A public meeting in Gloucester on October 27th provided another opportunity for representatives from the Care Quality Commission (CQC) to listen to people’s views and experiences of the 2gether NHS Foundation Trust.
This meeting seemed quite different from the previous one, and I’m not sure why. Not quite so many people attended, but it was in a bigger room. The chairs were arranged in a big circle instead of around a table. Maybe this made the atmosphere less intense.
No director from the Trust was present, and the presenters from the CQC seemed more relaxed and confident, but it’s impossible to know whether these things were related. Perhaps it was just that the presenters had been nervous the first time.
Anyway, the presenter who took notes seemed much more confident asking people to clarify things so she could note them accurately, and the main presenter seemed much more confident in responding to people and asking the group about specific points of interest to the CQC.
Representing the Trust
This time I was the one who aroused suspicion right from the start when I said I’m a governor of the Trust. People felt that they wouldn’t be able to speak freely with a representative of the Trust present. I had to give a little speech pointing out that as a governor I’m an unpaid volunteer, that I volunteer for other organizations too, and that I don’t represent the Trust.
After this there was a sort of informal vote on whether I should be allowed to stay. It was unanimously agreed that I should be allowed to stay. But there was a vote!
If the meeting had ended there and then, the CQC would have known pretty much all they need to know about the Trust, I mused.
As before, most people told stories about their experiences, which I won’t document in any detail.
Lack of any care plan was a common theme. Lack of any stable diagnosis, even. Someone reported being told that it’s better not to have a diagnosis.
Staff not really paying attention to service users seemed to be another theme. For example, there were reports suggesting that staff sometimes feel it’s OK to discharge patients from care while they are still ill.
Staff turnover came up a couple of times, and resulting lack of continuity of care. Bullying was mentioned a couple of times. Someone mentioned a staff member being too frightened to raise issues, and good staff leaving because of this.
The ease of escaping from hospital wards was discussed (as it had been in the previous meeting). Lack of meaningful activity or treatment in hospital was also mentioned.
There was some discussion about crisis teams, and someone remarked that the police are a more responsive option when you need help in a mental health crisis. However, someone reported being held in a police cell just because he was mentally ill at the time.
A carer reported poor communication between the Trust and GPs, and being made to feel a nuisance. Others reported poor communication among staff of the Trust, and between staff and patients.
The CQC inspection
We learned a few things about the CQC inspection. “We’ve smelt the paint”, was one remark they made about evidence of hasty refurbishment before the arrival of inspectors. (Actually, the Trust has seen this inspection coming for many months, even if they didn’t know the exact date.)
A more important aspect of the inspection is that it doesn’t look at care pathways from beginning to end. The CQC has plans for future inspections to adopt a better approach.
The group was asked about whether PALS had been effective in solving some of the problems that people had reported. There was an uncomfortable silence. PALS doesn’t seem to be widely used. Someone had tried PALS without much success. Someone else said that with PALS, Healthwatch and advocacy organizations all appearing to do similar things, it was too confusing. So it wasn’t clear whether PALS really doesn’t work, or whether there’s just lack of knowledge about it, or a perception that it doesn’t work.
For example, someone reported contacting one of the Trust’s service managers directly and being unable to get any useful response. It’s not obvious to me why PALS should be able to do any better. A good concept to apply in these matters, I think, is that there should be “no wrong door”. It shouldn’t matter who a service user contacts about a problem, the outcome should be the same. So the slight implication that if people didn’t use PALS they were the cause of their own misfortune because they pushed on the wrong door was uncomfortable. No one voiced this explicitly in the meeting, though.
Several people had experience of either using or providing advocacy, and the general feeling was that it’s often essential to have someone who understands the system on your side.
SEAP, which has the mental health advocacy contract for Gloucestershire, was praised in glowing terms.
Overall, this meeting was similar to the previous one in that the focus was on criticism of the Trust in the area of adult mental health. Again, learning disability wasn’t mentioned.
The meeting seemed less intense than the previous one, but the picture of chaotic and uncaring services was similar. It struck me that in any large organization things are going to go wrong all the time, and if you hold a meeting where people can come along and have a moan, you’ll always find people who want to come along and have a moan. But what we were hearing in these meetings wasn’t just anecdotes about the odd thing going wrong, we were hearing about systematic uncorrected failings over extended periods of time.
As I write, I’ve just heard that the CQC inspectors will be meeting with governors of the Trust. This won’t be a public meeting and so I won’t report on it here. But as I think about systematic uncorrected failings, and about the suspicion with which I was greeted at the start of this listening event, I have to reflect on the extent to which we governors have allowed ourselves to become part of the problem.