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STOP PRESS

UPDATE re the INCIDENT DECISION TREE of the National Patient Safety Agency

The National Patient Safety Agency (NPSA) has an updated, legally based, INCIDENT DECISION TREE (IDT) online. It is to be used whenever a patient safety incident has occurred, and its aim is to reduce unnecessary suspensions/exclusions from work.

To access/print off the IDT framework,
go to www.npsa.nhs.uk, and
· type 'IDT' in the search bar on the website homepage
· click on "Help" (left side), then
· click on "how the incident decision tree works"
For those of you who want to have a go at using the IDT online practically, it goes through the steps a question at a time - Click on "Start"
You might also be interested in the definition of suspension (see "glossary" on the IDT home page) - which those of you currently suspended under terms that should not be used - 'gardening leave', 'paid authorised leave', 'leave of absence'...etc can refer to and quote to your managers/unions.
The IDT framework is legally based, as it looks at the foresight and substitution tests (also known as the Bolam test).
For any of you who work by your NMC code and expose concerns, but then are eliminated by way of malicious, false allegations of misconduct or clinical negligence - this IDT is your bible to protect you, or at least then be able to litigate for constructive/unfair/wrongful dismissal!
Craig Longstaff

You have been suspended and you wonder what you should do now.  You are also in a state of shock and are finding it hard to think coherently.

When people email me, they sometimes ask me where they can get help because they feel so powerless; they are waiting all the time for people to act and no one is listening to them.  They may also be facing false allegations.

SUSPENSION/EXCLUSION

Crisis management guide

Positively managing an extreme situation

Positively managing your suspension/exclusion will require a lot of work on your behalf.

It will need you to take control and responsibility, and be active.

‘Ought, should, must’ thinking is a waste of your time and energy. Work with what is, be decisive, and take action to change the situation. Not all things will work, and there is no universal answer, but it is important that you make an effort, and keep trying until you find the solution you are happy with (especially long term).

IMMEDIATELY:

1. Seek counsel

¨ Union representation: Make them deliver on their advertised services
Request a second/independent opinion if they decline anything
Request they put any rejection/withdrawal in writing
Hold them to account for any failures/refusals/omissions
¨ Free, confidential legal advice via union, CAB, solicitor, local services/facilities, house insurance
¨ Employment advisors Eg ACAS, TUC
¨ Suspension/exclusion experts

2. Union to act

¨ As per best practice – see notes
¨ Seek legal advice AND full time officer input/supervision
¨ Send letter – see below and template
¨ Contact: the Director/CEO/Board – complain, overturn, investigate
the area SHA
the Healthcare Commission – dysfunctional, inept, repressive
the applicable Ombudsman
the CNO and NHS Employers
¨ Insist that organisation adheres to DH framework/guidelines

3. Complete an incident report form

4. Write a full statement

¨ Background, chronology, account




5. Get it confirmed (verbally and then in writing), at the point of exclusion:

¨ Who authorised/made the decision to suspend/exclude, and:
> did they have the authority?
(check any suspension/exclusion or disciplinary policy – usually it is a director for majority of staff, and CEO for Directors)
> Ascertain the skills/training of the managers involved in your case
Eg Management training
Employment legislation
Investigation/RCA training
Situation-specific Eg Suspension/exclusion, discipline, grievance
¨ The SPECIFIC reasons(s) for being suspended/excluded (nature of allegations) [or why did not provide, if not given at point of exclusion]
¨ Preliminary supporting evidence (basis of allegations)
¨ What further action is contemplated
¨ That a formal meeting will take place (and what the arrangements are)
¨ Of any interim restrictions/sanctions being applied
¨ Of your statutory employment/legal rights
¨ Of any support available/on offer/being arranged
¨ That you should consult a trade union/other representative
¨ Applicable policy being used/invoked
¨ Aware of Duty of Care?
¨ Aware of regulations and obligations – legal, professional/regulatory, organisational?
¨ [Why denied representation, if did]
¨ Why suspension/exclusion: What was the emergency/high risk?
Why weren’t alternatives considered/used?


SOON THEREAFTER AND THROUGHOUT:


6. Send your employer letters

¨ At the start of your suspension – see above
¨ Informing your employer of any existing concerns, issues, breaches, etc
¨ Requesting your employer:
a) Reconsider the appropriateness of suspension/exclusion
b) Consider the detrimental effects – personally, professionally, organisationally
c) Overturn the suspension/replace it with recommended alternatives (see DH guidelines)
d) Transfer your case to/follow the DH’s guidelines
¨ Lodging a formal appeal or grievance
¨ Requesting an investigation into the suspension/exclusion, by an independent and/or external individual/organisation
¨ If, after 8 weeks (unless the case involves police enquiries or legal proceedings), no disciplinary action has been communicated to you in writing, appeal against the continuation of suspension/exclusion


7. Keep records

¨ Contemporaneous, hold on to everything, record everything
¨ Everything: Any contact – in person, correspondence (letters, e-mails), calls, meetings
Event/incident logs, diaries, chronologies
Statements, minutes, notes taken, evidence
Costs
¨ Put everything in writing/by e-mail: Your only evidence and ‘friend’
Ask them to acknowledge receipt and understanding
¨ Keep copies of ALL that you send/receive
¨ Organise filing system


8. Inform and equip (arm) yourself with knowledge and skills

¨ “Go into battle equipped and armoured”
¨ Access the resources listed in Issue 2 of the CAUSE a Scene e-newsletter
(see www.suspension-nhs.org.uk)
¨ Buy Discipline and Grievances at work handbook (Acas)
¨ Get a copy of: Maintaining High Professional Standards in the Modern NHS (DH 2005)
The 2006 CNO’s guidelines (when they are published)
The NPSA’s incident decision tree (IDT) and root cause analysis (RCA)
(see www.npsa.nhs.uk)
¨ Check out the NCAS’s suspension toolkit: www.ncas.npsa.nhs.uk/toolkit
¨ Get copies of applicable/relevant organisational, professional, and legal guidance
Eg Policies, protocols, procedures, guidelines, frameworks
¨ Know the reciprocal rights and responsibilities: Discipline/grievance practice
Suspension/exclusion practice
Employment legislation
Human rights legislation
Whistleblowing legislation
Settlements and gagging/silencing clauses
¨ Understand: Root cause analysis (RCA) – see the NPSA website: www.npsa.nhs.uk
Bullying – see www.bullyonline.co.uk
Behaviour and office politics: Games, agendas, ploys
Identify those in progress in your situation
Identify patterns
Read Survive office politics
Gagging/silencing clause issues: Confidentiality, further action, restrictions
Compromising regulatory obligations
Reciprocal policing, rights and responsibilities
Legality
Not using reference as part of bargaining
¨ Equip yourself with essential skills: Legal skills
Conflict management skills
Office politics
Positive assertiveness
Persuading, negotiating, influencing (PIN)
Investigating and gathering information
(Self-) representation and case presentation
Crisis management and self-help strategies
¨ Get your detective and legal head on: Gather information
Investigate, explore, scrutinise, assess
> Allegations
> Informants/witnesses
> Statements, notes, minutes, evidence
> Root cause analysis (RCA)
Appropriately question/challenge
Uncover/root out
¨ Find out and understand: Why they are behaving/doing as they are
What their (real) problem and/or issues is/are
What their agenda/motive is
¨ Then: Strategise
Disarm/neutralise
Counteract

9. Strategise and prepare your case

¨ Decide on: Where you are
Where you want/need to be, what you need to achieve, goals, objectives, (N)ECG
How you are going to get there, tackle the situation, achieve
How far you are willing to go
¨ Be aware of, take responsibility for, and prepare for the consequences/ramifications of your strategy and decisions
¨ Plan how you are going to manage your situation: Strategically
Mentally, psychologically
Emotionally
Verbally and non-verbally
Behaviourally
Physically
¨ Games, strategies, ploys
¨ Minimum/maximum outcomes
¨ Consider taking out a grievance against the managers/individuals involved and the trust
¨ If your internal complaints fail, go external (blow the whistle)
¨ If the ‘offender(s)’ is/are professionally registered or regulated (Eg with/by the NMC or GMC), consider reporting them to their regulatory body

10. Self-care – look after and manage yourself

¨ Emotionally, mentally, psychologically
¨ Physically
¨ Financially
¨ Domestically
¨ Socially
¨ Stress management: Recognise and accept how you feel
Get support: Important!
Informally, formally
You cannot focus, if not aware and in control
Either: Self-help, informal, or formal/professional
Remember: Everyone is different
Understand post-traumatic stress (PTSD)
¨ Emotional intelligence (EQ) and self-awareness
¨ Explore the part you have had to play so far in the situation
¨ Enlighten yourself – about yourself, and the situation
¨ Take responsibility: For the situation
For your behaviour/conduct and responses
¨ Recognise how you act/respond, its impact, and then manage yourself so you can manage your situation and others
¨ Take control: Be active, not passive – choose which way to go
Assert, rather than be victim
SAWD: Solution-focused, rather than adversarial
Action-orientated
Win-win
Dignified
¨ Believe in yourself, have confidence, be bold, be strong
¨ Normalisation
¨ Act with integrity
¨ Desensitise and re-programme yourself: Neutralise abusive/negative
Positive self-affirmations
Be dispassionate and factual
Deal with emotions after contact
Change your perceptions of their ‘power’
¨ Contain the situation: Contain your ruminations and efforts
Spend so much time on the situation, then time out/away
(as hard as it is!!)
¨ Sleep, diet, relaxation
¨ Ensure social time/contact


11. End/after care

¨ If return to work (RTW): Formal, written RTW plan
Arrangements for: Reintegration
Briefing/updating, re-equipping
Supporting
Monitoring and reviewing
¨ If do not RTW: Manage Eg Finances
Emotions – Rejection, grief, betrayal, mistrust
‘Redundancy’/job hunting issues – reference, employability, searching
¨ In either scenario, revalidation and rebuilding work needed: Confidence, esteem
‘Emotional gardening’
Trust
Abilities (knowledge, skills)
Craig Longstaff

OTHER INFORMATION

The Department of Health Directions, December ‘03

These were written for the management of suspensions of doctors and dentists.  In a letter from the Minister of State, Rt. Hon John Hutton, MP to Brian Jenkins MP dated or received 5^th Oct. ’04, Mr Hutton wrote that the ‘current procedures for doctors and dentists are based on the Advisory, Conciliation and Arbitration Service best practice and can be adapted for other staff groups’.

The Directions are therefore vital in the handling of your case.  They can be downloaded from www.dh.gov.uk A-Z site index, D scroll to Doctors and dentists discipline and suspension. For a summary of the main points see the web site ‘Important Directions whose principles are relevant to all staff’ for management of staff suspensions (click here if you would like to view a web-based version of these directions).  

New To view a suggested incident diary log click here (credit for this must go to Craig Longstaff).

The Nursing and Midwifery Council professional advisers will listen in confidence and give you their view.  Tel: 020 7333 6541/6550/6553. I have always found it fairly easy to get through to one of them.  They will also explain their procedures should your employer report you to them.

Advisory, Conciliation and Arbitration Service (ACAS) has a helpline 08457 474747.   The helpline advisor is able to explain employment processes and such matters as unfair dismissal and constructive dismissal.  They will also be able to explain the significance of the new Employment Law that came into force in October 2004.  

Legal advice from solicitors who specialise in employment law. You can find out who your local employment solicitors are by looking at www.lawsociety.org.uk The site will also give you advice about the service solicitors offer and how to prepare for meetings with them.

Addresses

Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS  

Tel: 0207210 3000

Web address: www.dh.gov.uk

Nursing and Midwifery Council

23 Portland Place, London W1B 1PZ   Tel: 020 7637 7181

www.nmc-uk.org

Advisory, Conciliation and Arbitration Service (ACAS)

Head Office: Brandon House, 180 Borough High St, London SE1 1LW

www.acas.org.uk