1 Tuesday, 23 August 2011
2 (10.00 am)
3 LORD MACLEAN: Good morning, Mr MacAulay.
4 MR MACAULAY: Good morning, my Lord. The next witness
5 I would like to call is Lesley Fox.
6 MS LESLEY NORMA FOX (sworn)
7 Examination by MR MACAULAY
8 MR MACAULAY: Are you Lesley Norma Fox?
9 A. I am, indeed, yes.
10 Q. I understand that your preference is to be addressed as
11 Sister Fox; is that correct?
12 A. Yes, thank you.
13 Q. I think that you have produced two statements to the
14 Inquiry. Could I ask you to have the statements in
15 front of you? I can give the references simply for the
16 notes. The first is WTS00960001, and your supplementary
17 statement is WTS01870001.
18 If we look to your first statement, Sister Fox, do
19 you tell us in paragraph 1 that you are currently
20 employed as the senior charge nurse within the
21 Vale of Leven Hospital? Is that correct?
22 A. That's right.
23 Q. As you are aware, today we are concerned with the period
24 1 January 2007 through, in particular, to
25 about June 2008. During that particular time, what
1
1 position did you hold in the hospital?
2 A. My position was that of ward manager.
3 Q. Is that something different to the position that you
4 hold today?
5 A. Not really. The name changed, but it is the same role.
6 Q. You are now designed as a senior charge nurse?
7 A. Yes.
8 Q. When did that change take place?
9 A. That was as a result of the senior charge nurse review,
10 and that would have been October/November time 2008.
11 Q. You tell us in paragraph 2 of your statement that your
12 duties as ward manager, ward 6, were to be responsible
13 for the ward 24 hours a day. Do you see that?
14 A. Yes, I do.
15 Q. How did that work in practice? Again, bear in mind I am
16 focusing on the period from January 2007 to June 2008.
17 Looking to that general responsibility for 24 hours
18 a day, can you just explain how that happened?
19 A. Yes. Well, as the ward manager, senior charge nurse, my
20 responsibility was the management and influencing of
21 care 24 hours a day. This didn't mean, obviously, that
22 I was there 24 hours a day, it was just -- it was my
23 responsibility to ensure that the ward ran as it should
24 run 24 hours a day.
25 Q. I will look in a moment at what your hours of work were
2
1 and how that operated in practice, but I think you tell
2 us in paragraph 2 of your statement that your
3 responsibility included implementing and carrying
4 forward new policies and procedures, maintaining nursing
5 care standards, managing staff, sickness absence,
6 recruitment and a devolved budget. Does that summarise
7 your position?
8 A. Yes, that is the role.
9 Q. Again, we will look at this later, but you say you also
10 attended Sisters' meetings, bed meetings and directorate
11 meetings; is that right?
12 A. Yes, that's correct.
13 Q. Just looking at the directorate meetings that you
14 attended, what were these?
15 A. These meetings were only of the unscheduled care
16 directorate, ECMS, which is emergency care medicine, and
17 these would be held, chaired, by our lead nurse, and it
18 was at these meetings that we would discuss our budget
19 and any other -- any other business which had been
20 filtered down through the directorate from my lead
21 nurses' bosses -- and they obviously were mine as
22 well -- you know, from the general manager, from the
23 service manager, and it was -- these meetings were used
24 to disseminate information, cascade information, and
25 make sure that we were up to date with what was
3
1 happening within our directorate.
2 Q. Were minutes kept of those meetings?
3 A. Yes, indeed.
4 Q. Looking to your current position and perhaps comparing
5 that to your previous position, you say in paragraph 3
6 of your statement, if we look to that:
7 "My current duties as senior charge nurse are much
8 the same except I do not have a direct patient caseload.
9 I am now involved a lot more in regular audits and
10 monitoring."
11 You indicate, as you mentioned a moment ago, why
12 your job title changed.
13 You say that now you are not involved in direct
14 patient caseload. What does that mean?
15 A. Well, at the time -- before the senior charge nurse
16 review, I was responsible for -- I worked as part of
17 the team, which meant -- you know, there were four
18 nurses on the ward and I would be part of that team
19 taking care of patients. Now my role is different.
20 I don't have -- with the exception of one day a week,
21 I don't have my own particular patients. I'm there as
22 a resource out on the ward, speaking to staff, advising
23 staff, speaking to patients.
24 Q. Is your job much more a managerial-type job now than it
25 was before?
4
1 A. Yes, I would have to say yes. Yes.
2 Q. I think also at the relevant time, that is
3 from January 2007 to June 2008, you were the tissue
4 viability nurse for the Vale of Leven Hospital; is that
5 correct?
6 A. Yes, that is correct.
7 Q. Do you still hold that position?
8 A. No, I don't.
9 Q. When did that change?
10 A. That changed in 2008 -- sorry. That changed in --
11 actually changed in 2009, the beginning of 2009, but
12 I didn't actually relinquish the role totally until the
13 replacement was in place, and that was
14 in August/September of 2009.
15 Q. Why did that change take place?
16 A. The change took place primarily -- as a result of
17 the senior charge nurse review and leading better care,
18 it became quite obvious to me that I could not devote
19 the time that I needed to do anything other than -- the
20 only time that I had would have to be firmly within
21 ward 6 and effecting the change that would occur as
22 a result of the senior charge nurse review, there were
23 many changes as a result of that.
24 Q. Do I understand that, before the change, and in
25 particular during the period that we were concerned
5
1 with, you were in charge of ward 6; is that correct?
2 A. That is correct.
3 Q. That involved having a patient caseload in ward 6?
4 A. Yes.
5 Q. But you also combined that job with the job of tissue
6 viability nurse for the whole of the hospital?
7 A. With the exception of the mental health, yes.
8 Q. That's the Fruin and Christie wards?
9 A. That's right, yes.
10 Q. Against that background, can I just ask you to respond
11 to a number of points I want to raise with you about
12 general nursing practice? I think we have heard this
13 from other evidence, but I understand that all
14 registered nurses have to register with the
15 Nursing & Midwifery Council. Is that correct?
16 A. That is correct, yes.
17 Q. That is the regulatory body in respect of registered
18 nurses?
19 A. Yes.
20 Q. You will be familiar, no doubt, with the Codes of
21 Practice that have emanated from that body over the
22 years?
23 A. Yes, indeed.
24 Q. Can you tell me, are these important documents?
25 A. This is a very important document. It fashions, it
6
1 shapes, it informs, it protects the patient, it also
2 protects staff, and it is the code that every nurse
3 would work within.
4 Q. Would you, yourself -- again, I am looking at the
5 relevant time -- have a copy of the relevant code
6 operating at the time close to hand?
7 A. Yes. There was always one within the ward area, and the
8 NMC would send us individual copies.
9 Q. Could I ask you then to look at a document for me? If
10 you could look, please, at INQ01970001.
11 You will see what you have on the screen,
12 Sister Fox, is the code that is relevant to 2004.
13 A. Yes.
14 Q. I don't think the essential elements of the code have
15 really changed significantly over the years.
16 A. No.
17 Q. If you could turn to page 3 of the document, if we look
18 to the right-hand side of the page, do we see here in
19 the code some fundamental principles that apply to all
20 registered nurses?
21 A. Yes, definitely.
22 Q. In particular, do we read that:
23 "As a registered nurse, midwife or specialist
24 community public health nurse, you are personally
25 accountable for your practice, and in caring for your
7
1 patients and clients, you must ..."
2 And a list is given as to these fundamental
3 principles.
4 A. Yes.
5 Q. Is that correct?
6 A. That is correct.
7 Q. Looking to the final point that you must do, that is to
8 "act to identify and minimise risk to patients and
9 clients".
10 A. Yes.
11 Q. If you turn then to page 4 of the document, there is
12 a section, section 1, headed "Introduction" that also
13 sets out some fundamental principles. Is that correct?
14 A. That's correct.
15 Q. Are you very familiar with this document?
16 A. I am indeed.
17 Q. I think you will have seen in evidence that has been
18 given to the Inquiry, if you have been following it,
19 that this document has featured quite largely?
20 A. I have indeed.
21 Q. If we pick up one or two of the points, at 1.2, are we
22 told:
23 "As a registered nurse, midwife or specialist
24 community public health nurse, you must:
25 "Protect and support the health of individual
8
1 patients and clients."
2 Was that something that was foremost in your mind at
3 the relevant time?
4 A. Absolutely, and this would be for any patient who was
5 ever admitted. Our role was to -- as a nurse, you know,
6 our role is to give the very best that we can give, and
7 this would be -- the protection is everything for the
8 patient: it is both the care that we give, it is the way
9 in which we actually deal with the patient. It is their
10 confidentiality, it is maintaining their dignity, it is
11 absolutely everything. This is what we do as nurses.
12 Q. At 1.3, we are told that you are personally accountable
13 for your practice. Does that properly reflect how you
14 would -- something you would accept?
15 A. Yes, I would accept that totally.
16 Q. At 1.4, it is stipulated that you have a duty of care to
17 your patients and clients, who are entitled to receive
18 safe and competent care?
19 A. Yes.
20 Q. "Safe and competent care", is that driven by best
21 practice?
22 A. It is driven by best practice. It can't be compromised,
23 you know. We would do the very best that we could as
24 a team, and each individual within that team would do
25 the very best that they could.
9
1 Q. We will in due course, Sister Fox, be looking at
2 particular patient records in relation to which
3 independent nurses who have given evidence to the
4 Inquiry have made certain criticisms in relation to, on
5 the face of it, the care given to a number of patients.
6 If I can give you an example, in some cases, for
7 example, the fluid balance charts were either not
8 completed at all or inadequately completed.
9 Now, would that represent safe and competent care,
10 in your opinion?
11 A. No, it wouldn't. However, if I may be allowed just to
12 speak just for a moment about the fluid balance chart,
13 I have read many of the documents with regard to each
14 and every patient that has been looked at within the
15 Inquiry, and there are some charts which are absolutely
16 fine. Unfortunately, the majority of charts are not,
17 and I can only accept that. I must accept that
18 criticism.
19 But what I would want to point out is that, within
20 the environment of ward 6, whilst the fluid charts
21 should have been completed in a much better manner than
22 they were, the fluid chart wasn't the only thing that
23 was being looked at; you know, the whole of the patient
24 was being looked at, their blood results were being
25 looked at, discussions were being had with medical staff
10
1 at the time. I do not believe that my staff willingly,
2 wantonly -- and myself -- failed to complete these
3 charts properly. We had many discussions -- many
4 discussions -- in the ward, where it was highlighted
5 that the fluid balance charts needed to be much more
6 accurately maintained, and this would improve, and then,
7 for whatever reason, it didn't happen. So they would
8 improve for a certain length of time and then it would
9 fall by the wayside again and reminders would have to be
10 given, discussions would have to be had, either as
11 a team or with individual nurses.
12 The patient was at the forefront of everything that
13 we did, the care of the patient was at the forefront of