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Why do staff keep silent in poorly performing trusts?


Julie Fagan, a founder of the Campaign Against Unnecessary Suspensions and Exclusions in the NHS, argues that managers’ power to suspend without reference must be curbed

One answer is that managers have the power to suspend staff and are not accountable for their actions. It is a very effective way of silencing the Graham Pinks of the nursing and midwifery world because a manager can suspend staff and no one outside the trust knows about it.

Why is this? Presumably because the National Office report of 2003 showed that a high number of nursing and midwifery staff had been suspended, but as the costs were not as high as doctor suspensions, nothing was done except the production of some guidelines that some malfunctioning managers can ignore as they do with their own policies and procedures.

And the processes some managers use are very effective. They call the practitioner they don’t like to an urgent meeting, with or without a colleague or union rep. They tell them that certain allegations have been made against them and that in due course they will receive a letter detailing these allegations with information about the investigation now to be conducted. They warn them to have no contact with colleagues and to stay away from trust property.

Then they march them off the premises in full view of patients and colleagues and leave them to get home as best they can in their distraught state.

The allegations may be unsubstantiated. They may be a long time arriving. There may be an investigation that ignores the practitioner’s evidence and a disciplinary hearing to decide their punishment. The practitioner needs a good legal team to protect their registration to keep their career, though now they may never wish to work in the NHS again.

Another able practitioner lost, large amounts of tax payers money spent in this destructive process, and still no one knows or wants to know.

The people who fill in incident forms in these organisations are very brave and to be applauded.

And how can I write with such authority about such events? Because as a founder member of CAUSE (UK) the Campaign Against Unnecessary Suspensions and Exclusions in the NHS, myself and the team have not only experienced the process for ourselves, we have also listened to the stories of many others who have made contact through our website.

Managers should not be allowed to suspend without reference to the incident decision tree on the National Patient Safety Agency’s website, using root cause analysis to look for systems’ failure. They should also have to report what is happening to an outside agency to ensure fairness, transparency and speedy resolution.  Then staff will be better protected and may dare to flag up poor care.


Readers' comments (2)

  • michael stone

    I am not a nurse, but in my opinion the problem here (for 'general' problems, not complaints about individual nurses) is that if a nurse thinks procedures or similar are wrong, it is her/his boss who is complained to.

    I think a panel of laymen should be the mechanism for that sort of complaint. The nurses raise concerns anonymously with a lay group, which 'thinks about things', then the lay group (which management cannot sack) raises any issues with management.

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  • michael stone

    Further to my earlier comment: if a specific nurse, or doctor, or manager, is incompetent, that is one type of issue.

    But if the 'operational procedures and policies' which govern behaviour as a 'unit' - for example the way nurses on a ward are being tasked, or anything outside of 'individual practice' - are the problems, it is pointless complaining at the people who imposed those things, if those people can also discipline the complainant.

    You need to separate the identification of possible problems, from the 'raising and consideration' of the possible problems - no system which effectively involves a nurse criticizing a manager, who was responsible for the thing being criticized, is likely to be very useful in producing change for the better.

    You need to ensure that the people 'arguing the point' cannot be silenced, by those managers they are talking to.

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