Reports and Updates

Letter to NMC from CAUSE dated 25th January 2010

Report "Suspension Failure in the NHS", September 2004 - click here to view

Directions from the Department of Health for the management of suspension of doctors and dentists (.pdf format) (click here to view in HTML format)

Report "The Role of Unions in NHS Suspensions" (.pdf format)

 Letter to Lord Warner, Minister of State, Department of Health - November 2005

Suffering of family members no surprise - Summary of Findings of Pilot Questionnaire for Family Members

Campaign Correspondence with Sir Nigel Crisp, DoH and many others- October 2005

Response from the Public Accounts Committee Dec 2005

NHS Employers Response - Dec 2005

Workforce Directorate Response - Jan 2006

Correspondence with Sir Nigel Crisp and others Oct-Dec 2005

To Sir Nigel Crisp (NHS Chief Executive) 31.10.2005

‘COVER LETTER’

Please find attached an e-mail letter (word document) sent to Sir Nigel Crisp regarding "Suspensions/Exclusions & Whistleblowing within the NHS"

The letter, being circulated as per the circulation list on pages 7-8, is asking Sir Nigel - & any other individuals/organizations with influence - to intervene &:

Please do not hesitate to contact me (contact details as per page 1 of the letter)

BY E-MAIL                                                                                                   Monday, 31 October 2005                                                

Dear Sir Nigel

I write to ask you to:

·        Stop the ‘suspension culture’ & unnecessary suspensions/exclusions of staff.

·        Stop the damage caused by suspension/exclusion.

·        Stop unethical suspension/exclusion practice.

·        Secure competent, statutory management & corporate governance of suspension/exclusion cases.

·        Provide real protection for those that “blow the whistle” for genuine reasons.

·        Ensure those who are suspended/excluded are supported.

·        Hold organisations, teams & individuals to account.

·        Secure arrangements for further, in-depth & specific research into suspension/exclusion.

I regrettably write as an ex-employee of the NHS. This letter has been generated with brevity in mind, to maintain attention on what is a very pertinent, complex & devastating issue.

Suspension/exclusion is currently portrayed as a neutral act, not punishment. This is, however, contradictory to dictionary definitions of suspension/exclusion1 & is not the real experiences of those suspended/excluded, which are more akin to dictionary definitions.

There are significant inequalities in how suspensions/exclusions are managed between the different disciplines & trades within the NHS. This is breaching the Employment Act 2000.

1              Please intervene to stop the unnecessary suspensions/exclusions of NHS staff, including nurses who make up the highest percentage of NHS staff suspended/excluded, & put an end to the ‘suspension culture’ still so prevalent & problematic within the NHS

1.1         This is despite current available legislation & several published reports not least by the National Audit Office, House of Commons Public Accounts Committee & www.suspension-nhs.org.

1.2         It may not be too long before groups of NHS employees collectively seek individual & corporate accountability at local AND national level, through the UK/European criminal justice system, for the injustices, travesties & wrong-doings experienced & exposed to. Let’s avoid this becoming a reality, by acting definitively & with integrity.

2              Suspension/exclusion should be a last resort, except in the most extreme of situations

2.1         Last resort is defined as: To ensure patient/client safety, to protect the public, to ensure staff safety & to prevent tampering with of evidence.

2.2         Suspension/exclusion is still being sought as the 1^st course of action (see point 3), & NHS organizations are not universally being held to account locally, nationally & publicly for doing this. Their actions are being intentionally covered up with the ‘gagging/silencing’ agreements (AKA “confidentiality clauses” & “compromise agreements”) often being ‘forced’ upon individuals, despite the plethora of reports & publications denouncing this practice as unethical, contrary to core NHS principles & preventing accountability.

2.3         NHS organisations are thus failing employees, the clients they service, & the taxpayer.

3              It is extensively documented & recognised as to when & why suspension/exclusion is inappropriately sought or sanctioned

3.1         For example:

Ø       When organisational/systemic inadequacies & failures are the real issue, but this will not be admitted to.

Ø       When a courageous & principled individual puts integrity before popularity by

a)     Speaking out (“blowing the whistle”) informally or formally

b)     Exposing individuals, systems or whole organisations

c)     Being unwilling to be ‘occupationally socialised’.

3.2         In such circumstances, suspension/exclusion is used to threaten, intimidate, silence & cover-up. This is confirmed by the new case of Paul Lewis (‘Trauma unit boss’) (Vs.) United Lincolnshire Hospitals NHS Trust, reported in the Daily Mirror (Saturday October 22, 2005, p22). This article also reinforces the concept that staff have to speak anonymously for fear of reprisals – thus weakening the rhetorical NHS principle of ‘transparency & openness’.

3.3         Many people do not believe such things can be happening. Sadly it is, & can be verified not least by many of the 100+ individuals who have contacted the website www.suspension-nhs.org (Author: Julie Fagan).

3.4         You also only have to examine the current, ongoing case of Andre Downer (RMN) (vs) SW London & St.George’s Mental Health Trust to become aware of standard abhorrent NHS tactics. Mr.Downer’s case, resulting in his (some would say ‘forced’) resignation & disclosure under the Public Interest Disclosure Act (PIDA) 2000, is the epitome of NHS Mental Health services. Mr.Downer was suspended for repeatedly raising concerns about safety on his unit, the latter of which resulted in the death of a staff member due to inaction & ignoring his concerns. A copy of Mr.Downer’s written disclosure under the PIDA 2000, which has been widely circulated to numerous MP’s & covered in several media articles, is readily available for perusal.

3.5         The above 2 cases cited as examples are high profile ones. There are many more ‘silenced’ cases, which are deliberately blocked from reaching the public arena.

4              The scale/extent, costs & effects – to individuals, their significant others, & to organisations – are unnecessary & avoidable

4.1         The ‘other’ costs2 (seen & unseen) to individuals & those closest to/around them are un-quantifiable – but far-reaching. Many staff do not return to work, or leave soon after, even if exonerated.

4.2         Attempts to estimate financial costs3 have been made by the House of Commons Public Accounts Committee, the National Audit Office, & Public Concern at Work. However there are currently no realistic figures, which are feasibly likely to be much higher than the estimates, which do not include all groups of staff & all types of suspension/exclusion & do not assess the associated costs4. If only taxpayers knew how much it was costing them & how much money is being diverted from healthcare.

5              The annual savings that can be made with taxpayer’s money provides a sound business case for a) preventing cases & b) minimizing case costs

5.1         This would be highly prudent financial management, especially in light of media reports that Chancellor Gordon Brown is to review NHS funding & Government spending by 2007 & is likely to limit extra cash for the NHS after 2008.

5.2         It would also be prudent in light of the current overspending in many NHS Trust budgets. These Trusts are now, underhandedly, ‘freezing’ nurse recruitment despite documented shortfalls (especially in Mental Health).

5.3         The savings made with taxpayer’s money could be re-routed to clinical care5 & better working environments for frontline staff. People are vying for funding, whilst others are trying to stop unnecessary or inefficiently managed suspensions/exclusions. A wise system would realise that the latter could remedy the former without any extra “fund finding”.

5.4         Senior national & local NHS managers should be publicly held to account for their failure to be more prudent with taxpayer’s money & wasting such a scarce, finite & precious resource.

6              Suspensions/exclusions can be prevented, or at the least minimised, by:

6.1         Securing & practicing Clinical & Corporate Governance at ALL levels. As I have fed back to Debbie Hall of the CGST, & previously to the Healthcare Commission, this is not occurring, more so in some trusts than others, despite the Healthcare Commission being told otherwise during their well-orchestrated visits.

6.2         Implementing good, basic employment & management practices (as listed by ACAS, the Health & Safety Executive, the Department for Trade & Industry for example) at ALL levels.

6.3         Taking formal, statutory measures to stop the extensive & widespread culture of bullying & harassment within the NHS, which tends to be a central, often unscrupulous facet within suspensions/exclusions.

6.4         Objectively & universally practising NHS principles & initiatives at ALL levels

ie. Stop the rhetoric & “walk the talk” on the shop floor, so to speak.

6.5         Informing, equipping, supporting, monitoring & developing colleagues/employees as the norm, rather than the exception (which is often the case, especially in mental health).

6.6         Ensuring colleague/employee mental health, wellbeing & welfare in the workplace (See the ‘Working Minds Toolkit’ at www.mindout.net or www.nimhe.org.uk.

6.7         Intervening proactively & early in deteriorating circumstances.

7              Formal AND informal raising of concerns by staff need to be positively & professionally managed, by:

7.1         Encouraging & welcoming formal AND informal disclosures, & protecting the individuals/groups who make them.

7.2         Ensuring formal AND informal concerns are logged, & that the systems for managing them are formally audited & reported back to internal AND external authorities.

7.3         Tracking & monitoring the concerns raised/reported by staff.

8              Employment law/practice needs changing to ensure individuals are truly protected

8.1         Currently, the law sides with the employer except in the most obviously corrupt/inept of cases, or where there is clear-cut wrongdoing. Ask those who have put the law to the test, & subsequently seen its effects & how NHS organisations manipulate loopholes before & during proceedings.

8.2         It is well documented that there are grave inequalities between an individual & a big organisation such as the NHS when it comes to legal aspects, especially financing legal advice & legal proceedings.

8.3         The current legal & corporate climate of encouraging ‘out of court’ settlements (with the aforementioned attachment of ‘conditions’ stated in point 2.2) further erodes public accountability. Especially at a local level where truth & reality are intentionally kept from the public, who then cannot question or challenge service providers & hold them to account for their actions/omissions.

8.4         The corporate practice of forcing NHS employees (overtly AND covertly) into redeployment or to “seek alternative employment” when they have spoken out (even if they have followed procedure) must stop. It is a form of underhand (covert) victimization.

For cases necessitating suspension/exclusion:

9              It is imperative to ensure ethical practice throughout the management of a case

9.1         Currently there is a lot of unethical practice occurring unchecked. For example:

Ø       Discouraging individuals from reporting genuine concerns about an individual or manager to their professional/regulatory body (Eg NMC; BMA).

Ø       Discouraging applications to employment tribunals through dirty tactics.

Ø       Re-deploying individuals under false pretences by exploiting loopholes & ambiguities.

Ø       Tampering with or preventing gathering of evidence.

Ø       Manipulating statistics.

Ø       Restricting the ‘remit’/‘terms of reference’ of investigations.

Ø       Allowing those with a clear conflict of interest to investigate matters, co-ordinate processes or sit on panels.

9.2         Often unethical practice can occur overtly as much as covertly.

9.3         ‘Case Managers’ & ‘Case Investigators’ should, as the norm rather than the exception:

a)     Have the pre-requisite training, knowledge, skills & experience – generally, regarding investigations, & relating to the ‘specialist fields’ of, for example, bullying/harassment, fraud, abuse, & discrimination.

b)     Comply with & conform to the ‘Code of Conduct for NHS Managers’ (2002)6. The experiences of those who have been suspended/excluded clearly indicates that managers are frequently in direct & overt breach of (usually several) aspects of this Code, & are facilitated/permitted to do so unchecked without admonishment.

10        Robust, universal, consistent & enforceable statutory processes are needed

10.1     Such as the current regulations for doctors & dentists. They need to be equally & universally applied to ALL trades & disciplines, as required by the employment Act 2000. This is currently not happening.

10.2     It is not acceptable to trust that NHS organisations will voluntarily apply the guidelines provided for doctors & dentists to all professions, because it is well documented & experienced that they do not.

10.3     Poor managers, usually rife in suspension/exclusion cases, who are already not complying with the Code of Conduct for NHS Managers 2002, or even basic good employment practices, & who do not even know the existence of the Leadership Qualities Framework let alone implement it, either do not know or intentionally do not implement ‘good/best practice’ suspension/exclusion guidelines. It is therefore inappropriate to appeal to their (already questionable) ‘better nature’.

10.4     For ALL disciplines & trades within the NHS, systems & standards need to be formally established, & formally monitored & evaluated for compliance, effectiveness & efficiency.

10.5     Those systems & standards, for the NHS to be excellent, need to be ‘gold’ rather than minimal.

11        Effective & efficient representation is essential

11.1     Trade & workplace unions have enormous responsibility to ensure this occurs.

11.2     However, many of the unfortunate individuals who have ‘been through the mill’ know all too well how unions have (often repeatedly & significantly) failed them, leaving the individual very isolated & vulnerable.

11.3     A report co-ordinated by Julie Fagan, titled “The role of unions in NHS suspensions” (available from www.suspension-nhs.org), validates these claims.

12        Adequate, comprehensive, holistic & individualised support of individuals suspended/excluded is paramount, if they are not to suffer further detriment than they already are doing, with likely irreversible/irretrievable consequences to themselves & those closest to/around them.

13        Exonerated persons need redress & support

13.1     Especially if any accusations, allegations & defamations are subsequently found to be false, misleading or malicious. This occurs more often than is recognised, with everlasting obvious & less-obvious consequences on the recipient & those closest to/around them.

13.2     As quoted on the National Clinical Assessment Service’s ‘toolkit’ website (www.ncaa.nhs.uk/toolkit), individuals need managing, developing, rebuilding & supporting.

14        Individuals, groups/teams & organisations need to be held to account, by:

14.1     Promoting ownership – clear lines of responsibility & accountability.

14.2     Fervently ensuring managers at ALL levels within the NHS comply with the ‘Code of Conduct for NHS Managers’ (2002)6, & openly holding them to account “…for their own performance, responsibilities & conduct” (Code of Conduct for NHS Managers 2002: p8; point 4). This seldom happens, sadly.

14.3     Stopping the practice of gagging/silencing individuals/groups with “confidentiality clauses” & “compromise agreements”, & not protecting unhealthy & detrimental teams & organisations.

14.4     Appropriately & reasonably disciplining, or even prosecuting, those who are found to have made false, misleading or malicious allegations, accusations & defamations.

14.5     Producing 6-monthly/yearly PUBLIC reports & statistics on each NHS organisation, detailing specific data, practices & performance regarding, for example:

Ø       Complaints & concerns (from all groups of people – public & employee);

Ø       Bullying, harassment & victimization

Ø       Grievance, disciplinary & suspension/exclusion cases;

Ø       Investigations held;

Ø       Recruitment, retention, ‘exit’, contract terminations (however generated) & labour turnover.

14.6     Such data should be incorporated into the yearly NHS ‘star ratings’, the responsibility of the Healthcare Commission. Once robust & unambiguous systems are established, the data would be easy to collate. Employees could also use this data to assess their actual or potential employer’s working ethos & employment practices – reliable indicators of good & bad employers.

14.7     I am sure many NHS organisations would oppose points 14.5 & 14.6, as they would then be exposed, & their purported awards (Eg as an ‘Investor in People’) & their employment/service rhetoric would be annulled.

15        Return to work (RTW) must be proactively planned for & well organised

15.1     The NCAS toolkit website clearly identifies that individuals need rebuilding.

15.2     This is true clinically AND also (especially) personally.

15.3     Once it is established that an individual is to return to work (RTW) from a period of suspension/exclusion, a robust, comprehensive & detailed, holistic & individualised ‘RTW’ needs assessment & plan must be collaboratively designed, recorded & secured.

15.4     To minimize RTW anxieties & RTW complications, this needs be before the scheduled return to work date rather than after.

15.5     RTW needs assessments & plans need to be incorporated into organisational policy. All too frequently those suspended/excluded are advised there is no specific organizational RTW policy relating to suspensions/exclusions, & they are thus returned to the workplace without any support, remedial interventions or re-validation – all of which are vital. Hence the statement in point 4.1, that many staff who have ‘been through the mill’ do not return to work or leave soon thereafter because of their experiences during & after suspension/exclusion.

16        Further, in-depth & specific research is paramount

16.1     To ascertain the true extent of suspensions/exclusions taking place, their cost (financially & otherwise), their management, effects/consequences, reasons, & antecedents/patterns.

16.2     There is currently no specific monitoring or ‘audit trail’.

  None of the information & suggestions presented herein constitutes ‘rocket science’, but rather common sense & basic values/principles & “standards of good employment practice” (Code of Conduct for NHS Managers 2002: p7; point 1). Furthermore, a lot of it is often economical or even free to implement with the minimum of disruption & effort. I urge you to act decisively to stop the current ‘suspension/exclusion’ culture, with the catalogue of obvious & less obvious consequences & wider implications to individuals, their significant others, teams, organizations, performance & standards, reputations, etc……

NHS staff – whatever their role, trade or level – should be treated with dignity & respect, as human beings.

The information presented herein is just the tip of the iceberg.

Please do not hesitate to contact myself (as above), Julie Fagan (enquiries@suspension-nhs.org) or Andre Downer should you wish to discuss matters further, clarify anything, be sign-posted to information referred to, or need further written/practical information & suggestions we have readily accessible.

I would be grateful if you would acknowledge this letter, & keep me informed of any actions you take/instigate in pursuance of the matters raised herein, along with their outcomes.

Thank-you for your time. I look forward to hearing from you.

Yours sincerely

CRAIG LONGSTAFF

Circulation List:

Government

NHS Chief Executive – Sir Nigel Crisp

Chancellor of the Exchequer – Gordon Brown (MP)

Attorney General – Lord Goldsmith

Secretary of State for Health – Patricia Hewitt (MP)

Secretary of State for Trade & Industry – Alan Johnson (MP)

Health Minister – Liam Byrne (MP)

European Parliament – Terry Wynn (MEP)

Local MP (Labour) – Shaun Woodward

House of Commons Public Accounts Committee – Edward Leigh (Chairman)

Audit Commission – Complaints & PIDA Manager

Health & Safety Executive (HSE) – Timothy Walker (Director General)

NHS/Health

Chief Nursing Officer (CNO) for England & Wales – Christine Beasley

NHS Litigation Authority (NHSLA) – Ron Bradshaw (Chairman)

NHS Confederation – Dame Gill Morgan (Chief Executive)

Cheshire & Merseyside Strategic Health Authority (SHA) – Chris Hanna (Chief Executive)

Healthcare Commission – Anna Walker (Chief Executive)

Clinical Governance – Aidan Halligan (Director of Clinical Governance for the NHS)

 Debbie Wall (Clinical Governance Support Team) (CGST)

National Institute for Innovation & Improvement – Professor Bernard Crump (Chief Executive)

National Patient Safety Agency (NPSA) – Susan Bothwell (Cheshire & Merseyside)

National Clinical Assessment Service (NCAS)

NIMHE North West – Neil Brimblecombe (Director of Mental Health Nursing)

Institute of Healthcare Management – Jeremy Millar (Interim Chief Executive)

Mental Health Service User Organizations

Sainsbury’s Centre for Mental Health

Rethink – Grainne Currie (North West Regional Manager)

Paul Corry (Press)

Mentality – Elizabeth Gale (Director)

NMC

Sarah Thewlis (Chief Executive)

Jonathan Ashbridge (President)

Craig Turton (Press & PR Officer)

RCN

Sylvia Denton (RCN President)

Beverly Malone (RCN General Secretary)

Chris Cox (Assistant Director, RCN Legal Services)

Steve Flannigan (RCN North West Regional Director)

Ferguson Doyle (Assistant RCN Officer (Legal), RCN North West Branch)

Employment Organizations

ACAS – John Taylor (Chief Executive)

Public Concern at Work (PCAW) – Guy Dehn (Director)

Press

The Daily Mirror – News desk

 Andrew Penman & Michael Greenwood (investigative journalists)

 Rod Chaytor

The Daily Telegraph

The Times – Home News Editor

The Guardian – Emily Bell (Editor in Chief)

The Daily Mail – Paul Dacre (Editor)

The Liverpool Echo – Alison (News Editor) & Helen Hunt (Health Correspondent)

The Manchester Evening News (MEN) – Paul Horrocks (Editor); News Desk

TV

Panorama (BBC 1) – Mike Robinson (Editor)

Newsnight (BBC 2) – Peter Barron

ITV

Channel 4 News

North West Tonight

Radio

Radio 1 – Newsbeat

Radio 5 – Julian Worricker (investigative journalist)

Publications

Health Service Journal (HSJ) – Nick Edwards (Editor)

Mental Health Practice – Ian McMillan (Editor)

Nursing Standard – Jean Gray (Editor)

 Graham Scott (News Editor)

 Christian Duffin (Deputy News Editor)

Nursing Times – Rachel Downey (Editor)

 Rebecca Norris (News Editor)

Professional Nurse – Carolyn Scott (Editor)

Miscellaneous

Julie Fagan (HV) – Author, www.suspension-nhs.org

Andre Downer (RMN) – Whistleblower & ex-NHS employee

Copy to File

Notes

 COMMENT/NOTE:

·     No responses – EXCEPT from the Public Accounts Committee (PAC) & the CGST – materialised until follow-up telephone calls were made. This is despite:

1.      The appeal in the ‘cover letter’ (2^nd paragraph) to any other individuals/organizations with influence - to intervene

2.      Asking (3^rd paragraph) at the end of the ‘cover letter’) for comment/discussion from the organisations circulated to

·     If nothing else, one would have thought that other organisations listed in the circulation list would have been proactive, recognised their contribution to/influence on the issues, & thus responded in some manner

·     Majority of the recipients on the circulation list, despite their status, have failed to respond after over 6 weeks

·     Positive/constructive responses to the letter circulated have been received from:

1.      The CGST. Following discussions with Debbie Wall of the CGST, who has been a tremendous support, a meeting is to be arranged in early 2006 with Aidan Halligan (Director of Clinical Governance for the NHS)

2.      The NPSA (Sue Bothwell)

3.      RCN (Andrew Barton)

4.      The PAC (Public Accounts Committee)

5.      The Nursing Standard – An ‘In Brief’ mention was made in the Nov 9 issue (Vol.20/No.9; 1995; p11)

·     Less positive/constructive responses to the letter circulated have been received from:

1.      Department of Health (Sir Nigel Crisp; Maureen Morgan)

2.      NHS Employers (Barbara Carter)

3.      NIMHE (National Institute for Mental Health – Neil Brimblecombe)

4.      NHSLA (NHS Litigation Authority)

 From Sir Nigel Crisp 08.11.2005

 Our ref: CEOPO43765

8^th November 2005

Dear Mr.Longstaff

Thank you for your email of 29 October.

I was interested to read your comments and views. NHS Employers was established a year ago to deal with NHS employment matters and promote good employment practice in the NHS. I have therefore passed your letter to them for response.

Yours sincerely

NIGEL CRISP

COMMENT/NOTE:

·     This letter was sent on DH headed paper

To Sir Nigel Crisp 08.12.2005

Thursday, 08 December 2005

Dear Sir Nigel

Further to you sign-posting me to NHS Employers to address the issues raised in my e-letter to you of 29.10.2005, I have received communications from Ms. Barbara Carter of NHS Employers.

Regrettably I remain unsatisfied. I have attached my 2 e-letters to Ms.Carter for your information. During our written communications & my discussions with others, it appears:

1.      NHS Employers has no authority to compel trusts to universally apply the existing arrangements for doctors & dentists, or to enforce good, basic employment practices in general

2.      NHS Employers is not leading the way regarding (1). It seemingly has a secondary rather than primary role

In writing to you with my original letter, I was aiming for an immediate, medium & long term multi-agency approach to address suspension/exclusion & whistle-blowing issues. I was also aiming to communicate with those persons/organisations having authority to make a difference & make changes to safeguard all employees. It appears clear that NHS Employers is not the lead authority.

Please can you redirect me/put me in contact with whoever has lead authority to address the issues raised in my original letter to you.

I look forward to hearing from you.

Yours sincerely

By E-mail

CRAIG LONGSTAFF

(Ex-NHS employee)

To DH 08.12.2005

Dear Ms.Morgan

I have been referred to you by Ms.Carter (NHS Employers), for information regarding the CNO’s working group which is reviewing suspension/exclusion practice of all other NHS staff.

Attached with this e-mail are 4 letters:

·     3^rd letter: Details the information referring me to you.

·     2^nd letter: Details the information I am requesting, & comments I have made regarding the working group, which I would be grateful for your response to.

·     1^st letter: An e-letter I sent to Sir Nigel crisp, regarding suspensions/exclusions & whistle-blowing in the NHS.

·     4^th letter: My final response to Ms.Carter.

I would be grateful for your response/feedback regarding the issues raised in all letters.

I look forward to hearing from you.

Kind regards & look after yourself

Remember:

Our lives begin to end the day we become silent about the things that matter (Martin Luther King)

Each individual is responsible for what they have done & for the people they have influenced

There can be no true success in a world of mediocrity

Craig Longstaff

From DH 09.12.2005

Dear Mr Longstaff, thank-you for your email outlining your concerns about suspensions, exclusions and whistle-blowing in the NHS.  I know you are aware of the remit of the expert group I am co-chairing with Dr Rosemary Field of the National Clinical Assessment Service, and of the work we are doing.  We anticipate our guidance will be available to all providers of health care, in the Spring of next year.  While we will cover suspensions and exclusions, we will not directly address whistle-blowing, as a policy already exists for this.  Though we will not comment on the detail of what should happen in individual organisations, we hope our work will help employers and others ensure they have good systems in place to protect the public while ensuring fairness and equity for staff.

I hope this is helpful.

Maureen Morgan

COMMENT/NOTE:

·     This response was not on headed paper, as one would have expected considering the NHS’s ‘corporate logo’ guidance to improve professionalism. Neither was any role/title given, or further contact details

·     The information requested was not provided, & there was no mention of the specific issues raised in the letters

To DH 13.12.2005

Dear Ms.Morgan

Thank you for your reply dated 09.12.2005, which I am quoting (along with this reply) in my response to the Public Accounts Committee.

As per my letter of 17.11.2005 to Barbara Carter (NHS Employers), which I sent you a copy of, you have not provided me with the information I requested regarding the working group you are co-chairing. I would be grateful for same as soon as possible.

I note your letter states guidance will be sent out to all health care providers in Spring 2006. Firstly, neither yourself nor Ms.Carter have answered my question of what is to happen to staff that fall foul of the ineffective system interim? Secondly, I specifically ask: Will these guidelines remain just voluntary guidelines, or will they become statutory/mandatory & if so when? If they remain voluntary, that is unacceptable - for the reasons stated in prior communications with yourself, Ms.Carter & Sir Nigel Crisp.

I am sorry your team will not directly address whistle-blowing due to (quote) a current policy existing. I have raised my concerns to Ms.Carter regarding the ineffectiveness & failures of this policy, & same were copied to you via my last e-mail. I am now assuming that, based on yours & Ms.Carters communications, my concerns are not being heard or addressed adequately. This will be shared publicly.

I am sorry you have not discussed issues raised in my previous e-mail.

I note your letter ends with "Though we will not comment on the details of what should happen in individual organisations,..." . Why will you not comment on individual organisations? I thought the NHS was open & transparent?

Lastly, whilst it is honourable to (quote) HOPE your work will help employers & others to ensure they have good systems in place to protect the public while ensuring fairness & equity for staff, hope is not scientific or evidence-based, & is at risk of failure. What happens if your "hopes" don’t come true - what then? Your work should be SECURING, rather than mere hoping for, good systems, & where necessary enforcing same.

I look forward to hearing from you.

Kind regards & look after yourself

Remember:

Our lives begin to end the day we become silent about the things that matter (Martin Luther King)

Each individual is responsible for what they have done & for the people they have influenced

There can be no true success in a world of mediocrity

Craig Longstaff

From PAC 06.12.2005

L.678/24/369

6 December 2005

Dear Mr Longstaff

Suspensions/exclusions and whistleblowing within the NHS

The Chairman of the Committee of Public Accounts has asked me to thank you for your e-mail of 31 October 2005 which highlights your concerns over the use of suspensions and exclusions and the need for a fair and open culture within the NHS.

As you know, the Committee of Public Accounts examined the management of suspensions and exclusions in 2004 based on a Report by Sir John Bourn, the Comptroller and Auditor General. A copy of this Report, The management and suspensions of clinical staff in NHS hospitals and ambulance trusts in England can be found on the National Audit Office website (www.nao.org.uk). The NAO Report expressed concerns over the quantity of clinical staff that were being excluded or suspended within the NHS and the different ways that these exclusions were managed by the Health Service and concluded that a large amount of money was being wasted as a result of staff exclusions. As you note, the National Audit Office made a number of important recommendations to improve the management of suspensions. The Committee’s own Report (HC 296, Session 2003–04) published in October 2004 made a number of further key recommendations which are relevant to your concerns.

One key issue that the Committee raised was that the Departmental guidance on the management of suspensions and that the various support systems provided applied only to doctors. The Committee of Public Accounts in its Report recommended that all clinical staff exclusions should be monitored, not just the formal suspensions of doctors, to take into account the large number of nurses and other clinical staff that are excluded and that proper guidance on the clinical staff disciplinary process should be provided to all trusts. The Committee suggested that the remit of the National Clinical Assessment Authority (now known as the National Clinical Assessment Service) should be extended to cover all clinical staff. Finally, the Committee advocated that ethnicity should be included in the monitoring of exclusions and that if trusts find that the numbers of ethnic minority staff that are excluded is disproportionate to the number employed they should investigate the reasoning behind this. In addition, the Committee recommended that action should be taken to resolve cases as promptly as possible particularly when patient safety is not at risk.

The Committee commented that where patient safety is not at risk and the issue is about personal conduct then the trust should use its own disciplinary processes, with suspension reserved for cases of gross misconduct which could result in dismissal. The Department’s Treasury Minute response noted that suspension may be necessary in such cases to ensure that the investigation is unhindered. The Department of Health’s response includes the introduction of a framework for managing exclusions and maintaining high professional standards, which was introduced in 2003 and updated in 2005. The Department of Health reports that, since the NAO Report, referrals to the National Clinical Assessment Service (NCAS) have resulted in alternative action to suspension in 85% of the cases referred.

The Committee’s examination and NAO Report on the management of suspensions highlighted many ways to strengthen the investigation process of exclusions and suspensions, including improving support for those staff who have been excluded or who are returning to work after exclusion. Partly as a result of the Committee’s work the Department of Health has agreed a number of changes:

Ø       Ethnicity is now included in monitoring of suspensions;

Ø       The NCAS now has responsibility for monitoring long term suspensions

Ø       The Department has agreed to promote early resolution to help minimise the cost and inconvenience of long term exclusions; and

Ø      The Department noted that it was deferring its decision about extending the NCAS’s services to other staff until after their merger with the National Patient Safety Agency.

Ø       I enclose a copy of the Department’s Treasury Minute response for your information.

 You may be interested to know that in October 2005 the NAO published a Report, A safer place for patients: learning to improve patient safety (HC 456, Session 2005–06) which highlights the need for an open and fair culture where clinicians are able to learn from near misses. The NAO Report found that whilst NHS trusts are becoming more open and fair and that most trusts have been able to reduce their blame culture pockets of blame still remain.

Whilst this Report recognises the NCAS’s contribution to this improvement, it notes that at present the support provided by the NCAS is confined to doctors. The NAO therefore recommend the need to expedite their earlier recommendation to extend their services to other clinical staff. The Committee is due to take evidence from the Department of Health on this report and in questioning the witnesses at the January Hearing we will bear in mind the points you have raised.

In due course the Committee will present its own report on patient safety. Thank you once again for sharing your concerns with the Committee.

Yours sincerely

NICK WRIGHT
Clerk of the Committee

Enc

Treasury Minute on the Forty-seventh Report from the Committee of Public Accounts 2003-2004 (Cm 6441, 26 January 2005)

Forty-seventh Report

Department of Health

The management of suspensions of clinical staff in NHS hospitals and ambulance trusts in England

PAC conclusion (i): …. There is a pressing need for accurate and timely reporting of exclusions to NHS trust and Foundation Hospital Boards, and Strategic Health Authorities to enable them to see that cases are properly managed. The Department needs a better grip on the management of all exclusions of clinical staff and should repeat the National Audit Office’s survey of all NHS trusts to determine the extent and costs of exclusions and report its results.

1. The Department agrees with the recommendation. The framework document published in December 20031 provides for periodic review and reporting of progress in individual cases and makes it clear that NHS trust boards have a responsibility to ensure that internal procedures are being followed.

2. Under the Secretary of State Directions which introduced the new framework,2 trust boards now receive a monthly statistical summary showing all exclusions with their duration and the number of times they have been reviewed and extended. A copy of the report must also be sent to the Strategic Health Authority (SHA), who will collate a single report for the National Clinical Assessment Authority (NCAA). The Department of Health (DH) has passed the responsibility for monitoring the number of long term suspensions to the NCAA.

3. The Department will liaise with NHS Employers (the new NHS employers’ organisation set up in October 2004) and the NCAA to undertake a repeat of the National Audit Office (NAO) survey of the extent and cost of exclusions.

PAC conclusion (ii): …. The Department should complete its negotiations with the British Medical Association and issue further guidance on disciplinary processes. The guidance only applies to doctors and, with several hundred other clinical staff excluded each year, it is unacceptable that similar arrangements have not been made for them. The Department should now issue extended guidance covering all clinical staff.

4. The Department agrees with the principle of extending guidance on exclusions to cover all clinical staff. Priority has been given to resolving the problem in medicine and dentistry as this is where 75 per cent of the savings can be made. It has always been the case that the principles in the framework can be applied to other staff groups. The Department will ask NHS Employers and the NCAA to consider how best to encourage the development of good practice in managing the exclusion of other clinical staff in parallel with the work already underway to improve the handling of performance concerns in other professional groups, as described in paragraph 14 below.

5. The Department completed negotiations with the British Medical Association in November 2004 and a new mandatory framework on disciplinary procedures should be published by spring 2005. The intention is that the new procedures should come into effect from 1 April 2005 and will cover all doctors and dentists employed in the NHS.

¹ HSC2003/012 Maintaining High Professional Standards in the Modern NHS

² The Restriction of Practice and Exclusion from Work Directions 2003

PAC conclusion (iii): ….Where cases are pending for more than six months, the Department should identify what actions it might take to promote an early resolution.

6. The Department agrees that every effort should be made to resolve longstanding cases. Normally there should be a maximum limit of six months exclusion, except for those cases involving criminal investigations. The new framework requires those exclusions which have been extended over six months to be reported to the SHA with the reason for continuing the exclusion, the anticipated timescale for completing the process and the actual and anticipated costs of the exclusion. The SHA will then form a view as to whether the case is proceeding at an appropriate pace and in the most effective manner and whether there is any advice they can offer to the board. The NCAA will also continue to provide advice until the case is concluded. It is not appropriate for the Department to intervene directly in matters concerning individual employers and their employees – this is a matter for the NHS.

PAC conclusion (iv): …. Some cases have taken more than two years, including cases where patient risk is not a factor. One long-running case is unlikely to be resolved until March 2005, resulting in an additional delay greater than the Department’s target of six months for dealing with new cases. Such personal conduct cases need to be dealt with much more expeditiously using the employing NHS trust’s disciplinary process, with its range of sanctions. Suspension should be reserved for cases of gross misconduct which could result in dismissal.

7. The Department agrees that exclusion should be reserved for exceptional cases though not exclusively restricted to those involving gross misconduct. The new disciplinary framework for doctors and dentists no longer distinguishes between personal and professional misconduct. Conduct cases such as the one described above will now be dealt with under the trust’s own disciplinary process which applies to all employees. The new framework provides for a separate process for handling concerns about a practitioner’s capability and is intended to resolve the problem before formal disciplinary action is required. Where formal action is considered appropriate the new framework will work in a less adversarial and legalistic way ensuring that the long delays which affected many previous cases are avoided in future.

8. The exclusions framework emphasises that exclusion from work should only be used as an interim measure in the most exceptional circumstances where alternative methods of maintaining patient safety are not possible or to enable the investigation to be completed unhindered by the presence of the practitioner.

PAC conclusion (v): …. The Department’s latest guidance on confidentiality clauses following our report on inappropriate adjustments to waiting lists is limited to chief executives and board directors. The Department should make clear that confidentiality clauses should not be used to prevent disclosure of settlements for any NHS staff.

9. The Department has always maintained that confidentiality clauses should not be used to prevent disclosure of settlements to staff.

10. The Department has no plans to extend the Direction HSC 2004/01 beyond board members but the Health Service Circular on Public Interest Disclosure Act (HSC 1999/198) does state that local policies should prohibit confidentiality gagging clauses in contracts of employment and compromise agreements which seek to prevent the disclosure of information in the public interest.

11. The new disciplinary procedure for doctors and dentists sets out a number of principles of good practice for agreeing terms of settlement on termination of employment. Deeds of Compromise must not include ‘clauses intended to cover up inappropriate behaviour or inadequate services.’

PAC conclusion (vi): The National Clinical Assessment Authority … should now be expected to achieve its target turnaround times for advising trusts and completing assessments. Foundation Hospitals should seek advice from the Authority and trust boards and Strategic Health Authorities should hold trust managers to account where Authority advice is not taken. The Authority only covers doctors, and the Department should consider extending its remit to other clinical staff.

12. The Department agrees that NCAA targets should be achieved and will continue to monitor the performance of the NCAA in achieving its target turnaround times.

13. The Department expects NHS trusts and Foundation trusts to follow the advice of the NCAA. The framework requires the chairman of the board to designate a non-executive member to oversee the case and ensure that momentum is maintained. The board will also receive a report on the progress of each case at the end of each period of exclusion demonstrating that procedures are being correctly followed and that all reasonable efforts are being made to bring the situation to an end as quickly as possible. However, there may be occasions where the circumstances of a particular case mean that it is not feasible to follow NCAA advice, for example, where there has been a complete breakdown of relationships or where the NCAA recommends retraining that is not available. In the rare instances where it is not possible to follow NCAA advice, the reasons for not doing so should be set out in the progress reports provided to trust boards and the SHA.

14. Following the report “Reconfiguring the Department of Health’s Arm’s Length Bodies” published in July 2004 the functions of the NCAA will be transferred to the National Patient Safety Agency from 1 April 2005. It would be inappropriate to look to extend the role of the NCAA to other clinical staff until these changes have been completed. However, DH, professional organisations, regulatory bodies and the NCAA met last year to explore ways in which different professional groups could share best practice about handling concerns about the performance of practitioners, including exclusion from work. Plans are in place to take this work forward and key stakeholders have agreed to take part.

PAC conclusion (vii): Trusts are failing to undertake the specified employment checks when recruiting staff and are therefore putting patient safety at risk …. Trusts should undertake employment checks for all new staff. They should ensure that they advise potential employees and regulatory bodies where they have concerns about clinical competence, and complete disciplinary action once begun.

15. The Department agrees the recommendation. Following the publication of the NAO report, the Department issued a reminder to all NHS employers that the pre appointment checks specified in HSC 2002/008 are mandatory under the Secretary of State’s power of direction. The HSC has been subject to review, including a formal consultation exercise with the NHS, and new guidance will be issued shortly. This will include guidance on Criminal Records Bureau checks, which will become mandatory for all eligible new NHS staff on 14 February 2005.

PAC conclusion (viii): …. The National Clinical Assessment Authority should monitor the ethnicity of doctors referred to it and make the relevant statistics known. As part of their diversity policy, trusts should monitor the ethnicity of excluded staff and if a disproportionate number of ethnic minority staff are excluded, should investigate the reasons.

16. The Department agrees the recommendation. The NCAA will shortly be assuming responsibility for the collection of data on exclusions (formerly called suspensions). As part of this, the Authority plans to start collecting data on ethnicity to help address some of the concerns raised in the NAO report. Over time such data will help give a clearer picture of the ethnicity of doctors on long term suspension and provide a foundation for further research.

 17. The Department agrees that trusts should monitor the ethnicity of excluded staff. However, the relatively small number of exclusions in a single trust makes it unlikely that significant trends would be visible. The Department, therefore, attaches greater importance to the monitoring of ethnicity at a national level by the NCAA.

From NHS Employers 10.11.2005

10 November 2005

Dear Mr.Longstaff

Thank you for you email of 8 November to Sir Nigel Crisp regarding suspensions/exclusions and whistleblowing in the NHS. Your email has been passed to me at NHS Employers as we have taken over responsibility for these areas from the Department of Health.

Following the introduction of the National Clinical Assessment Service in 2001 and publication of “Maintaining High Professional Standards in the Modern NHS – A framework for the initial handling of concerns about doctors and dentists in the NHS” in December 2003, the number of doctors and dentists on long term suspension has been greatly reduced. However, it is recognised that there is a need for a similar framework for other staff groups and a working group representing a number of interested parties such as the Royal Colleges, the Department of Health and NHS Employers has been set up by the Chief Nursing Officer to look at the handling of performance concerns for these groups including the use of exclusions or suspension. The group will be looking at a wide range of issues which I am sure will reflect many of the points raised in your letter.

I am afraid I am not able to comment on any individual cases of whistleblowing in the NHS. As you know, the Public Interest Disclosure Act gives significant statutory protection to employees who disclose information reasonably and responsibly in the public interest and are victimised as a result.

The Department of Health issued guidance on whistleblowing to the NHS (in September 1999) which stated that every NHS Trust and Health Authority should have in place policies and procedures which comply with the Act. Subsequently a whistleblowing pack (“So Long Silence”) was issued to all NHS employers in July 2003. The policy pack included:

·     An introductory booklet explaining what whistleblowing is and a practical summary of the Act

·     An implementation guide to help organisations successfully introduce whistleblowing policies.

The Government expects a climate of openness and dialogue in the NHS, which encourages all staff to feel able to raise concerns about healthcare matters in a reasonable and responsible way without fear of victimisation and NHS Employers continues to support the NHS to achieve this aim.

Your sincerely

By Email

Barbara Carter

NHS Employers

Cc: Nigel Crisp

COMMENT/NOTE:

·     This response was not on headed paper, as one would have expected considering the NHS’s ‘corporate logo’ guidance to improve professionalism. Neither was any role/title given, or further contact details

·     Many of the questions posed & issues raised were not addressed

·     Offer to NHS Employers to make contact to discuss issues in detail/extend dialogue not taken up

To NHS Employers 17.11.2005

Thursday, 17 November 2005

Dear Ms.Carter

RE:  Your e-mail response CEOP043765 dated 10 November 2005

Thank-you for your response, in relation to my e-mail letter to Sir Nigel Crisp dated 29 October 2005 (not 8 November as indicated) RE “Suspensions/Exclusions & Whistleblowing in the NHS.”

I am sorry you were unable to contact me by telephone to discuss this serious matter in more detail.

I have forwarded your response to interested parties.

Thank-you for advising that NHS Employers have taken over responsibility for ‘these areas’ (Suspension/Exclusion & Whistleblowing). Please can you identify who the accountable person(s) is/are, & provide specific contact details for direct communications & point of contact.

Responding to your letter:

1.    I note you confirm that the number of doctors & dentists on long-term suspension has been greatly reduced since the introduction of the NCAS in 2001 & the publication of the mandatory guidelines you & I refer to. This reinforces the need to have replica arrangements for ALL disciplines. I would add that short-term suspensions also need to be addressed.

2.    Regarding the working group set up by the Chief Nursing Officer to look at handling performance concerns of nurses & other disciplines:

2.1.    This is good news, which I shall pass on.

2.2.    I hope the work of the working group is expedient, as all the while the lives of individuals, their families & their significant others are being irreversibly affected & even destroyed, let alone the effects on organisations & the retention of high calibre staff within the NHS.

2.3.    I hope the ‘wheel’ will not be unnecessarily ‘reinvented’. All other disciplines should be treated the same as doctors/dentists, & therefore the same principles & needs apply.

2.4.    Will those who have ‘been through the mill’ be consulted? They are valuable ‘nuggets of gold’ whose experiences & recommendations should not be overlooked.

2.5.    Please can you clarify the representative professional groups making up the working party, the group’s accountable person(s), & relevant contact details. I hope the working group is truly multi-agency.

2.6.    Please can you clarify what the working group’s exact remit is. Does it include:

·      Those suspensions/exclusions inappropriately occurring for reasons other than performance-related issues?

·      Producing mandatory/statutory guidelines (enforceable), rather than ‘best practice’ guidance (non-enforceable)?

3.    Regarding commenting on individual cases of whistleblowing, I am already fully aware you are restricted in comments of a confidential nature. However, you are able to openly comment on non-identifiable information/audit data of the ‘wider picture’ Eg Costs; staff groups reasons; precipitators; processes; working environment; outcomes; patterns, etc.

4.    Regarding the “…significant statutory protection to employees who disclose information reasonably & responsibly in the public interest & are victimised as a result”:

4.1.    One is at risk of proactively dismissing the factual, real accounts of individuals who have been in such situations, who know all too well that the ‘system’ does not give protection. It only gives opportunities of redress – after the damage has been done (too late for many). Such opportunities have been known to amount to nothing.

4.2.    Furthermore, as if victimisation for speaking out is not traumatic enough, those at the receiving end have to endure further harm by going through the ever daunting & invasive ‘significant statutory protection’ process. That is, of course, assuming they haven’t already been beaten or coerced into submission/withdrawal by their employers (the NHS), or legal loopholes.

4.3.    ‘Reasonably & responsibly’ is vague & open to subjective local interpretation. In majority of real cases, employers insist the employee could have done ‘x’ or ‘y’/one more thing before blowing the whistle – moving the goal posts to suite. No matter how far an employee complies with procedure or makes attempts to reconcile matters, it is deemed never enough, as previously cited high-profile cases alone confirm. This is obviously confusing to those needing to raise concerns, & sends out a message of inconsistency.

5.    Regarding the September 1999 Department of Health whistle-blowing guidance, & the whistle-blowing policy pack ‘So Long Silence’ issued in July 2003:

5.1.    Having done extensive background & internet research, & from actual cases of whistle-blowing, I have yet to come across the policy pack you mention.

5.2.    It is one thing issuing guidance, quite another implementing and/or complying with it.

5.3.    Urgent leadership at all levels is needed to address the evident theory-practice gap.

6.    Your letter ends with “The Government expects a climate of openness & dialogue in the NHS, which encourages all staff to feel able to raise concerns about healthcare in a reasonable & responsible way without fear of victimisation…”

6.1.    It is one thing to expect such circumstances, another to create the environment for it to flourish in. Regrettably, reality speaks a different, dark truth. A truth that is being suppressed & not being proactively acted on. At local level, realistically speaking, staff in the NHS are not routinely being encouraged to express their concerns on a day-to-day basis, as those in authority feel threatened. When staff are given the sporadic opportunity (in theory anyway) to speak up, they decline to. This says a lot in itself. Generally, staff in the NHS do not feel they can raise concerns. I can readily back this statement up. When staff do speak out, positive dialogue is notably usually absent, as is local leadership, & their speaking out often results in false ‘performance’ allegations & subsequent exclusion.

6.2.    If there is a climate of openness within the NHS, then why are staff excluded AFTER speaking out, & why are settlement & confidentiality clauses still the norm? [It is not necessary for you to divulge confidential information in order to  answer this question adequately]

6.3.    I ask you this: If the ‘significant statutory protection’, guidelines & whistle-blowing packs you talk of are effective, then why is there still such a widespread, endemic fear of speaking up/raising concerns in the NHS, even anonymously, 6 & 2 years on? My answer is: Because the rhetoric & theory so often spoken of & promoted is worth nothing in reality. Experience and/or observation at ground level speaks volumes & relays the real culture/message.

6.4.    Fear of victimisation within the NHS for speaking up/raising concerns is real, & valid. Despite the ‘significant statutory protection’ staff are being victimized for speaking out, & not as ‘isolated incidents’ or infrequent events as some would try to portray.

Regrettably, your response to my letter to Sir Crisp does not satisfy me. It indicates further promotion of rhetoric. It is easy to quote theory, quite another to implement/comply with it. In reality, what you talk of is not occurring where it matters most – at local/individual level. Guidance is not being disseminated and/or implemented by Trusts, HR Managers or individual team managers. ‘Organisation with a Memory’ is not working at local level, because team managers are not aware of it or do not value it’s concepts. Most worryingly.

The alerts regularly being sounded out by real people, with real experience & real, valid concerns are not being listened to or acted on. Valuable warning signs from those at the receiving end of ramifications & detriment endured are being denied, ignored & minimalized. What will it take?

Please be in no doubt that the issues regarding exclusion & whistleblowing will not just ‘go away’; they command active, expedient resolution. The current scenario of rhetoric, denial, ignorance & minimalization is unacceptable. Unless it changes, those responsible in authority within the NHS will, without apology or reservation, be publicly challenged & held to account for their actions, inactions & omissions, & they will not be able to hide behind rhetorical smoke screens.

The Nursing Standard reported last week (p11) that plans to review current exclusion practice have been confirmed by the DoH as being ‘at an embryonic stage’. This needs to gather pace somewhat & be given high priority due to its financial & human costs.

Please do not hesitate to contact me as above, so we can extend the dialogue & generate real & long-lasting excellence in exclusion & whistleblowing practice.

I look forward to receiving the information requested herein, your responses to the questions posed, & to hearing from you.

Yours sincerely

By E-mail

Craig Longstaff (Ex-NHS Employee)

From NHS Employers 01.12.2005

1 December 2005

Dear Mr Longstaff

Thank you for your email of 17 November regarding my earlier response to your letter to Nigel Crisp of 10 November about exclusions and whistleblowing in the NHS. I understand you have spoken to my colleague Sean King on the telephone about these issues and I apologise if this response repeats some of what Sean has already said. 

The NCAS has played a key role in improving the management of suspensions of doctors but at present its remit does not cover other clinical staff. The National Audit Office report “A safer place for patients: Learning to improve patient safety” published on 31 October 2005 recommends that the Department of Health should fully consider extending the role of NCAS to other clinical staff. If the Department of Health implements this recommendation then nurses and other health professionals will start to benefit from the work of NCAS which, in the case of doctors, has been effective in finding alternatives to suspension in 80% of cases. This will, of course, take time. However, the Chief Nursing Officers working group may be able to provide a short-term solution.

The purpose of the working group set up by the Chief Nursing Officer is to:

·         Identify good practice in early identification and handling of concerns about the performance of health care professionals, including the use of exclusion.

·         Plan a document which will set out common principles applicable across all healthcare professionals, bringing together good practice from each

·         Identification for future collaboration and further work

The group will meet four times over six months with the work completed by the end of March 2006. A report  of good practice will be circulated to key personnel in NHS Trusts, such as HR Directors, Nurse Directors, Medical Directors, Pharmacy Leads etc soon after.

NHS Employers is a member of the group along with representatives of 16 other interested parties. If you are interested in further details of the group you may want to contact Maureen Morgan at the Department of Health.

With regard your comments on whistleblowing, it is true that further progress still needs to be made towards the achievement of a culture in the NHS where staff feel able to raise concerns freely without fear of victimisation or other negative consequences. It is impossible to achieve change in a deep-rooted cultural attitude immediately but there are plenty of signs that progress is being made and that the culture is changing for the better. The mailing of a whistleblowing policy pack to every general practice in the country this August, complementing a pack previously sent to every NHS Trust, shows the commitment of the Department of Health and NHS Employers to tackling this problem.

NHS Employers and DH will continue to seek ways to promote an open and fair culture in the NHS. The report of the Shipman Inquiry made recommendations to strengthen whistleblowing and a Government response to the recommendations is expected soon.

I hope this response and your conversation with Mr King has gone some way to reassure you that things are moving in the right direction. The issues you raise are being addressed and that the necessary changes and reforms are either in hand or already underway. Thank you again for your letters.

Yours sincerely

By email

Barbara Carter

NHS Employers

COMMENT/NOTE:

·     Basic NHS documentation guidelines state (& NHS Employers should be setting the example):

1.      Headed paper should be used

2.      Role/title should be given, along with further contact details

3.      Multiple pages should be numbered

·     Again many of the questions posed & issues raised not addressed…is a pattern emerging? Paragraphs of previous letter were numbered to make referencing easy

·     Again sign-posted elsewhere

·     2^nd offer to NHS Employers to make contact to discuss issues in detail/extend dialogue ignored

To NHS Employers 08.12.2005 – 1 of 2

Thursday, 08 December 2005

Dear Ms.Carter

Thank-you for your prompt response to my e-mail letter dated 17 November 2005.

As previously stated, my original letter to Sir Nigel Crisp was dated 29 October 2005, not 10 November, or 8 November.

I am sorry you have been unable to contact me, despite two offers, to extend dialogue & expand on facts/issues & possible solutions.

My phone conversation with Sean King, initiated by myself to elicit some related but different information, was indeed enlightening.

I acknowledge the information & learning gathered via your organisation & others, of long term suspension/exclusion initiatives underway. My concern is that these initiatives will not result in the same statutory arrangements now existing for doctors & dentists (& now also teachers), more so as when you refer to the latest NAO recommendations, you state: “IF the Department of Health implements this recommendation…” What happens if it does not implement (in whole or in part) them, or the findings of the working group?

As regards the latter:

·      I have pencilled it in to re-contact you/NHS Employers in March 2006 for an update.

·      The good practice report to be circulated already exists in a similar form – the guidelines for doctors & dentists – which are not being complied with for non-medical employees, so why should yet another (unenforceable) guide be implemented? What is the working party’s proactive plan to monitor implementation of the guidelines, & to pro-act should organisations not comply? Faulty organisations exposed in a poor light are by definition incompetent to a significant degree, & therefore the standards of professionalism & integrity within them are likely to be low (‘Fixing Britain? Investigative Journalism’; www.letsfixbritain.com). This philosophy equally applies to NHS employees exposing inept & corrupt NHS organisations. Voluntary guidelines are unacceptable. They should be, but you only have to look deeper into a faulty (sick) organisation to realise that leadership, internal systems & integrity are absent/inept. If  only one could indeed rely on organisations to operate with integrity. Then I & others would’nt need to communicate as we are. Statutory/mandatory guidelines are required.

All mentioned in your letters is medium to long term, if it succeeds. Nothing is being done interim at ground level. Whilst I acknowledge your comment that (quote) it is impossible to achieve change in a deep-rooted cultural attitude immediately, there has to be interim safeguards for those exposed to suspension/exclusion & whistle-blowing negligence/malpractice. What happens to those individuals who fall foul of the system in the meantime? Do they not matter, even though their lives are being irreversibly destroyed?

Sometimes, change needs to be drastic & urgent, requiring strong & decisive leadership.

Whilst I agree the DH & NHS Employers are tackling issues, those still suffering significant detriment are not consoled by your reassurances of things moving in the right direction, as they are not being protected interim, & there are no guarantees in what has been put forward. As stated previously, whilst things are happening ‘high up’, things are continuing unchecked at ground level.

I am sorry NHS Employers has been unable to provide me with the details of the working party despite being a part of it, thus having to sign-post me again. As you suggest, I will contact Maureen Morgan at the DH directly.

I note your feedback regarding the government responding to the Shipman Inquiry outcomes in relation to whistle-blowing. I await same with intrigue.  If only staff who have or wish to whistle-blow could be consulted & listened to. Their revelations would be all that needs to be known to generate an excellent proactive guideline/process, at a fraction of the current reactive costs.

I note you did not respond to the following points of my letter:

Point 1 – Short-term suspensions

Point 3 – Whistle-blowing facts/data

Point 5 – Issues RE ‘So Long Silence’

Points 6.2 & 6.3 – Specific questions asked

With regard Point 3, please see the attached letter requesting information under the Freedom of Information (FOI) Act (2000). I have put it in a separate letter for your operational convenience.

Finally:

In writing to Sir Nigel Crisp, I was aiming for an immediate, medium & long term multi-agency approach to address suspension/exclusion & whistle-blowing issues. I was also aiming to communicate with those persons/organisations having authority to make a difference & make changes to safeguard all employees. Sir Nigel Crisp sign-posted me to NHS Employers, stating it was (quote) established a year ago to deal with NHS employment matters & promote good practice. During our written communications & my discussions with others, it appears:

1.      NHS Employers has no authority to compel trusts to universally apply the existing arrangements for doctors & dentists, or to enforce good, basic employment practices in general;

2.      NHS Employers is not leading the way regarding (1). It seemingly has a secondary rather than primary role.

I shall thus re-direct my communications to Sir Nigel Crisp/the DH, to request to be put in contact with whoever has lead authority. Unless there are complications regarding the FOI Act (2000) request, which I hope there won’t be, this will be my last communication with yourself until March 2006 as discussed. There is no point in pursuing a closed avenue.

In the meantime, I hope NHS Employers will fulfil its obligations towards it’s NHS employees, by hearing & acting on the points raised in my 3 letters.

I am saddened there has as yet been no evidence in the communications received from government or NHS Employers, of an acknowledgement of, or apology for, the devastating consequences – on individual PEOPLE – resulting from both suspension/exclusion & whistle-blowing malpractice & negligence. As an ex-NHS employee I predicted this, hence why I have left the NHS.

NHS retention & role modelling at its ‘best’. In the words of Sir Liam Donaldson (Chief Medical Officer), as quoted by the NPSA: “To err is Human; To cover up is unforgivable; To fail to learn is inexcusable”.

Thank-you for your time & Best Wishes

Your sincerely

By E-mail

Craig Longstaff

(Ex-NHS Employee)

To NHS Employers 08.12.2005 – 2 of 2

Thursday, 08 December 2005

Dear Ms.Carter

Under the Freedom of Information (FOI) Act (2000), I request NHS Employers to provide by email (address as at start of letter), the following employment data/statistics regarding NHS employees. I request information according to the following criteria:

Since 2000 – Current date (as above)

Unresolved/open/ongoing AND resolved/closed

ALL disciplines/professions

ALL departments

ALL options of demographic characteristics  Eg Gender; Race; Discipline Location, etc

·     Number of grievances & staff complaints (internal & external)

·     Number of whistle-blowing cases

·     Number of suspension/exclusion cases (ALL types, formal AND informal))

·     Number of investigations into NHS employees (formal & informal)

·     Number of re-deployments (temporary & permanent)

·     Number of termination of contracts: Dismissals (ALL types)

  ‘Compromise agreements’ (settlements)

  Resignations (ALL reasons)

·     Number of confidentiality agreements signed before releasing employees from employment

·     Number of tribunals

I request this information from NHS Employers as the information is employment-related, which is what Sir Nigel Crisp has advised is the remit of NHS Employers.

As ACAS intimate in their publications on employment records, such information regarding labour turnover & employment practices (including conflict management & staff retention) is readily accessible in any good organisation. Same applies to organisations that practice good corporate governance. I therefore do not foresee any difficulty in the information requested being provided.

I look forward to hearing from you.

Your sincerely

By E-mail

Craig Longstaff

COMMENT/NOTE:

·     Information requested under the FOI Act (2000) as a last resort, for the following reasons:

1.      Questions not answered, despite at least 4 opportunities

2.      Issues raised not discussed/addressed, despite at least 4 opportunities

3.      As a result of 1 + 2, a pattern appears to be emerging: Non-transparency; Avoidance; Minimisation; Dismissal; “Fobbing off”

4.      Under basic NHS principles, leadership, & corporate governance, those with responsibility & authority should be held to account & their organisations publicly scrutinised – even by those in ‘lower’ positions

 Response from the Workforce Directorate January 2006 (on headed paper)

Our ref: CEPO53927

16 January 2006

Dear Mr Longstaff,

Suspension of NHS staff and whistleblowing

Thank you for your recent correspondence to Sir Nigel Crisp on the subjects of suspension of NHS staff and whistleblowing.  He has asked me to reply on his behalf.  I know that you have been dealing with both NHS Employers and us.  I apologise for the confusion this has caused.

We took steps in 2001 to improve the performance of the NHS in dealing with suspensions of doctors and dentists by establishing the National Clinical Assessment Authority, which is now part of the National Patient Safety Agency.  New suspensions procedures agreed in 2004 gave the National Clinical Assessment Authority a key role in advising on the management of all suspensions, now called exclusion from work.  By April 2005, the total of long-term exclusions of all types, including what was previously called ‘Gardening Leave,’ had halved from 56 in June 2003 to a figure of 25.

A new disciplinary framework agreed with the medical and dental professions was implemented in June2005.  It is mandatory across NHS trusts and will speed up local procedures for handling disciplinary cases.

Staff groups, other than doctors and dentists have traditionally had disciplinary issues dealt with by their local managers. We have no plans to legislate to change this position in the immediate future. NHS staff are covered by employment law, just like any other employees. One of the major policy initiatives of this Government has been to reduce the burden of central direction on the NHS. We feel that it is important to let local managers make local decisions across the whole range of their functions, including disciplinary matters.

I take the issue of whistleblowing seriously.  In July 2003, I sent NHS Human Resources Directors a policy pack to support them in developing whistleblowing policies and procedures in their organisations.  The pack was produced in partnership with Public Concern at Work, who are the UK's leading whistleblowing charity.

Previous guidance on whistleblowing in the NHS, was contained in HSC 1999/198, and issued in September 1999 following the coming into force of the Public Interest Disclosure Act 1998 (PIDA).  The HSC stated that every NHS Trust and Health Authority should have in place policies and procedures which comply with the Act.

As a minimum, the procedures should include:

·         guidance to help staff who have concerns about malpractice raise these reasonably and responsibly with the right parties;

·         the designation of a senior manager or non-executive director with specific responsibility for addressing;

·         concerns which need to be handled outside the usual line management chain;

·         a clear commitment that staff concerns will be taken seriously, and investigated; and

·         an unequivocal guarantee that staff who raise concerns responsibly and reasonably will be protected against victimisation.

PIDA gives significant statutory protection to employees who disclose information reasonably and responsibly in the public interest and are victimised as a result.

The Government expects a climate of openness and dialogue in the NHS, which encourages all staff to feel able to raise concerns about healthcare matters in a reasonable and responsible way without fear of victimisation.

I hope you will agree that we have acted effectively to help deal with the difficult issues you have raised.  Thank you for taking the trouble to write to Sir Nigel on these matters.

Yours Sincerely

Andrew Foster

Director of Workforce