker and her manager visited me and told me that Steven had been attacked. What they left out of the story was that the attack had been carried out by a member of staff. They led me to believe that it was another resident at the Unit that had assaulted Steven. Another stroke of luck was that about an hour after they left, I took a phone call from a policewoman, who had already started investigating. She told me that she would be interviewing Steven that evening and would I like to be present? The social worker and the manager of the Unit didn’t tell me about the police interview. Left to them, it would have happened without me.

An internal investigation started but we never found out the outcome of that. I was shown a draft copy of an interim report that was so heavily redacted it was unreadable. Thankfully, the police were more transparent and the CPS decided to prosecute. The two agency workers were the key witnesses for the prosecution. The defense was a shambles. The chief witness (the other shift leader) was late and the court clerk had to phone him to insist he appears to give evidence. The attacker made a complete pigs ear of his demonstration of how he “defended himself” and brought up stories from Steven’s past to present himself as the innocent party.

A strange thing happened at lunch. We adjourned for lunch. I could have gone home but decided to go and sit in the park and be alone with my thoughts. I nipped into Tesco to pick up a sandwich. As I leaned across the counter to pick up my egg mayonnaise roll, my hand touched another shopper. I looked up and it was the Judge. We didn’t exchange words but there was something in her glance that told me it was going to be okay.

The shift leader was found guilty and sentenced to 40 hours community service. I don’t know if his professional body took any action. I don’t know whether the internal safeguarding investigation took any action. One odd thing about sitting in court that day was the absence of any Hillingdon staff. It was like they had nothing to do with the event at all. The fact that it took place in their Unit and was carried out by their staff was lost. The whole thing was conducted in a vacuum. A Hillingdon free vacuum.

As a moving postscript to this story, when Steven came home eventually, he mentioned the shift leader’s name one day. I steeled myself to hear Steven’s version of that event. However the story Steven wanted to tell me had nothing to do with the assault and concerned something that had happened a few months before the assault. This was Steven’s story:

“N threw Steven Neary’s shoes in the garden. N pushed Steven Neary into the garden to get his shoes. Steven Neary’s socks got all muddy. N was laughing massive”.

Nobody spoke up that day.

Completely random.

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Who’s Listening?

I spoke at the National Advocacy Conference on Thursday. The organiser, Kate Mercer, delivered a great rousing opening address. She called on the advocates present to have a more collective voice. Whilst acknowledging the fine work they do on a 1:1 basis, she called for people to come together and speak out about systemic issues they encounter.

It made me think of the people in Cygnet’s Cedar House that we featured in the last 7 Days of Action campaign. To different degrees they all have some form of advocacy but nobody is speaking to each other and joining up the dots and making a bigger noise. Why is nobody shouting about the inordinate length of time people stay detained in Cedar House? (We came across four people with stays between five and fourteen years).

Inspired by Kate’s presentation, I decided to change my talk at the last minute. I thought I’d change the narrative of the Get Steven Home story and frame it as “Who listened to the advocates?” I bunked off the afternoon workshop and made some new bullet points.

Steven had quite a lot of advocates during 2010. Professional and non professional. But the impact they had on getting Hillingdon to listen was negligible. Their biggest problem is they were representing Steven’s view and wishes which were completely at odds with the Hillingdon position.

What advocacy did we have:

1. Late in the day, we finally got an IMCA. Even though Justice Jackson described her report as the “first best interests decision that deserves the name”, she was ignored by Hillingdon.

2. Four Best Interests Assessors. Unfortunately they allowed themselves to be so compromised they ended up acting against Steven.

3. The independent psychologist. His report was sat on for two and a half months because he presented a different view to Hillingdon’s.

4. The learning disability nurse and the manager of the support agency. From the minutes of various meetings, both challenged the party line. And for their efforts, both were never invited to future meetings.

5. The support workers. Both Francis and Chris gave evidence in court that they were never involved in discussions and planning about Steven’s care. In fact, when Francis challenged the managers he was subjected to the most awful violence that nearly led to him losing his job and home.

6. The press and media. They were met with the usual “we cannot comment on individual cases”. Until the court case, when Hillingdon decided to use the press by issuing their press release that presented Steven appallingly.

7. 5000 Facebook supporters. They were seen as people manipulated by me to back a one sided story.

8. Me. All my advocacy was turned against me and framed as “uncooperative, passive aggressive, unable to support Steven” with questions raised about my mental stability and integrity.

The point I wanted to make in the talk was that Steven’s biggest and best advocate was/is himself. If only he’d been respected enough to be listened to then the cast of characters above wouldn’t have been needed. Let’s look at how he self advocated:

1. In polite words. Several times a day for 358 days he would say to whoever he felt might listen, “want to live in the Uxbridge house with Dad”.

2. In making plans. He would seek the help of others to get him away. The unit had a rodent problem and one day Steven asked the Rentokil man, “Take Steven Neary in your van to the Uxbridge house”.

3. In song. Where verbal requests failed, Steven drew on his vast repertoire of songs to express his wishes. He would greet the manager daily with I Want To Break Free or Sloop John B (“I feel so broke up. I want to go home”). Nobody had the imagination or honesty to hear this.

4. In behaviour. As was glibly repeated by the unit, “all behaviour is communication”, they completely ignored the obvious message Steven was communicating.

5. By escaping. When all else fails, make a break for it. As the year wore on, Steven’s escapes became more intricately planned by him.

Where Steven shot himself in the foot was with his direct honesty and inability to play the game. All the people I mentioned above, having tried the direct approach, then moved to more tactical manoeuvres. Steven can’t do tactics. So what you get is, BOOM, in your face, truth. He paid a terrible price for that. State bodies cannot handle that level of truth and their only response is shocking violence against the truthsayer. Whether it was covering up Steven throwing his broccoli in the bin or matters more serious, his truthful actions were seen as a great threat. After Steven’s nighttime, barefoot escape, the social worker dismissed it as Steven being “terribly confused”. Yet to everyone not trying to hide the truth, they saw it as Steven having the capacity to plan and execute his dream.

Steven is perfectly capable of advocating for himself on most matters.

He only needs advocates because he’s seen by the State as not quite human and is subsequently not listened to.

But when Steven and a whole army of advocates aren’t listened to, what can the collective response be?

Kate? Any of the delegates? We need you but what can you do?

 

(Not) Joining The Dots

We hear a lot in social care about joined up thinking. Joined up working is pretty popular too. It’s such a shame that not much effort goes into joining up the dots. This post is a clumsy attempt at joining the dots of a few recent social care/ ATU stories.

There have been a number of news reports about the Cygnet owned hospital in Woking. This is the place that Matthew Garnett’s family fought like mad to get him moved from as they were so horrified by how much Matthew deteriorated whilst there. This week the CQC published their latest inspection report with an horrific overall rating of “inadequate”. Please read the report below. It makes for very distressing reading though:

http://www.cqc.org.uk/location/1-131834861

The report is expertly hidden on the Cygnet website but what takes pride of place is the news of a second unit currently being built in Harrow. This new 14 bed unit adds to the existing 44 bed unit on the same site. The most recent CQC inspection report for the current Harrow Unit carried a “Requires Improvement” rating.

https://www.cygnethealth.co.uk/news/building-work-begins-extension-cygnet-hospital-harrow/

Cygnet are clearly on an expansion roll. The new Harrow Unit follows their new 56 bed hospital that opened in Coventry back in April.

Another private company currently on an upward trajectory (profit wise) are ASC Healthcare. Back in August they opened an 18 bed unit in Manchester. Now, they have announced that building work has started on a 54 bed unit in Wrexham. I don’t know about you but that seems quite an investment to me. Local commissioners have distanced themselves from the project but you know the catchphrase from A Trade in People – “If you build it, they will come….”

Wrexham Low Secure Hospital – Coming Soon

Arcadia is the huge American company that recently snapped up all the Priory Group facilities. They have are also the parent company of Partnerships in Care. You may remember Stephen Andrade, one of the original dudes from the first 7 Days of Action campaign. Stephen has been in one of the Partnership in Care units for nearly five years. Back in March, the hospital received a “Requires Improvement” CQC rating. This week Stephen’s mother, Leo, posted a very disturbing update on her petition page. A police investigation is currently taking place so it would be inappropriate to comment further than the details Leo has already disclosed. It was recently discovered that Stephen’s clavicle was broken. Clavicles don’t just suddenly break for no reason. CCT footage has shown constant use of physical restraint, which appears to be the cause of the injury. Will the dots be joined on this one? What has happened in the six months since the “requires improvement” report? Will local safeguarding take this seriously?

https://www.change.org/p/nhs-islington-bring-my-son-stephen-home-care-for-him-in-our-community-bringstephenhome/u/21700942

Perhaps the strangest announcement of the week is the news of a 22 bed unit opening in Oxfordshire. What makes this one stand out is it’s an NHS unit. Qué Transforming Care? The mantra of TC is that it is about closing beds. Building 22 new ones doesn’t make any sense. We know that STATT was closed after the preventable death of Connor Sparrowhawk. We know of Oxford families who have campaigned tirelessly for crisis support. I think they had in mind at home support or short term respite provision. I don’t think they were after another 22 bed institution.

https://www.bbc.co.uk/news/amp/uk-england-oxfordshire-41611668

The awesome Julie Newcombe expressed her dismay on Twitter and asked for the rationale behind the build. She received the following reply from Anne Webster of NHS England:

“It’s part of the overall plan to reduce the overall number of hospital beds whilst being closer to home. A secure hospital closer to home = shorter length of stay & maintains relationships with family & community easier. Closures in other regions. It’s not alternative to crisis beds which would be part of CCG (non secure services) planning as alternative to admission to ATUs  “.

I find that baffling. Do you reduce beds by building 22 new ones? Local doesn’t mean shorter stays or maintaining relationships. Steven Neary was in a unit about half a mile from his home but was still kept there for a year. STATT was just down the road from Connor’s home and we all know how difficult the Unit made it for Connor to maintain his family relationships. I can’t find any logic in the response to Julie’s question.

Hard to know where all this leaves learning disabled people and their families. As I’ve been writing this, Steven has been listening to The Beautiful South song “Hold On To What”. He likes this song because it’s got a cheeky swear word in the lyric:

“Many years of service with a smile.

Up shit creek and down the Rhine”.

The Broccoli’s In The Bin

Something rather wonderful was suggested on Twitter this morning. Inspired by yesterday’s post “The Advocacy Games”, @ChoiceAdvocacy put forward the idea that we need a new metaphor to call out the spin of social care. A 2017 version of “Hey, the king’s not wearing any clothes”. The suggestion was that we adopt Steven’s response when he exposed the lie of the Unit’s food logging system:

“The broccoli is in the bin”.

Don’t get involved in a debate with the spinner. Disengage from the nonsense. Just simply tweet back, “Lol. The broccoli is in the bin”.

There were two fantastic examples of where this response would be the perfect reply earlier. The only reply, frankly.

There seems to be a gamut of social care conferences this week. It’s impossible to keep up. I saw a tweet from one where the delegates were assembling for a “Keeping it Real” plenary. I have a small tip for the organisers – your client’s lives are very real. It’s when you come along that they become unreal. Take Steven’s Community DoL. What could be more real than a man going off to Brighton with his mates to have a swim and meet up with an old friend? Just imagine a quaint version of Quadrophenia. In the eyes of the state, that trip, because it involved support workers amongst the Brighton bathers, constitutes Steven being deprived of his liberty. Perhaps the conference session should be titled, “Turning the Real into the Unreal”.

“Lol. The broccoli is in the bin”.

A quick scroll down by Twitter timeline and another conference, another tweet: “There is a long way to go before service users and their families accept partnership working”. Oi, Mr Tweeter. Families don’t want partners. Whatever happened to Munby’s famous quote about the state being the servants and not the masters? Partnerships is such a self important idea. When these people are in their own homes and their toilet floods, do they consider themselves in partnership with the plumber? It’s making out a level of input that is far more valuable than it really is. What do we want? We want you to provide services and we want you to provide the money to pay for the support. That’s it. Off you go now. Thanks.

“Lol. The broccoli is in the bin”.

Not a day goes by without an NHS Leaders conference. They always come up with prime material for the nation’s new catchphrase. Here’s just two from this week:

A call for “Disruptive Innovators”. Or it could have been “Innovative Disrupters”. I’ve forgotten already.

How about the great and the good going through a “Leadermorphis”? Altogether now….

“Lol. The broccoli is in the bin”.

If you’re actually in the same room and hear one of these gems, you need to act out the “Lol”. Bend double. Clutch your sides. Wipe your eyes. Impersonate the laughing policeman. Much more satisfying than debating the finer points of Leadermorphis.

If the disruptive innovator gets pissed off by your collapse into mirth, just say, “Look. We’re a partnership. I see our partnership along the same lines as Morecombe and Wise. You’re Eric, the comedian and I’m Ernie and my job is to crack up at your jokes”.

All catchphrases have to start somewhere. Even Bruce had to work his “Nice to see you, to see you nice” before it caught on.

Steven is watching.

The Advocacy Games

I’ve been invited to speak at an advocacy conference next week and have been asked to talk about the various aspects of Steven’s life where I have had to be his advocate. In preparing my talk, it’s brought home again that since transition to adult services, the areas where I’ve had to advocate are the very biggest stuff of life. The foundation stones to a normal human life.

Throughout 2010 to 2011, I had to advocate for Steven’s liberty. A fight to release him from unlawful detention, with the spectre of a life of institutionalism in the future should his liberty not be secured.

Then from 2012 to 2016, the fight was to get Steven a home. From being made homeless in 2012 (again unlawfully), until finding a home last year, the fight to be heard and for Steven’s needs to be respected was relentless.

And finally, from 2013 and ongoing, I have to advocate for Steven to get the right amount of funded support to enable him to live in his own home. Although the process is easier for me now, maintaining it is a very precarious venture. A change of social worker, a change to policy, an over officious direct payments manager can cause everything to come crashing down. It’s always unexpected so you have to be in your toes at all times.

Families are between a rock and a hard place when advocating for their children. Post 18, families are considered irrelevant and are actively excluded. Their input cannot be acknowledged because that exposes the void in services. From 2012 until the very last month of our homelessness adventure, the Local Authority did absolutely nothing in helping to find Steven a home. It left me to wander down the many blind alleys of private renting. Then I was left to navigate the labirynth mazes of the council housing bidding process. It would have been completely beyond Steven on his own: it was beyond me much of the time. It was taken for granted that I would do this but having got through the maze, I ended up dismissed as just a “live in carer” on the tenancy agreement.

The State sees families as a hindrance but relies on them totally for the stuff it is not prepared to do.

How much of the advocating that I do could Steven do for himself? The answer is a fair bit if the State was to view him as a human being. If the Local Authority had a genuine committment to human rights and the Mental Capacity Act, Steven’s voice may be a little more respected. Unfortunately we live in times where what should be positive legislation for learning disabled people is manipulated or ignored to serve the State’s hidden agenda. Lack of capacity is assumed; best interests decisions are contrived and violent repercussions are never far away for the learning disabled person who inadvertently exposes this.

Long time readers of this blog may remember the food recording story from Steven’s time in the Unit. The social worker had decided that I used food as a means of gaining Steven’s compliance. She kept boasting of how they’ve turned Steven’s diet around. I saw one of the logs and said to Steven, “Well done mate. You ate steak and broccoli last night”. He replied, “Just the steak. Threw the broccoli in the bin”. This honest answer from Steven had terrible repercussions. It exposed a lie: they recorded what they dished up, not what he ate. But because the lie couldn’t be admitted, Steven and I were severely punished for exposing it. The point of retelling the story is that revealing the kings new clothes of services is a tightrope that has to be precariously walked whenever there is some advocacy that needs doing. It’s horrid because it leads to full strength incongruence.

The truth is there are many areas of Steven’s life where he is capable of advocating for himself if he was afforded the respect of being listened to. Because he’s not, I have to step in. I’m rarely listened to either but I can play a tactical game that Steven wouldn’t be able to. I can study the law to firm up the ground I stand on.

So let’s give family advocates a bit of latitude. I don’t want credit. But I don’t want the lie that I’m irrelevant either.

Without me advocating out of love and duty, none of those three foundation stones of Steven’s life would be in place. Nobody from the State would be bothered.

Old Dreams: New Days

Yesterday, I stumbled across a ghost. It was me.

In preparation for my return to the gym today after a five year hiatus, I’d slipped down an Amazon wormhole. I’d only gone into Amazon to buy Steven the new Benny Anderson CD for Christmas. (I do think it’s wonderful that a man in his late seventies has managed to get primetime TV advertising for his latest album). Anyway, whilst there I thought I’d check out the gym gear and came away with some boots, three pairs of workout bottoms and five sweatshirts. It’s been an expensive few days as I’d already done a bulk Holland and Barrett order on Friday.

My other job for the day was sorting out our online photo albums. Steven loves looking at them but has an uncanny knack of moving photos from one album to another. It was while sifting through the Somerset 2011 holiday collection, I saw the ghost. It was a photo of me taken at the end of a three month bulking session. The biggest shock was that it was taken 10 years ago in 2007. I know it’s a sign of getting old and time speeding up but I thought it was more recent than that.

I remember the plan well. My trainer at the gym had the idea that I should enter a bodybuilding competition. I was 48 at the time and he was convinced that with two years hard work, I’d be more than ready to enter an over 50s contest. I wasn’t convinced at all but he persuaded me to try an experiment – to do a three month bulking programme so that I could see what could be achieved. I had to follow his every word – train how he told me to train; eat what he shoved down my throat. And much to my surprise, in amongst the pain, I actually found myself enjoying the experience.

I got much bigger than I was in the photo but we never took any more snaps. I never did the competition. I damaged my shoulder in 2008, so everything got put back a few months. Then one day he came into the gym with the flier – an open bodybuilding show in High Wycombe in April 2010. A month after my 52nd birthday and a passport to the Masters category.

Regular readers will know where the story is going by the date. In the midst of my contest prep, Steven was taken off to the ATU. And that was that. My mind went. I couldn’t find time for the training as I was in and out of multi disciplinary meetings. The times I could have been devoting to a monster leg workout, I was having to have a monster phone workout, trying to find a solicitor. By the summer, I’d stopped training altogether. I was exhausted from the fight and had no energy for anything else.

I did go back to the gym when Steven came home but six months later, Whistler’s Mother pulled another stunt and cancelled the contract with the support agency at a moment’s notice. For two weeks I had no support at all and couldn’t go anywhere – work and the gym went out of the window.

Fast forward 10 years from the photo. This is the little seed that got planted in my head yesterday. “You missed out on the over 50s. How about you aim for the over 60s?”

After all, if Benny Anderson can still do what he loves and does best at 77…..

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Transforming Care with Brian The Snail

I don’t know about you, but for me the word “Transforming” conjures up pictures of something dynamic taking place. Action. Movement. Things significantly better afterwards than before. You hear the word a lot on TV makeover programmes – “With the help of Gok’s team, Brenda was transformed from a 50 year old frump into the classy woman you see before you”. It’s very much a word of our times.

The NHS Transforming Care programme can claim none of the above adjectives. In terms of dynamism, it is less Gok Wan and more Brian the Snail. There is no sense of urgency. Nobody seems particularly bothered about the appalling human stories behind the bland statistics. It has become another uninspiring bureaucratic exercise.

NHS Digital publish monthly stats. The pace of change is glacial. The human tragedies rendered meaningless by the endless sea of figures. As you plough through the spreadsheets, it is impossible to retain the truth that the pages contain the daily realities for 2460 human beings.

Here are the lowlights of the August report. To demonstrate that Brian the Snail is truly in charge, I’ve compared the latest figures with the March 2017 figures.

But please remember these figures tell the story of Eden Norris, Tony Hickmott, Tianze Hi, Stephen Andrade, Pete Lawton, George Bartzis & 2454 other human beings.

Total number of people in LD in-patient services:

August 2017 = 2460        March 2017 = 2595

Length of time in services:

1 to 2 years = 295

2 to 5 years = 650

5 to 10 years = 520

10 years + = 360

Distance from Home:

Less than 20km = 630

20 to 50 km = 475

50 to 100 km = 440

100+ km = 560

Unknown???= 350

Top Ten Private Providers of in-patient beds (current patients):

Partnerships in Care: March 290 – August 270.

St Andrews: March 210 – August 195

Cambian: March 150 – August 140

Huntercombe: March 90 – August 100

Danshell: March 90 – August 95

Priory: March 70 – August 80

Cygnet: March 80 – August 75

Lighthouse: March 60 – August 60

Jeesal Akman: March 40 – August 40

Cheswold Park: March 25 – August 25

Top Ten Commissioning Areas:

Cumbria & North East – 210

Cheshire & Merseyside – 140

Greater Manchester – 120

Lancashire – 100

Black Country – 95

London South East – 90

South Yorkshire – 85

Kent & Medway – 85

Birmingham – 80

London North West – 75

One final statistic. 740 human beings included in the total 2460 currently in in-patient services are classified as “Do not need in-patient care”.

Brian – pull your finger out mate.