How’s yer Gaelic French?
Not your first language? Never mind… leave it to me.
There’s an old Gaelic French, military term meaning; a type of tent or cover to keep gun powder dry; a ‘cannee’.
Hence, solders who were in charge of the ‘cannee’ were vital if the weather was inclement.
So to carry the ‘cannee’, which became Anglicised to ‘can’, meant; to take responsibly for the army’s fire power. Very important job.
We still talk about ‘carrying the can’. Who’s responsible? Where does the buck stop?
With the Board?
There’s an expectation that ‘the board’ will have a higher standard of behaviour and a better understanding of their organisation. That’s why they are in charge. But…
… are they responsible or culpable?
They are responsible for governance, strategic direction and for the oversight and accountability of the organisation.
Where does accountability start and stop. When does accountability move to culpable.
Culpable means deserving blame. Censurable, found wanting.
There’s a fine line for a Board…
… avoid micro-managing the executive and being on top of what’s going on. It’s the difference between governing and managing.
Board papers are a giveaway.
Pages of them, full of the kind of detail that managers need, frequently bog-down Boards, in detail that makes it difficult to see the wood from the trees.
Look at it another way…
… the Board works ‘on’ the organisation, not ‘in’ the organisation. Sets a strategic direction and maintains control over the organisation, as a whole.
The Board should…
… assess the risk of delegating responsibilities and have monitoring, reporting processes, reviews and risk management assessments, of the effectiveness of their delegation mechanisms.
In other words, they carry-the-can. Particularly, the risks to the reputation and safety of the organisation.
Is this a bit basic and obvious, or arcane?
The BBC Panorama about the mistreatment of patients at Edenfield, under the charge of Greater Manchester Mental Health NHS Trust, makes it important to ask these questions.
The brutal treatment of patients was captured, by secret filming and broadcast a week ago.
Some patients, with mental health conditions, can be a huge challenge.
Those who are inpatients in secure wards can be violent, abusive, truculent, cunning, devious, manipulative and a handful.
It does not mean they do not have rights, complaints and must be listened to.
They are ill. Ill in ways that, perhaps, we don’t fully understand but because people are locked away does not mean they become prisoners of their illness.
It is the job of practitioners, best we can, to unlock these illnesses and free tortured lives.
It does not mean they can be abused, assaulted, overlooked, secluded, pinched, punched, neglected, baited, rough-handled and doomed to a meaningless life of vaping, music videos and made to feel worthless.
At Edenfield, a support worker described a ward as a “dangerous sh*t show”. Another said the hospital was “going to the dogs”.
Staff said;
‘… managers were not present on the wards enough to understand the reality on the ground.
In [this] absence of senior leadership and managers, a bizarre dynamic evolved. Staff behaviour was strange – sometimes juvenile, sometimes actively cruel.’
If the managers were absent… where was the managers’ manager?
If the managers’ manager wasn’t there, where was the site director?
Where was; the chief executive, the medical director, the nurse director… the non-executives and the chair?
Where were;
- the site reports,
- the risk assessments,
- the staff-side consultation group,
- the patients,
- the governors,
- the relatives group
- and the CQC…
… who rated this hell-hole as ‘Good’?
Were the Board complacent, misdirected, conned, lied to? Were the executives lazy, incompetent, self-admiring or smug?
Not everyone could have been blind-sided to this gravest of failures… of fragile, vulnerable people and their families.
The response from NHSE’s director of mental health?
The usual; ‘shameful’, ‘heartbreaking’ and a national review… giving everyone time to run for cover and sort out their issues. I haven’t read an apology, a regret an amende-honourable.
What should happen?
The Board of the hospital should be suspended and an interim management installed. Immediately.
Send shockwaves through the system. Demonstrate; intolerable management failings… aren’t tolerated.
The CQC should finally acknowledge how futile it is to use inspection as a method of maintaining quality. No21 should act.
This BMA report, on the decline of mental health services, is devastating. There’s more to Edenfield, than Edenfield. We still don’t know what happened here.
Our mental health services need new, national leadership and a fresh pair of eyes.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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