Brexit and the waning days of the United Kingdom

[Gups]

It's very important that the owners (whoever they are) feel the pain through loss of licenses to operate, or other ways. Executives going to gaol is likely a sacrifice healthcare owners are willing to make.

This is public sector

[The Brain]

It's very important that the owners (whoever they are) feel the pain through loss of licenses to operate, or other ways. Executives going to gaol is likely a sacrifice healthcare owners are willing to make.

This is public sector

As I said, whoever they are. If hospitals are forced to close if they act like this then the owners will, as if by magic, take a much greater interest in it not happening. The idea that the public sector should be allowed to treat people like crap without consequence is one of the problems.

You can never completely protect yourself from a serial killer operating in your hospital. You can ALWAYS protect yourself from ignoring it.

[Tamas]

Separately - can't find it but read a piece somewhere on Sunak's planned trip to India next month.

Apparently they're expecting a huge reception and it was slightly weird seeing Indian press reaction that, if it was in Britain, I would assume was incredibly far-right. Lots of stuff about he's still a "son of the soil" plus the "Indian son rises over the empire", "from age of empire to Rishi Raj" stuff - and apparently the discourse that it's a "reverse takeover" is really common

But I thought of it again today because I saw that apparently Sunak's visit to a Ram Katha in Cambridge (on Indian Independence Day) had gone viral in India. I recently saw the (excellent - if depressing) documentary on the Indian press, While We Watched and one of the Fox News syle debate shows did an entire two hour section on this. Which reminded me that there is this whole other (and vastly more positive) narrative about Sunak in India that we have no idea of. I think it'll be really interesting to see if he does get mobbed on that trip.

Incidentally this is the clip of the event from one of the Indian news channels. Thing that struck me is that I can't think of a recent serving British PM practicing their faith or talking about its importance to them in this way - certainly not in my lifetime. It's pretty unique from a British perspective. Sunak comes up at about 1 minute into this, also clear from this clip is how sincerely his faith matters:

Also striking - while this went viral in India, it was a local news story in the UK about him visiting a Hindu faith event in Cambridge.

Edit: I think that trip incidentally is for the G20 but Downing Street might try to tack on a few extra days before or after for a wider trip.

To some degree this seems understandable, to another degree it reminds me of the inferiority complex plaguing Eastern Europe and causing many of the far-right and nihilist nonsense there, so my amusement is limited. Also as you mentioned if India ever elected a PM of English origins, similar reactions in England would absolutely not be acceptable, so I guess it is also a question of when we want to start considering societies of formal colonies are equal, and hold them to the standards we hold ourselves.

[Tamas]

Also on the baby murderer nurse it seems you were right Sheilbh, concern for patient safety was way below concern for saving face.

https://www.theguardian.com/uk-news/2023/aug/19/doctors-were-forced-to-apologise-for-raising-alarm-over-lucy-letby-and-baby-deaths

...After Letby's removal from the unit in July 2016 there were discussions about contacting the police but the hospital decided to carry out two external reviews first.

Brearey said that on one occasion, Stephen Cross, the hospital's director of corporate affairs and legal services, said contacting the police would be "terrible" for the hospital's reputation and turn the neonatal unit into a crime scene.

Gibbs said he could not recall Cross's exact words but that they were "along the lines of 'the police will come in and everything will be disrupted and the police would treat the NNU [neonatal unit] as a crime scene'".

Gibbs told the Guardian: "Hearing Stephen Cross say that was really upsetting."

In a letter to consultants in May 2018, Chambers said the hospital trust had "always kept an open mind and had under consideration a potential police investigation" but there were "a series of reviews to be undertaken before getting to that point".

Chambers left the trust within weeks of Letby's arrest in July 2018.

An external review into the trust's handling of the spike in deaths was ordered by Chambers' successor as chief executive, Dr Susan Gilby. The review is understood to have been completed but has not yet been published.

In his May 2018 letter to consultants, Chambers said Harvey, the hospital's medical director, "accepts communications could have been better" but that Harvey was constrained about how much he could share with the consultant paediatricians due to the two inquiries and later the police investigation.

Chambers added: "Whilst inevitably there are lessons to be learned for us all, I believe the trust can demonstrate that it has taken the concerns that you have raised very seriously, and has been open and transparent with the coroner, our regulators, and as far as the police investigation allows, with staff, parents and the public."

He said it had been "one of the most intellectually and emotionally challenging sequence of events that I have ever had to manage in my professional career and I am sure I have been found lacking. Without doubt the need to balance the competing priorities of the safety of babies and their families, the health and wellbeing of our staff and the reputation of our services makes it easy to question my judgment and my approach to managing these. ...

Without a bloody doubt there should be no effort to balance those three because safety of patients (babies in this case) should be prioritised way above even wellbeing of staff, let alone the reputation of their services. Just what the hell.

And at the end of this letter he just doubled down on this:

"I am certain that I have not always got the balance right and inevitably managed to upset everybody including you, nurse X [Letby] and her family and the wider neonatal team; however, it is also important to remember that my stewardship responsibilities include that of the whole hospital and wider healthcare system."

Sure, babies were dropping like flies (in 2015 there were 3 deaths in a space of two weeks with the only common denominator is this nurse being there, while the article says 3 deaths is usually their yearly average) but hey there was the reputation of the healthcare system to consider.

[HVC]

Is there a ranking or grading for hospitals and are bonuses tied to such for upper management?

[Oexmelin]

Also on the baby murderer nurse it seems you were right Sheilbh, concern for patient safety was way below concern for saving face.

I fear this is increasingly a wider issue in society at large.

[Sheilbh]

To some degree this seems understandable, to another degree it reminds me of the inferiority complex plaguing Eastern Europe and causing many of the far-right and nihilist nonsense there, so my amusement is limited. Also as you mentioned if India ever elected a PM of English origins, similar reactions in England would absolutely not be acceptable, so I guess it is also a question of when we want to start considering societies of formal colonies are equal, and hold them to the standards we hold ourselves.

As you way I think it is in a way absolutely understandable - India was the largest bit of the British empire and British Asians from what was pre-partition India within the empire are the largest minority group in Britain.

And, you know, who am I to judge - my family's from the same village as the Kennedys which JFK visited which was an enormous deal, as was Biden's homecoming to Ireland.

I have absolutely no doubt in the sincerity of Sunak's faith - I don't think you could looking at that video. But I wonder if because I don't think we're as far along as the US is on people expressing pride in their heritage as British Indian, say, in the way Biden does ("I'm Irish"), his Hinduism is, in a way, also serving that purpose? I think it'd be weird here if Sunak said "I'm Indian" - although maybe in the US only those old (white) European identities get that pass anyway - I could be wrong but I can't imagine a US politician saying, say, "I'm Chinese" or "I'm Indian" in the way Irish or Italian or Polish heritage is held?

Also on the baby murderer nurse it seems you were right Sheilbh, concern for patient safety was way below concern for saving face.

Yeah as I say it reminds me of previous scandals in the NHS over negligence and really horrendous mis-treatment of patients - Mid Staffs scandal, the Bristol heart scandal. I think part of it is an instinct to cover up for people like you - doctors or nurses maybe worrying about a colleague but not wanting to raise concerns. But I think that behaviour is common in many professions and many institutions. This may be totally off base but I am struck at the number of senior leaders in that Trust who started their careers as nurses - not wanting to believe the absolute worst about one of your own was maybe even stronger for them?

I also think it reminds me of institutional child abuse scandals - whether it's the church, scouts, BBC, schools. I think institutions that people feel loyalty to and that have a purpose are particularly susceptible to people almost reflexively working to protect the institution over the needs of individuals and victims. I suspect that's probably almost stronger the worse the allegations are because the other possibility is so awful you almost don't want to imagine it to be true - again particularly here or with child sexual abuse.

None of that excuses the behaviour of management but I think those are the impulses and I think they are sadly, I think, quite common perhaps particularly in our most important instutitons because they serve a purpose that people believe in. I'm really not surprised to see "there are lessons to be learned for us all" in an email from an executive who suppressed reports about a possible murderer killing kids in their hospital.

There will be a public inquiry. There will be damning reports on institutional failures and "lessons learned". There will be recommendations and reforms coming out of this. But I think at the heart of it what is still missing (and may not happen) is accountability - those executives retired comfortable or kept on getting senior jobs within the NHS.

I think unless there's a sense that actually our individual decisions within a system matter and we are accountable for them - and that each individual human takes priority over any institution, however preciously attached to it we may be, whether that's a patient or a child or whoever else. I think it is unlikely there will ever be another story like this because Letby's crimes are beyond imagining, but there will be other mistreatment and negligence and abuse of patients - and I suspect that will carry on being a sad reality until there's a sense of individual accountability and responsibility to the people these institutions are serving or owe a duty of care to. Process and assessments and structural reforms are not, I don't think, enough - and I'd add again that the NHS has a very bad record/reputation on whistleblowers.

It's a really weird comparison but it feels almost like the reverse of "just following orders".

Is there a ranking or grading for hospitals and are bonuses tied to such for upper management?

There are rankings and gradings for hospitals, as well as regulators. I don't know how NHS bonuses work but they exist. It is worth saying that while these murders were happening that hospital's leadership was winning awards for patient safety - one of Letby's line managers (who was one of executives on these emails) was winning awards from the Nursing Times for her leadership etc. This wasn't a failing hospital where someone was able to get away with it, but a generally good one that didn't want to face up to something frankly evil happening in its walls.

The fact that deaths were apparently being recorded incorrectly so the spike in mortality in the neo-natal ward wasn't showing up within the system (although it was in the hospital) is one of the things that I think absolutely needs to be investigated for criminal charges.

And its one of the challenges - politically it's always been very difficult to have gradings/scorecards etc for the NHS (and for education). It was one of the big fights Blair had with the public sector because the unions largely oppose them - their argument is that they don't accurately reflect the quality of care and there's a bit of you work to what is assessed which means the rest goes to the wayside. I think there is something to that view. It also tends to be tied to a frontline v management framing. Although I am generally very Blairite on this - fund the public sector well but have transparent metrics so users (parents, patients etc) are able to make informed choices and also effective well-funded management of public services by people who are managers will allow nurses/teachers/doctors etc to do more of their actual job.

Edit:

I fear this is increasingly a wider issue in society at large.

I agree, sadly. As I say, because of the motivations/impulses, I think that perversely in some ways our best and most well-meaning/purposed institutions are most vulnerable. And the instinct to deny, doubt, disbelieve is possibly also almost stronger the more horrendous the reality.

[Josquius]

I wonder with this baby murderer how things are for other midwives. Is their job becoming harder due to terrified and distrustful parents?
Horrific stuff anyway.
I expect she is set for a life in solitary before eventual suicide

[Sheilbh]

Letby sentenced to a whole life term. It is worth reading details here:
https://www.bbc.co.uk/news/live/uk-66551231

The victim impact statements before sentencing are particularly heartbreaking. One parent noting that their daughter's funeral was before the due date.

Also striking from her barrister - I imagine it's very rare that none of the mitigating factors in sentencing guidelines apply:

Letby's defence offers no mitigating factors

Judith Moritz
Inside the courtroom
We're now hearing from Ben Myers KC, Letby's lawyer, who says "the sympathy of everyone lies with the victims and the bereaved families".

"Miss Letby has maintained her innocence throughout these proceedings," he says, adding that "she has now been convicted" and "the sentence to be passed is fixed by law".

"In those circumstances there is nothing that we are able to add in mitigation that is capable of reducing the sentence that will be passed."

[HVC]

Sounds like lawyer speak for I think she's guilty too but can't say it.

[Sheilbh]

Just looked up the sentencing council and these are the main mitigating factors (though there are others I think). Impossible to see what argument you could possibly make on these:

Mitigating factors

Factors indicating lower culpability:
a greater degree of provocation than normally expected;
mental illness or disability;
youth or age, where it affects the responsibility of the individual defendant;
the fact that the offender played only a minor role in the offence.

Offender mitigation
genuine remorse;
admissions to police in interview;
ready co-operation with authorities.

[HVC]

If she admitted guilt would  munchausen by proxy Count as a mental illness ?

[Sheilbh]

I don't know - admitting guilt, expressing remorse are mitigating factors. With Munchausen by proxy I'm not sure - I don't think I've ever heard it as a defence or mitigating factor here - in a way it was the opposite there were a series of miscarriages of justice in the 90s that were subsequently overturned of mothers being convicted of causing harm or killing their child. A lot of that expert witness was later determined to be very unsafe.

I know nothing about this but my understanding of Munchausen by proxy was that it's about getting attention and sympathy and treatment for a non-real illness in a person under your care. From what I understand that isn't what was happening, she wasn't slowly making the babies ill or calling codes on them and similarly she wasn't really looking for sympathy from other people (though some WhatsApp messages about this with fellow nurses).

It does get to her crimes though and I have no idea. It is the thing that is really chilling in this case. She was a competent nurse which was why she was able to get away with it. She appears to have particularly targeted twins and later triplets. She searched for and found the Facebook accounts of some of the parents and I believe liked some of their posts in mourning over their child. I don't know. I find it incomprehensible. But it seems more sadistic (especially following the grieving families on Facebook) than anything else.

[HVC]

From my vast research of reading two or three articles it seems like she was trying to get the attention of, and and proximity to, a doctor she may or may not have been screwing, so I think it would fall under Munchausen by proxy.


But regardless if it can be categorized as Munchausen by proxy or not, that's my theory of why she did it. 

[mongers]

I don't know - admitting guilt, expressing remorse are mitigating factors. With Munchausen by proxy I'm not sure - I don't think I've ever heard it as a defence or mitigating factor here - in a way it was the opposite there were a series of miscarriages of justice in the 90s that were subsequently overturned of mothers being convicted of causing harm or killing their child. A lot of that expert witness was later determined to be very unsafe.

I know nothing about this but my understanding of Munchausen by proxy was that it's about getting attention and sympathy and treatment for a non-real illness in a person under your care. From what I understand that isn't what was happening, she wasn't slowly making the babies ill or calling codes on them and similarly she wasn't really looking for sympathy from other people (though some WhatsApp messages about this with fellow nurses).

It does get to her crimes though and I have no idea. It is the thing that is really chilling in this case. She was a competent nurse which was why she was able to get away with it. She appears to have particularly targeted twins and later triplets. She searched for and found the Facebook accounts of some of the parents and I believe liked some of their posts in mourning over their child. I don't know. I find it incomprehensible. But it seems more sadistic (especially following the grieving families on Facebook) than anything else.

My understanding is that 'Munchausen by proxy' has been renamed and categorised differently by the NHS, to remove it from closeness to Munchausen behaviour.

Edit:
It's now defined as 'Fabricated or induced illness'

Details here:
https://www.nhs.uk/mental-health/conditions/fabricated-or-induced-illness/overview/

Tellingly it says this:

What to do if you suspect a child is at risk

FII is a child safeguarding issue and cannot be managed by the NHS alone.

Medical professionals who suspect FII is happening should liaise with social services and the police, and must follow local child safeguarding procedures.

If your job involves working with children, for example, if you're a nursery worker or teacher, tell the person in your organisation who's responsible for child safeguarding issues. If you do not know who this is, your immediate supervisor or manager should be able to tell you.

If you suspect someone you know may be fabricating or inducing illness in their child, do not confront them directly. It's unlikely to make the person admit to wrongdoing, and it may give them the opportunity to dispose of any evidence of abuse.

You can contact your local social services department, or telephone the NSPCC's child protection helpline on 0808 800 5000, or email the NSPCC at [email protected]. The helpline is open from 10am to 4pm Monday to Friday.