Inequalities in Nursing

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This assignment will critique the phenomenon of suspension within the NHS and explore the inequalities in how the Department of Health (DOH) manage this process. This will focus upon the differences between how medics (doctors and dentists) and nurses are managed within the NHS. The number of those affected by the process of suspension will be highlighted and there will be a discussion of the policies and procedures available to these professionals working within the NHS. A brief description of why suspension occurs will be offered and the experience of those affected by the process of suspension will be examined which will look at stress; in particular within nursing, bullying and harassment and look at how whistleblowers are treated. Much of the literature relating to suspension and discipline within nursing is found in the USA where suspension is a form of discipline that occurs after an investigation and hearing has concluded. This is of limited relevance as in the UK a nurse is suspended before the hearing and whilst the allegations are being investigated. Therefore, the literature had to be carefully reviewed in the light of differences in the meaning of suspension between the UK and USA. Every year, unknown but considerable numbers of NHS staff (other than doctors and dentists in England) are unjustly/unnecessarily suspended/excluded from work. This was established by the National Audit Office Report (NAO 2003 p.11) into suspensions and there appeared to be no improvement found somewhat three years later when a journalist using the Freedom of Information Act, discovered that the numbers of excluded staff still ran into hundreds at least (Roper 2006). The Department of Health may not be aware of the scale of the problem as it does not gather data on clinical staff other than doctors and dentists (NAO 2003 p.11). The Daily Mirror reported the cost of these suspensions to be up to £100 million (Roper 2006). This figure could be much higher due to gross underreporting (NAO 2003 p.20) and the estimated costs not taking into account the hidden costs such as, legal costs, sick pay, health care costs for those made ill, financial debt, relationship breakdowns and wider social detriment. Doctors and dentists in England are the only NHS staff groups to have had statutory Directions since 2005, managed by the National Clinical Assessment Service (NCAS). From analysing 1700 cases the Department of Health is rightly proud with finding alternatives to suspension in 85% of possible cases (DOH 2007). In handling suspensions at present there is a two tier service for employees of the NHS. The doctors and dentists are the top tier and other professionals including nurses are at the bottom. Within the NHS there are two documents for doctors and dentists which safeguard this professional group and staff must not be suspended unless they meet certain criteria. The first document is the work of the National Patient Safety Agency (NPSA) which has produced the incident decision tree (NPSA 2007). This is a flowchart to help managers decide what action to take if a patient safety incident has occurred or has been alleged. Its purpose is to help promote an open and fair culture in the NHS and to help managers determine a fair and consistent course of action to take with staff following a patient safety incident. The NPSA website has a learning tool for conducting root cause analysis, which is a way of looking at critical incidents and near misses to look for system failures and learn from them to prevent re-occurrences. This is a very positive tool which does not purely look at who is to blame and its main purpose is to learn lessons from the process of suspension. The second document is the Directions (DOH 2005), these are based on ACAS best practice and lay down clear timescales and processes. For example, there is a two week time period allotted for the initial investigation, carried out to establish the facts in...
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