Looking sideways at the problems of today:
Back in the 60s writers of the day were confidently anticipating that ours would be the Leisure Society: we would only have one day’s work each week because our technology and economic position in the world would be doing it all for us.
Few foresaw governments reluctant to let us enjoy our leisure. First they funnel us into never ending target led education, then they encourage us to audit each other by filling in more and more forms that make less and less sense, and now they plan to recruit half of us to therapize the other half and create a kind of smoke screen to conceal the real scene (Observer, 8th March).
Who will ask you how it feels to be all alone and without a home now that the bubble has burst? An army of newly recruited form filling government trained ‘therapists’ whose own good character will be policed and guaranteed by the hpc.
Showing posts with label NHS. Show all posts
Showing posts with label NHS. Show all posts
Sunday, 8 March 2009
Tuesday, 17 February 2009
FTP or management failing?
Today's case at the HPC is that of a physiotherapist. It is another case where the management structure of the NHS has clearly failed to take timely action on a minor question, and which has allowed the machinery of the HPC to blunder in. It is difficult to justify this as a serious misdemeanour from which the public needs protecting. It is more easily understood as petty malice on someone's behalf. Copied below is the allegation as printed on the HPC website. In the next financial year. The FTP budget for next financial year is estimated in the region £5.6million.
Your fitness to practise as a registered health professional is impaired by reason of your misconduct and/or lack of competence in that:
1. At all material times you were employed as a Physiotherapist by East Elmbridge and Mid Surrey Primary Care Trust.
2. On 1st August 2005 you took unauthorised absence from work whilst on duty.
3. On 6th February 2006 you took unauthorised absence from work whilst on duty.
4. Between March 2005 and February 2006 whilst on duty:
(a) you made excessive personal telephone calls on the Trust’s telephone and;
(b) this was contrary to Trust policy.
5. Following an audit of your patient treatment notes it was found that:
(a) there were discrepancies between the activity recorded on your statistics sheets and the activity documented in your patient notes;
(b) you failed to keep adequate patient notes.
(a) on 6th March 2006 you did not assess a patient, Mr A pre-operatively.
Thursday, 15 January 2009
habeas corpus - the case of missing Mr TH
Another missing man at the centre of this pernicious process. When I arrived this morning the waiting room was full of giggling women. It was as if they were out for a day's pleasure. The line manager, the line manager's line manager, and finally, the line manager's line manger's line manager (yes, another case from the NHS). Three women lining up to nail the coffin down of occupational therapist Mr TH.
The third in this happy parade was the one who submitted the complaint to the hpc. She did this about one or two years after Mr TH had left the employ of her team. Why? "he was a threat to public safety."
She spoke so quietly that I had to strain forward to hear her, so I stood up and moved forward to hear the rest of her statement. In the nano second it took for me to settle in the seat in front she was standing up and leaving. That was it! She had been called in order to recite this empty phrase! Bang, the final nail in the coffin.
At no point in this morning's proceedings did anyone mention what it was that he was doing with his patients that was such a threat. The entire discussion revolved around his note taking. The context of this is the computerisation of notes in the NHS - something which other occupational therapists are fed up about.
Why is it a threat to patient safety for Mr TH to not write notes according to the computer developers protocol? 'in case he doesn't come in and someone else has to take over his work'. (We're talking about occupational therapy remember.) Is there an example of the danger that ensued when he did not turn up for work (he went off sick, then resigned a few months after this witch hunt began). No, no examples. No examples at all in fact, all we had were vague generalisations and examples of his administrative skills: did he make a phone call, did he write a note. His work as an occupational therapist was absolutely absent from the case.
The line of questions that were presented to the witnesses got nowhere near uncovering any kind of truth. The three women were vague, one was verbose, and all were well versed in newspeak: 'got to get up to speed', 'golden rule is to keep accurate and up to date records', 'I did an audit of notes', 'a random selection of his files', 'there was insufficient detail', 'notes were vague'. No substantive content whatsoever in any of the three womens allegations. No sign of any patient in trouble, no whisper of any complaint from any of the people he worked with. None. Repeat: NONE.
Yet another case of people occupying positions of power in the New NHS who are blatantly unworthy of the responsibility on their shoulders. No gravitas, no experience, no compassion, no speech of their own, nothing to say except to mouth empty phrases that knock around like bricks doing random damage, no idea except to cover their backs. Not professional.
I wonder what the Panel will decide. Decision so far not posted.
The third in this happy parade was the one who submitted the complaint to the hpc. She did this about one or two years after Mr TH had left the employ of her team. Why? "he was a threat to public safety."
She spoke so quietly that I had to strain forward to hear her, so I stood up and moved forward to hear the rest of her statement. In the nano second it took for me to settle in the seat in front she was standing up and leaving. That was it! She had been called in order to recite this empty phrase! Bang, the final nail in the coffin.
At no point in this morning's proceedings did anyone mention what it was that he was doing with his patients that was such a threat. The entire discussion revolved around his note taking. The context of this is the computerisation of notes in the NHS - something which other occupational therapists are fed up about.
Why is it a threat to patient safety for Mr TH to not write notes according to the computer developers protocol? 'in case he doesn't come in and someone else has to take over his work'. (We're talking about occupational therapy remember.) Is there an example of the danger that ensued when he did not turn up for work (he went off sick, then resigned a few months after this witch hunt began). No, no examples. No examples at all in fact, all we had were vague generalisations and examples of his administrative skills: did he make a phone call, did he write a note. His work as an occupational therapist was absolutely absent from the case.
The line of questions that were presented to the witnesses got nowhere near uncovering any kind of truth. The three women were vague, one was verbose, and all were well versed in newspeak: 'got to get up to speed', 'golden rule is to keep accurate and up to date records', 'I did an audit of notes', 'a random selection of his files', 'there was insufficient detail', 'notes were vague'. No substantive content whatsoever in any of the three womens allegations. No sign of any patient in trouble, no whisper of any complaint from any of the people he worked with. None. Repeat: NONE.
Yet another case of people occupying positions of power in the New NHS who are blatantly unworthy of the responsibility on their shoulders. No gravitas, no experience, no compassion, no speech of their own, nothing to say except to mouth empty phrases that knock around like bricks doing random damage, no idea except to cover their backs. Not professional.
I wonder what the Panel will decide. Decision so far not posted.
Wednesday, 14 January 2009
The right decision but the wrong reason
Mr W's panel agreed that the allegation against Mr R did not amount to a damnation of his fitness to practice. If you want to read their decision you will have to email the HPC because it won't be published on the website.
Why not? Because Mr R wants his name removed from any further damaging publicity. Fair enough.
I wonder, tho, whether the HPC would consider publishing an apology.
This seems only right. For it was they who thought that Ms B had uncovered a serious case of misconduct that amounted to a significant threat to the public's safety; and it was they who have made Mr R's life extremely unpleasant during the time it takes for the allegation to actually come to trial; and it was they who hired the legal counsel (Ms T) to attack Mr R on their behalf in public on January 5th, 2009. Yes, I would say she attacked and have asked for the full transcript so that I can describe it on a future blog where you may judge for yourself. From my seat in the public gallery it seemed almost obscene to allow her to hammer away for so long when the case was so obvious a non-starter. The law lost its position of objectivity and Ms T went out for her own satisfaction to get a positive result. Not professional, not competent. And Ms B? What might we think of her fitness to practise, judged on her actions in this case?
But the reason that the panel gave for coming to its conclusion continues to miss the point. To be charitable, I shall say that the HPC has been set up on a twisted logic which makes it very difficult for anyone to do a decent job there. The twist is of course difficult to reveal - it is concealed behind a facade which effectively corrupts the truth (hence my reference to George Smiley in the twitter bar) and it will be the subject of several more blog entries, I'm sure. But for now I need to focus on the point of the unfortunate Mr R's Kafkaesque experience.
If you remember, Mr R is a speech and language therapist. This work is not renowned for is life threatening qualities, unlike, say heart surgery, or administering morphine. Nor is it clear why only an NHS employee in office hours may administer a treatment. What is the evidence that giving extra sessions outside the jurisdiction of the NHS will present a danger to the public? Absolutely none in this case.
The taken for granted assumption behind the HPC's action against Mr R can be deduced: that professionals are greedy, money grabbing creatures who will deceive the public if they are not subject to close scrutiny by their colleagues and managers in the NHS together with the weight of authority of the HPC. Puerile.
Mr R is innocent even if he charges the going rate for extra sessions. In fact, by charging the going rate he enters into a relation where both he and his clients are protected. The financial arrangement between people is in itself a form of regulation. The HPC and the NHS here seem to think that money is a filthy contaminator which must be treated like excrement that only they have the expertise to manage. They have invented a new harm - money - against which the public must be protected. This idea is juvenile and has no place in an institution underwritten by the laws of this land.
Why not? Because Mr R wants his name removed from any further damaging publicity. Fair enough.
I wonder, tho, whether the HPC would consider publishing an apology.
This seems only right. For it was they who thought that Ms B had uncovered a serious case of misconduct that amounted to a significant threat to the public's safety; and it was they who have made Mr R's life extremely unpleasant during the time it takes for the allegation to actually come to trial; and it was they who hired the legal counsel (Ms T) to attack Mr R on their behalf in public on January 5th, 2009. Yes, I would say she attacked and have asked for the full transcript so that I can describe it on a future blog where you may judge for yourself. From my seat in the public gallery it seemed almost obscene to allow her to hammer away for so long when the case was so obvious a non-starter. The law lost its position of objectivity and Ms T went out for her own satisfaction to get a positive result. Not professional, not competent. And Ms B? What might we think of her fitness to practise, judged on her actions in this case?
But the reason that the panel gave for coming to its conclusion continues to miss the point. To be charitable, I shall say that the HPC has been set up on a twisted logic which makes it very difficult for anyone to do a decent job there. The twist is of course difficult to reveal - it is concealed behind a facade which effectively corrupts the truth (hence my reference to George Smiley in the twitter bar) and it will be the subject of several more blog entries, I'm sure. But for now I need to focus on the point of the unfortunate Mr R's Kafkaesque experience.
If you remember, Mr R is a speech and language therapist. This work is not renowned for is life threatening qualities, unlike, say heart surgery, or administering morphine. Nor is it clear why only an NHS employee in office hours may administer a treatment. What is the evidence that giving extra sessions outside the jurisdiction of the NHS will present a danger to the public? Absolutely none in this case.
The taken for granted assumption behind the HPC's action against Mr R can be deduced: that professionals are greedy, money grabbing creatures who will deceive the public if they are not subject to close scrutiny by their colleagues and managers in the NHS together with the weight of authority of the HPC. Puerile.
Mr R is innocent even if he charges the going rate for extra sessions. In fact, by charging the going rate he enters into a relation where both he and his clients are protected. The financial arrangement between people is in itself a form of regulation. The HPC and the NHS here seem to think that money is a filthy contaminator which must be treated like excrement that only they have the expertise to manage. They have invented a new harm - money - against which the public must be protected. This idea is juvenile and has no place in an institution underwritten by the laws of this land.
Monday, 5 January 2009
Money, charity, the NHS and the case of Mr R
There was snow on the ground, and big flakes in the air this morning as I boarded the bus to Kennington. It is the 11th day of Christmas, and the first day back at work for many people in the country. There are quite a few cases beginning today in the Fitness to Practice rooms, so many indeed that the HPC was renting some from its neighbour the Evangelical Alliance. As I walked through the doors I was greeted by a flat screen tv display telling me 'Kind words are like honey, sweet to the taste and good for your health'. Proverbs 16 24
Kind words can cost you your reputation as an HPC health professional, or at least, a kind act can if today's case is a typical example.
The allegation in this case is a short one: "that Mr R provided private speech and language therapy treatment to [a client] whilst also treating them on NHS caseload at [a PCT]". When I popped my head round the door to see if the business had begun the Chair was quizzing the Barrister on the use of the word 'them'.
The writer of the allegation had been at pains to avoid bringing the patient into view. For this reason she had avoided the word 'him' and used 'them' in its place. This switch from single to plural had created the impression that Mr R was in the habit of taking his patients into his private practice. The point clarified that only one patient was in question, and that language might be used for other purposes than simply stating facts.
There was only one witness in today's case: Ms B. She had been employed to replace Mr R when he resigned at the end of Sabbatical. They had never met. Mr R had seen his patient for the standard 5 sessions and was closing the case. However, he had not filled in the last form before going off on leave. So, when Ms B turned up she acquired a case that was all but closed, needing only one final act to make it so. She visited the patient at home to make her assessment, and agreed to close the case.
In this morning's part of the hearing a lot of context and detail was revealed. For example, it turns out that the patient is a young man, probably in his twenties. He is married, but still lives at home with his mum and dad whose culture and religion happens to be the same as Mr R. They all speak the same two home languages as well as English. In the detail of the discussions this morning, I understood that mum and dad were doing their best to 'normalise' their Down Syndrome son, and had high hopes that the 'articulation process' of the speech and language therapy would make him just like anyone else. In the meantime dad often spoke on his behalf, jumping in to answer questions and give opinions instead of leaving a space for his son to struggle in. Mr R put it like this - he said there was a lot of energy in the room when the parents were present. In fact, as the case unfolded, Mr R said that his own intervention was less to do with administering the standard procedure and more focused on working with the family to create space in which the young man could find his own way to communicate.
By all accounts the work was successful but the STAP [the South Tyneside Assessment of Phonology] showed that further standardised treatment was unlikely to match target outcomes. The patient and his parents all wanted to carry on with the work, and all agreed that Mr R was the man to do it. The parents were particularly keen, and asked Mr R several times if he would carry on - never mind the rule about 5 sessions, they would pay they were so pleased with the results.
When Ms Betts turned up to make her assessment, the patient's parents let slip that Mr R had done some work with their son outside the domain of the NHS. As soon as they had said this they realised they had dumped their man in trouble and clammed up. But Ms B was not to be deflected. She wanted to know how often this had happened and how much he had been paid. The more she asked the less they said, the message had been instantly transmitted! Something unspeakable had happened, and now the family began to worry that they had caused Mr R to be sacked.
In a way they were right. They had not reckoned on Ms B clinging so tenaciously to the rule book, nor indeed that such a rule book had in fact been written, and they certainly never imagined anything like the HPC who would use such a book to purge the profession of any imaginary stain.
As it turned out Mr R did see this family about four more times outside the NHS protocol. He accepted about £6 from them to avoid the embarrassment that was created through his refusal to accept a proper fee. Today, 2 or 3 years later he says he would definitely never do that again.
Quite right; if he does work in private, he should participate directly in the symbolic exchange that regulates it. He might negotiate a proper price for himself, refer the case to a colleague in private practice, or perhaps he could channel the money to a charity.
No! None of these ideas were considered. Mr R now knows not to accept private work because it would catch him in this dreadful process that might ultimately prevent him from working. For if he is struck off (and that is the HPCs intention - 'a clear case of misconduct'), then he will be legally prevented from practice. In future, he will not try to help a family in need, he will attend only to the requirements of his cv.
From where I sat in this proceeding, I would say there's a very strong possibility that money is a tabu topic in the NHS and forecloses any sensible discussion about working effectively with patients. It certainly muddied the discussion at the HPC. (Was he accused because he took money - sub-text because was greedy? Or because he gave charity - sub-text that he was naive? The prosecuting agent didn't mind which, so long as she nailed him with one.) What was quite clear from this morning's discussion was that the family made direct and repeated demands for treatment that the NHS protocol ruled out. Mr R however, could see that something less rigid and more responsive could and would have a good effect. For goodness sake! What on earth is wrong with that? That Mr R will never do that again is, well, it's a shame. And if The Public conjured up colludes with this ruse then we are in bigger trouble than I had thought.
It was said several times by Ms B that a professional must act ethically to protect himself from suspicion. This puts a curious twist on the question "who is being protected by the HPC, and from what?" Listening to Ms B it seems that 'the public' that is protected is the one that belongs to a profession. What the HPC is protecting this public from is the accusation from an ill-informed mob who might otherwise point the finger of suspicion. There are two kinds of public here. One is being protected from the truth, the other is being protected from any possible accusation of suspicion.
Poor show. Doubly so, for in another time or another place it would be quite normal to deal with this question in an ordinary conversation between people (supervision? seminar? collegiate conversation? quiet personal reflection?), or even just getting on with the job and accepting a fee for it. What we have instead is an elaborate construction of something approaching a kangaroo court dressed up as respectable profession.
Kind words can cost you your reputation as an HPC health professional, or at least, a kind act can if today's case is a typical example.
The allegation in this case is a short one: "that Mr R provided private speech and language therapy treatment to [a client] whilst also treating them on NHS caseload at [a PCT]". When I popped my head round the door to see if the business had begun the Chair was quizzing the Barrister on the use of the word 'them'.
The writer of the allegation had been at pains to avoid bringing the patient into view. For this reason she had avoided the word 'him' and used 'them' in its place. This switch from single to plural had created the impression that Mr R was in the habit of taking his patients into his private practice. The point clarified that only one patient was in question, and that language might be used for other purposes than simply stating facts.
There was only one witness in today's case: Ms B. She had been employed to replace Mr R when he resigned at the end of Sabbatical. They had never met. Mr R had seen his patient for the standard 5 sessions and was closing the case. However, he had not filled in the last form before going off on leave. So, when Ms B turned up she acquired a case that was all but closed, needing only one final act to make it so. She visited the patient at home to make her assessment, and agreed to close the case.
In this morning's part of the hearing a lot of context and detail was revealed. For example, it turns out that the patient is a young man, probably in his twenties. He is married, but still lives at home with his mum and dad whose culture and religion happens to be the same as Mr R. They all speak the same two home languages as well as English. In the detail of the discussions this morning, I understood that mum and dad were doing their best to 'normalise' their Down Syndrome son, and had high hopes that the 'articulation process' of the speech and language therapy would make him just like anyone else. In the meantime dad often spoke on his behalf, jumping in to answer questions and give opinions instead of leaving a space for his son to struggle in. Mr R put it like this - he said there was a lot of energy in the room when the parents were present. In fact, as the case unfolded, Mr R said that his own intervention was less to do with administering the standard procedure and more focused on working with the family to create space in which the young man could find his own way to communicate.
By all accounts the work was successful but the STAP [the South Tyneside Assessment of Phonology] showed that further standardised treatment was unlikely to match target outcomes. The patient and his parents all wanted to carry on with the work, and all agreed that Mr R was the man to do it. The parents were particularly keen, and asked Mr R several times if he would carry on - never mind the rule about 5 sessions, they would pay they were so pleased with the results.
When Ms Betts turned up to make her assessment, the patient's parents let slip that Mr R had done some work with their son outside the domain of the NHS. As soon as they had said this they realised they had dumped their man in trouble and clammed up. But Ms B was not to be deflected. She wanted to know how often this had happened and how much he had been paid. The more she asked the less they said, the message had been instantly transmitted! Something unspeakable had happened, and now the family began to worry that they had caused Mr R to be sacked.
In a way they were right. They had not reckoned on Ms B clinging so tenaciously to the rule book, nor indeed that such a rule book had in fact been written, and they certainly never imagined anything like the HPC who would use such a book to purge the profession of any imaginary stain.
As it turned out Mr R did see this family about four more times outside the NHS protocol. He accepted about £6 from them to avoid the embarrassment that was created through his refusal to accept a proper fee. Today, 2 or 3 years later he says he would definitely never do that again.
Quite right; if he does work in private, he should participate directly in the symbolic exchange that regulates it. He might negotiate a proper price for himself, refer the case to a colleague in private practice, or perhaps he could channel the money to a charity.
No! None of these ideas were considered. Mr R now knows not to accept private work because it would catch him in this dreadful process that might ultimately prevent him from working. For if he is struck off (and that is the HPCs intention - 'a clear case of misconduct'), then he will be legally prevented from practice. In future, he will not try to help a family in need, he will attend only to the requirements of his cv.
From where I sat in this proceeding, I would say there's a very strong possibility that money is a tabu topic in the NHS and forecloses any sensible discussion about working effectively with patients. It certainly muddied the discussion at the HPC. (Was he accused because he took money - sub-text because was greedy? Or because he gave charity - sub-text that he was naive? The prosecuting agent didn't mind which, so long as she nailed him with one.) What was quite clear from this morning's discussion was that the family made direct and repeated demands for treatment that the NHS protocol ruled out. Mr R however, could see that something less rigid and more responsive could and would have a good effect. For goodness sake! What on earth is wrong with that? That Mr R will never do that again is, well, it's a shame. And if The Public conjured up colludes with this ruse then we are in bigger trouble than I had thought.
It was said several times by Ms B that a professional must act ethically to protect himself from suspicion. This puts a curious twist on the question "who is being protected by the HPC, and from what?" Listening to Ms B it seems that 'the public' that is protected is the one that belongs to a profession. What the HPC is protecting this public from is the accusation from an ill-informed mob who might otherwise point the finger of suspicion. There are two kinds of public here. One is being protected from the truth, the other is being protected from any possible accusation of suspicion.
Poor show. Doubly so, for in another time or another place it would be quite normal to deal with this question in an ordinary conversation between people (supervision? seminar? collegiate conversation? quiet personal reflection?), or even just getting on with the job and accepting a fee for it. What we have instead is an elaborate construction of something approaching a kangaroo court dressed up as respectable profession.
Monday, 8 December 2008
Physiotherapists and their notes: Mr H's FTP hearing
Today's Fitness to Practice Hearing focused mainly on the question: can Mr H write notes according to the rule book. His chosen practice is Physiotherapy.
The case opened this morning, and is expected to unfold over three days. I stayed for four hours and listened to the cross examination of two witnesses, who seemed to be the whistle blowers in this case. They had been his Band 6 and Band 7 supervisors in a rotation he (Band 5) undertook a year ago.
There was no word of a problem with his actual practice, but a lot of trouble with his ability to recite the rules, and especially with writing them down in the case notes. This is how the two women want to invest their trust in him - can he write notes the way they can?
He is not like them. He is dyslexic, and he has a different relation to the written world.
One witness coughed her way through her performance, and sprinkled it with so many generalisations and ready made phrases that I wondered whether she might inadvertently prove herself unfit for practice.
She and her colleague were effectively questioning the man's qualification, which had been awarded by some other body. This opens up a can of worms. Clearly something had shaken their trust and he had become the object of their fear. So much so indeed that they had decided he must be excluded not just from their work environment, but from their profession and his chosen trade. They had, however, a great deal of difficulty making their case clear.
A lot of the talk and cross-questioning concerned the grading of the jobs, the level of staffing, the role of a crisis team, bits of specialist equipment, and other NHS organisational details. This gave a glimpse context within which this drama was taking place, and opens up another can of worms.
Times have indeed changed, and the structural context of both universities and hospitals have been transformed radically by successive government policies. One upshot of this is that today we can watch witch hunts and construct scape goats rather than think about the process, the system, the context or the way people end up scrapping when they feel under threat themselves. This may not be the intention, but it requires a lot of effort to subvert that 'natural' effect. The arena in which our assembly are obliged to meet is structured in such a way to exclude any other kind of outcome. It was a relief, then, to hear the Panel ask for details of the context that threw some real light on situation in question.
The much respected GP George Freeman (trainer, teacher, and practitioner) told me earlier this year that now, for the first time in his long experience, the British Government was supporting a glut of students in the medical profession. He said that many more were going through medical school than there were jobs in hospitals, and in rotations etc. This is a kind of State induced over-production which is often justified by reference to a false kind of 'natural selection'. You don't need me to spell out the kind of benefits that arise for the Government, and the inconvenience to the students that this nonsense implies. (click here to find the full text of that conversation).
It is the kind of competition that Chris Woodhead and Margaret Thatcher enjoyed provoking. It is based on the mistaken belief that you bring out the best in people by artificially undermining the basis of their trust and then injecting fear.
The way the two women spoke in this case revealed lots of inconsistencies and incoherences that left me thinking that they simply didn't understand the way Mr H worked, and couldn't appreciate the value he was providing. He is just not like them.
For example, one of the 'cases' they brought against him was an incident with a patient who was, as it turned out, about to die. It seems that Mr H had read the situation quickly and correctly from the social relations in the room - the family were assembled around the bed of the patient - so when he entered, he let them tell him what had happened (a stroke), listened to the patient's chest through his stethoscope (perhaps to give comfort, it was suggested) before leaving without conducting the planned physiotherapy treatment.
His supervisors complained that he didn't read the information from the file but got it from the relatives, furthermore he should have collected all the 'objective and subjective data' and he should have talked to the medics involved in the case. This was indeed the course of action then taken by the Grade 5 (a woman who knows what is required) after which she arrived at the same conclusion - that today's regime of physiotherapy would be completely out of place.
The case opened this morning, and is expected to unfold over three days. I stayed for four hours and listened to the cross examination of two witnesses, who seemed to be the whistle blowers in this case. They had been his Band 6 and Band 7 supervisors in a rotation he (Band 5) undertook a year ago.
There was no word of a problem with his actual practice, but a lot of trouble with his ability to recite the rules, and especially with writing them down in the case notes. This is how the two women want to invest their trust in him - can he write notes the way they can?
He is not like them. He is dyslexic, and he has a different relation to the written world.
One witness coughed her way through her performance, and sprinkled it with so many generalisations and ready made phrases that I wondered whether she might inadvertently prove herself unfit for practice.
She and her colleague were effectively questioning the man's qualification, which had been awarded by some other body. This opens up a can of worms. Clearly something had shaken their trust and he had become the object of their fear. So much so indeed that they had decided he must be excluded not just from their work environment, but from their profession and his chosen trade. They had, however, a great deal of difficulty making their case clear.
A lot of the talk and cross-questioning concerned the grading of the jobs, the level of staffing, the role of a crisis team, bits of specialist equipment, and other NHS organisational details. This gave a glimpse context within which this drama was taking place, and opens up another can of worms.
Times have indeed changed, and the structural context of both universities and hospitals have been transformed radically by successive government policies. One upshot of this is that today we can watch witch hunts and construct scape goats rather than think about the process, the system, the context or the way people end up scrapping when they feel under threat themselves. This may not be the intention, but it requires a lot of effort to subvert that 'natural' effect. The arena in which our assembly are obliged to meet is structured in such a way to exclude any other kind of outcome. It was a relief, then, to hear the Panel ask for details of the context that threw some real light on situation in question.
The much respected GP George Freeman (trainer, teacher, and practitioner) told me earlier this year that now, for the first time in his long experience, the British Government was supporting a glut of students in the medical profession. He said that many more were going through medical school than there were jobs in hospitals, and in rotations etc. This is a kind of State induced over-production which is often justified by reference to a false kind of 'natural selection'. You don't need me to spell out the kind of benefits that arise for the Government, and the inconvenience to the students that this nonsense implies. (click here to find the full text of that conversation).
It is the kind of competition that Chris Woodhead and Margaret Thatcher enjoyed provoking. It is based on the mistaken belief that you bring out the best in people by artificially undermining the basis of their trust and then injecting fear.
The way the two women spoke in this case revealed lots of inconsistencies and incoherences that left me thinking that they simply didn't understand the way Mr H worked, and couldn't appreciate the value he was providing. He is just not like them.
For example, one of the 'cases' they brought against him was an incident with a patient who was, as it turned out, about to die. It seems that Mr H had read the situation quickly and correctly from the social relations in the room - the family were assembled around the bed of the patient - so when he entered, he let them tell him what had happened (a stroke), listened to the patient's chest through his stethoscope (perhaps to give comfort, it was suggested) before leaving without conducting the planned physiotherapy treatment.
His supervisors complained that he didn't read the information from the file but got it from the relatives, furthermore he should have collected all the 'objective and subjective data' and he should have talked to the medics involved in the case. This was indeed the course of action then taken by the Grade 5 (a woman who knows what is required) after which she arrived at the same conclusion - that today's regime of physiotherapy would be completely out of place.
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