The modern matron sent the letter below, and email versions, to large numbers of staff at Norfolk & Suffolk NHS Foundation Trust (NSFT) in the days immediately preceding the recent full CQC inspection, which began on 20th October 2014.
Staff at NSFT, quite rightly, saw these letters as a blatant attempt both to intimidate by threatening disciplinary action and to shift blame away from the Board and management and onto clinicians in anticipation of a poor CQC inspection report. You can imagine the impact on staff morale in a trust which has already has problems with stress and bullying.
Some front-line clinical staff, working in services that are chronically under-resourced yet experiencing increasing demand, have sometimes been forced to choose between paperwork and patient care. Staff were previously told by their managers not to report the ‘problems’ now raised as ‘an inability to fulfil your contractual obligations’; when issues have been reported, including to the staff confidential whistleblower helpline, the reports appear to have frequently been ignored. Many of the issues raised in the letter have never been raised previously by managers, in supervision or otherwise.
As we have said before, leadership is about taking personal responsibility rather than blaming, bullying or scapegoating frontline staff.
Note the ‘cc. P-File’. Nice.
Here’s the letter (the emboldening is our own):
The lead up to the CQC inspection means that we, as a service, are under an increasing degree of inspection to ensure that we are meeting the prescribed Trust standards. Audits within recent weeks have highlighted some significant issues with completion of paperwork, which I must bring to your attention.
Whilst the management team within the [service name] share, and fully understand the pressures staff are under, and we acknowledge the ever changing culture we work in makes this particularly challenging to manage, we are under mounting scrutiny to ensure that we are reaching and maintaining the appropriate levels of quality and safety.
You will be aware throughout your employment within the [service name] the need for you, as a professional, to comply with your appropriate code of practice. Trust policy is an essential element of your practice.
Failure to comply with these standards, or to report to your senior your inability to fulfil your contractual obligations, will lead to your practice being reviewed informally with the potential that this could lead to more formal review if required.
To enable me to support you in your practice and to identify areas where we can improve our systems, I will be inviting anyone who is found to not be complying with Trust policy to meet with me to discuss the situation.
The areas of specific concern are completion of documentation for example:
- Section 132
- DPA C10
- Signing of care plan by SU/Carer or recording reason for no signature
- Signing of risk assessment by SU/ carer or recording of reason for no signature
- Medicine management C112
- Mental Capacity Statement – Capacity to agree to informal admision C105
- Physical health screening C01
You are also required to have clinical supervision C16b. Should you find that you are unable to fulfil your contractual obligations despite the support of your line manager, I will be inviting you to write to me with the reasoning.
I would welcome any suggestions regarding support that either myself or the management team can facilitate to assist you with these matters.
Should you have any questions or concerns regarding anything related above, please do not hesitate in contacting me.
Here is the ‘clarification’ issued by Jane Sayer, Director of Nursing at NSFT.
The apology is typical NSFT fare: it is belated, doesn’t come from the person who sent the letter, doesn’t directly refer to the letter, doesn’t actually say sorry and appears to have been reluctantly sent after pressure from Unison. It is a perfect example of how to issue an insincere and unconvincing apology.
*The redaction is reluctant because one of the most significant causes of the crisis at NSFT is a management culture which does not demand personal responsibility and public accountability.
We would like to reassure all staff that we fully support you to speak to the CQC inspection team about any issues you would like to raise.
It is important that the CQC hear from you about any problems you face and your great work, honestly and openly.
A number of you may have been led to believe that any information you provide the CQC could be placed on your personal file. We would like apologise if this has caused staff any anxiety as this was never the intention.
Furthermore we want to stress the importance of you feeling confident to raise any issues that you want with the CQC.
There are still opportunities to speak to the CQC today, which is the last full day of inspection. Therefore, we encourage you to use the forums that are open to staff or talk to the inspectors when they are visiting clinical services.
The Trust Board and Staffside fully support the right of all staff to share their experiences with the CQC in order to promote learning and improvement from the inspection.
Jane Sayer: Director of Nursing, Quality and Patient Safety
Carol Briggs: Unison Representative