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More likely, expectations indicated a haphazard approach to treating older people, lagging behind best practice recommendations. Compared to similar hospitals, Friern also lacked social workers to assist with arranging discharge: it had one qualified and two unqualified social workers with high rates of staff turnover Ministry of Health MoH , p. They also found an absence of dentures and hearing aids. The staff told the committee that these items were not permanently removed, but after a pair of spectacles went missing, staff collected them at night for safe keeping and handed them out the next morning.

However, the committee visited during the day and saw patients without these items, incompatible with staff explanations. Staff levels were too low to provide adequate individual attention to the patients, two of whom were confined to bed with fractured femurs and many others required time-consuming physical care because of incontinence and frailty.

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Photograph by author. Hackett chaired, and Blofeld attended, the RHB meeting that discussed her report. Similar to Friern HMC when faced with unfavourable reports on nurse staffing, 47 the main deficits were concealed, giving no chance of the report benefitting patients. It might have indicated her dissatisfaction with the response to her report. The Ministry sent a letter to RHBs in December offering guidance on stripping, remarkably swiftly after the letter in the Times.

The guidance also referred to personal possessions such as jewellery and watches.

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The Ministry, despite claiming to deplore stripping, was half-hearted in its attempt to prevent it. Friern HMC discussed the stripping guidance. Any action over dentures, spectacles and hearing aids to assist independence paled into insignificance compared to worries over the financial value of watches and jewellery.

Staff control made life easier for the nurses but undermined confidence, independence and rehabilitation for the patients. I can remember the shock of misery with which I read the letters that came to me after the New Statesman article…despairing cries of decent, ordinary people unable to get a hearing in the hospital world. Abel-Smith and Rolph could not fathom out why Robinson was so uncooperative about stripping.

AEGIS proposed three ways to improve, monitor and maintain standards in the NHS: effective local complaints mechanisms; a health service commissioner or ombudsman to investigate complaints that could not be resolved any other way; and independent inspection of hospitals Abel-Smith Concerning complaints, no guidance for handling them was introduced at the inception of the NHS. The only formal mechanism outside the law courts was the General Medical Council, which, since , managed complaints against doctors.

In —, the Ministry noted several examples of poorly managed complaints. Not a valid complaint, as it is inevitable if the patient has nowhere safe to put them. Not a valid complaint: sister says it would not happen on her ward and, anyway, it would be impossible to get to the truth. Although Abel-Smith contributed to developing the new guidance Cochrane , p. It advised prompt and impartial handling of all complaints, at all degrees of seriousness, and informing the complainant of the result of the investigation and action taken.

Barbara received a copy via Abel-Smith Cochrane , p. The Institute of Hospital Administrators Anon. He sat with his arms outstretched across the table, the sheaf of notes between and when he was speaking he kept his head bowed down to the papers or staring at his hands. The complainant requested a written report but did not receive one. Others wrote to Barbara about similar experiences. The new guidance made little impact at the Ministry which justifiably could have been expected to set an example.

It described inadequate food; rude ward staff; staff insisting on bathing the patient even thought she was frightened and unaccustomed to sitting in a bath; and incontinence causing distress when the patient was unable to get out of bed. The Ministry also thought it prudent to give the NHS complaints procedures a trial before introducing another scheme. Explanations for this relate to the establishment of the NHS.

One organisational option for the NHS was to delegate responsibility to local authorities, as for schools. That model gave central government a supervisory role, with inspectors essential to it, to report back to assist with supervision. The Ministry would appoint these bodies which would be directly accountable to it, so inspection and feedback were not required.

Mental hospitals, however, also had to comply with mental health legislation, so continued to undergo independent inspection by the Board of Control. Many staff appreciated these visits and the opportunity they provided to pass on information and ideas from one hospital to another and the way they could focus interest on needs long recognised by hospital staff but ignored by HMCs and RHBs DHSS , p.

In the course of the Royal Commission on mental illness and mental deficiency, the British Medical Association and Royal Medico-Psychological Association later Royal College of Psychiatrists argued for an independent inspectorate. Thus independent inspections of mental hospitals ceased when the Mental Health Act abolished the Board of Control.

This brought mental hospitals into line with general hospitals, a far-reaching step that implemented decades-old principles of treating people with mental illness, as far as possible, under the same NHS principles as those with physical illness. It would remove independent inspections but had the potential to reduce stigma and encourage community services Hilton a.

In — when MPs requested inspectors for hospitals, Robinson reiterated that such a system was inappropriate. By the time Barbara compiled Sans Everything , the Ministry had provided no plans for an inspectorate. Disclosure might be hurtful for descendants of patients or staff. AEGIS planned tactically. Rolph wanted the same for Sans Everything.

The title Sans Everything was not a given. It also reveals similar personality and employment characteristics, likely to have influenced staff willingness to whistle-blow, a subject relevant to the NHS in Hilton b ; NHS Improvement The amount of biographical detail available for each witness varies and is drawn from several sources, including from their correspondence with Barbara and from verbatim transcripts of inquiries and, for Joyce Daniel, from information provided by her sons.

None of the witnesses received payment for his or her writing or for involvement with AEGIS: they all participated to appease their consciences. I was appalled. I am appalled. She also wrote that patients responded warmly to her interactions with them. When she complained about staff behaviours, she was taken off duties with patients and transferred to cleaning copper pipes in the ward bathroom. Her colleagues were angry with her, saying her comments created an unpleasant work atmosphere and that nurses should be loyal and unified. She resigned. The primacy of loyalty defended staff against criticism: the critic became the unacceptable deviant.

Punishing critics was common—for example, ordering them to do domestic work rather than work with patients, making life intolerable so that they resign, 99 or dismissing them DHSS Occasionally the Ministry became involved in an appeal against dismissal on grounds of transgressing the etiquette of loyalty. The case of Mrs Glynn in illustrates this. Glynn was a nursing assistant. Russell Barton , p. He lived in Manchester with his wife, Phyllis, and their daughter. He served in the RAF during the war, but no farther afield than the Isle of Man where he worked with injured servicemen.

He then worked in the Savings Bank department of the Post Office before buying a hardware and ironmongery business. He sold the business around , expecting to find alternative employment, but it proved difficult. Davie took a job as an auxiliary nurse at Storthes Hall during a recruitment drive by the hospital Davie He worked on several wards there, including a long-stay ward for men of all ages. His allegations included that staff hit and bruised patients or caused other injuries, then attributed the injuries to patients assaulting each another.

Sometimes, patients were punished by depriving them of food and water, nurses shoved them out of bed with a broom and he was left in charge of a ward, despite being unqualified. In , after leaving Storthes Hall, Davie went to Springfield. Storthes Hall HMC minutes reveal their preoccupation with the environment and administrative matters, paying little attention to therapeutic relationships, activities for patients or rehabilitation.

The minutes reported that the staff were reprimanded but did not state who tipped off the police or why at that time. In , the HMC documented only one complaint, from a mother about violence towards her teenage daughter, a patient. Storthes Hall had a custodial and paternalistic regime, a pattern seen elsewhere, such as at Friern. Less is known about the other six author-witnesses, mainly because verbatim transcripts of the inquiries into their allegations have not been traced. There, she was appointed sister in charge of a psychiatric ward, a prestigious post at a time when general hospitals were just beginning to provide psychiatric services.

Biss resigned after four months. Dennis Moodie was also a senior nurse who moved from hospital to hospital, frustrated by his inability to make improvements. He alleged wards being kept locked for staff convenience; violence towards patients; victimisation of staff who complained; and a HMC chairman who told him that his HMC was powerless to remedy the situation Moodie When Barbara met Tooth she received a report about powerlessness at the Ministry, giving the impression that various tiers of NHS management could declare powerlessness, pass the buck, shrug off criticism and avoid taking initiative to make changes.

Moodie , p. And it is always easier, in all professions, to accept the status quo.

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Porter looked for a job when her daughter got a place at university. She joined the staff at Cowley Road in Two social workers also contributed to Sans Everything. Social workers were, to some degree, outside the rigid hospital hierarchy so somewhat protected from the victimisation experienced by the nurses. Roger Moody was a trainee social worker at Friern in the early s. The other social worker, Dorothy Crofts , described the care of her elderly father at Friern.

The Aegis Chronicles: Vol 1

The brief profiles of the eight witnesses make up a very small sample from which to draw conclusions. Nevertheless, some patterns emerge. Of the six nurses, four left jobs because of negative experiences. Although untrained in nursing skills, the experiences of the unqualified or recently qualified nurses were diverse, including war work, bringing up children and doing jobs that required numerous interpersonal skills, which helped them interact meaningfully with patients. Little was interpreted as deliberate cruelty.

The witnesses considered it their duty to speak out, despite victimisation by doing so. Types of allegations, witness characteristics and responses by the authorities in Sans Everything were disturbingly consistent with those described by Virginia Beardshaw , pp. Similar to Martin , p. AEGIS needed to build a strong relationship with the nursing profession to try to buffer any misinterpretations. This was complicated, partly because psychiatric nurses were not fully accepted into the profession.

They were allowed to join the Royal College of Nursing RCN only in , and then only if they also held a general nursing qualification. Bill Kirkpatrick , p. Kirkpatrick , p. Some would not do so even if leaving a hospital, dreading that their next employer might hear of it. Staff left rather than complain, and fear of punishment affected morale.

Allies within the medical profession, particularly psychiatrists, were also crucial. We must do something now. What can I do? Bathing was in public…to all intents and purposes…the doctors would go in…we would see them bathing…yes…there was no privacy. That was one of the big things…I was a fresh young man, I wanted dignity, without thinking of the word…as a great word…the correct word…it just came.

We had a long ward in Shelton, and that became mine. In each of the wards, starting with one female and one male, I got carpets. The men who went out to the farm got a second suit. Then they got a narrow cupboard. Orphan work: attempts have been made to identify copyright owner. Institutions develop powerful instruments of defence for their protection and perpetuation. Sometimes their officers or governing bodies lose sight of the primary purpose for which they were planned and their energies become deployed in rituals or personality conflicts.

The purpose becomes subordinated to the personnel Barton , p. AEGIS needed to prepare for potentially hard-hitting negative responses. Abel-Smith , p. Enoch , pp. He lay the blame for the situation on the whole of society, people who were involved in any way and those who did not want to know. Named because of the urgency to get it under way by , it provided a financial and housing solution. Homes built on publicly owned land would be low cost. Rents from tenants could be ploughed back into NHS projects and used to finance an assortment of services and housing for older people, in small blocks and integrated into the new communities.

A Lancet editorial expressed disadvantages of Project 70, particularly about moving older people when they were settled in one place, stating that human relationships are more important than the physical environment Anon. No-one knows how long it takes a new town to become a real community. Project 70 would help achieve government goals of providing suburban housing and closing psychiatric hospitals, both of which needed to be done economically and effectively MoH a , p.

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Ministry indifference, even to further research on the idea, was thus unexpected. However, they agreed that Barbara should not approach Robinson about it. Robinson objected to Project 70 on three issues. First, like the writer of the Lancet editorial, he did not want to move older people from place to place unnecessarily. Second, if relatives lived with the older person in these new towns, when the older person died the relatives would be ejected from their home. Third, that placing homes for older people in hospital grounds was against NHS plans to provide accommodation closer to their previous homes.

Nevertheless, Robinson said he was interested in a Project 70 plan not on hospital land, although that was troublingly inconsistent with his first two objections. Extremely disparaging analogies compared the worst happenings in psychiatric hospitals with barbarities under Nazi rule during the s and s. Goffman , pp. Dickinson , pp. Nurses who carried out tasks in an inhumane or harmful way would try to limit any feelings of guilt and culpability. One way to do this was to ensure that they were not responsible for individual patients.

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