Impersonal correspondence: paras 4-6 #nhssm

This post continues on from Impersonal correspondence: paras 1-3, all the context is there. This post continues to deconstruct the letter, starting at paragraph 4:

‘Like every single organisation and individual in the world, we are not perfect and on a rare number of occasions we get things wrong, sometimes with deeply distressing consequences. On these rare occasions, my role as a Leader is to do everything in mine and my organisation’s power to offer our deep and sincere apologies, to work with everyone concerned – including relatives and regulators – in as positive and productive a way as possible to learn from what went wrong and put in place arrangements to try to ensure nothing similar happens in future’

Wooooooooow there, another storming paragraph, let’s take it bit by bit.

Like every single organisation and individual in the world’ paragraph three introduced ‘fellow human beings‘ and now we’re stepping it up to everyone in the world. Now this either reads like a primary school homework task gone wrong, or it’s an attempt to paint poor KP as just your average Joe, like anyone else in the world. This entire statement is pointless.

we are not perfect’ there’s a first time for everything, at this point you may be on the verge of expecting candour, compassion, empathy, is this a trigger warning for self awareness? We keep hoping, but don’t hold your breath for too long…

on a rare number of occasions we get things wrong, sometimes with deeply distressing consequences’ Here’s a free piece of advice to anyone reading this wondering how the hell do we convey our apology when we’ve let someone die in our care. Don’t frame it as a rare, one off. It’s a bloody given that it should be a one off (of course in this environment we’re not sure, hence NHS England have agreed to review deaths in their care), but paragraph three spoke of KP’s pride in their brilliant provision, then next on the continuum was reasonably well and now we have rare occasions. If my son, brother, father, sister, mother, friend, relative, hell any fellow human being had died a preventable death in hospital I’d hope it was bloody rare. Couching the response in this language almost infers that Sara is being a nuisance, imagine the tenacity and courage it takes for a grieving mother to even have to ask these questions, then to be framed in this language, subtext of simmer down luv it’s a rare event. As for the deeply distressing consequences it is impossible to read this letter and believe that they have any modicum of realisation of the consequences that they have not only created, but continue to enflame and stoke.

‘my role as a Leader’ I would think this comical if it wasn’t that this entire interaction sparked from the blog at NHS Leadership Academy about how KP is leading in these difficult times. Leader with a Capital L!! Is this ego at play, some sort of self appointed name badge? Does KP actually see herself as some sort of superhero Leader for the NHS? Does she look in the mirror every morning, tell herself to keep the faith, pin on a Leader badge and head off into the depths of Southern Health?

everything in mine and my organisation’s power to offer our deep and sincere apologies’ Ummm, this is up there with rarity, it’s a given that if you and your organisation are responsible for someone’s preventable death you bloody well apologise, it would be amazing if it was actually deep and sincere, but suspect they’re relative concepts! Notice the ownership language again, me me me, my organisation, my power – glad to know she takes it so personally.

to work with everyone concerned – including relatives and regulators’ Another blow me moment this one. How generously condescending of KP to state this, perhaps this reveals the level of expectation behind the statement. If it’s noteworthy that they will work with the relatives and regulators, it’s obviously deemed some sort of exception. Well we know it is given Connor’s death was chalked down to natural causes before his body was cold in the morgue. FOI reports clearly show that activity quickly moved to creating a narrative of ‘tragic accident’ within 24 hours of Connor’s death, it immediately became about managing reputation and managing media. Shame that this was more important than truth or candour, and even as communications professionals you can see the need for this (everyone can comprehend the need), to do so *so* badly is quite breathtaking. Oh and in case anyone isn’t up to speed working with regulators is not usually optional, so again stating this is like it’s some generous concession is bizarre.

positive and productive a way as possible’ Good to hear, but very value laden statement. Who judges positive and productive? When writing to a grieving family do you really consider it’s time to roll out efficiency statements? I’ll reiterate a point in the last post, Sara and Connor’s family and friends are not equal to a woman paid £165k a year to deal with this. One party in this equation is heartbroken, lost, seeking answers, the other is seeking to protect herself, one might wonder her self concept and ego based on this letter, and ‘her organisation’ – these are not equal parties, given that, you’d think it would be for the grieving and injured party to decide on what is positive and productive to them – hold onto that thought.

learn from what went wrong and put in place arrangements to try to ensure nothing similar happens in future’ Reasonable aspiration, but again you’d allow the person who you wish to learn from to decide on how they’d want to do that right? Or would you fix your own agenda and refuse to engage unless it suits you?

‘In this regard, I believe it was absolutely right for us to offer our profound and public apologies to you for the death in our care of your son, Connor. It was also absolutely right for us to commission and publish in full an independent review of the events leading up to his death. It was absolutely right for us to then put in place a series of measures and improvements, helped by input from the Care Quality Commission, to address some of the weaknesses in our care arrangements identified’.

At this stage if you’ve not read Sara’s original letter, I really suggest you do so. Otherwise you could be mistaken to think that this was a reply to Sara was complaining about KP apologising. There is nothing in this response so far that addresses any of Sara’s questions raised. Honesty? Candour? Openness? So what do we have in this paragraph exactly, we have KP asserting her absolute authority, or trying to, no less than three times.

I believe‘ there we go again, I, I, I, me, me, me

it was absolutely right for us to offer our profound and public apologies to you for the death in our care of your son, Connor’ Wow. At last, five paragraphs in, almost at the bottom of the page, word 373 is Connor. Finally, it stops being about KP, her reputation, her ego, her organisation and actually mentions the young man that her organisation is responsible for dying a preventable death. As for you offering apologies, are you really writing this stuff? Really? You’re asserting your absolute right to offer apologies for a young man’s death in your organisation?

for us to commission and publish in full an independent review of the events leading up to his death‘. Hmmmm, yes. Again someone new to this may think that this was KP’s contribution, that as soon as Connor died her team jumped into action to commission a review to learn everything they could to ensure something similar didn’t happen again. Again, documents clearly show that this was not the case, that Connor’s death was dismissed as natural causes, that Sara and Connor’s family had to fight to ensure his death wasn’t swept under the carpet like it so easily could have been. Yes Southern Health commissioned the review, at the families insistence, and one of Sara’s questions to KP was

  • Can you explain why we had to fight so hard to get the final copy of the independent report into LB’s death published?

Now either Sara is mistaken or KP is. Luckily the documentation on this matter is quite clear. The independent review in question states:

4.1 The trust would usually carry out a internal investigation following the death of a patient or other serious incidents. Due to the seriousness of this incident and after discussion with CS’ family the trust commissioned Verita to conduct an independent review.

Given the absolute right and certainty elsewhere, one can assume that ‘discussion with CS’ family’ wasn’t because Southern Health were desperate to learn more and they requested Connor’s family help them with that. Enough said.

‘absolutely right for us to then put in place a series of measures and improvements, helped by input from the Care Quality Commission, to address some of the weaknesses in our care arrangements identified’ Man alive, this sentence. OK, firstly there is no need to stress an ‘absolute right’ for something that is so common sensical.

If you run an NHS organisation you have a duty of care, it’s not anything to do with the CEO’s absolute rights (because believe it or not this provision does not exist for their benefit and wages), it is a legal requirement that they provide safe care. First line of the NHS Constitution is that it belongs to the people, us, mere citizens with absolute rights to safe care and accountability and the rest. So yes there is a legal requirement to keep people safe and make improvements, in fact I’m left wondering whether the Trust could be considered negligent in waiting to commission a report before making improvements but that’s an aside.

The other fascinating language reference in this paragraph is to the helpful input from CQC. Ummm, CQC sent inspectors into the provision where Connor died, months later and they issued enforcement notices due to the poor standard of care. Months after Connor died. If you didn’t know who the CQC were, you could be mistaken for thinking they’re a little improvement consultancy, who helpfully agreed to give Southern Health some advice on improving their practice. They’re the bloody regulator. They closed down the unit where Connor died, and later on uncovered a bath ban in another unit, a seismic indicator of the complete inability to provide personalised care and support, that people with learning disabilities have an absolute right to receive.

‘I also strongly believe it was – and remains – absolutely right to invite you to work in partnership with us to identify, learn and apply any further lessons. I am well aware that you do not agree with this and do not feel able at this time to accept this offer and fully respect your views and decision at this time. That does not mean it is the wrong course of action. I strongly believe it is’.

Phew, I can only analyse this letter in chunks of three paragraphs at a time because it’s so dense and the rational, processing bit of my brain struggles to compute it. Paragraph six is another corker.

I also strongly believe‘ I, I, I, me, me, me

absolutely right to invite you to work in partnership with us to identify, learn and apply any further lessons’. She’s off on her absolute rights again, if you’re left drafting a letter like this in your work, why not give it to someone external to review before sending it, I’m sure they’d be able to point out that four absolute rights about the author, in the face of the preventable and avoidable snuffing out of the absolute right to life of Connor, isn’t wise.

As for inviting Sara to work in partnership, ummm, really? This is a grieving mother who has repeatedly blogged and shared insight and information about how things could be improved, you could start with this post Imagine written back in February. Let’s not paint Sara in a light of selfish, self indulgent grief. This is a woman who has been on a campaign and a mission to ensure no more lives are lost, this is a woman who has gone above and beyond what anyone could consider necessary in the light of such horrendous circumstances. So yes Katrina, you can invite her, you can’t command her, or expect her, or demand her, or insist her, or infer that she should meet you or work with you, because life and death and grief is not all about you. Back to an earlier point Sara is a grieving mother, not an improvement consultant. She doesn’t get a £165k salary to ensure quality, she doesn’t have any obligation to do anything, and KP’s complete inability to acknowledge what Sara has contributed is mind blowing – more on that later.

‘I am well aware that you do not agree with this’ ummm, hang on a minute, if this letter is for Sara (the recipient at the top) why are you telling her what she doesn’t agree with? If you’re well aware surely you wouldn’t assert your absolute right? Surely?

‘do not feel able at this time to accept this offer’, there we go again, another attempt to discredit Sara as some weak, victim like figure. What is the inference, that she’s not strong/ready/selfless enough?

‘fully respect your views and decision at this time’ not sure if this is just bad grammar/wording but you should fully respect her views at any time, it’s another bloody given. You may think this is progress, an acceptance and respect for Sara’s position, but wait, hang on…

that does not mean it is the wrong course of action’ wowwww there Nellie, how can you fully respect someone’s view and then tell them that they’re wrong? Your absolute right is right? This letter is torturous.

‘I strongly believe it is’ Ummm, not sure whether KP strongly believes that her course of action is wrong, or Sara’s, diabolically written letter with zero attention to comprehension. Think we can safely assume Katrina strongly believes herself to be right again, absolutely right I imagine. We’ll come back to this.

The next instalment will look at paragraphs 7 to 9, maybe more if I can manage it. Once we’ve analysed this fascinating missive, I’ll attempt to pull some learning points together and maybe even crowdsource a more appropriate alternative. I know there are some great people working in NHS communications, sadly I suspect they didn’t get anywhere near this letter, we can of course learn from it. We’ve an absolute right to do so.

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