Persecution: Black Riders Seen in the Shire

Fifth in the Persecution Series, after The Persecution of Heretics, The Persecution of Vulnerable Adults, Harassment from the BBC to GMC, Harassment from Rolf Harris to James Coyne to Doctor Who.

On the left is a map of North Wales, on the right Middle Earth from Lord of the Rings. Tolkien based his story on North Wales geography, with the Hergest Unit based right in the middle of the Shire.

Lord of the pills

One Pill to Rule them All
One Pill to Find them
One Pill to Bring them All
And in the Darkness Bind them.

I wrote Pharmageddon in 2008. It took four years to get it published. When written it was about the state of healthcare outside the backwaters of the Shire – we seemed to have been mercifully spared. By the time it was published, Black Riders had appeared. Now the forces destroying healthcare worldwide almost seem concentrated here.

Richard Tranter’s account below gives a feel for how things were like. This was written two years ago when he left North Wales.

Richard’s story

I had an enormously positive experience as a trainee in Bangor in the late 1990s and early 2000s. At the time the service had the best functioning inpatient unit I had worked in. The environment seemed genuinely therapeutic. There was an empathy and respect for patients and staff involved in the service.

As a psychiatrist the environment was stimulating and exciting, with senior staff heavily involved in the training of junior staff and an appetite to explore ideas and innovation. Consultants had a range of styles and views, were not afraid to express them in robust debate, yet there was a cohesiveness to the consultant body that did not exist elsewhere in North Wales. It was also a service that operated safely, sensibly and within its means. I worked at all sites across North Wales, and during this period was aware how management decisions were being made, particularly in Wrexham, in a style that was not inclusive, was divisive, and with little communication. To me it seemed obvious that Bangor was the place for me as a consultant.

I greatly enjoyed my first years as a consultant. Not only was there an excellent peer group of senior psychiatrists, but also I felt well supported by the wider management. We had consistently high feedback from trainees and students. The quality of the training provided was very clear to me in my role as undergraduate organiser for the trust.

On a personal level, we built our own house in a unique location on Ynys Mon with the intention of spending the rest of our lives there.

Leading up to the creation of BCUHB (Betsi), and throughout its existence, the environment changed beyond recognition. There was a tangible sense of operating in a hostile managerial environment. My feeling is that the mental health services in Bangor were felt to be a threat due to the coherence and esprit du corps amongst staff. Every opportunity was taken to criticise and denigrate those services, even when major adverse events were occurring at other sites in BCU.

Attempts at innovation and development originating from Bangor were consistently blocked, even when these initiatives were bringing new resources into the region. I consistently faced the prospect of losing funding I had worked hard to secure because of bureaucratic hurdles within the organisation, inexcusable when the organisation was facing freezes on staff recruitment. Despite bringing new resources into the organisation I repeatedly lost organisational support myself, for instance having secretarial support taken from me and losing my junior doctor.

The inpatient team I worked with was decimated by a ward closure. They were one of the best teams I had worked with in my career. Patients were being admitted to the unit without being assessed by a doctor. I felt this was medico-legally indefensible, yet our concerns over safety were ignored. Ultimately, I was faced with the concern that as senior doctors we were working in an environment where we would no longer be supported by management if there was an adverse event. It is impossible to function as a psychiatrist in such an environment.

I was also concerned about holding senior positions within an organisation that was collapsing with increasing risks of a Mid-Staffordshire-like situation arising. The GMC places tricky responsibilities on senior doctors faced with these organisational crises, yet, our future revalidation in the UK is now heavily linked into appraisal processes controlled by these organisations.

It is unfortunate that moving to New Zealand was driven by negative forces. I wish I could say honestly that my move was driven by a quest for new experience and adventure. The move is so far working out well, and I can only fully appreciate how damaging my previous work environment was by being in a far more benign work situation now. It is still an odd feeling to interact with people in work who are happy with their jobs, happy to help you, are friendly and not expressing hostility.

Yet I feel very guilty at dragging my family away from North Wales, from the idyllic setting and quality of life we had on Ynys Mon, and selling the home we had poured our souls into. That has been heart-breaking. But I would not want to return to the work environment that has been created across BCU.

Betsi: Son of a gun

Betsi Cadwaladr was born in 1789, the year of the French Revolution. She moved to Liverpool as a domestic servant at the age of fourteen. Somehow she got herself on ships and traveled around much of the world – spending time in the Caribean but also in Sydney at a time when it was mainly inhabited by convicts.

On her travels, almost Zelig like, she was everywhere that counts. She was on the field at Waterloo, after the battle, where she tended the wounded. Either here, or on board one of her ocean voyages, she gravitated toward nursing. One of the jobs on board was to help women deliver babies. If having difficulties, they were placed between the broadside guns. Although there are unlikely ever to be controlled trials of this approach, firing a cannon seems to have been a reliable way to bring on labor – giving rise on the way to the phrase Son of a Gun.

Having been at almost every major historical event, Betsi ended up in the Crimean War in the 1850s, where she found Florence Nightingale a prissy pain in the neck – too much focused on ticking boxes and not enough on caring for people.

You’d have to wonder what she would make of Betsi Cadwaladr University Health Board (Betsi – BCUHB).