Policy on Supporting Staff Involved in a Traumatic/Stressful. Incident, Complaint or Claim Associated with Employment

Transcription

1 Policy on Supporting Staff Involved in a Traumatic/Stressful Incident, Complaint or Claim Associated with Employment DOCUMENT CONTROL: Version: 3 Ratified by: Human Resources and Organisational Development Group Date ratified: 01 November 2012 Name of originator/author: Director of Workforce and Organisational Development Name of responsible committee/individual: Human Resources and Organisational Development Group Date issued: 07 December 2012 Review date: November 2015 Target Audience All staff

2 CONTENTS SECTION PAGE NO 1. INTRODUCTION 3 2. PURPOSE 3 3. SCOPE RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES Duties covered under this policy Chief Executive and Board of Directors Assistant Directors/ Head of Department Line Managers Employees Occupational Health Counselling Services Human Resources Department Trade Unions/Professional Organisation Representatives (Staff Side Representatives) PROCEDURE/IMPLEMENTATION Action for Line Managers when an employee is experiencing difficulties Procedure for Accessing Support Ongoing Support where employees are experiencing difficulties Witnesses Record Keeping Monitoring Funding Communication and Awareness TRAINING IMPLICATIONS 10 7 MONITORING ARRANGEMENTS EQUALITY IMPACT ASSESSMENT SCREENING Privacy, Dignity and Respect Mental Capacity Act LINKS TO ANY ASSOCIATED DOCUMENTS REFERENCES APPENDICES Appendix A - Flow Diagram for the provision of Support to Employee Appendix B - Trust protocol for supporting staff following adverse events/incidents Page 2 of 18

3 1. INTRODUCTION Employers have a duty of care to ensure their employees are not harmed by work related stress and in recognition of the fact that any involvement in traumatic/stressful incidents, complaints or claims can be a source of stress for employees, the Trust is committed to offering support in an attempt to minimise such effects which, wherever possible, is tailored to meet the individual needs of employees. This document is designed to provide best practice guidance for all managers in offering support to employees involved in incidents, complaints or claims and to reduce the likelihood of employees being absent from work or leaving as a consequence of poor experiences following traumatic and stressful incidents or investigations. 2. PURPOSE The purpose of this policy is two-fold: 1. To make a commitment to provide a range of support for employees in the general course of their work but in particular to support them when they are involved in a traumatic/stressful incident, complaint or claim and; 2. To set out guidance on the form of that support and the method through which it can be accessed 3. SCOPE This policy covers all employees and will apply specifically to those situations where an employee is involved in a traumatic/stressful incident, complaint or claim associated with their employment. It is acknowledged that there are other employment policies, which recognise the need for employees to be supported. Whilst the arrangements set out herein to provide pastoral and counselling support are universal, reference to those policies should be made, where relevant, to ensure that the right form of support has been identified. The application of some elements of support set out in this policy may be constrained where there is a contra-indicator to the Trust providing direct support to the employee in question e.g. where there is prima facie disciplinary case arising out of an incident. In such circumstances the Trust will nevertheless signpost the employee to an appropriate source of support. The following are examples where employees may require support in relation to this policy framework. Traumatic/Stressful incidents Page 3 of 18

4 Serious Incident Investigations Coroners Inquests Complaints Allegations of Negligence (Clinical Negligence claims) Non-Clinical Litigation (e.g. claims brought by staff or visitors) Police Enquiries or Investigations Professional Conduct Hearings (e.g. General Medical Council, Nursing and Midwifery Council) Child Protection / Care Proceedings Court Hearings (such as Clinical Negligence claims) Tribunals The above list is not exhaustive. Where applicable employees are encouraged to share this with HR, their line manager or their staff side/trade union/professional organisation representative. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Duties covered under this policy 4.2 Chief Executive and Board of Directors The Chief Executive and Board of Directors are responsible for the health and well-being of Trust employees, and to achieve this must have effective systems in place to manage any traumatic events which may occur. They are also responsible for ensuring that a fair and consistent approach is taken to individuals involved in traumatic or stressful incidents, investigations, complaints, claims and Coroners Inquests 4.3 Assistant Director/ Head of Service The Assistant Directors/ Heads of Service are responsible for the implementation of this policy within their Business Divisions/ Directorates. Assistant Directors and Heads of Service have a duty to ensure that Line Managers follow the requirements of this policy in a timely manner and offer immediate and ongoing support to employees involved in an incident, complaint or claim. Additionally Assistant Directors and Heads of Service are responsible for ensuring that the provision of support mechanisms to employees are documented and that monitoring arrangements are in place in order to identify any shortfalls and take steps to ensure that these are addressed. Page 4 of 18

5 Assistant Directors/Head of Service will review all incidents or allegations of negligence, to ascertain whether there is a need to offer support to employees Assistant Directors/Head of Service should review the support offered to determine any future learning s. 4.4 Line Manager Line managers have a duty to raise awareness of this policy with employees through local induction processes and when this policy framework is being utilised/applied. Line Managers must respond positively and promptly to employees who highlight an issue, need or concern. Each line manager will be responsible for supporting their employees when they are involved in an incident, complaint or claim. In accordance with the procedure set out below. This support will take the form of an initial discussion with the employee to ascertain how they are feeling and to identify what type of support may be most beneficial to them. The line manager must also report to the Director of Workforce and Organisational Development any comments received from employees about the support they have utilised through use of this policy as a result of a major incident. The line manager must therefore be aware of this policy and of the types of support signposted within it. He/she will also consider any recommendation(s) from the Occupational Health Service regarding alternative sources of support for the employee, which is not directly accessible within the internal Trust provision. The line manager will also be responsible for assessing the employee s presentation at work both immediately after the incident and for a subsequent period thereafter to ensure that the after-effects of the incident are not having a continuing adverse impact on their employee. This should be done via regular meetings, supervision or via sickness absence review meetings if the employee is absent from work as a consequence, all of which should be clearly documented on the employee s personal file. Should an incident take place at a time when the customary line manager is not available e.g. out of hours, then the manager dealing with the incident at the time it occurs should act as a proxy until such time as the line manager is available to assume their customary role. The line manager or proxy has a duty to record all offers of support and/or any actions taken as a result of a traumatic/stressful incident. (please refer to Paragraph 5.4) 4.5 Employees Page 5 of 18

6 Are encouraged to raise issues in an appropriate and timely way with their Line Manager, or if they feel unable to do this, with another appropriate party. Employees may also wish to raise concerns in accordance with the Disclosure of Concerns on Healthcare Matters (Whistleblowing) Policy To work in partnership with their manager, colleagues and staff representatives where appropriate and provide all appropriate information to enable the appropriate response to their situation. 4.6 Occupational Health The Occupational Health Service will provide help and support whether the referral is made by the line manager or the employee self refers. They will offer both direct support and, where appropriate, signpost the employee to alternative sources of support. 4.7 Counselling Services External Counselling services are available to support employees in a range of circumstances which can be accessed through Human Resources/Occupational Health. If an employee wishes to access the counselling support services, they should discuss this with their Line Manager or Human Resources who will share the list of counsellors. 4.8 Human Resources Department It will be the responsibility of the Human Resource Department to raise awareness of this policy through Trust Induction and inclusion in the Employee Handbook. The Human Resources Department will, in conjunction with the Occupational Health Service, be responsible for advising the Line Manager on appropriate methods of support to an employee suffering any ill health as a consequence of involvement in an incident, complaint or claim in line with the Policy Relating to the Management of Sickness Absence. Furthermore the Human Resources Department will be involved in supporting the process undertaken to investigate any concerns raised by an employee involved in an incident, complaint or claim raised though the Trust Grievance and Dispute Procedure. 4.9 Trade Unions/Professional Organisation Representatives (Staff Side Representatives) Trade Union/Professional Organisation Representatives support the Trust in its efforts to ensure that all employees are supported and Page 6 of 18

7 received tailored support following a traumatic/stressful Incident, Complaint or Claim. to inform the workforce of the policy and to encourage employees who may have problems, to use the facilities and support mechanisms available within this policy and procedure. to advise members of their rights and responsibilities under the policy and to be available to represent individuals at appropriate 5. PROCEDURE/IMPLEMENTATION 5.1 Action for Line Managers when an employee is experiencing difficulties Each line manager will be responsible for supporting their employees when they are involved in an incident, complaint or claim. In accordance with the procedure set out below. This support will take the form of an initial discussion with the employee to ascertain how they are feeling and to identify what type of support may be most beneficial to them. The line manager must also report to the Director of Workforce and Organisational Development any comments received from employees about the support they have utilised through use of this policy as a result of a major incident. 5.2 Procedure for accessing support immediate support offered to employees The customary procedure to be followed when supporting an employee who has been involved in an incident, complaint or claim is set out in the flow chart attached at Appendix A. The process is illustrative rather than prescriptive and the guiding principle of tailoring the offer of support to the needs of the employee will always take precedence Each line manager will be responsible for supporting their employees when they are involved in an incident, complaint or claim. In accordance with the procedure set out below. This support will take the form of an initial discussion with the employee to ascertain how they are feeling and to identify what type of support may be most beneficial to them. The line manager must also report to the Director of Workforce and Organisational Development any comments received from employees about the support they have utilised through use of this policy as a result of a major incident. The support process is designed to: Page 7 of 18

8 Value, support and to protect employees. Ensure a fair and consistent approach to individuals involved in investigations and/or proceedings. Provide support which is in the best interests of the individual. Help reduce stress and anxiety caused by involvement in incidents or investigation. Reduce instances of employees leaving or being absent due to poor experiences of investigations and/or proceedings. Balance the duties and needs of the organisation against the need to protect and support employees. Aid liaison with appropriate supporting contacts internally and externally. It is recognised that the type and source of support required may vary according to the individual circumstances. This may range from a listening ear to help an employee come to terms with a difficult situation; moral and/or technical support when an employee has to give evidence e.g. at Coroner s court; through to professional/clinical help to deal with traumatic experiences. Consideration can also be given to temporary/permanent redeployment, this will require the input of the Occupational Health Service taking into account the needs of all parties. The timeline for the duration of the support may also be dependent upon the specific circumstances of the case, the length of any investigations or court proceedings, or the length of trauma or ill health experienced by the employee and as indicated above the source of support may be internal to the Trust or external. As a basic expectation, pastoral support for the employee may come initially from the line manager but may also come from other colleagues either formally or informally. Formally the Occupational Health Service and members of the Counselling Service may be primary sources of support, as may members of the Trust Chaplaincy team. Pastoral care can also be a term generally applied to the practice of looking after the personal and social wellbeing of employees. It can encompass a wide variety of issues including health, social education, behavior management and emotional support. It reflects the managerial responsibilities for managers to support employees. The Occupational Health Service will signpost the employee to other forms of clinical support if this proves necessary. A Trust protocol for supporting staff following adverse events/incidents is included at Appendix B. Page 8 of 18

9 5.3 Ongoing Support where employees experiencing difficulties Individuals, regardless of grade/banding or position, may often feel anxious about their involvement and their future role in the process. Support needed may vary, depending on the issues and the specific needs of the individual. The following are examples of support arrangements that may be made available to employees: Provision of a Named Contact who will ensure that appropriate support is made available Provision of regular, clear, concise information regarding any investigation or proceedings Advice from relevant professional groups/staff side (e.g. RCN, RCM, GMC, Unison) that may be able to help Agreed timetable with the individual for review and communication Support for witnesses at Hearings etc as appropriate Access to legal and professional advice if appropriate Regular updates on case outcomes and recommendations Opportunity to evaluate the effectiveness of the support offered and provide suggestions on improvement Referral to Occupational Health as required In circumstances where a conflict of interest exists between the organisation and an employee, employees will be encouraged to seek external advice from professional groups for example the RCN, GMC or their Union Representative. They may also choose to seek external legal advice from groups such as the Medical Defence Union or Medical Protection Society. 5.4 Witnesses According to the circumstances, specialist support e.g. the Trust legal advisors, may be available where the employee is required as a witness to give evidence in proceedings.. Employees required to give evidence in proceedings may also consult with their trade union/ professional body, who will be able to support and assist the employee. Should an employee be required to act as a witness and need further support, they should speak to their line manager/ appropriate manager or seek advice from the Human Resources Department. 5.5 Record keeping The offer of support and any specific action by managers where employees are experiencing difficulties associated with a traumatic /stressful event will be recorded in the employees personal file by the line manager. 5.6 Monitoring Page 9 of 18

10 The responsibilities for monitoring compliance of this policy are detailed at section 7. Should any shortfalls be identified within the monitoring arrangements an action plan will be devised by the Assistant Director/ Head of Service to address such shortfalls, which will be shared with the Line Manager and relevant parties involved in order to ensure learning has taken place, and to minimise future shortfalls. 5.7 Funding The elements of support identified in this policy are principally covered by the Trust s current resources. Any requests for support outside the scope of this policy will be recorded and considered by the Director/Chief Operating Officer of the service in question 5.8 Communication and Awareness This policy and procedure will be communicated to all employees through inclusion on the Trust intranet and referenced to within the Employee Handbook. It will also be included in the briefings given to Appointing Officers. 6. TRAINING IMPLICATIONS There are no specific training needs in relation to this policy, but Appointing Officers and Line Managers will need to be familiar with its contents as well as any other individual or group with a responsibility for implementing the contents of this policy As a Trust policy, all employees need to be aware of the key points that the policy covers. Employees can be made aware through a variety of means such as; Local Induction / Employee handbook Team Brief One to one meetings / Supervision 7. MONITORING ARRANGEMENTS Area for Monitoring How Who by Reported to Frequency Duties covered under this policy IR1 forms Audit of processes undertaken by directorate Assistant Director/ Audit Team Director of Workforce and OD Ad hoc/ annually Page 10 of 18

11 Immediate support offered to staff Verbal feedback to line manager Staff Survey Line manager Director of Workforce and OD Ad hoc / annually Ongoing support offered to staff Advice available to staff in the event that they are called as a witness Action for managers or individuals to take if the staff member is experiencing difficulties associated with the event Staff Survey Sickness Absence Management Procedure Verbal feedback to line manager Request for information from HR Sickness absence management procedure Verbal feedback from line manager Feedback from Occupational Health Department Supervision arrangements HR/ Line Manager HR/ Line manager Line manager/ HR/ Occupational Health Department Director of Workforce and OD Director of Workforce and OD Director of Workforce and OD Ad hoc/ Annually Ad hoc as and when required Ad hoc. 8. EQUALITY IMPACT ASSESSMENT SCREENING - The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here 8.1 Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. Indicate how this will be met Policy does not relate to patients As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). Page 11 of 18

12 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Indicate How This Will Be Achieved. All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act (Section 1) Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. 9. LINKS TO ANY ASSOCIATED DOCUMENTS - Policy for the Prevention and Management of Work Related Violence Clinical Policies, section 6 - Policy for the Management of Serious Incidents General Policies - Being open, communicating service user safety incidents with service users and their carers Clinical policies, section 6 - Policy and Procedure for the handling of Formal Complaints General Policies - Claims handling Policy General policies - Incident Reporting Policy - Health and Safety policies - Personal Harassment policy Employment policies, section B, - Policy for the disclosure of concerns Employment policies, section B - Policy and Procedure for the Management of Disciplinary Matters Employment policies, section B - Policy Framework for the positive management of pressure /stress in the workplace Employment policies, section C - Policy Relating to the Management of Sickness Absence Employment Page 12 of 18

13 Policies Section C - Grievance and Dispute Procedure Employment Policies Section B 10 REFERENCES NHS employers (2005) Making the Stress Management Standards Work Post traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care. Clinical guideline 26, March (NICE) NHS Litigation Authority Risk Management Standards 11 APPENDICES Appendix A Flow Diagram for the provision of Support to Employees Appendix B Trust protocol for supporting staff following adverse events/incidents Page 13 of 18

14 Flow Diagram for the provision of Support to Employees APPENDIX A Traumatic/ stressful incident/ event occurs Meeting arranged for staff member with line manager or other appropriate manager (if meeting with line manager might compromise any investigation). Options for support are discussed Options available Offer entry into staff counselling scheme Further sessions of managerial support/ supervision Temporary adjustment to working arrangements Support via Chaplaincy Team Refer to Occupational Health Regular meeting with, and review by, Line or Appropriate Manager to assess for symptoms of continuing adverse impact on member of staff. Where severe symptoms are reported and/or evident refer to occupational health and/or advise individual to see GP. Further interview with manager to take place routinely to ascertain impact of event/experience on staff member and effectiveness of support to date. Ongoing support offered if required. All support to be clearly documented on personal file No symptoms reported or evident - no further action Page 14 of 18 Symptoms reported or evident - refer (back) to Occupational Health

15 APPENDIX B Trust protocol for supporting staff following adverse events/incidents This protocol covers the actions of the trust in the event of staff requiring support following adverse events or incidents. Examples of adverse incidents would be; Following the death of a patient Witnessing, or being the victim of, a violent incident or Major incident This protocol utilises Department of Health guidelines (DH, 2005) for post traumatic stress disorder (PTSD); Guidance for the Provision of Psycho-social Support to Staff during a Flu Pandemic and addresses the actions the Trust will take in the event of staff requiring support following adverse events or incidents. Post-traumatic stress disorder (PTSD) develops following a stressful event or situation of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. PTSD does not therefore develop following those upsetting situations that are described as traumatic in everyday language, for example, divorce, loss of job, or failing an exam. PTSD is a disorder that can affect people of all ages. Around 25 30% of people experiencing a traumatic event may go on to develop PTSD. (DH, 2005) This suggests that employee support will fall into two distinct processes dependent upon the nature of the event or experience. In the event of a Major Incident we are likely to see large numbers of employees requiring support and /or psychological therapy interventions. It will be necessary, if this were the case, to consider the following: Offering overtime to psychological therapy employees Requiring staff to temporarily suspend non-urgent service user appointments (under supervision) Contracting with external providers of counsellors Page 15 of 18

16 Process 1 following a threatening/catastrophic event/major incident Meeting arranged for staff member with line manager or other appropriate manager if this might compromise any investigation. Manager will consider leave arrangements or adjustments in the short term. Staff routinely monitored for evidence of PTSD symptoms (see appendix 1) Where severe symptoms are evident refer to occupational health and/or advise individual to see GP. Second interview with manager to take place, to ascertain impact of event/experience on staff member. No symptoms reported or evident no further action Symptoms reported or evident refer to occupational health for appropriate diagnosis Treatments Trauma focused CBT Or EMDR NB the systematic provision of individual de-briefing that focuses on the incident should NOT be offered routinely Page 16 of 18

17 Process 2 Following a distressing or stressful incident/event that is not catastrophic or extremely threatening Meeting arranged for staff member with line manager or other appropriate manager if this might compromise any investigation. Offer entry into staff counselling scheme, and/or Further sessions of managerial support/supervision and/or Refer to occupational health Temporary adjustments to working arrangements Support from the Chaplaincy Team The symptoms of PTSD (DH, 2005) The most characteristic symptoms of PTSD are re-experiencing symptoms. PTSD sufferers involuntarily re-experience aspects of the traumatic event in a very vivid and distressing way. This includes flashbacks where the person acts or feels as if the event was recurring; nightmares; and repetitive and distressing intrusive images or other sensory impressions from the event. Reminders of the traumatic event arouse intense distress and/or physiological reactions. In children, re-experiencing symptoms may take the form of reenacting the experience, repetitive play or frightening dreams without recognisable content. Avoidance of reminders of the trauma is another core symptom of PTSD. This includes people, situations or circumstances resembling or associated with the event. People with PTSD often try to push memories of the event out of their mind and avoid thinking or talking about it in detail, particularly about its worst moments. On the other hand, many ruminate excessively about questions that prevent them from coming to terms with the event (for example, about why the event happened to them, about how it could have been prevented, or about how they could take revenge). PTSD sufferers also experience symptoms of hyperarousal including hypervigilance for threat, exaggerated startle responses, irritability and difficulty concentrating, and sleep problems. Others with PTSD also describe symptoms of emotional numbing. These include lack of ability to experience feelings, feeling detached from other people, giving up previously significant activities, and amnesia for significant parts of the event. Page 17 of 18

18 Symptoms of PTSD often develop immediately after the traumatic event but in some (less than 15% of all sufferers) the onset of symptoms may be delayed. PTSD sufferers may not present for treatment for months or years after the onset of symptoms despite the considerable distress experienced, but PTSD is a treatable disorder even when problems present many years after the traumatic event. Assessment of PTSD can, however, present significant challenges as many people avoid talking about their problems even when presenting with associated complaints. Psychological Support for Staff during a Pandemic In a pandemic, NHS employees are called on to cope with stressors that are inherent in the ways in which widespread disease intersects with their jobs. Inherent stressors include; exposure to the disease; exposure to on-site dangers; exposure to survivors suffering and their relatives stories; inability to provide help at the level and at the time that it is needed. Non-inherent stressors include; lack of skills or training needed to do the job; lack of materials (supplies, equipment) needed to do the job; unclear expectations; lack of support at work; poor scheduling of work (long hours, few breaks, lack of leave time); poor communications (within teams, agencies and with families). The recovery phase will be swifter for staff and services if staff feel supported and are confident about the overall plans that are in place to manage the pandemic. NHS staff and other healthcare staff are also family members and during a pandemic, they have to balance their professional values and obligations with the needs of their families. The leadership and management required will include preparatory responses and training intended to build personal and collective resilience preventing longer-term consequences, which will support staff with the intention of reducing the psychosocial impacts on them working in a pandemic. Page 18 of 18