Researching Inquiry Reports and Textually Mediated Relations in Health and Social Care

1
Researching Inquiry Reports and Textually
Mediated Relations in Health and Social Care

• Jo Warner
• University of Kent
• ESRC Research Methods Festival 2008

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Inquiries and Risk

• Inquiries into adverse events make a significant
  contribution to the way risk is understood in
  modern society and the reports they produce
  therefore represent an important textual
  development.

3

• Methodological approach based (loosely) on
  Dorothy Smiths institutional ethnography but
  more specifically the idea of textually mediated
  social relations
• That is, how a text has the power to coordinate
  and concert to hold people to acting in
  particular ways (Campbell Gregor 200232)

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Homicide inquiry reports in mental health
services have played a key role in reconstituting
professional practice in relation to risk in the
following interrelated ways

• Their success in focusing attention on
  individual failings rather than the broader
  context for service delivery
• The creation of a culture of inquiry and blame
  characterised by heightened levels of anxiety
  among professionals

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• The promotion of specific forms of defensive
  practice as good practice
• The association of the category high-risk with
  danger to others rather than other, much more
  common forms of risk for mental health service
  users such as self-harm

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The data

• Documents in the form of inquiry reports
• Policy documents and legislation linked to
  inquiries
• Media accounts of inquiries
• Semi-structured interviews with practitioners

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Analysis

• Analysis of texts in the form of inquiry reports,
  media accounts of events, and policy documents
• Mapping the activation of these texts through
  analysis of themes in interview data

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Daily Mirror 29th April 2008

• Complacency in the justice system left
  schizophrenic Anthony Joseph free to stab an
  innocent man to death, a report revealed
  yesterday.
• Systematic errors which resulted in Joseph
  wrongly being let loose just hours before he
  killed Richard Whelan, 28, were spotlighted by
  the inquiry into the fiasco.

9

• Investigators revealed how Richard, who tried to
  stop the killer throwing chips at his girlfriend
  on a bus, was failed by the authorities.
• They said officials in the courts, probation and
  police were "lackadaisical or nonchalant" and
  showed "apparent acceptance" of breached bail
  conditions.

10
The Guardian 29th April 2008

• The inquiry into the murder of a bus passenger
  stabbed to death by a paranoid schizophrenic man
  when the victim objected to him throwing chips at
  his girlfriend yesterday strongly criticised
  "lackadaisical and nonchalant" attitudes in the
  criminal justice system.

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Anthony Joseph (Peart) Inquiry (Criminal Justice
Joint Inspection 2008)

• Conclusion
• 3.66 We have found nothing in the course of the
  extensive enquiries undertaken as part of this
  review to suggest that the criminal justice
  agencies should have been aware that the
  defendant was likely to commit an offence of
  extreme violence or that he was suffering from an
  extreme mental illness.

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• His record of offending was not strikingly
  different, but regrettably all too familiar to
  those who work within the CJS.

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• 3.67 There is no single or specific act or
  omission in the course of events which can
  properly be said to constitute a predictable link
  leading to the chain of events leading to the
  defendant killing Richard Whelan while there was
  an outstanding warrant for his arrest.

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• However, what we have found is what may best be
  described as a lackadaisical or nonchalant
  approach within the CJS to many routine aspects
  of the handling of cases, the cumulative effect
  of which was to lead to the sequence of events
  which culminated on 29 July 2005.

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How are such texts activated in everyday
practice?

• Predictably, the subject of inquiries came up at
  an early stage in interviews, before explicit
  questions were asked
• Towards the end of their interviews, respondents
  were asked which, if any, inquiry reports they
  had actually read
• They were then asked detailed questions about the
  impact of inquiries and/or the so-called culture
  of inquiry

16

• Communication within teams both informally and
  formally, through in-service training meant
  that practitioners felt the impact of inquiry
  reports even if they had not read them directly

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• I think there is a trickle down effect so that,
  even if they havent read the reports, but people
  doing training have or their managers might go on
  training courses that allude to the reports, so
  there is a slow trickle down (Interview 10,
  female ASW with 4 years experience)

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• The format of inquiry reports clearly had a
  direct impact on practitioners reading of them
  and their likely impact on practice. Their
  intertextuality with policy documents was also
  indicated

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• Interviewer Do you think these inquiry
  reports have any effect on the way you practice
  as an ASW care manager?
• Manager I think the Clunis report has. I think
  that was a very well written report and also a
  very interesting report. I recommended it to my
  student.

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• I was thinking that it balances out very well
  with material that has been written on working
  together with the health service, the Building
  Bridges document government guidance on
  inter-agency working, Department of Health 1995
  and I think because it is written in what I would
  call an entertaining way, it brought it to life
  more, in a dramatic way. It read like a thriller
  to me. (Interview 27, female ASW with 7 years
  experience)

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• Anxiety about being the subject of an inquiry was
  a relevant factor in instituting a changed
  approach to practice with texts such as case
  records receiving explicit attention

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• I think the key thing that really exercises
  everyone about inquiries is that when you start
  to think about if an inquiry happens here with
  me have I covered myself in a way that makes it
  quite clear that I have done my job? Which is
  rather different from doing the job. (Interview
  26, male ASW with 8 years experience)

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• Interviewer An extra emphasis then on keeping
  clear records?
• ASW Yes, keeping clear records, not from the
  point of view of recording the data that is
  needed in order to manage it the risk, it may
  even add an extra tier because you know if
  something goes wrong, someone is going to ask you
  to evidence what you did do and your documentary
  evidence is the way in which you protect yourself
  in an Inquiry. (Interview 26, male ASW with 8
  years experience)

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Conclusion - The organising power of homicide
inquiry reports as active texts is realised
through

• Their intertextuality with media accounts of
  homicide, policy documents and other inquiry
  reports
• Their format in terms of the description of
  events in a linear sequence and a dramatic
  narrative
• The allegorical power of the Clunis inquiry as
  the index inquiry report in socio-cultural
  terms