I’ve written about apologies before, about the value of candour, about non apologies, the othering of learning disabled people and allegedly inquisitorial inquests.

Today I’m more than a bit disappointed, but if I’m honest not surprised, to add Dimensions UK to the list. This is a post I wrote before Sally’s inquest started. In it I detail my own working relationship with Dimensions. Whilst I have questions around the timing of the work, including being asked to work on a guide for bereaved families on the day that Sally died, it didn’t cross my mind that relatively new CEO of Dimensions, Rachael Dodgson, would be so evasive.

In a pre-emptive strike before Sally’s inquest, Ms Dodgson shared a press release on the Dimensions website, hidden away in the press release section, not on the front page on 9 May 2023. This is what it said:

From 24th May we will be listening to the findings from an inquest regarding the death in 2017 of Sally Lewis, a woman we had supported for many years.

At this time, our thoughts are once again with Sally’s family.

Sally’s death has had a profound effect across our organisation, and particularly on the colleagues who supported her for twenty years and felt her death sharply. As we have done already in public and in private, we would like to take this opportunity to offer our sincere condolences again to Sally’s family for their loss.

The circumstances surrounding Sally’s death have previously been investigated by various organisations and we have co-operated fully with these.  Our own understanding of the situation was described by our then-CEO back in January 2018 as part of our efforts to raise awareness of the risks of constipation; you can read about this here.

We will not be commenting further before or during the inquest. This is because we will be listening carefully to any new findings coming out of this inquest, and considering any further actions we could take to keep the people we support safe.

We will reflect on all the information that is shared during the inquest and will update this statement with our response once the inquest has concluded.

Just a few thoughts about this statement, before we even go near the one issued yesterday when Sally’s inquest concluded.

Para 1: listening to the findings – this attempts to paint Dimensions in a passive role, mere innocent bystanders. The reality of course was that there were 23 witnesses giving evidence at Sally’s inquest if you include the CQC inspector, of those 23 witnesses, 15 of them were employed by Dimensions at the time of Sally’s death. Dimensions were obviously, given how and where Sally died, the most significant organisation to give evidence to the court. They, and their Operations Director Julie Campbell who was an Interested Person in her own right, were both represented by Kings Counsel, and Mr Hassall KC for Dimensions asked questions of every witness who gave live evidence (as is his role, there’s nothing unusual or wrong about that) but it is ridiculous to suggest Dimensions would just be listening.

Para 2: I have spoken with Sally’s sister, Julie, and she was never sent this statement. How is it possible to claim your thoughts are with Sally’s family, without telling Sally’s family? Julie also told me that Rachael Dodgson approached her at lunchtime on the first day of Sally’s inquest, as soon as she set foot outside the court room and she told her that she didn’t wish to speak to her at that point. In case anyone is wondering how they could be better, an easy way around this, rather than pouncing on bereaved relatives without warning, is to get your legal team to speak with theirs, and ask whether they’d like to speak with you.

Para 3: Centring staff and Dimensions and their feelings about Sally’s death. Personally I don’t think there’s ever a time for an organisation to make such statements in their press releases. Of course the CEO of any organisation will be thinking of their staff, they’d have to be pretty narcissistic not to, but you don’t need to be telling the world about it.

Para 4: Of course you’ve engaged with other investigations, why on earth wouldn’t you? Whether you fearlessly sought to get to the bottom of what happened and understand how Sally came to die is another matter. Remember the evidence of Deborah Hubbocks, author of the internal Dimensions ‘investigation’ after Sally died, who agreed with the coroner’s suggestion that she’d just accepted what staff said, rather than scrutinising their answers. A classic example of performative scrutiny, a lot of being seen to respond, activity without scrutiny.

Ms Dodgson then says that “their own understanding” was written about by Steve Scown in January 2018. This is the blog post that Julie recalls Dimensions asking if they could write about Sally, her agreeing providing she saw it first, but nothing being shared with her.

This statement suggests it’s all very innocent sounding, until you realise that despite Dimensions’ own internal investigation being very light touch, it *did* identify that staff had failed to give Sally, her as required Laxido medication for 10 months before she died, that it *did* identify that audits weren’t being conducted by staff or managers, it *did* identify Sally had a missed dose of Senna that staff failed to give her 4 days before her death, and *it did* identify that there were only three recorded bowel movements for Sally in the 10 months preceding her death. So it’s not at all accurate to say that Steve was offering Dimensions’ understanding, for him to suggest it then, or for Ms Dodgson to say it now. It’s simply not true. We also heard in court from Julie Harris of Worcestershire County Council Adult Safeguarding Team that they’d opened their investigation in January as a result of a complaint made by Sally’s sister, Julie, so again, not true that Dimensions understanding was all so light touch and accidental, a mistaken gastric bug.

Paras 5 and 6: Pointless, again situating Dimensions as innocent bystanders just waiting to listen.

After Sally’s inquest how did Ms Dodgson and Dimensions respond? I’m sure that it won’t surprise you to hear they issued another press release, hidden away again, not on the front page, and as Terry, Sally’s brother pointed out, not shared on their facebook pages either.

It’s entitled: Our response following the inquest into the death of Sally Lewis and rather bizarrely it has a large photograph of the CEO Rachael Dodgson on it. Which is the first indicator that this is in no way either sensitive to Sally’s family, or had been in any way run past them. I suspect if there was a genuine apology anywhere to be seen, if it had been shared with Sally’s family, that they’d have provided a photograph of Sally, but instead we get to look at Ms Dodgson. The text is as follows:

“The way we supported Sally Lewis in respect of her constipation simply wasn’t good enough. We could and should have done better. For that I am truly sorry and would like to apologise again to Sally’s family.

Our last CEO previously set out what had gone wrong, based upon our understanding at the time. The inquest has undertaken a deeper examination of the circumstances surrounding Sally’s death; it is clear that our processes, systems, management oversight and day-to-day support for Sally’s bowel management were not what they should have been.

That was almost six years ago and, in that time, a huge amount of organisational energy has gone into making things better. In the second half of this blog I am going to talk about what is different at Dimensions now and, just possibly, what others can learn from our experiences. But first, I want to talk about Sally, who is the most important person in all of this:

We supported Sally for 20 years. Sally was known to be at risk of constipation. Her medical records and prescriptions made that clear. And yet bowel monitoring was not done consistently and robustly.  Yes, there were some ticks put into some boxes but not routinely, and whilst our colleagues verbally discussed Sally’s bowel movements between them, that wasn’t enough to make sure they, or Dimensions’ management, understood what was happening.  We did not make our expectations to colleagues sufficiently clear in terms of recording.  Furthermore, our systems and processes to check the quality of records and support weren’t delivered effectively.  And this meant that nobody put all the pieces together. When Sally died, no-one around her realised she was constipated. And as a result, she hadn’t been receiving her PRN (“as needed”) medicine.

From the start we have said that one of the key issues here is how to balance individual dignity, privacy and rights with safety.  Sally found it difficult for people to accompany her to the bathroom and this could trigger significant behaviours of distress for her.  This meant that we couldn’t monitor how often she opened her bowels and the consistency, size and shape of her faeces. That issue stands but the key issue here was our acceptance of this. We should have raised this as a risk with her GP, the care manager, her family and with all those around her so we could work together to identify a way forward. I don’t think we did enough to help Sally herself understand why it was so important to be accompanied to the loo. And I don’t think we did enough to ensure our colleagues supporting her understood clearly the risks associated with long term constipation.

I would like to turn to what is different at Dimensions now. Sally’s death has had a profound effect upon our organisation, and we didn’t wait for the inquest to identify the lessons we needed to learn, although following the Coroner’s findings we will reflect and consider carefully if there is any more we can do. We acted swiftly to make the necessary changes. We now have mandatory training for everyone supporting a person at known risk of constipation. We have a Bowel Toolkit which includes bowel management plans, improved bowel recording charts, a constipation screening and referral tool, guidance on how to prepare for a constipation appointment and more.  It is an organisational requirement that all people we support are regularly screened for constipation and bowel health. Specialist advice is available from our Health and Wellbeing Lead.

Our electronic daily records system which is now fully embedded means it is much easier for managers to scrutinise all records relating to the people we support.  And families also have access to these electronic records at any time from their own homes.  There are, simply, many more pairs of eyes able to see what is going on.  And we know that partnership working with families and loved ones results in better outcomes for the people we support.

Constipation is now one of seven ‘Never Events’ at Dimensions. Never events are a well-known concept in the NHS. Quite simply it means that, with the right training, behaviours, systems and processes, an incident that carries a potential risk of harm, injury or death should never happen. Specifically, at Dimensions, we say that “No one should suffer any harm as a result of a failure to administer or monitor the medication prescribed, or to follow established processes, for the relief or avoidance of constipation.”  And we work to provide the right training and processes, and ensure the right behaviours, accordingly.

Our CQC registrations, previously held at Operations Director level, are now held by Locality Managers across our organisation to ensure that those directly responsible for the oversight of delivery of individual care and support are closer to the people we support. That’s a critical change; if any providers reading this have yet to make a similar change, I urge them to do so.

We have also undertaken a great deal of work externally to raise awareness of the risks and issues surrounding constipation for people with learning disabilities, to enable us and others to do everything possible to keep people at risk of constipation safe and well:

We produced an animation for our colleagues which has been used by the NHS, and this accessible book, funded by Dimensions and co-produced with Beyond Words.

Many colleagues have also devised extraordinarily creative ways of delivering what we continue to believe is a very important message, and one that we will continue to deliver. Sally’s inquest is an incredibly sad but important and timely reminder that we must always make sure support plans are clear, followed by our colleagues in how they support people, and that checks take place to ensure all those things are happening, whether that’s in relation to people’s bowels or any other areas of support.

I will end this by simply saying, to Sally’s family, I’m truly sorry.  Nothing can bring Sally back but I’m determined that we will continue to do all we can to minimise the risk of this ever happening to anyone else.”

Rachael Dodgson, Chief Executive, Dimensions

Eurgh. Where to even start.

Para 1: I’ll start by pointing out that any meaningful apology would start with a meaningful statement of regret. When a coroner has ruled your organisations neglect caused someone’s death, that they simply would not have died if your staff had followed the instructions given to them by a GP, if staff had made meaningful records of Sally’s bowel movements, if your managers, Julie McGirr and Julie Campbell had actually done any managing, if they’d audited the records that staff weren’t completing effectively, that Sally was wholly dependent on you for her care, and she was let down in a gross and basic way, that’s what you need to acknowledge. Your neglect.

That’s what you’re remunerated over £180k a year to take responsibility for (see here, page 54). Whilst Sally’s bereaved family members have to fundraise to cover their legal bill, and my reporting happens thanks to crowdfunders who want the premature and preventable deaths of learning disabled people to receive the public scrutiny they deserve.

Could and should have done better, what utterly offensive understatement. As for suggesting you’d like to apologise to Sally’s family, if you really wanted to do that, you need to do it in person, to them, if they want to hear from you, not to the media. This is an almost carbon copy of how Southern Health behaved at the end of Connor Sparrowhawk’s inquest, there is a brilliant video of Victoria Macdonald of Channel 4, challenging Lesley Stephens on that.

Para 2: Steve’s blog again, see comments from the pre-inquest statement above, except this time Ms Dodgson goes even further, claiming that the inquest had uncovered the neglect through a deeper examination. Except “it is clear that our processes, systems, management oversight and day-to-day support for Sally’s bowel management were not what they should have been” and Dimensions knew *all* of that in January 2018 when Deborah Hubbocks had concluded her half hearted investigation. Before Steve wrote his blog post, which cherry picked which findings to share. This is digging yourself into an even deeper hole of denial.

Para 3: All a long time ago, move along now. Enormous organisational energy in addressing things, whilst simultaneously investing a lot of time, energy and money in trying to sink the CQC criminal prosecution on a timescale technicality. Not mentioned at all in Ms Dodgson’s statement. The convenient partial non-apology narrative. Then she says she’s going to talk about Sally, the most important person in all of this. The person who is dead, due to their organisation’s neglect.

Para 4: The next paragraph doesn’t talk about Sally at all, beyond saying Dimensions supported her for 20 years. It talks about them and their staff, like they after all are who are important in this.

Para 5: Talks about Sally, negatively. A classic example of victim blaming. A half hearted apology, that Dimensions didn’t do enough to help Sally help herself. Woooooo there. Just stop. I wonder when the last time Rachael Dodgson had a colleague or a learning disabled person or their family member accompany her to the bathroom to scrutinise her bowel movements. The way in which Sally’s alleged wish for privacy has been bandied around at Sally’s inquest has gobsmacked me on a couple of occasions. Who on earth would want to have their bowel movements monitored, Sally wasn’t unreasonable in reacting negatively to being accompanied to the toilet, and given how constipated she was for the entire final 18 months of her life, is it any wonder she didn’t want someone stood in a doorway, watching her, putting her under pressure when she would have already known that opening her bowels would likely have been extremely painful and non productive. There is no room in an apology for blaming Sally.

I can’t even face commenting on the rest of the statement, a lot of activity, but from what I’ve heard from the families who’ve been in touch with me since Sally’s inquest started no real change on the ground. It’s almost like reputation is king.

When I’ve recovered from the last week I’ll write about the extremes that Ms Dodgson and her instructed legal team went to to ensure that the CQC’s prosecution of them and Julie Campbell was unsuccessful. You can then judge for yourself whether this is a learning organisation.