Report "Suspension Failure in the NHS", September 2004 - click here to view
Concerns and
recommendations for the management of suspension for nurses.
| Please
send an email giving a brief outline of your story – as brief as possible
– and send it to the people listed. |
| Please
would you send me a copy too so I have an idea how many there are, ready for
the next press release. As
always, the information will be strictly confidential. |
| You
will see we have included contacts in the nursing press.
Delete them if you are not comfortable with that – no problem.
|
| An
outline has been suggested for you, to save you time and my own story given
as an example, which I will send March 4. (Very hard to make it short!) |
The
Public Accounts Committee is due to interview Sir Liam Donaldson and Sir Nigel
Crisp on Jan. 28th re:
the National Audit Office report 6.11.03. However,
since that is the date of the publication of the Hutton enquiry, it may be
changed.
Summary
·
Excellent progress for doctors and dentists because there is recognition
that current processes are very
harmful and ineffective.
·
Framework provides the possibility of a much fairer investigation.
·
Directions mean that they have to be followed.
·
Protection of whistleblowers being planned.
SO
WHY NOT FOR EVERYONE?
The truths are the same. The
damage is the same. And no-one knows what is going on out there because there is
no requirement to report suspensions. So the suffering continues unabated.
·
Dr Reid said the ‘people are fantastic – the biggest army for good in
the world’ and that in the future
‘I can guarantee there will be more resources’ (NT 6 Jan 04 p 22).
·
But by denying the directions for all employees of the NHS his actions
prove this is not true.(There is a vague assertion that the principles may be
used in disciplinary matters (FAQs p2) .
·
This is a massive betrayal. We are second class members, even the
underclass.
·
WE NEED ACTION NOW just like the doctors and dentists. We may not cost as
much or have such good defence lawyers, but we hurt just the same and we need
the same protection.
·
If Dr Reid saw the emails received through www.suspension-nhs.org
and the pain and despair they contain, he would take immediate action as an act
of mercy. It is a black hole in the NHS.
Introduction
The directions are a major step
forward because there is acceptance by the DoH that suspension is wasteful
in every way, largely thanks to the National Audit Office report of Nov 6th.
Since April 2001, the National Clinical Assessment Agency has handled 600
referrals approx and in 85% of cases suspension was avoided. (framework sect:13
and sect:1). All credit to the DoH for responding to the report by issuing these
important directions.
New insights and understandings
and better practice.
·
That most failures in standards of care are caused by systems weaknesses
(framework intro p 2 section 3)
·
To abandon the ‘suspension culture’ ditto
·
The need for a speedy resolution (if the exclusion is not actively
reviewed after 4 weeks, the practitioner is entitled to return to work!) p2
section 6
·
That exclusion is not a solution (sect: 6).
·
That it may only now be used for the most exceptional circumstances
(sect: 6.) Hurray!!
·
The creation of a non-punitive and anonymous reporting and learning
system by the National Patient Safety Agency for patient-related adverse events,
near misses and medical errors ie PROTECT WHISTLEBLOWERS. Sect: 11
·
The need for the chief executive’s involvement means that poor
management decisions may be prevented - hopefully. Action sect: 4
·
The appointment of a non-executive board member (sect: 4) gives the hope
that there may be some impartiality possible – a major failing of the
previous/current system. Board
member can request reports and keep the process moving (restrictions sect 9)
Defendant may make representations to the board member at any time after letter
with allegations is received (restr: sect: 20) ie has the possibility of a
mediator/advocate.
·
The involvement of the NCAA as an impartial outsider to look afresh at
the problem allows the possibility of recognising work systems problems rather
than the individual or see if there is a wider problem (sect: 9).
·
Much greater fairness for the ‘defendant’ ie see all correspondence,
know who will be interviewed. (sect: 13)
·
THAT THE PURPOSE OF THE INVESTIGATION IS TO ASCERTAIN THE FACTS IN AN
UNBIASED MANNER AND NOT TO SECURE EVIDENCE AGAINST THE PRACTITIONER (AS HAPPENS
AT PRESENT). Sect:15.
·
It must be factual information (restrictions sect: 12)
·
Involve an outside practitioner if case is complex. Sect: 16
·
A definition of what constitutes serious or repetitive performance
difficulties (sect: 19).
·
Exclusion from premises no longer allowed except under exceptional
circumstances (restr: sect: 24) so can retain contact with colleagues, take part
in clinical audit, keep up to date with developments, undertake training and
research.
·
Exclusions will now be monitored by the DoH via the strategic health
authority from data provided by the board. (restr: sect: 38). The board has to
ensure these procedures are followed and that the case is being progressed.
·
Recognition that many of the principles in the framework reflect ACAS
best practice and can therefore be applied to other NHS groups (FAQs page 2).
Indeed, under the Employment Act 2002, disciplinary action has to be consistent but
that only applies to disciplinary action. And will employers take any notice of
this best practice?
A few negatives
·
Very doctor-focused ie the cost to the NHS is greater when doctors are
involved than for most other staff.
·
Very little recognition of the damage done to the individual, very
cost-focused. This is supposed to be the N Health S.
| Recognition
that unfounded and malicious allegations must be investigated because of the
damage they can do but no action advocated against the bringers of these
allegations when found to be false/malicious. What about an equivalent to
the police charge of wasting time? |
Conclusion
Let
us hope that these Directions will have the desired effect for doctors and
dentists. But we need them for all NHS employees, clinicians and managers both,
and we need them now.
Not an exhaustive list, and emailed to the assistant chief nurse on 1.11.03
General points
| Suspension
is unavoidable when there is clear evidence to show gross misconduct, in
order to protect the public and possibly the clinician too. |
| There
is no statutory requirement to notify the Department of Health or any other
body when suspension (sometimes called special leave) has occurred. Human
resources departments have to keep a record of all staff excluded from work
after 28 days. |
| Each
trust or organisation has its own guidelines about who has the power to
suspend and how it will be dealt with. |
| Suspensions
are often the result of jealousy, arguments between managers and colleagues,
punishment for whistle blowing and not very often as a result of patients’
complaints. |
Current situation nationally regarding research
| The
National Audit Office has undertaken a comprehensive study into the
management of suspensions of clinicians in NHS hospital and ambulance
trusts. They are hoping to publish their report on Nov. 6th.
(Taken from the NAO website and telephone conversations.) |
| They
have used some of Rachel Murray’s Ph D study into suspensions (now in its
final stages of writing; telephone conversation 27.8.03) and reported in the
Nursing Times 19.8.03. RCN data had shown that in 2002, over 200 nurses had
contacted the RCN for help following suspension. It is thought the numbers
involved may be much higher. |
| Sir
Liam Donaldson’s annual report details how the National Clinical
Assessment Authority has been effective in preventing unnecessary
suspensions i.e. 30 out of 36 cases were offered alternative proposals in a
20 month period. Dr Tim Tomlin would challenge this however. He said “the
NCAA has no teeth. It cannot make a trust reinstate a suspended doctor”
Reader’s Digest Nov 2003. |
| My
own experience of suspension has made me painfully aware of the cost to the
individual and their families. I set up a web site to help others www.suspension-nhs.org
There are over 100 hits a month and so far 16 people have contacted
me through it. |
| Prior
to my own suspension, I thought that suspension was such a serious step to
take, there must be some grounds for it. I now know better! |
Concerns
about suspension based on common themes from people’s stories and my own.
| People
are being suspended for no adequate reason. This is happening to managers
and clinicians alike. |
| People
are being suspended because of false allegations. When a colleague has
refused to respond in anyway to suggestions for improving her work
performance she uses false allegations to protect herself in case of”
Whistle Blowing”. |
| Suspension
with immediate effect denies people the opportunity to explain their actions
or provide evidence supporting their actions before suspension is
implemented. |
| Some
people go off sick anticipating that things are going badly wrong and they
fear suspension. They are subsequently placed on half pay after 6 months and
then statutory sickness benefit after a year, because the situation has
still not been resolved, causing severe financial hardship. |
| Every
situation is unique. |
| Managers
appear to have little experience or knowledge of how to deal with complaints
or of the criteria for suspending staff. |
| There
may be no urgency to deal with the situation. They may continue for months.
Industry deals with suspensions as an emergency. They usually last no longer
than one week. (Sources: former Marks and Spencer’s manager; human
resources manager for a multi-national company; former managing director of
a steel business; managing director of a European environmental research
company.) They do so, not only because of the cost to the company, but also
because of the cost to the individual and their family
|
| The
person conducting the investigation may be the person making the allegation.
|
| This
person is usually a manager, who will find it very difficult to be impartial
when management colleagues are involved. |
| Disciplinary
policies & procedures are not being followed. |
| The
whole process is very adversarial. |
| The
suspendee is not kept informed about what is happening e.g. when the next
decisions will be taken. |
| If
no disciplinary action is to be taken, suspendees cannot appeal against the
investigation report findings and recommendations even though they may hold
new and unsubstantiated allegations. Although technically no disciplinary
action means there is no case to answer, at least one person was threatened
with disciplinary action if she did not accept the report. Since the same
people would then be conducting the disciplinary hearing, she felt
challenging it would be a waste of time. |
| Disciplinary
hearings are very adversarial and very stressful. |
| To
justify the suspension, managers put some form of supervision/assessment in
place regardless of the outcomes. |
| Costs
are high. As well as the loss of a staff member, there is the cost of cover
for the suspended nurse, if any is provided, the cost of managers’ time
for dealing with the process, plus the cost in lowered morale by colleagues,
and damage to health for all involved. The suspendee may well become
clinically depressed and require treatment. In the Nursing Times article the
cost was being put at £25 – 50 million per annum. |
Other
issues
| Union
representatives vary enormously in the amount of time and support they are
able to give. Sometimes there is a lack of knowledge of the issues and how
to deal with them. When good sound advice is given trust senior managers may
choose to ignore advice and recommendations from union representatives and
this produces a confrontational situation. |
| It
is notoriously difficult to gain justice when NHS trust management refuses
to acknowledge or work within current employment legislation. Specialist
solicitors are very expensive to hire. Industrial tribunals are extremely
stressful events for all involved. MPs may sometimes be able to demand an
enquiry but generally they have little power. This often results in good
competent practitioners leaving the NHS and the morale of others being
affected. |
| All
this contravenes the Government’s attempts to change the culture within
the NHS from a culture of blame to a culture of responsibility (cf Donaldson
2000 An Organisation with a Memory) |
| The
suspendee suffers terribly. Please see the web site for more details. So
does that person’s family. Some do not return to nursing. |
| Return
to work is very difficult. The person’s confidence has been badly
undermined and reputation damaged or destroyed. |
| Bullying
and malicious allegations have been features of some people’s experiences.
Suspension and bullying seem to bear many similarities in their effects.
Often no action is taken against the people making the false
allegations. |
Recommendations
to stop further suffering.
1.
An immediate stop to all suspensions by all organisations except in cases of
gross misconduct where there is strong evidence to support the allegations.
2. A statutory duty to report all suspensions
to the strategic health authority or the Department of Health and the
introduction of a monitoring system on how quickly and effectively Trusts are
dealing with these issues.
3. When suspension is unavoidable, the
suspension to be for one month only and a review to take place with the
suspendee present and able to contribute.
4.
Examples of good practice for dealing with allegations, to be made available
nationally.
5.
National guidelines for dealing with allegations of poor performance.
6.
A body similar to the NCAA to advise organisations in the management of alleged
poor performance.
7.
Independent, impartial investigators to conduct the investigation and mediate
a solution.
Wider issues
| Research
to investigate the current culture within the NHS including the high numbers
of reported cases of bullying, with the use of systems failure analysis to
try and identify what is going wrong. |
| The
Government to look at the effects of rapid changes and need for data, with a
view to making changes. The current situation puts managers under excessive
stress and prevents them from engaging with staff. |
| Research
into the outcomes of cases managed by the NCAA to identify effective
practice and beneficial outcomes.
|
02.11.03
ADDENDUM
The
National Audit Office (NAO) report (www.nao.gov.uk)
- Management of Suspensions of Clinical Staff etc 6.11.03 – recommends two
week rapid investigations, obtaining an independent view and involving the staff
against whom the allegations are made.
Due
to emails from victims of unjust allegations, my thinking at present is that
suspension should only be used if there are allegations of gross misconduct, and
only if the allegations are properly substantiated by an independent
investigator.
As
an alternative and safer way of PREVENTING allegations of poor work performance,
there should already be regular team leader or peer reviews of practice so that
managers have confidence in their staff and staff are protected from false and
malicious allegations. Only then will staff be safe to practice.
Where
there is a breakdown in confidence in a clinician or manager’s performance,
someone from a neighbouring trust should be appointed (to ensure impartiality)
to investigate and MEDIATE a solution. All parties should have access to all
reports etc.
The
cost of such a response would be offset by the colossal waste of resources
currently occurring, causing immense and widespread damage.
Julie
Fagan
25.11.03
Letter sent to Health Service Journal, Nursing Standard, Nursing Times for publication 26.8.03
To the Editor
26.8.03
Dear Editor
When
there is strong evidence that patients or colleagues are being put at risk
and that a patient or professional is a danger to themselves, or the
public, clinicians have a duty of care to report such behaviour to their line
managers. The action taken at this point should be in line with NHS Policy &
Procedure and suspension from duty with immediate effect may be the only option
open to the employer.
However,
there is a growing body of evidence available, collected through the website www.suspension-nhs.org
and in an unpublished report by Rachel Murray, deputy head of counselling at De
Montfort University (Nursing Times 19 August ’03) that a number of healthcare
professionals at all levels have been wrongly suspended and their situation
dealt with unfairly. Their stories make sober reading and the damage to career,
mental and physical health, relationships and family life has been enormous.
This is not to mention the damage to the NHS in legal costs and investigations,
during what are often protracted periods of absence from work.
Some highly qualified and competent practitioners never return to work.
Even after they have been exonerated the experience has been devastating.
As a group we would want to see changes being made that will protect
staff from unjust and unnecessary suspensions.
Industry
treats suspension as an emergency and deals with the situation rapidly. Other
work has to wait. They say the cost to their business and the cost to the health
of the individual make this imperative. The evidence so far collected through
the website, suggests that the NHS does not respond in such an efficient manner
and there is little thought given to the individual who has been suspended. The
phrase ‘guilty until proven innocent’ seems to be the approach. In a
multi-national business a suspension would last one week, in the NHS anything up
to two or three years.
The
National Audit Commission is currently looking at the management of suspensions
of doctors and dentists in NHS Hospitals and Community Trusts.
They have received so much data that their report has been delayed
several times and may now be ready for October 2003. Our group awaits its
publication with interest.
In
the meantime, I would invite any colleagues who believe they have been unjustly
treated or suspended, to contact me via the web site www.suspension-nhs.org
I also invite any Senior Managers who want to share information and give
examples of how these matters can be dealt with sensitively, quickly and
efficiently to also contact www.suspension-nhs.org
in order that best practice can be shared and current practice improved.
Sir
Liam Donaldson in his recent annual report (Dept of Health 2003) recommended
that in the case of suspension of doctors, local NHS bodies should consult with
the National Clinical Assessment Authority prior to taking any action and that
if suspension proceeds it should be for a one month period only, renewable after
review and not in perpetuity as at present. As a group we believe that these
recommendations should be extended to all NHS personnel as a matter of urgency.
Yours
faithfully
Julie Fagan, secretary to the group.