PATIENT NEGLECT AND DO NO HARM + LPFT’S CONCEPT OF HUMAN RIGHTS FEATURING CARE CONCERNS UNSIGNED EMAIL TO ME TODAY
From: susan bevis
Sent: 29 February 2024 12:38
To: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Cc: NEUROLOGYSECRETARIESLINCOLN (UNITED LINCOLNSHIRE HOSPITALS NHS TRUST) <ulh.tr-neurologysecs.lincoln@nhs.net>; Christopher Reid <Chris.Reid@parliament.uk>; Enquiries <Enquiries@cqc.org.uk>; CONNERY, Sarah (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <sarah.connery@nhs.net>
Subject: Re: EB – Update
I wish to address the serious threats made verbally by Dr WK.
“I am banning you indefinitely for inciting your daughter to attack members of staff on Xmas Day“. I want an apology for that for a start.
You have no right to take away the phone we as a family pay a contract. The matter of human rights will be address before the High Court. You are in breach of Art 8, 5, 3, Equality Act and the Code of Conduct for the MHA / MCA. Staff are acting ultra vires and you are treating my daughter like a restricted prisoner under the MHA 1983. What you are doing is entirely unlawful.
The restrictions you claim to have ended are very much continuing. You have no right to treat my daughter the way you are doing in the most degrading manner against all codes of conduct and the files will be requested by the court including all the notes being written behind my back by healthcare assistants who have been instructed to.
You are not using proper diagnostic scale PANSS and there is no proper scanner only a 1.5 Tesla and I am going to all the newspapers and TV stations to advise as this has cost someone their life before more lives are lost and Elizabeth will need to go to Sheffield to be re-tested under ultrasound for the cancer scare she had at Ash Villa since a Tesla 1.5 will not detect everything.
You had no right to ban the visits and now I want those comments made by Dr K and threats said to me verbally addressed and an apology. I will continue to issue invoices because you are depriving my daughter of her phone so that she cannot play her music and readily have contact therefore LPFT are guilty of discrimination. I will need all your reports Into your investigation of the alleged incident where Police were called on Xmas Day and to know that staff themselves who reported “concerns” have completed a Section 9 statement as we did. I have contacted the NMC who are taking my complaint very seriously as nursing staff are in breach of their own code of conduct but acting on instructions from a combination of Management, Clinical Lead and of course the person with ultimate control Responsible Clinician Dr Waqqas Khokhar who is acting ultra vires. Please do not assume Fridays as I am unable to visit on set days of the week.
You are acting totally unlawfully.
Yours faithfully
Susan A Bevis
Mother POA and Litigation Friend.
From: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Sent: 29 February 2024 12:17
To: susanb
Subject: LB – Update
Dear Mrs Bevis,
We would like to communicate the following –
- Ward round for E is at 12pm tomorrow, 1st March 2024. The clinical staff involved in E’s care would like for you to attend, specifically to discuss the filming of E’s episodes of distress to allow for further investigation of this with ULHT staff.
- To address your recent concerns around E’s access to her mobile phone, E’s phone access was limited for a fixed period of time as part of a comprehensive care plan that considered E’s human rights. This was to ensure the response to her phone use did not adversely impact her engagement with, or the efficacy of, her treatment plan. This was ceased on Monday 5th February 2024 following a review of all of the relevant factors. To clarify this further, E’s phone is kept securely by ward staff, but E is able to request to use her phone at any time. In addition, ward staff regularly encourage E to use her phone to maintain contact with family.
- Please be advised following your recent visit to Castle Ward that supervised visits to Castle Ward will be facilitated once a week, for one hour at a time. To request a time slot for visitation, please email the care concerns inbox. The inbox will confirm the date and time for the following week’s visit each Friday. All visits must be pre-arranged.
Kind regards,
The Mental Health Act Team.
Damning reports on patient care attached. One states that “patient neglect is a breach of the most fundamental medical ethics of all ‘first do no harm’.
LPFT have denied Elizabeth the medical ethic of autonomy and benificence by not getting her fully examined and monitored.
Their obsession with what she might be telling me at the expense of her care is a gross breach of the most fundamental of all the Principalist ethics of Beauchamp & Childress.
Here are examples of abuse from both Enfield and Lincolnshire:
My daughter was abused in the former area under both hospitals and supported living which is why I moved as I wanted her to be in the right environment like I provided briefly under and to give her a fresh start in what I thought was the right environment. I had challenged care in the community in a supported living scheme where things went wrong. There was no honesty and no rectification of anything in the circumstances. Everything stemmed from there onwards. Elizabeth had been subject to institutional care on and off where not once when things went wrong did anyone raise their hands.
The Discharge Note stated “Abnormal Findings on Scan pointing to CNS twice. I have not been unable to get an explanation?
Upon moving we have been subject to extreme bullying because I have continually asked what the scans meant done by former area. When I discovered Dr Shahpasandy of Ash Villa did some fantastic research on the Limbic System I asked if Elizabeth could be included. I was then faced with no end of excuses. It was as though none of these doctors (Psychiatrists) wanted her to have the research that discovered that a former patient did not in fact have schizophrenia but inflammation of the brain and needed a different form of treatment and as a result of that became better. That is all I have ever wanted for my daughter to be properly pathologically tests since according to past file copies, it clearly says “Anterior Region Medial Temporal Compromise and so I checked what this meant and I was told “well done” by Headways that MH professionals training did not go nearly far enough to be able to conclude on neurological conditions, she was a former MH nurse. This puts into question the training for a start and that why isn’t training under MH more comprehensive and that it should in fact go much further in order that patients are not dismissed for underlying physical health conditions that may need a different kind of medical treatment.
Because I have dared to question I have been subject to bullying – extreme bullying. I was told “I am displacing you as NR” I thought not again as I have had a lifetime of this kind of treatment. It would appear all you have to do is to challenge in order to be the subject of bullying and various people including carers and former patients have tried to advise me that I should go along with everything but how can I when people are dying from being misdiagnosed and not having the right kind of treatment because the NHS is failing to look properly into neurological and underlying physical health conditions which could be autoimmune, could be endocrine dysfunction, thyroid, infection. It is very wrong to give someone a label for life and not be open to consider that there may be underlying physical health factors that need proper investigation.
Just now I have been on the phone to Ron Coleman. Both he and Karen Taylor through “Working-to-recovery provided wonderful care at their home on the Isle of Lewis. This care took my daughter to Spain and all over France and then to Australia, the account of this is on the Rightful Lives Website. She was in a terrible state before going away but came home unrecognisable. I will be forever grateful to Working-to-Recovery and thanked Ron Coleman for his wonderful care today and how the entire family took my daughter to the most wonderful locations and tried to work properly with her for the first time ever UNLIKE THE NHS. Unfortunately the NHS is rife with bullying and what I am finding right now is that staff are acting ultra vires. When my daughter returned home from Australia she wanted a job, she was totally unrecognisable as she had psychotherapy but because my shocking area of Enfield provided nothing she went downhill again. How I wish she had stayed forever in Australia. If I never saw my daughter again I would be happy in the knowledge she was in the right company and environment.
Via the NHS I have been described as someone who is controlling, abusive, aggressive – a vile person. I am not going to defend myself. I will leave it to my readers to decide.
Via the NHS upon moving I have been subject to severe bullying as follows:
First of all they declined to get the treatment up and running which was the clopixol depot leading to her going downhill – even I as just a mother knows that you cannot just stop these powerful drugs in one go.
Secondly they wanted the POA so they tried to make me look abusive – psychological abuse was mentioned. The Public Guardian Office had to investigate and found in my favour.
Thirdly they wanted the role of NR to be given to the social services, a conflict of interest. There followed months and months of litigation where I desperately tried to defend myself but there was no hope under this court because judges do not have the remit to challenge whether someone is really suitable or not. I was threatened constantly with costs as a result. That is known as SLAPPS.
“Suitability” should surely be a parent and carer who visits regularly and who cares. I have no say in anything in terms of treatment as this comes under doctors however I have gone by past file records. I have reports from other doctors who thoroughly dispute the diagnosis and I have noticed how Elizabeth has not been listened to so have done what any parent would do and stick up for her – defend her which has not made me popular. However no-one can dispute the fact that I have tried to help giving everything I have got to my disabled daughter and not expecting anything in return apart from the continuation of the former area’s medication whether I agreed with it or not. It is not that I am saying no-one else cares in the family but I happen to live the closest plus visit weekly. Anyway, the County Court Displaced me and all I will say is noone has effectively acted as NR and social services in any case are “a conflict of interest” and have done nothing to safeguard my daughter during the time at Ash Villa.
Anyway because I dared to challenge I was treated in the same way as present previously at Ash Villa:
phone restricted and visiting 2-1. No leave for months and months on end. Several flawed capacity assessments done not taking into account Principle 4, accident leading to possible injury and the start of the “epileptic fits” which noone knows really what is the cause. Today I have been asked whether Elizabeth agrees to be filmed during an episode. She disagreed. So what now? I personally think she needs to be assessed properly in Sheffield as an inpatient on a neurological ward and where they have the correct scanner ie a Tesla 3.
I am making everyone aware that there is a need for a Tesla 3 scanner at Lincs because a 1.5 does not pick everything up and has been known to miss tumours. All I want is an explanation of what is show on the MRI scans in certain images.
The treatment has been awful for my daughter. She is already held a prisoner but imagine how this would feel when denied basic human rights and proper pathological tests.
She has been treated in a degrading manner for far too long with phone taken away, visits restricted and medical pathological tests flatly refused.
I will add to this blog later to describe what treatment is given to patients under LPFT
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-156/figures/1
BMC HEALTH SERVICES RESEARCH
Reader and Gillespie BMC Health Services Research 2013, 13:156
R E S EAR CH A R TIC L E
Patient neglect in healthcare institutions: a systematic review and conceptual model
Tom W Reader* and Alex Gillespie
Abstract Background: Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error.
Method: The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated:
(1) the definition of patient neglect,
(2) the forms of behaviour associated with neglect,
(3) the reported frequency of neglect, and
(4) the causes of neglect.
Results: Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients.
Conclusion: A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of
i) differences between patients and healthcare staff in how they perceive neglect,
ii) the association with patient neglect and health outcomes,
iii) the relative importance
of system and organisational factors in causing neglect, and
iv) the design of interventions and health policy to
reduce patient neglect.
Keywords: Neglect, Patient safety, Caring, Organisational culture, Systematic review
Background
Patient neglect, defined as “the failure of a designated care giver to meet the needs of a dependent”
1, has become an issue of concern in both North America and Europe
[2,3]. In the UK, this has been driven by media outlets
[4,5], charities
[6], and health regulators
[7]. Headlines such as “Want to know the NHS’s real problem? Ask a nurse for a bowl of cornflakes”
[8], “Shamed hospital accused of leaving dying patients to starve”
[9], and “Can patient neglect be a violation of
human rights?”
[10] capture concerns relating to patient neglect. They reflect public anxiety, with patients and
families making 22,845 complaints to the NHS in 2011on issues relating to staff attitudes, communication, and patient dignity
[11]. Senior politicians acknowledge the issue, and argue that neglect has been “hidden away”
[12] and that healthcare institutions must ensure “every
patient is cared for with compassion and dignity”
[13].Solutions include “reducing stifling bureaucracy” [14],
ensuring nursing staff talk to patients at least “once an
hour” [13], utilising legislation and regulation to ensure staff consider patient’ “wellbeing and dignity”
[15], and making staff sign-up to a “code of conduct” on dignity
and respect
[16]. The solutions reflect a belief that healthcare staff are responsible for instances of patient * Correspondence: t.w.reader@lse.ac.uk
Institute of Social Psychology, London School of Economics, Houghton
Street, London WC2A 2AE, UK
© 2013 Reader and Gillespie; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Reader and Gillespie BMC Health Services Research 2013, 13:156
http://www.biomedcentral.com/1472-6963/13/156
neglect, but they are also contradictory (e.g. reducing
bureaucracy to free staff from form-filling whilst simultaneously increasing bureaucracy to ensure staff care for patients properly), or involve regulating aspects of behaviour that are difficult to measure and assumed to be lacking (e.g. compassion). These contradictions reveal the lack of a clear understanding of the nature and causes of patient neglect.
High-profile scandals have made patient neglect a key issue for policy makers. Scandals have included patients being regularly physically (e.g. left malnourished, dehydrated, in pain, and unwashed) or emotionally (e.g. being ignored whilst in need, not shown compassion, loss of dignity) neglected by healthcare staff [17-20]. Linking patient neglect to specific metrics of patient harm or clinical outcomes is difficult due to the often complex conditions of patients and their treatment [21]. Furthermore, conducting research is challenging due to the toxicity of the subject (e.g. questioning the abilities, motivation and ethics of staff ) and a media narrative which seeks to blame rather than understand why poor care occurs [22,23]. However, cases such as the Mid-Staffordshire NHS Foundation Trust scandal, where routine and basic failings in care resulted in up to 1,200 patients deaths between 2005 and 2008, show the catastrophic implications for patient care when neglect becomes systemic across an organisation [21,24].
Researchers in medicine, health sciences, and psychology have for some time investigated how institutional processes, clinical environments, and the behaviour of healthcare staff influence patient safety [25]. These investigations have resulted in interventions (e.g. team-training, care bundles, skill validation) to reduce medical error and improve clinical outcomes [26]. Although they might be expected to reduce patient neglect, it appears necessary for practical (e.g. to meet public and political concerns)
and conceptual reasons (e.g. to develop suitable interventions) to distinguish patient neglect from unintentional error, or intentional abuse. This is because reports on neglect such as those cited above often refer to: i) staff behaviours that may not directly lead to patient harm (e.g. not aiding patients to go to the toilet), but are crucial for care and probably do not reflect a competency gap; ii) staff attitudes and behaviours towards patients that cannot be regulated or easily measured (e.g. compassion); iii) a mixture
of causal factors leading to patient neglect, some of which indicate neglect to be unintentional (e.g. due to a lack of resources) or alternatively not related to error (e.g. rudeness) [27]; iv) differing beliefs between patients, families, and staff as to whether neglect has occurred (e.g. for loss of patient dignity) and the causes of neglect; and v) breakdowns in institutional structures (e.g. communication between staff and management) that are a prerequisite to introducing interventions to improve care [26]. This article reviews the research literature on patient neglect, and interprets this work within the framework of organisational and social psychology. This structure is utilised in order to reflect the observation that patient
neglect emerges from a complex mixture of organisational (e.g. resources, management) and social factors (e.g. relationships between patients and healthcare staff ). In particular, the interactions and perspectives of staff and patients appear especially important for understanding when and why neglect occurs. The overall aim of the review is to contribute to the public dialogue and academic understanding of neglect. Its specific objectives are to:
1) Review what is meant by patient neglect, and
consider how it differs from other constructs
relating to poor patient care.
2) Describe the staff behaviours reported in studies of
patient neglect.
3) Examine how healthcare staff and patients perceive
neglect (and whether there are differences).
4) Identify the causal factors commonly cited as
leading to instances of patient neglect.
Method
This is the first literature review on the nature and causes of patient neglect. Accordingly no protocol exists to guide the review, so standard protocols for literature review were applied [28]. The eligibility criteria were articles or reports published in English reporting primary data, since 1990, on the occurrence or causes of patient neglect anywhere in the world. In the first instance, the search for articles on patient neglect was framed using Lachs and Pillemer’s [1] (p.437), widely used definition (in reference to neglect of
elderly patients) of “the failure of a designated care giver to meet the needs of a dependent”. From this perspective, patient neglect is behavioural (intentionally or unintentionally failing to meet the needs of a caregiver). The information sources, search terms used, and study selection procedure are outlined in Figure 1.
To evaluate the methodological quality of the research studies, we applied the SIGN system [29]. This provides ratings through which to assess the quality of data collected in quantitative and qualitative studies. The assessments for each study are reported in Table 1, with the quality ratings being the following:
1++: High quality meta-analyses, systematic reviews of
RCTs, or RCTs with a very low risk of bias.
1+: Well-conducted meta-analyses, systematic reviews,
or RCTs with a low risk of bias.
1-: Meta-analyses, systematic reviews, or RCTs with a
high risk of bias.
2++: High quality systematic reviews of case control or
cohort or studies. High quality case control or cohort
Reader and Gillespie BMC Health Services Research 2013, 13:156 Page 2 of 15
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studies with a very low risk of confounding or bias and
a high probability that the relationship is causal.
2+: Well-conducted case control or cohort studies with
a low risk of confounding or bias and a moderate
probability that the relationship is causal.
2-: Case control or cohort studies with a high risk of
confounding or bias and a significant risk that the
relationship is not causal.
3: Non-analytic studies, e.g. case reports, case series.
4: Expert opinion.
The following data extraction exercise was performed.
First, the meaning of neglect was reviewed in each paper. Second, behaviours identified in studies of patient neglect were identified. Third, frequencies of neglectful behaviours reported by healthcare staff, patients, and families were captured. Fourth, causal factors identified
by articles and reports as contributing to instances of patient neglect were extracted. This included the capture of both qualitative data (TR) and quantitative data (AG).
The extracted data were not amenable to meta-analysis due to a mixture of qualitative and quantitative studies being identified. Consistent with similar reviews of literature with mixed forms of data, a narrative analysis was used to synthesise the findings of the review [30,31].
Results
Figure 1 reports the results of the literature review. Ten
research articles were included, with data largely collected in Scandinavia, South Africa, and the US. The
majority of articles used survey methods to measure
staff, family, or patient observations of neglectful behaviours [32-39]. Two qualitative papers investigated staff
perceptions of patient neglect [40,41], and patient perceptions of neglectful behaviours were also of interest
[39,42]. Several studies were conducted in elderly care.
The hand search identified four qualitative UK government reports investigating patient neglect at both individual and unit/hospital level [24,43-45]. Many discussion articles (e.g. on legal issues) and studies of related topics (e.g. patient dignity, ethics) were also identified, and were informative in understanding what is meant by patient neglect. However, they were not included in the review due a lack of relevant primary data focussing explicitly on patient neglect. The number of studies and reports seems to be increasing rapidly, with 8/14 (57%) being published between 2009–2012.
In comparison to the other literatures linking behaviours and outcomes in healthcare (e.g. medical error) [46], the number of studies investigating neglect is limited, and data was mostly descriptive. Quantitati
Doing No Harm: Enabling, Enacting, and Elaborating a Culture of Safety in Health Care
Author(s): Timothy J. Vogus, Kathleen M. Sutcliffe and Karl E. Weick
Source: Academy of Management Perspectives , November 2010, Vol. 24, No. 4
(November 2010), pp. 60-77
Published by: Academy of Management
Stable URL: https://www.jstor.org/stable/29764991
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Academy of Management Perspectives
ARTICLES
Doing No Harm:
Enabling, Enacting, and Elaborating a Culture of Safety in Health Care
by Timothy J. Vogus, Kathleen M. Sutcliffe, and Karl E. Weick
Academy of Management is collaborating with JSTOR to digitize, preserve and extend access to
Academy of Management Perspectives This content downloaded from https://www.jstor.org/stable/29764991
Published by: Academy of Management
Stable URL: https://www.jstor.org/stable/29764991
Executive Overview
Medical error has reached epidemic proportions, and researchers have developed insufficiently sophisticated models of safety culture to match the complexity of the challenge of safety in health care. This has left providers and researchers with an inadequate conceptual toolkit for improving safety. To rectify the resulting crisis we consolidate fragments of management research into a comprehensive and integrative framework of how patient safety is produced and sustained through safety culture. Safety culture involves actions that single out and focus safety-relevant premises and cultural practices that reduce harm. This entails (a) enabling, which consolidates the premises for a safety culture; (b) enacting, which translates consolidated premises into concrete practices that prioritize safety; and (c) elaborating, which enlarges and refines the consolidation and translation. We close by discussing the implications of our framework for future research on key issues such as efficiency-safety trade-offs, interactions among components of the framework, and feedback loops. In the face of competing priorities (e.g., efficiency), organizations often inadequately prioritize safety relative to other goals (Perrow, 1984)* Although safety challenges plague many industries, the problem is especially acute in health care. Health care presents a challenging paradox by pairing the mandate to “do no harm” with mounting evidence that much harm is done in the course of delivering care. In 1999 the Institute of Medicine (IOM) released a report titled
To Err Is Human, in which medical error was citedas the eighth leading cause of death in the United
States (more than motor vehicle accidents, breast cancer, or AIDS), responsible for as many as
98,000 deaths annually (IOM, 1999). A 2002 report by the Centers for Disease Control (CDC)
stated that almost 2 million Americans acquire infections in the hospital, contributing to those
98,000 deaths each year. More specifically, 48,600 central-line bloodstream infections occur annu?
ally, with one third of those patients dying (Buerhaus, 2007). Additionally, an estimated 2% to 4%
of patients (between 670,000 and 1.3 million) fall during their hospitalization in the United States
annually, with 2% to 6% of those falls (13,000 to 78,000) resulting in injury. In sum, as many as 88
people out of every 1,000 will suffer injury or Timothy J. Vogus (timothy.vogus@owen.vanderbilt.edu) is Assistant Professor of Management at the Owen Graduate School of Management, Vanderbilt University.
Kathleen M. Sutcliffe (ksutclif@umich.edu) is the Gilbert and Ruth Whitaker Professor of Management and Organizations at the Stephen M. Ross School of Business, University of Michigan.
Karl E. Weick (karlw@umich.edu) is the Rensis Likert Distinguished University Professor of Organizational Behavior and Psychology at the Stephen M. Ross School of Business, University of Michigan.
Copyright by the Academy of Management; all rights reserved. Contents may not be copied, e-mailed, posted to a listserv, or otherwise transmitted without the copyright holder’s express written
permission. Users may print, download, or e-mail articles for individual use only.
We would like to thank AMP Editor Garry Bruton, Peter Cappelli, Ranga Ramanujam, Jen Vogus, and two anonymous reviewers for thoughtful and constructive comments that substantially improved the quality and contribution of this manuscript. We also thank Aidan Vogus for helping us see the importance of this work.
Psychiatric Abuse UK 