From spin to bullshit

That’s now two blog post headings with the word ‘bullshit’ in them (see other one)! I’m meaning the technical definition of bullshit which means a corporate rhetoric that creates a positive image regardless of the organisational reality. I think the point to emphasise is that the organisation doesn’t care about the real situation. Instead it has become more concerned with words and rituals which are actually empty. Management speak is supposed to give the impression of expertise, but actually avoids dealing with the real issues. Producing, distributing and consuming bullshit becomes a goal in itself. Rampant bureaucracy creates forms to be filled in, procedures to be followed and standards to be complied with. Managers feel compelled to deal with a problem by bullshitting.

Truthful, accurate and transparent communications are crucial to keeping people properly informed. How an organisation presents and promotes itself can be packaged, which has potentially problematic implications in a democracy. Communication has become a formidable industry in politics and business. Spin has always existed where there are people to be influenced. Something new developed, though, in British politics in the 1990s. "The media, industry, politics, the establishment and the arts conspired to bring us not their constituent parts, but a presentation of what they would like us to think they were" (see Demos article). Presentation seemed to become all and form overcame content. A lack of substance in what was being said and interpretation parading as facts meant that 'spin' eventually became a pejorative term. 

Even though there may have been signs that the spin culture had run its course as people disapproved of spin because it was lacking substance, I'm not convinced we have moved on to a culture in which there is an open and honest debate. Instead there is still too much bullshitting, which is actually worse than mere spin because it is an indication that the organisation doing the bullshitting does not care. I may well post further once I have read André Spicer's Business Bullshit.

Münchausen by proxy infanticide

I’ve mentioned David Southall three times previously (see first, second and third posts). He was a professor of paediatrics and a child protection specialist with a worldwide reputation. He spent 14 years under investigation (including being struck off and reinstated) by the General Medical Council.

As a specialist at the Royal Brompton in babies’ breathing problems, he set up a system with the cooperation of police and social services of covert video suveillance, which showed that some parents were suffocating their children. He became a leading expert on Münchausen syndrome by proxy, first named by Sir Roy Meadow in 1977. Meadow too was struck off by the GMC, but appeal to the Court of Appeal was found in his favour by a majority. What got him into trouble was his so-called law that “one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise“. This was because Sally Clark’s conviction for the murder of her two baby sons, primarily on the basis of Meadow’s law, was overturned by the Court of Appeal (see BBC news report).. 

People do kill defenceless infants. This even includes health care staff, such as Beverley Allitt (see Wikipedia entry) and Lucy Letby. I doubt the Lucy Letby statutory inquiry, which will include looking at the Trust’s response to the consultants who expressed their suspicions of infanticide (see SOS statement), will take us forward much in the understanding of Munchausen by proxy infanticide, about which the consultants will have had some knowledge. However, the inquiry should improve working relationships between managers and consultants in the NHS. The primary problem is that, because of increased accountability over recent years, managers have usurped clinical responsibility. Instead they need to be held to account for creating the right environment in which clinicians can exert that clinical responsibility. Clinicians shouldn’t necessarily be accused of bullying, or some other disciplinary offence, because they express dissent (see eg. my BMJ letter). Managers must not misuse their disciplinary power (see previous post). If they hadn’t in the Letby case, her serial killing might have been detected earlier.

Bullshit in NHS Foundation Trusts

As Dave Pilgrim writes in British psychology in crisis:-

‘Management speak’ with confident terminology and phrases abound, and many employees now simply expect their managers to talk bullshit. Clichés are offered, as and when required, to mollify the public. When the latter are assured about probity, transparency, or safety in a press release, then there are often good grounds for healthy suspicion from the ordinary citizen.

In the NHS, for example, this means that managers can spend their time bullshitting to protect the organisation rather than improving patient care. Non-executive directors in Foundation Trusts, who are supposed to ensure that patient care is improving, fail to challenge executives, leaving sceptical members of the Trust and the public in general without confidence, even in their elected Council of Governors.

Norfolk and Suffolk NHS Foundation Trust, where I used to work and was a governor for 7 years, has been found inadequate four times by the Care Quality Commission. I could see the fourth inadequate coming and publicly called for the resignation of the Chair (who was going anyway), the two vice Chairs, the Senior Independent Director (SID) and the lead governor. This wasn’t because of personal antagonism to the people in post, all of whom I knew through working as a governor and keeping in touch subsequently as a member.

Of course this did not happen! The Chair designate came into post and has helped to get the CQC rating improved to ‘Needs improvement’ rather than ‘Inadequate’. The SID has moved on and one of the vice-Chairs is also due to come to the end of his term soon. Still, I thought the better way for the Trust to manage its difficulties was to accept accountability by these public resignations. 

The Trust still, therefore, lurches from scandal to crisis and back, most recently with a BBC Newsnight investigation (see BBC report). This was partly about the Trust’s handling of its mortality data, but also about the need for an open and honest debate about the state of mental health services in Norfolk and Suffolk. I still don’t fully understand what the Trust is saying about how it has handled, is handling and will handle its mortality data. The concern about the state and quality of services is due to the fact that the Trust has still not properly recovered from its first CQC inadequate rating due to the disastrous implementation of its radical redesign before that first inadequate rating. 

There are of course national issues also about the state of mental health services in this country. NHS England seems to be leaving Trusts to sort out their own messes, so there still needs to be an open and honest discussion about the state of mental health services in Norfolk and Suffolk. If non-executive directors are not willing to facilitate this discussion, they should resign and be held to account by the Trust Governors.

Being a University student

Still revelling in having spent more than 7 years of my life (3 years BA, 2 years and a term clinical studies and two years part-time PhD) as a student at Trinity College Cambridge.

Solving the problem of the NHS

It doesn’t go down well to say that we have too much medicine (eg. see previous post) when we have so many people on NHS waiting lists. Although it is true that the NHS is currently unsustainable, particularly when care has become so fragmented and dysfunctional, the answer is not just more money. Hopefully the recently announced NHS Long Term Workforce Plan will help, but more fundamentally the NHS does need to prioritise responding to need rather than demand. 

Ironically, it is the NHS itself that has often inflated demand. The overmedicalisation of society must be reversed in the interests of the country’s health.

Prince Charles’ room in New Court, Cambridge was a bit grander than the average freshman’s. A bath was even installed on the staircase. He left Trinity in the academic year before I started, and the bath in the next staircase saved me having to go across the court in my second year. I remember going to the Wren library and presumably there is a similar photo of me in the admissions book from 1970, although I can’t remember it being taken.

Human thinking and ChatGPT

An interesting paper by Durt et al discusses why ChatGPT and other large language models may seem so good at modelling human thinking. Generative artificial intelligence uses structures and patterns of human language to produce outputs that can be strikingly like human beings. The so-called neural network architecture of ChatGPT, although it can't act independently or make decisions, generates responses based on the patterns and associations found in the vast amount of inputted text. Meaning really has no existence outside of language use and rather results from it, so perhaps we shouldn't be so surprised by the extent to which thinking is guided by patterns. Thinking can be intuitive, even creative, but most of the time we're just pinching ideas from other people. 

Visit to Cambridge University library embellished by excursion to Trinity College fellows’ garden (see website).

Being unacceptable

I have been looking at the website for the research project on the work of Don Cupitt (listen to eg. Radio 4 programme about Cupitt’s 1980s TV series Sea of faith). He was one of my supervisors when I switched to Religious Studies for my Part II at Cambridge (see eg. previous post). Interestingly, he had an exhibition to Trinity Hall for Part I of his degree in Natural Sciences before switching to theology. I had an exhibition to Trinity eighteen years later to study Medical Sciences before changing to Religious Studies. Maybe I’ve been as much as a provocateur for psychiatry as he has been for religion. 

Having flirted with death of God theology (see previous post), I gave up my involvement with the church a few years after Cambridge. Actually I’ve never wanted to be a heretic within psychiatry. As I’ve said throughout my Relational Psychiatry blog, psychiatry does need to change. I’m not wanting to abolish it.

I came across two portraits online (see link and another) painted by my great uncle, Alfred H. Page, who I never knew.

Just to prove it, I’ve come across my certificate from August 1979 showing I am an Associate of the Institute of Bankers. I did not like working for Lloyds bank for four years, but was grateful they lent me money cheaply to buy our house when mortgage rates were even higher than now.

Chance and necessity revisited

Jacques Monod viewed molecular biology as justification for a mechanistic and deterministic view of life, which he elucidated in his best seller Chance and necessity. The book influenced me when I was an undergraduate at Cambridge University doing Part I Medical Sciences in 1970-2. It was only when I switched to Religious Studies for my Part II that I realised that a reductionist and positivistic view of science was at least open to question.

Monod argued that living beings are chemical and self-constructing machines. He acknowledged that “our understanding of the mechanisms of development is still very imperfect” (p. 52). Nonetheless he was clear that the “process of spontaneous and autonomous morphogenetic is based on stereospecific recognition properties of proteins”. I’m sure it is, but the question is whether proteins “animate and build living systems (p.52)”? Contra Monod,  I’ve come to accept Kant’s view that life cannot be explained in mechanical terms (eg. see post on my Relational Psychiatry blog).

Even though the scientific and professional establishment tend to agree with Monod, it’s not just the human sciences, but also biology, that need to be anti-reductionist (see eg. another post from my Relational Psychiatry blog). The implication for psychiatry (see my Relational Psychiatry blog passim) and for medicine in general, is that it is not person-centred enough.

The end of an era

Sustaining the NHS

Sajid Javid in the introduction to his keynote speech to Policy Exchange on 'Digital transformation in health and social care' said "The truth is that our health and social care system is following an unsustainable path that is too often not delivering for patients". He went on, "At the start of this century health service spending represented some 27% of day-to-day public service spending. By 2024 it is set to account for 44%. ... But can we really say we've seen an equivalent improvement in outcomes?"

Obviously this rhetorical question was meant to be answered in the negative and I would agree. I've said before (eg. see previous post) that overmedicalisation of society has created too much medicine. This situation is ironic as the currently fragmented and dysfunctional NHS has also inflated demand so that it cannot cope. The NHS needs to relearn to concentrate on priorities. There needs to be a shift back towards meeting need rather than demand.

The BMJ has recently called for a reset in its campaign against too much medicine (see editorial). A rushed article of mine 'The limits of psychiatry' was published (with several fairly minor errors eg. picture of Alfred rather than Adolf Meyer) in a BMJ theme issue in 2002 highlighting the dangers of too much medicine. As the recent editorial says. "Evidence for the damaging effect of overdiagnosis and overtreatment continues to grow". And as it concludes, there needs to be a move from "rhetoric and scattered evidence to actionable evidence and measurable impact".

England’s test summer begins

Peter the Great was no saint

Commentary in Politico suggest Vladimir Putin is no Peter the Great because he has failed to stop murder and rape in Ukraine. But this tapestry of Peter shows him looking pretty pleased with the carnage of the Battle of Poltava in Ukraine in the background.

Battle was raging between Russian forces and the army of Charles XII of Sweden, marking the beginning of Russian hegemony in Northern Europe.

The easternmost point in the UK

Along the River Blyth

From Wenhaston to Blythburgh

Death rattle through Buttler hit wicket

Brave fight comes to an end. Day 5 of second Ashes test. Let’s hope England are good enough to come back.

Painful blow at the end but at least there’s a fifth day

Day four of Ashes second test. At least Malan and Root develop their all-round skills with two wickets each.

Worst day of series for England?

Malan and Root did not bat all day unfortunately (day 3 of second Ashes test). Other partnerships are needed. But Warner got confused leading to a runout. So, is this a repeat of 1936-7 in reverse (see previous post). Is there rain predicted?

Australia in command, I admit it, but …

Day 2 of the second Ashes test. Australia got to more than 450 but England have plenty of batting after losing two wickets. And it is first pink ball Ashes test (see article). And it’s hot, watch the lightning.

Dropping a sitter is embarrassing, but so what?

Rubbing in Buttler’s embarrassment is easy game, but he’s playing a real match. Let’s see after day one of second test. (See previous post posted in Australia).

Discover Lowestoft

Lowestoft in olden times (1899 edition by David Price)