Campaign Against Unnecessary Suspensions & Exclusions in the NHS (CAUSE)

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Chief Nurse insists there are no unhealthy, corrupt, repressive and dysfunctional NHS organisations, managers or teams and sees no evidence of detriment or suffering amongst non medical employees. Click here to see her letter to Craig Longstaff 31. 1 06 

Report “Suspension Failure in the NHS”, September 2004 – click here to view

Response to new directions from the Department of Health for the management of suspension of doctors and dentists.

Concerns and recommendations for the management of suspension for nurses.  

NEW Chief Nurse says no evidence of malpractice and suffering amongst staff will you enlighten her please!

The Chief Nurse Christine Beasley says she is unaware that staff are suffering detriment and dismisses the presence of dysfunctional management styles in the NHS which are wrecking peoples lives. (See website to read Chief Nurses letter.)

We are the evidence and proof to the Department of Health and the Chief Nurse that devastating behaviours by organisations are wrecking lives and destroying careers.

How you can help

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!)

 

Campaign to date

Craig Longstaff (co-campaigner) and I have hit a brick wall with Lord Warner, former Secretary of State for Health, the NHS chief executive Sir Nigel Crisp, Andrew Foster Director of Workforce Directorate ie head of HR in the NHS, Barbara Carter at NHS Employers and the Chief Nurse Christine Beasley.

BUT the Public Accounts Committee and the National Audit Office both say extend the Directions and the National Clinical Assessment Service to all staff.   Your suspension (for those of you who were suspended; some of you were working in very hostile environments and were in fear of it) would not have been allowed.

Please forgive me if this raises up old memories and hurt and let me know if you dont want to be contacted again.   It is perfectly understandable.

Suggested outline and please would you add the CAUSE logo at the bottom of the page if you are comfortable with that.

IN STRICTEST CONFIDENCE; NOT FOR PUBLICATION (unless you dont mind)

The Chief Nurse says she is unaware that staff are suffering detriment and dismisses the presence of dysfunctional management styles in the NHS which are wrecking peoples lives. I hope my story and the story of others, will enlighten her.

I was a ���������..I was accused of���

I did not receive the allegations until�������������. There was no evidence for this.

I faced a disciplinary hearing ..months later.     My evidence was ignored

My union rep did his/her best/was very unhelpful�����

The outcome was that I���

The effect on my health was ��� and the effect on my family was������

I have not named the organisation for fear of����������..

Name�������� (optional)

If you want me to send this to keep your details secure, just let me know

 

MAKE UNNECESSARY NHS SUSPENSIONS HISTORY

 

(I have just sent my story – March 3rd with a copy to my MP, and it worked! Just copy it into the address line and heres hoping!)

Emma Vere-Jones works for the Nursing Times, Christian Duffin works for the Nursing Standard.   Both are very interested and supportive of the campaign. Daniel Martin works for the Health Service Journal; they have published things in the past of interest to managers. They are not afraid to be controversial.   Just delete their email addresses if you don�t want them involved.   As the piece says not for publication, it is my belief they will honour that. It will hopefully help them campaign with conviction when they hear of the terrible injustices.

 

Your MP

They can be very effective.   Please would you copy your story to him/her and ask them to ask a question in the House on your behalf such as

Why is the Department of Health producing guidelines for staff performance management when research has already shown, they can be ignored (National Audit Office report into Suspensions in the NHS 2003)

Why is the Department of Health refusing to collect any data to know how many non medical staff are suspended, for what reason, how it is being managed and the outcome?

or your own question..

See www.parliament.co.uk for details of how to contact your MP. If your MP has email  see alphabetical list of MPs  it will only allow 4000 characters so you may need to send a paper copy to your MP at House of Commons, London, SW1A 0AA. Alternatively you can contact their local office for their office email address.   Your local library will have details.

If you can help, please would you act as soon as possible and send your story. It would be very helpful if you could let me have a copy too.

50 stories would be wonderful. 30 would be significant and to date, 26 stories have been emailed that I know about, stories of terrible injustices and harm.

Often when people contact me, they say that although it is too late for them, they would like to stop the awful trauma for others if they can.   Here is your chance, not forgetting that some of you have already been working for change.

Many thanks and very best wishes.

Julie and Craig

 

CAUSE (UK)

Campaign Against Unnecessary Suspensions and Exclusions in the NHS (UK)

E-mail:enquiries@suspension-nhs.org

Campaign Co-ordinator: Julie Fagan; Co campaigner Craig Longstaff

 

Example: (I have omitted IN STRICTEST CONFIDENCE etc as I dont have to keep my story confidential.)

MAKE UNNECESSARY NHS SUSPENSIONS HISTORY

The Chief Nurse says she is unaware that staff are suffering detriment and dismisses the presence of dysfunctional management styles in the NHS which are wrecking peoples lives.

I hope my story and the story of others, will enlighten her.

I work as a health visitor.   I was accused of putting a child at risk by sending a secure fax to a social work colleague proposing a different course of action to the case conference. I know that the system prevents a written proposal putting a child at risk.

My explanation was ignored. I was offered a 6 month assessment of my practice or face a disciplinary hearing.   As I was not being listened to, I opted for the assessment, humiliating as that was. This was finally set up after 35 weeks of suspension.

My union regional rep thought I was guilty in some way so was not very helpful until the end.

The outcome of the assessment was that nothing was found wrong with my practice but two months later I was dismissed for breach of trust and confidence because I had refused to admit I had put a child at risk. The decision was taken by the full trust board.

I was reported to our regulatory body, the Nursing and Midwifery Council (NMC), and 6 months later received papers outlining the case against me.   I now saw the four statements that had resulted in the managements decision of my case. I was able to refute the unsubstantiated allegations made against me and my case was closed by the NMC.

The trust settled on the eve of the Employment Tribunal two years and seven months after my suspension, with an apology, a substantial confidential settlement and the understanding that I would publicise my story without naming them.

Until I was cleared by the regulatory body, I was unable to work. I have now worked as a health visitor for a year through an agency.   I am unable to trust NHS managers again.

It was my faith, family and friends that prevented me from having a nervous breakdown. My family was appalled by these events and it has taken its toll on my husbands health.

Running the website to help others and hearing many similar horrendous stories, has fuelled my determination to continue with this battle until all staff have the same services and support that medical colleagues receive.

Julie Fagan

CAUSE (UK)

Campaign Against Unnecessary Suspensions and Exclusions in the NHS (UK)

Press release – Feb 2006

 

Chief Nurse confirms that non medical staff are seen as second class citizens in today�s NHS

Too many staff and not expensive enough, were the Chief Nurses reasons why the Department of Health continues to refuse to extend the National Clinical Assessment Service management of suspensions of doctors and dentists, to all NHS staff.

The Department of Health will therefore continue to be in breach of 2002 Employment Law by denying equity of treatment for all its staff.

The National Clinical Assessment Service is successfully preventing suspension in 85% of medical cases referred to them and assisting in the speedy resolution of the remaining cases, hence the recommendations by the Public Accounts Committee and the National Audit Office for the inclusion of all NHS staff.

Reports have repeatedly shown since 1995 that guidelines on the management of suspension/exclusions of staff, are consistently ignored by some managers but the Chief Nurse states new guidelines will be produced in the spring for non medical staff.

The Chief Nurse denies the existence of poor management practices and subsequent suffering it causes and maintains that the local managers (causing the problems) will continue to be allowed to deal with suspensions (see attached letter).

Meanwhile the Department of Health refuses to collect data to monitor the size of the problem and continues to allow injury to non-medical staff who are victims of this destructive two tier system and who continue to contact CAUSE for help.

 

CAUSE (UK)

Campaign Against Unnecessary Suspensions and Exclusions in the NHS (UK)

Authors:

Julie Fagan, health visitor and founder of the web site www.suspension-nhs.org.

Craig Longstaff, mental health nurse, whistle blower and fellow campaigner.

 

6.2.06

Response to new directions from the Department of Health for the management of suspension of doctors and dentists (see www.doh.gov.uk under human resources)

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  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 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 executives 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
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.

 

Concerns and recommendations for the management of suspension for nurses.

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 Murrays 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 Donaldsons 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 Readers 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 peoples 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 Spencers 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 Governments 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 persons family. Some do not return to nursing.

 

Return to work is very difficult. The persons confidence has been badly undermined and reputation damaged or destroyed.

 

Bullying and malicious allegations have been features of some peoples 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 managers 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.