Time is rushing on and as we approach the summer Bank Holiday, there’s no shortage of news so there’s zero excuse for the media resorting to Silly Season mode. Large numbers of migrants are still arriving here despite the government’s ‘small boats’ policy and, embarrassingly, Small Boats Week; ministers seized on what they present as a reduction in inflation but it was only prices rising less rapidly, not to mention data showing private sector salaries having increased by 16%; more evidence has emerged of creeping NHS privatization; the decision to restrict the new Covid jab to those over 65 represents further inroads into the NHS model and poses considerable danger because of a powerful new Covid variant hitting London; there’s more flak for the royals following the King’s and Prince William’s decisions not to attend the World Cup in Australia despite William being FA President; and yet more corruption, for example crony contracting for more migrant barges and Sunak and others’ investments in vaccine and other health companies bent on infiltrating the NHS.
But what has shaken the country to the core is the conviction of multiple child murderer Lucy Letby (7 babies, attempted murder of 6 more and questions still hanging over 30 more babies) following a long and arduous trial, which led to her being given a whole life sentence. Despite various suggestions being made to ensure Letby heard the victim statements and her sentence as she’d refused to come into the dock for this, these came to nothing and there was widespread condemnation of her cowardice in not facing the court. Needless to say, despite many calls for the law to be changed so that the convicted would be forced to hear their sentence read out, the government just said they would ‘look at it’ and bring it into legislation ‘in due course’. Besides acknowledging the magnitude of this tragedy for the parents concerned, attention initially turned to the ‘independent public inquiry’ to follow and again, needless to say, despite even some Tory ministers pressing for a statutory inquiry, which would compel witnesses to give evidence and swear an oath in court, the government is still sticking to the non-statutory decision. One of these is sanctimonious bore Nick Gibb (Schools Minister), who described this option as the ‘appropriate’ one which would enable parents to get the answers they needed, etc, when it manifestly will not to do that without compulsory witness attendance. A question here is, does the Minister think we’re stupid to be taken in by such a cynical line, or is he too stupid to understand this format’s limitations?
To add insult to injury, he (and others) wheeled out the same old clichés heard at such times, which should surely be a giveaway verging on the unacceptable, ie ‘lessons need to be learned’ and ‘this must never happen again’. But it does. A key quote in this whole terrible episode came from former prosecutor Nazir Afzal, who, pressing hard for a statutory inquiry, said: ‘The only time we hear ‘lessons need to be learned’ is when they haven’t been learned’. Others have also pointed to the wadges of previous inquiries undertaken, reports written, which then sit on a shelf and gather dust with no monitoring as to whether or not their recommendations have been implemented. This led some to suggest (essential, surely) that a key term of reference for this new inquiry should be an assessment of previous NHS inquiries and the outcomes of their recommendations.
What seems to have been overlooked somewhat is the terrible effect of all this on the NHS whistleblowers, who found out to their cost that fear of reputational damage to the Trust and to senior staff trumped patient safety issues. (These fears were cited as the reason for not calling in the police, instead commissioning two reviews).
It beggars belief that doctors including paediatric consultant Dr Stephen Brearey repeatedly drew attention to their concerns but were effectively silenced and not taken seriously. Listening to him being interviewed on Radio 4’s Today programme on Tuesday, I was struck by how natural, straightforward and convincing he sounded, compared with the cynical wordsmithing we’ve become familiar with from politicians and staff in executive positions. Amongst those who were guilty of the silencing are three seniors (and this is a common syndrome) who moved around the revolving doors NHS, one of whom now having been suspended from their current post and three who retired, one now living in France. It’s these people who should be compelled to give evidence and if they are found guilty of criminal acts they could be liable for the loss of their generous NHS pensions.
The one recently suspended from her current role (Director of Nursing for Rochdale Care Organisation, part of the Northern Care Alliance), Alison Kelly, former nursing manager at the Countess of Chester hospital, has tried to turn the blame on Dr Brearey, and the former CEO, Tony Chambers, extraordinarily, instructed senior doctors to write a letter of apology to Letby on 26 January 2017 for repeatedly raising concerns about her. The apology was ordered on the basis of two external reviews, which executives felt exonerated Letby. But neither review was designed to examine whether she, or any other member of staff, was responsible for the deaths and both recommended that several deaths be investigated further. The fact that these ‘reviews’ failed to address the key issue so reveals the culture of pushing the problematic under the carpet. One of the mysteries of life is surely how those culpable of such strategies think they will permanently get away with it. Letby was only arrested and suspended by the hospital in 2018, three years after Dr Brearey had first raised the alarm.
This (from Dr Brearey) was the Independent’s quote of the day on Wednesday, reflecting an appalling state of affairs:
| ‘I think our experiences aren’t uncommon in the NHS, that you go to senior colleagues with a problem and you come away confused and anxious because that problem is being turned in a way in which you start to realise that they’re seeing you as a problem rather than the concern that you have’. https://tinyurl.com/47au7jh7 |
Remarkably quiet so far have been the usual NHS and satellite organizations often called upon by the media to give their views, namely the CQC (regulator), the Department of Health and Social Care, NHS England, the NHS Confederation, NHS Providers and NHS Employers. They should be summoned to give evidence on various issues including the fragmentation of the NHS, which has led to damaging competitiveness between trusts, the culture of secrecy, blame and bullying, the promotion and protection of managers known to be ineffective and the clear disrespect for expert clinical staff. Remember when Michael Gove famously said ‘I think we’ve all had enough of experts’? This appalling attitude has filtered down from the government into various areas and professions and now we see the results of that. In my view Letby’s parents should also be called, since, extraordinarily, they had threatened the Trust with referral to the General Medical Council if Lucy was not reinstated on the neo-natal unit she had been taken off. What on earth were the parents doing getting involved? It amounts to unacceptable infantilisation and interference.
Education Minister Gillian Keegan has now joined those rightly saying that NHS managers and executives should be regulated and held to account in the same way that clinicians are. Absolutely right, but how does she think this could ever happen under her government, with its ideological aversion to regulation of any kind? You also have to admire her irony bypass, because, as we’ve found so often in recent years, MPs aren’t regulated or held to account either.
This case raises so many issues besides those immediately in front of us, for example the quality of managers and executives across the entire workplace, quite a few of whom are inadequate, bullies or worse, yet somehow get to ascend the greasy pole. Having spent most of my working life in the public sector including the NHS, I have witnessed (and suffered the effects of) numerous examples. In some organizations it seems customary to promote people for their technical ability and malleability, despite their lack of people skills. In others (a more frequent syndrome, probably) those who ‘get on’ are often those prepared to compromise their principles, perhaps even abandoning their moral compass, to bully and harass to get results and to curry favour with those in positions to help them advance. Some time ago it was suggested that the lack of management education in this country was at fault, that more should have MBAs as they do in the States, but I don’t know whether this qualification in itself is sufficient to enable good managers.
The confusion, secrecy and alleged incompetence surrounding the thefts at the British Museum (chair is one George Osborne) further bear out the evidence of inadequate management across the board, some suggesting that the right people aren’t selected to head up organizations. What’s the betting many are selected via cronyism and for their potential for colluding with cover-ups, should they be required.
It’s really worth reading NHS commentator Roy Lilley’s piece on the Letby case, which analyses the causes and what needs to change. ‘Letby is the case no one wanted to believe was true. That was the problem. Along with the un-holy trinity of cognitive bias, confirmation bias and group think. … Reputation management is upmost in most managers’ minds. The first whiff of a problem… the instinct is to circle the wagons.
Don’t let NHSE’s regional apparatchiks anywhere near it. Keep the press away and heaven forfend… the police’. You can see the abdication of responsibility in several areas. The Chair at the Countess, at the time was Sir Duncan Nichol, former boss of the whole NHS. He says the Board was misled by managers. I say, it was the Board’s job to ensure they were not misled by managers. Ask; why, what, really, show me, prove it, tell me again, how, if, what about? A Board is not a showcase or a club. It is an engine room, a test bed and a proving ground. Put those three killer components together and you can see why it is; all the ‘speaking-up’ guardians, red-flags, Patient Safety Incident Response Frameworks, well-led frameworks , medical examiners and never event blah, blah will never trump human behaviour’.
It’s also worth reading this one, as a picture of the revolving doors NHS, a syndrome lending itself to the creation of then moving from messes or, in this case, disasters. Chief Executive Tony Chambers ‘resigned from his £160,000-a-year role in September 2018, three months after Letby was arrested, saying the past months had been “particularly challenging” and it was the right time for the hospital “to focus on its future and for me to explore new opportunities and the next stage of my career”. He went on to work for several other NHS trusts as interim chief executive after leaving the Countess of Chester hospital’. That piece of management-speak about exploring new opportunities is very telling. What comes across very strongly with the chronologies of all these five executives are the long delays before taking action on concerns expressed to them yet the speed with which they subsequently leapt to blame others. Not to mention benefits accrued during those journeys: we’re told the former medical director retired on a pension pot of £1.8m.
The NHS management organizations might have been quiet during the immediate wake of the Letby trial conclusion, but, as so often, organizations like NHS Providers are brought forth to comment on NHS issues in general and strikes in particular. This was the case on the Today programme, as another consultants’ strike started: Sir Julian Hartley, head of NHS Providers, said that the ‘ongoing impact of disruption means waiting lists are likely to rise’. No sh*t: you or I could have said this. As discussed above, the Letby case has focused more attention on the rise, in recent years and facilitated by this cronyism government, of well-educated managerial types with little hands-on experience rising up organizations, moving around and no doubt cultivating influential contacts. Questions were asked this morning as to what Hartley’s qualifications are, one listener tweeting: ‘We can see why Sir Julian Hartley has his job. Ability to deflect and dissemble without providing any answers. Prime committee fodder.’ Another said: ‘Hearing the interview with the NHS boss on Today makes me think we need a rethink about who we place in leadership positions of organisations. Are we really hiring the right sort of people into these roles simply because they’ve lucked into senior management roles in the past?’
Following Cambridge, Durham and an MBA, we’re told his career in the NHS began as a general management trainee, before working in a number of NHS management posts at hospital, health authority, regional and national level. This sounds to have been a vital element in his advancement: described as a ‘highly experienced leader’ he was invited in 2019 by Dido Harding (of Track and Trace infamy)Julian Hartley to lead the new workforce implementation plan for the NHS. He was then knighted in the (2022) Queen’s Platinum Jubilee Honours list. The media should be thinking much more carefully about whom they invite onto ‘flagship’ news programmes because their contact books can be remarkably narrow and predictable.
Meanwhile, Rishi Sunak is back from his long holiday in California but appears to be running out of steam fast. His robotic repetition of the first answer he gives in media interviews regardless of subsequent questions suggests he’s not had his batteries changed. And he still hasn’t taken action on Nadine Dorries, still squatting on her Mid-Bedfordshire seat (and its salary and those of her daughters) while doing zero work in that constituency. Dorries says she won’t go until she gets an explanation as to why she didn’t get the peerage. Good luck with that as she has no entitlement to one. But is Sunak intending to allow the status quo until the next election? That’s a lot of public money wasted. He’s increasingly seen as a weak caretaker prime minister, though he’s hardly taking care of anything except his own interests and those of cronies. The Guardian’s John Crace captures the situation: ‘…At best, the country was totally indifferent to his efforts. At worst it was hostile. Now he was reduced to ever more meaningless photo ops with people bewildered to know why he was there. It wasn’t as if he had anything new to say. How much longer could he go on announcing things that were probably never going to happen? Even he could see he was at his best when he was doing nothing. The invisible man’.
Amongst other things Sunak is under the microscope for yet more corruption and conflicts of interest. It’s been known for a while that he broke parliament’s code of conduct by not declaring his wife’s shareholding in a childcare company benefitting from government policy but no action was taken (no surprise there) because the breach was said to be ‘inadvertent’. Not to mention the involvement of Tory donors in migrant barge procurement.
But there are more examples, such as a private healthcare firm handed a government contract to reduce regional NHS waiting lists being linked to a No 10 policy adviser. Bill Morgan, a founding partner of the PR and lobbying firm Evoke Incisive Health (EIH), joined Downing Street as a health policy adviser last November to help drive through NHS efficiencies.
‘InHealth, a fee-paying client of EIH when Morgan was a founding partner, has since been awarded a contract as an independent sector-led diagnostic centre, to run the south-west network…. Morgan is also a member of the elective recovery taskforce (ERT) convened by the health secretary, Steve Barclay, to cut waiting lists’. Although we’re told ‘Morgan no longer works for Incisive Health and has no financial connection or continuing interest in his former employer or InHealth’, this doesn’t alter the position which pertained when the contract was awarded.
It’s no surprise to know that the NHS had already increased use of the private (often euphemistically called ‘independent’) sector by more than a third since April 2021 and it seems these community diagnostic centres are a good example. There are more than 100 across England but of 13 more to be launched, 8 will apparently be run by the private sector – NHS privatisation no longer by stealth but in plain sight. The one near me, opened by Therese Coffey during her very short stint as Health Secretary last October, certainly doesn’t work as effectively as it might: GPs didn’t know about them, or understand the key facts as to how they worked and the wording on the CDC leaflet is confusing. Effectively, despite being billed ‘walk in’, they aren’t, unless you want to wait two hours for a blood test. I drew the attention of the overarching NHS trust to these issues and they just said GPs had been informed, etc, but it seems no checking has been done to see if there’s effective communication between the CDC and primary care and that includes the local Healthwatch.
More broadly re the NHS, ‘in the past two years, private equity firms have struck 150 deals for UK healthcare companies, according to figures reported by the Financial Times. These firms have bought up ambulance fleets, eye-care clinics and diagnostics companies. Last month, it was reported that one such firm acquired a staffing agency that employs NHS doctors and nurses, betting that the painful backlog of rescheduled appointments will be good for business’. The title of this article by Hettie O’Brien gets it in one: ‘Private equity has its sights on the NHS – and with it our faith in public services altogether’. It’s worth reading the whole thing, which explains what private equity firms actually do how they came about and, alarmingly, the hold they now have over our health and care services and, of course, it’s all about cynical profit making from vulnerable people. ‘When high-octane finance starts moving into hospitals and nurseries, it’s a morbid sign that other opportunities for productive investment have been exhausted. Rather than financing new ideas, investors are capitalising on the basic necessities of life’.
‘Under the guise of reform, politicians have broken the NHS up into smaller pieces like Lego bricks, creating new opportunities for private providers to step in. The lines between “private” and “public”, “citizen” and “consumer”, have become so scrambled that it is difficult to tell where one ends and the other begins’. And, of course, the confusing blurring of these lines is part of the overarching cynical ideological strategy. I find it extremely worrying that, by the time of the next election, this process of undermining and breaking up the public sector will be so much advanced, perhaps so much so it will be difficult for these private inroads to be rolled back.
One of the latest examples is the absurd and false economy decision not to provide Covid jabs to the under 65s, forcing the concerned to ‘go private’, those companies often having links to the Conservative Party. The timing is even worse because a dangerous new variant has been found in circulation, and with many more unvaccinated people this could spread even faster as we go into autumn and winter. But it could be even worse than that as we’re told the private vaccines won’t be ready for the autumn booster programme. ‘A UKHSA (UK Health Security Agency) spokesperson also told the Times: “We have spoken to manufacturers we’re in contract with and made it clear we won’t prevent them initiating a private market for Covid-19 vaccines; rather, we’d welcome such an innovation in the UK. As far as we’re concerned, the ball is in the court of the manufacturers to develop the market with private healthcare providers.” What kind of unregulated mess is this?
As we reach the height of the traditional summer holiday season, news of unreliable airlines, heat and fires in Europe and elsewhere, strike-bound railways, knotty issues of second homes and Airbnbs distrupting local housing markets and sewage discharges into rivers and along coasts, it could feel that no holiday option is straightforward. Sad, then to hear (but a no surprise false economy) that the government has markedly reduced funding to the Canal and River Trust from 2027 and that the cash-strapped Youth Hostels Association is selling 20 of its 150 hostels, with question marks hanging over another 30. These places have long enabled a holiday opportunity for those who may otherwise be unable to afford it. The decision is yet another resulting from government action or inaction, eg the cost of living crisis and the post-Brexit decline in school trips from Europe.
No doubt some will be staying at home, for financial or any of the above reasons, but the trouble with that is every day perhaps being faced with jobs needing doing around the house and garden if you have one. It reminds me of an expert saying not so long ago how important it was to actually be in your garden (relaxing and enjoying it etc) as opposed to solely working on the garden. Easy to fall into as gardening jobs never stop even in a small patch.
An interesting article poses the gardening conundrum, long acknowledged as good for our mental health but also with the potential for our self-laceration. This writer is surely talking about our competitive spirits and how gardening (those endless tv programmes might not help with this!) can become performative, so if your roses or tomatoes die it must be your fault! ‘On top of embarrassment at my ineptitude, I’ve experienced anxiety, disappointment, shame and self-loathing: all the good stuff. Plus, seething envy – why does no one talk about garden envy?’
I hope you manage to have a decent Bank Holiday and keep ‘garden envy’ at bay!
Politics and mental health - the missing link? 