Persecution: Was Collective Narcissism Mordor’s Problem?

This is the Sixth 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, & Persecution: Black Riders in the Shire. This completes the scene setting. Next week the posts will get down to the gritty-nitty.

The Shire – Bangor – is to the North West of North Wales, Middle Earth while Wrexham is to the South East.

Pesky Hobbits

Betsi Cadwaladr University Health Board (BCUHB) involved a take over of Bangor by Wrexham. Before the take-over Wrexham was running a serious deficit and was in all kinds of trouble, Bangor was running a surplus. The take-over involved Wrexham management replacing Bangor management thoughout North Wales. After the take-over, Betsi ran a huge deficit and ended up in special measures with its CEO and Chair dismissed and many board members replaced.

Two years ago in the wake of protracted discussions about the management of the mental health Clinical Programme Group (CPG) within Betsi I ended up taking out both Grievance and Raising Concerns Processes. The Grievance and Raising Concerns actions were, I would say, sabotaged. This led to a meeting with Geoff Lang, then Acting CEO of BCUHB while the Betsi Board was falling apart.

At this meeting Geoff raised the fact that there were Board level concerns about the operation of the mental health services in North West Wales, in the Hergest Unit, and these concerns were driving the processes instituted by the Board that I was unhappy with. But Mr Lang was unable to say what these Board concerns were.

I had been hearing Wrexham complain about Bangor since coming into my post 24 years previously, even when, and perhaps particularly when, the services in Bangor were manifestly superior to those in Wrexham.

What’s going on? (This post was written eighteen months ago).

The wild men from the mountains

My initial experience in North Wales, from 1990, was as part of an all North Wales Academic Department that had inputs from Wrexham and Bangor. I was based in Bangor. When the first Director, Greg Wilkinson, Wrexham based, left in 1992 I found to my astonishment that my appointment in his place was violently contested by Mabel Tannahill, then the lead psychiatrist in Wrexham. The ensuing disputes dragged on over several years.

The University Department had been based in the center of North Wales. The disputes resulted in Wrexham splitting the University Department in two and removing their posts to Wrexham.

At the time (1995) Wrexham were hoping to create a University. Several key people saw University Office in their future, while Wrexham Council were persuaded that a University would be a money-spinner for the area.

Around this time, a meeting with the then Professor of Medicine in Cardiff, Les Boriseyewich, stated publicly at a meeting that when he as the Professor of Medicine in Cardiff was approached about academic positions in North Wales, he was told by the Cardiff hierarchy that “we only deal with Wrexham – we have nothing to do with the Wild Men of North West Wales”.

DeChallenge

After the Academic Unit was eviscerated, the Western part came under the aegis of North West Wales Acute Trust (NWW) based in Bangor.

I had no close relationships with the NWW CEO or Board members. In general, relationships were arms’ length, but there was a feeling that there were people there to consult, who were pleasant to deal with, and who were not obstructive. They were not the enemy. There was no sense of the micro-management that has been so prominent since the formation of BCU.

Within NWW’s mental health directorate, my relations with the clinical director, which had once been close, were distant after he entered management. This was appropriate. There was certainly no basis for anyone to point to cronyism or favoritism of the kind that now seems almost endemic to BCU.

I chaired the consultant group and there were no significant arguments with management. There was a sense we were all on the same page on how to treat patients and develop services, and as with NWW management in general no sense of micro-management.

As Richard Tranter’s account shows, many of the consultant staff who worked in Bangor during this period or trained there and later became consultants describe the workplace as one of the most exciting and congenial they ever worked in. The case conferences were close to un-miss-able. The level of debate at case conferences or in other settings was likely better than anywhere else in Wales.

Trainees were keen to be placed in Bangor. Bangor trainees when based in Wrexham were seen as bringing a more questioning attitude and many of them found that this attitude was not welcome.

ReChallenge

My first re-encounter with the Wrexham bias was as University representative on a consultant psychiatrist interview panel in Wrexham for a number of consultant posts.

The Chair of the panel was Michael Williams, then Chair of the North Wales Health Board. Before the interview started he made it clear that the mental health services in Wrexham were of sterling quality but that those in Bangor fell short of Wrexham standards and that something would have to be done to bring them up to standard.

This was at a point when by any reasonable reckoning the services in Bangor were superior to those in Wrexham. NWW had a track record of having all consultant posts filled and having arguably the best staff in Wales. Hergest had the lowest rate of bed usage in Wales, fewer SUIs than elsewhere, and a track record of having led on a range of innovations from community mental health teams to patients being copied in on correspondence. Sarah Watkins of Welsh Government later described it as possibly the best service in Wales.

For many years the academic program in Bangor attracted Nobel Laureates as lecturers and the research footing of the psychiatric department had grown and attracted in several international stars.

A few years previously in contrast, the Wrexham component of the North Wales training scheme had come close to being shut down by a Royal College of Psychiatrists accreditation team. Wrexham had a large number of locums in consultant posts. Its academic base had disintegrated.

My reaction at the time was to feel as stung as you might at a social gathering exposed to gross sexism or racism. It was difficult to walkout as an interview was just beginning.

This incident speaks to an attitude continuous with attitudes from the 1990s.

My subsequent experience of BCU has borne out this initial impression. From the start there has been no meeting of either minds or people. I had never met a member of the current BCU board before meeting Geoff Lang.

Neither I nor any of my colleagues have had any sense of being on the same page as management. Micromanagement has become the order of day with staff being told how they have to do things by clinical managers (either medical or nursing) whom we view as much less clinically competent than we are.

The management has been almost entirely Wrexham based. And in a range of forums, Wrexham management have expressed the view that things are chaotic over in Bangor.

Repeated requests to managers at all levels to provide justification for this view produce nothing.

Reviews have been imposed on Bangor – on what appear to be trumped up charges. For instance 3-4 SUIs have been noted – many of which can be traced to management failings rather than service failings. In contrast, in the same period there have been double the number of SUIs in Wrexham but, as in failing hospitals like Mid-Staffordshire, these have been dismissed as stemming from better reporting than elsewhere in North Wales and have not led to reviews.

As a result Bangor has lost some of its best staff. All others – bar one – have applied for jobs elsewhere or wished they could leave. Almost all senior nursing staff, some of whom had never taken sick leave before, have taken time off citing bullying as a significant reason for their leave. Rates of sick leave across BCU were double what they were in Bangor but Bangor has caught up.

The situation can be described in terms of mass constructive dismissal.

Collective narcissism

A service or institution can take pride in real achievements. This forms the basis of Harvard and Cambridge’s estimation of their own merits. A certain amount of narcissism may be appropriate. It risks becoming unhelpful if the narcissist believes he has a monopoly on insight and merit. It is not possible for someone who is blind to the merits of others to be fraternal.

Being located closer to England, Wrexham has been able to attract from a wider range of English professionals than the rest of North Wales. Welsh government has also had to pump more money and resources into Wrexham in order to stop patients going over the border. As a result there may be areas of medicine where things have been done better in Wrexham.

Around half of all North Wales patients live within 10 miles of the English border making Wrexham feel that – even though it is eccentrically placed – it is the centre of gravity of North Wales. The political weight has usually lain to the East.

Historically also there has been a suspicion of the North West part of Wales. The town-dwellers of Wrexham have regarded the Welsh speakers living in the mountains as semi-barbarians. In Health terms, Bangor has tended to go its own way. This pattern is long-standing – it was very visible in the story of the founding of and later records of the North Wales hospital dating back to the 1840s.

Bangor may have gone its own way to some extent because it has a more distinct regional identity than Wrexham. But the suspicion this has engendered in Wrexham seems to be of a piece with the paranoia that expresses itself in the strange idea that the Welsh only start speaking Welsh when an English person comes into the room. In its full-blown “English” form, the Welsh have been viewed as immoral, lazy and ignorant and certainly incapable of running a better mental health service than “we” do.

A more pathological form of narcissism – collective narcissism – happens when someone who has been bullied or injured by another reacts with puffery and takes out his injury on a third party. In this case somewhere like Wrexham, a relatively poor and industrial town, nestled close to Chester, one of the most affluent cities in England, will almost inevitably have felt second-class.

There are two options in this case. The healthier option is to draw on the culture and resources of its hinterland. The other is to identify with the aggressor.

If they identify with the aggressor, anything good for Bangor, such as a University, will threaten the stability of Wrexham. Under BCU influence, several international academic stars who had moved here have all left. There was no attempt to encourage any to stay – linked to Bangor.

The clinical issues today are presented in terms of whether the services in Bangor are prepared to buy into Betsi and are prepared to do things in a standardized way when in fact what is really happening is that Wrexham is not prepared to dissolve into Betsi – it expects to run it.

Postscript

Many years after 1995 above, a university was set up in Wrexham, Glyndwr University. At the time of writing this post, two years after writing the content above, Glyndwr University is mired in scandal and questions as to whether it will survive.