[Image: Wellcome Library, London]
Between Christmas cake and 1001 leftover turkey recipes, I’ve been mulling over the Mazars review of deaths in Southern Health NHS Foundation Trust and how they were (not) investigated (see https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2015/12/mazars-rep.pdf ). In particular, I’ve been wondering: 1) whether the NHS England/DH attempt to shut this down by publishing it within a couple of hours of parliament going into recess before Christmas will be successful; and 2) whether the squawks of outrage press released by various charities will be quietly shelved for ‘business as usual’ at the usual DH and NHS England tables in the new year.
In my own mind, I’ve never really resolved the insider-outsider conundrum. Is it better to be working ‘on the inside’ to get something done, even in profoundly unpropitious circumstances, with all the attendant compromises involved? Or is ‘influence’ a comforting illusion which can begin to look like collusion? Can shouting from the ‘outside’ ever be effective rather than just being self-counsciously virtuous, or does it alienate people on the ‘inside’ who might otherwise be receptive to what you’re saying? Does withdrawing from the insider table send an important message, or just leave a smaller number of people round the table to carry on without having to hear from dissenting voices? I’m also acutely aware that this is not a choice that is available to pretty much everyone with learning disabilities or their families, who are shut out from meaningful decision-making.
For me personally, the Mazars review and how DH/NHS England have dealt with it represent a fundamental failure at a crucial moment. I do quite a lot of work with DH and NHS England as part of my work for IHaL, the learning disabilities public health observatory funded by Public Health England. I also have ongoing contacts with DH and NHS England as an academic, trying to offer advice around what the available research evidence says on a range of issues.
The day after the Mazars review and the responses were published, I sent the following email to a colleague in DH who had asked me to be involved in something as an academic – I sent a very similar message to someone in NHS England too:
Thanks for your message – I was waiting until I saw the Department of Health response to the Mazars report. Personally, how DH responded to the Mazars report was a crucial barometer for me of whether DH as an entity can be trusted to stand with people with learning disabilities and families when the going gets difficult, and whether DH are prepared to address the fundamental discrimination faced by people with learning disabilities. I’m gutted to find that I personally think DH have catastrophically failed. This makes me feel that, in terms of national initiatives to transform care for people with learning disabilities, I have no confidence in the capacity of DH to do this properly.
If I am required to take part in this process as part of my Public Health England responsibilities then I will do so, and to the best of my ability. If you’re asking me to do this as an academic, then I must say no. I can’t continue with ‘business as usual’ and collude in processes that I don’t have confidence in. I’m gutted to say this, and this isn’t at all to question your personal commitment and capacity to do the right thing which I respect greatly. I just feel that the response to the Mazars report has shown that the DH system as a whole isn’t ready to do what really needs to be done.
Best wishes, and take care
Depending on how you look at it (and I oscillate wildly in how I think of it myself), this is anything from foolish through mushy compromise to fatuous virtue signalling (compounded by putting it in this blog).
My real point here is not to signal this as a good decision, or to encourage other people to do something similar – there are a wide range of perfectly defensible and reasonable decisions that could be made. My point is simply that I would ask other people, and particularly big and influential charities and other organisations, not to unreflectingly carry on with ‘business as usual’ but to ask themselves searching questions about: 1) What their strategy is about engaging (or not) with DH and/or NHS England (and ADASS too); 2) What their rationale is for their strategy; and 3) How would they know whether their strategy is successful or not, and whether there are any circumstances under which their engagement strategy would change? And I would want big charities and other organisations to make their decision-making process public.
I’m not a natural ‘boat rocker’ (ha!) and writing this post feels uncomfortable (which it should do). I’d be really interested in people’s opinions.