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.