Nil By Mouth

I have been wanting an excuse for an entry with a focus on ‘regulation‘ for some time, and a number of issues have come together at the same time to provide one.

Right: The (now) 89 year old Frank Holland - the original 'Dutch'

Last week, my 89 year old ‘Gramps‘ was admitted by ambulance to hospital, with severe stomach pains, and bleeding.  He is like a second Dad, with me having been a latch-key kid during the 1970s and 80s – and it is from him that much of the inspiration for the name ‘Dutch‘ comes.

For five days since his emergency admission, there was little progress on a diagnosis of his problem.  He was in the very ward visited by David Cameron, Nick Clegg and Andrew Lansley, from where they kicked off their ‘Pause, Listen, etc’ consultation exercise on the NHS reforms in March.

NHS consultation, kicking-off at the local hospital where Gramps found himself admitted via A&E recently

This blog isn’t a rant against those changes (I’ve done that elsewhere), but more one against a general atmosphere which prevents us ‘little people’ ever really getting their hands on the source of a problem; of seeking accountability, and for people in their every-day work being given the autonomy to flourish (but also to take a sense of responsibility for what they do) – in short, it is against a ‘tick-box’ regulation culture that prevents any kind of resolution or authentic reaction.

My ‘Gramps’ lay in his hospital ward.  Cameron and Clegg have been and gone.  So, I am reliably informed has the regular and pre-announced Care ‘Quality’ inspection. Check  ✔. Check  ✔.  100% compliance laminated bar charts produced and placed on walls around ward?  Check  ✔.  Check  ✔.

Funny though, the shiny, new, wipe clean metal signs above every bed on the ward remained empty.  I’m told they were there for ‘Quality’ Care’s inspection and for Cameron’s visit (must have made a better photo opportunity), but actually, to fill them in breaches patient confidentiality.

Nil by Mouth? (Source: BBC: 'Getting On')

Staff needed to know that my ‘Gramps’ was ‘Nil By Mouth‘.  By relying on this tick-box approach to managing care, they have encouraged him to eat food when he shouldn’t;  then when it has been decided that it is too late and he should carry on eating, the message hasn’t kept up, and the people with the food have decided he is ‘Nil By Mouth’ again, even though he is not.  As a result, there is no progress on diagnosis, and he has not even advanced out of the care of ‘A&E’ to a surgical consultant.

Breaching patient confidentiality?  The same information was kept on a chart in the corridor of the ward for ALL passing to see, but somehow, that did not breach confidentiality.

'Nils By Mouth' - not the actual state of the walls

By Day Five of his stay, and no further forward on his care, the Hospital told him he could go home.  Before he had a chance to leave the grounds of the hospital, he had been manhandled by a three-strong security team, who saw fit to prevent him leaving the hospital, and having done so, did not seem to have an idea of how to manage the intervention in someone’s physical space without winding him up further.

Back on the ward, but after I had whisked him off site bruised and incensed, a doctor had finally read his notes – and realised that he should not have been discharged – and because of his medication regime, should have been treated immediately, as we had been originally told.  Too late – I’m not sure he’ll ever set foot in a hospital again.

This is not an issue about a single hospital, or nursing staff – although who orders an 89 year old with a violent stomach condition and an unlikely relationship with ‘exotic’ food sweet and sour pork for dinner?  He was also discharged with someone else’s medication – another breach of confidentiality that was somehow ‘ok’.

For me, this is about an issue prevalent in every walk of life.

It hits the headlines in the regulation of private care homes; bonuses and credit availability in the banking sector; railway companies and ticketing; the Press Complaints Commission and ‘phone hacking‘; and quality of care in the NHS through the Care Quality Commission.  I had first hand experience this last week of how the latter’s pre-announced inspections are more interested in the punctuation used on a member of staff’s CV, than they are the real life experiences of people like my Gramps (I saw such an incident happen).

Closer to home, in higher education, students at my former university, University of the Arts London were vindicated recently, when in a landmark ruling, the Quality Assurance Agency (QAA) made a general ruling under its ‘Cause for Concern’ procedures about the issues I have been blogging about for some time (and resigned my job over in November 2009).  This is a big deal, as it is difficult enough to find your way around the system, let alone have the confidence to do anything about it.  And for it to take 18 months to get ‘justice’ after exhausting the democratic procedures of the elected college structure; one-to-one meetings; demonstrations; occupations and public meetings.

But the result of that regulator’s ruling?  Nothing!  While it found in favour of the student complainants, It also found that there were no future issues for concern likely to impact on the student experience.  This is from a university that left students on courses with NO dissertation supervisior for a term, no personal tutor, and countless examples of courses with no lecturers, purely as a result of the decisions of the head of college – and this was courses that did NOT close.

LCC's Head of College, Sandra Kemp

Who is to say that cannot happen again?  It happened because one senior member of staff decided to make changes without sticking to the relevant course change procedures, and ignoring warnings about lack of staff cover on existing courses.  Guarantees of quality, yes, but look more closely, and you would have seen courses having very little money spent on them, few unique resources, and in the case of the degree I am proud to have resigned from rather than ‘play the game’, they have been unable to appoint a permanent, specialist replacement in over 18 months, despite advertising, shortlisting and making job offers – because everyone else has seen through them too.  They, like me have made an ethical judgement.

"Nil By Mouth" you could say - Jacob Black finds himself gagged, just like lecturing staff

We were even asked to lie to parents of incoming students about whether courses were to close – “Nil By Mouth” you could say.

When I asked QAA if they were interested in my testimony, after six weeks of no reply, a prod resulted in another “Nil By Mouth” response.  Now they have got what the THE described as their “unprecedented” slap on the wrists, it is likely that my former College will seek to shore up what is left of its reputation by seeking accreditation from the Chartered Institute of Public Relations for the PR degree course it kept.  There is no way it should get it, purely on the staffing situation alone.  But they will pay their accreditation fee.  Someone will ask a ‘difficult’ question.  Its answer will be minuted.  And all will be well in the world?

Regulation isn’t working.  Unless citizens or consumers are given the tools to become more active in using the channels available to them, I despair.  Unless we all reflect a little more about how power is at play, we may as well all give up.  Fees will increase next year from around £3k per year to £9k – effectively a ‘blank cheque’ for the unpunished institution, which was making in the region of £100k per year clear profit from courses such as this even back then!  It is also about effective policy-making (or lack of) which often is responsible for creating the messes which need regulating in the first place.

If any of those students did want to try their hand at securing compensation for what even the regulator described as disrupted studies, they wouldn’t get it from the university, they wouldn’t get it from the university funding body (HEFCE) – they wouldn’t get it from the regulator, QAA.  No, they would have start a whole new separate process, through a totally different body, the Office of the Independent Adjudicator (OIA)!  Run for your lives!!!!!

I think Charles Dickens perfectly fingered the regulators in Little Dorritt.

“The Circumlocution Office was (as everybody knows without being told) the most important Department under Government. No public business of any kind could possibly be done at any time without the acquiescence of the Circumlocution Office. Its finger was in the largest public pie, and in the smallest public tart. It was equally impossible to do the plainest right and to undo the plainest wrong without the express authority of the Circumlocution Office.”

Idealism? Take a Stand? or Give Up? Chicken Soup with Barley

If you’ll excuse me, I’ve got my own laminated bar charts to produce – another successful year you’ll be surprised to hear.  If you are interested in the issues raised, I thoroughly recommend Arnold Wesker’s play “Chicken Soup with Barley” at the Royal Court till July 16th.  After a slow start, tracking one family’s fight against the fascists in the East End of London in the 1930s, by the end I didn’t think the tears would ever stop – and that was a matinee performance!

Do we give up on our idealism?  Maybe we need to adapt our tactics to the terrain?  But surely we can’t cease caring in the face of a ceaseless, faceless bureaucratic onslaught?  It is tempting when the weight of forms take us away from the frontline, and from our talents, but when we remind ourselves that we are part of a wider human fraternity: real people like my 89 year old Gramps;  young people starting out on their careers?  We must put them at the centre of everything we do – in life, and in professions, such as mine of public relations.  Ethical codes and regulation are a sign that we have already failed, as are playing too safe in the delivery of our communication strategies in PR.  Kirsty Maccoll could have taught Ed Miliband a few things about Labour’s message and delivery had she still been alive.

Gramps meanwhile has forbidden the family from getting involved, but he needs us to bat on his behalf and navigate the official procedures.  He has already started seeking justice – in his mind, he ‘naturally’ went to the local police force.  They have since referred it to the neighbouring police force (where the hospital is based), who have since referred it back to the Hospital, who insist he submit a formal complaint about the hospital – but he does not want to complain about nurses personally, and does not understand these elaborate procedures.  We all know, “Computer Says No“!  ‘PALS’ process activated?  Check ✔  Letter to CEO?  Check ✔  What’s the betting the computer will still say ‘No’, even if it says ‘Yes’?

* Apologies for being away so long