Patterns in the sand

The Executive meeting had begun. Mike Farrier chaired the small group that included Carole McPhail, Alison Harman and the Director of Public Health Jill Mangan. McPherson had been asked to attend at 10:00 o’clock to speak to his paper and had arrived a few minutes early. He sat in the outer office and chatted with the Chief Executive’s secretary. Ten o’clock came and went but this was normal. He felt uneasy at what he was about to say, particularly as he didn’t know how Mike Farrier was likely to react. He believed most Chief Executives to be fence sitters who avoided taking risks if possible. At 10:20 the secretary rang through to remind the Chief Executive that McPherson was waiting. Five minutes later the door opened and he was ushered into the large but plainly furnished office with its views over the front car park.

 

He felt at ease with the people in the room except the Chief Executive. Never being one to “curry favour” he had not done as colleagues had and made himself known to Mike over the four years he had worked at the Authority. He had made his own decisions and dealt with any matters through the Directors rather than beating a path to the door of the Chairman and the Chief Executive.

 

“Put in simple terms I am now very concerned at the pattern of events which have taken place over the past few months at Arthur Lodge. Two weeks ago we had a second high profile escape to add to the Davies case two weeks previous to that. The press are having a field day and the local MP is making political capital out of the situation”. He paused to draw breath and to try to gauge the mood of the gathered directors. They listened impassively. “Through quality monitoring it is plain that the unit is in dire straights. You will be aware of the previous highly critical internal report to which I contributed two years ago and the subsequent white wash by the Health Advisory Service.” He paused again and looked round the room to give the Directors time to comment but none took the opportunity; they listened impassively. But he felt that somehow he had their attention.

 

“The escapes are all from secure areas and the riot is an extremely serious matter; not to mention the trusts failure to notify us about it. The press has done its homework and has counted twelve escapes over the last three years. The residents association is up in arms and we need to be seen to have taken firm action. In view of the two inquiries in recent times I recommend we set up a full independent inquiry into Arthur Lodge. Anything less will simply be perpetuating the situation and will not be in anyone’s interest. I am particularly concerned about the complacency of the managers of the unit.  To be honest that is a major concern to us all.”

 

“Thanks for that John. Is there anything else?” asked Mike.

“Well, the Stamp inquiry will be published tomorrow and as you will be aware it highlights deficits in the CPA process as well as record keeping, again, the need for good risk assessment, the need to improve team communication and necessary improvements to discharge planning. These quite frankly are the basics so I am beginning to think the problems are much wider; endemic in fact. Not only do we have this critical situation at Arthur Lodge but we also have the series of incidents, which led to the closure of Bland Ward at the end of last year and we now have a third homicide inquiry. If you add to that the difficulties in implementing the Care Programme Approach, questions about the competence of the Chief Executive and her managers begin to arise.”

“Thank you John” said the Chief Executive making it plain his contribution to the meeting was over.

***

She was not her usual self. The regular monthly meeting had a different air about it. She was sombre and less light hearted. He had asked her to consider the recent events and the implications for the Trust Board. At first she had tried to stick by the party line that such incidents were part and parcel of the risks faced by mental health trusts. She had launched again into invective about the damage done to hard working staff by homicide inquiries. He had patiently persisted and catalogued the incidents and events as a whole. She suddenly stopped and looked at him.

“I’m struggling between my loyalty to the Trust and what I believe to be right” she admitted

“Maureen” he said “your conscience will not allow you to do anything other than what is right. You owe no debt to the Trust or to Janet. You owe it to yourself to discharge your duty as Director of Nursing and Quality. The nurses need you and nursing needs you to stand up for what is right.”

She nodded

“Yes I know.” She said with resignation. “Thanks.”

***

He climbed into bed. She had gone some half-hour earlier and seemed asleep; he was cautious not to disturb her and wedged himself on his edge of the bed with his back to her. He wondered why sex was now a once a month event and usually at his instigation when he awoke aroused in the night. He loved her deeply and hated the hurt that he had caused her. Luckily for him their love was rich and they were both there for the kids. They needed to make some changes. Needed time for each other…….

***

“Mike, the Minister is very concerned. What on earth is happening? You know there is an election in May so we don’t want anything that might raise political issues which either party can use to beat the health service drum with. The Minister has told me to instruct the Authority to set up a full independent inquiry into Arthur Lodge. And for God sake please don’t let any more incidents happen in the meantime” The Regional Director rang off. He and Mike had a good relationship but with the Minister so closely involved and a question raised on the floor of the House of Commons he would need to be prepared to distance himself from the situation should it turn any nastier. The press had been informed that the Minister had taken firm action and ordered the Authority to set up an inquiry.

***

He was angry. He felt let down and undermined. He had been the one to spot the situation and yet in front of him was the press report stating that the authority had been ordered to set up an independent inquiry. The fact of the matter was that the authority was only one of ten in the Region that used Arthur Lodge. Only two years previous the authority had been told by the Region, following the Health Advisory Service report, that the Region was responsible for monitoring Arthur Lodge and did not expect any monitoring to be carried out by McPherson. With devolution of the budget for medium secure forensic care to health authorities from April 1996 he had volunteered as “host purchaser” representative to carry out quality monitoring. The Regional Office had accepted this offer, but it was now only a matter of weeks since he had secured the agreement of the other nine authorities to his monitoring plan. It had taken the short space of time between getting the agreement and now, a matter of some two months, for him to see the pattern of failure upon failure, of complacency and complicity. And still no action had been taken against Janet Brady. Politics was not his strong point; he tried to be straight and speak as he found. He felt drained.

***

She was away overnight again. On Thursdays he always fetched chips, fishcakes and a plain sausage from the village “chippy”. He arrived home to find the nanny had the kids in their pyjamas, ready for their meal. He thanked his luck that they had found Maggie; she was so good at anticipating and making life easier. He loved sitting down at the table with Jane and Jason. When Alice was home, more often than not, the kids would eat in the living room in front of the TV or watch one of the many videos they owned. He loved the normality of sitting at the table with them. It gave him the sense of quality time, of family and sharing. Alice didn’t seem to attach the same importance to family values. She was way too busy.

 

Jane and Jason had eaten their meal and had their desert; Rolo pudding. They had now gone off to play in the living room while he cleared away the dishes into the dishwasher. It was a bit of a rush but he had his routine and if he got on with it he would be sitting down with Jane to read by seven-thirty. The phone rang. At this time in the evening it was likely to be for Alice, a business call. Sometimes when she was away he felt like he was her secretary. He recognised the measured tone of Anthony Geenhaugh, Chairman of the mental health trust. He had given him his home number recently in passing after the Chairman had indicated a need to speak with him privately. He knew why he had called.

 

“How’s the mother in-law?” inquired Greenhaugh. McPhersons mother-in�"law had worked as the Chairman’s secretary for many years while he was in local government. McPherson had never tried to use this connection and had seen little of the Chairman over the years except in passing. He did feel though that they shared a mutual bond as both held Jean in the highest esteem.

“Fine.” He replied “We are going over to Sunday lunch. So I get to do the washing up again.”

“Good.  Give her my regards, won’t you?…..You know why I’m ringing John? He asked with a sigh, “What is your assessment of the situation?” Greenhaugh inquired.

“Well I’ll be straight with you. I don’t think there is any option. I think that as Chairman you need to get rid of Janet. Something has to be seen to be done. If it’s not done and everything gets out, questions will be asked about why no action was taken.” Advised McPherson. “I think that leaves you and the Trust Board exposed. I can’t see you have many alternatives. The Authority and Region seem reluctant to bloody their hands.”

“John I’m really grateful” said Greenhaugh ending the conversation.

***

He looked at his screen. The file he had open in front of him was PANEL.doc, a list of possible panel members for independent inquiries that he had pulled together. It was getting more difficult the more inquiries that he had to deal with. He used his knowledge of the mental health field and his network of contacts. He had easily pulled Brunton and Stamp together. Pathak had been more difficult; the fourth inquiry in seven months had presented a significant challenge. He had selected possible chairs and panel members for the Independent Review of Arthur Lodge and had earmarked possible back ups. It was a case of ringing round now to secure agreements in principle. He had found it surprising that most people were happy to become involved. He felt a sense of pride that he had been able to pull the inquiries to date together through his own resourcefulness. He had drafted terms of reference and had worked closely with Melanie Sherman who was outstanding at the administration and support functions for panels. He had made a wise choice when he recommended her for the job.

 

He picked up the phone and dialled. He heard Phil’s Yorkshire accent down the phone line and pictured his shaven head.

“Hi John. What can I do for you?”

“Phil. This is a difficult situation” he said pausing “There have now been a whole series of failures. If things go pear shaped are we in a position to defend not having taken some action?” he asked. “Frankly I’m worried that if we don’t we will be seen as complicit. Janet has to go. There is little alternative” he concluded.

“Look John, I’ll talk to Philip Howarth. I can’t promise anything but I hear what you’re saying. Thanks John” he said “I’ll speak to you again.”

***

His nerves were taught. He had strained and pushed and listened for messages that he was being taken seriously. He had tried to tell everyone who needed to know what needed to be done, and then stood back and waited for the fallout. None came. His mind was consumed. He had laid his cards on the table and prodded some potentially viscous beasts with his stick. He felt exposed. He was small potatoes and he knew from past experience that they were the kind most likely to get fried if push came to shove. He was up against the power of the system and it did not feel too good. He knew though that he needed to see it through. He felt such a sense of injustice and was determined to risk his own career. She thought him daft. He was always fighting a cause these days and putting everything at risk. If he had learned years ago to be less “in yer face” his career progress might have been quicker. As it was he had always built up and moved from a firm platform and had challenged the system wherever he went. He was not a meteoric rising star. He had moved from base camp to base camp in a slow careful assent. He was proud to have completed his Master of Business Administration degree while working and supporting the family. He now felt ready to move on after four years in purchasing. Alice had also moved on. She had completed her masters degree in human resource management two years previous and had seemed to do so with ease. He had had to work hard for his. Now her career was taking her to even greater heights and she was beginning to see a new world in front of her; a world of fast cars, big business and the good things in life. She had her foot hard to the floor and was accelerating away while he was still standing at the traffic lights waiting for green.

***

“A penny for them.”  Helen the secretary he shared with three other managers offered, breaking his train of thought.

“Oh just a lot going on.” he said in as nonchalant a way as he could muster.

 He took the letters she had produced from his dictation tape and began to quickly proof read them before signing them and handing them back one by one.  Helen took them and left his office. He watched her go.  She was in her early thirties, brunette with deep brown eyes. Married with one child she seemed the ideal wife and mother.  She worked less than full time so she could collect her son from school and she dropped him at school on her way to the office.  She was a good secretary and although he felt he was always down the pecking order in her work priorities he liked her. Her standard of work was good and she was far more professional than secretaries he had had in the past. From many office conversations he had gathered that she was happily settled and was very focussed upon her husband and son.  He felt a pang of envy. 

***

When it came, the news astounded him. He could not believe such naivety. Such a lack of insight was unbelievable and must be taken seriously. He was strung out and paced the floor of his office in anger; he saw the press release as the straw that broke the camel’s back. He could not believe that such complacency could exist within a public organisation.

‘Arthur lodge man in escape-and return’ screamed the local evening news headline. The press release that had been issued by the directorate manager, Susan Goss on behalf of the trust, had stated that the incident had not been treated as serious because the escapee had no intention of absconding and had returned without the need for police involvement. The young man had escaped by the same method as previous cases. Forcing the polycarbonate glass out of its frame, he had climbed out of the compound and gone to a local chip shop, returning some twenty minutes later and presenting himself at the front door. And they didn’t regard someone escaping at will as a serious incident. They were so out of touch with reality and seemed to totally disregard public safety.

 

Simon Gill sat impassively contemplating the papers in front of him. As McPherson arrived, Carole McPhail was in the outer office briefing her secretary on some action she wanted taken.

 

“Hi John, how’s things? Simon is here already” she informed him without waiting for an answer and turning and heading back into her office.

“Let’s take stock” Carole suggested “before we launch into any potential action”

“Carole there is little to discuss. On top of everything we already know the Trust issued this deplorable press release, which demonstrates their complacency and lack of regard for public safety. Janet has to go. There is no other solution” John issued forcibly.

“Mike thinks that this has nothing to do with the Authority. It is a matter for the Regional Director and the Chairman of the Trust.”

“Well Mike ought to consider the way the Authority will be viewed if any of this gets out. We will all be tarred with the same brush, the Trust, Region and the Authority. Besides we have a public duty to the residents of Leicestershire to deal with the matter.”

“You may be right but it’s not as simple as that. There are higher politics involved here.” Carole ventured.

“Well as far as I see it it’s the politics of sitting on the fence, and I’m not prepared to be part of it. I’m prepared to go to the press if needs be” warned McPherson.

“Don’t be rash John” soothed Simon Gill.

“Rash Simon? We are talking about serious matters here involving life and death and risk to the public. Given our knowledge it’s difficult to see how putting our cards on the table can be seen as rash. This isn’t about waiting times or dirty toilets” He said angrily. “I’ve had enough of complacency. If I have to I’ll go to the press.”

“Your trouble John is that your integrity is far higher than the Authority can aspire to………Look, Mike is not around until Friday. Lets draft a letter to the Regional Director on his behalf and I will speak to him.” Soothed Carole picking up the phone.

“Michelle, get me Mike in Sheffield please. Tell him it’s urgent.” She instructed putting down the handset.

***

Maureen Auld sat in the office. She always looked forward to his company. Two Celts together, two people with similar views and aspirations.

“John we are making management changes at Arthur Lodge. A new Clinical Director is being appointed and we are going to make Vincent Penerio Director of Operations Maureen said.

He looked pained.

“What’s wrong?” she asked

“Well Vincent is part of the problem. He’s hardly part of the solution now is he?” he protested.

“No, but who else do we have, Stan is out and there is no one else.” Maureen chipped in. I don’t have the budget to engage someone new.

“Maureen there are two people in this Trust who could do the job, Dave Sowden and Jim McKay and they are both currently on your staff.”

Maureen Auld sat impassively.

“Dave could do it but it will take a courageous person with balls. Continued McPherson

“Jim. Jim is the only person in the Trust at this moment in time who could take this on.”

“They’d never wear it” Maureen said incredulously. “The doctors would be up in arms.”

“Don’t worry about them” he said “I have already spoken to Carole and our Chairman and I’ve told them that Jim is the only person who can take this on. This is a serious situation and it needs dealing with.” He concluded.

“I’ll talk to Anthony Greenhaugh.” Auld sighed with more than a tinge of desperation in her voice.

                          ***

She arrived home at her usual time. He loved Friday evenings and looked forward to his pasta or risotto. He wanted to hug her and welcome her home. He wanted to hold her but something held him back. He felt hurt that she was prepared to not only spend so much time away from the family but that she was prepared to keep increasing her time away. He felt she didn’t care about family life anymore. He didn’t want to stop her doing what she enjoyed and excelled at, but the dilemma forced him to retreat into himself. To show his love might reinforce her behaviour and give her the message that it was ok to be away. The telephone calls most evenings and at weekends were also an intrusion into family life. He resented it, but he wanted to love her, he just didn’t know how to do it under the circumstances. He watched her dress so sexily to go out in the mornings and he commented to her that she never dressed that way for him. She made some dismissive remark and the point was lost. He didn’t think any more about it, but it was constantly playing at the back of his mind.

                                   ***

He asked for the Health Editor. He had tried on several occasions to get hold of her and she had never returned his calls. He chose the Independent because he felt it was a good broadsheet and would give fair coverage to the piece. He had also seen the coverage given to mental health issues over the years by the paper. He had seen her name against articles most days and her picture appeared recently against a column she was doing in the Independent on Saturday. He couldn’t get over how young she looked. I must be getting old he’d thought.

“I’m afraid she’s in an editorial meeting, can I get her to call you back?” inquired the clerk.

“Yes please” he said almost despairingly.

Reviews

[Claire Twinn]

A very frustrating time, a nightmare of pointless bureacracy and a crumbling marriage. The annoying politics of finding a scapegoat and replacing her rather than dealing with the problem only exasperates the situation. Well written as always!

[John Alexander McFadyen]

Thank you Claire. Sometimes I forget this is real life. It happened. Almost every word of it.