A life most ordinary

The notice on the door was “Boardroom”. The room, like the rest of the building was lacking in character and certainly not a place of inspiration. It was functional in the extreme. Blandly coloured partition walls provided little soundproofing. The floor coverings were neutral and the furniture also bland. The room did not give off any sense of dynamism. The view from the only windows was into the dead space of a false courtyard. The only boardroom type concession was a number of old heavy wood framed photographs of medical superintendents from the days of the Charlton Hope Hospital that hung irregularly round the room; a reminder of the times of the large lunatic asylums, electro convulsive therapy, insulin therapy and semi-narcosis. They had traded the splendour of the Victorian and Edwardian asylums, with their imposing, mocking water towers, grand facades and extensive well-kept grounds, for an industrial unit a few miles north of the city, a characterless, almost featureless, functional place.

 

All rooms in the building were surrounded with partition walls you’d be afraid to press a pin tack into, and had floorboards that creaked so much that there was little danger of any back-stabbing, at least in the literal sense. The building had a feel of being temporary in nature; nothing like the permanence of the old lunatic asylums that were built to stand the test of time. The Trust headquarters building was far removed from the now widely dispersed hospital and out patient clinic services which looked after the mentally ill of this large Midlands County a century on from Medical Superintendents. Gone where the days of matrons who struck the fear of god into everyone; patients and staff. Gone were the days when it was jobs for life with entire families employed, generation after generation to work in these mini villages and care for the lunatics, the days when everyone knew everyone else.

 

In the Boardroom, the modern, heavy, light coloured wood suite of tables, were arranged in a rectangle with a void in the middle. The chairs round the table were dressed in a blushed pink with a diamond pattern and thick comfortable pads. Only the Chairman’s had arm rests.

 

 He sat, his chair slightly back from the table, his expression was stern, his head bowed as he listened intently to the debate. He had spent most of his working life in local government, his face etched with years of political shenanigans. He had enjoyed a moderate success as Director of Housing and as retirement approached had sought out a position with which to ease gently into later life. His appointment had been a surprise to many as he hadn’t appeared the strongest candidate, although the field was not extensive and far from outstanding. He was thick set, only slightly overweight for his age and height because of his passion for rugby, which he played up until his mid forties. He had never lost the habit of exercise even after hanging up his boots, and had taken up hill walking instead.

 

His half moon spectacles balanced on the end of his nose, he flicked over his paper in irritation and peered around the room at the other board members seated at the table.

“I feel we have exhausted this subject for the time being” he said “No doubt it will appear on the Board’s next agenda so I am moving now to agenda item number four…. unless there are any objections” he menaced……. “Financial report…Robert” he said nodding permission to the Director of Finance.

***

The fax had been hand delivered to his office. Sylvia, the manager in charge of out of county health care placements or extra contractual referrals, had made plain her displeasure that it had come through on her “safe haven” fax machine. This, she told him, was only for confidential patient based requests for treatment not covered within the contracts already held by the Authority. Sylvia always had something to hold court on or complain about. He had taken the fax and listened patiently to her complaint and then mentioned that the agreed procedure for such incident reporting was through her office fax as it was the only confidential one in the building. He thanked her for delivering the serious untoward incident report. When she had left he read the fax and cursed his luck. His workload was heavy at the best of times but could be put under severe stress by mental health ECR requests and serious untoward incident reports. Either of these could come at any time and both usually required him to drop what he was doing and take immediate action. As he read the short report, on the form that he had designed specifically for the purpose, his blood ran cold.

 

The Director of Nursing, a tenacious Scot in her fiftieth year, had been about to launch into a defence of funding to underwrite the cost of a national conference she was planning. The door to the Boardroom swung open and Bernadette her secretary strode in, apologised assertively for interrupting, handed her the short report form and whispered in her ear.

 

“Chairman, Board colleagues, it seems we may have our first homicide inquiry on our hands” she announced. “If you’ll excuse me I hope to have further news before the meeting concludes”. With that she gathered the papers from the table in front of her, pushed back her chair and strode purposefully for the door.

***

He dialled the tie line number and was answered almost immediately by the switchboard operator.

“Regional Executive, how can I help you”

He asked for Philip Drake by name and was shunted up the line to a secretary who announced “Mr Drake’s office” before putting him through. He told Philip that he had received details from the Trust of a murder involving a man who had been receiving mental health treatment. Under the NHS Executive Guidance HSG(94)27 he knew that health authorities were obliged to set up independent inquiries in all cases of homicide involving mentally ill people.

“Phil it looks inevitable at this stage. I will set the wheels in motion and draft terms of reference. As it’s our first I’d appreciate your comments.” He suggested.

“OK. Keep me informed John” replied Drake in a broad Sheffield accent.

***

“Look Janet, I’m fed up with Maureen Auld throwing her weight around at board meetings. I realise that she has the largest workforce and is responsible for organisational quality but if she antagonises the Division of Psychiatry any further there’s no telling what may happen.”

The Medical Director paced as she spoke. She was a handsome woman in her mid forties, fastidious and a good psychiatrist. The caucus of doctors who held the power base within the Trust had lobbied her. They had warned her that Maureen Auld had to be kept under control. She paused and turned to see the response from Janet Brady the Chief Executive.

 

Janet had “inherited” the role of Chief Executive when the Trust had formed on 1^st April 1994. She was a career administrator who could not be more distant from clinical care. She was known as hard but in reality was like most chief executives, a fence sitter.

“Leave Maureen to me” she entreated, “I’ll have a word, you know how passionate she gets being a Celt; I’ll warn her off; now how about lunch?”

***

The smell of cooking greeted him as he turned his front door key in the latch and pushed open the white UPVC front door. His daughter squealed “Daddy” with great delight and launched herself from the kitchen, down the hall and into his arms in one motion. He swept her up and hugged her.

“Hi darling how are you?” he asked planting a kiss on her left cheek.

“Fine” she replied, sliding to the floor and scampering into the lounge to watch the video that had been ignored by her until that moment. He went into the kitchen where his wife was preparing the evening meal for the two of them, the nanny having fed the children earlier. These days, eating in the early evening was rare. Since his wife had started her own business as a management consultant it was more often than not that they would eat late-pizza or jacket potato or on Fridays a risotto or pasta dish. Three days per month she was on overnight stays and he was left to fend for himself.

 

“Hi darling, how’s things? Is Jason all right? He asked as he opened the dinning room door and placed his briefcase by the display cabinet.

“Oh fine, how was your day?” she asked affectionately.

“Bloody awful” he replied, “It looks like I’ll be setting up our first homicide inquiry on top of everything else. I don’t know how they expect me to fit it all in. It’s not my job really.”

She listened politely.

“Dinner is almost ready” she said gently.

“I’ll get changed.” he said.  He stopped briefly to pop into the lounge and kiss Jason, who was sitting mesmerised in front of the video beside his older sister, then headed for the stairs.

 

John McPherson was a Glaswegian in his late thirties who had moved to England some eighteen years earlier to escape from life in a large catholic family and a sheltered frightened existence in a violent city. He had taken a three-year training course to become a Registered Mental Nurse.  He never quite knew why he had chosen such a career move save that he vaguely recalled his mother having a spell in a psychiatric ward in Duke Street Hospital, Glasgow for a bout of depression and it gave him a job with accommodation in the south of England. He had spent a year in Kent as a child of ten, and had yearned to return to the orchards and oast houses of South East England.  It was a far cry from his first real job on leaving school as a trainee stock market dealer with a Glasgow firm of stockbrokers, Easton Goff and Company in West Nile Street, close to the city centre. McPherson was tenacious, determined and strong minded but he had inherited his father’s enthusiasm for “causes” and had stinted his career by taking on a succession of crusades which he championed, ostensibly for the sake of the wider good. In the early days as a student nurse he had approached everything with enthusiasm. Rose tinted specks he concluded in later years. His cause for the past decade had been the care and treatment of the severely mentally ill, which he believed was not being addressed by policy makers and practitioners alike. He wrote on the subject for professional journals and spoke at national and local conferences. He was often viewed as outspoken and “politically offside”.

 

He obtained two scholarships which he used to go the United States to observe and study a service he had read about and which he thought might address the care deficit brought about by closing the mental hospitals but allowing community nurses to work with less severely ill people referred by their family doctors for anxiety, stress and minor depression. The net effect he contended being the abandonment of the mentally ill. The first tour in 1985 was to Detroit for two weeks and the second a four centre tour taking in Chicago, Madison Wisconsin, Traverse City in Northern Michigan and Grand Rapids in Michigan.  He was passionate about ensuring the severely ill were seen as the priority and on returning from his second study tour he set about convincing the Department of Health who eventually adopted the Assertive Community Treatment model into policy and funded its set up across the country.  He saw the rising number of homicides committed by people with mental health problems given publicity as an indication of how far the pendulum had swung in the wrong direction.

***

 “Ok, I’ve selected a panel.” McPherson stated drawing himself up to his full five foot-five and a quarter inches. The quarter was important as it took him almost to five-six. Size had mattered to him all those years ago as he had wanted to be a policeman in his early teens but could never have reached the five foot eight height requirement. In fact over the years as he saw smaller and smaller policemen he regretted he had missed out, as he felt his personal qualities would have been well suited to the task.

“We have a respected psychiatrist, an experienced senior nurse and an ex director of social services who has served on a previous inquiry. The Chair is a barrister from the West Country with experience of mental health legislation. I’ve drafted the terms of reference and have asked Phil at Region to have a look at them for me.”

 

Carole McPhail looked at him, smiled and said in her usual measured tone.

“Good, thank you John, you’ve done a good job.”

As Chief Nursing Adviser to the Authority and a full board member she had done well. Her career had accelerated from humble Health Visitor to her current role, which also incorporated responsibility for managing the mental health purchasing team, in a relatively short space of time. She was an elegant, cultured creature in her mid forties. She was attractive but not beautiful. She sometimes wore clothes more suited to a younger woman but she was a sound, shrewd and politically aware animal. He had sometimes thought in passing that he could fancy her but was never certain he found her that attractive. Besides he would not have had the confidence to make a move and she was way out of his class.

“Anything else needs to be done at this time? She asked.

“Yes, I need to talk to Alison about support and administrative arrangements for the panel and to clarify where the costs will be allocated.” He replied.

“OK, keep me briefed and keep Simon up to speed.” She concluded.

***

“What’s on your list John?” asked Maureen Auld as they settled into their regular monthly meeting in her office at Trust HQ. The office was rectangular, medium sized with a round table for meetings at the end closest to the door. A computer, rarely used, sat on the desk and the room was adorned with souvenirs from Disney Land. Bernadette, Maureen’s efficient and loyal secretary had brought a tray of tea and reminded Maureen that she was seeing the Chairman at 12:00. That gave them a couple of hours, which they always filled with ease. They had developed a close working relationship since starting in the same year. Maureen as Director of Nursing and Quality at the Trust and John McPherson as Quality Manager at the Health Authority with specific responsibility for quality monitoring of the mental health trust. John had developed a quality audit and a programme of site visits which he and Maureen conducted together. It was an unusual partnership for two usually adversarial roles; the inspected and the inspector, not always the best of bed-fellows. Maureen had a straight no nonsense approach, open and honest. It was a characteristic they shared, fellow Scots with very compatible temperaments. Not a partnership that was in evidence across other trusts in the county, which viewed monitoring as an intrusion to be tolerated as a necessary evil.

 

“We’ve got the quality schedule to discuss, the forthcoming monitoring visit to Bland Ward, the Care Programme Approach, serious untoward incident reports and last but not least the Brunton Inquiry.” 

“That’s enough to go on with.” Laughed Maureen, “but let me tell you about the plans for the conference. You will be coming won’t you? It’s shaping up nicely. In fact I wanted to talk to you about presenting a paper yourself”

***

She had gone to bed. He sat at the computer in the fourth bedroom that doubled as an office. Jane and Jason had been sound asleep for some hours. He had arrived home at his usual time of just after six o’clock. He had prepared the kid’s beds and he had changed Jason, the youngest while Jane put on her pyjamas. He quickly read the Independent, particularly scanning for any mental health news.

 

“Another homicide by someone with mental illness in today.” He said to his wife of thirteen years. “Mental health in this country is really going off the rails.” She listened sympathetically.

She gathered Jason up and made him kiss Jane and his father goodnight before she carried him upstairs to read a bedtime story. Jason was fairly good at going up to bed once he had got over his initial token protest. He sat and listened to Jane read her schoolbook. It was a ritual they had developed and both enjoyed. It was paying dividends as Jane’s reading at school was well developed for her age. It was for him protected time. When they had finished Jane fetched her treat, usually a chocolate snack bar, and he made a pot of tea. His wife came back down stairs and they watched The Bill on ITV while they drank. When it ended Jane curled up on his knee to sleep. It rarely took her long and he carried her gently up to her bedroom and tucked her into bed. His wife put the baked potatoes in the microwave oven. Before reading with his daughter, he had prepared the tray with condiments and cutlery, grated the cheese and opened the tin of Sainsbury’s baked beans. They sat on the floor in front of the TV with a can of beer and ate.

 

He loaded the dishwasher before News at Ten. Shortly after it finished his wife went to bed and he to the computer to finish off the report of the days visit to Foley Ward. He needed to complete the report on the same day otherwise he was likely to struggle to recall all the detail from the notes taken at the time. The visit was routine-nothing to cause any great concern.

 

He stopped at just gone midnight, closed down the computer, washed, brushed his teeth and undressed before sliding quietly into bed so as not to disturb her. He could hear her breathing gently and he could feel her warmth.  He wondered at what time Jane would appear for her often twice nightly wanderings. He would usually get up and cuddle her until she went back to sleep. She was such a gorgeous child.  He felt very tired.

***

Jim McKay stood in the middle of the room. His broad Glaswegian accent reverberated round the office.  Maureen Auld sat impassively as McKay, her deputy, let rip.

“Maureen, this is utterly ludicrous. It’s a scandal. We should be supported in putting this conference together. The nurses need it. The Trust needs it. The Chairman supports it….why are Janet and Robert being so difficult? All we are asking is for the Trust to underwrite the cost. It should pay for itself. All we want is a safety net.”

 

“Jim calm down I’ll speak to Janet again. But you know as well as I do that the “docs” are not happy to see nurses getting their heads.” soothed Maureen. “It’s taken blood sweat and tears over this past year to develop the Department of Nursing and Quality, and we are now seen as a threat to the medical power base.”

***

The fax was on his desk. He read it then stood and took the lever arch file from the filing cabinet that scraped metallic whenever the drawer was opened, causing him to grit his teeth. He logged the report and allocated it a number then filled in the details in the box at the bottom of the form to register receipt at the authority. He walked to the photocopying machine himself rather than hand the form to his secretary; or rather one of a long line of temporary secretaries he’d had to work with this past three and a half years since Pat Wright had left. Once again his set schedule had been interrupted by an incident report. He had three ECR requests outstanding and the Authority had been threatened with a judicial review over one that he had previously refused. He made three copies of the form then handed them to his secretary to distribute before returning to his office to place the form on file. It was the fourth escape from Bland ward in two weeks. The impending visit to this locked ward would be all the more important now. He could never get down to strategic issues and to planning the quality strategy. The phone rang and broke his train of thought.

 

“John McPherson” he offered into the mouthpiece.

“Hi Stan how are you?” He said brightly. He had known Stan since both were trainee nurses in the seventies down at the Epsom cluster of hospitals in Surrey. Stan now worked on Maureen Auld’s nursing and quality team at the trust. Maureen had inherited a group of displaced senior managers. Stan was one. He moved from the Regional Secure Unit where he was senior nurse, when an internal report was critical about aspects of the operation of the unit. Stan was the sacrificial lamb. McPherson had himself been a member of the internal inquiry after being offered to the trust by the then Director of Public Health Jill Mangen. He had been so shocked and incensed by some of the evidence they had uncovered that he had written a memo to Dr Mangen advising the removal of the Clinical Director of Arthur Lodge. His advice had fallen upon ears stuffed with the thick sticky wax of politics. A change in Clinical Director did eventually come about, but because this was done in a low-key fashion the culture remained largely unaffected and the appalling practices continued unabated. The Regional Health Authority had been quick to invite the Health Advisory Service in and their report had rubbished the internal one. A whitewash if McPherson had ever seen one. And following the HAS report the Region had made it plain that the health authority was not to have any responsibility for monitoring this regionally run unit. It came as a relief to McPherson and to the Chief Executive of the authority and both gave a sigh of relief that was to be short lived.

 

Stan was known as “Stan the man”. He was always full of fun and bonhomie. He laughed

“How the hell are you John…What about the Lodge then?

“What about it? John asked quizzically.

“You mean you haven’t heard? The lunatics took over the asylum last night. All hell broke loose.”

“What do you mean?”

“Quite literally that. A group of PDs took hostages and we had a full-scale police operation swing into place. Riot shields, police helicopter, negotiators the lot” He chortled… “didn’t anybody tell you?”

“I think we would want to know about a group of dangerous psychopaths going on the rampage within the medium secure unit. I’ll have to look into it and find out why I wasn’t notified. Thanks Stan.” He said replacing the handset.

***

Miss Alison Harman was Director of Corporate Management at the Authority. She was responsible for all communications and all the internal operational functions of the Authority. She was a determined woman, seen as hard, cold and calculating. She was three years off retirement and although looking forward to it she enjoyed the challenge of what she did.

 

John McPherson updated her on progress with the Brunton Inquiry, confirmed the level of expenses to which the panel were entitled and informed her of the provisional date for the panel to begin hearing evidence. The panel could not begin its work until the criminal trial had ended but all the wheels had to be in motion so that they could kick off at the conclusion of the court case. There were witnesses to arrange, stenographers and rooms to book and arrangements for catering and accommodation for the panel members to be made. There was written evidence and supporting documentation to gather for the panel and letters to send out informing a large number of people of the Inquiry. There was also the media to handle.

 

“We will have to find someone to service the panel,……I agree with your advice about using stenographers but we still need someone to give admin support and organise the whole thing.”  Miss Harman mused.

“The only person in the authority capable of taking it on would be Melanie Sherman. As secretary to the Authority she has all the necessary skill and experience. She is the only person I think could handle it.” John suggested.

“Good idea, yes Melanie it is then.” She concluded.

***

Simon Gill was Purchasing Manager for mental health services. He was John McPherson’s Manager and ran a small core team consisting of John and an epidemiologist called Dr Sharon Rude. The core team was supported by a finance manger and an information manager.  They met once a month and were joined by Carole McPhail in her capacity as Director of Mental Health Purchasing. Simon was a Pavarotti of a man, including the beard. He had a mild and cultured manner. And was a thoroughly nice man and lover of Shakespeare who rarely showed signs of irritation despite an ongoing tension between his two key team members, Sharon and John. He excused their daggers drawn attitude to each other as a positive dynamic influence. John found this frustrating and had had to complain to Simon as Sharon had undermined him on several occasions for no reason other than he had challenged her open attacks upon a colleague as unprofessional. Sharon had a reputation for such behaviour and it seemed she was allowed to get away with it. She was the partner of one of the powerful psychiatrists at the mental health trust and although he had no real proof he knew they often worked together to manipulate and get their own way.  John felt the tension between him and Dr Rude, and the fact he could not work with her, was holding back progress for the team but Simon let it go thus avoiding dealing with the matter as he put a positive spin on it.  It was so bad that a good day for John was one when he did not hear Dr Rude arrive for work in her next door office.

 

The monthly meeting had just concluded and they were beginning to disintegrate as the finance manager, information manager and Sharon Rude drifted towards the door.

“Carole…Simon, can I just have a quick word? Asked John

They both remained seated so he continued.

“I don’t want to worry you but I am concerned over the growing number of incidents occurring at the mental health trust….we have the homicide inquiry, four escapes from Bland Ward, a riot at Arthur Lodge and yet another escapee there too. The riot was not even reported as a serious untoward incident. When I follow these incidents up I’m fobbed off and told that I should expect such incidents at a mental health trust.” He paused, “I don’t buy that. In fact it is the casual attitude towards these events that bothers me most”

“What should we do John?” asked Carole

“Well I’m due to visit Bland Ward with Maureen Auld next week. I’ll share my concerns with her and let you know the outcome.”

***

The Chairman liked Maureen. She was straight talking and was one of the only Directors not to keep him excluded and at arms length as much as possible. The others seemed to spend most of their time sending him up blind alleys or feeding him half the picture. He enjoyed chewing things over with her and from time to time they ate an amicable spot of lunch together down at the “Harrow Inn” in Thurmaston village; which they joked about being a ‘Harrow-Inn experience’

“Chairman” Maureen began sternly, “I need your support for the scheduled nursing conference…It’s well planned and should be self financing but I’m looking to secure agreement from the Trust to underwrite the cost should things not quite work out.” She paused, “It will be a great opportunity to give the Trust some good exposure for a change, and we have some top speakers attending.”

“So what’s the problem Maureen? I’ll be there, so you will have my full support. I expect you would like me to make the opening address. And of course I would be delighted…”

“Chairman there seems to be some resistance to underwriting the costs and we cannot go ahead on that basis. My budget just can’t cover it. Janet and Robert are not exactly rushing to give me their support. I expect the Division of Psychiatry has got something to do with that.” She said pointedly.

“I’ll speak to Janet and to Robert Maureen. Leave them to me. It’s good to have a prudent Director of Finance, Don’t you think?”

Reviews

[Claire Twinn]

I like your characterisation of John and the contrast with his work and family life. You are building up the issues well, it all feels very real and lifelike. I did find it a little hard to take in all the details about the other board members, but hopefully it'll be worth it!

[John Alexander McFadyen]

OMG the fact you are reading it Claire. Thank you. It shouls build a picture and will bring everything together eventually.

[Anonymous Girl]

This one's good as well.. But am confused! What's the whole book about?? Can please explain?? Thanks :)
100/100

[John Alexander McFadyen]

It is about the NHS mental health services and how in the 90s they covered up serious incidents

[Anonymous Girl]

Oh right... Is the whole book like this??

[John Alexander McFadyen]

It moves on eventually as I bring the events and the life of the character together.

[Anonymous Girl]

Aha!! Right.. Sorry if I didn't comment on the chapters.. I will comment when I've finished it... ^^

[John Alexander McFadyen]

Just so many thanks for taking the time 'Girl'. The events are all based on fact and are full of detail mixed with a little fiction.

[Anonymous Girl]

You are welcome ^^
I like the idea of fact and fiction! Nice!