A linguistics student looks at language used by the NHS Trust whose negligence contributed to the death of her cousin. (Ahead of Wednesday’s Parliamentary debate on Southern Health).
Last year, as a humble final year linguistics undergraduate, I wrote a 12,000-word dissertation on the apologies of Southern Health regarding the death of Connor Sparrowhawk. Connor was my cousin, and before he died I used to read his mum Sara’s blog as a way of ignoring university deadlines. She called him Laughing Boy, LB for short. On the 4th of July 2013, I saw the blog post that started with “LB died this morning.”, and that’s when Southern Health became a massive, unwanted part of my life.
To summarise my dissertation very briefly, I found that Southern Health used language in an interesting way. The effect was a succession of non-apologies, blame pinned on staff for failings, and positive actions attributed to Southern Health.
Rather than focus on the literal content of Southern Health’s statements, I looked at the positioning of the subject and the object in the sentence, and non-apologies, for example: “I’m sorry for what I did” versus “I’m sorry if anyone was offended by what I did”.
Lately Southern Health has been the subject of damning Care Quality Commission reports following the release of the Mazars report in December revealing the extent to which Southern Health had failed to investigate unexpected deaths within its hospitals. The unexpected deaths of people with learning disabilities were the least likely to merit Southern Health’s attention.
I’ve been looking at the language used in statements surrounding these events and I’ve spotted some features that pop up repeatedly, such as suggesting ongoing change, a focus on staff rather than patients, repetition of the curious phrase “not always good enough”, and the non-apology.
Here is some of the language that suggests ongoing and pre-existing change: “improve further”, “further changes”, “continue to share”, “continue to lead”, “keep improving” etc.
Such phrases presuppose that these things have already been happening, and all Southern Health needs to do is simply carry on doing what it has been doing. And so these actions are presented, not as a response to a critical report, but as good work that was anyway in progress.
Unfortunately, these examples appear in the responses to both the Mazars and the CQC reports five months apart, so this apparent action may not be happening as quickly as Southern Health suggests.
Katrina Percy, the CEO of Southern Health, often makes reference to Southern Health’s staff. The most recent CQC report in April 2016 found that Southern Health was still failing properly to investigate incidents, and that inspectors were worried about the safety of patients within Southern Health units. So what did the CEO have to say about these results?
She made a public statement including this sentence: “I want to reassure our patients, their families and carers that I am absolutely focused on addressing the CQC’s concerns and supporting our staff to provide the best care possible.”
Let’s take another look at that.
You might think that patients, families and carers would be more concerned about the persistent and serious issues present in Southern Health hospitals rather than how well Southern Health supports its staff, but Katrina Percy’s concern seems focused on staff rather than the patients who rely on Southern Health.
Percy’s statement goes on: “I am pleased the CQC recognises our staff’s caring attitude to patients” and “this progress reflects the ongoing dedication of our staff”. In a 183-word statement, there was only one reference to “patients” , and the emphasis seems to be placed squarely on the positive actions of staff.
In April 2016, the BBC reported that 12 patients in a Southern Health unit had escaped by jumping from the roof. Southern Health made a statement including this quote: “Our staff are the most important safety feature we have, and they assess any risks […] associated with individual patients.”
In one sentence, Southern Health not only positioned the staff as being vital security elements, but also framed patients as being one of the threats to that security.
The only other mention of “patients” comes here: “At all our units there is a balance to be struck between providing effective security and a therapeutic environment for our service users.”
In the entire statement, patients are framed as needing a calm environment and posing a risk to the security of the unit. Together with the previous statement, these two statements suggest an emphasis on staff over patients, with patients either left out of the discourse or presented as something to be coped with.
It is also worth pointing out that the phrase “service user” is used alongside “patients”. Southern Health is not alone in using this term. Research has found that people prefer to be called “patients” rather than “service users”. To me at least, “service user” seems more appropriate for someone buying a broadband contract or a gym membership, rather than people with learning disabilities or mental health problems who need medical care.
And what about this one?
Our processes, reporting, etc “has not always been good enough”.
In December, the Mazars report was leaked to the press before it was officially published. In response, Southern Health made a public statement that used this phrase: “We fully accept that our reporting processes following a patient death have not always been good enough.”
Katrina Percy also made a statement using this phrase: “We have accepted that our processes have not always been as good as they need to be.”
Mazars revealed that Southern Health had investigated just 4% of unexpected deaths. Yes, 4%.
How might you describe that? Appalling? Lamentable? Shameful? Reckless? Irresponsible?
Which words did Katrina Percy choose?
“We fully accept that our processes for reporting and investigating deaths […] were not always as good as they should have been”.
And: “Our engagement with families and carers of people who have died in our care has not always been good enough”.
Was the phrase accidental? You’d expect public statements on matters so grave to be drafted and redrafted, words carefully chosen.
Linguistically, the phrase “not always good enough” contains what’s known as a scalar implicature, creating a scale of “not good enough” to “good enough”.
Framing scandalous failure as “not always good enough” understates the case and implies that most of the time Southern Health are good enough. After the damning nature of the Mazars and CQC reports it seems insensitive to frame the “not always good enough” actions against actions that are felt to be satisfactory, especially when these reporting processes fail to the point that patients are at risk, and the resulting lack of engagement with families increases the “pain and distress” felt (Katrina Percy’s words).
Let’s look at apologies. On December 10, in a statement made to ITV regarding the Mazars report, Katrina Percy made a cracker of a non-apology: “We apologise to anybody who feels let down by any aspect of our service.”
Let’s break this down: the use of “anybody” rather than “everybody” suggests doubt that anyone needs an apology at all, and the focus on ‘feels’ in “anybody who feels let down” suggests that an apology is necessary only if you felt let down.
In one small sentence, Katrina Percy not only casts doubt on the idea that anyone does in fact have an issue with Southern Health but then puts the responsibility for this feeling on to the people themselves.
Maybe Southern Health didn’t intend to produce these misleading effects. Perhaps the tendencies I’ve identified are just the result of shoddy work.
Whatever the intention, non-apologies, implied change, misplaced focus and minimisations reflect badly on the speaker and can cause real hurt. If you’re sorry that your neglect has contributed to someone’s death, then say so.
Fareham MP Suella Fernandes has secured a debate in Parliament about the governance of Southern Health, scheduled for Wednesday 8 June at 2.30pm. Ahead of the debate, Fernandes told the Southern Daily Echo: “I know many of my colleagues in Hampshire and beyond have expressed serious doubts about the governance of the Trust, and remain to be convinced that the necessary improvements are being made quickly enough.” More on the debate and supporting papers can be found here.