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Exclusive: The intimidating letter which caused uproar in the week before the CQC inspection and the ‘apology’ from NSFT

Learning about letters

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.

Yours sincerely

[reluctantly redacted*]

Modern Matron

cc. P-File

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.

Dear Colleagues,

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

14 thoughts on “Exclusive: The intimidating letter which caused uproar in the week before the CQC inspection and the ‘apology’ from NSFT

  1. Night owl says:

    I am a bit lost. The campaign now doesn’t want standards to be upheld? It’s not ok to raise these issues? Will the campaign now be advocating for a culture of management ignoring these issues? What message are you trying to send?

    I hope you will support the service concerned when issues about performing are raised when managrs feel unable to raise concerns about performance (which affects patients care, rights and safety) due to fear of public persecution?

    Very wrong in my opinion.

    Let the flaming of my response begin….

  2. Nurse says:

    You are just trying to be offensive, aren’t you?

  3. Bobby says:

    more like a eagle than an owl the reason people are so angry has soared high over the top of your head.

  4. Tina Turner says:

    Good lord! The campaign wants the modern matron to stop monitoring and implementing standards? Its the matrons job for pity’s sake. Its very unfair to print such a letter and single individuals out like this. This smacks of red top newspaper tactics. Print the headline, forget about the real story and bugger the hurt caused to the subject of the story.

  5. Kate says:

    Sadly, I think you have become a little bit confused about the difference between quality management and ineffective bullying.

    Of course, our campaign ‘doesn’t want standards to be upheld’: it wants them improved. Which is why we have campaigned so vigorously regarding the hundreds of unallocated cases, the closure of assertive outreach teams without any replacement or plan, the closure of the homeless team, the Section 75 turmoil, the squalor of the hostels, the millions of pounds wasted on redundancies in the midst of a recruitment crisis, the transportation of the mentally ill in crisis across the country, the totally inadequate number of beds for Clozapine or voluntary admissions, the under-staffing of wards, the slashing of CAMHS budgets, the failure of AAT, the de-skilling of the Crisis teams, etc. There was indeed ‘a culture of management ignoring these issues’ until we started campaigning about them.

    If the management of NSFT had been doing its job properly, monitoring quality continuously rather than burying its head in the sand of endless cliquey meetings until panicking in the weeks before the CQC visit, matters might have been different when the CQC visited.

    If the attitude hadn’t been to ignore warnings, clinical advice and evidence with a ‘we’ve got to give it a go’ mentality, matters might have been different when the CQC visited.

    If NSFT hadn’t ignored our common sense programme and denied there was a crisis, matters might have been different when the CQC visited.

    Staff reported how under-resourced they were, not having the time and resources to deliver a safe service, never mind complete paperwork, but NSFT management didn’t want to know until the CQC was about to turn up at the door.

    When the NSFT Board has wasted millions of pounds, doesn’t have enough beds to treat those in crisis, has too few staff to allocate hundreds of cases, is forced to employ agency workers and has a demotivated workforce, don’t you think it might be counter-productive to attempt to scapegoat ordinary staff for the failings of the management team?

  6. Night owl says:

    Really can’t see where the scapegoating is? An audit was completed of some pretty standard issues that are important to maintain care standards. Staff were asked to meet these standards.

    Should this not be expected?

    And the comments that these issues were not raised in supervision. Do we all need to be informed of our basic duties now to know what our jobs are.

    For all the campaign’s comments about management bullying this article smacks of exactly the same to me.

  7. Terry Skyrme says:

    Night owl completely ignores the issues facing front-line staff. NSFT stated publicly that Care Coordinators should only have a caseload of 25-35 patients, yet because of the staffing crisis created by NSFT management consistently pressurised staff to exceed these numbers. Allocation by email without reference to the pressures on staff became the norm. Care-plans and personal budgets could not be delivered; patients were discharged from services inappropriately; carers were left to cope without support. Staff are then faced with a choice; something has to go. As one care coordinator said to me, “In our locality we made a conscious choice to let paperwork slip, but to make sure we visited patients.” As for supervision the numbers of team managers have been reduced so that it is almost impossible to provide quality supervision which enables staff to develop in a constructive way. The pressure on Team Managers is to allocate work come what may. i.e. pass the pressure and the responsibility downwards. The result of cuts is a culture of blame and bullying and veiled threats. It is incredible that a letter can be sent to staff quoting professional standards when these very managers colluded with the radical redesign, implimented savage staffing cuts which did more than anything else to undermine professional standards. Is there not a professional responsibility on NHS managers to speak out when they see staffing levels cut to an unsafe standard? No, let’s just keep quiet, make sure our boxes are ticked, and pass the pressure downwards.

  8. Night owl says:

    Blimey Terry. I wish the world was as black and white simple as you believe it is. It would be easy to sit and point the finger then.

  9. Sid says:

    If managers have concerns regarding record keeping, supervision or any other aspect of an individual’s performance; there are clear standards in place for dealing with those concerns. They don’t include puting a letter in the P file of all staff, they are easy to follow however.

  10. Sid says:

    And, while I think about it; not adhering to those standards could be seen as breaching terms and conditions. So there!

  11. iMac says:

    Very worrying that some people find the letter acceptable. I found it so inappropriate yet typical of the behaviour that has dragged us down to the depths we are in , it can only be a matter of time before the sender gets a promotion – we surely can’t let such an act go unrewarded .

  12. Terry Skyrme says:

    Well, I thought the Modern Matron’s letter was very black or white……meet the Trusts’ protocols or else! Or rather make sure you APPEAR to be meeting the protocols.

  13. mesugana says:

    All this talk about protocols. It is ridiculous because the wonderful care co-ordinators do not have sufficient time to do their jobs! Those who manage them should have a bit of sympathy and get real. Sending threatening letters to protect themselves shows the cultural decadence of the Trust management.

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