The Hermeneutics of Victimology

The last five days has seen the first week of the inquest into the death of Richard Handley.  The inquest has been expertly live tweeted by George Julian and following the testimonies unfold has been harrowing reading. If you want to catch up on the evidence to date, follow @HandleyInquest on Twitter.

Richard died an appalling death. Constipation had been a problem from birth but his family, and latterly the care home had managed this distressing issue. Things started to go wrong when the owners of the care home deregistered its care home status and rebranded itself as supported living. The level of support that Richard had previously received dropped off alarmingly, all in the name of “independence” and “choice” but was really about saving money for the care company on that pesky thing called “care”. The “flats” became dirty as it was no longer seen as anyone’s job to do the cleaning. More seriously for Richard, his diet, which had been a mainstay in managing his condition changed as it was decided that Richard had the capacity the decide what he should eat. The rebranding was the starting point for the catastrophe that was to follow. Two days before Richard died medics removed 10kg of faeces from his rectum. That was just a small amount in his body as the post mortem revealed much more had become impacted in Richard’s bowel. His abdomen was so extended as to resemble someone “40 weeks pregnant”. Richard vomited up his own faeces. In the end, his heart gave out. We hear a lot about “a good death”. This was a very bad death.

The inquest has been distressing but compelling reading. The importance of George’s work has become more and more evident as the week has progressed. We are learning things of such importance about the coronial process, the state of adult social care, the tactics that professional bodies use to subvert justice and to avoid accountability. I knew some of this stuff through my experience in 2010 and others’ since but this week feels like we now know what the template is. This inquest is so similar to Connor Sparrowhawk’s inquest, it is beyond coincidence. It is data that we must learn, absorb, pass on and use to bring about the change we need. The change to seeing learning disabled people as valuable, as having human rights, in life as well as death.

There are a number of things that families impacted by social care need to learn from the remarkable records that are being compiled. To use that old professional cliche – “lessons must be learned”.

Richard’s inquest is glaringly revealing how dangerous supported living can be when the providers have a different agenda. We know this already from the death of Nico Reed but the evidence this week shouts at us that when money saving/profit making is disguised as person centred independence, horrific outcomes are just around the corner. Barren lives lived because the care provider won’t provide enough staff to facilitate meaningful activities. Good health maintenance jetisoned because “choice” is used to disguise the truth that the provider can’t be bothered to invest in the health of their customers. Lesson one – we have to improve our laser vision. We have to see what is going on behind the person centred, independence smokescreen.

In order to achieve the above, the State and the care providers have to exclude the families. And to be brutally frank, part of the exclusion is to lie to them. Richard’s family genuinely believed that his diet was being followed. They sincerely believed that his toileting routines were being maintained. Why should they think otherwise? Lesson two – we need to think otherwise. We cannot trust that there isn’t an alternative agenda in play.

As sure as night follows day, family blaming follows the exclusion of families. In the cross examination of Sheila, Richard’s mother, the suggestion was made that the family hadn’t told the providers or monitored Richard’s diet and toilet plan. Reading it felt like Groundhog Day. At Connor’s inquest, the psychiatrist’s brief battered Sara with questions along the lines of; why didn’t Sara inform the unit that Connor needed bathtime supervision. It’s nigh on impossible for the person (the bereaved person) not to take this personally. They musn’t. Lesson three – do not be drawn into the blame game and do not take it personally. Obviously when you are under attack, the tactic has more purchase. But as we have learned through following these inquests, the name of the game for the various barristers is to shift blame anywhere than on their client. From their point of view an inquest isn’t a fact finding inquiry. It is a vehicle to avoid any accountability at any costs. Yesterday we heard the testimony of the lead GP in the practice Richard was registered with. In the space of ten minutes, the blame was shifted from the computer system, the trainee GP, Richard’s mother, the care company. It was hard to keep up. It was the most horrid game of non accountability bingo. But that is the purpose of an inquest for the professional “interested parties”.

It still shocks me to my bones, how much the Mental Capacity Act is ignored or abused. One of the witnesses said that they assumed Richard had capacity because he wasn’t disagreeing with the professionals! It became clear very early on that the and the notion of best interests didn’t appear on the radar of most of the medics involved in Richard’s care. I tweeted that I felt that in case after case, the ignoring and manipulation of the Mental Capacity Act must be wilful. It can’t be accidently forgotten about. After all, the law is over 10 years old now. A social care professional who I respect enormously replied that the professionals know their law and tend to ignore it when it doesn’t support their own agenda. This is terrifying confirmation if you have a learning disability or are a family member. The piece of legislation that is meant to protect and enable you doesn’t work unless you are compliant with the State agenda. Lesson four – know your law. You can be trusted more than the State to make a best interests decision without an unpure motive.

The final lesson from this week is utterly bizarre but led to the title of this post (Thanks to my friend Val for the title). As yesterday’s hearing was wrapping up, one of the barristers announced to the coroner that the CEO of the hospital trust who he was represented, reported that he had been “goaded” on Twitter. George was understandably horrified by this accusation & trawled the Twitter feed for any goading tweets. Unable to find any, she tweeted the CEO to ask for clarification & he replied with the following screenshot:


Can you see what the CEO did here? This was evidence from the morning session. If it was “goading” it was done from the witness box. The inference in his complaint though was very different. Does this ring any bells? How about the time that Katrina Pearcy reported that Justice For LB supporters had hacked the Southern Health account? It happened to me in court. As the social work manager took to the witness box he asked if he could make a statement before taking counsel’s questions. He announced that the social worker was absent from the court due to sickness. Her sickness being stress brought on by receiving an anonymous, threatening letter signed by “a friend of the Neary family”. No letter was ever produced to back up the accusation. Thankfully Justice Jackson gave the claim a nanusecond of attention. He didn’t mention it all in his final judgement.

So what’s the point? Nobody is taken in by these allegations. They must be dreamt up by the bodies’ PR departments. They are designed to shift the “perpetrator” into the victim position. Grandstanding for sympathy. It’s not meant to appeal to the court but to the wider audience. After all we have a strong victim culture now, so any claim of “goading” or trolling or threatened violence is likely to resonate. Job done. Lesson Five – do not engage with this game. You are being used as collateral. Just trust that the people who matter will see straight through the nonsense. It’s horrible. A well paid CEO is so brittle he needs to wrestle the Handley family from the victim position (not that once have Richard’s family played the victim card. They have far too much congruence for that).

There’s bound to be more lessons that I’ve overlooked and more to come as the inquest continues.

But we have to get a handle on all this. We’re in this for the truth; our lives. We have to understand the rules of the game that our search for truth takes place in.

15 thoughts on “The Hermeneutics of Victimology”

  1. Mark Once again, read the judgment on Martin’s case which is in the public domain. The first judgment 8th August 2017. The judge accepted evidence that Martin had capacity, and removed him from the protection of DoLs. Not a single mention of “capacity must be assumed, incapacity proven” during the whole case. It made a travesty of the whole MCA in the open court, with Martin present. It also made him a pawn in a power game which includes everything about which you write.

  2. Mark,

    and how many other victims have their been of LA’s who around a decade ago chopped up their learning disability services, and fired all their long tenured experienced community support staff ?

    How many LA’s, at the same, time popped off speedy assessments by people brought in on short tenure to slash needs and costs, to the bone,…shrink all community support to the minimum?

    How many LA’s hired, on cheapest tender, agencies with no previous experience of people with learning disabilities’ agencies staffed by poorly paid staff with little or no experience of supporting people – far less increasingly isolated people with learning disabilities ?.

    How many LA’s at he same time transformed their day services into a ‘hub; in …Witherspoon’s..,
    say ?,

    For the ‘lucky’ few…

    How many LA’s did/do no monitoring at all of agency care, other than of contract and cost ?

    LA’s – safeguarding? What safeguarding ?.,

    How many LA ,passed on all responsibility for access to health care; general, chronic and acute, to NHS. who said ……’not our responsibility’.

    How many families challenge dodgy assessments, meet all unmet community and other needs. monitor all care. anticipate and support all health care needs….and find public law support to repeatedly challenge LA;s increasingly skilled at blocking the outcome of same ?

    How many vulnerable learning disabled people – with or without family… have suffered – will suffer – – die quietly – from – Statutory neglect………..

    and much, much worse ?

  3. So sorry to read this.
    Supported Living still comes with a care plan which can say whether or not the environment must be kept safe and clean if the person can’t do it, so care plans must be absolutely clear.
    A good residential care home should be like Supported Living, etc., but these games of profit and laziness are beyond belief, leading to illness and death.
    Yes, the families do most of the work, and also die doing it sooner than they ever should. They never enjoy lazy days and are the real heroes. It’s a scandal – how can we stop this?

  4. Thank you for keeping us posted. i was unaware of what had happened to Richard Handley and to Nico Reed. Heartbreaking to read.

    I agree wholehearted with Lesson 1 and Lesson 2.

    Lesson 3 – do not be drawn into the blame game and do not take it personally – is a tricky one. The difficulty is that the point at which blame starts getting thrown at family is usually the point at which tragedy has struck, where the negligence or failures of a support provider or Local Authority or whatever has resulted in a terrible outcome, possibly the sort of outcome the family had been warning could happen all along if nobody was going to listen and improve. I think it takes nearly inhuman levels of strength to detach from the insults and not to take it personally. And that creates horrific and probably dangerous levels of stress within our bodies. Maybe we should stop standing tall and dignified when being persecuted and should let them know how personally we are taking their hatefulness? I regret how hard I worked simply to collect and control myself despite despicable vicious unprofessional treatment from a support provider and Local Authority.

    I agree with Lesson 4 although I think it is unfair we have to ensure we know law. But we do need to.

    Lesson 5 ends with “just trust that the people who matter will see straight through the nonsense”. Sadly, few of us who have suffered or whose family member has suffered distress or injury or even death don’t ever get remotely near or to speak to or to be heard by the “people who matter”. They are just left traumatised by the issue, by the covering up and failure by authorities to learn lessons or apologise or just be kind, and by being viliifed by a whole army of self-serving, blame-throwing nasty suits. If only we could get statistics to show how many people with learning disabilities are wronged/neglected/let down to huge detriment, what percentage then get to a point of meaningful and honest investigation, then how many make it to a court of inquest and how many get their story properly and fairly heard by the people who matter. Very very very few indeed. People who get their stories heard and some level of justice are extraordinary. It will have needed a combination of most of a list of near impossible things – really strong clever family member, grit, determination, luck, sacrifice, access to funding for legal action etc etc etc. Those who do get their stories out there are to be congratulated. What they have done and do is vital. But stuff is happening to people with learning disabilities. Families who speak out are being vilified and blamed. Finding our way to the “people who matter” and who have the power to right some wrongs is a difficult path not many of us can find, never mind navigate…..

    1. Kate, I agree.
      Occasionally good people do help out.
      I think as many stories as possible should be told, or collected, so things aren’t hidden. And good stories should be collected too.
      We already have the CIPOLD report as a reference.
      Doing away with advocacy services has ruined support, but we must have useful people to turn to – Lesson 4 needs a detached professional to translate for people in distress. Bad service people have a huge safety net, so lone parents need something.
      Even the bad guys have problems, so we shouldn’t let them off the hook.

      1. Thank you FF.

        For all the occasional good people who do help out, there are many more who will defend and cover up dreadful behaviour. It has become a norm.
        And the good people are being crushed if they have it in them to stand up to be counted.

        You are right that lack of advocacy is a major issue.

        I don’t know much about CIPOLD and i will take note and read reports. The horror is, though, that they only report when you are dead. Those investigations/enquiries/reports are essential (and I hope they do get to the truth and don’t leave truths hidden or families let down and further hurt) . But there are probably so so many untold stories where service has been appalling, families have been vilified and distressed and their loved one is anything between “living a pretty grim existence and/or living an OK existence but missing out on all sorts regards quality and well led services and/or has been seriously harmed.” And for many, they only discover the lengths of lying and covering up and vilifying authorities will stoop to when the crisis has happened and you are in crisis yourself. And for those who fight the system and speak out when things are bad BUT before the serious incident that has been feared hasn’t actually happened “yet”, if they discover they are being stonewalled, vilfied, threatened and bullied, they wonder why they hadn’t just accepted “grim” and kept their heads down.

        Mark is right, horrific (or even more horrific, should we say) outcomes are just around the corner.

  5. This is where Degree nursing will take us. Patients best interests don’t come into it. Care plans were just the beginning and from ones I have read to compile reports, they may just as well have been used for loo roll! The care I was taught to give may have been a little dictatorial but things got done. I have no faith left in our current care system. The experiences of my Grandaughter at the hands of staff in a hospital in Surrey, at the mercies of staff who caused injuries that were never investigated because Social Services deemed her prime for adoption. The staff stayed quiet and the parents sent to prison. If I had not witnessed the injuries being caused throughout the process of procedures done by arrogant incompetent staff I could not be so sure. So many patients are like this poor soul and my Grandaughter , wictims of the change of direction nursing and medicine have taken over the past 3 and a half decades

  6. Late to this discussion having found my way here from a more recent post. My career began in legal working with and alongside some ruthless, soulless legal professionals and almost accidentally, I sidestepped briefly into social care eventually making it my stop.

    No professional experience in LD but working in older people’s care prior to the introduction of care standards and regulations set me down the route of fighting the corner for those that had no means of fighting for themselves.

    Became a care home manager, dementia / safeguarding trainer, safeguarding practitioner and now occasionally work in special advisory compliance for CQC.

    The worst, most appalling thing reading this is the brass balls they had to think about heading down the “It’s the family at fault” nonsense.

    A care provider contracted to give suitable, appropriate and safe care to someone is responsible for that person being given suitable, appropriate and safe care. It doesn’t matter if the family says their loved one can swim the channel, take up sword swallowing or fire breathing; the provider and manager has to carry out their own assessment and determine if they can, should and it’s safe.

    It’s that simple.

    Even saying they hadn’t been kept informed, given relevant info and felt that meant some of the blame ought to be placed on families just shows the level of incompetence and highlights the increased risk of it happening again. They didn’t even see what the issue was or how absurd and embarrassing their thought process.

    I will follow these cases and others still ongoing with interest but just wanted to stop off and give props and full respect to those of you that somehow managed to keep cool and composed even when attacked.

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