INCIDENT DECISION TREES AND THE NHS

 

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As reported by Michelle Roberts, http://www.bbc.co.uk, 26 Jan. 2016, ‘Doubts have been raised about whether England’s NHS out-of-hours helpline is able to identify serious illnesses in children, after a baby died of blood poisoning following a chest infection.

NHS 111 call handlers are not medically trained, and a report on the 2014 death of William Mead, from Cornwall, said he might have lived if they had realised the seriousness of his condition.

But it said that if a medic had taken the final phone call, instead of an NHS 111 adviser using a computer system, they probably would have realised William’s “cries as a child in distress” meant he needed urgent medical attention’.

A data mining algorithm is a set of calculations that creates a model of action from data. To create a model, the algorithm first analyzes the data you provide, looking for specific types of patterns or trends. The algorithm uses the results of this analysis to define the optimal course of action. The result is a decision tree that predicts an outcome, and suggests remedies.

The 111 emergency service uses NHS Pathways as its decision-support software, which is also used by English ambulance services to assess 999 callers. The NHS system is managed by the Health and Social Care Information Centre. They acquired their decision-support software from AXA Assistance in 2000.

Charlotte Jones, the BMA’s GP lead on unscheduled care, says the reliance on algorithms is part of the problem, “they are not always applicable to the clinical setting or, if they are, they don’t allow for subtleties in symptoms, and symptoms don’t always fall neatly into boxes.

“So the computer algorithms that call handlers have to follow don’t allow handlers to move away from them when common sense or your own individual knowledge calls for it”.

Janette Turner, senior research fellow at the University of Sheffield, agrees that any kind of phone service is limited by the fact that it cannot diagnose.

You need a clinician face-to-face to make a diagnosis, to look at people and do tests,” she says. “This is about assessing the level of urgency and the level of care. The question is how well algorithms can assess, compared with clinically trained staff.”

Lindsey Scott, director of nursing with NHS England in the South West, said: “Everyone involved in this report (into the death of William Mead) is determined to make sure lessons are learned from William’s death, so other families don’t have to go through the same trauma”.

Does that mean replacing cheap staff with a decision making machine with experienced and well qualified nurses who could have red-flagged William’s sepsis?

Of course not, it just means tweeking the machine.

There were other failings before William’s condition was fed into a machine (the out-of-hours GP service had not had access to William’s primary care records), but this young life may not have been lost if an experienced and well qualified nurse was at the other end of the phone.

They cut costs in order to privatise, so offering a tasty morsel to their corporate masters.

lenin nightingale 2016
p.s.

The process of passing responsibility to ‘decision making trees’ is to spread within the NHS, as this piece of propaganda lays out: ‘The National Patient Safety Agency has developed the Incident Decision Tree to help National Health Service (NHS) managers in the United Kingdom determine a fair and consistent course of action toward staff involved in patient safety incidents. Research shows that systems failures are the root cause of the majority of safety incidents.

The Incident Decision Tree supports the aim of creating an open culture (my arse), where employees feel able to report patient safety incidents without undue fear of the consequences. The tool comprises an algorithm with accompanying guidelines and poses a series of structured questions to help managers decide whether suspension is essential or whether alternatives might be feasible. The approach does not seek to diminish health care professionals’ individual accountability, but encourages key decision makers to consider systems and organizational issues in the management of error. Initial findings show the Incident Decision Tree to be robust and adaptable for use in a range of health care environments and across all professional groups‘ (www.ahrq.gov).

There you have it, dearhearts. Nurses and doctors will be reported to the NMC and BMA if an Incident Decision Tree recommends this! Thus, all apparent bias is removed from this process. This is not so, of course, as anyone with half a brain knows that the decision you get out relies on the data you put in, and fictitious data can come from lying colleagues and vindictive managers. Imagine it, some drone of the NMC reads out the charges against you.” Incident Decision Tree, model xcd 12578, charges you with ….”.

Will ’employees feel able to report patient safety incidents without undue fear’?

Pig shit.

You can not throw yourself on the mercy of an Incident Decision Tree because the vindictive manager will know you have done this, and ‘new’ evidence will be dredged up from imagination, so that the ‘Tree of Justice’ comes out with the decision they want.

OUR MASTERS ARE CONTEMPTUOUS OF EVERYONE, INCLUDING THEIR NHS MANAGEMENT UNDERLINGS.

THE ONLY SOLUTION IS TO REPLACE OUR MASTERS.

lenin nightingale 2016

FAKE FILIPINO NURSES

chua

The following is a reproduction of excellent information written by Filipino nurses, who are concerned about the issue of Filipinos working as nurses with fake certificates. Quite rightly, their main concern is the potential injury to patients as a consequence of such impersonation. It is also a concern that ‘fake nurses’ are lessening the reputation of hard-working and well qualified Filipino nurses.

They give excellent advise to employers, which includes a link to the Filipino version of the NMC’s ‘check a nurse’ facility. They identify that a common form of fakery is the altering of a name on a genuine certificate, and advise employers to check original documents only, and, what I suggest is vital, to check a nurse applicant’s registration ID photograph. Their suggestions could be carried out in retrospect by employers harbouring suspicions about the authenticity of a nurse. A very practical tip is provided, which is to ‘google’ an applicant’s name, which might carry a history contrary to what is claimed.

In short, there is much by way of verification of certificates which can easily be done.

It is to be assumed that the 8 or so staff the NMC employ (out of 600) to check certificates use the facilities suggested by genuine Filipino nurses, and do not just look at certificates and ‘pass’ them if they ‘look’ genuine, and ‘appear’ to have a ‘genuine’ stamp. It is to be naturally assumed that registration ID photographs are compared to an applicant’s (in person) face (not a face at the other end of an internet link).

I ask the NMC to confirm they undertake such ckecks.

I suggest all employers should have a statutory obligation to undertake such checks, independently of the NMC, which, as in the ‘Chua’ case, seems an all too easy defence to breach.

I call for all such checks to be done in retrospectively during 2016 on all Filipinos working as nurses in the UK. This is what genuine Filipino nurses want, as the following information written by Filipino nurses makes clear.

BEWARE OF UNSCRUPULOUS FILIPINO MAIDS AND INDIVIDUALS PRETENDING TO BE A REGISTERED NURSE OR CAREGIVERS!!!!

We, the concerned registered nurses, working as a freelance Private Duty Nurse (PDN) in Malaysia would like to raise awareness regarding the rampant and uncontrollable booming of FAKE NURSES.

WE ARE CONCERNED BECAUSE OUR PROFESSION IS AT STAKE. WE ARE CONCERNED BECAUSE YOUR LOVED ONE MAYBE THEIR NEXT TARGET. WE ARE CONCERNED BECAUSE THEY ARE EVERYWHERE.

So are you going to put your loved one’s health to someone who is pretending? Are you going to pay hundreds of bucks for a fake individual? We would like to stop the stupidity. We want your cooperation as we want you to simply educate yourself about the matter.

Private duty Nursing is currently in demand and will continously rise throughout because of the New Trends in Health Care Delivery System. PRIVATE DUTY NURSING is only done by Registered Nurses (RN) who undergo proper education and trainings. In the Philippines, Registered nurses must posses an Official Transcript of Record (OTR) which contains all the Academic grades and must have a Diploma which they obtain after they graduated from the 4 years course of Bachelor of Science in Nursing or BSN from Accredited Universities. They Must also pass the national board exam for nurses which termed as the Nursing Licensure Examination (NLE) to be able to have a LICENSE for them to be allowed to practice Nursing Profession.

AS for the Caregivers, they should have EXCLUSIVE training and education for 6 months to 1 year to learn all the basic Foundation of Basic Care. Like Nurses, they must also possess Official Transcript of Records and should have Diploma under Accredited Body as a proof that they enter a Caregiving School.

In the Philippines, studying Caregiving is promising. It is a short TESDA (Technical Education and Skills Development Authority) course that focuses on skills to provide care to children, the elderly, and the disabled. This includes helping them to do basic tasks like eating, taking a bath, changing their clothes or making their living spaces safe and clean and responding to simple emergency situations.

CAREGIVER COURSE must follow THE STANDARD Caregiver training which is SIX TO SEVEN (6-7) MONTHS of comprehensive program that trains students to be professional caregiver. The course duration requires a MINIMUM of 760 hours of lecture and laboratory and 240 hours of on-the-job training in a hospital or health care institutions.

BUT Caregivers are only allowed to do Caregiving Duties or Basic Home Care Aides but NOT as a private nurse as they are not licensed to do so. Same to those individuals who did NOT pass the Philippine Nursing Licensure Examination, they are NOT allowed as they are NOT licensed to practice the nursing profession.

The most alarming is … Most of the PRETENDERS or FAKE NURSES are Run away maids. The run away maids escaped from their employers and took advantaged by taking the oppurtunity to work as a FAKE PRIVATE DUTY NURSE or CAREGIVERS because they find the job lucrative. They managed to FAKE their douments by putting their name in SOMEONE’S Official Transcript of Records, Diploma, Nursing License and Certificates of Trainings. The modern technology make it possible for them to edit OTHER’S credentials. ANOTHER unlawful thing they do is, they WILL PRETEND that the person from Somebody’s documents is them

The run away maids also managed to process their permits to paid agents or agencies that offer any working permits under a ghost employer for them to stay and continue their unethical thing. They have also the guts to cheat local private nursing agencies for them to have a job earning hourly rate of 20-25 RM following the standard rate of private nurses here and in other countries compared to their previous salary which is 1500 RM per month (standard Maid salary).

For them to survive, they managed to attend NON accredited schools here in Kuala Lumpur for them to be called “Caregivers”. THE NON ACCREDITED SCHOOLS offer caregiving course for only 2 hours of lecture every sunday twice in a month which is NOT sufficient to study the foundation of basic care or fundamentals of Nursing. The Schools are not listed in the accrediting body here in Malaysia, the students attending has NO Related learning Experience or in short Actual training in a hospital which is a requirement to finish the course. The RLE is a clinical duty or exposure to various hospitals putting all the Nursing concepts into actual situation. Moreover, run away maids WHO ARE GOOD IN PRETENDING learn also Nursing Care from TRUE REGISTERED NURSES who dont know that they are FAKE.

As mentioned earlier, A TRUE CERTIFIED CAREGIVER must have an exclusive education and training with a minimum of 750 hours of lecture and 240 hours related learning experience or actual training. In the Philippines, they need to undergo and Pass the TESDA Assessment and will be given CAREGIVER NATIONAL CERTIFICATE II in short Caregiver NC II.

CLAIM A COPY OF THEIR PHILIPPINE PASSPORT. (MUST NOT BE PHOTOSTAT) NOTE THAT THE NAME WRITTEN IN THE PHILIPPINE PASSPORT MUST BE THE SAME NAME WRITTEN IN THEIR CREDENTIALS AND DOCUMENTS
CLAIM A COPY OF
1. OFFICIAL TRANSCRIPT OF RECORDS
2. DIPLOMA
3. PROFESSIONAL NURSING LICENSE (PRC ID)

For Verification of a True Professional Nurse, just visit the website of Professional Regulation Commission the Authorizing body in issuing professional license in the Philippines (www.prc.gov.ph) and go to their Services section. Click and look for Verification of Professionals. Key in the name of complete name of the nurse or the license number, it will automatically check if the person is a Registered Nurse.
4. Certificates of trainings (optional)

FOR A CAREGIVER:
CLAIM A COPY OF THEIR PHILIPPINE PASSPORT. (MUST NOT BE PHOTOSTAT). NOTE THAT THE NAME WRITTEN IN THE PHILIPPINE PASSPORT MUST BE THE SAME NAME WRITTEN IN THEIR CREDENTIALS AND DOCUMENTS.
CLAIM A COPY OF
1. OFFICIAL TRANSCRIPT OF RECORDS
2. CAREGIVER NATIONAL CERTIFICATE II OR CAREGIVER NC II.
3. Certificate of trainings if any.

MAID NURSES WOULD REASON OUT THAT THEIR NAME ISN’T ONLINE BECAUSE THEIR LICENSE ARE EXPIRED WHICH IS A LIE.

Once a graduate nurse passed the Licensure Exam she will be known as REGISTERED NURSE and automatically she/he will be listed in the Registry of Professional Regulation Commission Philippines as a Professional Nurse. If a license is expired, it does NOT mean that the PROFESSIONAL NAME is delisted or remove from the PRC Book of Registry. A licensed that is expired only means that it is not valid. So the professional must renew their license for them to update their profession. Being a Registered Nurse is a lifetime privileged and governed by local and international laws.

NOTE: IF AN INDIVIDUAL SHOW YOU AN EXPIRED LICENSE, STILL YOU CAN CHECK HIS/HER NAME IN THE PRC WEBSITE http://www.prc.gov.ph/ for ONCE AN INDIVIDUAL IS A PROFESSIONAL IN THE PHILIPPINES, HIS/ HER NAME IS LISTED IN THE BOOK OF PRC. IT IS A LIFETIME PRIVILEGED WHETHER YOUR LICENSE IS EXPIRED OR NOT.

So if you encounter an individual with an expired license and telling you that you cannot check their name on the list of PRC online because their license is expired. ITS A BIG LIE !!! and they are a BIG FAKE!! BE vigilant for the safety of your loved ones and Be safe Life is precious.

How to spot? Demand their Original Passport NOT Photocopy for all photocopies can be edit, others use a Professional Name which isn’t their name. Next step Demand their License ID and make comparisons of all the details such as pictures, name, birth place, birthdate if the personal information in passport and license Id are same.

Please refer to attached photos. The FOUNDERS name can appear in Google Search about their professional information. Internet source is an accurate data base

An incident in the UK recently this year about a Filipino Nurse in the person of Victorino Chua who was now in jailed for poisoning his patients to death. The hospitals send an undercover agent to Philippines to investigate Victorino Chua’s because the hospital is doubting his credentials whom he used in his application. The undercover agent found out that the real Victotino Chua is working at the Philippines and this convicted man isn’t a nurse. All his credentials are not real and bought it at Recto Manila the number 1 producing sight for fake documents. He use the name Victorino Chua since they have a similar name.

To verify a Professional Status in the Philippines can be found online and is more accurate than in papers for these documents in papers can be edited which is common in Malaysia and use by fake nurses as an advantage over Local Employers who have NO KNOWLEDGE about the Nursing Status in the Philippines. For they are only after of the good pay and not thinking about the Patient sake even they don’t have the qualifications as a Nurse.

http://www.prc.gov.ph/services/?id=16

http://www.filipinoprivatedutynurseonline.com/beware-of-fake-nurses/fake-filipino-nurse-beware-of-a-maid-nurse

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What Lurks within Your Care Home?

This article will focus on staff bullying within care homes . It is largely an opinion piece. Relevant literature is offered at the end and experiences of some staff have been incorporated..

What gives individuals the right to make others feel worthless?

That feeling of worthlessness may overule a person’s life so much so that they are afraid to do anything or to interact with others. The one bullied may believe that he or she deserves  to be bullied. Whilst this applies to so many establishments or relationships, such as schools, marriage, or hospital wards, bullying may be rife in care homes. Yet care homes one would expect (as other areas), are staffed by individuals who have  a “caring nature “.

The theories  of John Knox contribute to this belief of “worth”- one has to be worthy which determines rewards or punishments. Who gives anybody the right to judge ?

Individuals who are at greater risk of being bullied include staff from overseas, young or inexperienced staff, volunteers. In fact anybody who appears “different” and does not fit into the group criteria. Try raising issues within a care home, or questioning the routine.

There have for example, been examples of staff who were told “to return to their own country”, name- calling, physical abuse, cold shoulders in the staff room, exclusion from discussions, or more subtle approaches such as being left the worse jobs or shifts to do.. Such actions may be taken by individuals or the whole team. Studies indicate that gender may contribute (see below)- most staff within care homes are indeed women. Women are desribed as being rather more “bitchy” than men. Gender may also determine the reaction of the one being bullied to the bullies.

Many people who are bullied, are too distressed to take the case further by considering such as tribunals. Indeed few staff within care homes are members of a union- especially unqualified staff. Approaching the manager may actually worsen the situation- especially if staff are informed. Eventually the one being bullied may leave their post. Yet it may not end there with years of suffering or mental illness to follow. Some may suffer from nightmares and bouts of crying for example. Indeed many may fear working again.

There may be many “reasons” for bullying including survival of the fittest group (Darwin)-  the one being bullied is excluded from group membership . Groups survive by mutual cooperation of they who agree with it’s core principles.Bullies may like the power that bullying offers them. This may be determined by their personality type or indeed, reflective of some form of mental ilness such as dellusions of grandeur.

Many cases of bullying would be identified by the use of cameras (CCTV) within areas of care.

Further reading

Darwin C On the Origin of Species  1st published 1859

John Knox –

Gender –

Maslach C, Santee RT, Wade C (1987) Individuals, Gender Roles and Dissent Psychology 53 (6) p 1088-1093

Steffensmeier D , Allan E (1996) Gender and Crime : Toward  a Gendered Theory of Female Offending Ann. Rev. Social (2 p459-67

Useful articles;

http://www.telegraph.co.uk/women/womens-business/12000580/Workplace-bullying-How-to-deal-with-it.html

http://www.theguardian.com/money/us-money-blog/2014/jul/06/bullying-at-work-political-experiences-bullies-solutions

http://www.huffingtonpost.com/news/workplace-bullying/

Bullying stories;

http://www.thejournal.ie/readme/bullying-in-work-665391-Jun2014/

http://legalcareers.about.com/od/careertrends/a/Bullying-Stories.htm

http://www.stopbullying.eu/case-study-lorna.php

http://ehstoday.com/safety/workplace-bullying-victims-share-their-stories  USA

Supportive Associations

Bullying UK  http://www.bullying.co.uk/

http://bullyonline.org/index.php

http://www.workplacebullying.co.uk/

https://www.gov.uk/workplace-bullying-and-harassment

http://www.noplace4hate.org/real-bullying-stories/

http://www.mentalhealthy.co.uk/other/mental-health/bullying-in-the-workplace.html

Free representation in the workplace UK http://www.acas.org.uk/index.aspx?articleid=1461

http://nobullying.com/adult-bullying-stories-war-in-the-workplace/

More Associations/ links to come.

You are welcome to submit examples of this.

 

THE NHS AND GOEBBELS

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“It would not be impossible to prove with sufficient repetition and a psychological understanding of the people concerned that a square is in fact a circle. They are mere words, and words can be molded until they clothe ideas and disguise” ― Joseph Goebbels.

Jeremy Hunt claims that patients are more likely to die at weekends.

Freemantle, M Richardson, J Wood, D Ray, S Khosla, D Shahian, WR Roche, I Stephens, B Keogh, D Pagano, J R Soc Med. 2012 February; 105(2): 74–84:

‘The research, published online today (15 May 2014) in the European Respiratory Journal, is the first to assess death rates among patients staying in hospital over the weekend, irrespective of the day of admission.

Previous studies have identified the ‘weekend effect’, where patients admitted to hospital at the weekend have an increased risk of dying. While this could be down to a shortage of staff, it could also be due to the fact that more severe patients will admit themselves to hospital during a weekend, while those with milder symptoms would wait to speak to their doctor the following week.

This new study analysed the ‘weekend effect’ in a different way by assessing whether patients who stayed in hospital over the weekend, even if they were admitted earlier in the week, were also experiencing an increased risk of death.

The principal finding of our study is that hospital admission at the weekend (Saturday or Sunday) is associated with a significant increased risk of in hospital death over the 30-day follow-up period, but being in hospital at the weekend is associated with reduced risk of death. Thus for every 100 deaths among patients admitted on a Wednesday, we would expect 116 among otherwise similar patients admitted on a Sunday. However, for every 100 deaths among patients in hospital on Wednesday we would expect to see 92 among similar patients already in hospital on a Sunday.

These findings are consistent for emergency and for elective admissions. The findings for the English NHS were consistent with the analysis from 254 academic and not-for-profit US hospitals, suggesting that this finding may be systematic in health care organizations

Our study showed an increased 30-day mortality risk for patients admitted with emergency conditions over the weekend period compared to the rest of the week. This finding confirms previous reports for specific clinical conditions and a more recent survey of outcomes in the NHS. The increased mortality associated with emergency weekend hospital admissions may be multifactorial. The cohort of patients admitted during the weekend will include those patients who would otherwise, had they been less ill, have had their admission postponed until a week-day.

Jeremy Hunt claiming that patients are more likely to die at weekends is an attempt to convince people that a square is a circle. He has taken facts out of their context for political purposes, and, as such, uses the same techniques of truth manipulation that Joseph Goebbels would have approved.

The NHS is not a business.

The NHS has the amount of money the government decides to spend on it.

Claiming that Hospitals are overunning their budgets is like saying “Oliver Twist is asking for more, he says he can not not survive on what we give him”. It is like saying a square is a circle, and, if we repeat this often enough, fools will believe us, and the only remaining trick is to ensure that enough fools vote for us.

ALL those who work in the NHS – UNITE!

OPPOSE THE COMMON ENEMY.

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NEW NURSE TRAINING IN TOWN

practical nurse

This American link (http://www.practicalnursing.org/) gives an excellent insight into the cost-driven type of nursing which is to be introduced into the UK, as a result of government deliberation on calls by Hospital Trust managers to ‘adjust’ the nursing mix by enabling nurse assistants to ‘train up’ and take over more tasks that were once confined to registered nurses.

The UK version of American Licensed Practical Nurse (LPN) training will be known as Associate Nurse Training. (ANT).

This will be based on the American system of the trainee (or their sponsor, the Trust Hospital), paying, or co-paying, for the cost of the course.

The section of the above given website entitled ‘Cost of LPN Programs & Schools’ gives what I consider will be an accurate reflection of the costs to trainees and/or their sponsors, it can be noticed that payment can be based on an assessment of needs approach:

‘Grants can come from the federal or state governments. They can also come from companies, organizations, colleges, or individuals. Grants are usually need-based. This is money that does not need to be repaid. It is given on a basis of financial need’. To put this into context: ‘Average cost of tuition for LPN programs is about $10,000 to $15,000 nationally’, for a typical 18 months course.

The section entitled ‘Working As A Licensed Practical Nurse (LPN), What Do LPN’s DO?, gives an expansive list of nursing tasks that LPN’s carry out, in the context of which the registered nurse is the organiser of ‘broad plans of care’; ‘At work, the RN usually organizes the patient’s broad plan of care, which is something the LPN then helps to carry out’. This system allows for less ‘generals’ and more (cheaper) ‘captains’.

The LPN may:

•Administer oral and intravenous medications
•Chart in the medical record
•Take the patient’s vital signs
•Change wound dressings
•Collect specimens such as blood, urine, sputum, etc
•Insert and care for urinary catheters
•Care for patients with tracheostomy tube and ventilators
•Insert and care for patients that need nasogastric tubes
•Give feedings through a nasogastric or gastrostomy tube
•Care for ostomies
•Monitor patients for a change in clinical condition
•Call the physician if needed
•Perform CPR in emergencies
•Are supervised by an RN
Although each state sets the scope of practice for the LPN, each organization can narrow the scope. It is important, therefore, to know what the specific organization does not allow the LPN to do. In some organizations, but not all, the RN is expected to carry out the following tasks:

•Start, monitor, and/or discontinue intravenous catheters or the intravenous fluids
•Start, monitor, or change critical intravenous medications that stabilize the heart or blood pressure
•Take phone or verbal orders from the MD
•Administer intravenous medication that are given “push” or very quickly
•Care of central intravenous lines (that go to or near the patient’s heart)

My main concern with this system is the lack of legal accountability of LPN’s; the onus for mistakes will be placed on fewer registered nurses.

Be that as it may, the LPN/Associate Nurse, will not be ‘registerable’ by the NMC (as yet?), and the way would seem open for unions such as UNISON and UNITE, who already represent many nursing assistants in the NHS, to (1) sponsor/co-sponsor members’ training (with members paying a set amount out of their monthly salary); (2) set up their own registration body, which will adjudicate over complaints about members’ actions and attitudes concerning nursing duties. The RCN, of course, will also be free to battle for the subscription fees of Nurse Associates.

This model, of people already involved in nursing tasks being the main body of recruits to Nurse Associate training, will be the norm in the UK.

The training of the new (old SEN, in reality) breed of practical nurses will be college based, probably on a day/s release basis.

There will be the prospect of graduates of this programme becoming a degree level registered nurse, although there will be substantially fewer of these required.

The only entry into nursing will be via this new (old, in reality) type of training.

The only way for university nurse education departments to (substantially) survive will be to amalgamate with their equivalents in local colleges, to offer ‘a seamless career in nursing’, with universities/lecturers ‘overseeing’ college based courses/validating training materials, of which there is a large amountin America, which could be ‘fine tuned’ for UK needs.

The Nurse Associate, I predict, will be the only ‘nurse’ in nursing homes.

Any debate on defending the status quo is rather like Canute and his courtiers chatting with the tide up to their belly buttons.

All the best, dearhearts,

lenin nightingale 2016

NMC (IN HOUSE) APPEAL PLANS

 

nurses-appeals-england-wales-300x155

 

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The government’s Nursing Regime, by its other name, the NMC, are a reflection of a dark past. During the English Civil War there were hundreds of witch trials by ordeal in England. Everyone knew witches float, so toss the accused witch into the lake, and if she floats then she is a witch. If she sinks, she is innocent, probably dead from drowning, but, oh well.

It is the same with nurses who are accused of violating the NMC’s  code of conduct. Those accused by their employers, who gather evidence from co-workers, which may include historical, petty misdemeanours, must be cleared by an NMC fitness to practice panel, but, if out of work, as many nurses accused by employers are, must also drown on Job Seeekers Allowance.

Let it be made clear, the NMC’s role in this is as a front of government control of the ‘medical professions‘. Anyone reading the Department of Health’s consulatation document (The Nursing and Midwifery Council: proposed changes to the governing legislation, 17/04/2014) will be fully assured that the NMC is open to  government review, and is little more than a quango, whose governing council is directly appointed by the Privy Council, and which is only ‘independent’ in name.

This is why a key principle of the NMC’s report-a-nurse protocol allows a potentially vindictive employer to readily make an accusation, whether due dilligence of the veracity of the claim as been done or not. I have a personal recollection of such an instance, when a very able nurse was accused of errors in drug administration by a matron whose best friend’s ex-husband was dating the accused nurse.

To be vindictive is human. In a recent High Court (Administrative Court) Decision, Suddock v The Nursing and Midwifery Council (2015] EWHC 3612 (Admin) (11 December 2015), Mrs. Justice Andrews, DBE, made, what I consider to be, ‘benchmark’ comments concerning the plausibility of witnesses giving evidence at NMC fitness to practice panels.

The following are general comments made by Mrs. Justice Andrews on some of the charges levelled against Ms Suddock:

136. ‘There was no weighing up of whose version of events was inherently more plausible, or more consistent either with earlier statements or with the contemporaneous documents‘.

141. ‘This is one of those rare situations in which, despite the advantages that the panel had of seeing and hearing the witnesses, I can safely conclude that it was both plainly wrong and unfair to find the charge proved against Ms Suddock … Whilst there is no duty on a panel to give anything more than adequate reasons for its decision, here there were no reasons given at all, and that is unfair. However this is not simply a case of inadequate reasoning; for all the reasons I have set out, the finding is not supported by the evidence. Not to put too fine a point on it, it is perverse’.

153. ‘What would the panel have done had it appreciated that the charge depended on the word of a witness who had made up a story about very serious wrongdoing, versus that of Ms Suddock, in respect of whom the panel had been given a good character direction?* … The panel had to be satisfied that it was more likely than not that these remarks were made by Ms Suddock as … alleged, not simply that they were remarks of a nature that she was likely to have made because, rightly or wrongly, she regarded herself as more knowledgeable than the HCAs’. *Good CQC inspection reports, etc.

154. ‘A further point is that the panel found Ms Suddock’s behaviour at the hearing to be “assertive and challenging” and treated this as negative. However, it may have looked at her behaviour in a very different light if it had appreciated that there was clear evidence that someone was trying to frame her, and that one of the witnesses against her was demonstrably untruthful, not just muddled. An innocent person facing that situation might well have presented as assertive and challenging, especially if she was trying to represent herself’.

160. ‘If one of the key witnesses of fact was lying, or at the very least was so confused that no weight could be placed on her evidence, and another was not available for cross-examination, but demonstrably contradicted herself in two statements taken two years apart, and embellished her evidence in the later statement by adding more serious allegations against Ms Suddock, the evidence of the other two and their motives for saying what they did might well come more closely under the microscope. I would expect a panel, in those circumstances, to have gone about its evaluation of their evidence somewhat differently‘.

167. ‘The panel failed to make it clear that it was not relying on that evidence as evidence of the truth of what the witnesses were told, but merely as evidence that staff at the Home had made similar or consistent allegations to their employer or to independent parties in the past’.

189. ‘However, and despite my extreme disquiet about some of the evidence that was relied on by the panel, plus its flawed approach to examination of the credibility of the witnesses, I cannot substitute my own decisions for the panel’s. I therefore have to decide whether to direct that some or all of these Charges be remitted. If the Charges are to be remitted, they would have to be heard by a different panel of the CCC. I cannot send them back for reconsideration by this panel because (a) however scrupulous its members might be about trying to put out of their minds the unfavourable impression they formed of Ms Suddock and the favourable impression they formed of the other witnesses it would be asking the impossible of them to do so, and (b) the reasonable observer would not believe that justice was being seen to be done unless the case against Ms Suddock was looked at through completely fresh eyes’.

193. ‘Ms Suddock has already been through the terrible experience of being falsely accused of serious wrongdoing in a number of respects, and threatened with losing her livelihood in consequence. The question is whether it would really be in the interests of justice and in the public interest to subject her to a second hearing of charges that she maintains are equally false. Ms Suddock submits that it would not. None of the specialist bodies charged with looking after the interests of vulnerable patients has seen fit to take any action against her; including the SHA following a Serious Case Report in the wake of Dr 10’s preliminary inquiries. That point is a powerful counterbalance to Ms Flack’s submission about the NMC’s statutory duties of public protection and upholding the public interest‘.

Thus, Mrs. Justice Andrews suggested that the NMC panel based its decision on a favourable impression they had formed of the witnesses against Ms Suddock, and a contrasting unfavourable impression they had formed about Ms Sudock, which was inconsistent with contemporaneous documents, and also relied on accusations that were the perceptions of witnesses of what the accused was likely to have done or said and not what she had actually done or said.

This is like saying this NMC’s (£310 a day) panel members acted like judges on a tv talent show.

Compare and contrast some of the points made by Mrs. Justice Andrews with suggestions made in the aforementioned ‘The Nursing and Midwifery Council: proposed changes to the governing legislation, 17/04/2014’:

17. ‘The system requires arrangements to be made for booking individual panellists from the pool to attend and although there is regular training and guidance provided, it can be difficult to achieve and demonstrate consistent, quality decision-making among a very large pool of panel members sitting in panels of at least three people’.

Comment: There is no consistent, quality decision-making. In fact, many decisions seem perverse.

26. Where a decision is made … which the NMC considers to be materially flawed, there is no power for this decision to be re-considered under the current legislation and action cannot be taken to address this without a successful judicial review by an affected third party, which is a lengthy and expensive process.

Comment: The NMC’s paymaster’s (the government) do not want individual nurses to seek redress in the courts. They would prefer to keep the process of appeal ‘in house’, rather like the approach supported by the NMC and the RCN on ‘whistleblowing’.

27. ‘This current approach prevents the NMC from acting efficiently or in the public interest in order to protect the public and restricts its ability as a regulator to fulfil its duty. This lack of a power to review IC decisions is inconsistent with the powers of the GMC and the General Dental Council’.

Comment: Mrs. Justice Andrews commented: ‘If the Charges are to be remitted, they would have to be heard by a different panel of the CCC. I cannot send them back for reconsideration by this panel because (a) however scrupulous its members might be about trying to put out of their minds the unfavourable impression they formed of Ms Suddock and the favourable impression they formed of the other witnesses it would be asking the impossible of them to do so, and (b) the reasonable observer would not believe that justice was being seen to be done unless the case against Ms Suddock was looked at through completely fresh eyes’. To extend the logic of this precept, would it not be fair to ask if justice can not be seen to be done unless the case against any nurse is looked at by other than the NMC?

28. ‘Proposal: It is proposed that where Case Examiners or a panel … have determined that there is no case for a nurse or midwife to answer following allegations that their Fitness-to-Practise is impaired:
• The NMC will be given the power to review such decisions.
• The NMC would have the ability to make Rules for carrying out such reviews’.

Comment: This refers to the initial ‘case-no-case’ to answer stage of accusation. The great danger here is in the likelihood (I suggest) of the principle of retrospective action being applied to decisions of  fitness to practice panels. The principle of retrospective review is like ‘letting a Geni out of the bag’.

29. ‘This amendment is necessary because it will allow the NMC to properly fulfil its duty as a regulator by ensuring it can give further consideration, and where necessary, take direct action to re-visit closed cases in specified circumstances. (Please refer to the NMC consultation on changes to the Fitness-to-Practise Rules and to the Registration Rules). This is important because it improves public protection and would bring the NMC’s powers into line with the GMC and GDC and will ensure the public have equal confidence in the NMC as an effective regulator and public confidence in the nursing and midwifery professions to be maintained’.

Comment: The government will eventually allow (1) the NMC to investigate unsafe decisions made by its fitness to practice panels, as in the judgement against Ms Suddock, (2) decisions of its panels that found the nurse not guilty of charges, (3) ‘accusers’ (organisations) to present new evidence of ‘guilt’ concerning nurses at all stages of the  fitness to practice process.

Thus, a double-edged sword will be offered; one edge of it giving a nurse recourse to an ‘in-house’ appeal; the sharper edge being dangled as the Sword of Damocles over the heads of those who believed they have been cleared of charges. A charter for vindictive employers to try and try again.

Yes, not all nurses are good, and if new and genuine evidence is found against them it should be considered, but, under the doctrine that I propose will be adopted, a large number of good nurses would be open to continuous dredging up of  new, false accusations.

Will it be made compulsory for all nurses to have to exhaust the ‘in-house’ appeals procedure before being allowed to seek redress in the courts? Whose nerves could survive this mental obstacle course? The NMC will review your case because our panel members may have got it wrong, but we are open to receive further evidence against you!

To want to chain nurses to the same dictates as operated by the GMC is not about improving ‘public protection’, it is about extending the control of the State.

Nurses should pay a monthly fee into a fund set up by solicitors, to defend themselves against false accusation, instead of paying RCN subscription fees, which cover the cost of more than just defending nurses.

Before any NMC hearing, solicitors should write to the NMC stating that their client’s defense will be one of ‘false accusation’, and ask if any organisation bringing charges have done ‘due dilligence’ as to the veracity of witness statements, and are not a party to defamation by neglect of proper investigation (due dilligence).

Solicitors should use the judgements made in ‘Suddock v The Nursing and Midwifery Council’ to ask if a panel has based its decisions on perceptions of the plausibility of witnesses against that of the accused, and are these perceptions ‘consistent with the documents and the uncontroversial facts’, and, if not, are they not a party to defamation by neglect of proper investigation? (due dilligence).

Do not just simply lay down and take it, unless you are one of the untold thousands who chose to leave nursing because there are far more safer ways of earning a crust, and leave the way open for Nursings’ great conveyor belt of new cannon fodder to relace you.

You should not be blamed for doing this.

Who would want to go through the ordeal of a modern day witch trial?

lenin nightingale 2016

See:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304575/nmc-governing-legislation-consult.pdf