Disciplinary Procedure And Disciplinary Rules

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					            ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS

                                           NHS TRUST



                                            NHS
                                    TRUST POLICY

                            Disciplinary Procedure
                                      And
                              Disciplinary Rules


                NUMBER:                                  A01

                AUTHOR:                                  Bryan Carpenter
                                                         Director of Human Resources




                APPROVED BY:                             JCNC
                                                         UMB


                                                         ………………………..
                                                         (Signature)


                PRODUCED:                                                      February 2005

                REVIEWED IN FULL

                NEXT REVIEW:                                                   February 2008




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           THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALS NHS TRUST



                                   DISCIPLINARY PROCEDURE

                                                 and

                                       DISCIPLINARY RULES



                                                                                              Page

  1     Introduction                                                                            3

  2     General Principles                                                                      3

  3     Procedural Steps                                                                        6

  4     Appeals                                                                                 8

        Action in the event of Police Enquiries or Legal Proceedings

        Review

        Guidance on Disciplinary Rules/Offences (Appendix 1)                                   10

        Levels of Management who may give warnings and dismiss staff (Appendix 2)              12

        Medical and Dental Staff (Appendix 3)                                                  13

        How to make a Statement (Appendix 4)                                                   14

        Procedure for Formal Disciplinary Appeals (Appendix 5)                                 15

        Guidelines for drug errors/Adverse incidents (Appendix 6)                              16

        Dealing with Poor Performance – Guidance for Managers (Appendix 7)                     17

        Occupational Health Assessment Form (Appendix 8)                                       18




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             THE ROYAL BOURNEMOUTH & CHRISTCHURCH HOSPITALS NHS TRUST

                                     DISCIPLINARY PROCEDURE

1.      INTRODUCTION

1.1     Application and Scope

        This procedure applies to all staff employed by the Royal Bournemouth & Christchurch
        Hospitals NHS Trust but does not apply to self employed workers or private contractors
        working with the NHS. It takes account of Whitley Council agreements made up to October
        2004.

        The arrangements set out in the Trust’s Policy E01 - Procedure to be followed in the event of
        concerns being raised regarding clinical performance of Senior Medical Staff and Policy E02 –
        Policy on restriction of practice of medical staff and exclusion of medical practitioners from
        work concerning the professional conduct and professional competence of medical and dental
        staff are not superseded by this procedure.

1.2     Objectives

        This procedure aims to: -

        a)       Ensure the safe and effective operation of the Trust.

        b)       Ensure that management, unions and employees are aware of their rights and
                 obligations in respect of disciplinary and appeals machinery.

        c)       Ensure that disciplinary action is fairly and consistently applied throughout the Trust.

        d)       Promote and maintain high standards of conduct, professionalism and attendance.

2.      GENERAL PRINCIPLES

2.1     Counselling

        In many cases the right word, at the right time and in the right way may be a more satisfactory
        method of dealing with a breach of discipline than a formal interview.

        When counselling an employee, the following guidance should be borne in mind: -

        •    It is essential to hold the discussion out of the hearing of other employees. It should be a
             two-way discussion, aimed at pointing out any shortcomings in conduct or performance
             and encouraging improvement. Criticism should be constructive, and the emphasis
             should be on finding ways in which the employee can remedy any shortcomings.

       •     Listen to any explanation put forward by the employee. If it becomes evident that there is
             no case to answer this should be made clear to the employee.

       •     Where an improvement is required, make sure that the employee understands what
             needs to be done, how performance or conduct will be reviewed, and over what period.
             The employee should be told that if there is no improvement, the next stage will be the
             formal disciplinary procedure.

       •     Take care that a counselling interview does not turn into a formal disciplinary hearing. If,
             during the meeting it becomes obvious that the matter is more serious, the discussion
             should be adjourned and it should be made clear that the matter will be pursued under the
             formal disciplinary procedure.

       •     Keep a note of any counselling for reference purposes if improvement is required the note
             should include information on how performance or conduct will be reviewed and over
             what period.



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2.2     Investigation

        The manager/supervisor should find out all the relevant facts promptly including anything the
        employee wishes to say. If there are witnesses, statements should be obtained from them at
        the earliest opportunity. The manager should be clear about the precise nature of the
        offence. Personal details such as age, length of service and any current warnings should be
        obtained before the hearing as well as any necessary records or relevant documents.

        In serious disciplinary cases which could result in dismissal, the manager carrying out
        the investigation should not be the same as the manager who would make the decision
        to dismiss.

        Managers should advise the staff making the statement to seek advice from their union
        representative or colleague, or refer to Appendix 4, “How to Make a Statement”. Following
        investigation the Manager, acting on advice from their Human Resource Manager, shall
        decide what further action should be taken.

2.3     Representation

        Employees have a Statutory Right to be accompanied by their Union representative or by a
        friend not acting in a legal capacity, during all stages of the process. A member of staff who
        has been requested to accompany a colleague during the disciplinary process is entitled to
        take a reasonable amount of paid time off duty to fulfil this responsibility.

2.4     Type of Warning

        It may not be necessary to follow all the procedural steps set out below in every case. The
        point at which the procedure is entered or the omission of any of its stages will be entirely
        dependent on the degree of seriousness of the offence. A series of minor offences or a
        repetition of one offence may involve working through the entire procedure whilst a serious
        offence may lead directly to a final warning. Gross misconduct may lead to dismissal without
        prior warning.

        Appendix 1 to this procedure gives examples of the interpretation of disciplinary rules.

2.5     Records

        In general, warnings for minor offences will be valid for up to 6 months, whilst final warnings
        will remain in force for 12 months or more.

        Warnings should normally cease to be ‘live’ following the specified period of satisfactory
        conduct and should be disregarded for future disciplinary purposes. There may however be
        occasions where an employee’s conduct is satisfactory throughout the period the warning is
        in force only to lapse very soon thereafter. Where a pattern emerges and there is evidence of
        abuse, the employee’s disciplinary record should be borne in mind in deciding how long any
        current warning should last.

2.6     Authorised Officers

        Appendix 2 outlines the levels of management who may dismiss or give warnings.
        Dismissal of staff will always be the subject of consultation with an appropriate HR Manager.

2.7     Human Resources Involvement

        Management are advised to contact their Human Resources Manager as soon as an incident
        occurs which may lead to disciplinary action being taken. A Human Resources Manager
        must always be consulted before a final warning or dismissal takes place.




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2.8     Conduct of Disciplinary Interviews

        Employees should be given notification of the details of the issues involved, including
        documentary evidence where appropriate, normally seven days in advance of a disciplinary
        hearing.

        At the commencement of any interview at which disciplinary action may be taken against the
        employee, the supervisor or manager must state clearly that the interview is being held under
        the formal disciplinary procedure.

        Employees will be able to claim time off in lieu or be paid for attending a disciplinary interview
        if such a hearing is conducted outside normal working hours.

2.9     Sickness absence during disciplinary proceedings

        It is in the interests of the employee for the disciplinary hearing to be held as quickly as
        possible. However, if an employee becomes sick during disciplinary proceedings, which
        prevents them from attending the hearing, then a doctor’s medical certificate must be
        provided. A second date for the hearing should be arranged for the day after the expiry of the
        medical certificate or as soon as possible after that date. The employee should be notified in
        writing of the details of the re-arranged hearing. If the employee is still sick for the second
        date, then they will be referred to the Occupational Health Doctor who will advise on when the
        employee will be fit to attend a disciplinary hearing. It may be appropriate for Occupational
        Health to contact the employee’s GP to ascertain whether or not there is any other relevant
        medical condition which the disciplinary panel should consider. (The Occupational Health
        Doctor will be asked to complete the form Appendix 8 and to give a copy to the employee.)

        Where the reason for sickness does not preclude the employee attending a disciplinary
        hearing and the employee is willing for the hearing to proceed it can be held whilst the
        employee is off sick. Alternatively, the disciplinary hearing may be held in the absence of the
        employee. The employee may send in a written statement in answer to the allegations to be
        considered by the panel and/or have their union representative attend on their behalf.

2.10    Professional Advice and Involvement

        The relevant professional adviser/manager should always be consulted over standards of
        performance involving the professional conduct or competence of professional staff. Where
        an employee is a member of a profession and is accountable to the manager who is not
        within that profession and is subject to a disciplinary enquiry relating to a professional issue,
        then the appropriate professional adviser/manager will be fully involved in all aspects of the
        disciplinary process. Human Resources Managers should be consulted where doubt exists
        relating to the application of the disciplinary procedure. In cases of a serious breach of
        professional standards the appropriate professional adviser/manager should refer the
        employee to the relevant regulatory body. Any allegation made against a health professional
        who is on the health professions council to the effect that their fitness to practice is impaired
        by misconduct, lack of competence, conviction or caution for a criminal offence or physical or
        mental health must be reported to the HPC.

2.11    Suspension

        The suspension of an employee from duty is not a disciplinary measure in its own right, and
        must only be used as a means for allowing sufficient time for enquiries to be completed or
        where it would be unsafe, or inappropriate, to allow the employee to continue working.
        Suspension will be authorised by Managers with power to dismiss, or a designated officer for
        example the site manager. Suspension must be confirmed in writing with the appropriate
        reasons. Employees will receive average weekly net earnings calculated over thirteen weeks
        prior to the date of suspension. The employee will be advised that they should not enter Trust
        property without prior agreement of the Trust, their Trade Union representative, the Staff


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        Counselling Service out of hours or the Occupational Health Department unless they are a
        patient.
2.12    Trade Union Representatives

        Where disciplinary action is being considered against an accredited Trade Union
        representative, the full circumstances of the case shall be discussed with a HR Manager and
        the appropriate full time Trade Union official.

2.13    Witnesses

        If a representative requests a witness to attend a disciplinary hearing or appeal, the manager
        of the witness should ensure the member of staff will be available.

        Witnesses will be able to claim time off in lieu or be paid for attending a disciplinary hearing or
        appeal if it is held outside normal working hours.

2.14    Resignation

        Where an employee chooses to resign rather than go through the disciplinary procedure, the
        Manager in conjunction with the Human Resources Manager will record the facts of the case.
        This information will remain on the personal file and may be used should the employee ask
        for a reference or apply to be re-employed.

3       PROCEDURAL STEPS

3.1     Disciplinary Sanctions

3.1.1   First Level Warning (Verbal Warning)

        If counselling has not led to an improvement in performance or evidence of a minor breach of
        policy, rules etc., has been obtained, the employee shall be invited to attend a formal meeting
        with the appropriate supervisor or manager. A first warning will be given if the circumstances
        warrant it. The employee must be sent written confirmation of the warning within seven
        working days of the meeting. The letter should state: -
                 - the reasons for the warning
                 - the consequences of a repeat offence
                 - the length of time the warning will be valid for, usually up to 6 months
                 - the right of appeal, including time limits
                 - to whom an appeal should be made.

        A signature should be obtained for receipt of the letter and an additional copy will be sent to
        the employee’s representative. (Refer to para 2-3 and 2-7.)

3.1.2   Second Level Warning (First Written Warning)

        If the offence is of a serious nature, or if performance or conduct has not improved as a result
        of a first warning, the supervisor or manager should invite the employee to a formal meeting
        and if the circumstances warrant it, notify the employee that a second warning will be issued.
        The employee must be sent a written confirmation of the first written warning within seven
        working days. The warning letter should state: -
                  - the reasons for the warning
                  - the consequences of a repeat offence i.e. if there is no sustained satisfactory
                     improvement or change in the conduct that led to the giving of the warning then a
                     Final Written Warning may be considered
                  - the length of time the warning wil be valid for, usually up to 6 months
                  - the right of appeal, including time limits
                  - to whom an appeal should be made.




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        A signature should be obtained for receipt of the letter and an additional copy will be sent to
        the employee’s representative. (Refer to para 2-3 and 2-7)


3.1.3   Final Warning (Final Written Warning)

        A final warning may be issued: -

        a)      where there has been repetition of offences already the subject of current warning(s)
                or
        b)      where serious misconduct has taken place.

        A formal meeting should be held with the employee and his/her representative at which all the
        relevant information should be considered. If the facts of the matter are substantiated, the
        employee should be told that a final warning will be issued not later than seven working days
        after the meeting, and that there is a right of appeal. The letter should state: -
                 - the reason for the warning
                 - that similar misconduct could lead to dismissal or some other action short of
                     dismissal
                 - the length of time for which the warning will be valid (usually 12 months –
                     see3.1.4)
                 - the right of appeal, including time limits and to whom an appeal should be made.

        A signature should be obtained for receipt of the letter and an additional copy will be sent to
        the employee’s representative. (Refer to para 2-3 and 2-7)

3.1.4   Action short of dismissal

        Where the very exceptional circumstances of a case are taken into account and a final written
        warning is issued when in normal circumstances dismissal would occur the final written
        warning will remain on file for up to 3 years.

3.1.5   Dismissal

        Dismissal may take place: -

        a)      following an act of gross misconduct;
        b)      where there has been repetition of offences already the subject of current warning(s).
                (A final written warning will already have been issued).

        In both types of dismissal the Manager empowered to dismiss will hold a meeting with the
        employee and his/her representative at the earliest possible opportunity and if the facts of the
        matter are substantiated the employee should be informed that the contract is being
        terminated and he/she is dismissed from employment. The appropriate period of notice
        should be given except in exceptional circumstances where it is decided to give dismissal
        without notice. The employee should be told of his/her rights of appeal.

        A dismissal letter should be issued to the employee within seven working days stating: -
                - the reason for dismissal
                - the amount of notice given
                - the date on which the contract of employment will terminate
                - the right of appeal including time limits and to whom an appeal should be made.

        A signature should be obtained for receipt of the letter and an additional copy will be sent to
        the employee’s representative.

        Summary dismissal will not take place until the case has been fully investigated.          (See
        Appendix 1 – Gross Misconduct)



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3.2     Standard Procedures

        These should be followed in all cases other than extreme cases of gross misconduct



3.2.1   Step 1: Investigation

        The Manager/Supervisor should find out all the relevant facts promptly including anything the
        employee wishes to say (refer to para 2.2)

3.2.2   Step 2: Statement of grounds for action and invitation to meeting

        The Manager/Supervisor must set out in writing the employee’s alleged conduct or
        characteristics, or other circumstances, which lead him/her to contemplate taking disciplinary
        action against the employee and invite the employee to a meeting to discuss the matter. The
        Manager/Supervisor must send to the employee all relevant documentation whether gathered
        as part of the investigation or otherwise, which the allegations are based on, prior to the
        meeting.

3.2.3   Step 3: Meeting

        A meeting must take place before action is taken, except in the case where the action
        consists of suspension. The meeting must not take place unless the employee has been
        informed of the basis on which the allegations are based and the employee has had a
        reasonable opportunity to consider his/her response to that information.

        The employee must take all reasonable steps to attend the meeting. After the meeting, the
        Manager/Supervisor must inform the employee of his decision, within 7 working days of the
        meeting and notify him/her of the right to appeal against the decision if he/she is not satisfied
        with it.

3.2.4   Step 4: Appeal

        If the employee does wish to appeal he/she must inform the Director of Human Resources. If
        the employee informs the Director of Human Resources of his/her wish to appeal, the
        employee must be invited to attend an appeal meeting. Every endeavour will be made for the
        formal appeal to take place within 4 weeks of the receipt of the notice of appeal. The
        employee must take all reasonable steps to attend the meeting. The appeal meeting need
        not take place before the dismissal or disciplinary action takes effect. After the appeal
        meeting, the employer must inform the employee of his final decision.

3.3     General Requirement

        Each step and action under the procedure must be taken without unreasonable delay. The
        timing and location of meeting must be reasonable. Meetings must be conducted in a manner
        that enables both employer and employee to explain their cases.

3.4     Measures Short of Dismissal

        There may be situations where disciplinary action is required either because of misconduct or
        failure to meet required standards, but where dismissal, though justified, seems to be
        inappropriate.   In these circumstances the employee and, where appropriate, the
        representative, may agree with the management to measures short of dismissal.

4       APPEALS




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4.1     An employee has a right to appeal against a second level warning (first written warning) to the
        next level of Management. The next level of Management shall make a final decision on the
        appeal. There is no entitlement to an appeal hearing for a first level warning (verbal warning).



4.2     An employee has the right to appeal against a final warning or dismissal and this can be heard
        by a Formal Appeal Panel. An employee wishing to appeal should write to the appropriate
        Director of Human Resources and lodge an appeal in writing within 21 days of receipt of the
        warning or dismissal letter.

        Every endeavour will be made for the formal appeal to take place within 4 weeks of the
        receipt of the notice of appeal.

4.2.1   Formal Appeal Panel

        The Formal Appeal will be heard by a panel of three Trust Directors, one of whom shall be an
        Executive Director. The Appeal Panel will review a final warning or dismissal previously
        imposed.




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                                                                                           APPENDIX 1
                             GUIDANCE ON DISCIPLINARY RULES/OFFENCES

        It is not practical to draw up a detailed list of all occurrences which could lead to disciplinary
        action, as circumstances will always vary. The following is merely intended to be a range of
        examples to assist in determining appropriate courses of action.

        Minor Misconduct

        Examples of offences which might lead to a first level warning would be lateness without
        reasonable explanation, minor variation from accepted standards, minor causes of
        insubordination, verbal abuse to other members of staff, absenteeism, etc. Repetition of such
        offences could lead to further disciplinary action being taken.

        Serious Misconduct

        Failure to respond to previous warnings could result in either a second level or a final
        warning, depending on the severity of the misconduct, but additionally certain types of
        conduct could lead directly to this form of disciplinary action. Examples of breaches of
        discipline included in this category might be: -
                 - refusal to carry out reasonable instructions
                 - repeated failure to wear protective clothing as prescribed, or, a single case where
                     failure to do so placed the individual or others at considerable risk
                 - failure to carry out clear safe working practices where this resulted in a significant
                     risk to self or others
                 - unauthorised disclosure of matters of a confidential nature
                 - breaches of conduct according to the Professional Codes of Practice

        Gross Misconduct

        Examples of breaches of discipline which could warrant dismissal would include: -

        a)      Theft               Unauthorised possession of property belonging to the Trust,
                                    patients or staff

        b)      Corrupt             Unlawful receipt of money, goods, favours or excessive hospitality
                Practices           in respect of services rendered

        c)      Fraud               Any deliberate attempt to defraud the Trust or patient or members
                                    of staff. This would include the falsifying of time records, and
                                    obtaining employment by deception.

        d)      Assault/physical    Violence or malicious ill treatment of patients or other members of
                violence            staff.

        e)      Incapacity          Incapacity to perform normal duties through the consumption of
                through drink or    alcohol or the misuse of drugs. Due recognition will be taken of
                drugs               the Alcohol & Substance Misuse Policy.

        f)      Illegal             Being in possession of an illegal substance; or being involved in
                Substances          the sale or distribution of illegal drugs.



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        g)     Betting/gambling    Betting or gambling whilst on the Trust’s premises

        h)     Damage              Intentionally causing damage to the property of the Trust, patients
                                   or other members of staff.

        i)     Health & Safety     A deliberate act which seriously endangered the health or safety of
                                   oneself or others. Knowingly allowing a serious breach of the
                                   Trust and/or Statutory Health & Safety Regulations.

        j)     Confidentiality     Serious breaches of confidentiality.

        k)     Insubordination     Serious insubordination to senior employees

        l)     Professional        Serious breaches of conduct according to the Professional Codes
               Misconduct          of Practice.

        m)     Negligence          Negligence in the performance of the employee’s duties

        n)     Misuse              Misuse of the Trusts time, property or name

        o)     Misuse of the       Deliberately accessing internet sites containing pornographic,
               Internet            offensive or obscene material

        p)     Disrepute           Bring the Trust into serious disrepute

        q)     Serious bullying,   Any deliberate attempt to bully, unlawfully discriminate, harass or
               discrimination,     victimise patients or other members of staff whether on the
               harassment or       grounds or disability, race or sex or any other reason.
               victimisation




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                                                                                         APPENDIX 2

              LEVELS OF MANAGEMENT WHO MAY GIVE WARNINGS AND DISMISS STAFF
                           (For Medical and Dental Staff see Appendix 3)

        The levels of management at which warnings will be given and staff dismissed will be as
        follows: -

1.      Warnings


                    Level of Management                                   Level of Warning

        1.1 Immediate Manager                            First Level warning

        1.2 Head of Department/General Manager           Second Level warning

        1.3 Head of Department/General Manager           Final warning



        These levels of management will need clarification within Directorates and Departments. In a
        Department with few levels of management, the Head of Department/Manager may be
        involved in giving both second level and final warnings. For the same reason an Executive
        Director/Member of the Unit Management Board may be involved in giving a second level or
        final warning.

2.      Dismissal


                     Level of Management                              Level of Staff
                    empowered to dismiss                    who dismissing officer can dismiss

        2.1   Chairman, Chief Executive                 Executive Director
                                                        Managers who are members of the unit
                                                        Management Board

        2.2   Executive Director                        Managers at the level immediately below
                                                        Executive Director/Member of the Unit
                                                        Management Board

        2.3 Executive Director Director/Member of       All other staff
            the Unit Management Board


        Normally, the Executive Directors and Members of the Unit Management Board will only be
        present when a senior member of their staff is being dismissed but no dismissal will take


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        place without the appropriate Executive Director/Member of the Unit Management Board
        being informed beforehand about possible disciplinary proceedings which could lead to
        dismissal. The Executive Director/Member of the Unit Management Board may only delegate
        the responsibility to dismiss to General Manager or Head of Department.




                                                                                          APPENDIX 3

                                      MEDICAL AND DENTAL STAFF

        The following Senior Medical staff will be involved in the issue of warnings and/or dismissals.


         Disciplinary        Level of staff being disciplined       Level of Management applying
           Action                                                         disciplinary action


                                        Consultant                           Medical Director
            Warning

                                        Junior Staff                            Consultant


                                        Consultant                         Chief Executive and
                                                                            Medical Director
           Dismissal

                                        Junior Staff                       Medical Director and
                                                                            Clinical Director




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                                                                                        APPENDIX 4

                                        HOW TO MAKE A STATEMENT

Name ………………………………………………………………………………………………………………

Department ……………………………………………………………………. Extension No. ………………

Position/Grade ……………………………………………………………………………………………………

Address ……………………………………………………………………………………………………………

Home telephone no. ……………………………………………………………………………………………..

Your Union/Organisation ………………………………………………………………………………………...

Your representative’s name ……………………………………………………………………………………..

Representative’s address ………………………………………………………………………………………..

Representative’s telephone no. …………………………………………………………………………………

Line Manager ……………………………………………………………………………………………………..

Date and time of incident ………………………………………………………………………………………..

Number of staff on duty at time of incident …………………………………………………………………….

Names of staff on duty …………………………………………………………………………………………..

Witnesses to the incident ………………………………………………………………………………………..


Have you been suspended?         Yes/No           If ‘yes’ – date suspended ………………………………

Name of manager involved ……………………………………………………………………………………...

If you feel a diagram would be useful, on a separate piece of paper draw the work place area where
the incident took place.

Describe in detail the events leading up to the incident.

Describe the incident, who was involved, the names of any people who could help explain what
happened.




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Describe what action you took after the incident, and who you contacted, stating the content of your
conversation.

You should seek the help of your union representative if you are a member, for advice.

It is of paramount importance that you truthfully state and record the facts and not express opinions.

The statement should be written on A4 paper. You should make 5 clear photocopies which should be
given to: -

a) the investigating manager     b) your representative x 2        c) yourself x 2




                                                                                              APPENDIX 5

                      PROCEDURE FOR FORMAL DISCIPLINARY APPEALS

At the hearing of an appeal before the Panel, the following procedure shall be observed:

a)      The representative of the appellant shall state the case for the appellant and call any
        witnesses.

b)      The members of the Panel and the representative of the Trust shall be entitled to question
        any witnesses called.

c)      The representative of the appellant may re-examine his or her witnesses on any matters
        referred to in their examination by members of the Committee or the representative of the
        Trust.

d)      The representative of the Trust shall state the case for the employer and call any witnesses.

e)      The members of the Panel and the representative of the appellant shall be entitled to question
        any witnesses called.

f)      The representative of the Trust may re-examine his or her witnesses on any matters referred
        to in their examination by members of the Panel or the representative of the appellant

g)      The representative of the appellant shall be entitled to reply to the Trust’s case.

h)      Nothing in the foregoing procedure shall prevent the members of the Panel from inviting the
        representative of either party to elucidate or amplify any statement he or she may have made;
        or from asking the representative such questions as may be necessary.

i)      The panel may at their discretion adjourn an appeal in order that further evidence may be
        produced by either party to the dispute.

j)      The panel will give their judgement in writing to both parties as soon as possible and normally
        within seven days.




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                                                                                        APPENDIX 6

                                 GUIDELINES FOR ADVERSE INCIDENTS

EACH INCIDENT must be judged and considered on its individual circumstances. However, under
normal circumstances errors will be dealt with via appropriate counselling, re-training, support and
supervision.

ADVERSE INCIDENT POLICY STATEMENT (APRIL 2005)

“The Trust’s procedures for reporting and investigating incidents aim to support active
learning and to ensure that the positive lessons learnt from the adverse events are
embedded into the organisations culture and practices. Learning from adverse events is an
essential part of Clinical Governance and Risk Management within the Trust. The emphasis
of the Policy is therefore one of problem solving and learning rather than blame and
punishment”

“It is recognised that fear of reprisal, blame and/or disciplinary action may deter staff from
reporting an incident (or potential incident). The policy of the Trust Board is that unless there
is clear evidence of flagrant malpractice, maliciousness, illegal behaviour or intent to harm,
the disciplinary policy will not form part of the response to an incident investigation”


INTRODUCTION

1.      With any clinical procedures a high professional standard is expected.

2.      We want to encourage ALL STAFF to report clinical errors and for them to feel comfortable
        and to be open, frank and honest in discussions relating to adverse patient safety incidents.
        Any adverse incident should be reported in accordance with the Trust’s Adverse Incident
        Policy.

3.      The patient should be reviewed after any adverse event.

4.      Each incident must be judged on it’s own individual circumstances.


CONSIDERATION BEFORE ANY DECISION

1.      Undertake a full and proper incident investigation in accordance with the Trust AIR Policy and
        Procedures for the Investigation of Adverse Events.



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2.      Obtain full written statements from staff involved including: name of the employee,
        wards/department, date and time of incident, Dr. informed – date, time and action advised by
        the doctor, description of the circumstances of any clinical error, contributory factors, details
        of when appropriate manager informed and, any immediate and further action taken.

3.      Circumstances in which the incident occurred and the contributory and root cause factors
        involved, e.g. availability and compliance with procedure; how busy was the ward/dept; is
        more than one employee involved; was there a prescribing, dispensing or administration
        error; the training the employee had received.



DISCIPLINARY ACTION IS MORE LIKELY IF:

        Blatant disregard of procedures – including failure to report incident.

        Repeated malpractice reflecting a repeated unwillingness to comply with safety standards,
        accept personal responsibility for safety and, reflect and learn from the error for future

        Flagrant malpractice

        Intent to harm

        Illegal behaviour e.g. Theft of drugs, taking drugs for personal use



NATIONAL PATIENT SAFETY AGENCY – INCIDENT DECISION TREE


The NPSA has developed an Incident Decision Tree (ICT) tool to help NHS managers take a fair and
consistent course of action with staff following a serious patient safety incident. The IDT forms part of
a suite of NPSA Tools developed to promote an open and fair culture in the NHS – a culture in which
staff feel able to report patient safety incidents without undue fear of reprimand. The Incident
Decision Tree therefore helps to focus upon what and why instead of who. The tool focuses on why
the individual acted in a certain way rather than who was to blame.

The IDT can be used for any employee involved in a patient safety incident. However, although it
promotes good management practice it is not designed for use in other situations such as poor
performance or absenteeism.

The        IDT      can       be     downloaded         from         the          NPSA    web        site
http://81.144.177.110/health/resources/incident_decision_tree.

 The Incident Decision Tree is based on a flowchart and guides managers through a series of
structured questions about the individuals actions and behaviour at the time of the patient safety
incident. The questions move through 4 sequential tests:

a)       The Deliberate Harm Test. In the majority of patient safety incidents the individual had the
patients well being at heart. However in a few exceedingly rare cases the intent may have been to
cause harm. The IDT poses questions to eliminate this possibility at the outset of the investigation.

b)       The Incapacity Test. These questions help to identify whether ill health etc contributed to the
patient safety incident. I.e. was the member of staff incapacitated in such a way as to affect safe
practice.

c)     The Forsight Test. If deliberate harm and incapacity have been discounted the next test
examines whether protocols and safe working practices were adhered to.



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d)       The Substitution Test. If protocols were not in place or proved ineffective, the substitution
test helps to assess how a peer would have been likely to deal with the situation.

Working through each test in turn possible reasons for individuals actions are reviewed, a list of
recommended options then appear for consideration.

The IDT was developed nationally by the NPSA involving input from the medical and nursing
professional bodies and staff side representation. Its is recognised as a means for ensuring that the
NHS becomes more open about the way in which it deals with professional mistakes and recognises
that honest failures should not be responded to with blame and retribution but by learning and
support.




                                                                                        APPENDIX 7

                             DEALING WITH POOR PERFORMANCE
                                   Guidance for Managers

Introduction

Consistent poor performance at work is a disciplinary issue, however, there are a number of
measures which should be considered before invoking the disciplinary process.

Informal Discussion

It is necessary to ensure that the employee is made fully aware when his/her performance is not
reaching the required standard. Initially this should be through informal discussion when the manager
should quote specific examples. A record should be kept on the personal file detailing the date and
content of the discussion and the agreed way forward.

Counselling

If, following informal discussion, performance does not improve/reach the required standard then
counselling should be considered. See Section 2.1 of the Disciplinary Procedure.

Prior to the counselling meeting, the employee should receive a draft framework which assesses
current performance and outlines areas for improvement.

The framework should comprise: -

•      Areas of Performance Giving Concern

•      The Effects of Poor Performance

•      Required Standards

       The employee may believe that his/her performance has been satisfactory. It is, therefore,
       important to detail what standards are required.

•      Development Plan

       This section should identify ways in which performance can be improved. This may include
       objective setting, on the job coaching or appropriate training.

•      Monitoring


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        This section should clearly state what monitoring will take place, by whom, the frequency and
        time scale. It should also detail how the monitoring process will be recorded.

The counselling meeting should be followed with a letter from the Manager which details any
amendments made to the framework as a result of the discussion and ideas put forward by the
employee. It should also detail at what stage the disciplinary procedure will be invoked if the required
standard of performance is not achieved.

(One copy of this form is to be given to the employee, one copy sent to their Human Resources
Manager/Line Manager and one to be kept on the Occupational Health File).




                                                                                          APPENDIX 8

                         OCCUPATIONAL HEALTH ASSESSMENT FORM
                                  Disciplinary Hearings



Name of Employee: ………………………………………………………………………………………………


Date: ……………………………………………………………………………………………………………….


The above named employee has had an appointment with regards to their fitness to attend a
disciplinary hearing. I consider that they are fit to attend a disciplinary hearing on: -


(insert date of scheduled hearing if known) ……………………………………………………………………


Or after: -


(Insert date of when employee will be fit enough to attend hearing) ………………………………………..


………………………………………………………………………………………………………………………



Signed: …………………………………………………………………………………………………………….


Designation: ……………………………………………………………………………………………………….




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