Wednesday, 29 January 2020

Amazing but wasted response by Baroness Harding to the tragic death of Amin Abdullah in 2016

The guidance that Baroness Harding has produced in response to the grave injustices and subsequent death of Amin Abdullah, a gifted charge nurse at a London hospital, are very well researched and written.
They were published last May and distributed to Care Quality Commission Chair, NHS Providers Chair, Nursing and Midwifery Council Chief Executive and NHS Employers.
I’m not sure what happened to them then.  I was told about the guidance by a suspended member of NHS staff whose treatment was a devastating travesty of justice and whose organisation claimed to be following the guidance. 
That perfectly illustrates the failing of the guidance, that it has no teeth and is being successfully sidelined.  Organisations ignore it, just as we hear of yet another report of avoidable and tragic deaths of babies, causing immeasurable grief to the parents, and of the astronomical bill for legal claims and costs paid out by the NHS for mistakes being made.  Where were the whistleblowers? Probably silenced.
The only way the guidance will have any protection for staff is if NHS Improvement or similar organisation, is able to legally require trusts to implement the guidance and demonstrate that they are doing so. 
It could also be a statutory requirement for the Nursing and Midwifery Council to ensure that referrals to them have followed the processes set out by the Guidance.  That would make a huge difference to the numbers of staff being falsely accused of malpractice or being referred when lesser options could be used if there are problems.
It might also be possible to prevent malicious allegations and retrain or remove poorly performing managers who ignore the guidance, a matter that no one in any previous guidance has dealt with.
So the excellent guidance will have been a huge waste of resources, and will achieve nothing.   Amin Abdullah, who had a very strong sense of justice and who suffered so terribly, will have died in vain and his partner and his legal counsel will have laboured in vain.
I publish the Guidance below before it disappears without trace as so many guidelines and reports and initiatives have done before it.
Yours with no glimmer of hope
Julie Fagan
Additional guidance relating to the management and oversight of local investigation and disciplinary procedures
1. Adhering to best practice a) The development and application of local investigation and disciplinary procedures should be informed and underpinned by the provisions of current best practice, principally that which is detailed in the Acas ‘code of practice on disciplinary and grievance procedures’ and other non-statutory Acas guidance; the GMC’s ‘principles of a good investigation’; and the NMC’s ‘best practice guidance on local investigations’ (when published).
b) All measures should be taken to ensure that complete independence and objectivity is maintained at every stage of an investigation and disciplinary procedure, and that identified or perceived conflicts of interest are acknowledged and appropriately mitigated (this may require the sourcing of independent external advice and expertise).
2. Applying a rigorous decision-making methodology
 a) Consistent with the application of ‘just culture’ principles, which recognise that it is not always appropriate or necessary to invoke formal management action in response to a concern or incident, a comprehensive and consistent decision-making methodology should be applied that provides for full and careful consideration of context and prevailing factors when determining next steps.
b) In all decision-making that relates to the application of sanctions, the principle of plurality should be adopted, such that important decisions which have potentially serious consequences are very well informed, reviewed from multiple perspectives, and never taken by one person alone.
3. Ensuring people are fully trained and competent to carry out their role
Individuals should not be appointed as case managers, case investigators or panel members unless they have received related up to date training and, through such training, are able to demonstrate the aptitude and competencies (in areas such as awareness of relevant aspects of best practice and principles of natural justice, and appreciation of race and cultural considerations) required to undertake these roles.
4. Assigning sufficient resources
Before commencing investigation and disciplinary procedures, appointed case managers, case investigators and other individuals charged with specific responsibilities should be provided with the resources that will fully support the timely and thorough completion of these procedures. Within the overall context of ‘resourcing’, the extent to which individuals charged with such responsibilities (especially members of disciplinary panels) are truly independent should also be considered.
5. Decisions relating to the implementation of suspensions/exclusions
 Any decision to suspend/exclude an individual should not be taken by one person alone, or by anyone who has an identified or perceived conflict of interest. Except where immediate safety or security issues prevail, any decision to suspend/exclude should be a measure of last resort that is proportionate, time bound and only applied when there is full justification for doing so. The continued suspension/exclusion of any individual should be subject to appropriate senior-level oversight and sanction.
6. Safeguarding people’s health and wellbeing
a) Concern for the health and welfare of people involved in investigation and disciplinary procedures should be paramount and continually assessed. Appropriate professional occupational health assessments and intervention should be made available to any person who either requests or is identified as requiring such support.
b) A communication plan should be established with people who are the subject of an investigation or disciplinary procedure, with the plan forming part of the associated terms of reference. The underlying principle should be that all communication, in whatever form it takes, is timely; comprehensive; unambiguous; sensitive; and compassionate.
c) Where a person who is the subject of an investigation or disciplinary procedure suffers any form of serious harm, whether physical or mental, this should be treated as a ‘never event’ which therefore is the subject of an immediate independent investigation commissioned and received by the board. Further, prompt action should be taken in response to the identified harm and its causes.
7. Board-level oversight
Mechanisms should be established by which comprehensive data relating to investigation and disciplinary procedures is collated, recorded, and regularly and openly reported at board level. Associated data collation and reporting should include, for example: numbers of procedures; reasons for those procedures; adherence to process; justification for any suspensions/exclusions; decision-making relating to outcomes; impact on patient care and employees; and lessons learnt.
Thank you for your attention to these vital issues.
Best wishes
Baroness Dido Harding, Chair, NHS Improvement

Saturday, 15 June 2019

NMC Fitness to Practice destroys staff

So often when staff are referred to the Nursing and Midwifery Council (NMC) Fitness to Practice (FtP) court the allegation being made is unjustified or worse still, untrue and therefore unsubstantiated.

Unfortunately the FtP panels start from the premise that the allegations are true and the registrant has to prove otherwise.  Of course that is completely against natural justice let alone human rights but only the powerless registrants seem to know practically of this grave injustice, when the malpractice unfolds before them at their hearing.

Cathryn Watters was a very experienced oncology nurse.  She left an unsatisfactory post, looked at finding her next step through agency work, didn’t find anything that met her requirements and then landed a dream job with a private company. 

She was about a year into working there when she received a letter from the NMC informing her that one of the dates on her certificates had been altered.  The NMC were investigating the possibility that the alteration had been made in order to deceive.

Shocked, Cathryn informed her employer and notified the agencies she’d applied to even though she had never progressed beyond applying.  She had no idea why or how the date on the certificate had been altered but immediately ensured that records were corrected.   (It remains a mystery… was it a disgruntled colleague...was the form never accurate in the first place…who knows …)

Cathryn wrote this poem after the FtP found her guilty and she was ‘struck off’ the register, that very expression underlining the immensity of this outcome.  She had been found guilty because she failed to admit her dishonesty, showing no insight!  It takes my breath away to write that.  What devastating injustice. 

Her poem eloquently describes the impact this verdict had on her.  

She dedicated it to the 15 nurses who died whilst waiting for their FtP cases to be concluded, such is the impact of this lengthy and horrendous process.


This day I put my faith in you,
And hoped you’d see my side.
I sat there, tried to listen hard,
But really only cried.

This day I put my faith in you,
I respected all you said.
I felt I owed you everything,
I believed each word I read.

This day I put my faith in you,
I thought you’d have my back.
But as I sat and listened,
I began to see the cracks.

This day I put my faith in you,
I should have stayed at home.
Today you walked away from me,
You told me I was done.

This day I lost my faith in you,
My PIN is yours to hold.
It was never mine, but on loan to me,
And now it’s yours I’m told.

This day I lost my faith in you,
You brandished me unfit.
My years they count for nothing,
I disappear… I sit.

This day I lost my faith in you,
As you listened to the lies.
I thought you’d care for me as well,
I’m not worthy in your eyes.

This day I put my faith in you,
But you washed your hands of me.
So now I try to build my life,
Scarred by NMC.

This day I lost my faith in you,
I have nowhere I can turn.
The largest part of me is gone,
There’s no lessons that you learn.

This day I tried to find the strength,
Not to hold my head in shame.
I know I did the best I could,
I was not the one to blame.

This day I try to carry on,
To see that I am more,
Than just my PIN, my life as a nurse,
My growth, my ethos and my core.

This day our patients lost their chance,
To have my care and skill
Your panel took that chance away,
One less to help the ill.

One day you may a lesson learn
That few of us recover
Broken by your lack of care
A line of souls to suffer.

Dedicated to the 15 nurses who died since April 2015,
 before their Fitness to Practice cases concluded.

NMCWatch supports nurses and midwives affected by the Fitness to Practice process.
If you would like to support visit:

Monday, 11 February 2019

How to protect yourself if you need to blow the whistle.

An honest practitioner with a very high level of integrity, wishes to ‘come out’ about the failure of an NHS service in their area, as serious as any already in the public domain, costing lives.

What does that person have to do, to ‘come out’ safely and unscathed?  Is it even possible?

Even writing these questions feels dangerous, such is the corrupt nature of some of our NHS management.

For example, in order to prepare for his whistleblowing, a consultant had his mental health checked before he blew the whistle because he knew they would say he was mentally ill - and they did!  He had the evidence to show he was in fact perfectly sane.

If an activist ‘comes out’ the huge danger is that management will make false allegations and the activist will be suspended with all that follows, therefore stopping the campaign and  causing the activist long term harm.

Would it be possible to take a very very low profile, to be unidentifiable?  Or even resign from post. And then be active.
What a choice to have to make.

Might there be a high profile champion, and would this champion be safe from false allegations and action against them too?  Probably not judging by the high profile people who have become victims over these last years.   Ironically, allowing the failings, even knowing they are in the wrong, seems to drive management forward, loudly proclaiming their innocence almost as a matter of principle, or is it all about protecting themselves?

Craig Longstaff is a veteran whistleblower.  He added the following very insightful safety requirements.

(1) If someone wants to be "active", they need to go to the very top & garner full support from the chief executive officer, or resign & then become active.

(2) NEVER blow the whistle or rock the boat from within, while you are vulnerable & dependant on them paying you - find another job, resign (stating why in the resignation letter - as per recent case law on the issue of resignation letters / dismissal claims) - & blow the whistle in writing on the exit day.

(3) Ensure, before they start rocking the boat / striking the match, that the person has up-to-date appraisal / performance reviews (& get copies if they don’t have them) that are dated & signed by both the staff member AND (especially) the senior/reviewer.

Hopefully this will show positive outcomes; they need to make sure it is covered & documented in their appraisals that management have no issues.

When the time comes - & sadly on balance it will - where they are accused falsely, investigated & the chronology of "issues" is back-trawled (it has been known to be 4 years and longer)  they  can use their appraisal/s to link sudden changes to any "non-compliant" activity managers are claiming, thus creating legal causal link to bullying and harassment /victimisation.

(4) Be mentally & emotionally aware of the ramifications of good actions around socio-psychopathic managers & HR staff; you can never prepare for the depths they stoop to, but you can be aware & try to counter.

(5) In any investigation say as little as possible  because they WILL "misinterpret" & manipulate your words to fit their intended outcome.

It is for them to prove guilt, not the accused to prove their innocence, whilst countering any "evidence" presented where necessary.

If possible, make written statements only (so first meeting/s, let them know nothing will be said until the very end when they've provided all their accusations & evidence - be VERY aware of trap interview tactics. Reply to their questions with more questions, rather than pliable verbal replies / statements, as much as possible.

(6) Finally, keep focused & see the wood for the trees (keep situationally aware & avoid tunnel vision), & don't become a victim - I did, & I'm still recovering.

There is a lot of published research to support what is being written here.  Here is one such powerful recent example.

Dr Rachael Pope has found organisational silence to be a significant aspect of NHS organisational dysfunction that is very powerful and stops those organisations from learning and changing, hence recurrent public inquiries into failed and failing NHS services that may cost patients their lives.

Dr Pope’s research has identified a culture of blindness, deafness and destructive behaviours that effectively silence and destroy.

Staff are afraid to speak out.  Their actions won’t hit brick walls but instead effective silencing actions that can engulf and destroy them.

How different it would be if the NHS was willing to listen and learn honestly in a culture of respect.

See Organizational silence in the NHS: 'Hear no, see no, speak no' -

The practitioner alone has to make the decision, one they can live with.

For myself, I would leave the organisation with all the evidence I required, get settled in my new job and then ‘blow that whistle’ but knowing that it would be a costly and lonely journey to take.

Yours sadly,

Wednesday, 11 July 2018

Disastrous monitoring by PSA protecting malfunctioning managers

Is the Nursing and Midwifery Council (NMC  ) Fit to practice (FtP)?  But maybe more importantly, is the Professional Standards Authority for Health and Social Care (PSA )fit to judge?  Not according to their latest performance review of the NMC’s Fitness to Practice outcomes at the beginning of June this year.  It makes for unbelievable absence of insight or sound judgement.  Instead it is another part of the destructive and failing system.

To see the document for yourself go to 

Astonishingly the report concluded that the NMC met all but one of its standards, namely that bereaved families in the Morecombe Bay inquiry had their concerns ignored, and had not been treated with respect nor kept informed of progress. 

But wait a minute, nor do registrants get treated with respect, nor are they kept informed of the progress of their interminable cases.  All part of the wearing down process that makes it so difficult for registrants to defend themselves.

Moreover and shockingly, the fact that 1170 registrants’ cases had not been concluded for over a year, that 294 registrants were still waiting after 2 years and 71 were still waiting after 3 years was ok? 
I quote ‘There has been a significant reduction in the number of cases over 52 weeks held by the NMC, from 1,437 last year to 1,170 this year. The numbers of cases older than 104 weeks and 156 weeks have only increased by 13 and 23 respectively, indicating that the reduction in cases over 52 weeks has not just been achieved by cases passing the threshold into the next age category (whatever that means?). The overall caseload over 52 weeks has reduced this year by 231 cases.
An achievement?

Can no one in the Department of Health see these glaring failures of judgement?

There is now significant help from a closed Facebook support and information group called NMC Watch: registrant care (previously The case against the NMC) founded by Cathryn Watters.  See if you wish to find out more. 

The group has powerful and substantive evidence of the harm that the NMC process causes with 60 responses to their on line survey available from the Facebook group or myself as a Word document, by emailing me

But it seems the PSA is not interested or just doesn’t have insight into the terrible harm caused. 

It should be known that people who have already been through a disciplinary process with their organisation, are now in a poor state of physical and mental health.  Finances are probably in dire straits too, not to mention other aspects of their lives.  The thought of now fighting for their registration sends their anxiety levels ever higher. 

Because of the complex legalities around the proceedings, registrants find it difficult to understand the process.  The unions often don’t help, warning people against writing anything of significance in case they make their situation worse, whilst not understanding that the NMC views such lack of response as a lack of insight, which makes their defence even harder.

There is much more in the PSA report that signifies how poor the FtP process and outcomes is.  The PSA is immersed in their processes and just can’t see how the processes and legalities are failing staff most cruelly.

Is the Nursing and Midwifery Council (NMC) Fit to practice?  Am I wrong in claiming that the NMC is not Fit to Practice?

Staff who have been through the FtP process know that it is definitely not fit to practice for many reasons.  Length of time taken is an obvious one, remembering that many of these people should not have been disciplined or referred in the first place.  Another reason is the way people are considered guilty unless they have good evidence to show they are not. 

Very often, the manager’s word is believed against the registrant’s just because they are the manager.  Then there are the lost papers, papers delivered to the wrong address, a lack of any communication and updating, and problems speaking with case workers.

One midwife tells how she and her team waited for 3 hours before they discovered that the NMC court had finished for the day and gone home but had forgotten to notify them.   Unbelievable but symptomatic of the disregard they have for the ‘accused’.

Will these injustices and the suffering caused ever end?  At the present moment, with the PSA mostly blind to the failings of the NMC, sadly and realistically, I doubt it.

Yours despairingly

Saturday, 10 February 2018

Scapegoating staff after critical incidents

Poor Dr Bawa-Garba struck off by her own professional body that has not a clue about working conditions in the NHS nor the implications of their action that sounded so vindictive.  What did they hope to achieve by it?  The fallout from their action, wasting doctors’ money going to the High Court to have the verdict of the Medical Practitioners Tribunal overturned, raised all sorts of questions about them and for practitioners too.  

Jenni Middleton, Editor of the Nursing Times ( has commented on her article for On the pulse this week that nurse Isabel Amaro, was also convicted of manslaughter by gross negligence for her part  and struck off by the Nursing and Midwifery Council in 2016 .  

Ironically, the trust involved, has since made changes to their systems to prevent a re-occurrence of such a tragedy.  In other words the doctor and the nurse’s claims about many failings that day were justified.  Oh the injustice of it all.  

The Secret Barrister has written a very insightful article about the doctor’s case and the safety of having lay people decide complex situations about which they know very little or nothing at all, for example, the way junior doctors are expected to cover large caseloads. 

This is not far removed from nurses being in a similar situation, having to care for a high number of sick people with very few staff, often covering extra shifts as well as working long hours.  Many leave their shifts in distress because they just could not physically meet the demands being made on them.  How can this ever be safe for patients and staff alike?
Scapegoating is alive and well according to people who contact the website .   What is so frustrating is that someone is seriously injured by the action taken against them – psychologically, physically, emotionally, financially.  In every way you can think of, that person is harmed.   Sometimes the harm is irreversible.  The harm to their families is immense too.   Anecdotally, relationship break up is common.

I hate to think how Dr Bawa-Garba is feeling now or poor Nurse Omara.  Maybe if their names had been double barrelled English names they might have suffered a lesser fate or even have been spared all this terrible action against them?  (The doctor was initially informed by the CPS in 2012 that she would not be prosecuted at all.  I don’t know about the nurse.)  

Consider the time all this has taken, from 2011 till 2016 for the nurse to have her career ended and now for the doctor.  What a toll it must have taken on these poor people and their families and friends.  

A frequent complaint against the NMC by staff who are unnecessarily or unjustly reported to them is that they suffer long periods of time before they discover their fate too.  Even worse, many feel they were presumed guilty until they could prove their innocence.   

What a mess.  

Tuesday, 7 November 2017

Light at the end of the tunnel: re-thinking disciplinary action in the NHS

At present a manager informs HR that s/he is planning to suspend a member of staff for what they claim is gross misconduct.  The HR manager presumably checks that what is being alleged, is actually gross misconduct (though there is no evidence that I know, to suggest that) and then the awful process unfolds.  The worst case scenario is that the innocent victim is called to a meeting with their manager, without knowing what the meeting is about – congratulations for their hard work in very difficult circumstances maybe? 

What follows puts them into a state of shock and the direction is now downhill all the way – vague allegations, exclusion from the work premises (with the embarrassment of being marched off in many cases), long delays, no fairness or transparency in the process and finally some punitive outcome.

Patient care suffers – one less member of staff, other staff demoralised by their colleague’s disappearance, vague rumours. 

BUT there is hope.  A few managers are stopping this awful waste of staff and time.  Roger Kline, Research Fellow in Middlesex University Business School, has described the different approach in his seminal work, re-thinking disciplinary action in the NHS.  See .  See also for more examples of different approaches summarised by Roger  (pp 110-143).

At last some trusts are recognising that the disciplinary route is usually not appropriate or even necessary (though sometimes it is of course), that preliminary investigations need to be more robust and that most often, any clinical ‘never or near miss’ events have a strong element of systems failure when root cause analysis is used.

Using the Incident Decision Tree series of questions as an initial guide helps to clarify the issues and the course of action needed. 

The new processes move away from the destructive and futile culture of blame which usually fails to achieve a single positive outcome.  Looking at the possibility that there has been systems failure, using root cause analysis, any critical incidents are dealt with in a constructive manner and ‘lessons truly are learnt’ as trusts like to say, when it usually means quite the opposite under the present system.

These new approaches may also prevent unnecessary formal disciplinary procedures where unsubstantiated allegations have been made because of personality clashes, or worse still, bullying behaviour by inept, incompetent even possibly psychopathic managers.  The damage to people’s health, relationships and career to name just a few outcomes of the destructive nature of suspension and all that follows, is immense.  Employees disappear into the NHS ‘Black hole’ a place  little recognised by the public till recently, thanks to the high profile whistleblowers and the reporting of the often illegal actions taken against them to silence them.

What now needs to happen is that these improvements are rolled out throughout the NHS and made mandatory, with reports to a central agent to identify where there are problems in an organisation.

What a hope and what a difference it would make.  Thank you Roger.
Julie Fagan  

Wednesday, 20 September 2017

Dysfunctional NHS managers with narcissistic or psychopathic personality disorders

A contact recently sent me an article about people with narcissistic personality disorders.  If you enter those words into your search engine, several articles will appear giving the same information.  Most of it is copyright.  It was new information to me. 

There is some work on the difference between psychopaths and narcissists on line too.  One writer says not to worry about the label, just avoid becoming a victim.  That is all very well in personal relationships if you can get away from them, but very different if you have to work with them. 

Signs of serious problems will be the number of staff who leave.  Another sign is the number of staff who are being suspended, a very effective way of destroying an innocent person who dares to complain.  My strong advice in those situations is to leave.  If you read the stories on the  website and see what power and harm these people can do, you will understand why I write that.

Why do organisations fail to recognise this obvious sign and continue to support the perpetrator, unless of course the whole culture is one of bullying by the management team including the person at the helm, the chief executive?

If you are or have suffered at the hands of a malfunctioning manager/team leader/ work colleague, who is unbelievably bullying and manipulative the information is very relevant.  The signs of these disorders are very clear by the way they behave.  For example, they never apologise and never take responsibility for their actions.  It will be yours or someone else’s fault.  

They lack empathy.  They really don’t care.  For narcissists, the theory is that the person is deeply hurt from childhood and cannot face dealing with the hurt.  For the psychopath, there is no obvious reason why they lack emotional intelligence. 

I feel sad for these people.  Treatment is not easy or obvious and if they don’t realise they have a problem, then the future looks bleak.

I feel alarm for their victims because the perpetrators are so powerful within the structures of the NHS due to the absence of accountability, the anonymity of the people working in the organisations and the perpetual culture of blame that encourages this type of behaviour. And the Department of Health has too many problems to deal with this one even if it wanted to it seems inspite of the huge costs.  How will it ever change?

If you have any ideas please email me at Thank you