Charlotte Monro case proves nothing has been learned from Mid Staffs

The comments of Health Secretary Jeremy Hunt following the revelations over patient abuse at Mid Staffordshire Foundation Health Trust sounded good.

"We will foster a climate of openness, where staff are supported to do the right thing and where we put people first at all times," he declared.
The sad thing is that as hospital trusts are squeezed across the country, often at the behest of paying huge private finance initiative (PFI) debts, it seems exactly the opposite is taking place.
Indeed some would argue that what is happening now makes the chances of another Mid Staffordshire situation all the more likely to recur.
Take the case of Charlotte Monro, a union rep who worked at Whipps Cross hospital in east London for the past 26 years.
An occupational therapist and moving and handling co-ordinator, who four years ago received a special award, Monro was dismissed on October 30.
The dismissal followed an investigation that began after she addressed the local Waltham Forest scrutiny committee for Whipps Cross hospital in east London.
The scrutiny committee is a body made up of local representatives such as councillors and other concerned individuals charged with ensuring that local citizens receive the services to which they are entitled.
Monro addressed the scrutiny committee on June 26 2013, only to be told on July 2 that she was being investigated.
The final dismissal was justified on the grounds of bringing the Barts Health Trust into disrepute by speaking to the scrutiny committee and of speaking to staff she worked with prior to the official opening of a consultation on their service.
The trust also dredged up a charge of failing to disclose previous convictions relating to protest activities that occurred back in the 1970s. Monro had been involved in protests against apartheid and for peace in Ireland. This was never regarded as an issue over her previous 26 years of exemplary service.
Upon appeal, the charge of bringing the trust into disrepute was dropped, while breach of confidentiality and the failure to disclose the convictions were upheld. Monro is now planning to take her case to an employment tribunal.
The whole attack on Monro came about after the formation of Barts Health Trust in 2012. In a reorganisation, Whipps Cross, Newham General Hospital, St Bartholomews Hospital, the Royal London and Mile End hospitals were brought together under one body.
Monro tells how when she was dealing with the hospital management at Whipps Cross there was a good constructive working relationship based on respect.
This all changed when Barts Health Trust became involved.
"They were clearly out to get me as a union rep," says Monro, who sees her case as part of a wider effort to destabilise staff generally by creating an atmosphere of insecurity.
At a time when there have been job losses and posts are being down-graded, an action like this warns others who might think about putting their heads above the parapet as to what might happen.
The neutering of union activity in the NHS will also make it less likely that people will speak out. The union is a source of security and support to workers, allowing them when necessary to have the confidence and support to speak out about wrongdoing.
The unions themselves also represent a crucial element of any effective regulation or monitoring process across the NHS.
The role of a union is crucial to any ideas the government may have of fostering a "climate of openness" when people will not be afraid to speak out.
What seems certain is that the staff at Barts Health Trust need that voice. The latest report from the Care Quality Commission on Barts Health Trust says: "Morale across the trust is low, with staff being uncertain of their future with the trust and a perception of a closed culture and bullying.
"Too many members of staff of all levels and across all sites came to us to express their concerns about being bullied. Many only agreed to speak with us if they could be anonymous.
"In the 2013 staff survey 32 per cent of staff reported being bullied. The average score for trusts in England was 24 per cent.
"Staff told us they felt stressed at work and said there were not equal opportunities for career development. This must be addressed urgently if the trust's vision is to be realised."
Of course in the background of this process are the ongoing deficits caused by PFI.
Big trusts like Barts have been created so that there can be economies of scale, making cuts as and when possible.
These cuts are bound to hit patient care somewhere down the line.
Under section 118 of the care Bill going through Parliament, trust special administrators (TSAs) will be free to close, merge or privatise hospitals regardless of doctors, patients or the public.
In the light of the Monro case and other recent developments, maybe Hunt should go back and reread Robert Francis's report into Mid-Staffordshire Foundation Health Trust.
Francis referred to a story of "the appalling and unnecessary suffering of hundreds of people.
"They were failed by the system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety."
The question then is what has changed. Beyond the rhetoric of compassion, the market is being allowed to run riot in the NHS to the cost of staff and patients alike.
The potential whistleblowers who ensured that scandals like Mid Staffs were exposed are being forced out amid a growing atmosphere of fear and retribution.

  * Morning Star - 21/1/2014
* Tribune - 24/1/2014

Coronation Street breaks new ground on assisted dying

Coronation Street fans will have been gripped over recent months by the unfolding story about the death of Hayley Cropper.

Played by actress Julie Hesmondhalgh, the character of Hayley has been a stalwart of the show for the past 16 years. The latest plotline though brought that time to a sad end as the character took her own life by taking poison.

The plot line began some months ago when Hayley was diagnosed with pancreatic cancer. The script writers then built the tension, with viewers no doubt expecting Hayley, as with other past cancer based soap plot lines, to recover. Not this time though.

Coronation Street have trod new territory, with the character facing terminal cancer. Tension builds further, when having thought she had a few months to live, it suddenly becomes clear Hayley now has just weeks.

There is a debate between Hayley and her screen husband Roy about what is going to happen. They seek to make the best of their final weeks together but Roy is horrified when Hayley reveals her plan to take her own life. He initially won’t contemplate the idea but comes round to agreement after seeing the pain she is under. This culminated in the final scenes, where Hayley takes poison and dies.

Coronation Street has certainly broken new ground with the Hayley story, stepping into the controversial area of assisted dying and suicide. It will be interesting to see the impact the programme has on the debate. When soaps have addressed such controversial subjects in the past, like Eastenders taking on aids, via the character of Mark Fowler, it has had a huge impact. The soap plot had far more impact than any series of public service information broadcasts on the subject.

Like them or loath them the soaps draw huge audiences on a weekly basis. They also tread that somewhat strange territory of being fictional yet causing so many of the public to relate directly to the character’s experiences.

It is this power that makes this genre of drama so attractive to those with a public service message to get across. So issues like homosexuality, domestic violence, child abuse and rape have all found their way into the plot lines of the soaps over recent years.

Given the past impact of such story lines on real world scenarios, it would seem likely that this latest offering will reignite the assisted dying debate.

Indeed, Hayley’s story is likely to have more impact than any number of documentaries on the subject.

So how does the soap depiction of assisted dying measure up to reality? In the early stages of Hayley’s diagnosis she meets someone called Jane from a support group. Jane also has terminal cancer. This element of the story, together with the latter part of Hayley’s life show some elements of palliative care. The desire to make the best of the time left comes through in both the characters of Jane and Hayley. When Jane suddenly dies, it comes as a shock and really sets Hayley on the road to her decision to take her own life.

Hayley is supported by husband Roy and her friends. The whole community seem to rally round to support Hayley. She takes her decision in what appears a very rational and considered way.

The problem with this sort of depiction of assisted dying or suicide is that it can simplify the argument to one of a person with support, who just cannot take any more pain and wants to die.

The reality is that there are the cases of the individual who does not have that support network. The person with no friends or family, alone afraid in the hospital bed. There will be the support of medical staff but in these cash strapped times, this type of support is becoming less likely to be available. Indeed, the pressure on NHS resources is a great worry in terms of how medical staff come to evaluate life. We have already seen the way that the Liverpool Care Pathway has been misused on occasion to bring about early death. Some argue that any loosening up on the rules on assisted dying will be the first steps on the road to euthanasia.

Then there is the situation of the greedy relatives who have little concern for the person who is dying but simply want to get their hands on their money as soon as possible. This element was briefly touched on in the Hayley story, when her estranged son appears on the scene with two grandchildren she didn’t know existed. He manages to effectively emotionally blackmail Hayley to give him some money in return for seeing the children.

The threat though of the greedy relative in the real world, maybe less of an issue in the case of a terminal illness, especially when life expectancy is so short.

There has been no effort in the soap script to take in faith dimensions of suicide. This would have been difficult though as the character was never shown to have any religious intent. Indeed, dramatically, the initial abhorrence of Roy, an atheist, to the idea of suicide, gives real insight.

Overall, the production team at Coronation Street deserve credit for this excellent piece of drama. However, the concern must be that it will be used to feed into a building momentum in the secular media to push forward the cause of assisted dying. This ofcourse is not a reason to ignore the subject.

It is important though to remember that this is fictional drama not fact based reality. It contributes something to the national discourse on the subject of assisted dying but should not be used as a prop for those seeking to make it easier for individuals to take their own lives. Maybe in the name of balance the next soap on the subject should create the character of the terminally ill person with no friends or family stranded in the hospital bed – less gripping viewing maybe but a dose of what amounts to reality for many in our society today.

*universe - 26/1/2014

Not reporting a rise in deaths at Beachy Head

The story seemed a straightforward one. The number of people committing suicide by jumping off Beachy Head in East Sussex was on the rise. There had been 604 searches on the cliff up to the end of August. Some 252 people were saved. This compares with 428 and 423 searches for the comparable period in 2012 and 2011. Despite the rise in numbers, the story I was seeking to tell was a positive one, concerning the excellent work being done by the Beachy Head Chaplaincy Team (BHCT), which has saved 2,088 people since it began operations back in 2004. The chaplaincy run teams of people who patrol the cliffs looking for likely jumpers. They are also tipped off if police, coastguards, staff at the local pub and cafe and members of the public see someone they think might be about to commit suicide. It was a good news story. Naively, I thought the BHCT would welcome the opportunity to tell what they did. I could have a meeting, go out with them and ideally meet one or two people who had been saved and put their lives back together. I was looking to do the story for the Church press, initially the Catholic weekly the Universe, then the Church Times and Tablet. It came as something of a shock having explained what I wanted to do, as well as providing examples of previous work, to be told they did not speak to the media. The journalistic hackles went up: the routine response that these people don’t want this story out – what have they to hide did not really apply. It was quite clear what they wanted to hide which was the fact that people wanted to jump off Beachy Head. The argument of the director of the BHCT Mark Pybus was that the media ban applied because they got a rise in people coming up to Beachy Head to attempt suicide whenever there was significant coverage in the media. He highlighted the case of the Puttick family, who died on 1 June 2009. The case, where parents Neil and Kazumi, killed themselves at Beachy Head after five year old son Sam died of meningitis, drew international media attention. In the month that followed there was a surge in the number of people coming to the beauty spot seeking to end their lives. The week that followed the BHCT conducted 33 searches, saving 15 despondent people. Similar patterns have been noted with other high profile cases. The point seemed a fair one, he was also right that I did not want to be responsible for someone jumping off. I tried to explain though that it was a positive article promoting their work and there was a big difference between the more niche like confines of the church press and the Daily Mail, Sun or BBC. I also said that these operations would do the story anyway, whether the chaplaincy spoke to them or not. The chaplaincy could get a constructive sensitive side into the story by co-operating. Nor would they stop the story getting out, as the nationals would likely receive tip offs from the emergency services, some of whom were less than happy anyway at having to pick up the remains of jumpers. The seeming piecemeal nature of the media ban was also irritating. They did seem willing to talk to local papers like the Brighton Argus but not a Church paper, which probably had a smaller circulation. In the end, I could see I was not going to get the full co-operation sought at the start but would settle for an updated version of what the BHCT team had told the Brighton Argus last December, namely that there could be a link between the economic recession and the rising number of people seeking to jump. The intervening months had simply proved the point. The reality of the story was that most of the material required in terms of statistics were all on the BHCT’s website. Beyond that, a simply google search brings up all anyone could want to know about committing suicide at Beachy Head. It was possible to do the story, with virtually no input from the BHCT. This though was slightly bizarre, as the point of the story was to highlight the good work that the BHCT were doing. The story though took on more bizarre twists. Pybus shifted his ground, agreeing that the Church press were not the same as the national media. He was the newly appointed director and could see the need for some good publicity. So he would co-operate but he wanted to see the copy. The Universe had already sent over the feature. I sent him the news story for the Church Times. He then helpfully came back with more up to date statistics. The quote provided was a slight variation on that provided to the Brighton Argus in December. All seemed fine and ready to go. However, then came the question as to how the Church Times was sold, if too many went through the newsagents then Pybus would not agree to the article. Paul Handley, editor at the Church Times confirmed that only 2 per cent of sales went through the newsagent, the rest being via subscription and the churches. This was acceptable. The Universe, however, told Pybus that 15 per cent of their sale went through newsagents. This was too much so the BHCT would not agree to publication. The Universe fell in line, spiking the article. It was surprising that the Universe did not point out to Pybus that there was a thing called the internet. The BHCT seemed to be suggesting that people tempted to jump off Beachy Head were all hard copy readers of newspapers, who bought their copies of these small circulation publications from the newsagents? Given also that any would-be jumper could find all they needed to know about Beachy Head from a google search the argument seemed all the more absurd. In the end, the news piece did get published in the Church Times and the feature went to the Tablet, who did not even enter into this tortuous process of dealing with BHCT. The arguments of BHCT while well intentioned showed a lack of understanding of the journalistic process and how media works in the 21st century. They cannot just control the information flow and by refusing to speak they just limited their own impact.

* British Journalism Review - December 

Pensions debate should not be set in the context of inter-generational conflict

Why are pensioner’s issues increasingly getting framed in the public discourse in terms of inter-generational conflict.

There was a recent example of this happening when Prime Minister David Cameron announced that his government would be retaining the triple lock approach to pension rises beyond the next general election. The triple lock ensures that pensions will increase by the level of inflation, wage rises or 2.5% whichever is the greater.

The immediate media response was to contrast this approach with that of the freeze that has been imposed on benefit rises that go to younger people.

So there was a visible effort to set one generation against another. This dangerous argument has been being fostered in the media for some time now, namely that younger people are having a tough time because the elderly are getting all the benefits and have lived in a profligate way in the past.

It is an insidious development that follows the attempts to set worker against worker and low paid worker against benefit recipient – the idea of the deserving and undeserving poor, the striver and skiver. It is a very reductionist argument.

The National Pensioners Convention makes the point that pensioners should not be seen as some sort of drain on the country.

“Whilst the overall cost to the Exchequer (providing pensions, age-related welfare payments and health services) was found to be £136.2bn, the revenues from older people (financial or otherwise) added up to £175.8bn. The overall net contribution by older people to the economy was therefore almost £40bn a year,” said a spokesperson for the NPC.

In addition, between £3.7 and £5.5 billion of means-tested benefits that should rightfully go to older people in Britain went unclaimed in 2009-10. 

The reality is that pensions and benefits can be afforded for old and young alike. At present, the National Insurance Fund, which pays for the state pensions is actually £30 billion in surplus, so there is no shortage of funding.

The pot may need to be made bigger in the future but why not look to do increase income by collecting more tax from the richest in society as well as claiming the tax from the large corporate tax dodgers.

Let’s stop wasting so much money on conflicts in countries like Afghanistan and Iraq, as well as scrapping weapons like the Trident nuclear system. Then there would be a lot more funding available.

Let’s not fall for divide and rule arguments. Pensions that enable everyone when they reach retirement age to live above the poverty line are easily affordable as well as being for the common good of all – young and old alike.  

If Cameron's government can't get to grips with climate change they should go

The floods crisis has once again shown the total lack of environmental priorities of the Coalition government.
David Cameron starts criticising the local councils -that his administration have stripped of resources-for not coping.
More flooding follows, so obviously it must be time to make savage cuts to the body charged with dealing with the crisis, so1,500 jobs are to go at the Environment Agency.
The unspoken possibility must be that climate change is not only happening but happening far more quickly than previously predicted. Given the urgency of the situation can we really afford to have a government stuffed full of climate sceptics.

Indeed, if Cameron did refer to the need to “get rid of the green crap” as recently reported, then he should head the list of those resigning from government. Neither he nor his colleagues are fit for the purpose of governing in these dangerous times.
Climate change is happening, responsible people are needed in government who recognise the crisis and will prioritise resources accordingly

Debt crisis gets personal

Debt has become an ever growing problem over recent years, with payday loans in particular driving people deeper into trouble.
Debt has become a reality of modern life. It seems almost from the moment a person leaves school or university they become saddled with debts. Student fees, credit cards and then mortgages - all add up to a lifetime of debt.
The total level of personal debt in Britain is £1.43 trillion, an average of £54,000 per household - up from £29,000 a decade ago. Some £1.27tn of the debt is now owed in mortgages and £158 billion in consumer credit.
People are being driven increasingly in these cash-strapped times to look for loans to tide them over. After the credit cards are maxed out the next place to look is the bank overdraft or loan companies.
Of course, if people were paid more there would be less need to go to the loan companies.
Data from the Office for National Statistics shows that between 1977 and 2008 the wage share fell from 59 per cent of national income to 53 per cent, while the share of profits rose from 25 per cent to 29 per cent.
Payday loans are theoretically supposed to tide the person over until pay or benefits day. The problem comes with the practice.
The Daily Record reported recently on a woman who took out four payday loans of £300 each to pay for her father's funeral.
She thought she would get the money and pay the loans off but they just kept building up. She would take out one loan to repay the other and also got bank charges.
Then when she got paid the companies took the money. "I would be paid at midnight and the money would be gone in an hour or two. It meant I didn't have a penny. I ended up with rent arrears and was threatened with eviction. I couldn't eat and had to beg and borrow to get my two kids anything. We were surviving on 25p noodles," she told the paper.
She then got harassed by debt collectors, being bombarded with constant phone calls, texts and emails. She has now got on top of her debts with the help of the Govern Law Centre.
The payday loan can be OK if it is paid off in the time agreed. If you were to borrow £90 from a typical lender for three days it would cost £8.37, which is likely to be less than the bank charges for an unauthorised overdraft.
So if a £200 loan was taken out over 14 days, it would cost £234.27. If the lender is unable to retrieve that money from the borrower's account on the repayment date, a £20 late payment charge is applied. If the loan is rolled over for another 14 days then £274.17 will be owed. If then it is rolled over for another month, the debt will be £368.77.
If the lender cannot be repaid on the final agreed day, interest is added for up to 60 days at 1 per cent a day, then frozen. In this example, that would add more than £200 to the cost before fees were frozen. After four months the debt would have grown to almost £600.
The rates of 5,853 per cent APR quoted by the lender Wonga and 2,400.8 per cent APR by Money Shop are over a year (APR means annual percentage rate). The lenders point out that these are intended to be short-term loans, so APR is not a good indicator.
Critics claim that the companies do not check out the creditworthiness of the borrowers. The Citizens Advice Bureau has reported that among 2,000 loans taken out with 113 lenders, in nine out of 10 cases the borrower was not asked to provide documents to show they could afford the loan.
Of those who had repayment problems, seven in 10 said they had been put under pressure to extend the loan, while 84 per cent said they had not been offered a freeze on interest rates and charges when they said they were struggling to repay.
The use of Continuous Payment Authorities, whereby the lenders can access borrowers' bank accounts, have also caused problems.
"It is unacceptable that in a modern society, growing numbers of low-income households have little choice but to resort to unscrupulous lenders and to be subject to the abuse of power and increased deprivation to which this can lead," says Church Action on Poverty director Niall Cooper.
"Better regulation of the credit industry is urgently needed to bring down the cost of socially harmful credit and to ensure that lenders behave more responsibly."
A recent survey commissioned by consumer organisation Which? revealed that 400,000 people are using payday loans to pay food and fuel bills and 240,000 people are using the loans to pay off existing debts.
Government it seems is finally acting on payday loans, capping the amount that the companies can charge.
Though as Financial Conduct Authority (FCA) chief Martin Wheatley has warned limiting rates, loan terms or advertising would not necessarily curb lenders' behaviour - and could force consumers to use even less reputable providers.
The FCA has already proposed other changes to payday loans, including limiting roll-overs to a maximum of two and introducing more controls on how continuous payment authorities can be used.
One alternative source of credit is provided by credit unions. Credit unions are mutual loan and savings organisations made up of members drawn from a particular area, such as trade unions, the police or a religious group. So there is a need to be qualified by virtue of being a part of one of these groups.
There are now 400 credit unions in Britain and Northern Ireland, with over one million members. In other countries they are much more popular, with 45 per cent of US citizens and three-quarters of people in Ireland being members of a credit union.
The British government is keen to extend credit unions, looking to double the number of members.
Credit unions are prepared to offer loans of between £50 and £3,000. They offer loans at more reasonable rates - typically 6 per cent rising to 26 per cent APR.
Sometimes loans can be under 6 per cent a year, but the interest is usually around 12.7 per cent APR going up to a maximum 26.8 per cent APR. So if £100 is borrowed over a year, the most that needs to be repaid is around £127.
In order to borrow from a credit union, an individual has to be a member and to have paid in for a period.
There are also savings accounts available. Credit unions do not have shareholders, so all funds go into the running of the organisation and better terms for savers and borrowers.
They are also beginning to expand into other products like current accounts and morgages.
Credit unions certainly represent a better option for those looking to borrow. But maybe if wages went up, with measures like the living wage implemented across the board, there might be less need to borrow in the first place.

Challenge for the Pope is whether his teachings result in real social justice inside and outside the Church

The papacy of Pope Francis has brought a breath of fresh air to the Catholic Church.

His message has been one of social justice, not only about embracing the poor but asking why in a world of such abundance so many live in poverty.

It is these fundamentals of his message that many, particularly in the media world, choose to ignore.

Instead of embracing the message of social justice and its ramifications, many have chosen instead to idolise the man himself.

Maybe in the inane modern world of celebrity this was inevitable but it is also to misunderstand the message that the Pope is trying to convey. It is not all about charity but justice.

Christmas is a time when charity comes to the fore. People reach out and give to the homeless, foodbanks and other charities. However, charity as an end in itself has little merit.

Giving to a homeless charity at Christmas, whilst ignoring the homeless for the rest of the year could almost amount to self-indulgence.

It was Pope John XXIII who said that charity can never be a substitute for justice – this appears to be a mantra that Pope Francis also embraces.

Simply adopting a charitable response to social problems that can easily be resolved if the political will exists is simply putting a band aid on the problem. At best a salver of conscience, at worst willful collusion in the causes of the injustice in the first place.

So a campaigner for justice cannot accept a situation of growing homelessness, much of it caused by deliberate government policies being implemented to cut benefits.

Similarly, nor can they accept in a country of 88 billionaires that 500,000 people have to go to food banks.

In the coming year, it must also be hoped that more is heard from Pope Francis on the need to attain equality as well as address poverty.

The Pope has made a bold start in tackling Vatican corruption, consulting the laity and in setting up the commission on child abuse. However, the basic structures of the Church need to change.

A Church based on social justice cannot go on discriminating against women in the way that it presently does.

If it is serious about child abuse then the structures that allowed that abuse to occur in the first place need to change.

The position of priest needs to be reviewed and reformed, from qualifications to practice. Structural change will be the mettle test of whether the Catholic Church really is changing.

The Pope has made a great start at a rhetorical and reforming level; the challenge though will be how far these changes can be made reality.

How far pursuit of the social teachings means demanding justice, not just charity and also whether that demand for justice will extend to the structures of the Church itself.