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Welcome to the very first e-mail newsletter from CAUSE (UK).

Julie has e-mailed this newsletter to you. She has kept your contact details confidential, and sends her good wishes to you. She wishes to assure you that she is giving her full support to piloting this new e-mail newsletter.

Please let me introduce myself. I am Craig. One of the stories on is mine, however because I succumbed to a gagging clause (in ignorance), you will have to guess which one is mine. Due to Julie’s web site, I made contact in September 2004. How time has flown! I have now formally joined in the campaign, thanks to Julie taking me under her most inspirational ‘wing’.

Because you are reading this, it is likely you’ve been affected by suspension/exclusion, either directly or indirectly. Welcome to the club. Please know that you are not alone, that there is support and understanding, and that people are actively trying to generate change.

As this is the first edition of ‘CAUSE a scene’, it is more bulky than it should be. This is to ‘regroup’ and summarise important facts, events and progress to date. Apologies for having no appealing graphics, due to lack of resources and IT competence!

In this first volume (will you keep it as a keepsake for when we are famous, and for your time capsule memento…?), you can find little ‘nuggets of gold’ (practical information) on:

The group’s brief history (page 2)

Achievements so far (page 2)

Campaign communications (pages 2-3)

Diary dates (page 3)

External links (page 4)

Feedback (pages 4-5)

Frequently asked questions (FAQ’s) (pages 5-6)

Headlines (pages 6-7)

Practical resources (page 7)

Statistics, Data and Research (page 8)

Self-care and Inspirations (page 8)

Stories (page 8)

Membership (page 8)

Governance (how a group is run) (pages 8-10)

And the final word…(page 10)

We hope the info is supportive, reassuring, practical, empowering, and inspirational to you and those around you.

If you would like to receive this e-mail newsletter on a regular basis, just follow the instructions in ‘Governance: A new e-mail newsletter is being piloted’ (towards the end of this newsletter).

We understand however, if you want to forget these awful events in your life and choose not to continue receiving ‘CAUSE a scene’. As the newsletter is an ‘opt in’ resource, you need do nothing further.

Once you have read on, we hope you will (if you are able and ready) get in touch and join us gallant few who are trying to “CAUSE a scene” [non-violently], by campaigning those in the ivory clouds above us to

stop what they are doing,

end their rhetoric,

listen to us mere (possibly ex-) employees who really do have more clout than they wish (we just need to find it, then flex it!), and

make significant changes to current practice and attitudes.

What ever you do, always remember your fundamental moral and legal human rights.

Bon appetite, and be kind to yourself.

from Craig at

for the CAUSE (UK) campaign team

Group history

Founder: Julie Fagan (Health Visitor)

Julie set up the web site in 2003 due to her own experience of being unfairly and unjustly suspended from work.

Through her web site, Julie has provided invaluable, support, guidance and inspiration to many people who have sadly been affected by unnecessary suspension/exclusion.

Achievements

Julie Fagan has produced and circulated 2 reports:

Suspension failure in the NHS (August 2004)

The role of Unions in NHS suspensions (March 2005), following a small-scale research project conducted in February 2005

Thanks to Julie’s efforts, and web site, there

is increasing support for NHS employees,

and increasing campaign ‘friends’, and thus

increasing campaign lobbying – see ‘Campaign communications’

Meetings are slowly beginning to take place – see ‘Diary’.

Campaign communications

I sent an e-letter to Sir Nigel Crisp in October 2005, and circulated to over 30 NHS and non-NHS agencies.

E-mail responses have been received from:

The Department of Health (DH): Sir Nigel Crisp

Maureen Morgan

Public Accounts Committee (PAC)

NHS Employers

NHS Litigation Authority (NHSLA)

No e-mail responses have yet been received from:

NHS Confederation

Cheshire and Merseyside Strategic Health Authority (SHA)

Institute of Healthcare Management

National Clinical Assessment Authority (NCAA) [formally NCAS]

Nursing and Midwifery Council (NMC)

Royal College of Nursing (RCN)

  • From the above, it has been established that a working group was set up by the Chief Nursing Officer (CNO), Christine Beasley, to review suspension and exclusion practice amongst non-medical staff. Regrettably, and despite formal concerns being raised, the DH and NHS Employers have confirmed they are only going to produce and circulate yet more voluntary guidelines.
  • The NHSLA stated it was unable to advise or assist.
  • The response from the PAC was very helpful, and it included a transcript of the Treasury Minutes of the 47th report from the Committee of Public Accounts 2003-2004 (Cm 6441; 26 January 2005) (PAC 26 January 2005), which has given us valuable information to use against the DH.

A letter was sent to Private Eye on 05.01.2006, to see if they will investigate the government.

A letter was sent to the Information Commissioner, appealing against a request under the Freedom of Information Act (FOI) 2000 made to NHS Employers. The Information Commissioner has agreed with NHS Employers, that they are not currently a public body - - despite spending public monies!! We’re looking further into this.

A response letter was sent to the PAC on 05.01.2006.

A letter was sent to the National Audit Office (NAO) 09.01.2006, which has yet to be replied to.

Follow-up calls to the Chief Executive’s (Anna Walker) private office at the Healthcare Commission (HCC) finally confirm that the letter to Sir Crisp has been internally forwarded to HCC staff, especially those covering whistle-blowing cases.

A press release is in the final draft stages. We will include this with the next issue if it has been circulated.

A letter has been received from Andrew Foster CBE, Director of the DH Workforce Directorate, putting in writing, amongst usual rhetoric, that the government is not going to legislate regarding suspension/exclusion of non-medical staff. We finally have it in writing – and will be circulating the letter to several agencies.

Diary

Please let us know your thoughts and suggestions to take to the following meetings - ASAP

14.02.2005: Meeting with Andrew Barton (Head of RCN reps training)

WHERE: Birmingham RCN offices

AIMS: (1) To discuss the role of union reps in suspension and exclusion

(2) To discuss what training union reps need, to manage suspensions and exclusions

TBC: Meeting with Aidan Halligan (Director of NHS Clinical Governance)

External links

Practical

or (both lead to same site)

Lists all government legislation –handy to have when trying to influence change!!!!!!!

The National Patient Safety Agency (NPSA) has produced the following:

> Incident decision tree (IDT) – should be used in suspension/exclusion

> Root cause analysis (RCA) – should be considered in suspension/exclusion

> 7 steps to patient safety (2004)

ACAS is an employment-related organisation that advises and produces written information on numerous employment issues, including: Grievances; disputes; disciplinaries; investigations; employment practices. ACAS also have a helpline: (08457) 47 47 47

The Health and Safety Executive (HSE) advises and produces written information on numerous health and safety workplace issues, including: Stress; return to work and re-deployment.

Very useful guidance on writing skills, and a good A-Z section on legal terms.

A campaign site aiming to equip people to take action on problems affecting them

It’s guidelist ( covers many topics. Excellent for campaigning guidance and writing skills.

Inspirational

Click on spiritual/soul and ‘Thought for the day’ (often from by the Dalai Lama).

For a bit of fun/distraction

Feedback

Feedback is vital to ensuring we meet your needs and are running things effectively and efficiently.

Campaign

Please let us know if you have any suggestions on how we can increase awareness and publicity about the group and the campaign.

Web site

Julie has had some excellent feedback about her web site and its role. As we all know, we ‘owe’ Julie for her courage to stand up and speak out through her web site. I know you are very modest Julie, but we all I am sure cannot say “thanks” enough to you.

E-mail newsletter

Please feed back regarding the newsletter’s:

> Content (relevance; practical use; inspiration; appropriateness), and

> Frequency of publication/distribution

EXAMPLE: Produce it more frequent (monthly is the minimum!)

Produce it less frequently (every 2-3 months)

Please also report any problems receiving it.

Feel free to recommend any ‘formatting’ or design tricks!

Frequently asked questions (FAQ’s)

This month: The statutory suspension, exclusion and disciplinary guidelines for doctors and dentists (medical staff)

Formal name?

a)The suspension and exclusion guidelines are formally called the Restriction of Practice and Exclusion from Work Directions 2003.

b)The disciplinary guidelines are formally called the Directions on Disciplinary Procedures 2005.

What are they?

The statutory suspension, exclusion and disciplinary guidelines for doctors and dentists (medical staff), come in 2 sections:

a)Guidelines regarding suspension and exclusion from work, which came out in 2003 as the Restriction of Practice and Exclusion from Work Directions 2003:

Part I – Action when a concern arises

Part II – Restriction of practice & exclusion from work

b)Guidelines regarding disciplining staff, which came out in 2005 as the Directions on Disciplinary Procedures 2005:

Part III – Conduct hearings & disciplinary matters

Part IV – Procedures for dealing with issues of capability

Part V – Handling concerns about a practitioner’s health

Who produced them?

The Department of Health (DH).

Are they enforceable in law (‘statutory’)?

Yes. The Secretary of State has passed 2 laws making them legally binding, one in 2003 and the other in 2005.

Who do they apply to?

Statutorily, only medical staff (doctors and dentists).

However, the guidelines also apply – voluntarily – to cases involving non-medical staff:

1)The DH identifies in Point 9 under the heading ‘The new framework’ of Maintaining High Professional Standards in the Modern NHS: a framework for the initial handling of concerns about doctors & dentists in the NHS (DH 2003), that under the Employment Act 2002 actions across an organisation must be consistent.

2)The DH states in PAC Conclusion (ii) #4 of the Treasury Minutes of the 47th report from the Committee of Public Accounts 2003-2004 (Cm 6441; 26 January 2005), that it has always been the case that the principles of the framework can be applied to other staff groups.

For non-medical staff, there are real issues regarding ‘voluntariness’ – organisations not voluntarily implementing and adhering to the guidelines……which is what this campaign - CAUSE (UK) is all about.

Headlines

The following items may be useful to you. Read about them to see if they apply to your specific circumstances, or discuss them with us. Don’t forget you can access legislation at or

Current useful statutory guidance and legislation (enforceable in law)

  • Common law Duty of Care
  • Tort of negligence: Duty of care; duty breached; harm resulted
  • Dignity at Work Bill (work in progress)
  • Dismissal: Unfair (v) Constructive (v) Wrongful (contractual)
  • Defamation Act 1952 (libel = written) (slander = spoken)
  • Health and Safety at Work Act 1974
  • Sex Discrimination Act 1975
  • Race Relations Act 1976
  • Data Protection Act 1984
  • Access to Health Records 1990
  • Trade Union & Labour Relations (Consolidation) Act 1992
  • Disability Discrimination Act 1995
  • Employment Rights Act 1996
  • Employment Tribunals Act 1996
  • Protection from Harassment Act 1997
  • Human Rights Act 1998/2000
  • Public Interest Disclosure Act (PIDA) 1998 (Whistle-blowing)
  • Working Time Regulations 1998/Working Time Directive
  • National Minimum Wage Act 1998
  • Management of Health and Safety at Work Regulations 1999
  • Employment Relations Act 1999
  • Contracts (Rights of Third Parties) Act 1999
  • Freedom of Information (FOI) Act 2000
  • Part-time Workers (Prevention of Less Favourable Treatment) Regulations 2000
  • Employment Act 2002
  • Restriction of Practice and Exclusion from Work Directions 2003 (DH) (parts I-II)
  • Employment Equality (Religion or Belief) Regulations 2003
  • Employment Equality (Sexual Orientation) Regulations 2003
  • Employment Act 2002 (Dispute Resolution) Regulations 2004
  • Directions on Disciplinary Procedures 2005 (DH) (parts III-V)

Current relevant reports:

  • An organisation with a memory (DH 2000)
  • Building a Safer NHS for patients: Implementing Organisation with a Memory (DH, 2001)
  • Workability (RCN 2000)
  • MINDout for Mental Health:

> “Line Managers’ Resource” (Mental health; return to work)

> Working Minds policy paper (2001)

> Working Minds Toolkit

  • Code of professional conduct (NMC 2002)
  • Workability 2 (RCN 2003) (return to work; redeployment)
  • The Management of Suspensions of Clinical Staff in NHS Hospital & Ambulance Trusts in England

(HC 1143; Session 2002-2003; 6 November 2003) (NAO 6 November 2003)

  • Maintaining High Professional Standards in the Modern NHS: a framework for the initial handling of concerns about doctors & dentists in the NHS

(DH 29 December 2003)

  • Suspension failure in the NHS (Julie Fagan, August 2004)
  • The management of suspensions of clinical staff in NHS hospitals and ambulance trusts in England (House of Commons Committee of Public Accounts 47th Report of Session 2003-04; HC 296) (PAC 16 November 2004)
  • House of Commons Committee of Public Accounts 47th Report of Session 2003-04 (HC 296): The management of suspensions of clinical staff in NHS hospitals and ambulance trusts in England (PAC, 2004)
  • Treasury Minutes of the 47th report from the Committee of Public Accounts 2003-2004 (Cm 6441; 26 January 2005) (PAC 26 January 2005)
  • The role of unions in NHS suspensions (Julie Fagan, March 2005)
  • A Safer Place for Patients: Learning to improve patient safety (NAO, 2005)
  • Maintaining High Professional Standards in the Modern NHS (DH 2005)
  • A Safer Place for Patients: Learning to Improve Patient Safety

(HC 456; Session 2005 – 2006 3 November 2005 (NAO 3 November 2005)

National Clinical Assessment Service (NCAS)

Their remit does not currently include non-medical staff, despite recommendations from the National Audit Office (NAO) and Public Accounts Committee (PAC), and admissions from the Department of Health (DH) about its effectiveness. Apparently, the DH was waiting until the NCAS has been transferred to the National Patient Safety Agency (NPSA), which has now occurred. Watch this space…

Practical resources

You have the legislation and reports in ‘Headlines’ which you can refer to and if appropriate use in your specific situation.

A draft legal perspective/argument has been produced. We will include this as an attachment with the next issue. It is our thoughts on how the government and employers are ‘flouting’ current laws. It has not been tested legally…yet. We are trying to find a union or solicitor to take up the cause. If you are in contact with either of these, feel free to take it with you (when you get it) to see what they think. All we ask is that you give credit where it is due (to Julie and Craig), for the time and toil spent. Thanks.

‘Key change actions required’ has been produced, outlining all the necessary changes we are asking to be made to current suspension/exclusion practice. If Julie has had the time, you will find the document on her web site.

You have a list of web sites you can access (listed under ‘External Links’).

If you are having trouble with team relationships, contact your organisation’s Clinical Governance Support Team (CGST). They will advise you. If relationships and dynamics are so bad, they can possibly bring in a team to sort things out.

If you have tried internal means of resolving matters, consider contacting your MP. Visit for more guidance on this. On the ‘Guidelist’ page, scroll down to ‘Democracy and local government’, and click on ‘Understanding what MPs do and how they can help you’.

Self-care & Inspirations

Small things done are better than big things planned

By making a steady effort, I think we can overcome any form of negative conditioning and make positive changes in our lives. But you still need to realise that genuine change doesn’t happen overnight (Dalia Lama)

Statistics, Data and Research

None new at present… The Department of Health has no idea how many non medical staff are currently suspended/excluded, how long for, who is being excluded, how it is being dealt with, nor do they plan to in the foreseeable future. So they have no idea of financial costs.

Stories

Julie currently has six heart-wrenching, yet unsurprising stories on her web site, and is eager for more.

Writing stories of peoples’ experiences are helpful to their authors (cathartic), as well as to the readers.

To avoid litigation, anonymity must be maintained. This includes omitting or being vague with:

Names of people and/or organisations

Specific dates and/or places

Specific and/or detailed accounts of events

If you would like to share your story with others, please contact Julie for help and guidance.

Membership

  • Number of web site hits : Approximately 150 a month, recently increased to 600
  • Number of personal contacts made to Julie so far : 114 NHS staff

(93 = nurses, midwives and health visitors)

Governance (how a group is run)

The campaign group name is

‘CAUSE’ – Campaign Against Unnecessary Suspensions and Exclusions in the NHS (UK).

Benefits of having a group name include:

Increases public credibility

Gives a professional, co-ordinated, organised look/image

Provides identity for members

Encourages ownership and solidarity for members

‘CAUSE’ analogies

These were my thoughts when thinking of the name ‘CAUSE’:

Cause

> The group’s cause is its aims and objectives

Causes include sick, faulty, repressive, dysfunctional: People, Teams and/or Organisations

> Root cause analysis (RCA) (National Patient Safety Agency)

> Suspension/exclusion causes detriment and (often-irreversible) damage/destruction