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Archive for November, 2012

Industrial Relations Law Reports/2012/May 2012/CRAWFORD and another (appellants) v. SUFFOLK

MENTAL HEALTH PARTNERSHIP NHS TRUST (respondent) – [2012] IRLR 402

CRAWFORD and another (appellants) v. SUFFOLK MENTAL HEALTH PARTNERSHIP NHS TRUST (respondent)

[2012] EWCA Civ 138

[2012] IRLR 402

Court of Appeal (CA)

200 Unfair dismissal

234.51 Reason for dismissal – conduct – relationship with people other than employees – customers

234.6 Reason for dismissal – conduct – alleged or proven criminal acts

234.7 Reason for dismissal – conduct – breach of contract or company rules

252.11 Sufficiency of reason for dismissal – reasonableness in the circumstances – disciplinary procedure -fair and effective arrangements

253 Sufficiency of reason for dismissal – reasonableness in the circumstances: conduct and capability

253.11 Sufficiency of reason for dismissal – reasonableness in the circumstances: conduct and capability -employer responsibility – inquiry and investigation

253.12 Sufficiency of reason for dismissal – reasonableness in the circumstances: conduct and capability -employer responsibility – to establish validity of reason

The facts:

The claimants, Mrs Crawford and Mr Preston, were both nurses employed by the respondent NHS trust in a ward where patients principally suffered from depression, anxiety or dementia. Particular difficulties had been experienced in relation to the handling of a patient “JE”, who was 87 and suffered from dementia. He had been agitated, aggressive, hitting things, spitting, swearing, throwing drinks, kicking and punching, and generally requiring particularly close attention. Medication was administered forcibly because he was refusing both food and medicine. Staff had used a safe handling technique to restrain him, which had caused skin tears on his arms to be opened. In the evening, Ms Paula Jeffrey, a very experienced staff nurse, noticed the claimants and two other night staff surrounding a chair in which JE was sitting. She said that he was restless and trying to get out of the chair. She noticed that the chair was secured to a dining room table by a sheet or two and that there was another sheet around JE’s body. She did not say anything to the staff nurses at the time, but reported the matter on her next shift, which was three days later, in a statement to the ward manager. The trust suspended the claimants pending further investigations into the “alleged assault”. It then reported the matter to the police but, a month later, the police informed the trust that no further action would be taken against the claimants. The trust’s internal investigation recommended that: the incident be dealt with under its disciplinary policy, areas of development for the individuals be identified, and appropriate training be provided.

At the trust’s disciplinary hearings before Mr Mansfield, the claimants accepted that they had tied JE’s chair to the table, but denied tying him to the chair with the sheet across his chest. Mrs Crawford explained how the sheet had been wrapped around JE’s chest. In order to test this evidence, Mr Mansfield and a colleague attempted to replicate what Mrs Crawford had claimed she had done. Neither Mrs Crawford nor her representative were informed that this experiment was being undertaken. From the experiment, Mr Mansfield concluded that the sheet across the chest could not have been wrapped in the way that she had explained.

He did not obtain the initial statement made by Ms Jeffrey and make it available to the claimants. Mr Mansfield found that the claimants had tied one sheet around JE’s upper body and the chair and also secured the chair to the table; that treatment had not afforded JE “dignity and respect, safety and security” had been an inappropriate restraint and had constituted an assault in breach of the trust’s policies and procedures. The claimants were dismissed for gross misconduct. They appealed internally, but the appeal panel was satisfied that there had been a thorough investigation reaching a fair and reasonable decision.

The claimants successfully brought claims against the trust for unfair dismissal. The employment tribunal identified two procedural defects in the procedure adopted by Mr Mansfield. The first was the failure to obtain the initial written statement by Ms Jeffrey, which had departed, arguably at least, from the way in which her evidence had been presented at the disciplinary hearings. The second was the carrying out of the experiment on the chair without any notification to the appellants or their representatives. The tribunal concluded, interalia, that no reasonable employer properly could have preferred the evidence given by Ms Jeffrey, who had not felt sufficiently strongly to report the matter or remonstrate immediately as her professional conduct code had required, and who had had no more than a fleeting view of the circumstances, to the evidence of the four night staff who had been present throughout the incident. The EAT allowed an appeal by the trust, accepting its principal submission that the tribunal had mistakenly substituted its view for that of the employer. The claimants appealed.

The Court of Appeal (Lord Justice Laws, Lord Justice Elias and Lord Justice Kitchin) by a reserved judgment dated 17 February 2012 allowed the claimants’ appeal in part.

The Court of Appeal held:

252.11, 253.11, 253.12

The tribunal had been entitled to find that the claimants had been unfairly dismissed due to procedural errors in the disciplinary process.

The tribunal had been entitled, in view of the observations in Roldan, to look particularly carefully at the procedures given that not only the particular jobs, but also the ability of the claimants to pursue their chosen careers, was at stake. It had been entitled to conclude that the experiment carried out by Mr Mansfield had been an unfair procedure. It would have been very easy for Mrs Crawford, together with her representative, to have been present and to have demonstrated what she had alleged had occurred. This failure with respect to a vital piece of evidence had meant that the procedures taken over all had been rendered unfair. The tribunal had also been entitled to conclude that Mr Mansfield’s failure to have obtained the first statement made by Ms Jeffrey and to have made it available to the claimants had been a failure which a reasonable employer would not have made. There had been matters in that statement which would have been capable of supporting the claimants’ case and which were inconsistent with the way in which Mr Mansfield perceived matters. Although the tribunal had gone too far in concluding that no reasonable employer could have preferred the evidence of Ms Jeffrey to that of the four members of night staff, that error had not invalidated the finding of unfair dismissal itself.

It had not been open to a reasonable employer to dismiss members of staff with 20 years’ service simply for adopting the method for securing JE in his chair. It was perverse to suggest that that was any more detrimental to his dignity than physically restraining him in other ways, perhaps less so. Moreover, the evidence showed that during the previous shift JE had been pinned to the chair in virtually the same way, save that instead of achieving this mechanically by tying the chair to the table, it was done by two nurses holding it there. To treat the one as permissible and the other as justifying the dismissal of employees with 20 years’ service, simply it seems because it was not an approach permitted by the procedures, was clearly perverse.

The case was remitted for consideration of whether the dismissal would have taken place even if fair procedures had been employed and, if so, how that should be factored into the assessment of compensation.

 Observed:

234.51, 234.6, 234.7, 253

It appears to be the almost automatic response of many employers to allegations of the kind in the present case to suspend the employees concerned and to forbid them from contacting anyone as soon as a complaint is made, and quite irrespective of the likelihood of the complaint being established. As Lady Justice Hale, as she was, pointed out in Gogay v Hertfordshire County Council, even where there is evidence supporting an investigation, that does not mean that suspension is automatically justified. It should not be a knee jerk reaction, and it will be a breach of the duty of trust and confidence towards the employee if it is. Suspension is often said to be in the employee’s best interests, but many employees would question that and would often be right to do so. They will frequently feel belittled and demoralised by the total exclusion from work and the enforced removal from their work colleagues, many of whom will be friends. This can be psychologically very damaging. Even if they are subsequently cleared of the charges, the suspicions are likely to linger, not least because the suspension appears to add credence to them. That was not to suggest that the decision to suspend in the instant case had been a knee jerk reaction. It was, however, difficult to believe that the relevant body could have thought that there was any real risk of treatment of this kind being repeated, given that it had resulted in the charges. Moreover, the committee would have been expected to have paid close attention to the unblemished service of the relevant staff when assessing future risk, as perhaps it did.

Whatever the justification for the suspension, it was little short of astonishing that it could ever have been thought appropriate to refer the matter to the police. Although it is important that hospitals must be seen to be acting transparently and not concealing wrongdoing, they also owe duties to their long serving staff; defensive management responses which focus solely on their own interests do them little credit. Being under the cloud of possible criminal proceedings is a very heavy burden for an employee to face. Employers should not subject employees to that burden without the most careful consideration and a genuine and reasonable belief that the case, if established, might justify the epithet “criminal” being applied to the employee’s conduct. That requirement was not satisfied in the present case. No-one suggested that the appellants were acting other than in the best interests of JE and the other patients. The restriction was not essentially different to the physical restraint which had been carried out in the day shift. It could only be assumed that the relevant committee had been influenced by the fact that technically tying JE to the chair had been an assault, with the implication that this was a grave matter. But so is it an assault when nurses physically restrain a patient, or compel him to wear a mask when he is spitting at people, as happened with JE. There had been obvious justification for restraining the patient, even if the appropriate procedures for doing so had not been employed, and the police should never have been involved.

 Cases referred to:

A v B [2003] IRLR 405 EAT

British Home Stores v Burchell [1978] IRLR 379 EAT

Fuller v London Borough of Brent [2011] IRLR 414 CA

Gogay v Hertfordshire County Council [2000] IRLR 703 CA

Polkey v A E Dayton Services Ltd [1987] IRLR 503 HL

Salford Royal NHS Foundation Trust v Roldan [2010] IRLR 721 CA

Taylor v OCS Group Ltd [2006] IRLR 613 CA

Appearances:

For the claimants:

ROBIN HOWARD, instructed by Attwells Solicitors LLP

For the trust:

PETER WALLINGTON QC, instructed by The Law Offices of Richard Hemmings

1

LORD JUSTICE ELIAS: The appellants, Mrs Crawford and Mr Preston, were both nurses employed by the respondent trust until their employments were terminated on 13 March 2009. The reason for their dismissals was alleged gross misconduct arising out of the way in which they handled a patient known as JE on the evening of 22 September 2008.

2

Following a complaint about the handling of that patient they were suspended and indeed the police were notified of potential criminal offences. There was an investigation, leading to disciplinary proceedings, and the whole process took some six months before their ultimate dismissal.

3

They lodged a complaint to the employment tribunal that they had been unfairly dismissed, and that was successful. The trust in turn successfully appealed to the Employment Appeal Tribunal (HH Judge Birtles presiding) who overturned the ET decision and remitted the matter for a fresh determination by a different tribunal. The appellants now seek to restore the decision of the employment tribunal.

4

The facts

The essential facts are as follows. The Westgate ward at the West Suffolk Hospital in Bury St Edmunds is an admission and assessment ward where patients are admitted from home or from residential care or other hospitals. The patients are principally suffering from depression, anxiety or dementia.

5

On the night of 22 September 2008 the two appellants, together with two healthcare workers, were the only staff taking care of 17 patients. It was clear from the handover notes from the previous shift that particular difficulties had been experienced in relation to the handling of JE. He was 87 and suffered from dementia. On the day in question he had been agitated, aggressive, hitting things, spitting, swearing, throwing drinks, kicking and punching, and generally requiring particularly close attention. It was noted that the safe handling technique used by the staff on the previous shift had caused skin tears on his arms to be opened. Medication had to be administered forcibly because he was refusing both food and medicine.

6

Ms Paula Jeffrey, a very experienced staff nurse, had been concerned about the way in which JE had been treated on the day shift. She wrote a report immediately after the shift to the matron saying that JE was being cared for in ‘a less than best way’, that he had required on occasions two to one observation for safety reasons, and that as a result the other patients had only their basic needs attended to. Ms Jeffrey was on her way out of the ward, having written this report, when she noticed night staff in the dining room surrounding a chair in which JE was sitting. She said he was restless and trying to get out of the chair. She noticed that the chair was secured to a dining room table by a sheet or two and that there was another sheet across his stomach. She says that she was shocked by this although she did not say anything to the nurses at the time.

This was on a Monday evening. Surprisingly, she did not make any complaint about this until she next came on shift on Thursday 25 September when she reported to the ward manager, Mrs Helen Jackson, what she had witnessed on that previous Monday.

7

Mrs Jackson sensibly asked Ms Jeffrey to make a statement as soon as possible, and Ms Jeffrey did.

Mrs Jackson contacted the human resources officer and also discussed the incident with her line manager, Ms Sue Howlett. Mrs Jackson and Ms Powell from human resources saw the four members of staff, including the two appellants, on the following day. They were asked about the incident and were suspended pending further investigations. The reason for the suspension was the ‘alleged assault of a client on Westgate Ward on 22 September.’ Mrs Jackson was plainly shocked by the alleged actions. She raised the matter with certain hospital consultants, including the patient’s own consultant, but they were far more sanguine about it. It appeared to cause them little concern; Mrs Jackson noted that they were not ‘shocked, angry or even mildly emotional about the allegation’. She felt that they were not treating the incident seriously enough.

8

On 30 September the vulnerable adult protection committee, strategy meeting met and they determined that the police should investigate the incident. All this involved some delay in the hospital’s investigation since it was resolved not to take matters further until the police had responded. On 30 October the police informed Mrs Jackson that their investigations had been completed and, not surprisingly, they concluded that no further action would be taken. At that point the internal investigation was instituted but the terms of reference were not given to the claimants until 1 December. They were then amended a short time later, in part at the instigation of the union representatives acting for the appellants. As a result the scope of the investigation extended beyond the incident itself. The investigators were asked to identify the policy and practice for the care of clients on the ward, particularly during the night; and also to determine whether there had been a breach of confidentiality by any of the named employees.

9

The persons asked to investigate were Ms Sue Tiller, PA to the service development and business manager, and Mrs Cox, a retired service manager for older people’s services. They interviewed the four members of staff against whom the allegations had been made. They also interviewed Ms Jeffrey and Mrs Jackson. The investigation was concluded in January 2009. They found that the chair was tied to the table and that attempts were made to secure the patient to his chair with a sheet, although they did not say that they had been successful. They recommended that the incident be dealt with under the trust’s disciplinary policy. They also, however, recommended that areas of development for the individuals should be identified, and appropriate training should be provided.

10

There was a disciplinary hearing which began on 9 March before the service manager for rehabilitation and recovery, Mr Mansfield. He alone was to make the decision as to what, if any, disciplinary sanction should be imposed. It was agreed that there should be separate hearings for each member of staff, taking place over four successive days. A number of witnesses were called and they were all present on the day Mr Preston’s case was under consideration, but by agreement with Mrs Crawford’s union representative, only Ms Jeffrey and Mrs Jackson attended her hearing.

11

The allegations against each of the appellants were as follows:

‘… the patient, JE, was observed in the dining room … seated in a chair near to a table with one bed sheet tied around

the upper part of JE’s body and the chair and one bed sheet tied around the lower part of the chair encircling the arms of

the chair. The sheet around the lower part of the chair was securing the chair to the table.’

12

It was then asserted that:

‘This treatment did not afford the patient, JE, dignity and respect, safety and security, and is a serious breach of good

practice.’

And that:

‘The treatment of patient, JE, was not reported by you nor was any attempt made by you to release patient, JE, from this

situation.’

13

This treatment was alleged to be a breach of the nursing and midwifery code of professional conduct; gross misconduct under paras. 7.4 and 7.12 of the respondent’s disciplinary procedure; and a contravention of the trust’s code of conduct and the prevention of management aggression policy. In Mr Preston’s case it was also alleged that as shift co-ordinator, he was ultimately responsible for the care and treatment of JE.

14

Paragraph 7.4 of the disciplinary rules provides that gross misconduct includes:

‘Any verbal or physical assault on a patient … arising out of employment with the trust’

Paragraph 7.12 states that:

‘Contravention of professional codes of practice is professional misconduct.’

Paragraph 7.6 is also relevant to this appeal. It identifies as misconduct:

‘any act or failure to act which affects the health and safety of a patient, member of the public, …’

15

The appellants accepted that they tied JE’s chair to the table. However, they denied tying him to the chair with the sheet across his chest.

16

In the course of Mrs Crawford’s hearing, she gave an explanation as to how the sheet had been wrapped around JE’s chest. In order to test this evidence, Mr Mansfield and the senior HR adviser, Ms Verzijl, went to the relevant chair and Ms Verzijl sat in the chair while Mr Mansfield attempted to wrap the sheet around her in the manner described by Mrs Crawford. They did not believe that it could have been wrapped in the way she explained. Neither Mrs Crawford nor her representative were informed that this experiment was being undertaken.

17

Mr Mansfield found that each of the allegations was proved and the appellants were notified in what were, for the most part, identical letters dated 12 March. The letters gave further particulars of his findings as follows:

‘The allegation of tying patient, JE’s, chair to the table is admitted by yourself and not disputed. This is mechanical restraint and not a form of restraint recognised anywhere in Trust policies or procedures nor in national protocols or guidelines. It is clear that patient, JE, did have a sheet surrounding the upper part of his body and evidence suggests that this would only stay in place by securing the sheet. This is inappropriate restraint.’

18

The letters went on to say that the appellants had failed to report the incident and ‘nor was there any attempt made by you to release patient JE from the situation.’ Mr Mansfield concluded that the actions constituted an assault in breach of para. 4 of the disciplinary rules; negligence contrary to para. 6 (although this was not in fact one of the charges); and professional misconduct under para. 12. The letters also stated that Mr Mansfield had taken into consideration the plea of mitigation, without spelling out precisely what had been raised in that plea.

19

The appellants appealed internally and the appeal was heard by a panel consisting of Mr Bolas, the director of nursing, Mr Clarke, director of specialist services, and Mr Hulme, a non-executive director selected because of his background in human resources. As Mr Bolas confirmed in his witness statement before the employment tribunal, the function of the appeal panel was to review Mr Mansfield’s decision to determine whether it was a fair and reasonable decision. It was not, therefore, a rehearing coming to a fresh determination. No witnesses were called and Mr Mansfield presented management’s case.

20

The appellants contested the fairness of the proceedings; they alleged that there had been an inadequate investigation, that the facts were not sufficiently substantiated, and that the sanction of dismissal was unfair and unreasonable. It was alleged that undue weight had been given to the evidence of the complainant staff nurse, Ms Jeffrey.

21

Mr Mansfield confirmed to the appeal panel that he considered the act of tying the chair to the table was a form of restraint and a form of assault, as well as being an act of negligence. He accepted Ms Jeffrey’s account of the way in which the patient had been tied by a sheet because her evidence had been consistent throughout.

22

The appeal panel also concluded, on the balance of probabilities, that the patient had been tied in the chair as alleged. They said that they could not otherwise understand why a third sheet would have been used. They did not refer to Mrs Crawford’s explanation, which was that the purpose was to make JE feel as though he were in bed, the other patients being in bed at this time.

23

Mr Bolas said in evidence that having heard the various representations, the panel was satisfied that there had been a thorough investigation reaching a fair and reasonable decision.

24

The letter rejecting the appeal stated that the act of restraining JE had been against the trust’s policy and the Mental Health Act Code of Practice and constituted physical assault. It concluded that the actions of the appellants constituted a complete break down of trust and confidence. The panel was also critical of the failure to seek further advice about how to restrain JE and of the failure to make a report of the restraint.

25

The relevant law

The basic legal principles are not in dispute. Ever since the seminal case of British Home Stores v Burchell [1978] IRLR 379 (as modified to the extent that the burden of proof has since been amended by legislation) it has been recognised that it is for the employer to satisfy the tribunal that he dismissed for a potentially fair reason. Thereafter, the tribunal has to determine whether the employer acted reasonably in treating that reason as sufficient to dismiss the employee. It is accepted by the trust that the following self-direction given by the tribunal accurately reflects the law:

‘It is for us to consider whether the employer had an honest belief in the misconduct alleged and that that belief was

based upon reasonable grounds after having carried out sufficient investigation. It is not for us to determine on the

evidence that we have heard whether we believe the misconduct had occurred. The tribunal views the matter through the

eyes of a reasonable employer. Provided that the actions of this employer fall within a range of responses by a

reasonable employer, the tribunal cannot interfere. It is also an exercise which is carried out when considering the

penalty that follows from the employer’s belief. It may be that the tribunal would have imposed a different penalty but the

sole question is whether the penalty applied by this employer was such that no reasonable employer would have applied

such a penalty.’

26

The tribunal reminded itself on numerous occasions throughout its decision that it must not substitute its own view for that of the employer.

27

Moreover, as I observed in the Court of Appeal in Salford Royal NHS Foundation Trust v Roldan [2010] IRLR 721 paragraph 13, it is particularly important that employers take seriously their responsibilities to conduct a fair investigation where, as is the case here, the employee’s reputation or ability to work in his or her chosen field of employment is likely to be affected by a finding of misconduct. The court was approving a passage to that effect in A v B [2003] IRLR 405.

28

Of course, the mere fact that there has been an appropriate self-direction will not preclude an appellate court from finding that there has been an error of law if it is satisfied that the tribunal has, in fact, failed to act in accordance with that self-direction. As Lord Justice Mummery observed in Brent London Borough Council v Fuller [2011] IRLR 414 at paragraph 30:

‘…. There are occasions when a correct self-direction of law is stated by the tribunal but then overlooked or misapplied at

the point of decision. The tribunal judgment must be read carefully to see if it has, in fact, correctly applied the law which

it has said is applicable. The reading of an employment tribunal decision must not, however, be so fussy that it produces

pernickety critiques, over-analysing of the reasoning process; being hyper-critical of the way in which the decision is

written; focusing too much on particular passages or turns of phrase to the neglect of the decision read in the round:

those are all appellate weaknesses to avoid.’

However, it should not readily be assumed that a tribunal has failed to follow its own directions. There must be a proper basis for an appellate court to conclude that the tribunal has failed to follow its own self-direction; see Roldan, paragraph 51.

29

The decision of the employment tribunal

The tribunal noted that the trust were dealing with two very long serving nurses who had no disciplinary record and against whom no malicious intent was alleged. They also observed that the dismissal of a qualified nurse in these circumstances could be what they described as:

‘a career-changing decision in that a reference to the relevant professional body can involve that nurse in being unable to

gain other employment within the profession. It follows therefore that evidence of misconduct must be clear and cogent.’

[2012] IRLR 402 at 406

30

The tribunal was critical of the delays in this case, some six months from suspension to dismissal.

31

The tribunal accepted that the genuine reason for dismissal was misconduct and that the issue on which they had to focus was whether the dismissal was reasonable ‘measuring the actions of the respondent against the yardstick of a reasonable employer.’

32

The tribunal began by commenting that any period of suspension should be for the minimum period, and that six months put a lot of unnecessary pressure on the appellants. It also observed how the precise allegations had altered as the internal processes developed. For example, the internal investigators found that there were attempts to tie JE to the chair but the final allegation was that he had been the subject of physical assault.

33

The tribunal then identified five specific errors in the manner in which the disciplinary process was handled. They go to the heart of this appeal. First, the tribunal concluded that some of the findings of Mr Mansfield were simply impossible to sustain even on his own findings. For example, he appeared to believe that tying the chair to the table was itself a physical assault. Likewise, the respondent accepts that the finding of negligence is also wrong. There is no evidence of that, and in any event it was never one of the charges which the appellants were facing. It is accepted by the trust that these conclusions could not be sustained.

34

Second, the tribunal identified two procedural defects in the procedure adopted by Mr Mansfield. The first was the failure to obtain the very first written statement from Ms Jeffrey which she provided at the behest of Ms Jackson who had asked her to put in writing her concerns. It was noted that in certain respects this statement, arguably at least, departed from the way in which her evidence had been presented at the disciplinary hearings. For example, she said that patient, JE, had continued to move about in the chair and that the sheet around the abdomen was removed whilst she was watching him. The tribunal noted that had this observation been drawn to Mr Mansfield’s attention, it might have caused Mr Mansfield to reconsider his finding that ‘Nor was there any attempt made by you to release patient, JE, from the situation’.

35

Third – and the second procedural weakness identified by the tribunal – was the carrying out of the experiment on the chair without any notification to the appellants or their representatives that this was being done. The tribunal commented that Mr Mansfield had relied upon this ‘heavily and in our judgment impermissibly.’

36

Fourth, the tribunal concluded that no reasonable employer could have reached the decision that JE had been tied to the chair. It put the point as follows (paragraph 48):

‘We do not consider that a reasonable employer could properly have concluded that JE was tied to the chair with no

attempt to release him when faced with the evidence of the two nurses and two healthcare workers who were present

throughout as against the evidence given by a nurse who did not feel sufficiently strongly to report the matter or

remonstrate immediately as her professional conduct code required and who had no more than a fleeting view of the

circumstances, coupled with the lack of certainty as to whether there were two sheets or three.’

37

Finally, it formed the view that the employers had not properly taken the context into account (paragraph 49):

‘We also consider that a reasonable employer would have taken into account the content. Here was a patient who had

prompted Ms Jeffrey to express concern about his medical treatment, who had caused significant difficulty in handling

during the day shift when there were more nurses or carers on duty and where the admitted aim of the claimants was to

keep the patient safe by securing the chair in which he was sitting to prevent him from falling out of it. It is clear that he

was regularly agitated and difficult. He was attached to a “drip” on a stand and too much movement would have caused

difficulty for that equipment to function. There was a need for two nurses to attend to the administration of drugs and the

needs of 16 other patients in a way which kept all of those patients safe. There was no allegation that there was any

harm to JE and not suggested that the nurses or healthcare workers were doing anything other than attempting to keep

him safe from himself and his restless aggression …’

38

For all these reasons, therefore, the tribunal concluded that the dismissal was unfair. It summarised its conclusions as follows (paragraph 51):

‘For the above reasons, we do not consider that the respondent had sufficient evidence based on an adequate

investigation to ground their belief that the patient was tied to the chair by the claimants and that no effort was made to

release him and no reasonable employer could conclude that securing the patient’s chair to the table was a physical

assault as defined in their own PMA code. The decision to dismiss was therefore unfair …’

39

The tribunal was, however, critical of the appellants for failing to report what they accepted were unusual arrangements. It was for this reason that it reduced the compensation by 25%.

40

The tribunal did not in terms address the question whether even if the employers had been justified in finding the misconduct they did, the dismissal was outwith the range of sanctions which a reasonable employer could adopt, They did, however, give a hint of their thinking on this matter (paragraph 51):

‘It is most unfortunate for these claimants that the respondents did not reinstate them as soon as the police investigation

was concluded and then deal with them as was suggested in the investigation report by performance development

review training and some disciplinary sanction.’

41

There was a subsequent remedies hearing in which the tribunal awarded Mrs Crawford £29,507.42 and Mr Preston £73,550.00. Those awards are not themselves the direct subject of appeal but they are of course contingent upon liability being established. The trust did, however, submit to the tribunal that even if it found the dismissal to be unfair, it had to consider whether any compensation should be reduced on the Polkey principle established by the House of Lords decision of that name (Polkey v AE Dayton Services Ltd [1987]

IRLR 503). This requires a tribunal which finds a dismissal to be unfair to consider the chances that even if the employer had acted reasonably, the employee would have been fairly dismissed in any event. The compensation must be reduced to take into account that possibility. The tribunal did not consider this issue.

42

The hearing before the Employment Appeal Tribunal

The trust challenged the conclusion of the employment tribunal and advanced eleven detailed grounds which can, in my view, fairly be reduced to the following prin

[2012] IRLR 402 at 407

cipal complaints:

(i) It was alleged that notwithstanding that the tribunal had properly directed itself in law, it had in fact substituted its view for that of the employer, both in concluding that there had been procedural defects, and in its finding that no reasonable employer could have concluded on the evidence that JE had been tied up as alleged by Ms Jeffrey.

(ii) In any event, the appellants’ representatives had had the opportunity on the internal appeal to challenge the fairness of the experiment conducted by Mr Mansfield without notice to them and in their absence. It is well established that defects at an initial disciplinary stage can be remedied on appeal: see Taylor v OCS Group Ltd [2006] IRLR 613. That was the position here.

(iii) The tribunal had wrongly concluded that there had been undue delay. There was no significant delay given initially the need to await the police investigations and the problems of securing the presence of so many witnesses on the same day.

(iv) The tribunal had wrongly stated that the trust had failed to have proper regard to all the surrounding circumstances when, in fact, it was plain from the evidence before the tribunal that the employers were alert to these matters. They had been relied upon by the appellants by way of mitigation. The dismissal letters said in terms that the mitigating features had been considered. The trust were entitled to conclude that the offences were so serious that only the sanction of dismissal would do.

(v) Mr Mansfield was ill and unable to give evidence to the employment tribunal but evidence was given by Ms Verzijl who was present throughout the disciplinary hearings and was privy to Mr Mansfield’s thinking. She stated that Mr Mansfield had, in fact, considered that merely tying the table to the chair would of itself have constituted gross misconduct sufficient to justify dismissal. The trust complains that the tribunal failed to have any regard to that conclusion. It was obliged to consider whether dismissal for that reason would have been fair.

(vi) Finally, it was asserted that in any event even if the dismissal could properly be found to be unfair, it was incumbent upon the tribunal to apply the principles derived from the decision of the House of Lords in Polkey. This required the tribunal to assess the chances that even if proper procedures had been complied with, the dismissal would have occurred in any event and would have been fair. The tribunal had recognised in its decision that this was one of the issues it would need to address, but in fact it never did so.

43

The Employment Appeal Tribunal accepted most, but not all, of these grounds. It did not consider that the comments on delay had infused the tribunal’s conclusion that the dismissal was unfair; and it rejected a distinct allegation that the tribunal had set too high a standard of proof. However, it accepted the trust’s principal submission, namely that notwithstanding its self-direction, the tribunal had in fact substituted its view for that of the employer.

44

It relied upon a number of features of the decision in order to reach this conclusion. For example, it considered that the tribunal erred in criticising the terms of reference of the investigation and that it should have focused on the disciplinary charges themselves, which were clear. More significantly, the EAT held that it was not open to the tribunal to find that Mr Mansfield was not entitled as a reasonable employer to conclude that JE had been tied up in the way suggested by Ms Jeffrey.

45

As to the tribunal’s conclusion concerning the experiment conducted on the chair, the EAT held that the tribunal, in characterising the experiment carried out by Mr Mansfield as ‘impermissible’, was effectively substituting their own view for that of the employer. In any event the EAT accepted the submission that in accordance with Taylor v OCS Group it was a matter that could have been cured on appeal if only the appellants or their representatives had identified it. The tribunal had erred in failing even to consider that possibility.

46

It also held that the tribunal was not entitled to conclude that the first statement of Ms Jeffrey ought to have been considered by the tribunal. The question the tribunal ought to have asked itself, but did not, was whether the failure to obtain her first statement so vitiated the investigation that it was no longer a reasonable investigation.

47

The appeal

Initially, the appellants focused on the decision of the EAT and identified what were alleged to have been certain defects in its reasoning. Mr Wallington QC, counsel for the trust, accepts that some of the reasoning might have been difficult to sustain, but he submits that in any event it is now well established that whilst respect will be given to any decision of the EAT, ultimately the decision under review is that of the employment tribunal. That has been the focus of the submissions before us.

48

Mr Howard, counsel for the appellants, submits that there was no error in the employment tribunal’s analysis. It properly directed itself and there is no justification for saying that it did not respect that self-direction. As Mummery LJ pointed out in Fuller, appellate courts should no more substitute their view for the first instance court than that court should substitute its view for the employer. The EAT fell into precisely the same error that Mr Wallington attributes to the employment tribunal: it stepped into the shoes of the employment tribunal.

49

Mr Wallington broadly repeats the arguments advanced before the EAT. At the heart of these submissions remains the contention that the tribunal fell into the trap which it recognised would involve an error of law, namely it substituted its view for that of a reasonable employer as to whether the investigation had been reasonable in all the circumstances, and in particular whether the trust’s finding that JE was tied to the chair was one which was open to a reasonable employer.

50

Discussion

On the central issue, in my judgment, the employment tribunal was entitled to conclude that there had been the two procedural errors which they identified.

51

In this context I make the preliminary observation that in my view the employment tribunal was entitled, in view of the observations in Roldan, to look particularly carefully at the procedures given that not only the particular jobs, but also the ability of these appellants to pursue their chosen careers, were at stake. I reject a submission from Mr Wallington (which the EAT also rejected) that this involved the tribunal applying too high a burden of proof. Furthermore, as I have said, it ought not lightly to be assumed that a tribunal which has properly directed itself, as this tribunal did on numerous occasions, has ignored its own self-direction.

52

Bearing these considerations in mind, it was in my view open to the tribunal to conclude that in relation to one of the most fundamental issues before the tribunal, namely whether the sheet had been tied round JE as alleged by Ms Jeffrey, the experiment carried out by Mr Mansfield was an unfair procedure. The tribunal was entitled to conclude that it was a key part of the evidence on which Mr Mansfield relied. It would have been very easy for Mrs Crawford, together with her representative, to be present and to demonstrate what she alleged had occurred. I respectfully disagree with the EAT finding that the reference to the experiment being ‘impermissible’ denoted a substitution mind-set. In my judgment, the tribunal implicitly found that this failure with respect to a vital piece of evidence, meant that the procedures taken over all were rendered unfair. I think that it was entitled to reach that conclusion.

53

Nor do I accept that the error was corrected as a result of the appeal hearing. It is for the employer to ensure that a fair procedure is adopted. It is true that the union representatives conducting the appeal on behalf of these appellants could have made a complaint about this procedural defect, and it does not appear as though they did. It is a matter of pure speculation whether the appeal panel would have remedied the wrong had their attention been drawn to it or what the outcome would have been if it had. In my judgment, however, it cannot be enough for an employer to say that although a fair procedure was not adopted, the responsibility for failing to remedy it lies at the door of the employee for failing to alert him to the error.

54

In my view, the employment tribunal was also entitled to conclude that the second procedural defect identified, namely the failure to obtain the first statement made by Ms Jeffrey and make it available to the appellants, was a failure which a reasonable employer would not have made. Mr Wallington points out with some force that it is doubtful whether the statement would have affected in any significant way the conclusions of Mr Mansfield. He submits that reasonably read, the statement is entirely consistent with the later evidence given by Ms Jeffrey and in particular it suggests that JE was tied up as she later claimed in evidence. I will not set out the statement in full. Suffice it to say that Ms Jeffrey stated that the sheet was removed from the abdomen whilst she was watching. This would appear to be consistent with the view of the investigating committee that there was an attempt to tie JE to the chair but that he was not in fact tied up.

55

In any event, as the tribunal noted, there are certainly matters in that statement which would have provided some further material which was capable of supporting the appellants’ case and are inconsistent with the way in which Mr Mansfield perceived matters. Not least the statement seems wholly inconsistent with Mr Mansfield’s observation that the staff ‘had taken no steps to remove JE from the situation’ at least so far as any allegation of tying him directly to the chair was concerned, since the statement asserted that he had been freed. There was a proper basis for the tribunal’s conclusion that this was a failing in the process.

56

I accept, however, that the tribunal went too far in concluding that no reasonable employer could have preferred the evidence of Ms Jeffrey to that of the four members of staff. I would agree with the tribunal that it is on the face of it a surprising conclusion for Mr Mansfield to have made, essentially for the reasons given by the tribunal. But I do not think that a tribunal, properly directing itself, could conclude that no reasonable employer could have resolved the conflicting evidence in the way this employer did, provided at least that proper consideration was given to the potential weaknesses in Ms Jeffrey’s evidence. The tribunal was not in a position to conclude that there was no such consideration. The tribunal’s conclusion is in effect that the finding that JE had been physically restrained was a perverse assessment of the evidence. That is an extremely high hurdle which I do not think was surmounted here.

57

The question then arises whether this error by the employment tribunal invalidates the finding of unfair dismissal itself. I do not believe that it does. I recognise that in some circumstances a finding of some legal error by the tribunal may do so. For example, if a tribunal concludes that a dismissal is unfair for three grounds, two of which are relatively trivial and one of which is of real substance, then a conclusion that the finding with respect to the ground of substance is unwarranted will inevitably cast doubt upon the overall finding of unfairness. It could not reasonably be assumed that the same decision would have been reached absent the error. That, in my judgment, is not the position here. The procedural defects were, in my view, justifiably identified as failings which rendered this dismissal unfair; they carry significant weight in their own right quite independently of the erroneous conclusion about the assessment of the evidence.

58

Mr Wallington submits that in any event the tribunal had to engage with the evidence from Ms Verzijl that Mr Mansfield would have concluded that it was gross misconduct simply to tie the table to the chair. Since this was admitted misconduct, it was unaffected by the procedural defects. If the tribunal had concluded that it was open to a reasonable employer to dismiss for this reason, then it should have found that there was no unfair dismissal.

59

I have some reservations whether it is proper for the court to act on this evidence given that the decision letter itself does not seek to justify the dismissals on this independent basis. Furthermore, the appeal panel does not appear to have approached the matter on that alternative basis. But in any event, I accept the submissions of Mr Howard that that conclusion itself was based on the premise that the tying of the chair to the table constituted an assault on JE. As Mr Wallington accepts, it plainly did not. It no doubt prevented JE from leaving the chair, and indeed that was its purpose. Given that he was on a drip at the time, it was reasonable to want to keep him in the chair, even if the means used were inappropriate. I do not accept that the characterisation of the action of tying the chair to the table as an assault is simply an inept description, as Mr Wallington submits. It seems to me that it has pejorative overtones and would in all likelihood have coloured the way in which Mr Mansfield assessed the seriousness of this matter. The fact that Mr Mansfield also described the action as being negligent – although I accept that it is of little substance in itself, as Mr Wallington says – does nevertheless reinforce my impression that Mr Mansfield had misunderstood and exaggerated the nature of that particular alleged wrong doing.

60

Even if I am wrong about that, I do not think that it would have been open to a reasonable employer to dismiss members of staff with 20 years’ service simply for adopting this method for securing JE in his chair. It seems perverse to suggest that this is any more detrimental to his dignity than physically restraining him in other ways; one might have thought it less so. Moreover, the evidence showed that during the previous shift JE had been pinned to the chair in virtually the same way, save that instead of achieving this mechanically by tying the chair to the table, it was done by two nurses holding it there. To treat the one as permissible and the other as justifying the dismissal of employees with 20 years’ service, simply it seems because it is not an approach permitted by the procedures, is in my view clearly perverse. Mr Wallington suggests that this was different because with the physical restraint there were two nurses in the vicinity at all times to keep an eye on JE. But no one has suggested that there were fewer than two nurses present when the evening shift took over; and it was never the basis of the charge against these members of staff that they were leaving JE inadequately supervised.

61

As to the contention that the trust did not properly have regard to the context, I accept Mr Wallington’s submission that the evidence before the tribunal suggests that they did. The mitigation had focused strongly on the particular difficulties the appellants faced both because of the attitude of JE and the need to balance caring for him with their obligations to the other patients in the ward. The dismissal letter says that consideration was given to the mitigating features, and Ms Verzijl confirmed in her evidence that this was so.

In the light of that evidence I do not think that the tribunal could properly conclude that there had been no regard to context.

62

However, in my view nothing turns on this error so far as liability is concerned. The context has no bearing on whether the trust complied with appropriate procedures. Its relevance goes to the question whether dismissal was in all the circumstances within the range of sanctions which a reasonable employer could impose. I would accept that if the tribunal had concluded that dismissal was unreasonable because in imposing that sanction the employers had failed simply to have regard to the context then that would not have been a sustainable finding. That is not a finding which they made.

63

In fact I suspect that the tribunal may have been intending to say not that the trust had failed to have regard to this context, but rather that having proper regard to it, dismissal was not within the range of reasonable responses. However, I have come to the conclusion that it would not be right to read the finding in that way, particularly since when the tribunal summarises its conclusions at paragraph 51, it does not say that even if the findings of the employer were sustainable, dismissal was in any event a sanction which no reasonable employer could adopt.

64

As to the other points, like the EAT I do not accept that the tribunal made a finding that the delay rendered the dismissal unfair. There was merely what was in my view a wholly justified observation to the effect that six months suspension puts considerable pressure on staff. Mr Wallington, who has extensive experience of these matters, says that six months is far from unusual. That may be so, although I have to say that it is difficult to see why the investigation of a single incident of this nature should have taken so long. However, it is not referred to as a basis for the finding of unfair dismissal in the tribunal’s conclusions. Nor indeed is the tribunal’s conclusion that the charges were not clearly framed. As to that, I would accept Mr Wallington’s contention that the charges as such were clearly framed, although even if JE was tied to the chair, it is not obvious to me that this could properly be said in the circumstances to have offended his dignity and respect, given that it was preventing him from repeating his earlier undignified conduct; nor is it easy to see why it should threaten his safety or security. One might have thought that the contrary was the case. These consequences were always merely asserted. However, it is not alleged that these findings of themselves render the decision unfair.

65

The points relating to remedies

I turn to the two final points relied on by Mr Wallington which relate to remedies. Neither was considered by the EAT because given that they found that there was no liability, the issues did not arise.

66

First, Mr Wallington submits that even if the tribunal had been entitled to find that the dismissal was unfair, it was obliged to consider what would have happened had the employers not erred in their approach. The tribunal recognised that this was potentially a material matter for it to consider in paragraph 36 of its decision.

67

In my judgment, Mr Wallington must be right. I can understand, however, why the tribunal did not address that question. Having concluded that the finding that JE had been tied to the chair was not a sustainable finding for a reasonable employer to make, it did not have to address the Polkey question. On that analysis there was no basis on which the dismissal could have been considered fair.

68

Since I have found that the tribunal erred in concluding that no reasonable employer could have found that JE was tied to the chair, it follows that the tribunal ought to have considered the Polkey point. It has to decide whether the dismissal would have taken place even if fair procedures had been employed, and if so, whether such a dismissal would have been fair. If the conclusion is that the dismissal would not have been fair, even if it would or might in fact have occurred, for example because the sanction would have been out with the range of reasonable responses, then there would be no justification for reducing compensation on this ground at all, and the compensation awarded by the tribunal would stand. But if there was a chance that a fair dismissal might have occurred in any event, that must be factored into the assessment of compensation.

69

Mr Wallington also suggested that the finding of 25% contributory fault was not properly reasoned and should in any event have been more. I do not agree. The reason why the tribunal found contributory fault is clear, namely the failure to report the unusual restraining method. The choice of 25% is an exercise of judgment that does not warrant detailed explanation; it is a rough and ready figure to reflect the employees’ fault.

70

Conclusion

The appeal succeeds in part. I would restore the finding of unfair dismissal, but would remit the matter to the same Tribunal for it to determine, in the light of this judgment, whether it would be appropriate to reduce the compensation in accordance with the Polkey principles.

71

Footnote

This case raises a matter which causes me some concern. It appears to be the almost automatic response of many employers to allegations of this kind to suspend the employees concerned, and to forbid them from contacting anyone, as soon as a complaint is made, and quite irrespective of the likelihood of the complaint being established. As Lady Justice Hale, as she was, pointed out in Gogay v Hertfordshire County Council [2000] IRLR 703, even where there is evidence supporting an investigation, that does not mean that suspension is automatically justified. It should not be a knee jerk reaction, and it will be a breach of the duty of trust and confidence towards the employee if it is. I appreciate that suspension is often said to be in the employee’s best interests; but many employees would question that, and in my view they would often be right to do so. They will frequently feel belittled and demoralised by the total exclusion from work and the enforced removal from their work colleagues, many of whom will be friends. This can be psychologically very damaging. Even if they are subsequently cleared of the charges, the suspicions are likely to linger, not least I suspect because the suspension appears to add credence to them. It would be an interesting piece of social research to discover to what extent those conducting disciplinary hearings subconsciously start from the assumption that the employee suspended in this way is guilty and look for evidence to confirm it. It was partly to correct that danger that the courts have imposed an obligation on the employers to ensure that they focus as much on evidence which exculpates the employee as on that which inculpates him.

72

I am not suggesting that the decision to suspend in this case was a knee jerk reaction. The evidence about it, such as we have, suggests that there was some consideration given to that issue. I do, however, find it difficult to believe that the relevant body could have thought that there was any real risk of treatment of this kind being repeated, given that it had resulted in these charges. Moreover, I would expect the committee to have paid close attention to the unblemished service of the relevant staff when assessing future risk; and perhaps they did.

73

However, whatever the justification for the suspension, I confess that I do find it little short of astonishing that it could ever have been thought appropriate to refer this matter to the police. In my view it almost defies belief that anyone who gave proper consideration to all the circumstances of this case could have thought that they were under any obligation to take that step. I recognise that it is important that hospitals in this situation must be seen to be acting transparently and not concealing wrongdoing; but they also owe duties to their long serving staff, and defensive management responses which focus solely on their own interests do them little credit. Being under the cloud of possible criminal proceedings is a very heavy burden for an employee to face.

Employers should not subject employees to that burden without the most careful consideration and a genuine and reasonable belief that the case, if established, might justify the epithet ‘criminal’ being applied to the employee’s conduct. I do not think that requirement was satisfied here. No one suggested that the appellants were acting other than in the best interests of JE and the other patients. The restriction was not essentially different to the physical restraint which had been carried out in the day shift. I can only assume that the relevant committee was influenced, as I suspect Mr Mansfield was, by the fact that technically tying JE to the chair was an assault, with the implication that this is a grave matter. But so is it an assault when nurses physically restrain a patient, or compel him to wear a mask when he is spitting at people, as happened with JE. There was obvious justification for restraining this patient, even if the appropriate procedures for doing so were not employed, and in my view the police should never have been involved.

74

LORD JUSTICE KITCHIN: I agree.

75

LORD JUSTICE LAWS: I also agree.

 

http://arcuk.org.uk/membersarea/safeguarding-knee-jerk-suspension-of-staff-condemned/

 

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Saint Michaels Hospice has received a glowing review following an unannounced inspection by the Care Quality Commission.

The Care Quality Commission (CQC), which regulates and inspects all health and social care services in England, made an unannounced visit to the Hospice, which serves the Harrogate district, in October.

During the course of the day-long visit aspects of care, patient involvement, welfare and rights, as well as staff competency and reporting procedures were inspected.

Saint Michael’s chief executive Tony Collins said:

The dignity, privacy, individuality, needs and wishes of the people who use our services are our priority and this report evidences the quality of care we deliver.

I would like to thank every member of the Saint Michael’s team for the commitment they show to patients. “Whether they are care staff, volunteers, fundraisers, administrators or support staff, they each play a vital role is enabling this care to happen.

CQC inspectors regularly assess hospital, hospice and care homes across the country to ensure they are meeting the standards expected.
During their visit to Saint Michael’s, registered as Harrogate District Hospice Care Limited, inspectors spoke to people using the services and their families who described the care offered as ‘first class’ ‘top notch’ and somewhere they felt safe.

Staff were also praised for being ‘wonderful’, ‘very caring’ and ‘kindness personified’.

The Hospice was also recognised for involving patients in discussions about their own care and the way services are run. 
Other key areas assessed by inspectors included care standards, staff qualifications, ability to do their job and how well they protected patients from abuse.

Saint Michael’s was found to be fully compliant with every standard of quality and safety without exception. 
Saint Michael’s currently offers physical, emotional, psychological, practical or spiritual care that helps more than 2400 people each year to live with terminal illness and bereavement.

The care is offered free of charge available to people with all illnesses, not just cancer. 
These include people living with illnesses such as chronic obstructive pulmonary disease, Parkinson’s, Motor Neurone Disease and end stage heart and lung disease.

http://www.harrogate-news.co.uk/2012/11/29/hospice-standards-paised-by-care-inspector/

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Millions of people taking medicines for high cholesterol, cancer and to prevent heart attacks are at risk of potentially life threatening side effects if they eat grapefruits, doctors have warned.

A study has listed 43 major drugs which are affected by eating grapefruits or drinking the juice and experts have warned there needs to be more awareness of the risks.

The number of drugs that interact with grapefruit increased from 17 in 2000 to 43 in 2008, researchers in Canada found.

Eating one grapefruit a day or drinking 200ml of juice was enough to trigger significant side effects in some of the patients.

Elderly patients were at particular risk because they are more likely to eat grapefruit and be on the medicines that interact with it, while their bodies are less able to cope with the effects of an overdose, the researchers said.

Grapefruits and some other citrus fruits, contain specific chemicals that affects an enzyme in the gut which can lead to a greater proportion of the drug being absorbed into the body.

This can result in massive overdoses causing serious side effects ranging from hallucinations, low blood pressure, to kidney poisoning, muscle damage, high heart rate and breathing problems.

The findings were published in the Canadian Medical Association Journal.

Some people have died following the interaction and experts said doctors and pharmacists needed to be more aware of the problem.

The study, conducted by Dr David Bailey, of the Lawson Health Research Institute, in London, Ontario, listed several examples of interactions including one patient who suffered a potentially life threatening increase in heart rate while on the heart disease drug aimodarone and drinking between one and 1.5 litres of grapefruit juice a day.

Another one atorvastatin for high cholesterol suffered serious muscle damage after drinking freshly squeezed grapefruit juice daily for five days and one who developed a blood clot while on Ethinylestradiol, a form of hormone replacement therapy for menopause symptoms who had eaten a whole grapefruit at breakfast for three days.

Popular drugs affected in this way include simvastatin, taken for high cholesterol, clopidogrel to thin the blood, Tyverb for breast cancer, domperidone for sickness and powerful painkillers Fentanyl, Oxycodone and Ketamine.

One drug, dextromethorphan, is an anti-cough preparation used in over-the-counter products and other drugs that interact with grapefruit are some antibiotics, some anti-HIV drugs, quinine that is in tonic water and has been used against malaria, heart rhythm medicines, and anti-rejection drugs used following organ transplants.

For some drugs drinking 200ml of juice daily was enough to deliver three to six times the normal dose.

Dr Bailey said: “Many of the drugs that interact with grapefruit are highly prescribed and are essential for the treatment of important or common medical conditions.

“Unless health care professionals are aware of the possibility that the adverse event they are seeing might have an origin in the recent addition of grapefruit to the patient’s diet, it is very unlikely that they will investigate it.

“In addition, the patient may not volunteer this information. Thus, we contend that there remains a lack of knowledge about this interaction in the general healthcare community.”

The grapefruit effect can work in both ways, to reduce the amount of drug absorbed by the body, or to increase it, as was studied in this research.

Prof Simon Maxwell, Clinical Lead of Prescribing at the British Pharmacological Society and Professor of Clinical Pharmacology at the University of Edinburgh, said: “There are a lot of drugs on the list, including some very important high volume ones. But they represent a minuscule fraction of the compounds out there.

“Serious interactions are not a massive problem in Britain but we are probably not talking to our patients about it enough and awareness amongst doctors is definitely not high enough.”

He said some of the interactions were theoretical such as dextromethorphan used in some cough mixtures as the amount of the active drug used in those medicines was very low. Also, despite quinine in tonic water being listed as having caused a serious reaction in one patient, Prof Maxwell said this was likely to be extremely rare.

Prof Maxwell said researchers should investigate if the grapefruit effect could be harnessed so lower doses of these drugs could be prescribed with the juice to allow the same clinical effect from less of the active medicine.

But this would be complicated and costly to study he said.

Leyla Hannbeck, Head of Pharmacy at the National Pharmacy Association said: “Grapefruit juice and fresh grapefruit can interfere with the action of a range of prescription and non-prescription drugs.

“In some cases this can result in potentially dangerous levels of the active ingredient in the blood.

“So if you have any concerns about how your diet could affect your medicines ask your pharmacist for advice. A face-to-face discussion with the pharmacist can be the key to safer and more effective medicines use.”

Ten drugs affected by grapefruits and the side effects it can cause:

Tyverb, for breast cancer – fast heart rate and bone marrow problems

Amiodarone, to prevent blood clots after surgery – fast heart rate

Clopidogrel, to thin the blood – becomes less effective

Dronedarone, for heart rhythm disorder atrial fibrillation – fast heart rate

Rivaroxaban, a blood thinning tablet to prevent stroke – stomach bleeding

Buspirone, for anxiety – dizziness and sedation

Fentanyl given orally for pain relief – slows breathing

Domperidone, for sickness – fast heart rate

Atorvastatin for high cholesterol – kidney poisoning

Simvastatin for high cholesterol – kidney poisoning

Read more on The Telegraph.

http://uk.lifestyle.yahoo.com/grapefruits-can-trigger-overdoses-in-dozens-of-medicines-researchers-warn-083154632.html

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Christmas Quiz Night Fri 30th Nov 2012
At 7pm, on Friday 30th November the Friends of Lowestoft Library will be having a Christmas Quiz Night. Entry is £2 per person, or £10 per team (max. 6 in a team). First prize is a Luxury Hamper, there will also be a raffle with many prizes! Bring your own Food and Drink – microwave provided to heat up mulled wine! Telephone 01502 405342 for more info or to book a place for your team. Alternatively just turn up on the night!

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THE ALZHEIMER’S SOCIETY comments on the Care Quality Commission’s published ‘State of Care’ report. Where the CQC examines all care sectors for the first time and explores why some care services are failing to meet CQC standards.The Alzheimer’s Society

The report notes a growing demand for nursing care within social care settings. This is due to the increasing number of people with complex or multiple illnesses, and the rising numbers of older people with dementia.

The report also suggests that pressures on care services are increasing the risks of poor or unsafe care for people who are less able to speak up for themselves and those, who are more vulnerable including people with dementia. Across both health and social care, CQC inspectors found organisations who are failing to manage the impact of these challenges effectively, and delivering care that is task-based, not person-centred.

 Alzheimer’s Society comment:

‘800,000 people are living with dementia in the UK. By 2021 this will rise to over one million. With many of these people requiring care at some stage of their life, it is extremely disappointing that many care services are so far failing to meet their needs. We have known for a long time that the number of people with dementia is increasing so there is no excuse for not taking action.

‘Good services show us that quality care for people with dementia is possible. People with the condition deserve nothing less than the best care. Let this report be a wake up call to those who aren’t meeting the requirements.’

Andrew Chidgey

Director of External Affairs

Alzheimer’s Society

http://www.careindustrynews.co.uk/2012/11/pressure-on-care-providers-increases-the-risks-of-poor-or-unsafe-care/?goback=%2Egde_3858109_member_188853771

 

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NSPCC needs volunteers…

NSPCC needs volunteers to go into schools to present workshops on protect children against abuse. Could this be you?

Empower children by talking about abuse and ways they can get help

Speak to primary school children as a ChildLine Schools Service volunteer and help them understand issues like abuse and bullying and how to protect themselves.

As part of our ground-breaking service, we need volunteers to be trained to talk pupils in their local area about abuse in all its forms and make them aware of how and where to get support.

Who can volunteer

You don’t have to have previous experience of working with children in a school to be a ChildLine Schools Service volunteer, but we do ask that you:

  • share our vision and are committed to doing the very best for children
  • are willing to learn, complete training and accept feedback
  • have basic IT skills and transport to get to schools
  • are able to speak in front of a group of primary school children
  • can commit half a day a week during term time in school hours      (9:00am-3:00pm).

http://www.nspcc.org.uk/get-involved/volunteer-your-time/childline-volunteering/schools-service/schools-service_wda91863.html?utm_source=Facebook&utm_medium=promoted%2Bpost&utm_content=generic%2Bpost_1&utm_campaign=CLSS%2BNational%2BRecruitment%2BNov%2B2012

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To: Mr Jeremy Hunt [Health Secretary] & Jamie Reed [Labour’s Shadow Health Minister],

From: Suzan Collins [Author, Trainer & Consultant in Health, Social Care & Management].

After reading the report I would like to add the following:

I agree with you, there is a lack of standards out there, [but on some wards and not on whole hospitals!] and in some nursing homes [and care homes and care agencies which were not included in the report]. I totally agree that the standards need to be raised. I would like to add that there are many, many wards and care/nursing homes and nursing agencies doing some brilliant work looking after and supporting older vulnerable people and these should not be forgotten.

Jeremy Hunt, you are quoted as saying, “Where there are problems we expect the CQC and other regulators to take swift action.”

I would like to state that I expect yourself as the Health Secretary and others in Government to be proactive and not expect the Care Quality Commission [CQC] and hospital managers and home managers/owners to take action [and pick up the pieces when things have gone wrong].

Jamie Reed, you are quoted as saying, “This report raises worrying questions about the quality of care some people are receiving, particularly the most vulnerable in our society.”

My questions to you both are:

Have you completed a risk assessment which will highlight the risks and enable you to put things in place to reduce these risks?

Why is there a reactive approach and not a proactive one?

What are you going to do about it? This has gone on long enough!

It is obvious that the Government needs to be proactive and put things in place to prevent standards dropping, patients/residents being neglected and in some cases elderly residents moving from their current care homes to different ones. By doing something to prevent this happening to older, vulnerable people, you will be RESPECTING those that you say the care and health sector is failing!

When I deliver training on Dignity in Care I ask the learners, ‘What would you expect for a family member who was a vulnerable older person receiving care?’

I end this by asking you this, ‘What would you expect for a family member who was a vulnerable older person receiving care?’

Suzan Collins

www.spcconsultancy.com

To read the full report click here: http://news.sky.com/story/1015333/social-care-one-in-four-services-failing

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