Introduction
What could and should have been done differently? (Specifically to prevent Calocane)
I’ll start with a non-exhaustive list. And spend one or more posts exploring each.
1. Assertive outreach.
2. Refocus priorities onto –
a) Our first and foremost duty is to treat.
b) and then to focus on relapse prevention, public safety, patient quality of life, family QoL, neighbours’ QoL.
c) Risk.
3. At the same time, refocus priorities off –
a) Woke, PC, DEI (or however you want to phrase it) policies driven by the ECHR and other bureaucracies.
b) Repeal handcuffing over-regulation and other HR poison which produces stagnant, defensive practice and nothing positive ever gets done.
c) Stop measuring and monitoring everything that moves, especially trivia like ‘patient satisfaction’ instead of cure, recovery, healing, patients regaining their quality of life and other hard to measure values.
d) If we must have ‘productivity’ statistics, let the metric be patients who successfully recover, take ownership of their illness or disorder, engage, get their lives back, recover from addiction and stay that way, hold down a job, do not relapse, do not turn into neighbours from hell, do not get arrested and similar outcomes. How about wards and inpatient services being judged by the percentage of patients engaging in groupwork or the successful management of violent incidents. (NB success means no injuries, professionalism in the restraint and jabbing, release from seclusion only when the patient accepts responsibility and proves it by their actions afterwards and so on. It does not mean the patient completing a satisfaction survey or not being secluded at all because they were BME and management were incentivised to reduce those stats that month.)
4. Immediate repeal of ‘Least restrictive practice’ policies and enforcement.
4a) Later on, there must be a no stone unturned investigation into who wrote the LR policies, how the managers enforcing them were incentivised and rewarded, who received promotions etc. The investigation must be done not by DOH appointees from the establishment but by investigators with skin-in-the game, people who will be rewarded when they find an evidential chain leading to disciplinaries, civil damages cases and – fingers crossed – prosecutions for MIPO, negligence and corporate manslaughter. (Just in case you think it’s illiberal and wrong to do this Polly, (*) it’s no different from tabloid and Guardian reporters and hidden camera ‘investigators’) People with skin in the game are incentivised to do the best job. An example, there was an escape or near-escape from a high security mental hospital. The security department negotiated with a prison for some of their prisoners to test out the best ways of getting out. The prisoners did indeed successfully escape and hospital security was able to tighten up weaknesses they hadn’t been able to see. There’s no better person to see escape routes than a serving prisoner, who’s got little else to think about all boring day long. NB they didn’t do it out of altruism, there was a reward.
* other symbols of progressive/liberal royalty are available.
5. Fully staffed, resourced, empowered and protected community teams. Protected by legislation, improved industrial law, union law etc. Unions unlike the current RCN.
6. One of Sir Clive Woodward’s principles was unified direction, i.e. everyone in the organisation pulling in the same direction. And he recommends getting there by listening, not to the technocrats at the top of the ivory tower but the people on the ground, doing the job. I’ll have a lot to say on how to achieve this later. Maybe I should say how to start achieving it.
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