In praise of Sally Bercow

The wife of the Commons speaker is not normally someone who I’d go out of my way to admire. When she appeared on Celebrity Big Brother she struck me as somewhat vain and publicity-seeking. She’s also a former member of the Oxford University Conservative Association, a group that I’ve been gleefully sarcastic about in the past.

Even so, the news that she’s refused to settle in the matter of Lord McAlpine vs The Internet suggest the actions of someone with a lot of gumption. Libel cases can run into costs of £100,000 without even reaching court. Simply fighting the case (never mind losing it) can financially ruin all but the considerably wealthy.

Over the past month a lot of rubbish has been talked about the supposed evils of Twitter and other new media. This conveniently forgets that the original allegation was made in old media, and on usually-trustworthy Newsnight. The tweeters simply discovered that Newsnight was referring to accusations that had previously circulated, and correctly identified who they were talking about. Unfortunately, the Newsnight report then turned out to be inaccurate.

I can appreciate that Lord McAlpine must have experienced an extremely distressing week, but it’s also important to remember that he was not only generously financially compensated by the BBC and ITV. He was also quickly vindicated. The entire world now knows that Lord McAlpine is not a paedophile.

But more importantly, McAlpine’s subsequent legal action is one that could set a hugely dangerous precedent. That large numbers of people could be pursued and financially ruined for briefly and non-maliciously discussing the TV news. Those who’ve cheered on his pursuit of 10,000 people simply haven’t thought about the consequences.

News about his mass action against tweeters seems to have gone a bit quiet lately, but a few weeks ago these claims were circulated, suggesting that Twitter was simply refusing to hand over personal information to Lord McAlpine’s lawyers without 10,000 court orders, and that overtures to the police were being met with a bland “not a police matter”. I have to add some words of caution here in that these claims are unsourced, and if we should have learned anything recently, it’s not to believe everything that’s tweeted. Even so, it seems hard to imagine that any demand to Twitter that 10,000 sets of personal details be disclosed en masse would be met with anything other than a referral to the reply given in Arkell v Pressdram.

According to news reports, Lord McAlpine is demanding £50,000 and an apology from Sally Bercow. Given that Mrs Bercow has already publicly apologised, it seems likely that the sticking point on settlement may well be the matter of fifty thousand quid. And since, Mrs Bercow has indicated that she’ll meet him in court, what is her defence likely to be?

A quick disclaimer here. I’m not a lawyer, and I’m therefore not qualified to parse the following suggestions. For that reason the next few paragraphs should be treated as speculation and not as legal advice.

This blogger claims to have already obtained some legal opinions on any possible defence.

“The McAlpine case is weak on three grounds. First, the evidence that his reputation was maligned by contemporary tweeting is flakey, given the pre-existence of internet rumours going back a long way; second, suing individual tweeters for £500 could easily be construed by a Judge as a ridiculous not to say greedy valuation to put on one quite possibly neutral enquiry of others; and third, singling out Twitter alone is preposterous in the context of a multivariate world of online social networking. You have Facebook, Linkedin, blog threads and a dozen other equally effective ways of innocently transmitting speculation – up to and including word of mouth gossip in the office. To set a precedent in favour of civil prosecutions against mass opinion and gossip would be ridiculous. Further, we suspect that any higher Court (especially one within the EU’s legal framework) if faced with an appeal against any judgement favouring such a view would overturn the verdict without exception.”

‘The issue of intent is much murkier with regard to mentioning someone’s name on Twitter – especially if Mr X’s guilt or innocence in relation to the media expose was inconclusive at the time. Twitter users were simply commenting in real-time on what they were seeing, without any premeditated malicious intent,’ remarks another online source.

Meanwhile the political journalist Michael Crick has said that there’s another objection which will be raised by Bercow’s lawyers. Even in the worst libel cases, the maximum damages are usually around £220,000. Lord McAlpine has already received £310,000 from the BBC and ITV. Adding another £50,000 to the pile starts to look, well, a bit greedy.

The false accusations against Lord McAlpine were unfortunate, and they do show some of the potential pitfalls of social media. However, they also show the way in which our draconian libel laws can be used as a weapon by the rich and powerful against everyone else. This is why libel reform needs to happen as a matter of urgency. In the meantime, hats off to Sally Bercow for deciding to stand and fight.

 

 

Don’t hijack child welfare to attack gay marriage

I got home from work today to discover that this afternoon’s House of Commons debate had turned into a procession of backbench Tory MPs delivering a series of variations on “I’m not a homophobe but…” If David Cameron’s endorsement of gay marriage was intended to show a forward-thinking, tolerant conservatism, it seems a large section of his party failed to get the memo.

Much of the opposition to gay marriage has taken the form of concern trolling about what it’ll mean for our children. Yesterday David Davies MP said, “I hate to say this, in a way, because I expect it’s going to cause controversy – but I think most parents would prefer their children not to be gay, knowing most parents want grandchildren if nothing else.”

A few days ago another Tory MP, Bob Blackman, went further than just opposing gay marriage. He called the reintroduction of the notorious Section 28, which banned the ‘promotion of homosexuality’ in schools. He said, “I was one of those that strongly believed that Section 28 was the right rules to have in school so that we should not promote in any way shape or form promote same-sex relationships, I still abide by that and feel thats the right way forward, and if teachers are forced to say same-sex relationships are equivalent to heterosexual relationships I’d be very opposed to that.” As a quick history lesson, not a single prosecution was ever brought under Section 28, but it created a huge obstacle for teachers who wanted to prevent homophobic bullying.

A couple of weeks ago the Daily Telegraph suggested that teachers could be sacked for not promoting gay marriage in schools, and fulminated against such a grievous hypothetical outrage.

Since I work in child and adolescent mental health services (CAMHS), I think I’ll give my own thoughts on what gay marriage could mean for our children.

I won’t mention any individual cases, but I’ve been involved with several young people where events have followed a certain template. A teenager suddenly stops attending school, and stops seeing their friends. Often there were previously no issues with their school attendance. We’re asked to see them. They’re low in mood, but not necessarily at the level of a clinical depression. They can’t tell us why they won’t go to school, or why they’re locking themselves in their bedrooms, but whatever it is seems to be distressing them.

At some stage down the line, it turns out to be either a sexuality or a gender identity issue. Often this gets revealed accidentally. Perhaps they blurt something out in a moment of stress, or their parents discover same-sex images on their computer. They usually don’t simply come into the therapy room and tell us, because they’re terrified of how people will react.

What happens next is crucial. If the response of family and friends is a positive one – to tell them it’s okay, to accept this aspect of them, to let them know that this isn’t a problem – then the child has a good chance of getting their life back on track. They now have the opportunity to move forward, to be who they are, and to prosper.

If the disclosure is met with hostility and rejection, then the damage can be enormous. Instead of prospering, the kid can fall into depression, substance misuse, self-harm, school avoidance or any combination thereof.

Homophobic and transphobic bullying is still an issue in schools, but when I think of when I was at school in the late 80s and early 90s, the progress is enormous. I’ve worked with LGBT teenagers who describe being accepted by their classmates in a way that would have been inconceivable when I was a kid. Some of our local schools have LGBT student groups, and ask older pupils to act as mentors to young people who are coming out. There’s a support group for LGBT teenagers that we can signpost kids to. More and more young people are being presented with a very healthy idea – that being gay, bisexual or transgender is normal.  In that sense, many of our kids understand the future a lot better than the grey-haired fulminators on the Tory backbenches.

But there’s still a way to go. Gay marriage may not be the most important waypoint on the road to demonstrating that LGBT people are equal and normal in every way, but it is one of those waypoints. So, if you’re opposed to gay marriage, don’t do it because our kids supposedly need “protecting” from homosexuality. They don’t need protection; they need normalisation.

Beyond Winterbourne

Yesterday, the Department of Health published ‘Transforming Care : A national response to Winterbourne View Hospital’ (PDF)  the ‘final report’ about learning and developments following the case which highlighted, via a BBC Panorama documentary, the systematic abuse which was embedded in the running of a private hospital for people with learning disabilities ‘with a stated purpose of providing assessment, treatment and rehabilitation’.

The failings were found not only in operation of the hospital  but in a complicated and confused health and social care system which on the one hand seems to have been moving away from ‘institutionalisation’ over the past few decades while on the other hand commissioning services which embed institutionalisation and powerlessness into failing and very expensive systems’. The case of Winterbourne View also highlighted the failure of the regulator, the CQC, to respond to information provided by a whistle-blower and of local authorities and commissioning NHS Trusts to actually quality assure the services which are being provided.

Another related report which was also published yesterday (PDF)  came from Family Mosaic – a housing association which provides supported living services which highlights its own failings in terms of poor care and proactively looks at new policies and ways to turn this around. In a way, the Family Mosaic document – is a testament to an organisation which wants to learn pre-emptively and the organisation should be applauded for producing it.

I want to look at some of the issues in both these reports as I think they are  linked,.

Lessons from Winterbourne View

The introduction to the report sets the context of Winterbourne View Hospital – a placement for 24 adults with learning disabilities. The report explains that 48 patients had been referred there since its opening in 2006. The average cost of a placement was £3500 per week and

‘13 were referred by commissioners within 20 miles

12 were referred by commissioners within 20-40miles

14 were referred by commissioners between 40-120 miles

9 were referred by commissioners over 120 miles’

14 separate English NHS commissioning bodies had acquired places there plus some unspecified (presumably a problem with exact data) from Wales..

You’d think that maybe there’d be quite a lot of quality assurance going on with all that money streaming in.

Both the Serious Case Review and this report pick up on the amount of lost opportunities in terms of communication between agencies – between commissioners and between primary and secondary health care services. There has been a lot of confusion – not least from the Secretary of State about the position of Winterbourne View but that fact that it was a hospital and received detained patients (rather than a care home which it has been incorrectly yet frequently referred to) means some of the responsibilities and monitoring processes would be different.

The police, hospitals, commissioning bodies, local authority (who was responsible for safeguarding alerts), CQC Inspectors and Mental Health Act Commissioners seemed to have failed to ‘join the dots’.

While the Serious Case Review goes into detail about what went wrong, this report is more interesting in terms of what is going to happen next.

What is happening as a result

Immediately the CQC changed some of the systems for pulling in whistleblowing information and started an inspection programme for learning disabilities settings.

There was to be (and is to be) a focus on more local settings where possible as distance from family and familiar settings is crucial. Where it is not possible the placing authority should remain in close contact and plan moves back to local areas as soon as possible. A long term distant placement is not an option.

Hospital the report states, which should be obvious I guess, is not a long term placement and should only be used for the minimum time necessary.

If it is necessary at all.

The report talks about the need to listen to people with learning disabilities and their advocates as ‘not listening’ was a big failure. It’s important that listening is beyond hearing what someone might say as well – particularly if there are communication difficulties. It’s important that those who don’t have families to advocate for them are heard as well. Fortunately the report touches on the need for strong advocacy services to be developed.

What will happen

The Department of Health has set a timetable for June 2014 for a ‘rapid reduction in the number of people with challenging behaviour in hospitals or large scale residential care’.  These numbers will be monitored by the DoH.

I am interested when the report talks about ‘people with challenging behaviour’ if they are just referring to people with learning disabilities. My hope is that they aren’t and this will apply equality to those people who have more advanced dementias and may display behaviours which could be interpreted as challenging due to communication difficulties

There is an emphasis on ‘personal care plans’ being developed which partly shows the failing of the personalisation agenda to date as it has completely passed by swathes of people with the highest needs. Maybe there’ll be some attempt to ‘catch up’ now. Let’s hope.

Interesting to that the report nudges the CQC to consider the ‘model of care’ delivered in terms of regulation and compliance. .Personally I’d see that meaning that these larger institutions inherently carry a ‘higher risk’ but it will be interesting to see how that develops.

Interesting that the report focuses (rightly) on the involvement of ‘families and self advocates’ in driving quality and change. My only comment would be a plea for the Department of Health not to forget those people who have very high support needs and who are, due to their cognitive impairments, not able to ‘self-advocate’ and who do not have family advocates. There is a gap here and often these people are at high risk of abuse due to the lack of ‘supporting voices’. There must be a way for formal advocacy to speak on their behalf.

Strengthening Corporate Responsibility

The report also looks at the organisational failings of Castlebeck and the lack of responsibility taken by the organisation itself.  The report urges the CQC to take more enforcement action organisationally if necessary and there has been a move to appoint ‘Corporate Compliance Managers’ – presumably to hold large organisations to account.  The Department of Health will also be looking at the way the CQC are able to ensure the ‘fit and proper person; test which is applied to registration can apply to organisations – whether a board member is nominated to be responsible. However the powers do not exist in legislation for the CQC to check more than one appointed person. This is something that strays into the ‘to be decided’ part of the action plan but no doubt will be an interesting space to watch.

Improving Practice

The report highlights good practice in the hope it will be modelled  more broadly. A voluntary register for people working in adult social care is being mooted. Personally I favoured full regulation of the social care workforce but that’s likely to be too costly to organisations who are working on minimum wage payments to many staff whom they don’t necessarily want to professionalise even though the work is crucial. The low status of social care work is inherent in the attitudes of employing organisations. Training is important though and so is modelling of good care. While compassion doesn’t cost, environments in which it can flourish are better sustained when staff aren’t under constant pressure and are treated, themselves, with respect.

Whistleblowing mechanisms are mentioned and tightened where they haven’t been already.

Particularly interesting to me as a (now) ex-AMHP and BIA was mention of the Mental Health Act and Mental Capacity Act. The report confirms that 73% of the people are Winterbourne View were detained under the Mental Health Act. They should have had statutory protections of appeals and access to IMHAs. It also makes one wonder under what grounds the other 27% were being detained. Was it –really- ‘informal’? Were DoLs ever used? If not, were there any questions asked by those visiting about why or why not?

One of the most interesting ‘key actions’ to me is that

‘The Department of Health will work with CQC to agree how best to raise awareness of and ensure compliance with Deprivation of Liberty Safeguards (DoLs) provisions to protect individuals and their human rights and to report by Spring 2014.

I have a particular interest in DoLs – their use and their lack of use so will certainly be keeping a VERY close eye on this. I’ll try not to be cynical. I’ll really try.

Family Mosaic’s proactive report

Family Mosaic’s ‘No Going Back’ report (PDF) unfortunately has faded into second place in this post but it almost deserves more than one post to itself however the themes link in so tightly with the Winterbourne View Review.

I’d recommend that both reports are read together and it is commendable that Family Mosaic as a provider organisation have looked proactively at how they can do better in terms of challenging institutionalisation and poor practice among their own staff.

The report looks at the history of ‘deinstitutionalisation’ and the move to Community Care principles but also where the failings have crept back and cultures where care may be delivered in different settings but where the quality has been in question and abuse has resulted.

The organisation provides examples of poor and indeed, abusive care in its own settings to look at how to improve and what to offer in terms of building a better culture of delivery of care.

One of the interesting aspects they consider is the lack of ‘whistleblowing’ so that staff who might witness poor care and who have been on the requisite training may not feel they are in a position to report it or may not recognise it when they are involved in the delivery.

The report focuses on aims and action points for the organisation as a whole including a more open policy towards whistleblowers and those who raise concerns internally.

It explains clearly basic expectations for delivery of services to service users by staff and all in all, it is a fantastic piece of work by Family Mosaic who should be commended.

Conclusion

These two documents offer a way forward for delivery of care and attitudes towards those who need care. I wish we had a Winterbourne View type document and review of care for older people, particularly older people with dementia and hopefully when the document refers to ‘people with challenging behaviour (a term I don’t really like to be honest’ it isn’t only referring to those in learning disabilities settings – however I fear it is.  We need to have a wholesale reappraisal of large institutional settings for care delivery – be they hospitals for people with learning disabilities or 90 bedded nursing homes for people with dementia. Age/cognitive ability/family involvement/means to self-advocacy cannot determine ones right to dignified and high quality care.

Family Mosaic have presented a good model that moves beyond care for those with learning disabilities – I hope more providers take notice and take a proactive response.

However, there will be costs and if the government is truly intent on building better services across the board and for all sectors, there has to be an understanding that the money will have to come from somewhere.

I hope it will happen. The right noises are being made. I just hope the results are equally satisfying.

On Change

So I’ve ‘come out the other end’ so to speak and made the leap from a frontline social work post into another job. While I don’t want to cover the specifics of what I’m doing – that may come with time – except to say it’s related – I wanted to pause and consider how the move has gone.

On the positive, having come from being a social worker seconded into an NHS team employed by a local authority that barely seemed to remember that it had Mental Health Social Workers and couldn’t quite grasp the fact that not all of their employees could access their LA intranet/email system, it’s actually really pleasant to be a part of an organisation that remembers I exist!  While it can be easy to joke about, it could get both frustrating and lonely being out on the periphery between NHS and LA – owned by neither – and ‘belonging’ to an organisation can be important psychologically and certainly helped develop a loyalty to an organisation.

Organisational loyalty can be positive in the sense of belonging but there’s also a need to see beyond ‘blind loyalty’ and to be aware of accepting criticism where necessary.

I’ve done a lot of ‘meeting’ of people. One of the most refreshing developments over the last week is that I’ve met many people from different occupational backgrounds in a ‘work setting’ and that’s actually something very new for me. I’ve worked in social care since 1993. Gulp. While I dabbled briefly in another field for a couple of years since then, that was in a very different context but basically it’s been a LONG time since I’ve had constant contact with people who haven’t worked in the health and social care sector.

It has allowed me to see the world and particularly the sector through ‘different eyes’. So much of our ‘system’ makes no sense whatsoever that I’ve almost become used to it.

Putting more money into dementia screening but not providing any services for those who have dementia diagnoses to garner more personalised support makes no sense yet it will ‘tick another box’.

‘Personalisation’ in name only while Local Authorities deliver exactly the same ‘managed personal budgets’ that they did before the individual had an ‘personal budget’ with no more choice’.

The existence of residential care provided at high cost which delivers poor quality via staff on minimum wages while profits siphoned upwards.

None of this makes sense in the sector and yet the challenges to some of these from within the sector need to be listened to.

I’m in the middle of solid induction programme. The last proper induction I had was when I did my last social work placement which was.. um.. quite a few years – and a few jobs – ago. It’s something I’m trying to make the most of.  There’s a lot of learning which is exciting to me. I enjoy learning and while the skills I have are those which got me to the point of ‘getting the job’, I will need to develop a lot more to move on.

I’m excited about going to work – I know it’s still early days but while there were parts of my last job that I always loved – there were fewer of them.

On the other side, I miss people. I miss the people I worked with and the families I came to know. I miss my colleagues who were to an individual, a fine group of people who wanted to make a difference despite the organisational obstacles placed in their way and I miss the confidence I had in knowing what I was doing/who to talk to about things/how a particular organisation works.

It will take a long time for me to feel as comfortable in the new organisation as I did in the last one but that took years of experience and relationship building to grow. I had (I think!) a good reputation within the last organisation of working hard and I need to start building another reputation from scratch.

I may need a bit more time to adjust than I thought I would. After a week, fortunately, I still think it was the right thing to do. I’m thinking of the ways I can ‘transfer’ my skills and knowledge. I’m absolutely sure that I will be able to.

I never thought I’d leave ‘frontline social work’. I’ve been reflecting a lot on that. It  was absolutely the job I felt I was ‘made’ for and what I wanted to do. I also thought that those who moved away were ‘running away’ from the real social work. And I’ve done that myself. It was one reconfiguration of services too many as far as I was concerned.  I’m hoping my old team gets some fresher eyes to challenge with and some different perspectives to put some more fight into the sector. One thing the sector needs is more fight. Is staying put and fighting more ethically coherent than moving on when you feel ‘ready’ and challenging from the outside? I don’t know but I will continue to ponder and reflect.

Of course, I remain a registered social worker – having just renewed my registration although I would have registered regardless and can’t see myself giving up that registration ever really – and will continue to relish the values of advocacy and endeavour for better services but will be coming from a different angle.

Maybe it’s just now I’m seeing social work more broadly than I did last week and perhaps that’s no bad thing.

Nursing degrees aren’t the problem

On the Andrew Marr show today Ann Clwyd MP was speaking angrily about the poor care her husband received while at the University Hospital of Wales. She argued that nurses no longer display compassion, and one of the reasons for this was because, “since they made nursing a degree course the wrong kind of people are entering the profession… we do not need a load of snooty-nosed pen pushers”.

A couple of days ago Jo Brand gave a response in the Guardian to Mrs Clwyd’s recent statements on nursing. Her view was that nurses are not any less compassionate than they used to be, but that poor management, spending cuts and privatisation were eating away at standards of care. She too raised the question of nursing degrees, though she describes it as “a complex issue that is difficult to read.” She expressed concern that it might have “closed the door to a wealth of potentially impressive nursing staff whose academic skills were not up to degree level.”

I fully appreciate Mrs Clwyd’s anger and upset at her husband’s (lack of) care. Who wouldn’t be angry? But I don’t think nursing degrees are part of the problem, and I’d like to give some reasons why I think that. I hope this goes without saying, but in doing so I am not attempting in any way to excuse or minimise the failings with regard to her husband. Patients are entitled to dignity and compassion at all times, and if he did not receive it that is clearly unacceptable.

Nursing has been an all-degree profession in Scotland and Wales for some years now, and is in the process of switching over in England. I’ll declare an interest here in that I’m a degree-educated nurse who graduated with first class honours from a well-regarded Russell Group university. It was a tough, challenging course, which stretched me far harder – particularly emotionally and physically – than my previous degree in the humanities.

The first point to make is that the difference between a nursing degree and a diploma really isn’t very much. The length of time is exactly the same (three years) and crucially, the clinical placements are exactly the same. Whether a student is doing a degree or a diploma, they spend half their time in university and the other half out on placement – in hospital wards, outpatient departments, community teams. At the end of the third year, they spend the last three months of the course in a clinical area, taking on all the responsibilities of a staff nurse under the supervision of the qualified staff. At my university, the difference between a degree or a diploma was little more than whether you did a dissertation or an extended essay in the third year.

So, if the clinical placements haven’t changed, what about the suggestion that bringing in degrees has attracted a horde of snooty people who are, to use the media expression, “too clever to care”? Personally, I don’t see that it has. When I was a newly-qualified staff nurse on a ward, I certainly didn’t think that my fancy education meant I was too intelligent to wipe a bum. On the contrary, I felt very strongly that I needed to gain the respect of the nursing assistants I was now leading, and that meant demonstrating that such tasks weren’t beneath me. I really don’t see why having more intelligence would make you less compassionate, or that being clever makes you a bad nurse. On the contrary, when I think of the most outstanding nurses I’ve ever worked with, they’ve all been intelligent people. As for the bad ones, they’ve usually been…well, a bit dense. Nursing requires you to juggle a caseload, calculate medication doses, keep accurate records, liaise with patients, carers and fellow professionals, and think on your feet in rapidly-changing situations. Funnily enough, it helps to have something between your ears.

Then there’s the argument that degree courses are deterring people who would otherwise make good nurses. Again, I’m not convinced. I’m willing to stand corrected on this, but I haven’t heard anyone say, “I was planning to apply for nursing, but now they’re abolishing the diplomas, I’m not going to.” In an era of mass education, university degrees simply aren’t the elite qualifications they used to be perceived as. These days it’s practically a rite of passage school leavers to head off to university, and most people with a reasonable amount of intelligence and self-organisation can pass a degree. Some of the students on my course struggled with the essays, particularly mature students who had been out of education for some years. But crucially, those who kept at it did pass. They might not have got stellar grades, and they might have had to re-submit the odd essay, but they did get through. Once they’d done this, a nursing graduate who scraped a third is just as qualified as one who sailed through with a first. As for those few who flunked completely despite opportunities to resubmit work, they really didn’t come across any great loss to the profession.

Finally, it’s important to remember that many things can affect patient care and dignity besides nurse education. The ratio of nurses to patients. The ratio of qualified nurses to unqualified nursing assistants. Levels of support – is there a ward receptionist to deal with phone calls and queries so the nurses can get on with caring for patients? Equipment issues – for example, is the ward getting enough fresh linen? The calibre and personalities of the senior nurses. Even cultural factors can play a role. Those who gaze wistfully back to regimented wards under the dictatorship of Matron might wish to recall that back then Britain was more, well, regimented. When the NHS was founded it was the era of national service, with the Second World War still fresh in everyone’s memory. The values of nursing at the time were essentially military values. We don’t have that culture in Britain any more.

That said, there is the question of whether enough is being done to weed out bad student nurses and stop them qualifying. It makes a good headline to say it’s because universities only want them to write essays. But as is so often the case with a good headline, the reality is more complicated than that. For people who are interested in this topic, a good read is Kathleen Duffy’s seminal 2003 study on “failing to fail” student nurses. Unlike in the tabloid headlines, her focus wasn’t so much on the universities, but on the mentors; the qualified nurses who teach and supervise students while they’re out on placement.

I’m a mentor myself, and I regard it as one of the most rewarding parts of my job. Every few months I have a student nurse with me for six weeks, so they can develop their knowledge and clinical skills. It’s up to me to support them and also to assess both their skills and their professional attitudes. I’ll not just be looking at their ability to perform a task, but whether they interact well with patients and families, whether they respect confidentiality, actively seek out learning experiences, and so on.

For the most part, the students I’ve had come to me have been excellent. Keen, bright, eager to learn. But there remains the question of what to do with a bad student. Hence why Duffy’s paper was required reading when I did my mentorship training. She identified various reasons why a student might not be performing but still pass a placement, which she placed in four categories.

  • Leaving it too late – not identifying and addressing problems until the last week of the placement, perhaps not having a mid-placement meeting as you’re supposed to.
  • Personal consequences – an awareness by the mentor that this could result in a student’s career ending before it’s begun, with all the ways that might affect them and their families.
  • Facing personal challenges – a lot of nurses simply don’t like failing students because they feel it’s not a “nice” thing to do, particularly in a profession that’s supposed to put a premium on being nice.
  • Experience and confidence – mentors not feeling sure of their judgement in these matters, or perhaps being worried about getting a hostile response from the student.

Obviously none of these are valid reasons for passing an under-performing student nurse. Ultimately it’s our responsibility as mentors to flag up problems promptly and address them, for the benefit of the public. The take-home message from Duffy’s research is that if the wrong people are being allowed to qualify as nurses and join our ranks, then it isn’t the university’s fault. It’s our fault.

The #Rotherham #UKIP fostering row: Further details emerge

Another day, another set of details emerge about the UKIP fostering row. This time courtesy of the Daily Mail. I’ve said before that I’m not comfortable with the way a sensitive case about vulnerable children is being played out and discussed in the media, but since other people are clearly going to comment on the case, I suspect throwing a tuppence forth from this little blog isn’t going to make much difference in the grand scheme of things.

Last week the Guardian alluded to tensions between Rotherham Council and elements of the local East European community, and yesterday’s Daily Mail fills in some of the blanks regarding this. Apparently the council has been the subject of protests from Slovakian families following a number of removals of children into foster care. These families are accusing the council of “child-stealing” for racist reasons and of trying to impose British values on them. This has led to protests from the Slovakian government who appear to be taking the side of the families.

Though the “British values” in question appear to be things like children going to school, not wandering the streets at 2am, and not living in a mice infestation.

The Mail being the Mail, they don’t appear to see any irony at all in, a couple of weeks after accusing the council of ideologically-driven fixations with multiculturalism, then granting a fairly uncritical interview with an alleged abuser, strongly suggesting that the council are racist towards East Europeans.

The words “shot at from both sides” spring to mind.

And naturally, there’s a rentaquote from John Hemming, an MP who seems to live in a strange parallel world where child protection proceedings are nearly always due to scheming, malicious social workers and hardly ever about averting another Victoria Climbie or Baby Peter.

These arguments appear to have been made in the courts as well as in the media and council meetings, apparently with some success. As the Guardian said,

But a family court judge ruled three of the children should be returned to the parents after the birth parents successfully argued that the council had failed in their duty to ensure the children enjoyed the linguistic right to learn and speak the language of their birth.

In the light of the Guardian and Daily Mail reports, I’m going to make a rough educated guess at the backstory here, which may or may not have to amended as further details emerge into the public domain.

It seems likely that the council would have been anxious to avoid a repeat of this judicial ruling. It also seems likely that they may have been vigilant for anything that would be immediately be pounced upon by the birth family’s lawyers, by the Slovak protesters, possibly even by the Slovakian government and media.

Something like the foster carers being members of UKIP. They may well have been doing a perfectly good job as carers, but that wouldn’t be what the family’s lawyers would say in court.

One could argue that the local authority should have challenged the judicial rulings, ignored the Slovak government and media, and served up the local Slovak community a hefty slice of if-you-don’t-like-our-rules-you-don’t-have-to-come-here. I’ll leave others to argue that one out.

But either way, the application of Occam’s Razor doesn’t require the council to be acting out of an ideological crusade about multiculturalism, or a Labour-inspired grudge against UKIP, in order to have acted in this way.

It certainly doesn’t require any David Icke-style conspiracy theories about Common Purpose.

Such a scenario is entirely consistent with the local authority trying to tiptoe around one set of legal, social and political grenades, and in doing so accidentally setting off a completely different grenade. And that’s my guess as to what’s happened. Eventually time will tell whether I’m right or wrong.

One thing this case does show is how complex and difficult fostering cases can be. When such cases are seized upon for political reasons, whether by UKIP or the Slovakian government, such complexities and difficulties are rarely grasped.