I’ve not blogged about Connor Sparrowhawk for a good while now; not because I haven’t wanted to, but simply because Sara has enough on her plate without having to put up with my occasionally left field take on the world. But the judgement in the case against Dr Valerie Murphy was profoundly important not just for Connor’s family, but for all people with learning disabilities, and everybody who has anything to do with their lives. It reflects much of what is wrong with the care that people currently receive, and it is likely to reinforce many of the prejudices that shape the kind of medical care and support that our loved ones receive.
It is often said that the way in which we talk about something defines it; but sometimes it’s also about what that language gives us permission to be able to do or not do, and for me one of the most disturbing aspects of this judgement lies in use of the phrase “the difficult field of learning disability”, which was used to justify passing what most people seem to think is a lenient sanction. It’s fair to say that the social media response to the use of the phrase has been one of outrage. People have pointed out that it can be used to undermine the right of people with learning disabilities to good quality healthcare, and they are right, it can be and undoubtedly is. But the problem is that whilst people are right to argue that the use of the phrase undermines the rights of people with learning disability, whether we like it or not the world of learning disability can be difficult. The issue is how we respond to that difficulty.
I knew a young man who was nonverbal; who would sometimes express anger and distress by punching himself in the side of the head. It always had a cause, and was never done without reason, and the reasons were varied. He did it when he had a tooth ache, he would do it if he had indigestion or some other kind of tummy problem. He might sometimes do it if you changed his routine or if you tried to get him to do something that he didn’t want to do. He also did it if somebody he was close to didn’t turn up when he expected them to. Or if somebody he loved was no longer a part of his life. The challenge in trying to get him to stop, was working out what it was that was annoying or upsetting him. Had somebody made him wear a top he didn’t want to wear. Had they made him get out of the bath before he was ready to get out? Had he eaten too much cheese? Was he constipated? Had he fallen in love with somebody who worked with him. Was it pain or some other underlying medical issue.
Sometimes learning disability can be a difficult field and whether or not a person is able to speak for themselves makes little difference. The thing that separates the good practitioner from the poor is how they respond to that complexity. In order to understand a person and make a judgement about their care and support, they need to know them and if they do not have the time to get to know them, they have to draw on the knowledge and expertise of the people who know them best, which will most often be their family. I have seen it done incredibly well by practitioners with very little time and incredibly badly by those with no excuse.
In most forms of residential or hospital setting, practitioners do have the time to get to know people. They have the opportunity to work with families and to develop an insight into an individual’s life and stories. They have the time to work out what the key questions are – and sometimes those questions really aren’t that difficult – had he eaten too much cheese? Is he in love? The challenge is in knowing which questions to ask and if you don’t take the time to get to know the person in your care and if you don’t fully involve the people who know a person best in their care and support, then you are never going to know what those questions are. So maybe the mitigating phrase should have been – learning disability is a difficult field if you don’t get the fundamentals right – but I guess that wouldn’t have been quite as helpful in mitigating Dr Murphy’s sanction.
So, is the sanction lenient?
I suspect it is. Valerie Murphy didn’t get the fundamentals right. She spent little time with Connor, she didn’t respond appropriately to key incidents and self-evidently failed to draw on Sara’s knowledge and understanding of her son. The quality of her practice didn’t make learning disability a difficult field, it made it almost impossible for her to do her job with any hope of a positive outcome for Connor. These factors alone probably should have led to a significantly greater sanction.
But I suspect even that would fail to be any kind of justice for Connor. For any kind of suspension to be appropriate then all of the failings and shortcomings would need to have been born out of medical error. Genuine mistakes on the part of a well-meaning but (like the rest of us) ultimately flawed human being. But anybody who has followed George Julian’s live tweeting will know that much of the defence was too often about what Connor’s mum may or may not have done or said or blogged. As if, in Dr Murphy’s mind, Sara was somehow responsible for all the flaws and all the shortcomings of Connor’s care. And it is therefore difficult not to have the impression that Sara’s knowledge, experience and insight was deliberately cast aside as an act of petty vengeance on the part of a clinician with too much power and too little professionalism. And if this was the case then no kind of suspension or removal from medical register will give Connor the justice that he deserves.
We will probably never know if Valerie Murphy’s practice was as flawed as I suspect it might have been, only she can answer that question of herself.