Surmise/Choler: Making a Killing

• Making a Killing

Choler :

Making a Killing - a case study in NHS management:

Grimsby, 2008. A man named McMullan walks into the police station carrying a knife and saying: “I’m very frightened; the voices in my head are telling me I have to kill someone with this knife, and I don’t want to. Please help!” The police very properly section him and hand him over to Mental Health at the NE Lincs Trust.

At Mental Health he is seen by a psychiatrist, Krysztov Kielan, who immediately takes him off section, keeps him in for short-term observation, fills him up with anti-psychotic medication and finally discharges him on to the street; there is no proper follow-up arrangement to keep an eye on him.

This happens not once, but three times.

On the third occasion he is not even allowed into hospital but simply told to go away and keep taking the medication. The medication has extremely unpleasant side-effects; he says he doesn’t like it and it isn’t doing anything. Nobody checks properly whether he is taking it or what (if anything) it might be doing.

He then disappears for some months. When he reappears it is because he has stabbed and killed a random passer-by, a young pregnant girl and her baby. After the killing he makes no attempt to get away.

McMullan is around fifty, with a bad but not incapacitating alcohol problem, and with no criminal record. He has no history of psychosis or other mental “illness”. This indicates he is not psychotic; psychotic episodes do not suddenly start happening at this age, there would have been some previous traces.

What should have happened to prevent these deaths? Let us first take a brief look at the organisation involved and at some of the people in it.

The Director of Mental Health is Kevin Bond. He is an ex-psychiatric nurse unencumbered by any sort of clinical qualification (though later in this story he will claim on oath to be a “qualified clinician” on the basis of a few weekend courses). He knows - as do few others at this stage - that the Grimsby NHS Mental Health department is up for forced privatisation; a couple of years down the line it is going to become NAViGO, a “social enterprise” company independent of the NHS but with the advantage of still using expensive NHS facilities funded by the taxpayer. To have control of this little empire will be a great coup. Assisting him will be Barry Flintoft, currently an Assistant Director of Mental Health. The fledgling board of NAViGO also contains the wife of the psychiatrist Krysztov Kielan - in an interestingly unusual arrangement, she also functions as her own husband’s line-manager.

Flintoft is an ex-social worker. He too is wholly devoid of clinical qualification, but derives great benefit from having worked-up a PhD in Business Studies which means he can be referred to as “Doctor” Flintoft, a useful source of ambiguity and camouflage when surrounded by actual clinical doctors. He is big on something called “Root Cause Analysis”.

Bond and Flintoft are obsessed by (what else?) targets; being clinically unqualified, counting things is all they understand. Both are bullies, but in very different styles. Bond is a tall heavily-built ex-Rugby player who deploys a “me, I’m just an ordinary bloke” no-nonsense charming manner until things don’t go his way, when he will suddenly drop the friendly charm and start to yell, wave his arms and lean menacingly across people. Flintoft, thinner and more knife-like, is more in the “vicious bitch” mould; quiet, covert, lethal, in the long run much more dangerous than Bond because of his apparent incapacity for any kind of allegiance to anybody. As Assistant Director, Flintoft has the hands-on job of getting staff to conform to impossible and badly-conceived targets. The Psychology department for instance has been told to reduce its waiting-list as a priority over-riding all and any treatment requirements; they have a waiting-list of 400-500 (going back many years), and just two clinical psychologists to tackle it. Already under immense pressure, everyone in the organisation is subject to still more stress due to the up-coming privatisation and the need to stay looking squeaky-clean, though most don’t yet know this. The principal aims are: clear beds quickly, don’t let people in if you can help it, keep treatments short and cheap, above all clear the waiting-lists! Clinicians are routinely bullied on this basis.

Importantly, no proper structures are in place to manage risk at any level; neither Bond nor Flintoft has any professional understanding of “risk”. Asked what their action plan is in the event of a hostage-taking (which has happened here before), the response is: oh, er, we’ll ring the police. Similarly, they have no conception that patients can be violent; staff are frequently put at risk due to room layout (patient placed, say, between clinician and door) and many other logistical, organisational matters. Anyone with experience in high- or medium-secure units would know these things, but Bond and Flintoft have no such experience and do not know them; worse, they have no inkling of the extent of what they don’t know. Serious professionals trying to point this out are accused of “doom mongering”. Reality is kept firmly at arm’s length.

Now, what should have happened with McMullan? Let us resume.

Upon admission, it should have been immediately apparent that there was no history of psychosis and that further investigation was therefore necessary; obviously, anti-psychotic medication isn’t going to do much if you’re not psychotic. One possibility is brain damage; certain kinds of brain damage, notably from (recurrent) small strokes, can cause an effect of “voices” somewhat like psychosis but differing in an important respect: to the patient, psychotic voices tend to come from “over there” (behind radiators, inside domestic implements), whereas the voices arising from stroke-related brain damage tend to be “internal”. McMullan reported his voices as inside his head, and could point to the location; this was noted by Kielan but the implications were ignored.

With the possibility of brain damage, two things should have followed: McMullan’s medical records should have been reconsidered, and a neuro-psychological assessment made to test for such damage. Only then could possible treatments be formulated. The correct procedure would be for McMullan to be formally referred to Psychology for assessment; for this to happen, the psychologist on duty in the ward would first give a quick opinion as to whether such a referral and examination appeared to be necessary. The referral itself would involve the filling-in of a standard form, which would then be passed to Psychology admin and suitable entries made in the department computer records.

Grimsby, its fishing industry smashed and closed down, is a rough-and-ready place. On the day that McMullan was brought for possible referral the psychologist on duty, VE, was coping with seven immediately violent people, one actually wielding a knife on the ward - most of these were subsequently referred for psychological assessment in the normal way. In the short time available she asked McMullan a couple of questions, decided on the spot that referral for formal assessment was obviously necessary and indicated that this should take place. She assumed that Kielan would follow the referral procedure, and that next time she came on shift McMullan would be there for preliminary assessment prior to involving a (specialist, external, expensive) neuro-psychologist. She was therefore extremely surprised when next on the ward to find that McMullan had been discharged. But as no referral had been made, under the relentless pressure of targets and localised violence she paid the matter no further attention.

Psychiatrists are currently much further up the food chain than psychologists and carry more prestige, pay, and (above all) authority, possibly because they are medically-based. Unlike a psychologist (who works from a total systemic viewpoint), psychiatrists are doctors who start roughly from a position that mental “illnesses” can be handled with medication; and this view can readily be grasped by unqualified people wholly incapable of understanding the “total systemic” approach. Psychiatrists carry greater authority and thus tend to have the final word and the final responsibility. In the case of McMullan’s non-referral, the failure to follow up on VE’s recommendation for referral was entirely the responsibility of the psychiatrist involved.

The killing occurred. With one accord, management went into headless-chicken mode; how can we not be blamed? How can we stop this damaging our prospective privatisation? And how can we stop ourselves getting sued for negligence?

The obvious move would have been to scapegoat Kielan; he could have been blamed and quietly dropped overboard, and this would have the advantage of being at least partially true - Kielan was indubitably the one who didn’t make the referral, even if this happened in a context of shambolic system disorganisation and pressure to clear beds and tot up the numbers, all traceable to Bond and Flintoft. Kielan also had previous form from which something could be made; he’d been working at Bridgend in the period when there was a massive upsurge of teenage suicides there, and appears to have left in something of a hurry. But his wife - his line manager - was on the new NAViGO management board; and besides, there was an opportunity here to settle a quite unrelated score over an internal war that Flintoft had been having with Psychology.

The Head of Psychology was Ragnhild Saeland. An immensely experienced Clinical Forensic Consultant, she had previously been in charge of Psychology for the womens’ half of Rampton Special Hospital, dealing with serial killers on a daily basis; she’d been responsible for formulating systems to cope with suicidal prisoners for the States of Jersey, been involved in drafting UK guidelines towards “a seamless forensic service for mentally disordered offenders”, and much else. Born in Norway, both her parents were mathematicians; her father was a war hero, having been Chief of Staff of the Resistance. She was brought up (she says) “never to give in to bullies”, a principle that carries a lot of weight with Norwegians after what happened in the war. The extent of her knowledge and experience when compared to the unqualified riff-raff of failed nurses and social workers running NHS Grimsby verged on the embarrassing.

This sort of discrepancy always breeds resentment amongst the inadequate, and since Bond and Flintoft came to power in 2007 a number of attempts had been made to oust her and get control of what was (and, functionally, had to be) an effectively autonomous department. A patient kills herself; so an inexperienced coroner, primed-up by Flintoft, publicly castigates RS for not having gone round to the woman’s house by night in order to save her - something which would actually be illegal as well as impractical. An inept robbery occurs at the Trust in which large steel filing cabinets are thrown about and some files are stolen; so an un-evidenced attempt (which proves wholly false) is made to pin this on a junior psychologist who could have simply read the files freely at any time and who was anyway due in hospital next day for a major leg operation, utterly incapable of moving large cabinets. A reputable external psychologist is brought in to “investigate” the department; he is told untruthfully that RS doesn’t have the right qualifications (ah, the envy & resentment of the unqualified!) and tricked into a blatant fishing expedition examining RS’s files in the hope they should be somehow inadequate; he examines a large number of files carefully, scratches his head and finds nothing amiss - Bond is later heard through a wall yelling that this fool has not come up with the right answers.

All this and more is thrown at RS. None of it sticks. And now Bond and Flintoft (and the Trust CEO, Jane Lewington) still have a serious PR problem, some very inconvenient cracks to paper over.

“So, my fellow managers, a girl and her baby have been killed by someone we should have been treating and weren’t. The girl’s family could sue us over the horizon for negligence. We don’t want to blame the psychiatrist who didn’t make the referral. Who shall we blame?

????????????????

Ah yes, the psychologist on duty, VE.

She’s minor, no power or importance. No-one will notice if we drop her overboard. It’ll give us some leverage over RS, who’ll go along with it if we twist her arm; the media can be kept quiet and everything will calm down in time for NAViGO’s launch. Sorted!”

But, being brought up “never to give in to bullies”, RS didn’t go along with it. She’s of the old school, working from the principle that as Head of something you are responsible for your workers and should look after them; the notion that an innocent member of her staff should be sacrificed for corporate expediency disgusts her. Before Bond and Flintoft realised she wasn’t going along with it, she was allowed to examine the relevant ward notes; she found that at Kielan’s request (as admitted later), an assistant SHO had falsified the entry retrospectively to say that Kielan had made the referral as he should have done and that a full psychological assessment had taken place. Instantly spotting that this was a cover-up attempt, she formally complained to CEO Jane Lewington, blowing the whistle on clear wrong-doing. Lewington instantly wrote back threatening her with a Gross Misconduct charge and possible dismissal if she didn’t keep quiet.

A search showed that there was (of course) no trace of the supposed “referral” or “assessment” on the department computer or in the paperwork - and staff outside the office have no codes to access these or change anything. That should have settled it, but Flintoft wasn’t going to give up on his private war so easily. No referral paperwork or computer entries? That must be because… let’s see… ah, got it! … because Psychology is being run badly and staff are not being required to fill in paperwork properly! Yes indeed!

This convoluted botch was obviously preferable to the much simpler truth that Kielan had simply, under pressure to keep beds clear and meet targets, failed to make a referral. The fact that an assessment would have taken several (logged) sessions over several days and involved extensive psychometric testing (whose materials would have to be paid for and would therefore show up in the accounts), and the fact that VE was not a neuropsychologist and thus not qualified to undertake such an assessment anyway were deemed irrelevant. The faked ward notes claimed that VE had undertaken a full assessment and found “no psychological features”.

The phrasing is a giveaway. RS later pointed out that having “no psychological features” would mean that you were dead; this is not a phrase used by psychologists and has no meaning for them. The phrase “no psychotic features” is, however, regularly used by psychiatrists. This clumsy confusion alone points to fakery, even if it had not been admitted later.

Kielan’s tale was therefore: that he’d discharged McMullan because a junior psychologist with none of his authority had made a full-scale assessment which she hadn’t been asked to make, for which she didn’t have the qualifications and of which there was no trace in the records, and then told him there was nothing wrong. Flintoft found it convenient to accept this.

Kielan having been carefully ignored, the focus now switched from the attempt to scapegoat VE to a full-scale attack on RS. Flintoft demanded that RS hand over all her patient files for yet another fishing expedition. Psychologists are professionally not supposed to allow access to patient files by unqualified people, for confidentiality reasons; it can take a long time to build up patients’ trust, and the knowledge that their details will not be seen by non-professionals is an important part of the process. RS stated that she would hand over the files to a qualified professional, but not to non-qualified outsiders. Flintoft, unqualified and untrained, understood nothing of this; as far as he was concerned, he needed these files to try and find some irregularity to use as a weapon, and he was the Big Manager! There was an unseemly exchange of emails, with Flintoft petulantly crying out in one “I’m not going to carry on this conversation”. He claimed that another Assistant Director had been sent to fetch the files and that RS had “barricaded the door”, though it was later proved that the entire department (including RS) had been elsewhere on a scheduled awayday at that time and that this Assistant Director, visiting her on a quite different date, had later emailed her thanking her “for her co-operation and for the coffee”. But what are mere facts when there are privatisations and personal power at stake?

RS was abruptly suspended; the excuse given was “inappropriate challenging of management”. Had the matter really been about that, it could have been settled by a quick meeting; but of course it was actually about several much larger things. After a while, someone called Zena Robertson was wheeled in to do a “risk assessment” on RS’s fitness to return to work.

In giving accounts like this one, it is a point of principle that one should avoid ad hominem attacks, sniping at personality. Unfortunately with many of these people there is little option except personal attack because nothing else is going on; there is no “professional” side to deal with - and in this particular case, “personality” is clearly what one was expected to pay attention to. Zena Robertson rejoiced in the title “Interim Director of Quality” (Oh, chortled a BBC interviewer later, Do they have a Director of Quantity also?) She is yet another failed nurse (failed in the sense that nursing is a difficult and responsible job, and some people who try quickly decide that they can’t hack it and would rather go where the money and power is, thank you). Once again clinically unqualified, she can reasonably be characterised as the eternal loyal henchman: one of those people who can be deployed to go round getting the gold teeth out of the corpses after the gas is turned off (somehow there’s never a shortage of these). She wears enormous impractical (how do you type?) shiny red nails several inches long, and simpers flirtatiously all the time, even under barrister cross-examination; no-one appears to have suggested to her that dressing like a teenage street-walker might not be wholly advisable when you’re past fifty.

Zena, with no discernible skills, unqualified and untrained, profoundly ignorant of the field, utterly void of the slightest basis for the task, is instructed by Flintoft to join with one Maria Tomkinson (an HR drone) to undertake a “risk assessment”. The competence mismatch involved is so grotesquely total, so overwhelmingly vast that the image instantly arises of a couple of particularly dim supermarket checkout girls earnestly trying to do a risk assessment on a nuclear power station. Even through the small mean viciousness of it all a flickering glimmer of utter farce glints briefly.

With yawning predictability it is decided that RS should stay suspended. As VE has also been suspended, this means there are now no functioning clinical psychologists to deal with those waiting-list targets - a measure of how important this war has become to management.

And now something odd happens: McMullan is to be tried for murder. As obvious a Special Hospital candidate as you could ever see, he has been examined by a specialist from Rampton and been recommended for admission - RS has sat on the Rampton admissions panel and knows how difficult it can be to get people in, so that’s pretty clear cut. It is assumed that there will be a brief, open-and-shut trial for manslaughter - there being no question that he “did it” - and McMullan will then go to Rampton. But a full-scale, very expensive murder trial is mandated instead; after which McMullan will, inevitably, still go to Rampton but on a different piece of paper. What is the purpose of this? Who benefits? Ah, yes….

If McMullan is a madman not responsible for his actions, who Mental Health should have treated but didn’t, then Mental Health is in deep trouble. But if he’s totally sane and therefore a wicked evil murderer, it’s not Mental Health’s fault at all - what luck! No public safety is involved; we already know he’s guilty, we already know he’s going to be inside for life. There’s no possible benefit to the public. The only conceivable, the only possible reason for a full murder trial is to make Mental Health management look good.

They realise it is clearly necessary to keep RS on suspension till after the trial, several months away. Whilst she is suspended, she can be (and is) instructed not to speak to anyone, anywhere, about anything; particularly, she must not speak with work colleagues. But if they sack her at this point, she is in no mood to keep silent - she has already blown the whistle as far up the management chain as she can reach, even to MP level - and once free will obviously sing like an unusually forceful amplified canary to anyone within earshot. Much safer to keep her suspended and under control. That the patients meanwhile may be suffering through lack of treatment, that irreparable harm may be happening to people… collateral damage, omelettes can’t be made without breaking eggs you know; can’t be helped.

Flintoft now uses the opportunity of RS’s absence to take over and dismember Psychology; he writes a report bemoaning that he has no “metrics” to help him judge “quality” in psychology, and questions “the evidence base for psychological treatment”, finally recommending that Psychology be split up amongst all the other departments.

Meanwhile, McMullan’s medical history is examined by others. It is discovered that he did suffer several small strokes, of exactly the right kind to give rise to “voices”, only the year before; and in fact he suffered a small one whilst actually on the ward the first time he turned himself in, but this has for obvious reasons been quietly disappeared. Brain scans were already available; all someone had to do was walk down the corridor and examine them. At the trial, the defence are perfectly well aware of all this, but for no obvious reason fail to make anything out of it. During the trial, Kielan claims at three separate points that a full psychological examination took place. McMullan is found guilty of murder. The privatisation is saved.

The case has had a lot of media exposure; after the trial, BBC television shows us Bond in front of the courthouse in company with a policewoman, DS Christine Kelk. Kelk tells us (word-for-word) that McMullan is an “evil murderer” and she is “very glad he will be going to prison and not to hospital” [ie Rampton]. This is curious, as there is no way she cannot know that hospital, not prison, is absolutely where he will be going, and always was going. Bond with a twinkle on his no-nonsense friendly face then gives us the benefit of his unqualified expertise: “What gives him away as not having a mental health problem”, he says, “is that he claimed the voices were coming from inside his head. But everyone knows that when you’re psychotic, the voices come from outside!” And gives another little knowing twinkle, drawing us all in: good no-nonsense people like you and me, we aren’t taken in by this stuff, are we? Dear me no.

The instant the trial is over, moves are made to sack RS after a pointless and astonishingly expensive 18 months of suspension (remember, she was on full pay throughout; and, after eight months or so of damage-by-neglect to patients, an extremely expensive locum was finally imported). Unlimited public money is of course available to management to fund their legal defence. A series of rat-pit “disciplinary” meetings are held, which RS is not allowed to record and of which proper transcripts are not kept. A biddable external psychologist (non-practising) is wheeled in to pick out three of her patient files at random, pronounce them inadequate without specifying why and then replace them without noting which ones they are, making the accusations impossible to answer. When challenged later, he does this again with three different files. No defence was ever going to be possible and RS is sacked; VE has been forcibly "retired" a short while previously.

After the sacking, Bond and Flintoft report RS to just about every professional body in existence in the hope of finishing off her career; the aim is to ensure that if she speaks out against them she will lack credibility. It takes about eighteen months to work through all these, some of which are basically full-scale trials with barristers. It is at the Health Professions Council trial that I see Bond claiming to a panel of highly qualified professionals that he considers himself clinically qualified because of having attended a number of weekend courses; the faces of the panel as he delivers this almost make the occasion worth it. I also watch Flintoft, brought in at a late stage, giving without a flicker evidence completely contradicting Bond’s; at first I assume this is because they’ve been too stupid to collate their tales, but it slowly dawns on me that Flintoft is protecting his own position regardless of the effect on anyone else and I realise he is fundamentally untrustable, even to his partners in crime.

RS shakes off the accusations one by one and emerges professionally unscathed. And now, back home, there is an external inquiry. Flintoft has already conducted an internal one (including - what else? - Root Cause Analysis); but the process of one Director saying to another “Did we do it?” and the other answering “Noooo! Of course not!” is so self-evidently bent that it worries even NHS management. They stall for as long as they can but eventually something called Verita is brought in.

As everyone knows, persecution of NHS whistleblowers by Unskilled Management defending itself is at epidemic levels; and a number of organisations have grown up keen to feed on the pickings of this for as long as it lasts. There is for instance WellWork, an organisation dedicated to undermining the opinions of GPs on behalf of employers and proving that people certified by them as ill are not ill at all (“GPs just don’t understand employment law!” one of their staff said to me). But the biggest and probably the most lucrative is Verita.

I am unable to find any case examples of Verita not finding in favour of management, even in completely unwinnable cases such as that of John Watkinson, CEO of Royal Cornwall Hospitals Trust, where Verita’s investigation was angrily ripped to shreds (“this vindictive and expensive sacking”) in no uncertain terms by a subsequent Employment Tribunal. The impression I carry away is that Verita is a go-to organisation for the exoneration of NHS management; but this of course is just my opinion.

They carry out their investigation quite professionally (almost lavishly - as well they might given the levels of taxpayer funding involved). RS is given a long interview, at which I am present in a “support” capacity. In contrast to the blatantly rigged sacking meetings, this interview is properly recorded and a real transcript eventually sent, whose accuracy (having been there) I can vouch for. They eventually send a draft report for comment; but it is a travesty. RS’s words have been twisted into things quite different from anything actually said; ending in flights of pure invention, the report reaches exactly the conclusions Bond and Flintoft might have scripted themselves. RS sends extended comments back to Verita, tracing point by point the intellectual dishonesty of what they have magicked her words into and making it clear that, as the recording proves she said no such things, the matter will end in court if Verita continues to claim she did. Strangely, this has an effect; the final report is completely different from the draft. Possibly, as it is not their war, Verita don’t much care what the outcome is and prefer not to jeopardise their highly profitable business model? Who knows?

The most interesting part of the final report is this: Verita conclude there is no evidence of any psychological assessment ever taking place. This flatly contradicts Kielan’s statements on oath during the trial. The possibility of perjury is brought to the attention of the police, but they show no interest. Kielan had already been reported to the GMC, but their inquiry did not wait for the Verita report to come out and therefore missed the principal evidence.

Outcomes:

McMullan went to Rampton, just as he was always going to. The family of the murdered girl were successfully steered away from the possibility of suing for negligence (from which they could have got a great deal of money, even if that were small compensation for her loss). The wholly innocent psychologist VE was destroyed, became (as they say) “loopy”; when she was already unbalanced, one of the bullies threatened to have her pension removed if she ever talked about the case after being sacked (of course, they have no such power) and the stress caused her to become functionally incoherent, giving different accounts of what happened by the day day, even by the hour - her evidence to Verita included things which were functionally impossible; a very sad outcome considering she had done nothing amiss and had nothing to be ashamed of. RS spent years (and a great deal of money) fighting off the attempt to destroy her professionally, and finally succeeded in this; but in the current managerial climate she no longer considers the NHS a viable place to work. Even after ICO pressure, the internal report by Flintoft was never released, except for a page of “executive summary” wringing it’s hands that no-one will ever understand why the killing happened and smearily insinuating that it was all Psychology’s fault without ever quite saying anything clear enough to defend against (a typical Flintoft gambit); subsequent attempts to see the full report fail because the Mental Health department, the Trust and the area health authority above it have all been liquidated in the Conservative reforms and there’s no-one left to take responsibility, or to sue. The Grimsby Trust CEO, Jane Lewington, having undermined the whistleblowing and (against whistleblowing law) actively assisted in the scapegoating, moved on to run Lincolnshire Hospitals Trust (who’d just sacked their previous CEO on trumped-up charges after he indulged in his own whistleblowing). Bond and Flintoft pulled off their privatisation, making a splendid killing in the process - if you live in Grimsby and need mental health treatment, remember to move elsewhere first. Kielan (and his wife) to my knowledge are still happily working. Bond was recently on television promoting NAViGO as a fine example of a successful private health company, without the faintest acknowledgement that it had been purloined from the NHS.

In this one incident alone, the cost of privatisation was:

• A girl and her baby dead, unnecessarily.
• A man locked away for the rest of his life, unnecessarily.
• Two psychologists sacked, unnecessarily.
• Hundreds of patients deprived of treatment, unnecessarily, with all the long term damage that involves, plus concomitant damage spreading out through their relations, carers, etc.
• About half-a-million pounds or so of taxpayers’ money, conservatively estimated.
• The cost of a pointless full-scale murder trial which made no difference to the outcome and was of no public benefit.

Anyone considering using NAViGO should be aware of the character, abilities and history of those running it.

Unanswered Questions:

A good case can be made that Kielan committed perjury; this could and should be brought to trial. Why was no-one interested in this?

Why was there a murder trial at all? Who did it benefit except the upcoming NAViGO management?

Why did NHS management all the way to the top pay no attention at any stage to the (criminal, I believe) falsification of ward notes admitted by Kielan?

Why did DS Kelk make a statement on television, effectively supporting Bond and Flintoft, which she must have known to be untrue?

What are the backstairs connections between all of the above?

Why are NHS managers allowed the use of unlimited public money to defend themselves against whistleblowers?

Why, when there are questions about their behaviour, are managers allowed to investigate themselves? [though of course this is happening everywhere; cf the police].

Even after Stafford and all the other similar cases, why are there still no proper protections in place to safeguard whistleblowers, who basically forfeit their careers as soon as they speak up?

Why is the NHS now largely run by the clinically unqualified, by failed nurses and social workers, by people with a (quite literally) lethal lack of understanding of what they are managing?

Conclusions:

Privatisation of the NHS, driven by the built-in neo-Liberal bias of a series of EU directives (something curiously absent from public political discussion), is accelerating as we watch. Privatisation leads, inevitably, to little private empires, opaque to all oversight or control, with not the slightest guarantee that anyone inside knows what they’re doing and little possibility of any comeback when it turns out that they don’t. NHS Grimsby Mental Health could at least still be challenged, even if the challenge led nowhere. But what challenge can be made to NAViGO and its ilk? The purpose of a private business is to make money, not to be a service or some sort of charity; a business with shareholders has a legal duty to put the interests of those shareholders before anything else. We are told ad nauseam that privatisation is “efficient”, though all the evidence (and common sense) is against this and the question “efficient at what, exactly?” is never answered. “Efficiency”, of course, is meaningless without defining its object; a manager may be very efficient at losing money, a burglar may be very efficient (and “innovative”) in burgling your house, but that still doesn’t make these desirable. "Social enterprise" companies are merely a temporary, halfway stage to full commercial business. A service must be efficient at providing that service; but a business must be efficient merely at making money, which in law must be its priority. On what basis can such a system possibly provide good healthcare?

It is difficult to imagine the psychology of people who take part in this process. They cannot possibly imagine that it leads to public good; it must be wholly obvious to them that care will suffer - that indeed the very possibility of care will be slowly leeched away - that no system fragmented thus can possibly function - that any organisation run by people who don’t understand it will quickly become (before it collapses outright) nothing more than a way for those people to keep their jobs and prestige - that profiting from other people’s misfortune, from the sick, is inherently vile and despicable - that they themselves are assisting in a process whereby shadowy people even nastier (and much larger) than themselves destroy the whole network of services intended for the public good, purely for their personal aggrandisement - all this they must know, and yet still decide it’s too tempting to miss. What do they see when they look in their bathroom mirrors in the morning?

Of course, psychopaths and the personality-disordered never see themselves as doing harm. No Nazi ever caught sight of themself whilst cleaning their teeth and thought “Hey ho, fine morning for being an evil monster, what harm can we do today?” Rather, it will have been a slightly weary self-pity script: “I am doing all this for the public good, even though nobody thanks me for it; I have taken on this burden on behalf of everyone, a misunderstood martyr. Alas, the white man’s burden; poor me! But someone has to undertake the distasteful task of organising gas chambers; they’ll thank me in the end”.

The NHS, week by week being Balkanised out of existence, goes on being carved up and run into the ground by grubby little nobodies with no interest in care or health, people without conscience, skill, decency or anything much beyond a personality-disordered sense of their own entitlement and worth. People like Bond and Flintoft and their henchpersons are everywhere, not just in high-profile situations like Stafford, not just at the epicentres of the obvious disasters, but everywhere, all the while attracting and employing more people like themselves, all the while assisting at the perversion and demolition of one of the finest things the country ever invented. It is not obvious how to stop this, but stopped it must be; else for decent people there is nothing left but to crawl off and die.

To Bond and Flintoft: Nice killing you made there, lads! Feel good about it, do you?

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