Presented at the Dementias 2017 conference which was held in the Royal College of General Practitioners in London on 9th and 10th February 2017.

1. Barbara Robb
and
Sans Everything:
50 years on
CLAIRE HILTON
2017

2. Powick Hospital: Ward F13 (1968)
https://www.youtube.com/watch?v=UzjeBaBFWqw

3. Then and now
The work of Barbara Robb (1912-76)
her book Sans Everything (1967)
the outcome of her campaign (1965-75)
and why it is relevant today…….
 abuse continues
 overcrowding
 overcautious supervising
 whistle-blowers and whistle-blowing

4. Barbara: in the driving seat
Women role models in her
family….
a Catholic martyr
an opera singer
a magistrate
campaigners
authors
Aunt Ernestine - in first ever
Yorkshire women’s cricket team.

5. With grandfather Ernest c.1922
‘when you see somebody needing help - help him.’
Then once, when I was a little girl, I got stung by
nettles. He told me that wherever there were nettles
there were sure to be dock leaves to cure the sting.
And then he said: ‘Remember that everything in life is
like the nettles, there are always dock leaves if only
you look hard enough.’
----------------------------------
Later, Barbara trained in Jungian psychotherapy.
Jung said: ‘she decidedly leaves you guessing’

6. Amy Gibbs and Friern Hospital
I would never have
another really easy
moment unless I did
everything I could to try
to right this situation.
---------------------------
Founded AEGIS:
Aid for the Elderly in
Government Institutions

7. Lord Strabolgi, 1965…
… an atmosphere of humiliation and
neglect. The patients are … ‘pulped’.
They lose all sense of self-respect.
Worse than this, many are cowed and
frightened. All just vegetate and seem
lost to the world. And they are lost to
the world. There is nothing more
relentless than the State machine when
it gets the helpless into its maw.

9. The White Paper
‘would simply demolish Mrs Robb’
Kenneth Robinson, 1968:
I deeply regret the anxieties which
have been caused … by the
publication … of so many allegations
which are now authoritatively
discredited…
… the publication of the White Paper
should discourage anyone from
making … ill-founded and irresponsible
allegations in future.

10. NHS changes influenced by Barbara
1969-76
Richard Crossman, 1969-70
Openly visited hospitals to draw press attention to them
Condoned newspapers smuggling journalists into hospitals
Established Hospital Advisory Service
Allocated long stay hospitals more money
1969-74 Other inquiries, showed deficits
1971-2 Plans to improve mental illness (older and younger) and
‘mental handicap’ services
1971-3 Review complaints procedures
1973 Ombudsman
1976 First guidance on managing violence in hospitals

12. … and 50 years on …?

13. Overcrowding in 2017?
Too rapid throughput, patients discharged
before well enough = a pernicious form of
overcrowding, in time rather than space.
Managers proud of rapid throughput,
assume it indicates effective treatment in
a shorter time, so lower cost.
If staff levels calculated by bed numbers
rather than activity, staff under pressure
may carry out tasks, but neglect real
care.
Ely Hospital 1969

14. Complaints, criticisms and
over cautious supervising
1960s: rigid management, strict obedience to seniors
2010s: strict clinical protocols or ‘care pathways’
Top-down quantitative monitoring, associated with mechanistic, task-
driven practice
Difficult to deviate from pathways deemed to be correct
Don’t fit with individual’s care needs
Risk of objectifying and dehumanising person receiving care
Demotivate staff and stifle creativity
HOW MUCH DOES TIGHT MONITORING AND CONTROL RAISE STANDARDS?

15. Scandals and whistleblowing
Factors identified in scandals of care since 2010:
ageist attitudes
under-resourced and target-driven
cultures of blame
whistle-blowers scapegoated
institutional secrecy, despite duty of candour
Nursing Mirror survey, 1967, fear of speaking out…
National NHS Staff Survey, 2015: ‘unsafe’ clinical practice, would staff
know how to report concerns? 86% yes
feel secure in raising them? 70% agree
confident that their organisation would address them? 56% agree

16. Lessons on whistle-blowers
 New staff with minimal training often
had most insight into the humanity
and quality of the care provided.
 New staff and students are least
likely to be asked their views on
standards of practice.
 The ‘new eyes’ effect is under-
utilised.

17. Barbara Robb 50 years on...
 Barbara made a huge impact
in her time
 Understanding her work
contributes to policy agenda
today
 50 yrs since Sans Everything
and 40 since Barbara died, it is
fitting to recognise her place in
the history of the NHS.
Barbara
and
Brian Robb
1972

18. The Book!
Open access – free on line,
Palgrave Macmillan, later in 2017.
Thank you.