A psychiatrist’s damning indictment of 500 years of racism – now revived by Trump and 9/11


Suman Fernando. Pic credit: http://www.sumanfernando.com


Suman Fernando is a gentle soft spoken  consultant psychiatrist, lecturer and honorary professor at the London Metropolitan University.    The 85 year old is not the sort of person at first sight to produce such a searing critique of racism in the UK and the US and the baleful role psychiatrists have had in treating ethnic minorities in both countries.

His book released at  the end of last year and launched by ROTA – Race on the Agenda – looks at both the history of racism which he dates from 1492 when the Spanish finally  removed the Moors from Europe and the role of psychiatry in treating ” mentally ill”  black and brown patients over a very long period.

The book is particularly relevant as Theresa May has  quietly decided to review the UK’s mental health laws  which cover some of these issues – signalling her intent by  holding a meeting of psychiatrists at Number Ten Downing Street.

It also comes at a time when the election of Donald Trump, the rise of Islamophobia in the wake of 9/11 and to an extent, the worst excesses of some people supporting Brexit, has seen a revival of popular nationalism and in the US, white supremacists.

He traces racism from the bloody Inquisition in Spain through the development of the slave trade, the rise of eugenics leading to Nazism,  the Imperialist destruction of other cultures by colonisation to the ” rivers of blood” speech of Enoch Powell as Britain faced an immigration wave in the 1960s and 1970s.

His  thesis is that – mainly because of the 1970s race relations legislation in Britain – overt racism has until recently been replaced with a form of institutional racism and psychiatry is no exception to the rule.

Indeed some of the worse psychiatric theories to treat people as seen by superior whites as ” the other” came from this profession. This was the profession that applied the concept of  ‘Drapetomania’  to slaves in the USA, the primary symptom being a persistent urge to run away.  The implication was Black Afro-Caribbeans were supposed to be happy and content as slaves  and had mental problems if they wanted their freedom.

In Britain the book provides numerous examples of how different ways of dealing what is an obvious imbalance in the number of Afro-Caribbeans being sectioned compared to white Britons. Attempts to change treatment or properly research the issue by black psychiatrists were undermined in a typical British way – their work was subsumed by more conventional psychiatrists or their findings were ignored.

He also reveals  how attempts to change matters politically were undermined. Tony Blair  appointed Paul Boateng – now Lord Boateng- as the first minister for mental health in 1997. At the time he was known to be  strident in wanting to change the treatment of black Afro Caribbeans like himself- but within months he was squashed.

Since 9/11 the danger is that racism is on the rise with Muslims rather than Afro Caribbeans as the main target. That is why the timing of this book is relevant in the context that the mental health legislation is being revised. Already psychological research is being used as a basis in the Prevent programme to decide whether teachers or NHS staff, their pupils and their patients, should be reported to the authorities if they show signs of radicalism.

The next slippery step would be to decide that these people are insane – and should be sectioned rather than prosecuted. This is not as fanciful as it sounds. Under  Labour there was a move to classify stalkers of VIPs as a mental illness and Jack Straw when he was home secretary is said to have considered whether paedophiles should be classified as insane rather than criminals.

That is why this book is so interesting because it tells how deep seated racism is among white Europeans  and how insidious the present system is in dealing with the ” other” – from stop and search to sectioning.

The one sad thing is that the book itself has been “Ghettoised” – it has been pigeon holed by the publisher  as part of ” contemporary black history ” when it is much more of an account of how contemporary British and US society has reached such a view on black and brown people.

The German publisher has created another ghetto by price – Palgrave Macmillan have priced it at a ridiculous £67.99 or £53.99 as an e-book. Amazon have a Kindle version at £45.19. So I suggest you try and get it in a public library or if you are a student make sure your university library has got one.

Institutional Racism in Psychiatry and Clinical Psychology. Suman Fernando




Exclusive: Are whistleblowers now too frit to reveal when NHS patients and care home residents are in danger?


Dr Henrietta Hughes, 4 day a week National Guardian Pic Credit: CQC


Tucked away in a recent National Audit Office report on the NHS and social care regulator, the Care Quality Commission, is the extraordinary statistic that the number of whistleblowers who tipped off the regulator fell by a staggering 16 per cent to 7452 in 2016-17. That is one in six fewer whistleblowers than the previous year. See paragraph 2.19 of the report.

The figure compares with 153,000 members of the public – an increase of one per cent – expressing concerns about services during the same period.

I have written about this in Tribune this week.

And the latest figures come after  a report by Robert Francis QC to Jeremy Hunt, the health secretary,which was highly critical of the way some had been treated after they made a complaint.

In 2015, Francis reported widespread severe victimisation of staff by senior management when they spoke up for patients. Francis recognised that sacked whistleblowers are blacklisted and recommended a re-employment scheme but nothing seems to have come of it.

His most substantial recommendation was for a National Guardian to protect staff. This led the CQC to create a part time post with no powers. The first appointee, Dame Eileen Sills, quit before starting.

Since then Dr Henrietta Hughes . a GP has been appointed  as National Guardian, on a four day week. And according  to the CQC  yesterday marked her first year as the National Guardian for the NHS with the publication of her first case review report and her annual report highlighting the work of Freedom to Speak Up Guardians.

The one case review she published covered Southport and Ormskirk Health Trust which  has the unenviable reputation for bullying and discriminating against black and ethnic minority staff , a dodgy appointments system favouring some people against others and an attitude of not bothering when staff raise concerns about patients. This might sound familiar incidently for those who have followed my articles on staff practices at the Equality and Human Rights Commission but we should wait for the employment tribunals to see what happened there.

Dr Hughes has recommended a series of recommendations to put matters right – 22 in all – and there is promise from the interim chief executive of the trust, Karen Jackson, to act  with a new senior management team. We shall see. Also this was a trial – how many reports are we going to get from her in future?

The National Guardian has also produced a series of high flown documents which sound terribly good in theory – but again I think we should wait to see what happens.

What has happened so far is that the appointment of a national guardian has coincided with a drop in whistleblowers telling the CQC when things are going wrong.

What we do know is that staff do lose jobs are blacklisted and get the reputation of being troublemakers. There is a  website which covers 11 such cases here. All designed I suspect to cover up an NHS and care system creaking at the seams and not being adequately financed. I hope Dr Hughes does not turn out to be a convenient fig leaf for a service in trouble.


Gag, cover up and secret privatisation: What is the real story behind the NHS clinical correspondence scandal


NHS archives. Pic credit: Health IT Central


A week ago the media was full of the huge scandal of over 700,000 clinical correspondence documents – including details of sensitive patient conditions – going missing and  instead of being delivered to GPs being dumped in rooms.

The story was originally broken by the  Guardian in February this year which revealed that NHS England was secretly working on how to sort out it  without disclosing the scandal to the public. Jeremy Hunt had made a perfunctory statement to Parliament in 2016 not disclosing the full state of affairs in July 2016.

Last week the National Audit Office published a very thorough investigation into the scandal – including discovering that somehow the NHS also lost  highly confidential reports dating back to 2005 which identified children subject to child protection orders which must never be disclosed to the public without the individual’s consent. And in 1788 cases it look possible that patient treatment could have been harmed as a  result.

The mislaid and unprocessed correspondence covers GPs and now abolished Primary Care Trusts in the East Midlands, North East London and South West England .

The NHS has paid GPs £2.6m up front  to examine the mislaid documents but they have yet to complete the work so a proper picture can still not be obtained.

In one bizarre incident some 205,000 documents were kept in a room marked “ clinical notes”. The report says: “A subsequent review found that the label had been removed by an SBS general manager because “you don’t want to advertise what’s in that room”.

“ NHS SBS told us that it was important that documents were held securely and therefore not having a label on the door was appropriate as part of this.”

Now this scandal is bad enough but in the small print of the National Audit Office report there lurked another extraordinary scandal – SBS  and its auditors, BDO, decided to frustrate the National Audit Office finding out what had gone wrong.

Both the company and the auditor refused to hand over the files unless the National Audit Office signed an indemnity letter – which  could get them off the hook should enraged patients decide to sue them for their negligence.

The NAO to its credit refused to do so and in its own report says, if it had, Parliament would not have been told the full story. As the report says:

“NHS SBS and BDO felt unable to share with us their reports into the incident unless we also signed a letter (which would indemnify them). This is common practice among audit organisations.

“We declined to sign any letter that would limit our ability to report on the incident.”

Instead the NAO used its statutory powers to force NHS England, which had copies of the documents after signing the indemnity letters, to hand them over.

Now NHS Shared Business Services was set up as a joint venture with the private sector  under the Blair administration in 2004 when John ( now Lord ) Reid was health secretary. It was an equal partnership between the  Department of Health and Xansa Ltd,a British outsourcing technology company 50 per cent owned by the staff. In 2007 it was taken over by Steria, a French  rival, with British staff pocketing millions of pounds as the French paid a 70 per cent premium on the share price.

In 2014 Steria merged with another French rival Sopra creating a French owned global conglomerate. They are now planning to take over a Swedish firm

But two years before Andrew Lansley, then secretary of state for health, quietly and without any public announcement, transfered a single share to the French company, so it became the majority owner and could dictate policy. Just to make sure the Department of Health, which had civil servants on the board, declined to take up the directorships on the grounds of ” conflict of interest”.

I asked BDO and NHS Shared Business Services why they had sought to frustrate the NAO.

BDO replied putting the onus on the privatised company  saying :

“BDO was in no way obstructive or concerned about making its reports accessible to the relevant third parties.” BDO has a contractual duty of confidentiality to clients as well as an ethical duty of confidentiality under the Code of Ethics of the Institute of Chartered Accountants in England & Wales (ICAEW). Therefore, unless required by law or regulation, we cannot disclose information to third parties (such as the NAO) without the express permission of our client. 

The letters dealing with obtaining the necessary consents and agreeing the basis for access are drafted in accordance with professional guidance issued by the ICAEW. As the NAO report acknowledges in its report (paragraph 3.19), this is “common practice among audit organisations”.

 Patients of the NHS are not a party to such letters and therefore their legal rights are completely unaffected.”

NHS Business Shared Services said :

“The recent NAO report highlights a number of failings in the mail redirection service provided to NHS England. We regret this situation and have co-operated fully with the National Audit Office in its investigation. All of the correspondence backlog has now been delivered to GP surgeries for filing and NHS England has so far found no evidence of patient harm. NHS SBS no longer provides this mail redirection service.”

There appear to be contradictions in both statements.  I gather the safe delivery of clinical correspondence  is now in the hands of Capita.


Why we need disability campaigners like Lord Rix now

Lord Rix pc credit BBC

Lord Rix who died this week aged 92


The sad death recently of Lord Rix highlighted how much progress a determined individual can make in a particular field.

As well as being famous for his slapstick comedy Lord Rix went on to have  a second career fighting for people with learning disabilities ending up as a vocal champion in the House of Lords

I knew Lord Rix in the 1980s when I was social services correspondent of The Guardian and he became secretary general of Mencap, the charity which campaigns for people with learning disabilities.

At the time there was enormous stigma attached to people who were then called mentally handicapped or even worse, Mongols, which was both derogatory and racist.

Most of them at the time were locked away in a network of hospitals for the mentally handicapped which people often confused with hospitals for the mentally ill.

Reports on the treatment and living conditions for people with learning disabilities  and people with mental illness  in these hospitals were then kept confidential. Believe it or not, not only confidential, but protected by the Official Secrets Act, opening a person to prosecution if they were published.

It was then that Lord Rix and myself decided that this should stop and the living conditions for these people should be revealed.

We set up about collecting as many official reports on conditions in these hospitals as possible – both for the mentally handicapped and the mentally ill- and then in one fell swoop the Guardian published a front page news story and a summary of each report.

The reaction to disclosure of official reports was to re-open with a vengeance why these people were being locked up and kept in very bad conditions – without much privacy in neglected hospitals tucked away in rural areas.

I even discovered some people who had been placed in a Lancashire hospital way back in the early twentieth century and diagnosed as  “mentally ill ” because they had illegitimate children – something that is complete anathema in the 21st century.  They were so institutionalised that the hospital was creating flats on its premises – in the hope that they could go back to live in the community. They had to learn how to boil a kettle.

To his credit the response of Kenneth Clarke, then the health secretary, was not to order an investigation into the leaks but to scrap the provisions of the Official Secrets Act that banned their publication. It also speeded up the movement of people with learning disabilities into the community.

Lord Rix who has rightly received many accolades was extremely brave in helping with this enterprise –  and changed the debate.

Today enormous progress has been made but I feel with need a new generation of campaigners to fight disability on a wide range of fronts. The disabled – not only with learning difficulties but with physical challenges- are still facing neglect by the NHS and social services. Government cuts in benefits  are designed by this pernicious government to penalise the disabled and limit mobility. The British tabloid media with an agenda that many disabled people are scroungers or frauds does not help. They will need to be particularly vigilant with Britain leaving the European Union – as many of the disabled friendly advances have been made on the back of EU legislation.

The new challenges are as big as the old.


How the NHS wasted £16m of your money on a botched privatisation that collapsed within months


Meg Hillier MP:,chair of the Commons Public Accounts Committee, condemned the failings in the scheme


New ways of  helping the elderly and mentally ill survive in the community and not continually end up in hospital is a cornerstone of government policy.

So when a limited liability partnership offered a cash strapped  NHS commissioning group an initiative which promised better services for these people and could save them £178m over five years it sounded too good to be true.

The trouble is it was. As a devastating report from the National Audit Office reveals today the £800m scheme  ran into trouble just four weeks after it was launched and collapsed seven months later. You can read the full story on the Exaro website.

The scandal of the £800m scheme run by UnitingCare Partnership for Cambridgeshire and Peterborough clinical commissioning group may not be an isolated instance.That is why sources at the National Audit Office have highlighted it in their report – because it exposes an alarming lack of financial expertise inside the NHS and a flawed system to monitor whether projects like this are financially feasible  andcan  be properly checked.

The promised aim of the project was to establish  tapering payments to the partnership – with £152m up front and less money later, ¬ so that the financially challenged commissioning group could put money to better use.

But within four weeks of starting the contract the partnership was asking for an extra £34m, blaming a delay by the commissioning authority in starting the work. When the money was not forthcoming the scheme collapsed after eight months and the NHS was forced to provide services directly.

The NAO report reveals that despite employing reputable financial companies and lawyers, basic errors were made – including a failure to realise that sub-contractors could not recover the VAT from the partnership – a cost that had not been factored into the contract.

Auditors also report that nobody had overall oversight of the contract.

No wonder both Amyas Morse, the head of the NAO, and Meg Hillier, the Labour chair of the Commons Public Accounts Committee have been withering in their criticism.

Amyas Morse said: “This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen.”

Meg Hillier said: “The result is damning: a contract terminated before the ink had even dried out, at an unnecessary cost of £16m.”

What is disturbing is that the NAO point out that Monitor, the body which checks health bodies, had no locus to check whether the scheme was viable and NHS England were too remote to act.”

The report says: ““No organisation was responsible for taking a holistic view of the risks and benefits of this approach, or considering whether the anticipated longer‐term benefits were sufficient to justify additional short‐term support.“

What is really disturbing  is that £16m was wasted -plus £8.9m  on setting up a complex tendering operation and start up costs.

Far better to have spent this extra money on patient and community care – instead of throwing our money down the drain on a scheme that anyone would have thought to be too good to be true.


A worrying indictment of how child sex abuse cases are handled today


This week the inquiry into historic child sexual abuse under New Zealand judge Lady Justice Goddard will start preliminary hearings which could last years. On Wednesday it starts with a hearing into allegations against the late Lord Janner. The following Wednesday there are two short sessions looking into abuse inside the Anglican Church and at Knowl View and other venues in Rochdale and on Thursday March 24  into child sexual abuse of people in the care of Lambeth Council. The details are here.

Last week a report came out from the United Kingdom  Child Sex Abuse People’s Tribunal- a very small scale investigation that took evidence from 24 people covering different types of sexual abuse with families, institutions and paedophile rings. What comes out – apart from horrific stories from the testimony of individuals – is a system not capable of sensitively handling the issue. As it says in this paragraph:

people's tribunal two

That to my mind  is as important as the recommendations reported on Mail On line by  the Press Association here . These include a permanent commission,provision of advocates to survivors  proper links between mental health and  police investigating abuse  and a safe channel for victims yo give evidence anonymously.plus better training for police, the judiciary and the health service to handle cases.

This report deserves to be taken seriously as its steering committee was composed ,mainly of survivors themselves  aided by professional advisers and two experts, Regina Paulose, an American lawyer and former prosecutor and Alan Collins, a British solicitor with enormous experience in handling child abuse cases from Jersey’s Haut de la Garenne inquiry  to Australia and Kenya.

If the Goddard Inquiry really wants to tackle the issue they could  not do much better than take  this on board  when they start their hearings.

The full report can be found here.






Sneaky and Naive: The Department of Health’s plan to raise care home inspection fees

Care quality Commission


While MPs were enjoying their Christmas break the Department of Health sneaked out a consultation paper planning a massive increase in compulsory inspection fees for care homes, privately provided ambulance services and hospitals.

As part of the spending settlement the ministry has decided to recoup the present £120m  a year subsidy given to cover compulsory inspections made by the Care Quality Commission. Altogether the ministry want to recoup some £780m over a ten year period. I have written about this in Tribune magazine

There is a subsidy is because the CQC has had to up its game and do more through inspections after the scandals exposed by  the Robert Francis report into Mid-Staffordshire NHS Foundation Trust and the Winterbourne View private home for people with learning difficulties exposed by BBC Panorama.

The Treasury wants to abolish this subsidy on the grounds that it must recover all the costs of inspections rather than part of them.. Superficially this sounds fine as NHS trusts will not to have to pay for the inspection of their own hospitals and ambulance services. Neither will 94 per cent of GP surgeries.

However increasing privatisation and outsourcing of services by local authorities and health trusts to private firms means that the bill for the inspections which already run into thousands of pounds could fall on councils and trusts who commission the services.

The paper reveals that 90 per cent of  care services are already privatised and privatisation is increasing in the NHS with private ambulance providers becoming the norm and mental health provision and other services being outsourced.

To try and justify this civil servants have tried to tell ministers that this could have nil effect on health provision.

This naive view is bolstered by the belief that care homes s will accept a cut in their profits to prevent an adverse health outcome caused by councils and health trusts having to cut the number of people sent there because of the increased cost of inspection fees.

This is contradicted by negotiations for the present year’s fee increases. The paper says:

“There is a risk that any increases in fees could have a destabilising effect on providers, as many providers are facing a tough financial climate, with increased running costs and reductions in income. During the CQC’s consultation into their fee levels for 15/16, 80% of providers opposed the proposed 9% fee increases for this reason. “

This is hardly surprising given that to run a care home on a profit, they already pay staff little more than the minimum wage and cash strapped councils are unlikely to pay them any more for residents. It puts into question whether running a care home  is a suitable business for the private sector. Soon they will soon have to pay the living wage. So would anyone believe they will absorb higher inspection fees into their profit margins.


The paper also discloses that the review will mean they will cut inspection fees for private dentists as they make a profit. It then naively assumes that the dentist will pass on the saving to patients. Does anyone believe that?

Whoever drew up these proposals cannot really live in the real world – no wonder ministers are told what they want to know rather than face reality themselves.