Category Archives: equality

Audit, Inspection and Scrutiny: the three ugly sisters?

This popped into my inbox today:

“The need to drive up the quality of care for patients, whilst delivering efficiency and productivity, is a key principle for the NHS. As pressure on NHS finances continues to build, UKAS accreditation is increasingly being used as an effective way for purchasers and commissioners to demonstrate that they can achieve ‘more for less’.”

I felt a stirring of irritation. This blog is the result……….

I know organisations have to behave commercially and tick boxes in order to thrive. I spend part of my working life encouraging and supporting charities and NFPs to do exactly that, but without losing their heart and soul to it. It is possible. But as an old nurse (registered about a century ago) and vehement supporter of the NHS original principles of free at the point of need and paid for by the entire community I am increasingly dismayed by the passionless, sterile performance of the people tasked with – and paid handsomely for – managing “public” health services. I have seen patients become the enemy, clinical standards side-lined in favour of improvement on the balance sheet, kindness become irrelevant, and buzzwords and trends take the place of clinical and compassionate behaviour. Health and social services are scrutinised, inspected, audited, governed, examined, professionalised more than ever before and we still have Winterbourne, elder abuse, Southern Health (pauses to spit), frequent reports of casual abuse and cruelty (that we know of), and we will all know those “care” homes with a good CQC rating which pong and employ people you would not want to sit next to on the bus. We will all know of supported living services that are little more than one person institutions with little or no meaningful activity and engagement – or to put it another way, that warehouse people in units of one, creating the illusion of choice and a Life but deliver isolation and fear. We have seen Southern Health reduce victims and loving families to statistics and irrelevancies, destroying people in order to prop up a system that sucks and protect the very people who allowed and encouraged the system that killed people and fixed the blame on others, with lies, obfuscation and bluster.

Some inspection agencies, several tiers of consultancy and management and many more are too often yet another layer of “approval” or box ticking to chuck at organisations. Along with services like 111 –  a dangerous irrelevance that often removes much needed funding from frontline services for the return of reduced standards and increased risk –  they also create a cash cow for canny providers without delivering any improvement in clinical outcomes, or supporting real people with the very real challenges of everyday ill health. We seem to simply carry on increasing layers of approval, fresh hoops to leap through (some with fire) rather than examine very basic factors. Often the people creating those hoops are not clinical and have little understanding of how  things actually work in the real world. I keep hearing that we need more funding for this that and the other – I keep seeing a variety of groups being blamed for an ever increasing number of failures and deficits: currently GPs are getting a hammering despite being possibly the last group of professionals who should be blamed and who, along with dedicated skilled nurses have kept things going against the odds. Commissioning services is clunky, inappropriately targeted, poorly contracted and badly managed, which is a criticism of the process –  again often created by people who do not understand the real workings – and not the people who have to work with it. The competition itself reduces the capacity to develop and really grow health and social care support services because contracts are not only badly drawn and managed but are up for renewal so frequently it is impossible to invest in services and also make that holy grail of profit. Profit is not going to be the first thing to go.

I firmly believe in a skilled and educated workforce well managed and led and supported with career choices and pathways. I also firmly believe in holding organisations and individuals to account. I believe those can be delivered without the huge self-propagating self- perpetuating roundabout of new mandatory qualifications and accreditations, incompetent inspections, and without the workshops, consultancies, projects, papers, enquiries, processes, requirements and bottom feeding organisations that have sprung up around services that are actually intended to protect, care for and nurture us.

There comes a time when the volcano erupts, the boil is lanced, the pus drains and healing can take place. We need to recognise that the privatisation experiment which was trumpeted as the way to increase choice and competition which were equally being promoted as in our interests – I am pausing for the laugh here –  is a failure, delivering little more than profits for largely incompetent organisations and draining the body of the NHS of resources and talent. Choice is not what sick people want, overall – they want skilled professional care, close to home, delivered kindly by people they trust and with their involvement in the process. And answers if something goes wrong, with a meaningful apology attached. Dividing professionals and organisations with “competition”, asking for innovation when compassion is good enough, blaming good people for systemic failures and expecting mountains of assessments, graphs, justifications, and hounding good people for honest mistakes does not result in decent health and social support.

Have a look at this: Laugh and then weep.

Brexit. Trump. Strictly. No, don’t click me away! Bear with.

Cards on the table, I don’t much like the tellybox. I watch, occasionally, stuff like Railway Journeys with Portillo, or that wonderful Canal programme with Timothy and Prue, but on the whole most of it passes me by. Most of what I do see is caught accidentally when the rest of the family are watching and I stumble into the room on my way somewhere else. However, I have become surprisingly interested in Strictly Come Dancing this last couple of series – maybe it’s because I remember watching the original all those years ago, usually with an altered state of mind which helped.

Bear with…….

This year has been in interesting year for anyone with half an eye on politics. We have, allegedly, seen a rise in the proletariat offering a bit of a slap to the people who have seeped and dribbled into offices of power and decided they know best. Not only that they know best but that the proles know nothing and need to be kept in their place. Our place. To that end, arguably, Education and Health, and to a large extent the Criminal Justice System and Housing, have been morphing in recent decades, leaving behind much of the social construct and responsibility that most of us value and developing a profit motive that no longer has to try to hide. Priorities in socially important organisations changed of necessity – it was do or die –  and in part that has been supported passively by people still believing that someone with a lot of money and a private education knows better than them. Pair that with the desperate need of many to simply keep body and soul together leaving little time to be involved in much else and a consistent lowering of expectations and we have a perfect storm of passivity and fatigue that allows people who do have the time and money (and the networks developed at school and Uni and by family connections) to buy a pathway into power. I mention no names…….

And then came 2016. Hands up who approached 2016 thinking “Thank Goodness 2015 is over, what a year, it can only get better”…..? Yes, well that went well, didn’t it? Apart from lots of lovely people dying who had created my history and the musical and artistic backdrop to my youth, we also had Brexit and Trump. Divisions created deliberately by the powerful to conquer the masses led to the very public murder of one woman, an increase in the confidence of people with shameful attitudes, a legitimising of all kinds of isms from ageism (the older generation have spoiled things for the young/the young don’t understand the issues) through racism (go back to where you came from/who will you blow up next) and a general atmosphere of mistrust and hatred. Conversation was replaced by brick throwing and chanting, voting was seen as an act of defiance rather than an inalienable right and duty and more people voted for Brexit than at any General Election for years. Public dissatisfaction with politicians who fiddle expenses and despise their electorate was having some practical results. Trump had already hopped onto the bandwagon and shamelessly – alongside some of his opponents and supporters – traded insults and lies rather than debate and detail, whipping up his gang to hatred of others, violence, intolerance and a lack of facts. Taking mansplaining to a whole new level, and behaving publicly in a way that many parents would justifiably have slapped their children for, he set new and deeply unattractive guidelines for public debate and demeanour. In both of these events we witnessed the powerless grasping onto something over which they believed they had some control, a new experience for many. In reality the power and control remained exactly where they already were but the illusion of influence was conferred, more expertly in some areas than in others. That precious vote, hard won by ordinary people over the years, wrestled from the wealthy and powerful and certainly not given freely by them, was being manipulated to support the very people who stood to gain most. And that, Ladies and Gentlemen, is politics in the 21st Century. Ordinary people are encouraged to think they have had enough of the elite – by some of the elite – in order to get them to vote for the elite.

But something did happen. The idea of sticking it to the elite has taken hold. The concept that perhaps people can make choices, sometimes dangerous or wrong choices, and define their own reality and outcomes and live with the consequences is becoming clearer. And so we arrive at Strictly. I told you to bear with. Ed Balls joined the Strictly dancers and immediately gained the publics support for dancing badly, but with charm and warmth. The pubic enjoyed his efforts and his ineptitude, his determination to do his best and move forward – they liked it much better than some of the other dancers who danced better but were less appealingly human and had less distance to go to dance well. Someone who until recently appeared as part of the elite was shown to be Like Us. Not only Like Us, but likeable and funny. He charmed. The judges were ghastly to Ed and that just increased his popularity – they gurned when he danced, were outright discourteous, were way less encouraging to him than the other “better” dancers and generally behaved like, well, like the elite. Clearly they are the experts, clearly they are dancers, but their unpleasant behaviour rendered that immaterial – we liked Ed because he wasn’t an expert and wasn’t elite. We didn’t like the judges being smug and telling us what to like and what not to like. We Brexited them. We Trumped them. We voted in droves for the Little Man. Apparently. Well, job done. Ed is rehabilitated and the People have spoken. He has worked hard and redefined his place in the public eye.

Quite a few of The Elite are chums of mine. Quite a few of The People are chums of mine. I like them all – I think there is a little bit of fabulous about everyone, without exception. Their politics are not what I admire about them – if they charm me and make me laugh, if they have a brain and a heart, are kind, and hold a conversation well that is what I admire. What they do in the ballot box is not my business. What is my business is what happens when the votes are counted and policy decisions are being made. As someone who has worked for years in health, justice and social care and across all the sectors, and as a school governor, I have seen how public policy impacts actual people. Left and Right are almost irrelevant as long as socially important organisations and services remain at the whim of people many of whom will say and do almost anything to sit in a seat of power, many of whom have no meaningful experience of the departments they lead ( I am sure you know what I mean and who I mean……), and who potentially change direction regularly every few years. When there is actually a direction to change and not just a dogma to follow.  While we have no available Intensive Care beds for children anywhere in the country, while nearly 9,000 people slept on the streets in London alone in 2015/16 – and that is only the recorded figure – and 57,750 households were accepted as homeless and in ‘priority need’ in the same year, a six percent rise on the previous year, while mental health services are randomly delivered and under-funded and a false economy as so many people bounce around the expensive system, while almost as many people leave prison unable to read as entered it (this is changing, thank goodness, thanks to some fabbo people, but so slowly), while people with a criminal record are routinely excluded from jobs and housing denying them the opportunity to desist, while all of these things and more are happening Left and Right can argue until blue/red/green/yellow/purple in the face but it will remain a disgrace and the responsibility of all of them. And all of us.

There are some properly decent people in and around government and in and around some of the organisations that develop and deliver services, people who actually want to make a difference and not a fortune. I insist on feeling hopeful that the vote for Brexit – and Strictly – is an indication of the start of increased popular involvement in government. Whether or not I agree with outcomes upon which people vote does not matter – it is up to me to make a case for my view and debate properly. If votes go a different way to the one I would like I still rejoice that democracy has taken place. We have become a tad complacent in recent years, the freedoms and opportunities that have taken so long and so much painful sacrifice to attain are at risk. That complacency has allowed bad practices to slip under the wire – without some darn good journalism the expenses scandals would have remained unknown, for example, or at the least unremarked. Our inexplicable faith in people in positions of power, supported by the anaesthesia of media dependence, has let us take our collective eyes off the collective ball. My optimism tells me that people are perhaps willing to become more engaged and knowledgeable about the things that will affect their lives and less tribal in their allegiances. Brexit and Strictly both cut across most demographics…….

So, vote for Strictly! Vote in your local and general elections! Talk to your MP, find out what she or he actually thinks and don’t take it on face value – challenge, probe, question, scrutinise. And crucially, tell her or him what you think and what you expect of them. Own outcomes. Learn to Salsa and wear some fancy clothes. Dance and vote like no-one is watching.  And remember that T Blair is creating a global organisation to combat populism  – that’s you and me – and promote globalism – the thing that fills his pockets. We must be becoming dangerous……….

Germaine Greer at the Folkestone Quarterhouse, childbirth, and the Universe. (Warning, some dubious language is employed……..)

I nearly didn’t go. I was behind with everything and had so much to do, and am still working on not being a workaholic, which prompted me to actually go – take time for me. So, I went to the audience with Germaine Greer at the Folkestone Quarterhouse last week. And I am so glad I did – and a massive thank you to Stephanie Karpetas who arranged it.

Germaine has morphed so many times, as indeed we all have. We have to morph to keep up. And we have to keep up to make a living and to stay afloat – if we don’t morph we run  the risk of drowning in redundant self images and out of date mores, a painful way to go as they can stick in your throat.  Her current incarnation suits her well – a slightly world weary battle scarred Grande Dame who has worked out that she hasn’t worked it out yet but is still having a damn good try and is happy to take us with her. As a Spare Rib veteran and a bit of a Grande Dame myself I found no startling revelations and no new truths in the evening, but I wan’t expecting any. What I did find were prompts and nudges, a few winks and pointers towards where my natural urge for introspection should go. And a bit of a jolt. I found myself remembering how I had been, how I had felt all those years ago when I had realised the world was a bit off balance, that some people did not have the same opportunities and rights as others, and quelle horreur, I was one of them! As a woman there were some barriers to  what I might achieve. I remember as if I were back there watching how it felt and what I thought: fuck ’em, bring it on.

I am not going to get into the details of inequalities and all the complex events and factors that reduce a persons or a groups opportunities – those have been done to death and only those with something to lose if it changed would say that those inequalities do not exist or are easily overcome with “hard work” and “persistence”. Those help, but do not address the core challenges. I am also not going to list the multiple groups affected, such as women, people of colour (I think that is still safe to use), people identified as disabled, people with a forensic history………too many to list here. I will only say that coming from a Convent education it was a bit of a shock to realise that women might not be powerful, clever and interesting to everyone else. Even the unpleasant ones in my youth had been clever and interesting, and certainly powerful. And if they also made me laugh – which most did – I could forgive them almost anything. Actually that still works now. Dammit.

Germaine talked about many things, and in particular how our biology impacts our lives. Especially apt with Wolf Hall doing so well on the Tellybox. I think all of Henrys wives would agree that their biology dictated their lives and even their deaths. I was reminded – how could I forget – of the birth of my first surviving baby in the 1980s. We had miscarried a few beforehand so I was almost surprised to find myself in actual full term labour. Being a dutiful middle class educated woman I had, of course, attended NCT childbirth classes with the Old Man and we had made a loose birth plan which specifically said we don’t expect it to go according to plan but here are a few things I would like you (the health care professionals) to notice and we had been careful not to be demanding, only make suggestions. I will not bore you with details – or scare you with them. It was a long and difficult labour and I met a huge variety of people all primed and ready to patronise me and on whom I was dependent. One image I carry still, and which memory Germaine prodded into the front of my mind , was when I had almost had enough and was exhausted but still polite and meek, and the shifts changed on the ward – remember how long ago this was! – and a new doctor arrived. She loomed over me and said – and I remember the words, the voice and the tone as clearly as if she was here now – ” I have read your demands. You have to remember that you have a precious package in there”. I panted, I rocked forwards, tetchy by now, and I said ” And there was me” pant pant pant “thinking it was” pant pant pant “a bag of FUCKING SUGAR”  collapse pant pant. Not my finest hour.

And even then I was aware of how dangerous and precarious childbirth is and how it changes things. And I was surprised at how it – my biology – changed me over the next few years. I had made all sorts of plans about returning to work within weeks without even considering how I might feel. The Old Man – also at that time an unrepentant feminist – was going to stay at home and I would go back to work. I was earning more, it all made sense. What took no notice of sense at all, in fact it looked at sense, threw it to the floor and stepped on it, several times, was emotion. I could not leave my baby. Why had I not considered that might happen? My feminism and independence were both kicked into touch by my biology. Who knew…….

Things are better now. Even my subsequent experiences of childbirth were better, less botched – there was no non-English-speaking doctor Down There stitching me up silently with the odd disturbing giggle, for example. Yes, that did happen. And the midwives were more assertive and in control – a much better situation. And one of my own daughters recent experience of childbirth was excellent – although it was overnight, and seeing the day staff and watching them work I think that might have been sheer luck and in large part down to her magnificent awesomeness. But it was what it was and she had a good experience so we will just be grateful. And another daughter is herself working in Maternity and Obstetrics and I know she will make a positive difference.

Germaine, with a weary but acute eye, brought all those things into focus for me that evening. She turned my gaze – which is too often on work and survival – onto me, and onto my daughters and son – also, to my joy, an unrepentant feminist – and their futures. We have come so far, so fast. Only a sockful of years since women were first allowed to vote, and we now have woman clergy, for example. But still so far to go. As long as we have FGM (as Germaine pointed out, often perpetuated by women on their daughters), rape as a weapon of war, convicted rapists lauded by football fans, page 3 as a “right” (WTF?), and violent porn freely available to offer  that warped picture of sexuality to our youngsters; as long as we have slut-shaming and twitter-trolls offering to rape women who hold an opinion, rooms full of influential politicians without a woman to be seen, the ex-prospective French presidential candidate casually abusing women and still believing it was ok (allegedly…..), women on television routinely judged and criticised for their appearance rather than their performance where men are not, and women still being scared into anonymity after domestic abuse, we will still have a long way to go. Women are not the only group to find ourselves overshadowed, but it was women we were discussing last week and women I am discussing now, unashamedly.

So, I am glad I went to see Germaine. I also met some women there who I would not otherwise have met – always a bonus. And they were all, yes, interesting and amusing and excellent company. Thinking is a genuine pleasure, and how happy I am that Germaine prompted some thoughts. Thank you Germaine. And thank you Stephanie Karpetas! And finally, a huge shout out for the Folkestone Quarterhouse – my first visit there and I don’t understand why I haven’t been before. A lovely venue with terrific staff and a wonderful menu for the next few months.

https://www.quarterhouse.co.uk/

%d bloggers like this: