Week 6: Ecoutez et repetez #107days

Continuing our week exploring inquiries, today’s post comes from Chris Hatton

When I was a PhD student, the common room in the research centre where I ‘worked’ (yes, there were such things in the olden days) contained an unremarked upon filing cabinet. One idle afternoon (yes, there were such things in the olden days), out of curiosity, I opened it, to find an anti-Narnia of dusty inquiry reports. The rest of the afternoon went as I started reading through them, my shiny, unthinking bubble of an optimistic perpetual present (what history?) gradually deflating and then popping altogether. I consoled myself that this was all in the sepia-toned, bad, institutional past, though, and people with learning disabilities were on the path to a bright and better future (cue heroic socialist realist poster). As a metaphor for the history of inquiries, it’s so perfect as to be completely unconvincing.

Some quotes (and for more from recent inspections of ‘specialist’ services for people with learning disabilities see here):

  1. ‘Our investigation found that institutional abuse was widespread, preventing people from exercising their rights to independence, choice and inclusion. One person spent 16 hours a day tied to their bed or wheelchair, for what staff wrongly believed was for that person’s own protection. One man told investigators that he had never chosen any of the places he had lived as an adult’ Full report
  2. ‘The families of patients at Winterbourne View Hospital had no experience of being regarded as partners, deserving of trust and respect, or even of collaborating with Winterbourne View Hospital staff. Theirexpertise, borne of the lengths to which they had gone to keep their relatives at home and in care services, was not acknowledged by Winterbourne View Hospital. They were excluded from having a full picture of events at the hospital’ Full report
  3. ‘An unduly casual attitude towards sudden death [and] inadequate systems for reporting incidents’ Full report
  4. ‘1991: Allegations of assault. Investigations were made and evidence established, but the Inspector chose not to use the enforcement powers of the Act.
    December 1992 – April 1993: Allegations of multiple abuse. The evidence of abuse increased and the Inspectors accepted that there was a serious case to be answered. But no assessment of the risk to residents was undertaken nor were the police called in to help. Fearing intimidation of staff and residents, the Inspection Unit continued to rely on announced inspection visits.
    1993: Joint Police/Inspection Unit Investigation. There was no common understanding of the strategy to be followed. The Inspection Unit decided to take no action unless and until the Police decided not to prosecute. They failed to assess the evidence as it became available and so suspended their duty to consider whether enforcement action was needed.
    1994: The Inspection Unit Investigation. This was an extremely complex investigation for which the Inspectors had little experience. They did not seek help from the Health Authority, renew contact with the Police or use other specialist sources. Complaints about specific aspects of the care regime were never properly investigated. Social workers, families and the police were given no information about specific allegations.
    1994: Action on the Inspection Unit’s Report. The advice to Social Services Casework Sub-Committee not to take enforcement action under the Registered Homes Act 1984 to cancel the registrations in respect of the homes, as summarised in the final report which was put to the Social Services Sub-committee, did not reflect the professional judgement of the Inspection Unit’ Full report
  5. ‘For long periods of time the hospital buildings were neglected and dangerous. They were a patchwork quilt of makeshift repair and poor workmanship. The roof of the main building let in water for many years and the upper floor often had to be evacuated because rainwater poured in and it was feared that the ceiling would collapse. Patients were sometimes soaked as they slept. Buckets and tin baths littered the upper corridor…The standards of hygiene were often appalling and patients and staff alike suffered from demarcation disputes between nursing and domestic staff. Faeces and urine were frequently left unattended for days on end, with consequent risk to health and welfare of patients and staff’ Full report
  6. ‘Some individuals, as the trust has acknowledged, have suffered abuse including physical, emotional and environmental abuse. The trust’s own investigations at Budock Hospital have shown that some people using its services have had to endure years of abusive practices and some have suffered real injury as a result. For example, one person suffered multiple injuries over time, including a fractured skull after being hit by another person who used the trust’s services. Despite the development of numerous action plans, underlying problems have never been addressed and poor practice has become ingrained within the management of learning disability services and the provision of care’ Full report
  7. ‘There were examples of individual patients in Winterbourne View Hospital and their families being threatened with the improper use of mental health legislation’ Full report
  8. ‘All the male wards are seriously overcrowded. The buildings are old and ill-designed. The standards of amenity fall far short of what would nowadays be expected…The staff establishment [of one ward] is half the minimum desirable…’ Full report
  9. ‘The standard of nursing care was generally extremely low and the quality of life of many of the patients suffered accordingly. Shortage of staff at different levels was at various times a contributory factor, but it was by no means the principal cause of difficulty’ Full report

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A few observations from me. First, as the #JusticeforLB #107days inquiry timeline and Katherine Runswick-Cole’s post make clear, these successive inquiries, serious case reviews, independent investigations and inspections (46 years on from Ely Hospital now, almost as old as me!) have not resulted in the eradication of abuse of people with learning disabilities in ‘care’ services.

Second, these inquiries are clear-sighted about identifying the ‘causes’ of the abuse and poor practice reported time and again, but they generally do not try to get to what Sir Michael Marmot in a public health context calls ‘the causes of the causes’. We know that smoking causes lung cancer, but wouldn’t it be equally important to know why people take up smoking in the first place? These inquiries tell us what seemed to contribute towards abusive practices in each place, but not to address what causes these factors to recur, again and again.

The Utopia of Rules by David Graeber (see a long post on my reading of this here for a detailed expansion of the argument) struck me forcibly as providing part of an answer to this question. One of his central points is that bureaucracies can draw on (and indeed rely on) the threat of real violence for their enforcement. So, is the abuse reported in inquiry after inquiry a logical end-point, or a necessary element, of an intensely inhuman, bureaucratic ‘care’ system?

Is it also possible that the ‘failure’ of inquiries to eliminate abusive practices (and not just in services for people with learning disabilities, as this slideset from Prof Kieran Walshe makes clear) is partly because the recommendations they make are all about tinkering with these inhuman bureaucratic systems rather than seeing them as part of the problem and tackling them head on?

So, where might we go from here? Whenever I see a service really working for a person with learning disabilities, there’s always a person with a strong, human commitment to making whatever they’re doing work better for people, no matter what bureaucratic system they’re enmeshed within. Some people just seem to ‘get it’, and have the energy to bend/break bureaucratic systems to create a bubble of humanity within these systems. Why doesn’t this happen everywhere? I used to think part of the issue of ‘scaling up’ good practice was to design systems better so that good practices in a place could survive the committed person moving on. I now realise this was completely wrong-headed and bureaucratic as a way of thinking. Now I think what we need is to find, nurture and support as many ‘humans’ as we can to start to shake and dissolve the inhumanity of bureaucratic systems. A service needs to start without the bureaucratic threat of violence in its back pocket, for genuine, human relationships of trust to develop.

Sources
1, 6: Joint investigation into the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust, 2006
2, 7: Winterbourne View Serious Case Review, 2012
3, 8: Ely Hospital Inquiry, 1969
4: Independent Longcare Inquiry, 1998
5, 9: Normansfield Hospital Inquiry, 1978

Week 6: Do we need another inquiry? #107days

Here in the Justice Shed we’re quite responsive and organic in our approach to campaigning (which really means we aren’t amazingly good at forward planning and fly by the seat of our pants a little), one of the advantages of this is that we can respond to issues as they emerge. A tweet from Katherine Runswick-Cole and a blogpost from Chris Hatton stopped us in our tracks this week, and we decided to embrace the discomfort of them and make Week 6: Do we need another inquiry? week!

Screenshot 2015-04-29 11.35.53

A potted history of inquiries into abuse and mistreatment of learning disabled people in the UK follows:

1967, Ely Hospital Wales:

Conditions at Ely Hospital came to the attention of the world through the pages of the News of the World. It reported allegations of ill treatment of patients and pilfering by staff. The allegations were made by a nursing assistant at the hospital… The public outrage which followed led to the setting up a committee of inquiry…It was Howe who insisted the inquiry should go far beyond the events at Ely itself, to look at the whole system and the way in which people with learning difficulties – “mental handicap”, as it was known at the time – were treated within the 20-year-old NHS.

Nationally, the impact of events at Ely was profound. From this time onwards, the momentum to close the long-stay hospitals and to resettle patients in the community gathered unstoppable pace.

It wasn’t until 1996 that Ely eventually closed, a mere 29 years after the horrors first became known about.

Fast forward to 2007 and an almost identical scenario was uncovered at Orchard Hill Hospital in the London Borough of Sutton. Yet it took a further two years before, in 2009, Orchard Hill eventually closed, and even then some residents remained on site in bungalows awaiting purpose built community accommodation. Forty two years after Ely.

In between times, there were ‘scandals’ of abuse uncovered in Longcare in 1994 and Budock Hospital in Cornwall in 2006.

In recent times we have the Panorama uncovered abuse at Winterbourne View in 2011. At this stage we can take a look at a timeline that Sara put together to situate what happened to LB, within the ‘national outcry’ post-Winterbourne:

Sara_revised-timeline

The ‘post-Winterbourne’ era is marked by what can only be described as an apathy, everything is too hard or too complex. Everyone merrily talks about the shock and shame, hands are wrung up and down the country, and while some individuals and organisations work their socks off trying to get people out of ATUs, a larger group with vested financial interests join committees and reports, that seem to get us nowhere.

Earlier this year, in February 2015, the National Audit Office reported on Care services for people with learning disabilities and challenging behaviourA grilling by the Public Accounts Committee revealed Viv Cooper of the CBF to be just about the only person who appeared to both understand the task ahead and be passionately committed to closing ATUs now, rather than to be overwhelmed at the scale of the task or reluctant to commit. The Committee didn’t of course meet any experts with a learning disability. Our campaign responded to the NAO report with our own audit Actually improving care services for people with learning disabilities and challenging behaviour.

So the question of this week’s #107days is ‘Do we need another inquiry?’.

Day 94: Citizen Advocacy and Education Fest #107days

Day 94 is another shared day, this time between Barbara and Gail. They both opted to write blog posts, Barbara’s is featured below, together with extracts from Gail’s although you’ll need to visit her blog for the full piece.

When asked why she was supporting #107days and #JusticeforLB this is what Barbara had to say:

I’m a citizen advocate who is also a teaching assistant on the BA(Hons) Learning Disability Studies course at University of Manchester and a volunteer supporter with their Partnership Steering Group. I first became aware of LB when I stumbled on Sara’s tweets last winter as a novice on Twitter. Shocked by Connor’s death, struck by Sara’s frankness, I was and remain in total admiration of her determination and staying power. I too want to see Justice for LB, justice for all the dudes young and old. The campaign makes me wonder what becomes of abuse victims who don’t have anyone to speak up on their behalf… I believe many people, members of the public, can make a positive difference through citizen advocacy: you don’t have to be an expert to be an abuse watchdog.

Barbara asked to write a blog post for her action, which is reproduced below, Speaking up for Citizen Advocacy.

In this blog I am going to touch on abuse, promote citizen advocacy and question current advocacy trends for learning disabled people. Abuse continues despite numerous reviews and recommendations. The reasons are complex but two issues stand out for me:

1. Bureaucracy, ingrained in service culture, obstructs and takes precedence over the support and care of individuals. Ever expanding, repetitive and often seemingly pointless, it leads to the neglect and abuse of individuals who are supposedly being ‘served’. There would be less abuse if services streamlined all this red tape!

2. Social Devaluation: People make unconscious judgements about others. Negative judgements mean marginalised people like those labelled as learning disabled are considered of less value. This can lead to them being treated badly and abused. Also they may well be denied valued things in life like supportive relationships, respect, love, autonomy and participation in meaningful activity. To combat this social devaluation Wolf Wolfensberger, an American psychologist, promoted the importance of creating, supporting and defending valued social roles for people at risk, social roles like family member, friend, worker, volunteer, artist, cinemagoer, holidaymaker, car owner. Thus vulnerable individuals can gain self-esteem and are likely to be viewed more highly and treated better by others in society (Wolfensberger, 1998). This is how citizen advocacy originated.

Day94Advocacy

Citizen advocates are volunteers who develop long term relationships with vulnerable individuals and speak up on their behalf. The advocate partner is someone at risk of having choices, wishes and decisions ignored, and who needs help in making them known and making sure they are responded to. The citizen advocate also attempts to meet their advocate partner’s expressive needs like emotional support, warmth, commitment, friendship, love. More information about the citizen advocacy partnership is available here.

Over 10 years my advocate partner Gloria (not her real name) and I have built up a close relationship. Like LB, Gloria is fond of public transport and our weekly meets invariably entail a tram or bus trip as well as a bite to eat. I have supported her to be heard and helped realise her wishes to get a car and go on holiday. Gloria has experienced abuse. Often the system is at fault and staff aren’t always aware. Ways I have helped to counteract abuse

  • Money spent irresponsibly by past support workers was refunded to Gloria in response to my formal complaint.
  • With my instigation, Gloria has received support from familiar support workers during hospital admissions to ensure past experiences of fear and neglect were not repeated.
  • The service was obliged to shelve plans to set up a staff office in Gloria’s home due to my protest regarding her tenancy rights. Awareness-raising is an ongoing need, for instance the connecting door with the neighbouring tenancy, keeping it open is convenient for staff but this breaches the tenants’ right to a private life.
  • I alerted the CQC who discussed the negative effects of staff shortages and regular use of agency workers with Gloria’s support service. Recent increased permanent staffing will hopefully provide greater stability.

Benefits are reciprocal: I have gained massively too and will always be indebted to Gloria for many things, including my degree.

UK Citizen Advocacy was developed in the 1970s/80s to support individuals being resettled from the long stay institutions, some of those partnerships continue today. The 2001 Valuing People policy offered local authorities funding to set up self-advocacy and citizen advocacy projects. Development of the latter was patchy and the impact unclear and sadly citizen advocacy has gradually receded. This may have been partly due to the difficulty in measuring the effectiveness of this long-term partnership. Time-limited interventions are easier to substantiate and understandably commissioners want to fund evidence-based advocacy. So paid case advocacy has expanded and so have Independent Mental Capacity Advocates (IMCAs) as a result of the Mental Capacity Act. The different types of advocacy – case, IMCA, self, peer, citizen advocacy – all have their value but not at the expense of each other. The long-term benefits of the citizen advocacy partnership are equally if not more valuable in fighting abuse.

With the introduction of the new Care Act local authorities will be duty-bound to provide ‘independent’ advocacy for certain people to ensure they are better involved in the assessment and care/support planning processes and to support them through safeguarding enquiries. This is great but the Learning Disabilities Observatory believe there is a real danger that organisations will only be able to support learning disabled people assessed as ‘eligible’ for advocacy services and advocacy will come to be seen by commissioners as another professional ‘service’ to be delivered. Who is going to speak up for the rest? If services are at fault in the perpetuation of abuse why is advocacy, with its history of campaigning for rights and mission to question service organisations, increasingly joining the service provision fraternity?

Indeed the introduction of the City and Guilds advocacy qualification means advocacy is becoming increasingly professionalised with some contracts expecting organisations to employ qualified staff. Meanwhile recent policies like Building the Big Society 2010 and Learning Disability Good Practice 2013 encourage local volunteering and involvement in social action, capacity building and development of more community-based support. Plus person-centred circles of support are current good practice. To my mind citizen advocacy fits neatly with all of these. Another reason for it to be promoted not neglected.

A citizen advocate is also independent. Although, there is a lack of research into the extent to which independence supports, or otherwise, produce beneficial outcomes according to the School of Social Care Research, many advocacy organisations are not independent. Most are reliant on state funding, some provide care or support services and others share premises, email servers etc. with the services they are supposed to be holding to account. Advocacy organisations which are reliant, either totally or partly on state funding, are in a difficult position to dispute the parameters of their commissioning contracts. Indeed this Tuesday, Patrick Butler in the Guardian claimed charities (most advocacy organisations are) are having to tone down their campaigning for fear of losing state funding. Compromising independence is likely to reduce advocacy organisations’ effectiveness.

On the other hand, their ‘Loose Cannon’ characteristic enables citizen advocates to be more effective. Unlike in the US, due to public dependence on the UK welfare state and the fact it is taken for granted, the importance of independent advocacy is not properly understood or thought necessary by services or the general public according to Wolfensberger. But what we actually need are more independent citizen advocates who are prepared to speak up for people like LB and Gloria. At this crucial time when abuse isn’t going away, I call on commissioners, policy-makers, advocacy organisations, all those with influence to reflect on the current situation of advocacy in this country and promote more voluntary citizen advocacy. I believe many more people, members of the public, can make a positive difference through citizen advocacy. Come and join us!

Gail has this to say about supporting #107days and #JusticeforLB:

I wanted to do something for the #107 days campaign because apart from the collective outrage that has been so evident it’s restored my faith in humanity. The sense of positivity it has produced is infectious, heart warming and gives me some hope that things can and will change in the future.

Sara is one of my dearest friends and I’ve known Connor since he was around 5 or 6 years old. We are part of a group of six close friends who all met when our dudes attended the same academy for crazy little dudes. We call ourselves the ‘life raft’. Our families have all socialised together for years and so obviously our kids all grew up knowing each other well too. Connor’s death shocked and saddened all of us more that I can say and we remain incensed that it was so preventable. I’ve spoken a lot about Connor and Sara on my blog, not least because his death came just 6 weeks after the sudden and unexpected death of my husband Bob and we’ve been coping with grief shit stuff on a similar trajectory. Similar but not the same, because of course Bob’s death was no one else’s fault. As I’ve been trying to deal with my own grief I’ve watched my friend and her family endure the most inhumane treatment by those ultimately responsible for their son’s preventable death. Compounding their grief and making dealing with their loss so much harder.

Although I’ve adopted today I’ve been raising the Justice for LB campaign in all the work I do, both for Dimensions UK as a Family Consultant and Oxfordshire Family Support Network as Transition support coordinator. I’ve raised it in training, in meetings and parent workshops, basically any chance I get to get this story out there. And, I’ll continue to do this long after the #107 days campaign.

Today Gail is speaking at the the Sunday Times Education Festival. A large event covering all things education and special education. You can read Gail’s full post on her blog, but here’s a taster:

There are a lot of high profile speakers and I’m up against David Starkey (and many others) in my time slot, so I’m not sure how many people will come along and listen to me, but it’s a chance to talk about the SEND reforms and the Children and Families Act and what it should mean to families and I was thrilled to be asked. I’m dedicating my talk to Connor and his family.

Day94Gailpic

My main focus is on Person Centred approaches and why without them the SEND reforms are set to fail. The need for this way of working in health, education and social care to become embedded in the systems that surround our children and the need for families to be treated as respected partners, involved throughout.

Gail’s post, and indeed her talk, will discuss person centred approaches and the role that they can, and should, play in ensuring good support for all dudes.

Day 36: Cry me a river Katrina Percy #107days

Sarah got in touch with us over on facebook when she heard about #JusticeforLB. Sarah is a Canadian blogger, freelance writer and disability advocate who writes the Girl with the Cane blog. She was appalled at what had happened to LB and wanted to ensure that his story was heard on the other side of the atlantic, and so she kindly agreed to write the following blog for #107days, the context you are likely to be familiar with, but her thoughts and reflections are well worth reading:

I’ve recently been made aware of the story in the UK of an autistic young man that’s not getting any press that I’m aware of in the U.S. or Canada. I’d like to tell you about Connor Sparrowhawk’s story.

Connor, known as “Laughing Boy” or LB to his friends and family, was autistic and, from what I can gather, intellectually disabled (it’s difficult to tell when going by British sources sometimes, as they tend to refer to what North Americans call “intellectual disabilities” as “learning disabilities”). He also had epilepsy. In an interview with BBC Radio, LB’s mother, Sara, talks about how when her son turned 18, his normally happy disposition changed:

When he turned 18 in November, his behaviour sort of…he become very unhappy and anxious. And over the space of those 5 or 6 months, he became increasingly sot of unpredictable in his actions and very unlike himself, and he became very difficult for us to manage. We couldn’t get any help to look after him in school, really, and we were struggling to keep him in school.

LB punched a teacher’s assistant and was increasingly unsettled. The family felt that they had no choice but to send him to Slade House, a small treatment and assessment facility (seven beds) run by Southern Health NHS Foundation trust.

Sara talked to the BBC about her hopes the staff at Slade House would be able to figure out what was causing the changes in their son, and that they’d be provided with strategies to manage his anxiety and unhappiness. She feels that Slade House did very little to help either way. But if only that had been the worst of it.

LB was in Slade House for 107 days before he died on July 4, 2013. Sara got the phone call at work from a staff member when LB was on route to the hospital, she told the BBC. He’d been having a bath, and been found unconscious. Sara was told when she reached the hospital that doctors weren’t able to revive him.

The portmortem showed that LB had drowned, likely as a result of having a seizure, and was originally declared a death by natural causes by Southern Health NHS trust. However, an independent report found reasons to conclude otherwise, as indicated in this summary of the report’s findings on bindmans.com:

The report, completed by the independent organisation Verita, investigated LB’s death and found the following:

1. That LB’s death was preventable
2. That there were significant failings in his care and treatment
3. That the failure of staff to respond to and appropriately risk assess LB’s epilepsy led to a series of poor decisions around his care
4. That the level of observations in place at bath time was unsafe and failed to safeguard LB
5. That if a safe observation process had been put in place and LB had been appropriately supervised in the bath, he would not have died on 4 July 2013
6. That the STATT unit lacked effective clinical leadership
7. That there had been no comprehensive care plan in place for the management of LB’s epilepsy and his epilepsy was not considered as part of a risk assessment, in breach of NICE epilepsy guidance

The report follows a highly critical CQC inspection published in December 2013 in which the STATT unit failed on all 10 essential standards of quality and safety. Since that inspection report, the unit has been closed to new admissions.

Wow. Doesn’t seem to me like there’s much for the NHS to do but to try to determine what adequate compensation is in this situation (as if there is such a thing, when the death a loved one is involved), determine who was responsible and to what extent, “clean house” of those who were responsible, and commit to reviewing all the policies and procedures that may have contributed to LB’s death…and actually do so, of course.

But these things rarely happen that simply.

No Justice for LB
There’s not enough space today to get into the ways that justice has been put off for LB and his family, although Sara documents it all very well herself in her blog. Even a small facility like Slade House can be just as destructive as the larger warehouse-like institutions that are falling out of favour; it’s all a matter of attitudes and workplace culture. And like most stories involving professional misconduct in an institutional setting, this one gets uglier the more you find out about it.

I’d like to single out one person in particular.

Katrina Percy, chief executive of the Southern Health NHS Trust, doesn’t see why she should resign over this. After all, she’s apologized. She laments the lack of a “culture where people are able to be open when things don’t go as well as they possibly could.”

Cry me a river, Katrina Percy. That might go over if, after careful preparation and planning, LB had tried to go somewhere independently and gotten on the wrong bus to come home (he apparently loved buses). It doesn’t cut it even remotely when a young man with with multiple disabilities and epilepsy dies in the bathtub after a seizure because a medical unit (which turned out to be unsafe for patients anyway) for which you are ultimately responsible left huge gaps in both his care plan and its policies around observation during bath-time. And you don’t get to slam the family with vague comments about “people” not being “open” because you don’t want to take responsibility for this (or for the other two Southern Health facilities subsequently found to have safety failings after Slade House was investigated).

But then, as Chris Hatton has observed, all’s really not been well at Southern Health for the last while, has it? Quite sketchy indeed, Katrina Percy.

It never should have been acceptable for anything like this to happen, but isn’t this era where families couldn’t trust institutional care to meet the basic safety needs of their loved ones supposed to be over? Aren’t we supposed to know better, and act out of a ethos that demands we treat vulnerable people with dignity, and compassionate, responsible, reliable care?

I’m thinking about all the places that I’ve covered in this blog where people got hurt or died because disabled people were considered expendable and just given the absolute minimum of care. The abuses at Huronia Regional Health Centre in Ontario, Canada, happened a long time ago…Willowbrook State school in Long Island been closed for decades…but the abuse at Winterbourne View is still quite fresh in the UK’s memory, the New York State group home abuse scandal broke soon after I started this blog in 2011, and the men profiled in the New York Time’s recent “The Boys in the Bunkhouse” piece were only removed in 2009 from a horribly abuse group home/sheltered workshop situation that went on for decades.

This must stop.

The next time someone tells you that disabled people aren’t at risk in our society, point them to this video, and ask them what they think it would feel like to have a seizure in bathtub full of water and not be able to call out for help.

I know that it’s something that I don’t want to think about.

River Thames

Sarah drafted this post a month ago and has been (patiently) waiting for a #107days slot – what can I say, you’re all amazing and keen to get involved.

Since then her thoughts have become even more topical in light of Katrina Percy’s ‘performance’ at the Oxfordshire Learning Disability Partnership Board, see Gail’s brilliant blog posts on this meeting Dinosaurs and Elephants in the Room and How things could have been…and the float that sank.

Then yesterday KP faced more media attention after yet another critical report and a warning notice from CQC, and Monitor announcing they are taking enforcement action against Southern Health. You can read Sara’s latest post, Love tennis in health (and social care) towers, for her thoughts on this latest development.

To repeat Sarah’s catchphrase Cry me a river Katrina Percy, it’s time to do the decent thing.