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

2. 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 Smith’s 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 2002:32)

4. 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

5. 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

6. 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

7. 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

8. 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.”

11. 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.

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

13. 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.

14. 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.

15. 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:

17. “I think there is a trickle down effect so that, even if they haven’t 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)

18. The format of inquiry reports clearly had a direct impact on practitioner’s ‘reading’ of them and their likely impact on practice. Their intertextuality with policy documents was also indicated:

19. 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.

20. 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)

21. 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:

22. “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)

23. 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)

24. 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