September 9, 2009

"Excellent" Trust Gets a Good Kicking From the Mental Health Act Commission

"When I tell the truth, it is not for the sake of convincing those who do not know it, but for the sake of defending those that do"
William Blake

Don't look directly at Mr Sunshine by Baggelboy

The Mental Health Act Commission's (MHAC) job is to safeguard the interests of all people detained under the Mental Health Act 1983 (MHA). As an organisation it has the task of protecting of the human rights of detained patients.

It visits hospitals, meets with patients in private, and examines records relating to their detention or treatment. It also inspects the general living conditions of the wards, staff attitudes and the general hospital environment.

The MHAC report on the Cambridgeshire and Peterborough NHS Foundation Trust (the Trust) for 2008 has been delivered to the Trust, but for unknown reasons is not publicly available, although the Trust's response to this mysterious report, is available on the MHAC website.

Foundation Trust Watch has written to the MHAC asking to be provided with a copy of the report and we are awaiting their response.

Until we have the 2008 report, we will have to make do with the MHAC 2007 report. This document was compiled after 15 separate visits to various in-patient units, between December 2006 and September 2007. A total of 35 patients were interviewed in private.

The report makes horrific reading

It's difficult to know where to begin, so many and so serious are the MHAC's findings.

Section 58 of the MHA deals with treatment requiring consent or a second opinion.

The Mental Health Act requires written certification of the patient's understanding of the treatment being offered, and their consent to it. This is recorded on a "Form 38". If the patient is unable or unwilling to consent to treatment, a Second Opinion Appointed Doctor (SOAD) must be consulted. If the two doctors agree the treatment is in the patient's best interest, then this is recorded on a "Form 39"; the medication can then be given to the patient against their will and if necessary, by using force. A typical example of 'good practice' for the completion of these forms is here.

A copy of the form is then added to the patient's case notes, one is sent to the hospital's MHA Administrator (an officer appointed to oversee the application of the MHA), and one is attached to the patient's medicine card, kept on the ward. This is so staff can check the legality of their provision of medication.

Patients given medication unlawfully

In regard to two in-patient wards, the MHAC reported the following:

David Clarke House and Burnet House

The Commission has particular concerns about the administration of Section 58 on these wards.

Some of the Forms 38 examined were not completed in accordance with the Code of Practice guidelines.

One patient being treated at David Clark House under a Form 38 was not aware of the medication or what it was for. There appeared to be no indication that the doctor had assessed the patient’s capacity or consent as required.

Two patients were being treated under a Form 38 and had been prescribed and given up to three drugs which were not indicated on their Form 38 and were therefore being given without legal authorisation.

Several medicine cards did not have the corresponding Form 38/39 attached to them and it was difficult to see how nursing staff could check the legal authorisation of the medicine they were administering.

Both wards received a follow up visit six months a later... ...disappointingly, the evidence did not suggest [] much progress in David Clark House.

So it seems patients have been given psychotropic medication illegally. It also seems some staff, saw fit to ignore the law and continued to ignore the law, even when told they're acting illegally. Who are these doctors and nurses that have such a contemptuous attitude to the law? Why weren't they subject to disciplinary proceedings?

staff unaware of the law

Section 132 of the Mental Health Act is designed to ensure that the patients are aware of, and regularly reminded of their legal rights.

The Commission states that although patients were informed of their rights on admission, no further reminders were given and it seems to imply that documents were sent to the MHA Administrator indicating that reminders had been given to patients, when in fact, no such advice was offered.

The Commission goes on to say:

On Edith Cavell ward, Hawthorn ward and David Clark House, the Section 132 documents for a total of six patients indicated that they had understood their rights but on interview by the Commissioner it was clear that they lacked understanding.

At David Clark House staff appeared to be unaware of the requirements of Section 132.

How can it be that staff are unaware of the one of the fundamental parts of mental health legislation? At a Trust, who's Chief Executive claimed:

2007/08 has been no different to other years, in that we have continued to provide excellent care for service users and carers, evidenced by external reviews and assessments.

CPA reviews did not take place

Section 117 of the MHA and the Care Programme Approach (CPA)

Section 117 of the MHA sets out how each patients needs and wishes are to be met via the CPA. This is documented in their "Care Plans".

The Commission said:

The Trust has received feedback over the past year from both staff and service users that the CPA is not working well and this is reflected by the Commission’s findings at ward level.

On most wards visited the process appeared muddled; care plans were focused primarily on in-patient management rather then the total spectrum of care. There is little evidence to suggest that service users were involved in the planning of their care or that it was recorded in the documentation.

On one ward, CPA reviews did not appear to take place.

On another ward, the Commission visited in April the CPA documents examined appeared to be out of date or incomplete and detained patients had no care and risk management plans relating to their current status under the Mental Heath Act.

The Commission returned to this ward six months later and were:

Disappointed that there was no evidence patients had been involved in the planning of their care and the ample space in the documents to provide for this was blank.

At David Clark House, at the time of the Commission visit in April the CPA process was described as “somewhat chaotic”; detained patients appeared not to have received a thorough assessment of their needs and care plans were primarily focused very specific needs such as not smoking or getting out of bed.

It was not clear which care plans were current and there was little evidence that care plans were regularly reviewed or that risk assessments had been undertaken.

malodorous and not very clean

We will quickly skate over the Commission's findings that at Burnet House:

There were particular concerns about the male toilet/bathroom area which was malodorous and not very clean.

misuse of MHA for staff's convenience

Section 4 of the MHA dealing with emergency admissions to hospital of people under section 2 of the Act for assessment.

Section 4 of the MHA deals with emergency admission to hospital

The MHAC says:

There has been a small but significant increase in Section 4 admissions in the past year (especially from the Fenland area) and one ASW report examined by the Commissioner indicated that this was because of non-availability of an approved doctor.

The Commission draws the Trust's attention to the Code of Practice and in particular that Section 4 should be used for a genuine emergency, not for administrative convenience.

The Department of Health's Mental Health Act Code of Practice states:

Urgent necessity: Section 4 should be used only in a genuine emergency, where the patient's need for urgent assessment outweighs the desirability of waiting for a second doctor. Section 4 should never be used for administrative convenience.

The MHAC recommends:

The precise reason for a Section 4 admission should be recorded in detail on the ASW's report and its use closely monitored.

Trust Watch would like to know the name of the Approved Social Worker who saw fit to ignore the code of practice and it seems, broke the law.

distress caused to patients

Section 136 of the MHA - place of safety.

Section 136 of the MHA allows police to detain people they believe to be mentally disordered and convey them to a "place of safety". Many people maintain that a police station is not a "place of safety", and the use of police cells as such, is frowned upon generally: "Police custody is an unsuitable environment for someone with mental illness and may make their condition worse, particularly if they are not dealt with quickly, appropriately and don’t receive the care they need".

The Commission was informed that some patients were detained for 12/15 hours in a police cell whilst arrangements were made for a full Mental Health Assessment and/or a bed was located in an appropriate mental health ward. The Area Commissioner was given examples of the distress caused to patients in this situation and occasional lack of police sensitivity to patients in their temporary care.

One can only speculate as to the true nature and degree of the patient's "distress" and "occasional lack of police sensitivity to patients".

Trust's response "uncoordinated and unsatisfactory"

So, to summarize the findings of the Commission:

However, as last year (2006) there are continued concerns about the Consent to Treatment.

The Commission interviewed a number of patients who were unsure of their rights even though it was recorded that they understood them.

In many wards the Care Programme Approach did not appear to be working effectively.

In the first six months of the year (2007) the Trust's response to Commission visits appeared uncoordinated and unsatisfactory.

For four visits, the Commission did not receive the Trust's feedback response, despite reminders, until three to four months after the visit.

unfettered power

Perhaps the reason patients' rights and the Commission's findings were repeatedly ignored was because the Trust at the time was expending most of it's energies in a desperate, grasping bid for Foundation status and implementing the new LEAN management techniques, imported wholesale from a Japanese car maker.

The needs and rights of the patients, and the requirements of the law had simply dropped of the Trust's radar, to be replaced by the sea-clutter of corporate onanism and the prospect of the unfettered power that Foundation status would bring.


September 8, 2009

Excellent Chief Executive's Excellent Report

I hope you're sitting comfortably children, it's time for part 1 of a review of the Cambridgeshire and Peterborough NHS Foundation Trust's 2008 annual report.

A year of transformation and excellent care

Our Trust has always been at the forefront of providing excellent care.

The provision of in-patient care (one of the core activities of a mental health service) was rated as "fair" - that is, only one notch above the lowest possible rating.

As well as continuing to provide excellent care as we have always done, a big focus this year has been on transforming our services to ensure that they are effective, efficient and cost effective.

The excellence and cost effectiveness of the Trust's care was so damned good that it lost the contract for services to people with drug problems. This work is now being done by the charity Addaction.

Further excellence was evidenced by the loss of another contract to provide Supported Living Services to people with learning disabilities. The Thera Trust will now be taking on this role.

Undeterred by this double smack in the visi, the Trust looked to industry to provide the lead on how to continue to excel at excellence.

We were one of the first Trusts to introduce LEAN principles which were originally adopted in industry and which have now been implemented in the NHS.

The LEAN principles were developed by Toyota to make make cars. They're now being used to deliver your excellent mental health care. Let's look a little closer at what this will mean in practice:

Toyota says

"...we're conservative in our approach to applying automation. You can kaizen people very easily, but it's hard to kaizen a machine. Our process got far more productive and efficient, but the machine didn't. So, the machine had to come out."

Ah! Clearly "kaizen" must be the meat-grinder process, so beloved of our Trust.

They go on to say:

Genchi Genbutsu (現地現物) reflects the idea that whatever reports and measures and ideas are transmitted to management they are only an abstraction of what is actually going on in the "Gemba" to create value.

It's all beginning to seem clear now. It continues:

If the workload or the type of work fluctuates wildly from one moment to the other, people (and machines) never "get into the rhythm" and waste time switching between tasks. The production stalls and restarts all the time, workcells don't get the required raw materials.

Presumably in a mental health context "raw materials" are mad people.

Lean Production uses "Takt Time", a fixed rhythm which governs how fast each workcell works; Theory of Constraints uses the constraint as the "drum" to dictate the rhythm of the production line.

Yes, I can see how that would be useful on an acute mental health ward.

I'm going to have to stop now. I've become a little sickened from writing this post. The Trust's annual report is truly a nauseating example of grand organisational onanism.

To repeatedly claim excellence, while admitting to sub-standard care, loss of business and repeated failings of basic health and social care tasks, is double-think of the highest quality, made possible only by the application of 6 figure salaries to executive snout.

Excuse me while I vomit.

September 2, 2009

"Excellent" Trust - The Truth

This is the truth about the performance on the ground of the "Excellent" Cambridgeshire and Peterborough Foundation Trust:

Click on the image to see the Truth in Black & White and Blood-Red:

An absolute bloody disgrace that despite this the Trust is rated "Excellent".

But don't take the word of a drunken old hag like me. Read it for yourself from the Healthcare Commission's website.

I'm so depressed after reading it, that I'm going now, to get even more drunk, if indeed that's possible, and then listen to Flannagan and Allen.

On all of these points, the Trust scored in the LOWEST 20% of all NHS trusts:

Did the community psychiatric nurse listen
carefully to you?

Were you told about possible side effects of
any new medications?

In the last 12 months, did the provision of
talking therapies meet your requirements?

Can you contact your care co-ordinator if you
have a problem?

Do you understand what is in your care plan?

Have you been given (or offered) a written or
printed copy of your care plan?

In the last 12 months have you had a care

Were you told that you could bring a friend or
relative to your care review meetings?

Were you given a chance to talk to your care
co-ordinator about what would happen?

Were you given a chance to express your
views at the meeting?

Did you find the last care review helpful?

Were the activities provided by the day centre
or day hospital helpful?

Do you have the number of someone from NHS
services that you can phone out of office hours?

Has a member of your family or someone else
close to you been given enough information?

Has a member of your family or someone
else close to you had enough support?

Do you have enough say in decisions about
your care and treatment?



More Local NHS "Excellence"

Dr Rita Pal writes on her blog Ward 87 about losing her father in a local NHS hospital. It's almost to much to follow. But read it anyway, because this is the truth about "Excellence" in the NHS.

"A Day With No Sunlight by Dr Rita Pal
Actually, he was found dead by our family.

He was in an acute cardiac unit, had been left unmonitored in the hospital of Clinical Excellence.

Papworth NHS Trust is not compelled by the laws of this land to record of father as a statistic [see email from the Department of Health below].

So apart from this article, there is no record of his death within NHS statistics.

He just joins everyone else in the UK number of deaths.

In addition, because the doctors cleverly failed to take blood cultures, the MRSA found in his sputum and the high white cell count is not recorded as a MRSA death.

He is not part of the MRSA statistics yet he should be.

My father was a consultant surgeon. His doctors were as follows

1. Mr Samer Nashef
2. Dr MC Petch
3. Mr Wells.
4. Mr Robert Bonser
5. Dr Francisco Leyva Leon...."

Continue reading the rest of Dr Pal's post here.

I've got no cheap shots to take.

Some things are beyond satire.

September 1, 2009

Militant Excellence

Local radicals heed the call and win a stunning Victory on the price of a new Vauxhall

Groucho Marx before he was famous

So, in this mélange of Olympic class tick-boxing, coupled frantically with statistical "Excellence", what are our local patients' voice organisations doing? Are they venting their fury at ever increasingly acrimonious user consultation meetings? Are they, fuck.

And what about the original Foundation Trust Watch? Oh yes, we were not the first. Previously, the public workers' union said "UNISON believes Foundation Trust status undermine the principles of the national health service".

So outraged were they, they set up the original Foundation Trust Watch to surveil those evil bastards that were going to tear the NHS to shreds and throw the pieces to the private sector.

In a move of militant "Excellence"

In a move of militant "Excellence" they devolved the campaign to their branches, complete with a list of local organisations to infiltrate and subvert:

1 Local government scrutiny committees
2 Non executives on PCTs
3 Health councils and patient forums
4 Trades councils
5 Trade union branches
6 Local Labour party
7 Community organisations

Did they?

Did they, fuck.

Right at the crucial moment, when the revolution was to be sparked, they were distracted by a man from Vauxhall Motors with a special deal offering the union's members up 21% of the price of a new car.

Down came the Red Flag and up went the poster for the new Corsa Life 12i 16V.

while Napoleon projectile vomits statistics

And the lumpen proletariat falls back to their suicidal ideation and maximum strength shut-you-up pills, while Napoleon projectile vomits statistics in the face of the Inner Party, before getting her snout down for some serious Troughing and Squealer goes on the local radio to tell the rest of us to "be nice to Mad people 'cause there's a lot of it about".

Yes, being nice to Mad People would make a lovely change from staff lining up to take turns pissing on us.

It's "Excellence", of sorts, I suppose.


"Excellent" Trust Sends Autistics to Charities for Help

Trust to provide begging bowls in time for Christmas

A high functioning autistic

The "Excellent" Trust has in its Joint Strategic Needs Assessment, told high-functioning autistics in Cambridgeshire, that charities will have to provide housing, employment and social care services, despite admitting

"It is now accepted that the belief that ‘high functioning’ [autism] is a ‘mild’ form of autism, is unwarranted"

And that:

"There is a risk that people with ... [autism] are unable to or have difficulty in accessing services"

Yes, there certainly will be difficulties in them accessing services when you tell them to fuck off.

They go on to say:

"people with [autism] often have patterns of skills that are uneven so that, while they are excluded from support on the basis that their IQ score is above 70, this is made up of very good performance skills, which are of little use in everyday life"

And the coup de grâce?:

"in some cases, even when the person’s tested intellectual ability is uniformly high, in everyday life he or she is unable, because of difficulties associated with the psychopathology of [autism] to complete many of the most ordinary tasks"

So what does the "Excellent" trust say about providing for this extremely vulnerable group of more than 2500 adults in Cambridgeshire, that suffers from a 90% unemployment rate and sky-high levels of suicide?

"voluntary organisations could deliver these functions, to include: Training/employment, Education, Housing, Leisure and social activities, Welfare support, Information"

In other word we're going to do fuck all and palm you off on to the quixotic mercies of a bunch of upper-middle class twits, rattling the can at WI fetes, to pay for the basic social care services, that the government says must be provided by the state.


P.S. The National Autistic Society recently wrote to the Trust to ask them what they were doing for adult autistics. The Trust didn't bother replying.



August 29, 2009

Legal Aid to take "Excellent" Trust to the High Court.

Documents obtained by Trust Watch prove that their services are so "Excellent", that the Legal Aid board granted one patient more than £3500 to take the Trust to the High Court, to force them to provide services.

The Patient, already so ill and traumatized from many years of living rough had to give up the legal action because of the stress exacerbating his existing mental health and disabilities.

I was literally becoming psychotic from the extreme worry and anxiety

He said "I was already on a knife edge, terrified I was about to kill myself or someone else, I kept begging for help, and then on top of it, trying to cope with the stress of dealing with solicitors and barristers - it was just too much.

I was literally becoming psychotic from the extreme worry and anxiety. I had no choice, I had to tell the solicitor to forget it."

It is to say the least, unusual, for homeless, psychotics to be offered legal aid for judicial reviews - it attests to the "Excellence" of the Trust's commitment to offering

"best practice care and services".

August 7, 2009

Old Posh University teams up with "Excellent" Trust

Old Posh University teams up with "Excellent" Trust to deliver sub-standard care.
Peter Jones - Head of Old Posh University's Department of Psychiatry

Professor Peter Jones is the head of the University of Cambridge's Department of Psychiatry, and also has a role as a non-executive governor of the Trust. He is a thoroughly good clinician, well liked by the patients that are fortunate enough to have him as their doctor. He's very brainy, very hard working, honest and an all-round good-guy.

A patient has asked to send this letter to Peter, via Foundation Trust Watch:

Dear Peter,

Forgive me for getting straight to the point.

What the fuck's going on Peter?

Are you blind to the fact that the patients that aren't fortunate enough to have you looking after them, are having to put up having the shitty end of a sharp stick poked in their eye?

But, I mean, don't take our word for it, we're just a bunch of raving nutters - nobody listens to us, have a look at what the Healthcare Commission had to say about your Trust

And don't take their word for it either, the legal aid board reckoned that there was a better than evens chance of the Trust getting a good kicking in the High Court.

Do you think they're mad enough to throw money at mad people to go ranting through the judicial system, without there being some grain of truth in the demented ramblings of a homeless drunk?

Absolutely fucking atrocious care delivered (and often not delivered at all) at the whim and in the gift of a bunch of over-paid administrators, over-promoted clinicians, and delivered by under-qualified psychiatric care workers.

Get a Fucking Grip Peter.

Yours sincerely,


This is a guest post by a current patient of our "Excellent" Trust who wishes to remain anonymous, but will be writing under the psuedonym of "Intermezzo".

June 7, 2009

Patient's Message to "Excellent" Trust

I could be the driver in an articulated lorry
I could be a poet, I wouldn't need to worry
I could be the teacher in a classroom full of scholars
I could be the sergeant in a squadron full of wallahs

What a waste! What a waste!
What a waste! What a waste!

Because I tried to play the fool in a six-piece band
First-night nerves every one-night stand
I should be glad to be so inclined
What a waste! What a waste!
But the world don't mind

I could be a lawyer with stratagems and muses
I could be a doctor with poultices and bruises
I could be a writer with a growing reputation
I could be the ticket-man at Fulham Broadway station

What a waste! What a waste!
What a waste! What a waste!

Because I tried to play the fool in a six-piece band
First-night nerves every one-night stand
I should be glad to be so inclined
What a waste! What a waste!
But the world don't mind

I could be the catalyst that sparks the revolution
I could be an inmate in a long-term institution
I could lead to wide extremes, I could do or die
I could yawn and be withdrawn and watch them gullify

What a waste! What a waste!
What a waste! What a waste!

Because I tried to play the fool in a six-piece band
First-night nerves every one-night stand
I should be glad to be so inclined
What a waste! What a waste!
But the world don't mind

Chose to play the fool in a six-piece band
First-night nerves every one-night stand
I should be glad to be so inclined
What a waste! What a waste!
But the world don't mind
What a waste! What a waste!
But the world don't mind

Chose to play the fool in a six-piece band
First-night nerves every one-night stand
I should be glad to be so inclined
What a waste! What a waste!
But the world don't mind

January 28, 2009

"Excellent" Trust Wins MOD Contract

Coming Home to What?

The Trust has as part of a consortium of 7 organisations, won a contract to provide in-patient services to the military. Many of these will be suffering from the effects of service in Afghanistan and Iraq.

Why the MOD sees fit to involve a trust whose recent rating for its provision of in-patient services, was rated only one level above the lowest possible, is anyone's guess.

Kevan Jones MP, Under Secretary of State for Defence and Minister for Veterans, said: “This new contract for inpatient mental health care is a fantastic
opportunity to further develop support to our people. I want to make sure that when our people require inpatient care, they get the best available, close to their homes or parent unit... .... This is a good example of how well the military and NHS are learning to work together.”

I want to make sure... ...they get the best [care] available, close to their homes or parent unit...

Foundation Trust Watch has written to Kevan figure the officers are tough enough to fight their own battles/despair of being able to make a difference.