Southern Health Still Haven't Changed

Over the past few months, I and Denise Wyatt have continued our pressure on Southern Health following their proven failures of leadership and to care for our loved ones.

At Southampton City Council, we were appalled how the Health Scrutiny Panel of councillors let Southern Health off the hook. Not only that, the Chair of the Panel, Labour Councillor Sarah Bogle did not insist as we had asked that SH Chief Exec Katrina Percy and SH Chair Mike Petter attend. Instead, she let Ms Percy go on leave and send two other directors to attend. Worse, when I challenged her on this in a written question to Full Council, she appeared to try to justify this. In another conversation, it appeared to Denise and I that Cllr Bogle was just too busy to make Southern Health accountable.

Worse, the papers sent to the Panel were wrong, giving a false impression of progress to "learn the lessons" they claim to have learned. Such claims are bitterly disputed by fellow campaigners, highlighted again by new analysis published today by the Justice for LB campaign. Why were the papers wrong? It was just an error say SH. Obviously not deliberate.

So the Health Scrutiny Panel failed to do its job - why was it left to Denise and I as campaigners to read the papers and know they were wrong? It is the job of officers and members of the Scrutiny Panel to be aware. But they didn't do their job.

And as already stated on this blog, the governors and directors of SH have failed. This includes Labour Peartree Councillor Paul Lewzey who was the governor appointed by outgoing Freemantle Labour Councillor David Shields to represent Southampton's residents. The latter is the one who thought it was OK to try to gag the rest of us councillors. As the Daily Echo reported, it may work on Labour or Tory councillors but not on Independents like myself and Coxford Independent Don Thomas.

As for Governor Paul Lewzey, after waiting a long time for his answer to my question as to why he didn't back Governor John Green's proposal for an independent investigation into SH, all we got was a rambling non-answer. Towing the party line instead of proper accountability for failed governance and failed care is not on.

The regulators have also failed. Months after Mazars, the regulators are dragging their heals - will their threats in this week's media amount to anything? It is difficult to be confident of this given past experience.

So how do we hold the NHS to account? The answer is that we can't.

And sadly this is the inevitable consequence of how the NHS was set up in 1948. It cannot be top-down command and control. That is for Stalinists.

It has to be local, but with real, not imagined accountability.

In the meantime, campaigners have to use all forms of media and whatever other tools they can, to get rid of the failures of the existing system.

Join us!

Independent Councillor Andrew Pope

Southern Health Governors Must Go

There must be an investigation into the failures at Southern Health but it must be independent of the NHS, which has a vested interest in covering up. The CQC and Monitor are not independent. They are part of a failed system - a point which Southern Health Governor John Green has made very clear in his heroic work.

Southern Health Governor John Green

Unlike the other governors, he has put huge time and effort as a volunteer into trying to make things right, as reported by the Daily Echo this week.

But the other governors just don't get it - and it's time for them to go! 

They must not forget - as campaigner Denise Wyatt reminded them at the Council of Governors meeting in early January - governors are there to protect us and our loved ones. 

Why do I say this? For several weeks since we became aware of Southern Health's problems, governance expert Denise and I have been providing advice in good faith to Southern Health, its Company Secretary, Chair and Governors.

We wanted to patiently, in good faith and good grace, try to work with these people to improve the future for the patients, carers and families of Southern Health.

As part of this advice, Denise and I wrote a paper to advise Governors how to fulfill their role properly in holding the Trust Board to account. At our request, it was confirmed by the Company Secretary that this paper had been sent to all Governors. Only 2 governors (of 26) contacted us to thank us for our help, which we provided for free and in our own time.

How could it be then that when Governor John Green put his three constructive and relatively mild recommendations to this week's Council of Governors, that two governors - Helen Keats and Liz Hall - could question whether it was the Governors place to question the leadership of Southern Health? Denise and I were incredulous at such ignorance of the facts, and called out that "It's your job!" - leading to the Chair Mike Petter (also under pressure from the BBC for a conflict of interest) threatening to expel us from the meeting.

Did they read our advice? Did they ignore it? Did they not understand it?

The advice we provided is crystal clear:

"Holding the Non-Executive Directors to Account

The Southern Health Constitution states the Council of Governors are:
18.1.1. To hold the Non-Executive Directors individually and collectively to account for the performance of the Board of Directors;

What does this mean?

 “Governors are responsible for appointing the chair and other non-executive directors and may also remove them in the event of unsatisfactory performance.” Quote from  Your statutory duties A reference guide for NHS foundation trust governors

In light of the Mazars Report, do you think there has been satisfactory performance?

If not, you must use the powers you have to ensure a satisfactory performance.

You have the powers – please use them !"

If the Governors did not understand our advice, they could have got clarification from us or the Company Secretary. Instead, they ignored it and carried on their ignorance and failing to do their public duty and use the powers they have.

Added to these failures, the Trust Board and Council of Governors tried to explain their way out of the questions I put to both of these Foundation Trust bodies back in mid-December. Despite waiting for a month, I was disappointed that they did not properly answer the questions. Not only this, but they did not pursue the crucial points of the questions...

...that I had requested an investigation using the Nominations and Appointments committees and the proper use of the Governors powers to hold the leadership to account.

John Green was the only one who got it. Every single other governor present (apart from one abstention), including appointed governors Councillor Paul Lewzey (Southampton City Council), and Councillor Andrew Joy (Hampshire County Council) voted against his recommendations to independently investigate.

We were aghast at their negligence.

As the Mazars report states, Southern Health have failed to investigate deaths in a timely or accurate way. But at these meetings, people like Mike Petter and Dr Chris Gordon continue to maintain that the Mazars report did not criticise the care by Southern Health.

If you fail to investigate deaths, that surely shows a lack of commitment to quality of care?

This state of denial by the leadership of Southern Health has to stop. 

So can the other SH governors and the current SH leadership do it? No - we've given them a chance but they have blown it. This week's meeting was the final straw.

I have previously blogged that I wanted to give the governors a chance to prove that they could do it. I believed that there was a nucleus of governors that Denise and I could work with. But the Governors' rejection of John Green's recommendations for an independent investigation show that they have no wish to fulfill their statutory duties. My hopes have been dashed.

Anybody who voted against Mr Green's proposals is not fit to be a Governor. They seem to prefer to smooth things over rather than address the problems. They are not fit to represent me as a Southampton resident, nor anybody from across Hampshire and the other counties that Southern Health "look after".

So how are they to be removed?

Elections for the Council of Governors were only held last year. Several governors came to the end of their appointed times this week. And three more governors resigned before this week's meeting, leaving more holes in the proper governance of Southern Health.

Apart from John Green, who seems to be the only governor who understands his duties, every single one of them should resign or immediately receive urgent training to properly fulfill their public duties. I know that new governors are not being given adequate training, because I have asked them - but if they had any gumption, they should be demanding it. Time has run out. It's time for them to go.

If they do not resign, they must be removed by the public in new elections, or by the Secretary of State Jeremy Hunt.

Perhaps then the public will have governors who will do their duty and hold the leadership of Southern Health to account.

And then we can reform the governance of NHS Foundation Trusts so that they are truly accountable to local people.

UPDATED: Upping the Pressure on Southern Health

Update: There will be an Extraordinary Meeting of the Southampton Health Scrutiny Panel a week today on February 1st at 6.30pm in Committee Room 3 at the Civic Centre. The latest information I have is that Dr Chris Gordon and Lesley Stevens of the Southern Health Board will be answering questions from councillors and the public. More details are on the City Council website here.

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Having attended the very poorly-run Council of Governors meeting, I was hopeful that the Emergency Trust Board meeting of directors last Monday would be an improvement.

Sadly, I was as equally if not more, disappointed. Equally sadly, I was not surprised.

Once again, following the second request from me in as many meetings, the Chair Mike Petter REFUSED to bring forward questions from the public to be at the beginning of the agenda. As was shown on the BBC South Today report, I believe it is disrespectful to expect members of the public - who the Trust Board are meant to serve - to have to sit through hours of meetings before having their say. 

Many local authorities including Southampton bring items of public interest to the beginning of public meetings.

That is common courtesy.

But not Mike Petter. Although I asked him on camera*! He refused my request and "that's the end of the matter", he said.

It is even more disrespectful to press on with the Trust Board meeting when members of families who have suffered at the hands of Southern Health, and other patients, are at the meeting.

The meeting was packed because we the public showed up to express our anger.

And it is incredible that the Trust Board made decisions without listening to the public first, and the public's representatives - the Council of Governors, first.

The Chair continues to treat the public, and their elected representatives, the Council of Governors, with contempt.

He has a conflict of interest as Chair in resolving the crisis, because he has been part of the Trust for several years. The Chair should be removed by the Council of Governors, who have this power. Instead, when given the opportunity at the Council of Governors meeting to express in public their dismay with his performance, only one spoke up - the pompous Tory Councillor Andrew Joy, who expressed his confidence in Mr Petter. He may live to regret that support.

It is clear that large sections of both the Council of Governors and Trust Board are still in denial about the crisis that Southern Health faces. As I've said before, there are a nucleus of people who want to fix the malaise. But as it stands, they are outnumbered by those who are either in denial, or who lack the ability or motivation to act.

So I have now made the following request to the councillors who are Chairs of Southampton City Council's Overview and Scrutiny Management Committee, and Health Overview and Scrutiny Panel:

Dear Chairs of OSMC and HOSP,

I request that given:

1. the dire situations faced by my constituents and those across our City, who have suffered and may continue to suffer at the hands of Southern Health NHS Foundation Trust unless urgent action is taken, and 

2. the state of denial that was still clearly evident at both Emergency meetings that I attended in January 2016 of the Council of Governors and the Trust Board at Southern Health, including by statements made by the Chief Executive and Chair, and

3. that Monitor has stated that it will appoint an Improvement Director, and 

4. that Southampton City Council and other health bodies in Southampton commission services by Southern Health

that an emergency joint meeting is held of OSMC and HOSP to request that the Chair and Chief Executive attend to ask questions by members of both Panels, other councillors such as myself and by the Public.

I very much hope that they agree to my request. And I hope that members of the public attend the meeting.

If the Council of Governors who are supposed to hold the Trust Board to account don't want to or cannot do so, it must be up to the rest of us to do it.

All the best,

Andrew

*(interesting that there was no secret ballot at the Trust Board on recording of meetings - unlike at the recent Council of Governors - who decided this?). Perhaps my repeated requests had finally hit home?

A Future Predicted but not Prevented

Having attended Tuesday's Extraordinary Council Meeting of Governors, BBC journalist Michael Buchanan expressed his frustration, describing the meeting as "desperate".

He was not alone. 

I and other members of the public like Denise Wyatt were visibly angry as can be seen in the ITV Meridian and Daily Echo reports. Perish the thoughts of the families of loved ones affected by the neglect of Southern Health.

But are such farcical meetings of governors and governance unique to Southern Health as a foundation trust?

No, but the crisis engulfing Southern Health amplifies the flaws in governance that I highlighted in my research five years ago. That research is still relevant today.

Perhaps I am at fault for not publishing it more widely at the time, or being too trusting with the Quality Accounts published by NHS trusts in the South over the past few years.

Now with the benefit of hindsight and from the publicity generated by campaigners like Justice for LB, Richard West and Ian Penfold (it shouldn't have to have been exposed this way) we know Southern Health were stretching the truth - if not flat out lying!

When it came to presenting their Quality Accounts to my (much later) successors on the Southampton Health Overview and Scrutiny Panel in early 2015, the Southern Health documents were not ready - sounds sadly like the lateness of their investigations into unexpected deaths!

And the timeliness, accuracy and relevance of information presented to that Committee are questionable - just as it has been for the Council of Governors.

With such a large organisation as the NHS, it is impossible for one person to check the figures of all the trusts. Isn't that what the many regulators like the CQC and Monitor are for? Are they failing too?

Advice I have received from academics over the past few years was that the problems I highlighted in the FT research were well-known. So why hadn't research like mine been done before?

As well as being predicted, the problems at Southern Health and doubtless other foundation trusts have not been prevented. Why? The answers are in the research, and I will run through those another time.

But when I was going back through my research this week, it was almost like I had predicted the future - this was not difficult as the research showed the problems were already occurring in the present...

... so whenever I've had the opportunity: whether chairing the Southampton Health Overview and Scrutiny Panel, campaigning against privatisation of the NHS, or doing research and presentations on governance, I've pointed out the flaws in the governance of NHS foundation trusts.

Successive governments may have tinkered with the governance structures. But they have not removed the many flaws.

Those flaws in governance don't exist in abstract form.

They are very real. And they've changed lives - not necessarily for the better and in some cases very much for the worse. 

Governors are not responsible for day-to-day operation of the health trusts they are supposed to oversee and scrutinise. That is the job of the executive directors and staff. Governors have powers, even if these powers are not all they need to be. Where they don't have powers, they need to "use their noodle" or rather, use influence better.

That is to say, the flaws in governance have to be removed, but in the meantime they must be worked around, if governors are to properly fulfill their roles.

There are many well-intentioned people who are governors. But the good intentions of these volunteers have to be supported by the NHS to be better governors (e.g. proper training and timely information). It shouldn't be left to the public or outsiders to do it for them. 

We have done it, as volunteers, for free. But it shouldn't have to be this way.

Whilst there is an encouraging nucleus, it is clear from this week's meetings, from discussions with governors, and analysis of the minutes of previous meetings, that there are not yet enough governors at Southern Health that are performing the role fully.

This week, following us pointing out some of these flaws at the meeting and in our questions to governors, Denise and I wrote some advice that has been forwarded to all Southern Health governors. We've already received a constructive response from one of the governors, and hope to continue the dialogue.

We very much hope that our advice is listened and acted upon by all governors, and leads to better accountability of:

• the Chair
• the Trust Board collectively and 
• both executive and non-executive directors individually

for the dire crisis of care and management of care at Southern Health.

And that our advice will help governors to better fulfill their duties to avoid future crises at Southern Health and elsewhere in the NHS.

But if our advice is ignored or not acted upon, then we reserve our rights to campaign to remove those governors.

Latest Update from Southern Health

Tomorrow, Denise Wyatt, I and other campaigners and members of the public, will be attending the Extraordinary Council of Governors meeting at Tatchbury Mount, Calmore.

We will be asking questions of the Council of Governors, in addition to those I have already put in writing.

Earlier this evening, I received the following positive developments from the Company Secretary:

1. Although I was initially told that the Chair would not allow recording, following my and other campaigners' further robust challenge, there has been a change, and I quote:

"With regards your query regarding recording of the meeting, I have discussed this with the Chair.  He is content to put the question of recording of the Council of Governors’ meeting to a vote of the Council at the start of the meeting and for him to be bound by the view of the Governors. With respect to public sessions of the Board, on reflection, it is the Chair’s view that it would be inappropriate for an NHS Foundation Trust to be acting in a different manner than expected from other public bodies and therefore audio recording of these meetings will be allowed, subject to appropriate safeguarding controls."

This is a very welcome development, and I hope the Governors agree with my suggestion, in the interests of openness and transparency.

2. An anonymised list of questions will be asked of the Council of Governors. I understand that there are several, and these are still being processed. I am pleased that people are wanting to put these questions. Answers are urgently needed.

I have thanked the Company Secretary and Chair for their further consideration, and look forward to hearing their responses tomorrow.

I very much hope that this is the start of further developments for Justice for LB and other campaigners for reform at Southern Health, and across the National Health Service.

Andrew

Latest Update from Southern Health to Request for Investigation

Well, the Government and Southern Health may have shut down for Christmas, but campaigners have not!

Before I do have a short break, I wanted to provide this update.

Below is the response from the Company Secretary (my emphasis added), following up my earlier request, and my follow-up that I would expect meetings to be called immediately given the gravity of the situation.

I also asked for the details of the Council of Governors meeting, and said that I want to ask questions of the governors and Trust Board. I also asked permission to record the Governors meeting - this request has been refused by the Chair. Our understanding is that the new regulations that apply to councils and other public bodies, do not apply to NHS foundation trusts.

So I have gone back to them with this:

"I wish for the same questions that I wish to put to the Council of Governors, to be put to the Trust Board.

Regarding recording of the meetings, I am disappointed to hear that the Chair will not allow recording. There are new regulations requiring local authorities plus many other public bodies to allow recording.

Even if this is down to the discretion of the Chair, I would have thought the Chair would want to encourage openness and transparency. But it appears not. To clarify, I only wish to take an audio recording."

Can I please encourage people to attend? Perhaps they are going to need a bigger venue than they are used to!

I understand that Michael Buchanan of the BBC has already indicated he will be attending the Trust Board. I will be inviting other media.

Let me know what you think of the below (either by email, Twitter or posting below).

And if you are having a break, enjoy it and come back refreshed for the campaign.

Best wishes,
Andrew

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Dear Mr Pope,

Thank you for your further email.  With regards the timing of calling extraordinary Board and Council meetings; the report into Southern Health NHS Foundation Trust was released by NHS England on 17 December 2015.  Our governing documents routinely require that we provide five clear working days before each meeting.  As such, and recognising the important topic, it was agreed that it was pragmatic to wait until after the Christmas period to convene these meetings so as to ensure maximum attendance of Directors and Governors at their respective meetings.

Indeed, we are currently ascertaining availability of Governors to attend on 5 January, as it is essential that we are able to hold a quorate meeting (the Council is not able to convene to conduct business if this is not so).  We anticipate publishing the details of this meeting (time and venue) on our website by Thursday 24 December and would be happy to email you with this information once agreed.  I note from your email that you also wish to put questions to our Trust Board; there is an extraordinary meeting scheduled for the Trust Board on 11 January 2015 at 08:30.  Again, we are in the process of confirming final arrangements, but can send you this information as well in due course.

In terms of recording the meeting(s), I have discussed this matter with the Chair, who has not agreed to this request.  We will however be happy to send you the formal minutes of the meeting(s) once these have been approved.

If you wish to ask a question of either the Council of Governors, or the Trust Board, I would strongly encourage you to submit this in writing (via governors@southernhealth.nhs.uk or trustboard@southernhealth.nhs.uk).  For information, I have attached guidance from our website that relates to the rights of members of the public to ask questions of the Trust Board.  I have already noted down the previous question relating to the discussion relating to SIRIs that was recorded in the draft minutes of the meeting held on 27 October 2015 considered by the Board on 1 December 2015. 

If you have any further queries, please don’t hesitate to get in touch and I will look to respond to these.

A Deeper Investigation into Southern Health Failures is Needed Now

Despite attempts to silence me as an opposition councillor by the Labour councillors running Southampton City Council, I have taken action to investigate the failings at Southern Health described by the Mazars report commissioned by NHS England.

I have joined the Justice for LB campaign, who have responded by supporting my actions to instigate changes at Southern Health NHS Foundation Trust, including requesting a deeper investigation to be instigated by the Council of Governors and Trust Board. This was last week, as follows:

Good Evening,

I request that the Council of Governors works with directors and the relevant Nominations and Appointments committees to conduct an investigation as to how and why the draft minutes of the 1st December 2015 Trust Board stated that the Performance Director responded that there were "no major concerns" when challenged by a Non-Executive Director on SIRIs, as quoted below.

I would also appreciate a statement from the Trust as to whether the Chief Executive, the Trust Board and Council of Governors supports the view minuted.

As this issue is now of national importance, and has drawn the attention of the Health Secretary and Parliament, I and the residents, patients, carers and families of Southampton would appreciate an urgent response, preferably by the end of this week.

Kind regards,

Andrew Pope

8.15. Jon Allen, Non-Executive Director, enquired as to whether there were any Serious Incidents Requiring Investigation (SIRIs) that should be brought to the Board’s attention. Chris Gordon confirmed that there were currently no major concerns but that the SIRIs reported still required to be fully investigated. Della Warren referred to paragraph 27.5 which indicated an increase in the number of falls and suggested that this be the subject of a ‘deep dive’ by the Quality & Safety Committee. Sandra Grant noted that the Service Performance & Transformation Committee had noted the increased number of falls and sought assurance as to whether this was linked to staffing levels. She assured members that this was regularly reviewed by the Director of Nursing & Allied Health Professionals and reported to the Quality & Safety Committee.

I also urge you to write to the Council of Governors with something similar. They can be emailed at governors@southernhealth.nhs.uk. Unlike other Foundation Trusts, you cannot email them directly (I have checked). I have also:

• Sent a series of questions about Southern Health to the Chair of the Southampton Local Safeguarding Adults Board (at the time of writing I have had no response)
• Studied a wide range of documents from Southern Health, in which some of the claims made are hard to believe
• Written to my MP Alan Whitehead requesting support for the campaign (at the time of writing I have had no response)
• Referred back to the research I conducted in 2009-10 on the governance of NHS foundation trusts. The weaknesses of these structures, and those working in them, do not seem to have improved. As many people have found, it can all come down to individuals. More details on the research are here.
• Spoken with the BBC, who wished to interview me, but scheduling concerns changed their priorities
• Read the appalling media releases sent out by Southern Health in response to both the leaked report and the final version of the Mazars report

Please note that I have NOT called for the resignation of anybody, although this is tempting considering the continual failures documented in the report, especially when the coroner complained to the Trust time and again over a protracted period.

We have heard a lot of claims of being "sorry" by the Trust.

We have heard a lot of claims of lessons being learned.

But we now need an investigation into how this happened, and who was individually and collectively responsible for acting, and not acting.

Then action can be taken against those who have failed the patients, carers and families of so many people in the care of Southern Health NHS Foundation Trust.