By Dr Minh Alexander retired consultant psychiatrist 24 April 2022
This is a post about an Employment Tribunal judgment against Devon Partnership NHS Trust, a mental health provider, against a worker with a mental health condition.
I had intended to write it up as it has implications for all mental health providers. It has since become especially significant following the Secretary of State’s controversial decision to override bereaved families’ wishes, with an announcement late on a Friday that an NHS management old hand would chair a review into the maternity failings at Nottingham University Hospitals NHS Trust – Julie Dent, former Chair of Devon Partnership NHS Trust.
| Julie Dent |
This profile posted by the King’s Fund summarises her career in the NHS.
“Julie Dent CBE was Chief Executive of South West London Strategic Health Authority until 1 July 2006. She left the NHS in March 2007 after 22 years to take up a new portfolio career including being Chair of the London Probation Board from April 2007 to March 2012.
She became Chair of Torbay NHS Care Trust in December 2009, and since March 2013 has been Chair of Devon Partnership NHS Trust.
Prior to this she established her own consultancy/coaching company coaching chief executives, chairs and directors in the NHS. She has worked extensively across London and the South East with clinical commissioning group leaders, and in the past year has coached senior leaders in the third sector.
She is a trustee of the School Food Trust and the Children’s Food Trust. She is Chair of User Voice, a ground-breaking charity for offenders.
Julie was awarded the CBE in 2005, after the London bombings, for services to the NHS.”
Dent retired as Chair of Devon Partnership NHS Trust in February 2020
NHS Whistleblower scandals
Dent was reportedly one of several senior NHS officials who denigrated Ian Perkin St. Georges NHS whistleblower for not being a “corporate player”.
She was also Chair of Torbay and Southern Devon Health and Care NHS Trust when it was sued by whistleblowers who raised concerns about nepotism by the notorious Paula Vasco-Knight. The ET held that the other respondent trust was the guilty party, but did Dent push hard enough against the cover up by the chair of the other NHS trust?
Jon Andrewes Bogus NHS Exec scandal
Whilst Dent was Chair of Devon Partnership, Andrewes was employed as a trust NED, appointed to the trust Audit Committee and given special responsibility as Trust Freedom To Speak Up Guardian.
Jon Andrewes jailing in 2017:
Freedom to Speak Up Guardian jailed
On 18 March 2022 the Employment Tribunal ruled that Devon Partnership NHS Trust was found guilty of disability discrimination against a peer support worker, Mrs Zena Cockles.
This is the judgment:
The events in question started during Julie Dent’s tenure as trust Chair. Mrs Cockles was hired by the trust in 2019 as a peer support worker, someone with lived experience of mental ill health employed specifically to use that experience to support mental health patients.
Mrs Cockles attended Occupational Health before starting work, resulting in advice to the trust that she had a disability, was symptomatic but was fit for work, and in need of structured weekly discussions:
“Mrs Cockles has underlying psychological condition. She is not completely asymptomatic and feels that this is triggered by some ongoing difficult personal circumstances. I have advised her to continue to monitor her mood and should she feel that it continues to dip to contact her GP.
I feel that she is fit for work with adjustments mentioned below.” ….
“It is advisable that regular structured support under the form of weekly discussions is considered for the first month of her starting the job and regularly thereafter.”
The post was not at all structured as Mrs Cockles was left to define what the new role would be. She started work in November 2019. Not all trust staff were aware of her arrival, and there was awkwardness fitting in because her role was not clear. Structured weekly supervision did not take place, admittedly initially with Mrs Cockles’ agreement as she had asked for more frequent ad hoc contact. However, structure was still not provided long after it was clear that she was struggling without it, and had herself indicated that she needed structure:
“I feel lost at the moment. As anyone would feel with no routine or structure I cant function properly”
There was a disconnect noted between how her line manager saw the situation – desirable flexibility in how the role could be developed – and how Mrs Cockles described her experience of it.
The line manager recounted: “the role was new to the Directorate, but that this was exciting because it means the successful candidate would work with DPT to shape the role and identify what would work best.”
Mrs Cockles in fact felt at sea and not secure or properly welcomed. For example,
“Emailed EE again about my laptop as it was so hard trying to get into Rougemont all the time as I had no ID, no name badge, no keys or fobs to get in and around the place. EE replied 13/01 saying she will chase them up.”
The difference in perception between Mrs Cockles and her line manager was so great that the Employment Tribunal commented:
“This is in stark contrast to the position Mrs Cockles portrayed in the Grievance and we are left wondering if they had been in the same meeting”
A change of her role by managers from face to face work to telephone surveying of post discharge patients met with difficulty. Mrs Cockles reported a lack of guidance and information, and she was not happy with the major change:
“No one has been in touch with me to explain that this would now be my job role and this is the first I am hearing about it I said to her it has changed so much and that I had no idea what I was supposed to be doing anymore. I told her it was starting to stress me out and I just wanted a job role…. I said but I don’t have a job role. I was supposed to be seeing patients and talking to them on peer level of someone who has that understanding of what they are going through and so far I’ve not seen 1 patient in 3 months.”
When there was a change of line manager after fourteen weeks due to maternity leave, there was reportedly no evidence of handover about Mrs Cockles’ disability or the Occupational Health report and its recommendations. Mrs Cockles reported that her new line manager did not return her messages. She applied for a new peer support worker post. In the process, critical correspondence between managers was inadvertently copied to her.
The correspondence described Mrs Cockles as “unboundaried [sic] and confrontational” and questioned “that she has the self-awareness, insight and diplomacy required for this key role.”
This in itself was likely to be an act of discrimination because it displayed a lack of awareness that the behaviours criticised might be due to a relapsing or sub-optimally controlled mental illness ,(the ET noted a diagnosis of Bipolar illness, which is indeed a relapsing-remitting illness). Had this been better managed and supported, it might be no barrier to the post in question. Surprising that this did not seem to occur to a mental health organisation.
Indeed, a later consultation with a support service for trust workers during the pandemic noted a deterioration in Mrs Cockles’ mental health, and she was eventually signed off sick.
The employment arrangements continued to be sketchy, with a brief transfer to a non-peer support worker role. After a grievance process, the trust apologised for her poor experience and the lack of adequate support. Mrs Cockles accepted a new post but the ET noted that she withdrew her acceptance after she made a request that the learning about her experience to be shared and something be done about the “inappropriate” email that was copied to her. It is not clear what the trust response to her two requests was, but the ET implied it was not affirmative.
The ET noted: “Mrs Cockles reluctantly changed her position again, however, when it was explained to her that the extension of her contract was conditional on the acceptance of a post.”
If I understand this correctly, the trust left her with no real options.
Ultimately, “Mrs Cockles’ employment with the Trust ended on the expiry of the fixed term of her contract, on 24 February 2021.”
This is an uncomfortable story. Trusts should not employ vulnerable peer support workers as a matter of tokenism or virtue signalling, without thought and preparation. The idea of peer support workers of itself carries a kernel of stigma – the subtle implication being that “ordinary” staff do not have lived experience of mental ill health – when statistically, due to the frequency of mental ill health in the general population, many are bound to.
But where peer support workers are employed explicitly to use their own valuable experiences to help others, trusts have a special duty of care to ensure that the working environment is safe and supportive, and that the managers supervising such workers understand their task.
The fact that Mrs Cockles met with such an “unboundaried” [sic] organisational response to the employment of a peer support worker is ultimately a failure of board leadership to recognise and proactively manage the serious risks of any failure to support peer support workers. The trust board failed to ensure the delicate balance of empowering a user perspective without abrogating all responsibility as an employer, and in fact causing injury. Mrs Cockles should have had a very different reception and experience.
The tokenistic and undoubtedly ham-fisted organisational behaviour, which led to the Employment Tribunal awarding Mrs Cockles £10,613.59 just for injury to feelings, adds to the questions about whether the Trust’s former Chair is the best person to conduct a sensitive review and to understand and meet the needs of bereaved families at Nottingham.
This is what the trust claims to provide for peer support workers via a currently published trust leaflet.
UPDATE 4 May 2022
Julie Dent has decided not to chair the review into maternity safety at Nottingham after family opposition, citing personal reasons, as reported by NHSE/I:
Devon Partnership has been rated “Good” by the Care Quality Commission, but mental health trust ratings are unreliable when all are seriously under resourced and operating under serious, chronic bed pressure.
Listed below are published coroners’ Prevention of Future deaths reports – usually issued only exceptionally – that have been issued against the trust. They include a number of inpatient suicides. The case of Diane Knight revealed shocking practices of patients being allowed to cover observation windows – implying that it was commonplace not to carry out observations at night.
This was of particular concern because an earlier coroner’s PFD had highlighted the inpatient suicide of Elaine Jobe, in which lines of sight for observation were an issue:
There have also been a steady stream of serious incidents reported in the press.
These have included allegations by a whistleblower following an inpatient death, that trust managers repeatedly ignored concerns about unsafe staffing levels:
“An urgent probe has now been launched at The Haldon, part of Wonford House Hospital in Exeter after bosses were allegedly warned of the dangers that something like this could happen due to cuts in staffing levels.
The whistleblower said: “I am aware that staff have repeatedly raised concerns that the ward was unsafe due to insufficient staffing.
“It had been repeatedly flagged up by ward staff as a major risk factor.”
These are a sample of other media reports about serious incidents at the trust:
“Barrister Catherine Oborne, on behalf of the O’Sullivan family, cross examined both Mr Cole and Devon Partnership Trust’s Carolyn Crowe about why he had been discharged from the crisis team on December 5 and about the use of the diagnosis as a ‘malingerer’.
“The family of Alan Prettyjohn, 44, is calling to not judge people who suffer from mental health conditions and for better help to be made available to them in Devon….Alan did not even receive a mental health assessment.”
Local Health Politics
For followers of medical politics, Adrian James the President of the Royal College of Psychiatrists and former medical director of the trust is a consultant psychiatrist based at Devon Partnership NHS Trust. Prior to becoming President, he represented the Royal College as Chair of the Westminster Parliamentary Liaison Committee of the Royal College of Psychiatrists.
James is married to Sarah Wollaston, former local Tory MP and now Chair designate of the Integrated Care System for Devon.
As Chair of the Health Select Committee she declined for years to hold a follow up hearing into the government’s failures to meet the recommendations of her own Committee on NHS whistleblowing and the related failures of the NHS Freedom To Speak Up project.
Safe Staffing in the NHS
It is clear that maternity failures are widespread across the NHS and that there are systemic issues that have not been adequately tackled. One crucial matter is safe staffing – a recommendation from the MidStaffs Public Inquiry that has been resisted by successive Tory governments over the last decade, because they do not wish to fund it. NHS staff whistleblowing about safe staffing is not well handled, as it is a matter that sits in the “too difficult” box.
A recent whistleblowing matter at Sussex, where staff were told to stop raising concerns about unsafe staffing levels, illustrates this: