The last five days has seen the first week of the inquest into the death of Richard Handley. The inquest has been expertly live tweeted by George Julian and following the testimonies unfold has been harrowing reading. If you want to catch up on the evidence to date, follow @HandleyInquest on Twitter.
Richard died an appalling death. Constipation had been a problem from birth but his family, and latterly the care home had managed this distressing issue. Things started to go wrong when the owners of the care home deregistered its care home status and rebranded itself as supported living. The level of support that Richard had previously received dropped off alarmingly, all in the name of “independence” and “choice” but was really about saving money for the care company on that pesky thing called “care”. The “flats” became dirty as it was no longer seen as anyone’s job to do the cleaning. More seriously for Richard, his diet, which had been a mainstay in managing his condition changed as it was decided that Richard had the capacity the decide what he should eat. The rebranding was the starting point for the catastrophe that was to follow. Two days before Richard died medics removed 10kg of faeces from his rectum. That was just a small amount in his body as the post mortem revealed much more had become impacted in Richard’s bowel. His abdomen was so extended as to resemble someone “40 weeks pregnant”. Richard vomited up his own faeces. In the end, his heart gave out. We hear a lot about “a good death”. This was a very bad death.
The inquest has been distressing but compelling reading. The importance of George’s work has become more and more evident as the week has progressed. We are learning things of such importance about the coronial process, the state of adult social care, the tactics that professional bodies use to subvert justice and to avoid accountability. I knew some of this stuff through my experience in 2010 and others’ since but this week feels like we now know what the template is. This inquest is so similar to Connor Sparrowhawk’s inquest, it is beyond coincidence. It is data that we must learn, absorb, pass on and use to bring about the change we need. The change to seeing learning disabled people as valuable, as having human rights, in life as well as death.
There are a number of things that families impacted by social care need to learn from the remarkable records that are being compiled. To use that old professional cliche – “lessons must be learned”.
Richard’s inquest is glaringly revealing how dangerous supported living can be when the providers have a different agenda. We know this already from the death of Nico Reed but the evidence this week shouts at us that when money saving/profit making is disguised as person centred independence, horrific outcomes are just around the corner. Barren lives lived because the care provider won’t provide enough staff to facilitate meaningful activities. Good health maintenance jetisoned because “choice” is used to disguise the truth that the provider can’t be bothered to invest in the health of their customers. Lesson one – we have to improve our laser vision. We have to see what is going on behind the person centred, independence smokescreen.
In order to achieve the above, the State and the care providers have to exclude the families. And to be brutally frank, part of the exclusion is to lie to them. Richard’s family genuinely believed that his diet was being followed. They sincerely believed that his toileting routines were being maintained. Why should they think otherwise? Lesson two – we need to think otherwise. We cannot trust that there isn’t an alternative agenda in play.
As sure as night follows day, family blaming follows the exclusion of families. In the cross examination of Sheila, Richard’s mother, the suggestion was made that the family hadn’t told the providers or monitored Richard’s diet and toilet plan. Reading it felt like Groundhog Day. At Connor’s inquest, the psychiatrist’s brief battered Sara with questions along the lines of; why didn’t Sara inform the unit that Connor needed bathtime supervision. It’s nigh on impossible for the person (the bereaved person) not to take this personally. They musn’t. Lesson three – do not be drawn into the blame game and do not take it personally. Obviously when you are under attack, the tactic has more purchase. But as we have learned through following these inquests, the name of the game for the various barristers is to shift blame anywhere than on their client. From their point of view an inquest isn’t a fact finding inquiry. It is a vehicle to avoid any accountability at any costs. Yesterday we heard the testimony of the lead GP in the practice Richard was registered with. In the space of ten minutes, the blame was shifted from the computer system, the trainee GP, Richard’s mother, the care company. It was hard to keep up. It was the most horrid game of non accountability bingo. But that is the purpose of an inquest for the professional “interested parties”.
It still shocks me to my bones, how much the Mental Capacity Act is ignored or abused. One of the witnesses said that they assumed Richard had capacity because he wasn’t disagreeing with the professionals! It became clear very early on that the and the notion of best interests didn’t appear on the radar of most of the medics involved in Richard’s care. I tweeted that I felt that in case after case, the ignoring and manipulation of the Mental Capacity Act must be wilful. It can’t be accidently forgotten about. After all, the law is over 10 years old now. A social care professional who I respect enormously replied that the professionals know their law and tend to ignore it when it doesn’t support their own agenda. This is terrifying confirmation if you have a learning disability or are a family member. The piece of legislation that is meant to protect and enable you doesn’t work unless you are compliant with the State agenda. Lesson four – know your law. You can be trusted more than the State to make a best interests decision without an unpure motive.
The final lesson from this week is utterly bizarre but led to the title of this post (Thanks to my friend Val for the title). As yesterday’s hearing was wrapping up, one of the barristers announced to the coroner that the CEO of the hospital trust who he was represented, reported that he had been “goaded” on Twitter. George was understandably horrified by this accusation & trawled the Twitter feed for any goading tweets. Unable to find any, she tweeted the CEO to ask for clarification & he replied with the following screenshot:
Can you see what the CEO did here? This was evidence from the morning session. If it was “goading” it was done from the witness box. The inference in his complaint though was very different. Does this ring any bells? How about the time that Katrina Pearcy reported that Justice For LB supporters had hacked the Southern Health account? It happened to me in court. As the social work manager took to the witness box he asked if he could make a statement before taking counsel’s questions. He announced that the social worker was absent from the court due to sickness. Her sickness being stress brought on by receiving an anonymous, threatening letter signed by “a friend of the Neary family”. No letter was ever produced to back up the accusation. Thankfully Justice Jackson gave the claim a nanusecond of attention. He didn’t mention it all in his final judgement.
So what’s the point? Nobody is taken in by these allegations. They must be dreamt up by the bodies’ PR departments. They are designed to shift the “perpetrator” into the victim position. Grandstanding for sympathy. It’s not meant to appeal to the court but to the wider audience. After all we have a strong victim culture now, so any claim of “goading” or trolling or threatened violence is likely to resonate. Job done. Lesson Five – do not engage with this game. You are being used as collateral. Just trust that the people who matter will see straight through the nonsense. It’s horrible. A well paid CEO is so brittle he needs to wrestle the Handley family from the victim position (not that once have Richard’s family played the victim card. They have far too much congruence for that).
There’s bound to be more lessons that I’ve overlooked and more to come as the inquest continues.
But we have to get a handle on all this. We’re in this for the truth; our lives. We have to understand the rules of the game that our search for truth takes place in.