For anyone bereft since Breaking Bad came to an end, this is a second installment in The Persecution of Heretics Murder Mystery series. Episode one can be seen here.
The harassment of healthcare staff has been a backburner in British news recently. There have been a series of pieces in the Daily Mail, usually to the forefront of everything in healthcare, and the BMJ. A House of Commons committee was convened to explore the issue and produced a report – here.
But what does harassment in healthcare look like?
Slightly over a year ago, some of us here in North Wales saw gob-smacking (Irish for jaw-dropping) harassment at close quarters – bullying of a kind that none of us had never imagined seeing in our careers. After the event, disguising the identities of those involved, and adding some references, I wrote up a piece for a distinguished academic journal figuring that this was something that needed to be put on the map. The journal wouldn’t engage.
Here’s what was sent to them.
Just as a job contract protects an employee, so also a mechanism for the Protection of Vulnerable Adults (POVA) sounds like good thing. Interventions to achieve just this within healthcare began to take a statutory albeit vague shape in the late 1990s with the Protection of Children Act (1999), the Standards of Care Act in 2000 and the Safeguarding Vulnerable Adults Act in 2006.
But just as Zero Hours Contracts now sound more like a modern form of slavery than a good thing, so POVA reveals itself to have the potential to become an instrument of employment terror rather than something to protect the vulnerable.
Anyone working in healthcare comes across adults who by virtue of physical or mental infirmities and social situation are vulnerable – a woman who might be mentally handicapped being possibly beaten and locked away in an annex, for instance. A POVA team comprised of up to 10 professionals from varied backgrounds may be assembled to make the call as to what to do. This is not a recipe for agreement and effective intervention. And when something is done and the woman pleads to be let back to her “home”, what then?
This is what POVA was. Here is what it could morph into.
In an average sized mental health unit, there could be a significant incident a day where someone claims to have been abused or bullied by a member of staff. There are no criteria to distinguish between real or imagined abuses. There are no criteria to distinguish between properly vulnerable patients and psychopaths, or even management plants.
Alerted to a possible abuse of a patient that might involve a member of staff, managers of a service have a duty to act quickly – long before a team is assembled.
What do you do as a manager of the service in which a complaint arises? You have to ignore almost all complaints or life would be unmanageable. And you know your friends are not capable of abuse. But you have an option to claim you have to do something in the case of any incident that offers you an opportunity to achieve a strategic goal.
You could remove from duty the person who has been the object of the vulnerable person’s complaint, or a charge nurse for the ward that day, or the matron in general charge of the ward or the manager in charge of the unit in which the ward is, or any of the tiers of managers responsible for running the service of which this is one unit, all as part of a “securing the scene of the crime” operation.
In practice you pick the person who has been most awkward. The person who may be frustrating your plans because they have voiced concerns about patient safety after drastic reductions in staff-patient ratios or procedures that are increasing risk by putting continuity of data ahead of continuity of care.
As a manager you pretty well have to march someone out of their job on the spot with no questions to answer. You invoke POVA and Hey Presto their Union will do nothing except advise the person to do nothing while any investigation runs its course. POVA is complex. No one understands any more about it than the 99% of the readers of this article who will never have heard the term before.
You replace the removed person with one of your people – on a temporary basis of course. It’s likely you are operating in an organization that has a large number of people in acting positions, filled on the basis of expressions of interest rather than open advertisement. These will all move as told but may not be able to revert to their original positions as readily should the unlikely time ever come when this is required.
It’s all too easy for abuse like this to happen within a mental health setting and this may be why it seems to have developed there. But there is no reason for such a convenient management tool to remain there. If vulnerability has no operational definition then all patients are vulnerable.
An increasing proportion of the population has some condition like ADHD or autistic spectrum disorder or is on some medication that puts them at risk in some way and they too can be regarded as vulnerable if need be.
They may be “traumatized” by an interview with a journalist or by the subsequent representation of their story. As a senior manager you don’t have to send the journalist on gardening leave – you can send their immediate superior who is responsible for them.
If this sounds as unbelievable as Zero Hours Contracts once sounded, it is time to start adjusting.
This disguised account was based on real life events in the Hergest Unit where Anne Ward and Shyam Kishto, the managers in charge of Aneurin and Cynan wards were summarily dismissed on the First of July last year within minutes of each other. Supposedly two unrelated POVA events had happened on the wards that they were responsible for, and they could not be let darken the door of the Unit until these were investigated.
For anyone who has seen the old movie J’Accuse – it was just like the moment where Dreyfus was stripped of his medals, his epaulettes and the top of his hat was punched through.
Everyone knew for months this was coming. Anne and Shyam had been outspoken on issues of patient safety. It was only a matter of how management were going to do it. No one guessed POVA.
In response to what happened thirty five nursing staff blew whistles in support of Dreyfus One and Dreyfus Two. The Health Board didn’t listen. Their medical and nursing colleagues took the issue to Welsh Government and contacted David Sissling, then the CEO of NHS Wales (now left), who intervened and had them reinstated some months later.
It turned out that there were no incidents and there was no investigation. Ward and Kishto lodged a Grievance complaint which they won in full. All the papers from this are available.
The only outcome from the Grievance appears to have been that the manager with the greatest visibility in the process – and perhaps the most dispensable – was asked to apologize. He did so. The suspicion is that managers these days have training in how to respond to statements like “Your behavior is ******* appalling” with pat words like “thank- you for this constructive feedback”. Apologies are meaningless.
For the last year Ward and Kishto have had to work at close quarters with management staff that have done this to them. This might be endurable if management behavior had changed – but there is no sign of this – just the opposite in fact.
The Hergest Unit is one of three District General Hospital mental health inpatient units managed by the Mental Health CPG (Clinical Programme Group) within Betsi Cadwaladr University Health Board (BCUHB). The mental health CPG is run by Drs Giles Harborne, Marie Savage, Alberto Salmoiraghi, and senior nursing staff including Simon Pyke and Adrian Jones. This management team are answerable to the board of Betsi.
The Grievance taken out by Ward and Kishto found comprehensively against management within the CPG. But the Betsi Board have done nothing. CPG management continue to do ever more egregious things; getting me referred to the GMC is the latest.
For those of you who like your murder mysteries red in tooth and claw, the Ward-Kishto incident gives a feel for how “thuggish” local management can get. There might not seem to be any reason to look beyond local management and a revenge motivation to explain the abuses that have been happening since, particularly, as it would seem, local management can do pretty well anything without sanction from above. But:
So what is going on? Watch this space.
“If they stop telling lies about me, I will stop telling the truth about them”. David Lange
“Cricket is the English idea of fair play – eleven against one”. Beachcomber