Undercover Care : The abuse exposed – A Review of Panorama

I sat down to watch Panorama yesterday and the trailers and name of the programme were something of a giveaway so I wasn’t exactly unprepared for what was shown.

Panorama had been alerted to abuse within Winterbourne View near Bristol, which is a private hospital run by a company called Castlebeck for people with learning disabilities and autism and according to the description on their own website

..  is a purpose designed acute service, offering assessment and intervention and support for people with learning disabilities, complex needs and challenging behaviour.

It can also provide a service for those liable to be detained under the Mental Health Act 1983. It offers a stable, structured and therapeutic environment and the support of caring and dedicated staff.

Winterbourne View, which has 24 bedrooms, offers the chance for people to progress to more community-based living as part of their ongoing rehabilitation, at their own pace.

Winterbourne View charges an average of £3,500 per week for a place. I wonder how much is spent on staff costs and training.

Acting on the information from a former senior nurse there who had been whistleblowing, Panorama sent in an undercover support worker (journalist) and some hidden cameras. I knew I was prepared. I knew we were going to see abuse but nothing prepared me for the actual footage that I saw.

I try not to engage in hyperbole but what we saw was purely and simply torture of adults who have needs which make them more vulnerable.  Physical restraint was used as a punishment and some members of staff were deliberating provoking residents almost as if it were a sport and they were playing at bear baiting. It made for uncomfortable and emotional viewing.

I worked for many years in homes for adults with learning disabilities before I qualified as a support worker and the lack of humanity with with the residents in the hospital were treated was almost physically painful to watch. The programme showed a woman being given showers fully clothed and being dowsed with water outdoors on a cold, March day until she was shivering profusely. They showed her being pinned under a chair.

In one of the most troubling pieces of footage, a girl is shown as she had tried to jump out of the window and the staff mock her attempted suicide and taunt her to ‘try again’ and ‘make a better job of it’ saying things like ‘do you want me to open the window more’ and mockingly telling her she would make a ‘splat noise’. Even writing it out is difficult.

There were other things – comments made, pin downs and the use of martial arts techniques which are, unsurprisingly, wholly inappropriate and this footage was shown to a specialist psychologist with the Tizard Centre who would respond with the same gut horror that you didn’t need to be a psychologist to understand.

The footage really spoke for itself and I wondered about the position of the undercover journalist who stood by and watched some of the abuse occurring. There is an issue of ‘greater good’ versus ‘personal responsibility’ so the argument would be that the programme itself was able to prevent future harm coming to the residents by being transmitted but he admits that it was difficult for him.   He says here

I was watching on the sidelines, resisting putting a stop to this (abuse) and blowing my cover. Simone was staring at me as she lay on the floor, staring at the only person not abusing her.

I could not save Simone on that day. I had to resist my instinct to step in. I was there to gather the evidence that could help save others from a similar fate – and Simone herself from future abuse

Some of the more difficult responses came later in the programme as the CEO of Castlebeck was interviewed and of course expressed disgust and surprise at the levels of abuse in Winterbourne View. A company statement is published here and alongside all the usual guff is an acknowledgement that the whistleblowing policy was not adhered to when an initial complaint was made by a staff nurse on 11 October 2010. The footage was filmed between February and March 2011.

I was more furious by the response of the CQC. The whistleblower also contacted them, you see with the allegations of abuse. He contacted them three times.

Winterbourne View had last been inspected ‘two years ago’. Is that the kind of satisfactory inspection regime that we have, Mr Burstow? Oh, wait, it’s ok, because the statement from the CQC says Burstow has authorised a sample of 150 hospitals receive random unannounced inspections. Woah. Only 150? Only a random sample? Why just hospitals for people with learning disabilities? If random unannounced inspections are seen as necessary to prevent institutional abuse on such a wide scale, surely they should be the NORM for everyone who receives a service via a service inspected by the CQC.

No, you see, Burstow (and the Labour ministers before him) seem to think that self-regulation is the way to go. The way the man from the CQC squirmed as he insisted that the paperwork had been in order at Winterbourne View tells a tale all of its own.

And as for the staff, four have been arrested to be charged under s44 of the Mental Capacity Act which makes it an offence to ill-treat or wilfully neglect a person who lacks capacity.

It also begs the question – where were the Deprivation of Liberty Safeguards? Were any of the residents detained under DoLs  – or the Mental Health Act for that matter (as the hospital was assigned as such to accept people detained) and if that was the case, shouldn’t there be additional checks. Would independent advocates provide a further check?

There are a lot of questions that remain and the main one is the way that institutional abuse can fester in a residential care setting. There are wonderful care homes and hospitals around. I see them and I worked in them and often the ethos trickles down from top to bottom. Staff who see other staff abuse residents can ‘join in’ to be accepted – it is a classic position of bullying and unfortunately sometimes people who enjoy this kind of power play are attracted to work in social care. There needs to be an environment that does not accept this and that stamps down on it immediately and that was the real failing of Castleview.

This was not about 4 rogue members of staff. This was about an environment that allowed them to abuse and for that the senior management up to the Chief Executive should be responsible. Where is the support and training for staff who have to work in stressful environments? Where was the supervision that would have stamped out some of the abuse.  That doesn’t excuse those who were responsible for mistreatment  but it draws interesting parallels with the sacking of Shoesmith.  Wouldn’t we be baying for the blood of the CEO of Castleview? Or perhaps because the abuse took place in a private setting there are different lines of responsibility.

I think we should look long and hard about how we, as a society, seek to push people on the peripheries of society, because of age, disability or capacity to the margins of society and people to provide care who are not regulated and not supervised.

When the regulator fails so substantially as to ignore someone who whistleblows explicitly, do we not see a problem the ‘system’ that is increasingly reliant on proactive ‘complaints’ to trigger assessments?

There is much to do and much that needs to be changed.

I wouldn’t say I enjoyed the programme, it upset me and it angered me but I think everyone involved in the sector should watch it.

It can be viewed here on the BBC iPlayer.

Lansley, Nurses, Social Workers and Colleges

Yesterday, as a part of Lansley’s so-called ‘listening’ exercise, he found himself at the conference of the Royal College of Nursing (RCN) as they voted in favour of a  motion of no confidence in him personally by a fairly substantial 99%.  Rather marvellously when you take into account the 13 abstentions, only 6 nurses voted against the motion of no confidence. As was mentioned on Twitter yesterday, it seemed to be a miracle that 6 were to be found.

You’d have thought that that was quite a strong message for Listening Lansley to have paid heed to but no, he wanted to give a perception of listening (as if the vote of no confidence wasn’t a strong enough message!).

He asked for 60 specially chosen RCN representatives to talk to him while he ‘listened’ for 90 minutes in a room to which press were not allowed.

Well, nothing wrong with listening of course. I shouldn’t scoff but I can’t help it amid Lansley’s gruff and graceless apologies. Why? Because the listening should have been done before the plans were announced. The listening should be done with a whole wide range of people who have an interest in the health service.

He has got it wrong  but he doesn’t seem to want to listen as much as try and persuade and regroup around his message of privatisation.

The message from the Royal College of Nursing was strong, and powerful and it has caught the news media. People listen to nurses when they say things are wrong.

But we can’t forget how wrong the government got when they brought these proposals to Parliament in the first place. What does it say about a government that has to do its consulting AFTER it has taken a Bill to Parliament that has been so strongly attacked on all sides by public and professional opinion. It doesn’t exactly make one comfortable that we are ‘in safe hands’ as they like to promise at election time.  Maybe it’s because all the consultations they did before the Bill was presented were with private companies and party donors.

This is a government which is struggling under the surface and has been caught out already on many occasions by acting without any idea of what the plans that they propose actually signify. It is when they try messing around with the health service that people sit up and shout back but what about the other measures that they have proposed like the changes in the welfare benefit systems which seem force degrading and inappropriate ‘tests’ to claimants to jump through hoops to get the money they ‘deserve’.  This is what we need to speak up against as well.

And one of my sadder moments yesterday, when I thought about the impact of the nurses and the fact that they are at least being listened to for press purposes, is how we, in social work, have been poorly served by the organisations that supposedly represent our interests.

We should look at the RCN and what they have done and the effect a vote of confidence had on the ridiculousness of Lansley’s ‘listening’ exercise when with an almost unanimous voice they have humiliated him. Where is the nearest equivalent social work voice?

Community Care reports that the Chief Executive claiming that ‘he simply doesn’t believe’  Unison’s figures of having 40,000 social work members.

Honestly, is that the best he can do in rousing his members? Is that the best we can do as social workers when we should be at the heart of opposing the government agenda to heap the cuts on those who have the least? We just get into squabbles between Unison and BASW about who has the most social work members? Who is going to ‘lead’ the College of Social Work? Are we going to have a ‘Chief Social Worker’? Surely better to have a broad members organisation that can speak for all social workers rather than split members into different ‘camps’.  As for me, I’m a member of Unison AND a member of BASW. Generally, I’ve seen value in both.  It isn’t about a competition about who has more members and some people like me would be counted twice in the figures.

More than anything we can see the importance of having a strong, national voice as a profession and as representatives of a social care sector that is being and has been ravaged by repeated governments. Perhaps a broader College of Social Care might not  have been a bad idea.

The stronger the body the louder the voice.

Of course, that isn’t going to happen. It looks like we will be left with a College that few social workers who are on the front line will be interested in because we don’t have time for the politics within the profession. We have too much to do and need to focus on the politics of the country before everything that we know and love about this society is lost.  So while the College or Colleges (depending) spend all their time and money rewriting competencies or capabilities or capacities again and again and again ad infinitum – some of us will just be getting on with doing the actual work.

But the shame of it is that a College of Social Work/Social Care could perhaps have been a voice to shout against the Welfare Benefit Bill and the ridiculous tests that are put in place to make decisions as to ‘eligibility’  in the same way that the nurses are a voice to shout against the health and (oh the irony) social care bill.

We should be more like the nurses. We need to be if we are to survive and have relevancy.  We need to be listened to as well.  But in order to be listened to, we need to build support up amongst ourselves rather than squabble like schoolchildren. That is the pity.

Lessons from the Care Sector

One of the flagship policies of this new coalition government and one mentioned in the Spending Review is about outsourcing services from directly provided in-house type provision to a tendering out type market led style of outsourcing services.

This is not new in adult social care. It was an attempt of the 1990 NHS and Community Care Act. We (social workers) were going to be buying in services from many different sources. We were to be care managers rather than care providers. It was a seismic shift in social care provision driven by the ideology of Thatcherism which equated private sector as good versus the clunky inefficiency of the public sector.

Indeed, a part of the ‘Big Society’ ethos is ‘shifting power away from central government to the local level, – to citizens, communities and INDEPENDENT PROVIDERS’.

All sounds nice and fluffy but – we have local authorities in London at least (possibly throughout the country  but honestly, London is what I know best) merging services to create a potential democratic deficit – for the record, I don’t in general have an issue with joint service provision across boroughs but it doesn’t seem to fit 100% into the localism agenda. It is the ethos behind a move towards independent providers that I fear.

I  have seen the future and it is shaky and dangerous without exceptional and firm regulation and honestly if one thing is going in the cuts, it is exactly that.

Let me explain further taking the lessons learnt from the contracting out of services in social care.

Firstly, I have come across some exceptional private care providers but they are a rarity rather than the normality that they should be. That breaks my heart as I move from social worker to care manager. How much confidence can we have in recommending care packages when we know there will be issues in the quality of service provided by profit-making agencies.

We can see with the story that was in the news recently regarding Jamie Merrett, a 37 year old man who is tetraplegic following a road accident and who was reliant on care being provided by nursing staff. A nurse was supplied via an agency who was not able to manage his care and she switched off his  life support machine which lead to permanent brain damage.

Jamie had installed cameras into his home as he was concerned about the quality of care provision and it was this camera that allowed this error to be highlighted.

It isn’t the nurse at fault so much as the agency that sent her. The nurse Violetta Aylward was not trained in ventilator care. She was probably cheaper for Ambition 24 (the agency) to supply as a result.

The agencies must be held to account as much as the individual nurses especially if the nurses have been sent into situations that they are not trained to manage by the agencies.

This agency, Ambition 24, received ‘three stars’ from the CQC in their last inspection round. It will retain those three stars as the star system doesn’t exist any more so no new inspections will be made and those star ratings will not be changed.

Anyone seeking to use them (and I include procurement teams in local authorities and the NHS) might be swayed by those now, redundant three stars which are resplendently displayed on their site.

They are a large multinational firm that provide nursing care through a number of agencies internationally – no doubt making massive amounts of money and the question  has to be asked about the corner cutting that leads to incidents such as this. Where is the morality in the private sector? I know it exists  but it also seems to cost. That is the price that not all commissioners are willing to pay.

Yes, this is one case. One incident. But I could tell a few stories about multi-national care agencies providing poor care at high cost and cutting corners on the day to day care to maximise profit – unfortunately, they are not my stories to tell but rather the stories of those who are most affected.

This is what happens when private companies serve public authorities for profit-making purposes. Sure, they can lower some costs,  but what what cost?

How many people whose family have been actively affected would say that they get a better quality service from agencies than from the directly provided services that have now been decimated through the ideology of the previous Conservative government?

Some would, I’m sure. I think there would be a majority who would despair at the fall in the quality of care provided.

Direct payments and personal budgets will help some people recruit directly, possibly bypassing agencies but not everyone has the same level of choice. A part of my difficulty with personal budgets is that everyone should be equal but some (those who are able to manage their budgets themselves or have active family members to assist) are more equal than others and more likely to get the better services.

Remember for every case we hear about, for every Jamie Merrett who saw to put in a video camera into his home, there are probably thousands who don’t complain, who can’t complain and who we never know about because they either lack the capacity to have an understanding of the quality of care that is being provided or because they don’t want to ‘make a fuss’ because they fear their own carers or they just can’t speak out because the damage has been done.

Most of the safeguarding investigations I undertake involve formal carers. Those are just the ones we know about.

This is what happens when independent providers are left to patch up the gaps in public services and make profit from the care that they provide.

As I say, I know it isn’t all carers or nurses that work for private agencies but it is the agencies that I blame rather than the carers. They push people to work in areas that they are not trained to. They don’t pay for travel between service users’ homes and turn a blind eye or actively encourage shortened visits and less attention to care.

Equally, the local authorities bear a responsibility for caring more about getting services at the absolute lowest cost rather than judging by quality. Contracts are tendered and granted on the basis of cost.

It is a similar story with residential and nursing homes. Local authorities are pushing the payments down, providers are more concerned about the figures than the quality of care. If you pay someone minimum wage for doing such a vitally important job, you don’t provide them with the training and support they need, you don’t keep staffing levels up to staff levels then you will have increasingly poor quality care provided.

This should be a lesson to have been learnt from pushing the privatisation agenda.

Combined with a paring back of all regulatory bodies, this is dangerous. It will be those with the quieter voices who suffer the most.

My plea to the government would be ‘look at the history before you destroy the future’.

I know it is in vain but that won’t stop me shouting as long and hard as I can.

This is why I fear for the NHS in the future. We have seen the future. It doesn’t work.

Away Day and Old Acquaintances

As I was wandering around the office, stretching my legs, I fell upon a conversation between one of the social workers who works in a different locality team and her manager about the possibility of a whole team ‘team building away day’.

Of course this was too good an opportunity to miss. My view of an away day will always be a trip to a theme park or the zoo but unfortunately that wasn’t quite what was being proposed – it was more of a ‘sitting in a room and discussing’ type of team-building that was being proposed.

I thought paintballing sounded quite fun – we could split on a geographical basis or in our own type of geeky way, discussed a possible football match between ‘social model’ v ‘medical model’ with the doctors and nurses against the social workers and psychologists (as one of our clinical psychologists piped up at this point that she was very good at football!).

Of course this led to a discussion of which team would ‘claim’ the occupational therapists.. (I think we would because they are quite athletic and the social workers – if my colleagues will forgive me – are probably the least.. erm.. athletic.. to put it kindly).

Of course outside of my imagination, what is likely to happen is that the away day will consist of us all sitting in one of the Trust or Council offices discussing team dynamics and trying not to raise the issues that really need to be discussed.

image szlea at Flickr

Through various convoluted means that would be way too complicated to explain, today, I am going to an event at which my first practice teacher from my first placement as a social work student will be present. I qualified in 2000 and my first placement was in a local authority older adults community care team in 1998/9.

It was the first experience that I had in a statutory setting and I had a wonderfully kind and supportive practice teacher. I remember I was the first student she took as she was completing the practice teaching course as I was studying.

She was exceptionally thorough and has consistently been an inspiration to me of ‘how I would like to be at some point’. My second placement was a little less happy but fortunately, I had the experiences of the first placement to inspire me and carry me through. Through my own laziness really, we never kept in touch – although we said we would in that way you do when things come to an end – that and the fact that I left the country pretty soon after I qualified.

I saw her name though, on the distribution list for the invitations to the event. I wonder if she noticed mine. She’s probably had lots of students with and around her since so I’ll be one among many. I am not at all sure what I’ll say or even if she’ll recognise me after 10 years.

If ever though, there was a point for reflection of where I’ve come in these last ten years, it will be today..

Media Spins, Private Fostering and a Prayer

The British Association for Adoption and Fostering ran a campaign last week to raise awareness of private fostering.

As explained by the Fostering Network

Private fostering is when a child under the age of 16 (18 if disabled) lives with someone who is not their guardian or close relative (defined as grandparents, aunts, uncles and siblings), for 28 days or more, by private arrangement between parent and carer.

The law states that private foster carers must notify their local authority of any private fostering arrangements.

The Posters that have been up around near where I live are snappy and explicit. Let someone know if you are looking after a child who is not your own. The websites which follow the campaign are equally explicit and offer lots of links and suggestions, including charities to contact if you don’t feel ready to contact social services directly.

There are lists of people who are considered ‘close family’ such that the arrangement is not considered ‘private fostering’, for example, grandparents, step-families, brothers, sisters, uncles and aunts – whether by full-blood, half-blood or by marriage

Fairly straight-forward. Not something I think I’ve ever come across but clearly it is happening.

And so the campaign exists in my peripheral conscience.

And then I made the mistake (I really shouldn’t do this) of tentatively checking, among my rounds of looking at the daily news, the Daily Mail website.  And they have an unsurprising article entitled ‘Grandparent carers’ in fear from social service ‘snoops’.

The Grandparents Association is up in arms because the posters don’t explicitly mention that Grandparents (quite rightly) are allowed to look after their grandchildren.

You have to think that they don’t have anything better to worry about. The worst that would happen is that the matter would be resolved with one phone call.

I have to wonder too why the Daily Mail is seriously so vehemently opposed to the existence of child protection services. How far does the media have a role in whipping people up into a frenzy of anguish and anger that is wholly misplaced?

Newspaper
Image by vic15 via Flickr

I guess is it so much easier to write ‘rent-a-quote’ stories that have no insight because perhaps we, as consumers, are looking for stories and ideas that are easier on the mind rather than providing anything that might induce thought and consideration – reasoning through arguments and balancing up ideas.

Oh, this is the newspaper that today prints a story with a quote that the Christian community in the UK are the most discriminated against in our society because a nurse was disciplined when she offered a prayer for a woman she was visiting.

But looking at the story, the patient in question is quoted as saying (and this is a Daily Mail quote, where they are seeking to serve their own purposes remember)

The great-grandmother told the Mail last night: ‘It didn’t worry me, it just struck me as a strange thing for a nurse to do. She finished dressing my legs and before she left the last thing she asked was would you like me to say a prayer for you? I said “no thank you” and then she went.

Another part of the article goes on to say

She admits she received a previous warning about promoting her faith at work. Last October she offered to give a prayer card to an elderly male patient in Clevedon, Somerset. He accepted it but his carer raised concerns with the Primary Care Trust

The argument that this is a Christian being discriminated against does not hold up. Can you imagine any other religion, or better, an atheist promoting their beliefs to people they work with?

I have and continue to work alongside devoutly religious practitioners whose religion informs their social and moral interactions but never would they consider it acceptable to cross a line and bring this into a work environment.

And you know, it is completely inappropriate to evangelise at work, unless you are a preacher, I guess, in which case, it is your job . Even with the Mail’s spin I can’t see how a professional would see it as acceptable – especially considering she already had a warning.

I haven’t even started on the coverage of the grandparents objecting to their grandchildren being fostered by a homosexual couple.

Aethelread deals very ably with the issue and I don’t think I could manage his coherence.

So I know that this is a newspaper with its own agenda and issues – but it has become increasingly, a joke of a rag with little ability to create a coherent message through the course of one article.

It is however, one of the most popular newspaper websites in the country.

That is truly frightening.

Delayed Discharges

Since moving from a generic Community Care team into a specialist Mental Health team a few years ago, I haven’t had as much contact with the vagaries of the delayed discharge system as I did back then.

Yesterday was a rude (in every sense of the word) awakening.

The Community Care (Delayed Discharge) Act 2003 introduced procedures to speed along the process of hospital discharge from acute wards when beds were needed. The financial stick approach was favoured and social services become chargeable for people who remain in hospital for ‘social’ reasons. This prompted  much fear within these self-same social services departments and moved possible and potential delayed discharges into the ‘highest priority’ category as the costs mount up exceptionally quickly  (I can’t remember the exact costs now but it’s floats about £120 a day – am happy to accept corrections on that though.. it’s off the top of my head!).

image tahitianlime @ flickr

There are also government targets relating to delayed discharge figures which tends to get people moving.

The process is now quite clear. We (social workers) receive a section 2 notification when or shortly after someone is admitted to hospital. This is a request for an assessment. Off we go and assess and put all the post-hospital plans into place – ready to go.

We then get sent a Section 5 notification. This is the one that kicks us into action. It usually means we have 24 hours to actually set up the systems we have put into place. It’s like a starting gun..

This system is not in place in psychiatric hospitals – yet – which is the reason I have less contact with it than before.

Sometimes things don’t work quite as smoothly as they should. It isn’t surprising. People are people after all and sometimes, to quote old Rabbie Burns (my (scottish) mother would be proud)

‘The best laid schemes o’ mice an’ men
Gang aft agley,’

This issue remains my highest point of contention with hospital staff. Sometimes Section 2s and Section 5s turn up on the same day for someone that needs a new care package (restarts are usually easy to set up, in contrast). Sometimes, you phone after receiving a Section 2 and ask about possible discharge plans to time things accordingly and get a ‘there are no plans to discharge X or Y’ and leaving a message, you go back to your work – only to have a Section 5 turn up on your desk a couple of hours later.

Sometimes when you move from a general adult service to a specialist mental health service and mutter about Mr I being issued with Section 2 notification, people gasp in horror about never thinking that he needed a compulsory admission.. oops, I should actually have made that clearer when I was discussing it with team members I think!

But yesterday, in responding to a Section 2 Community Care (Delayed Discharge) Act, I went to see Mr I in hospital. Not as local a hospital as it could be either. We were discussing care plans and discharges when one of the nursing staff spotted me (I’d told them I was coming so it would have probably been obvious who I was!).

‘Mr I is going to be discharged this afternoon’

I gulped.

‘Hold on, what about the Section 5 notification’

‘The ward manager is writing that now’

I look at Mr I. I have, fortunately (well, you learn a trick or two in time) spoken to the care agency that provides a ‘rapid response’ cover a couple of hours before I’d even left for the hospital to find out how quickly they could provide a service if needed.

‘I need 24 hours notice of a discharge to arrange a care package’.

Nurse furrows his brow. I lead a lecture about procedures and then realise that some fights aren’t worth pursuing.

I could probably have pushed it if I really wanted to but in this situation it really didn’t seem worth it. Sometimes though, righteous indignation feels quite self-satisfying.

A couple of phone calls and I have a care package ready to go for the evening and I got my little ‘procedures’ lecture in. I know I shouldn’t do it  but sometimes (fortunately not in this case) that 24 hours really is crucial.

Talking shop

Last night at an event which had nothing to do with work by any stretch of the imagination, I met the neighbour of the daughter of a woman that I visit.

She recognised me because I had visited the flat next to her and she’d  have seen me coming and going and – as became apparent – the neighbours had chatted!

Generally she reported via daughter positive things about me (or else she was very discreet!).

‘Oh, you are Mrs S’s nurse, aren’t you?’

My gut instinct to shout ‘No, I’m not a nurse’ was tempered by the thought that this is probably what she had been told and in some ways, I can understand that it may create less waves to say your mother is seeing a nurse regularly than to say she is seeing a social worker.

I smiled, specifically trying not to nod in confirmation because I didn’t want to deny it but nor did I want to claim a status that I didn’t have or place the family in a difficult position.

I confirmed I’d see her around and what did she think of the problems with the lift in the block where she lived trying to shift the conversation away from the personal.

Spotting her chance though, she turned the conversation  to a second-hand dialogue about her neighbours thoughts of the services. Although I’d consider myself a sociable person, it was more than a little awkward as I really don’t want to be discussing anyone else and neither did I want to tell her to shut up.

miss karen miss karen @ flickr

I manipulated the conversation more successfully to the lack of any vegetarian-based sandwiches at the reception and the choice of herbal teas available. I think I must remember to talk about food in these situations – that will always get a response!

I like to think it was a bit of transference of communication skills to a more practical setting.