Having become unemployed through having three years of NMC "practice conditions" applied to my registration for "complaining without the victim of 9 hours of blood-smeared seclusion room abuse's consent" I was offered a temporary post at a small independent nursing home in Middlesbrough that has had personal and regulator complaints against it over the years. It didn't even ask for references or a CRB check. The manager was going on sick leave. I accepted and immediately noticed that residents were not being properly cared for eg basic hygiene used during toileting.. no gloves or parons used.. impatient feeding..  much telling off.. some aggressive staff etc. I tried to pave way with a little Zeiler & Jervey type feeding training. Completely rejected in favour of usual passive speed feeding. A resident became ill and confined to bed and I noticed food fluids untouched on her tray for return to kitchen. When I mentioned the reply was "oh, she doesn't want it" I therefore took over and demonstrated slow application.. touching lips with food.. establishing taste.. little by little.. completed in 30 minutes. I asked a carer to warm some tea back up.. she replied "later" and walked off with no intention to comply and I had to take complete responsibility for feeding and hydrating. Slowly the lady recovered and got her strength back. I only lasted five weeks until the manager returned briefed by regulars and was very unpleasant. I looked up owner and visited and sent a statement to social services. I was contacted by former staff who described their similar experiences and worse with one old lady in a wheelchair repeatedly shut in an empty bedroom for calling "help me, help me". Five residents had died in the previous three months during sickness and diarrhea outbreaks and another lady the previous summer admitted in good health for short term care who died a month later on a hospital drip. Middlesbrough social services disinterested as previously in respect of the bloodied seclusion room at Roseberry Park Hospital although described clearly in the care record. So I wrote another lengthy report outlining residents chronic 12 month weight losses and the weight increase of one lady in response to the Zeiler & Jervey feeding application. I left.. abruptly. Three months later a letter from the NMC arrived. They've received a referral from the home and are investigating. The CQC ring me. They've rung to confirm the truth of my Roseberry Park Hospital complaints both the incidents and the whitewash review after complaining and was fired for looking at the victims file for "too long". The NMC write again and declare their intention to prosecute five charges reduced from many some very ludicrous allegations against me. One alleged that I intended to put a resident in a karate suit to lay on the floor for a "kick about". Another suggested that a physically disabled resident with full capacity who had never been taken out for a walk in her wheelchair since admission years previously who had eagerly confirmed their interest in going for a walk had been "taken out with wet hair". As a behavior therapist I was interested to note all this and observe how the NMC itself appeared to be behaving. At that stage matters were quite laughable and the "charges" ridiculous until it started to become apparent that the NMC was deadly serious. A year later I am convicted of charges that have required no corroboration other than the allegation of the individual staff who alleged it. Thomas Cromwell would be proud. The wheelchair walk and wet hair has been craftily developed by an eager young NMC solicitor into a "consent" issue. Unlike the original description it is now suggested that the wheelchair resident expressly refused to go out but was forced along with the carer to go. The carer witness's subsequent witness stand performance was described by the NMC as "open and compelling". Further questions reveal that the 60 year old wheelchair lady who had gained 7% body weight during my time there had died four months later. Further questioning was curtailed. In the meantime six months later I managed to get another job at a 30 bedded male mental health rehab unit. It was a bit like stepping back to 1975 with patients languishing around corridors laying on carpets waiting to be taken to the local shop by purple-clad support worker for 'fags and coke' only to return and sit out in the crowded smoking hut whilst the lone support worker gazed bored into space smoking his own role-up awaiting the arrival of similar colleagues. The "gym" "computer room" and "ADL (activities of daily living) kitchen" proudly featured in the brochure empty and unavailable because of requiring staff for "supervision". I survived eight weeks until the sudden occurrence of a back-of-the-neck marching restraint of a delightful patient by a lone aggressive support worker and inserted into bedroom seclusion which prompted me to hard action. I complained directly with a meeting with the manager and head of care and despite ensuring that I had up-to-date bi-weekly positive appraisals over and above what the NMC required, yes that's right.. I was immediately fired and referred to the NMC for allegedly "not following service policy" in relation to bringing the complaint. Now this service knew how to discredit whistle blowers. Despite the signing of up-to-date appraisals the manager emailed staff with extended descriptions of discrediting allegations in an appeal for more. The best was.. "commented during a pop video saying 'Cor.. look at the tits on that.. what you could do with them, eh?'" Three months later the NMC decide that yes there is a case to answer. However it included my completed appraisal records whose highlighted positive findings are now reversed when the highlighting was photocopied and so redacted instead. Surely the £700 a day 'investigation' solicitor realized this and surely the NMC case-management team who decided to press charges noticed immediately? The NMC case management team declared that there was no substance to my complaint and that the service's own internal inquiry found nothing untoward so therefore was not compelled to take any action. Indeed that WHAT HAPPENED in respect of my complaint was pre-planned for the purpose of providing patients with 'GUIDANCE' except that isn't what the internal inquiry did find. It accepted that one support worker acted against company policy and restrained by himself. He was therefore sent for additional training. Is the NMC as well as providing a free whistleblower discrediting service also availing its powers to protect services who have already acknowledged wrongdoing by creating false findings? Surely No More Corruption?

Seclusion abuses. A small completely calm learning-disabled girl walked into ‘hospital’ seclusion for nearly four hours complete with alarm bells on entry and exit so that staff could apparently take breaks. My immediate verbal complaint saw my immediate cynically contrived suspension. Further similar complaints saw two internal 'inquiries' and the eventual "thanks" a year later (having remained suspended) of the Trust CEO following the second inquiry or ‘Seclusion Review’.."for bringing the matter of seclusion to my attention". I was then immediately fired for legitimately accessing the clinical file of one seclusion victim two years previously. I was then referred to the NMC with grossly misleading descriptors of my previous Trust practices during my ten month employment. The NMC declared in February 2014 that I had complained without the severely LD abuse victims consent and moreover had written the complaint on my home computer and not Trust equipment although as it was I had actually used Trust equipment for the first inquiry not that the type of allegation forms a reasonable charge if you’re suspended and haven’t got access. Two months after the NMCs formally declared findings and its resulting ongoing sanction of a three years total of severely restrictive practice-conditions and therefore  hyper-scrutiny (I must study ‘safeguarding’ and "raising and escalating concerns” with evidence and regular supervisions). However, two months after the NMC findings (July 2014) the CQC, following my relentless complaints to their national complaints board finally visited and slated the hospital for its safeguarding failures to protect service users from seclusion malpractices ..effectively confirming my complaints throughout which were originally brushed over by the CQC at the time in 2012. I then formally complained against the NMC who had also declared the prosecution Trusts managers as 'open and transparent' (but who had demonstrably lied under NMC oath) and that my complaints about Trust abuses represented a ‘blanket failure to avoid following Trust policies and procedures’ .. clearly untrue given two original 2011 internal hospital inquiries including a face to face meeting with the Trusts CEO in August 2011, the 2012 referral to Safeguarding, CQC and the police and Safeguardings subsequent declaration of ‘nothing found’ …then my continuing complaints to national CQC and finally the 2014 CQC slating of the Trust ..all following hundreds of pages of submissions over four years. My concern is that either an NHS Trust has fooled a professional regulator or the regulator has actively colluded with a rogue NHS Trust. Either way a grave individual injustice and more importantly a major disservice has been enacted against very vulnerable learning disabled people. The post-Winterbourne safeguarding effect is clearly not the exclusive result of media-compelling tattooed thugs.

The July 2O14 CQC announced inspection report stated..

Care and welfare of people who use services                    FAILED

Safeguarding people who use services from abuse           FAILED

Roseberry Park Hospital CQC report 2 years after I was fired for CO abusive seclusion

The July 2O14 CQC announced inspection report stated..

Care and welfare of people who use services                    FAILED

Safeguarding people who use services from abuse          FAILED

“Some of our findings highlighted that seclusion was used as a way of managing the ward environment rather than as a response to the violent or disturbed behaviour of individuals. An example of this was that we were told by staff that one person was in seclusion because the person's behaviour was difficult to manage. We spoke with the person's consultant and other health professionals involved in their care and found arrangements were not adequate to ensure the person received safe and appropriate care. For example; we saw periods of days where the person's behaviour was stable and they showed nonthreatening behaviour. We spoke with the person in seclusion and they told us they were unclear what they had to do to leave seclusion room and that none of the staff had explained this to them. However following our inspection the provider sent us information demonstrating the person had been appropriately informed. Considering all the information available, it was not clear what 'severely disturbed behaviour' had triggered the episode of long term-seclusion. This is not in line with the Mental Health Act Code of Practice, Paragraph 15.43, which states: "Its [seclusion] sole aim is to contain severely disturbed behaviour which is likely to cause harm to others. We looked at examples of three other people who had occupied rooms for seclusion that were not designated seclusion rooms, (these were referred to as quiet rooms) and found that people often spent long periods of time in the rooms without adequate reviews having taken place and without appropriate facilities being available. For example one person was told to urinate in a bowl when they required to use the toilet as there were no toilet facilities the person could use. Failing to ensure people were adequately reviewed during seclusion periods and not providing adequate facilities meant that people were not protected from the risks of receiving inappropriate care. We also looked at the risk assessments regarding the use of non-seclusion rooms and found these were not adequate. They did not address the privacy and dignity of people using the rooms during the time of seclusion due to lack of toilet facilities and also the fact the rooms could be overlooked by other parts of the hospital. We found that the hospital did not always treat people in the least restrictive manner and often enforced boundaries with punitive actions. For example staff told us that spitting and hitting staff was regarded as physical assault and would lead to a person having their leave cancelled. We saw an example in one person's care where they had seven days leave cancelled and 72 hours internal leave cancelled due to spitting at a member of staff. This meant they were unable to leave the ward. The situation had not been analysed prior to imposing such a restrictive measure. We found examining the information available that the incident had escalated due to the staff member's behaviour towards the person. There was little consideration of people's learning disabilities, challenging behaviours and levels of functional analysis when enforcing these levels of restrictions. This meant people were placed at risk of receiving inappropriate care. We looked at other areas of restrictive practices and found most people had restrictions in place regarding the use of telephones and family visits which often meant people were supervised during phone calls and visits. We looked at the risk assessments in place and found they were not adequate. They lacked detail on the risks to demonstrate why people required supervision. There was no forward plan detailing under what circumstances this could cease. People we spoke with told us they did not know why they were being supervised for phone calls and visits and did not understand their rights regarding privacy and restrictions. People told us about their meal time experience and said that if they did not turn up for meals on time they were not offered a hot meal and would be given a sandwich. Staff told us this was due to food hygiene regulations. However; we found the practice restrictive as the rules did not take into account people's complex behaviours that may mean they were unable to attend lunch /dinner or if they were attending visits or other appointments that meant they were not able to attend the mealtime. However we also found that people did not always have their care planned in a way which meant it was safe and effective and people were not always treated in a way where their human rights were protected. We provided a summary of feedback to the managers of the service during our inspection and expressed our concerns in relation to the way some people were cared for. People were placed in seclusion for often long periods of time where their behaviour did not amount to seriously disturbed behaviour which presented risks to themselves and others, and was used to manage often complex difficult behaviours without appropriate reviews from doctors taking place. The majority of staff we spoke with were not aware that it was the local authority safeguarding team that co-ordinated investigations and reviews into safeguarding adults cases, or that they could contact the safeguarding team directly if they were concerned that someone was being abused. Staff were not able to identify that restrictive practices such as cancelling people's leave and failing to analyse incidents in full detail, taking into account people's functional analysis, behaviours and learning disabilities, meant that people were subject to practices that may potentially have been abusive. We saw examples of where people had contacted external services to complain about leave being cancelled and to also complain about the way they were treated by some staff. People who used the service were not protected against the risk of unlawful or excessive physical restraint because the provider had not made suitable arrangements. We saw an example within records where people were restrained in rooms (quiet rooms) for long periods of time where they did not have access to appropriate facilities such as toilets. Staff told us due to people's presentation during restraint it was often difficult to move people to the hospital seclusion rooms safely. We also found where people had seclusion plans in place they were not allowed to come out from seclusion until the time stipulated in seclusion plans had lapsed, regardless if their behaviour had decreased. This meant that people were in seclusion for potentially longer periods than necessary.  Incident reports did not include analysing excessive use of seclusion and also providing care in the least restrictive manner. Overall, we did find examples of care practices where the restrictions imposed did not protect people from the risk of abuse. We also found arrangements in relation to the use of seclusion were inadequate and did not protect people from the risks of receiving care where restraint was potentially excessive and unlawful. We met with managers of the service during our inspection and expressed our concern relating to how people were treated and are seeking assurances from the service to ensure standards are improved.” (Selected extracts with some editing from the CQC inspection report into Roseberry Park hospital, July 2014).

NHS fired. NMC sanctioned. For complaining about patient abuse

I am a Bethlem &Maudsley trained (1982) LD challenging behaviour nurse therapist with nearly forty years experience and nearing retirement. Following years of managing and working as a nurse behaviour therapist in both NHS and private challenging behaviour services I took the post of staff nurse within TEWV NHS forensic LD service in January 2010 having moved to the north east for personal reasons and in anticipation of imminent retirement. I was particularly interested to experience at ground level a forensic LD service.

Although Roseberry Park hospital, part of TEWV NHS Trusts forensic services is an impressive new chromium and glass building, many employees view its operational culture as transplanted directly from the old St Luke’s asylum that it replaced.

I was employed by TEWV NHS Trust from January 2010 until my dismissal in March 2012. During this time I only actually worked for ten months during which I made many complaints involving various practices and was aware via participant observations of unkindness and incompetence on the part of various staff including two modern matrons and was aware of abusive behaviours and reputations of others. Moreover, abusive episodes of extended seclusions including a completely calm girl secluded on the 13.9.10 for nearly four hours. We puzzled for some time trying to understand the purpose of such an event but could only conclude that it might have been something like enabling staff to take tea breaks.

Another small female was secluded a month earlier (2.9.10) for over eight hours following incompetent, overzealous and insensitive handling on the part of a modern matron. Despite having calmed for most of the afternoon the girl was finally seen by the senior consultant who had hours earlier ordered the seclusion and who finally visited and ordered the administration of a powerful intramuscular tranquiliser resulting in her having to be helped from the room and unable to rake a call from her mother.

These and the other matters complained about eventually resulted in two internal inquiries (April 2011 and January 2012) and the acknowledged permanent changes to Trust practices according to the Social Services Safeguarding team and the active support of Cleveland police.

Following the first inquiry in early 2011 a second commenced (Seclusion Review) as a consequence of my rejection of the first because it completely failed to address the seclusion complaints. My appeal against the first inquiry findings, in line with Trust policy was to the Trust CEO Martin Barkley and HR Director David Levey in August 2011 resulting in the Seclusion Review, published in December 2011.

The Seclusion Review was undertaken by the most senior clinical and specialist practitioners within the forensic service but unfortunately coordinated by the very consultant who had ordered the eight hour seclusion. One of the other two senior practitioner investigators had also already heard my complaints at the time but had ignored them.

The Seclusion Review report represented a cover-up by failing to address specific complaints about the two particular seclusion episodes (2.9.10 and 12.10.10) by looking at only the ten previous episodes a year later that chronologically fell well short of the two episodes originally complained about.

Had an independent external specialist considered the ten “examined” episodes then they probably would also have been found to contain elements of concern as well.

The Seclusion Review merely declared a single minor error of paperwork in its findings, also the Chief Executive in his Trust Annual Review of 2011/12 declared that CQC interest during the year had been minor. This was untrue. There had occurred high level meetings involving Social Services Safeguarding, the CQC and even Cleveland police. Mr Barkley in his round-up also failed to mention the first or second inquiries.

Following the CEO’s written thanks to me for appealing against the first inquiry findings and raising the seclusion matters (3.2.12) prompting the Seclusion Review along with a copy of the Seclusion Review report itself I was immediately dismissed a month later on an allegation of confidentiality-breaching relating to the very seclusion incident (2.9.10) that prompted the Seclusion Review when I legitimately accessed the secluded patients personal computerised file to brief myself about the incident that led to the seclusion and crucially to know something of her operational strategies should I ever be summoned via inter-ward emergency alarm bells to assist in a similar incident.

On reading the circumstance of that seclusion however it was apparent that the incident had been 1) appallingly triggered via poor and provocative handling, 2) unnecessarily extended and very poorly managed throughout.

This female patient lived on an adjacent ward within Roseberry Park forensic hospital and my file accessing was held to be a serious breach of confidentiality. However in the circumstances of a forensic hospital it was not and adjacent ward file accessing was normal practice and was similarly applied even in the Trusts much less secure challenging behaviour residential service.

Following my spirited defence this allegation was necessarily reduced at my appeal-against-dismissal hearing to accessing the clinical file for too long or excessive “time volume” although no policy existed about what constituted a reasonable accessing time. I was then referred to the NMC by the manager who dismissed me, forensic LD service director Levi Buckley.

The generic reason offered by Mr Buckley for the NMC referral was the suggestion that my practice was out of date, that I was “stuck in the 70s and 80s" and that I had “failed to move on”. However the Seclusion Review report noted in its findings a single piece of modern up-to-date behavioural work within the forensic hospital which was mine.

It was an example of the Challenging Behaviour Pathway that I was asked to complete by the charge nurse because no other nurse had either heard of it or knew how to apply it. The technique was subsequently recommended in the Seclusion Reports findings in the absence of anything like it as something to be applied throughout the forensic service.

The dismissing service director, Levi Buckley claimed under NMC oath that he had never read the Seclusion Review, also that he was unaware of its findings. However the Seclusion Review report was a very significant document undertaken on the order of the trusts CEO and by the services most senior practitioners. Within its findings it specifically states that all operational directors were required to read it and to “note its findings”. 

The Trusts deputy CEO and the chairman of my later appeal-against-dismissal hearing Les Morgan also under NMC oath claimed that the transcript of my appeal-against-dismissal was not circulated afterwards because that was “against Trust policy”. However, the NMC solicitor who investigated and wrote the case against me, James Davies, (Morgan-Cole) was according to his own case told by the Trust that the transcript had been “lost”.

However, another former employee who resigned after making complaints and similarly referred to the NMC was given a copy of the transcript of their appeal-against-dismissal hearing.

My original appeal-against-dismissal hearing included my direct questioning of the Trust CEO Martin Barkley and also the Trust Chairman Jo Turnbull during which Mr Barkley admitted that Mrs Turnbull  had passed to him my private and confidential letter addressed to her. Therefore she breached confidentiality by passing it and he breached confidentiality by reading it. The Trust Chairman is a qualified solicitor.

Also revealed under my direct questioning was specialist clinical manager Ian Aisbit’s limited understanding of his own behavioural specialism. He was neither able to name the five types of formal direct observation nor explain the difference between formal direct and informal participatory observation ..quite basic to a suitably competent practitioner.  

Unsurprisingly he was not invited by the Trust to attend as a witness in the subsequent NMC hearing despite the fact that the hearing considered the one technical behavioural charge out of the three in which he was directly involved as the suspending nurse specialist manager of the community challenging behaviour service.

Those prosecution witnesses that did attend could barely remember anything under questioning and couldn’t answer even basic questions about their specialism, e.g. what is meant by a formal direct observation and how is it typically conducted? etc.

I am clearly dealing with dishonesty and incompetence.  However, the NMC have declared these individuals “creditable witnesses”. The NMC further declared that I had “used my complaints about various abuses..” as a “blanket excuse for my failure to follow the very policies that are designed to deal with such matters”.

On the contrary, I had indeed followed Trust policies and also NMC guidelines very closely and my actions were not those of a whistle blower but a complainant. I wrote hundreds of pages, letters, statements and reports throughout my short employment which resulted in two internal inquiries.

The response from the Trust was a hackneyed collection of contrived disciplinary allegations and a flawed referral to the NMC who took up and continues the challenge with apparent gusto.

The prominent NMC charge that repeats the Trusts earlier allegation was that I inapproprietelly accessed the clinical files of forensic wards patients on adjacent wards. This NMC allegation involved all thirteen originally alleged patients private clinical file accessings that were quickly dropped by the trust at the time to four at my trust dismissal hearing then to just one at my trust appeal-against-dismissal hearing which was then finally removed under the weight of argument that proved this to be both normal indeed expected practice in a forensic hospital and replaced by firstly, the time element that suggested that the single accessing had been too long, and secondly, the suggestion that as a member of staff who hadn’t completed local restraint training (me) that I would never be redeployed or called upon to attend another wards emergency alarm call so was not therefore required to access the file. Quite untrue.

This second part was simply untrue given my direct experience of having been called to an adjacent ward prior to MOVA training and supported by a written confirmation by the charge nurse confirming this to be  untrue all of which was explained at the NMC substantive hearing.

On accessing my original employment file the investigating NMC solicitor James Davies (Morgan-Cole) declared that I had additionally  breached confidentiality by writing my initial December 2010 statement  on my home computer and in so doing identified a double-dosing victim without the severely LD Downs Syndrome gentleman’s’ “consent” thus constituting an additional and what turned out to be the primary charge, i.e. failing to obtain permission from an abuse victim to report the abuse.

This original statement in which included this complaint was presented at a trust meeting on the 1.12.10 where it was agreed via the chairman to identity cited patients. Having used the statement throughout the meeting I submitted it at the end. The Trust did not present this as a disciplinary matter at the time for this very reason. However, it clearly didn’t deter the NMC from using it to create a new and central charge.

The NMC found me guilty on two out of three original pre APPEAL-AGAINST-DISMISSAL Trust charges plus their own new charge of confidentiality-breaching, i.e. revealing an abuse victims identity “without their consent” (but with the permission of the hearing in which it was heard).

These charges were upheld despite compelling explanations of why I was completely innocent of all of them. The NMC’s suggestion that the discredited Trust prosecution witnesses were credible is very, very untrue.

During the NMC’s eighteen month initial interim stage that included from the beginning very restrictive interim sanctions I proved that neither my various NMC caseworkers nor the various NMC interim hearing panellists were actually reading the NMC solicitor James Davies’s case material.

This occurred because the case material was replete with serious constructional errors including key reports split and pasted back to back making them incomprehensible. No one noticed, neither panellists of the various interim hearings nor three successive NMC case workers.

Despite my queries and prompts to the NMC about whether anything unusual had been noticed nothing was ever picked up on. I therefore formally complained to the NMC but the matter was never seriously considered and was dealt with via a brief email from manager Dan Regan.

Later at my substantive hearing, panellists declined to ask me any questions at the conclusion of my cross-examination by their barrister, David Clark QC. Panellists were not briefed on commencement of proceedings, were slow in starting and there was insufficient time to properly consider the matters. The only apparent haste was to allow sufficient time at the end to write up the outcome. Little heed was given to the principle of “leeway” typically forwarded towards unrepresented registrants.

Having already been subject to eighteen months of close professional scrutiny via an “interim conditions of practice order” prior to the substantive hearing and having subsequently been found guilty I was then sentenced to a further eighteen month “substantive conditions of practice order” which is even more arduous than the initial interim order and in addition requires a Personal Development Plan in which I am required to demonstrate learning in relation to charge-related topics, i.e. confidentiality. Thus my close scrutiny sanction in total is to be for three years.

From the moment of the NMC referral I have been prevented from either re-joining the NHS in the short to medium term or indeed achieving any kind of stable contracted employment at all other than zero hour contracts as at present. At the end of eighteen months the NMC will decide whether to conclude matters or to continue.

A crucial factor is that a single even merely perceived “breach” of any condition however trivial will result in the immediate suspension of my registration indefinitely and therefore stopping employment or the means to practice.

I represented myself throughout as the RCN quickly pulled out during the early interim stage when I insisted upon open and transparent dialogue with my NMC case worker. The chairman of the substantive hearing, Linda Stone was fairly hostile throughout and repeatedly interrupted my attempts to cross-examine trust prosecution witnesses two of whose testimony elements were subsequently demonstrated as untruthful.

I gratefully received expressions of encouragement from the NMC barrister David Clark. He told me outside of the hearing room that the NMC were “looking for a caution to a conditions-of-practice outcome”, and even offering friendly encouragement.

The participation of the two other panellists was minimal and no questions were offered at the conclusion of David Clarke’s cross-examination of me.

Each element of the three charges found guilty is disproven.

What has been demonstrated is that 1) very senior Trust managers have lied under oath and 2) the only demonstrable breach of confidentiality has been committed by the Chairman and Chief Executive of Tees Esk & Wear NHS Trust.

David Dickinson

13.6.14 

POSTSCRIPT (12.9.14)

On the 18.7.14 the CQC published the report of its visit to Roseberry Park hospital held just days previously. It found major shortcomings in relation to many aspects of care provision and resident safety including inappropriate, excessive and poorly applied seclusion practices.