A long-running dispute between managers and mental health nurses at a Manchester trust has led to a CPN losing her job. Emma Vere-Jones hears both sides of the argument.
Last week Manchester community psychiatric nurse Karen Reissmann (pictured above) lost her appeal against her trust’s decision to sack her.
Ms Reissmann, Unison branch secretary at the Manchester Mental Health and Social Care Trust, was dismissed on 8 November when an internal disciplinary panel, chaired by trust chief executive and former mental health nurse Sheila Foley (pictured right), found her guilty of gross misconduct (see News, p4).
The initial charge made against Ms Reissmann when she was originally suspended on 15 June, was that she had damaged the reputation of the trust by criticising a partner organisation during an interview she gave to Enterprise magazine in December 2006.
Ms Reissmann says the initial suspension came as a shock. ‘I was hauled out of the middle of an outpatient consultation, which wasn’t ideal. I was totally bewildered,’ she says.
Ironically, she arrived home that same day to a letter telling her she had been promoted to a senior practitioner within the trust.
‘In a way it made me feel better. I would have been really upset if I’d been suspended over my clinical work. I’ve always taken great pride in that,’ she told NT.
Between that day and the hearing in November, Ms Reissmann’s suspension triggered 14 days of strike action by Unison staff members at the trust.
During that time further allegations were made about Ms Reissmann’s conduct. The trust was critical of her decision to inform staff members, and the press, about the charges made against her and said she was wrong to publicly protest her innocence before the allegations were heard. She was also accused of misusing trust time on union activities.
The latter charge was not upheld at the November appeal. However, the panel decided Ms Reissmann had seriously damaged the reputation of the trust in the press and sacked her. The dismissal has resulted in a month of ongoing strike action by around 100 nurses and other trust employees.
Ms Reissmann believes the events will have serious consequences for the future of the NHS and the ability of clinicians working within it to speak publicly about what they think is best for patient care.
‘I’m not saying that what I say is always right but it’s what I believe in and I think I have the right to engage in debate and express dissent. What worries me is that less and less people feel they can exercise that right,’ Ms Reissmann says.
‘One thing the NMC code of conduct points out is that it’s not just about nurses having the right to speak out – it’s that we have the responsibility to do it,’ she adds.
However, neither side is happy that staff have had to resort to strike action.
‘It does have an impact on care and we apologise to users and carers for that and we
do it reluctantly,’ Ms Reissmann says. But, she argues, such action was being undertaken for the long-term benefit of service users and carers.
Meanwhile, Sheila Foley says: ‘I find it deeply distressing to see nurses on a picketline. I can’t remember having seen that in my career and I’ve been in the health service more years than I care to remember.
‘I think it’s sad that our industrial relations got to that point,’ she adds.
So what exactly went wrong? Relations between staff and trust management have been tense for some time, in no small part because of a major mental health service reorganisation in Manchester.
Entitled Change in Mind, the strategy, which was proposed in 2006 and implemented on 1 August 2007, has seen an extra £4m added to services overall, with increases in crisis home treatment and assertive outreach teams among other developments.
Ms Foley emphasises that the reorganisation was not a cost-cutting measure.
However, the increases in certain areas have come at a cost to others – namely the community mental health teams that were previously in place. These services have been cut from 24/7 to 9am–5pm, Monday to Friday.
Ms Foley was not the instigator of the changes – she only came into post in April 2007 – but she believes the strategy will bring the trust into line with the mental health National Service Framework.
‘The Change in Mind plan for Manchester is really nothing more than implementing the NSF, from which we were fairly well adrift,’ Ms Foley says. ‘But I also believe it will provide the people of Manchester with better care.’
Ms Reissmann does not disagree with the strategy in its entirety. She welcomes the increase in crisis home treatment and assertive outreach but she, and many of her colleagues, argue that the cuts to the community mental health teams will damage patient care.
Indeed, nurses at the trust were so unhappy with the proposals that in January around 400 Unison staff went on strike to oppose them.
Since that time some concessions have been won. Redundancies were prevented and in August the trust agreed not to implement all the planned cuts to the community mental health teams – instead agreeing to review the position further down the track.
‘When I arrived, I sat and listened to people at a number of meetings where they raised their issues with Change in Mind,’ Ms Foley says. ‘Then we did make some changes around the speed of implementation and listened to some of the practical issues that people raised. So I did make changes.’
But by that time Ms Reissmann had already been suspended and further strikes were taking place.
So how does the trust move forward from this stand-off? Undoubtedly this will not be the last chapter in what has already become a long-running saga.
Ms Reissmann plans to take the trust to an employment tribunal and says she will fight for her right to free speech all the way to the European Court of Justice.
Unison staff concluded their strike action last Friday and returned to work this week.
‘Obviously you can’t continue with indefinite strike action pending an employment tribunal,’ says Ms Reissmann. However, Unison has stated that it will continue to campaign vigorously on the issue.
Ms Foley knows that relations with staff will not be easy after all that has happened.
‘That’s obviously something we’ve got to work on going forwards,’ she says. ‘It’s not as easy as saying to people, “come back to work and that’s the end of it”. It’s about developing a relationship with staff. I’m used to having a very good relationship with staff, so that’s where I want to get to.’
Meanwhile, Ms Reissmann is unrepentant about her actions. But she admits the experience has taken its toll.
‘It’s hard when you’ve known your patients for a long time. One of my ex-patients has been very unwell and I can’t help him. Not knowing how he is – it’s not nice. You can’t just write people off, you can’t switch off and not care. That’s not the kind of nurse I am,’ she says.
Ultimately Ms Reissmann says that what she wants most of all is to get her job back.
‘I always thought I’d see out my days as a CPN in Manchester, working with the people I’ve worked with for 25 years,’ she says. ‘I love that job and it’s quite unnerving to think that the future I planned could be taken away from me. I’ll keep fighting to get that back.’