Seamus Murphy, Industrial Relations Officer, Psychiatric Nurses Association

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TRUST IN CARE
Trust in Care Dignity at Work
Seamus Murphy, Industrial Relations
Officer, Psychiatric Nurses Association
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TRUST IN CARE

• Status
• Published in May 2005
• This policy is the definitive document for the
  Health Service formally agreed between Health
  Service Employers and Unions
• The Mental Health Commission also endorsed the
  policy as being the definitive document for the
  Psychiatric Services
• Allegations of child abuse against an employee
  must be dealt with in accordance with the
  provisions of Children First National Guidelines
  for the Protection and Welfare of Children

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TRUST IN CARE

• Rationale
• Dignity
• High Standard of Care

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TRUST IN CARE

• The aim of this policy is two fold
• - Preventative - Procedural

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TRUST IN CARE

• Preventative - to outline the importance of the
  proper operation of human resource policies in
  communicating and maintaining high standards of
  care amongst health service staff
• Procedural - to ensure proper procedures for
  reporting suspicions or complaints of abuse and
  for managing allegations of abuse against health
  service staff in accordance with natural justice.

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TRUST IN CARE

• Rights of Staff Member -
• Natural Justice
• Presumption of Innocence
• Erroneous or vexatious allegations

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TRUST IN CARE

• Obligations on Employers-
• Provision of sufficient Services
• Provide staff necessary supervision, support and
  
• training.
• Safeguarding the rights of staff member pending
• hearing.
• Provide safe system of work
• Induction for new staff

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TRUST IN CARE

• What Constitutes Abuse
• Any form of behaviour that violates dignity of
  patients/clients
• Abuse may consist of a single act or repeated
  acts
• It may be physical, sexual, or
  psychological/emotional
• It may constitute neglect and poor professional
  practice

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TRUST IN CARE

• Recruitment and Selection
• Confirmation of Identity Passport/Driving
  Licence
• Verification of Qualifications
• Satisfactory references (which should include a
  reference directly obtained from the applicants
  current or most recent employer).
• Garda Clearance
• Declaration by candidate to disclose information
• Temporary or permanent
• Use of Volunteers

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TRUST IN CARE

• Policies Protocols of Behaviour
• Challenging behaviour
• Personal and intimate care
• Appropriate physical contact
• Control and restraint
• Boundaries of social interaction with
  patients/clients
• Medication
• Handling of patients/clients money and personal
• posessions

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TRUST IN CARE

• Complaints of Abuse may be raised -
• by the person who is abused or a concerned
  relative
• A member of staff
• It may come in the form of a verbal or written
  complaint
• It may be an expression of concern
• Any staff member who receives information,
  suspects or is concerned that a patient/client is
  being abused has a duty of care to report the
  matter to his/her immediate Line Manager as soon
  as possible

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TRUST IN CARE

• Guidance to staff on dealing with complaints of
  abuse from patients/clients
• Where a patient makes a complaint - encourage
  the patient/client to give as much detail as
  possible but to avoid asking leading questions,
  i.e. questions which suggest certain actions
  might have occurred or which name particular
  people who may have been involved.
• Allow the patient/client as much time as
  possible.
• Do not press the patient/client for details
  beyond that which s/he is willing to disclose
• Do not promise to keep the information a secret
• Obtain dates from witnesses

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TRUST IN CARE

• Preliminary Screening
• carried out by the immediate line manager
• to ascertain if it is possible that an abusive
  interaction could have occurred i.e. establish
  the facts
• Under no circumstances should the preliminary
  screening attempt to establish whether or not the
  abuse actually occurred

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TRUST IN CARE

• Managers role in preliminary screening
• Notify Staff Member that a preliminary screening
  process is being undertaken
• The staff member must be advised in advance of
  his/her right to be accompanied at this meeting
  by a union representative or work colleague
• ensure that the details of the alleged or
  suspected abuse are documented
• arrange for a physical or psychological
  assessment of the patient/client
• Consult with another member of management or
  appropriate professional colleague before he/she
  makes a final decision as to whether or not an
  abusive interaction could have occurred

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TRUST IN CARE

• Outcome of Preliminary Screening
• If the manager is satisfied that an abusive
  interaction could not have occurred and no
  further action is warranted, s/he should keep a
  record of the decision on the staff members
  personnel file
• If the preliminary screening indicates that an
  abusive interaction could have occurred then the
  matter should be referred to senior management
  who will decide whether the employee has a case
  to answer or whether the matter is capable of
  being dealt with at local level
• If it is decided that a formal investigation is
  warranted, a meeting should be arranged to advise
  the staff member of the intention to carry out a
  formal investigation. The staff member should be
  advised of his/her right to be accompanied at
  this meeting by a union representative or work
  colleague. The staff member should be given
  details of the complaint at the meeting and
  afforded an opportunity to make an initial
  response if s/he so wishes
• In this instance the Staff Member should be
  advised of support and counselling services that
  are available

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TRUST IN CARE

• Protective Measures
• Protective measures may be necessary to ensure
  that no patient/client/ or staff member is
  exposed to unacceptable risk
• Protective measures are not disciplinary
  measures and may include
• Providing an appropriate level of supervision for
  the staff member
• Moving the staff member to another Location
• Putting the staff member off duty with pay
  pending the outcome of the investigation (putting
  the staff member off duty pending the outcome of
  the investigation should be reserved for only the
  most exceptional of circumstances).

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TRUST IN CARE

• Steps in conducting the Formal investigation
• The investigation will be conducted by the
  designated person(s) agreed between the parties
• The investigation will be governed by clear
  terms of reference based on the written complaint
  and any other matters relevant to the complaint
• The investigation team will form preliminary
  conclusions and invite any person adversely
  affected by these conclusions to provide
  additional information or challenge any aspect of
  the evidence.
• On completion of the investigation, the
  investigation team will form its final
  conclusions based on the balance of probabilities
  and submit a written report of its findings and
  recommendations to senior management
• The staff Member against whom the complaint is
  made will be given a copy of the investigation
  report and an opportunity to comment before any
  action is decided upon by management .
• If the complaint is upheld, the matter will be
  referred to the chief executive officer (or
  equivalent) or designated manager who is
  empowered to take disciplinary action up to and
  including dismissal.

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TRUST IN CARE

• Informing Relatives/Guardians
• Where appropriate, the patient/clients
  immediate relatives or guardian should be
  notified that an investigation into the
  allegation is being carried out
• Where appropriate patients/clients should be
  offered the support of an advocate to act on
  their behalf if they wish

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TRUST IN CARE

• Anonymous Allegations
• Anonymous allegations on their own cannot lead
  to a formal investigation
• Possibility that they are vexatious

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TRUST IN CARE

• Informing An Garda Siochana
• Where there are reasonable grounds to suspect
  that a criminal act has been committed, the
  matter must be reported immediately to the Gardai
• Where the Gardai are notified, the agency may
  conduct its own independent investigation in
  parallel with the criminal investigation

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DIGNITY AT WORK
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• Published in May 2004
• Key objective of new Policy is to ensure that all
  reasonable efforts are made by local Management
  to deal with complaints of bullying or harassment
  without outside intervention

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Supervisors Managers require training to
enable them to discharge their specific
responsibilities effectively.
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• Backdrop to the Policy Employment Equality Act
  1999
• Discrimination outlined on nine main grounds
• Sex
• Marital Status
• Family Status
• Age
• Race
• Sexual orientation
• Membership of Travelling Community
• Religion
• Disability

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Who is Liable? Act provides Employer held liable
even where discrimination/harassment is
perpetrated by employee/s, by a client, customer,
member of public with whom employees may come in
contact during the course of their work
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• Dignity at Work Policy Statement
• Management must set out
• All employees treated with respect and
• dignity
• Provide safe working environment free
• from bullying and harassment
• Process for complaints procedure
• Complaints will be dealt with promptly
• and sensitively

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What is Bullying? Repeated inappropriate
behaviour, direct or indirect, whether verbal,
physical or otherwise, conducted by one or more
persons against another or others at the place of
work or in the course of employment which could
reasonably be regarded as undermining the
individuals right to dignity at work.
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• Key characteristics
• Repeated Acts over a period of time
• Regular or persistent inappropriate
• behaviour

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• What is not bullying?
• Isolated incident
• Fair and constructive criticism regarding
  performance, conduct or attendance
• Complaints relating to instructions issued by
  Manager/Supervisor (grievance)
• Assignment of duties (grievance)
• Terms conditions of employment (grievance)

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• Examples of bullying?
• Constant humiliation belittling in front of
  others
• Verbal abuse
• Hostility - exclusion
• Undermining persons role and authority
• Persistent fault finding
• Blame even where individual is not responsible

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• Employers responsibility
• Adequate resources to promote dignity
• and respect at work
• Communication of Policy Induction
• Appointment of Support Contact Person
• Regular monitoring

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• Employees responsibilities
• Respect the dignity of all colleagues
• Discourage bullying and harassment
• Inform Manager if colleague/s are being bullied

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• Managers Supervisors responsibilities
• Implementation of Policy
• Set good example
• Be vigilant and intervene before problem
• escalates
• Listen to your Staff
• Facilitate support contact person/s to
• carry out their role

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• Role of Support person
• Provide information and emotional support
• Confidential, non judgemental, off the record
• Role does not extend to other workplace
  grievances or
• personal problems
• Does not act as an advocate or representative
• Does not approach the alleged perpetrator
• Role extends to offering support to the alleged
  perpetrator
• Confidential except a crisis situation or
  potential danger
• Support contact person should be facilitated with
  time off
• No notes or records will be kept
• Meeting 45 minutes to 1 hour X 3 to 4 sessions
• No home or personal mobile numbers should be
  exchanged.

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• Union Officials responsibilities
• To co-operate with efforts to resolve complaints
  at local level.
• To co-operate with any Investigation Process.

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• Procedure
• Contact the support Contact person
• Approach the perpetrator directly
• Talk to colleagues Supervisor
• Talk with Union Representative
• Make formal complaint to Management

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• Role of Direct Supervisor/Manager to attempt to
  resolve the matter
• Informal low key and non-confrontational
• If not resolved refer to Management at more
  Senior level
• If not resolved. Mediation

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• Mediation
• All disputes not capable of being resolved
  directly between parties or at local level will
  be requested to attempt mediation
• Objective to resolve matter speedily and
  confidentially
• Requires voluntary participation and co-operation
  of both parties
• Mediator meets with both parties - initially
  separately
• Mediated solution no disciplinary process
  results

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• Formal investigation
• The complaint must be clearly formulated in
  writing, dates, witnesses etc.
• Alleged perpetrator advised of formal
  investigation process, given copies of written
  complaint response required within 2 weeks
• Investigator's may interview anyone they feel can
  assist
• Staff expected to fully co-operate

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• investigation Documentation
• All parties given all copies of relevant
  documentation
• Complaint
• Response
• Witness Statements (if any)
• Conclusions - Preliminary/Final

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investigation Preliminary Conclusions.
Invite any person adversely affected to provide
additional information or challenge any aspect
of evidence.
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Completion of investigation Formal Report
to Senior Management.
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• Outcome
• Complaint upheld
• Counselling
• Mediation
• Disciplinary Procedure
• Complaint not substantiated
• No action against the complainant once
  complaint made in
• good faith
• Malicious or vexatious complaints dealt with
  under
• disciplinary process if employee
• If not employee suspension or termination of
  service
• .