Policy Index (Scotland)

In the event that the company’s registered manager is unavailable to discharge their duties in respect of their role for a period of greater than 28 days, the company will notify the Care Inspectorate. Details would include the following:

i.   The absence;
ii.  The expected length of absence;
iii. Proposed arrangements to provide cover for the registered manager

Any arrangements for managing the nursing division in the absence of the registered manager will be with the approval of the Care Inspectorate.

This policy aims to define for agency staff what occurrences can be regarded as an ‘accident’ or an ‘incident’. Action to be taken in terms of reporting, recording and notifying such occurrences is referenced in the the policy document ‘Reporting, recording and notifying accidents, incidents, infectious diseases and deaths incl. RIDDOR arrangements’. Agency staff are reminded also to check the corresponding policy at the client organisation to ensure that any additional requirements at the location of the assignment are adhered to.

Definitions

INCIDENT: We use the word incident here to cover anything that occurs in the
workplace that could cause a situation that results in harm to people, damage to property or loss of service capacity, including accidents.

NEAR MISS: Describes an event that could have caused injury but narrowly missed doing so.

CRITICAL INCIDENT: The term ‘critical’ is used to reflect the actual or potential severity of the impact and the consequences of the event and would include the death or serious injury of a service user, visitor or staff member, serious assaults or serious medication incidents.

RIDDOR: The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) places a statutory duty upon the Agency to report and record all accidents, incidents, diseases and dangerous occurrences arising out of work activities.

DANGEROUS OCCURENCE: The term Dangerous Occurrence when applied to these guide- lines, relates exclusively to the definition of Dangerous Occurrence contained in the RIDDOR Regulations 1995.

LOST TIME INCIDENT: Major or other accidents resulting in absence from duty for over three days, excluding the day of the accident. This is reportable under RIDDOR to the Health and Safety Executive (HSE).

MAJOR INJURY: Any injury included in the list under RIDDOR

CONTEMPORANEOUS: Contemporaneous records are those made during and immediately after the incident. This is essential for providing an accurate account of what happened. Failure to keep contemporaneous records could prejudice
the validity of the evidence in court proceedings

Further guidance can be found here

Incident reporting and recording procedure

When an incident is reported to the company, the following steps are completed:

i.    An incident case file is opened using NREC 11.2 ‘Incident Records’, with an entry on the Incident Log created alongside a separate file folder in which to store documents specific to the incident;
ii.   The incident is reported to the Nursing Manager who is responsible for overseeing follow-up and close-off in collaboration with the candidate, Direct Medics staff service users and/or regulatory bodies as appropriate;
iii.  All relevant documents are stored in the appropriate case file folder, and a log of contacts and close-off is stored in the Incident Log.

1. Mail received daily is opened by the Company Director.
2. Mail is passed onto the relevant team members in the finance department.
3. Invoices are posted onto Sage when raised or received allocating the net and VAT to the correct nominal code.
4. Any income received is matched to the invoices on the Sage system eliminating these from the outstanding invoice list.
5. Any expenses are posted onto the Sage system once they have been authorised by the Director and paid out of the bank.
6. Bank reconciliations are completed regularly and signed off by the Director.
7. Any banking transactions are processed by the finance staff but are not released from the bank until the director has checked them and authorised the transfers electronically.
8. Any expenses paid by cheque are signed off by the Director as the signatory on the bank account

Agency nurses can administer any medicines or drugs that have been prescribed for the service user/patient by a qualified medical practitioner or nurse prescriber, which includes legally controlled drugs.

The role and responsibilities of a nurse who administers medication:

At the start of all assignments the agency nurse must establish local policy and procedures with regards to the administration of medication, however, within the domiciliary environment the patient’s medication plan, the Trusts policy and this policy must be followed.

The legal requirements of a nurse who administers medication:

All registered nurses should be familiar with:

• Ensure hazardous substances (medication) is stored in a safe place
• Understand the actions to take if a spillage occurs
• Ensure medication is not kept and stored after its shelf life
• Have a detailed knowledge about the substances in the medication e.g. corrosive etc.
• Maintain accurate records of receipt of medication, administration and disposal
• Ensure appropriate use of PPE as required

The Misuse of Drugs Act 1971 governs controlled drugs, drugs that are liable to abuse.  The Act states all transactions must be handled by appropriately trained staff and witnessed by another trained staff member.

The Medicines Act 1968 defines ‘medical products’ as substances sold or supplied for administration to humans for medicinal purposes.

A Registered Nurse is responsible for the initial and continued assessment of patients who are self-administering and have continuing responsibility for recognising and acting on changes in a patient’s condition with regards to the safety of the patient and others. In a service user/patients home where arrangements have been made for a parent, carer or service user/patient to administer their own medicinal products, as identified in the care plan, the Nurse should ascertain the service user/patient’s participation in this agreement.

The main aims of a nurse who administers medication:

• To assist the service user to manage their medication regime as effectively as possible by ensuring medication is administered following the ‘six rights’

1. Right patient
2. Right drug
3. Right dose
4. Right route
5. Right time
6. Right to refuse

• To monitor the condition of the service user/patient before, during and after administering the medication
• To document administration, refusal or omission of medication
• To record any medication errors made and escalate as appropriate
• To record any adverse reactions and escalate as appropriate

To minimise the risk of infection:

• Hands should ALWAYS be washed before preparing medication.
• A non-touch technique should ALWAYS be used
• Gloves and an apron should be worn both for the protection of the nurse and the service user/patient if provided.
• Standard infection control procedures should be followed

Establishing consent – please refer to the company’s Consent policy

Administration checklist

Before the administration of medication nurses should check:

• The name of the service user/patient matches the name on the medication
• That consent of the service user/patient has been gained
• The date medication was dispensed
• The dose prescribed
• Time medication is due
• Route prescribed
• Directions for use
• Any precautions
• Name of medication
• Expiry date
• The service user/patients allergy status
• That medication has not already been given
• All special precautions are adhered to e.g. an empty stomach, with food etc.
• That the service user/patient has a drink of water available, if applicable
• The service user/patient is in a safe position to have their medication and their privacy and dignity is being upheld

All these details should also be checked on the Medication Administration Record (MAR) or hospital medication chart before medication is administered.  If in any doubt ask a colleague to double check with you.

Reporting & Recording

All medication administration must be recorded on a Medication Administration Record (MAR) or Hospital medication chart. Any changes, disposal, accident, error etc. must be reported immediately to the ward manager or shift leader.

Records must be legible, understandable, accurate, factual, up-to-date and signed. All records must respect the service user/patient. Remember the Data Protection Act 1998 gives service user/patients the right to access their records.

Respect a service user/patient’s decision if they decide they do not want to take their medication, but explain to them the consequences of not taking the medication. This will need to be documented and reported following the Trust’s policy.

If medication has been administered incorrectly a nurse must:

• Assess the service user’s clinical status and respond to any changes immediately
• Follow the Trusts policy in a hospital environment or for the community follow the Individual Care Plan and TNS Policy
• Inform the senior nurse or doctor immediately
• Record the mistake in detail
• Calmly and carefully inform the service user/patient, and
• Inform Direct Medics of the error (manager@directmedics.com)

 ALL MEDICATION ERRORS MUST BE REPORTED IMMEDIATELY, BEFORE THE EXACT DETAILS CAN BE FORGOTTEN.

Reporting of Errors – Controlled Drugs

As per above, all medications errors must be reported to Direct Medics Ltd.  In the event that an error involves a controlled drug within Schedules 2, 3, 4 or 5 under the Misuse of Drugs Regulations 2001 (and subsequent amendments), such errors must also be reported to the Care Inspectorate.  Reportable events are as follows:

• Prescribing or dispensing error by e.g. pharmacy or doctor/dentist;
• Prescribed medication not available to be administered;
• Person given wrong medication or dose;
• Medication not recorded as given and no recorded explanation or justification;
• Medication incident/error resulting in injury, referral to the police or Procurator Fiscal;
• Medication incident/error requiring input or advice from healthcare professional, resulting in hospital admission, or considered as an adult or child protection matter;
• Medication incident/error: ‘near miss’ that could have led to injury of harm;
• Medication missing or stolen;
• Medication or controlled drug records falsified;
• Staff referred to professional registration body re: medicines management;
• Staff left during or before investigation re: missing or stolen medication;
• Staff left during or before investigation re: poor practice in management and administration of medication

Storage of Medication

In the acute sector medication should be stored in a lockable cupboard and should always be locked when not in use. It should never be left unlocked and unattended. For medication that needs to be stored in the fridge, there should be a separate lockable fridge to store these medications in.

Controlled drugs should be stored in a separate lockable cupboard.

In the community the service user is responsible for the storage of their medications. Agency workers can advise service users on safe storage, but the service user has the ultimate decision.

Storage of Controlled Drugs in the Community

In the community you should keep in mind the potential, but serious threat presented by the misuse of Controlled Drugs. Service user/patients should be encouraged to keep Controlled Drugs in as secure an environment as possible. If a locked cabinet is available this should be used. In many circumstances this is unlikely to be available; in this instance Controlled Drugs should at least be kept out of sight and reach of children, pets and visitors.

Disposal of medication

There are many reasons medication may need to be disposed of e.g. a service user/patient may pass away, medication may be changed, go out of date or be discontinued etc.  Follow the Trust policy that you are working for to dispose of unwanted medication.

NEVER DISPOSE OF MEDICATION DOWN THE TOILET, IN THE ‘SHARPS’ CONTAINER OR IN HOUSEHOLD WASTE

Always record any disposal on the correct recording sheet.  In the community all medications must be returned to the community pharmacy for disposal. A log must be kept of the medications returned.

Routes of administration of medication

Oral – this includes tablets/capsules, powders, syrups etc. Always take note of the instructions as they may state they need to be taken with food, on an empty stomach, some must be dissolved in water etc. Tablets and capsules should not be crushed, broken or opened (unless there are specific instructions to do so by the prescriber).

Inhalation – breathing in. This is usually via a nebuliser or inhaler for people with respiratory problems. However, there are also other medications available to ‘breathe in’ such as Entonox (also known as gas and air) for pain relief.

Transdermal – this method is used to describe ‘patches’ that are applied to the skin so that the medication is absorbed slowly over a number of hours.

Topical – this is medication that is applied to the skin surface, such as creams and ointments.

Intravenous – this method would only be carried out by an appropriately trained nurse or a doctor. It is direct into the vein of the patient and is designed to act quickly. This method of administration may be via an intravenous infusion pump or via a bolus injection which delivers a one-time dose of medication into the bloodstream.

Sublingual – this is when medicines are sprayed or dissolved under the tongue and not swallowed.

Rectal/Vaginal – Pessaries are inserted into the vagina and suppositories and enemas are inserted rectally. Subcutaneous – this is medication that is injected just beneath the skin e.g. insulin.

Intramuscular – this would only be done by an appropriately trained nurse or doctor. It involves an injection of medication directly into the large muscles of the buttocks, arms or legs. Intra-aural – this medication would be given in the ear.

Intraocular – this is medication that would be given via the eye and comes in the form of drops or ointments.

Naso-Gastric – medication administered through an NG tube into the service user’s stomach.

Gastrostomy – medication administered through a gastrostomy tube surgically inserted into the service user’s stomach.

Naso-Jejunostomy – medication administered through an NJ tube into the service user’s small bowel.

Jejunostomy – medication administered through a JEJ tube surgically inserted into the service user’s small bowel.

Side effects and adverse reactions

Common side effects of medication can include:

• Vomiting
• Nausea
• Diarrhoea
• Constipation
• Dry mouth
• Headache
• Breathing difficulties
• Stiffness
• Swelling
• Rash
• Shaking
• Drowsiness
• Weight gain

Please note that a mild reaction could worsen and develop into a severe reaction if medication is administered again. Severe adverse reactions could include:

• Sweating, blotches, redness of the skin or a feeling faint
• Difficulty breathing
• Swelling of hands, face and body

These symptoms are a medical emergency – expert help should be sought immediately. If your service user/patient displays any of the symptoms above it is important this is recorded and reported. Always follow the Trusts policy. The service user/patient will need to be observed and you may need to treat the symptoms. In an emergency you may need to resuscitate the service user/patient.

Direct Medics Ltd. endeavour to provide the highest quality of service to all individuals and bodies that we work with. Information from complaints is used to improve the quality of services. In the event that a service user believes the service to be unsatisfactory or are not completely happy with the service that we provide, the DHSSPSNI guidance on “Complaints in Health and Social Care, Standards and Guidelines for Resolution and Learning” (2009) are invoked and adhered to. As such, the complaint should be initially raised with the company itself, first with a nursing Recruitment Consultant; if however, the service user remains dissatisfied with the outcome of this and wishes to make a formal complaint to the company any details regarding the issue, previous attempts to resolve by informal means and contact details (email address and phone number) should be submitted. This must be made in writing and sent to our Nursing Manager at the following address:

Direct Medics Ltd.
33A Stockmans Way,
Belfast
BT9 7ET

All written complaints will be dealt with as follows:

i.   As soon as the complaint is received, it will be logged and the complainant will receive acknowledgement or receipt of the complaint within 14 working days, this may be by telephone or in writing;
ii.  We may contact the complainant to clarify the detail of the complaint and to discuss it with them and we will follow up any conversation in writing;
iii. We will keep the complainant informed at least every two weeks on the progress of our investigations;
iv.  The Nursing Manager will seek agreement that the complaint has been resolved to the complainant’s satisfaction

Throughout the investigation we will be careful to ensure that any information about the complainant is kept confidential and steps will then be taken, where possible, to prevent a reoccurrence.

If the above is not deemed satisfactory, the Nursing Manger will seek to agree further action to resolve the complaint. If no such action can be agreed, the complaint will be referred to the Managing Director of the Company, who will provide a final company response within seven working days.

Direct Medics Ltd. is governed by the standards of the Regulation and Quality Improvement Authority, and as such we aim to close off all complaints within 28 days. Where a complaint relates to a failure by Direct Medics Ltd. to comply with the statutory regulations service users can contact RQIA. Please see address details below:

The Regulation and Quality Improvement Authority
9th Floor Riverside Tower
5 Lanyon Place
Belfast
BT1 3BT

RQIA is a non-governmental public body, established under the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. RQIA is charged with providing independent assurances about the quality, safety and availability of health and social care services provided by independent and statutory bodies in Northern Ireland.

The role of RQIA is to assure the quality of services provided by the company, to ensure that every aspect of care reaches the standards laid down by the Department of Health, Social Services and Public Safety and expected by the public.

At any point through this process, should a service user require it an independent advocacy services may be engaged with in an attempt to resolve outstanding issues fairly. If required assistance will be provided to any service users requiring help to access the support needed need to articulate concerns and successfully navigate the system.
The company keeps records of all complaints and including details of all communications with complainants, the results of any investigations and the action taken. When required, a summary of all complaints, outcomes and actions taken is made available to the Regulation and Quality Improvement Authority.
Where a complaint relates to abuse, exploitation or neglect, the Regional “Safeguarding Vulnerable Adults” Policy and Procedural guidance and the associated Protocol for joint Investigation of Alleged or Suspected cases of Abuse of Vulnerable Adults will be activated.

The company co-operates with any complaints investigation carried out by the HSC Trust, the Regulation and Quality Improvement Authority or the NI Commissioner for Complaints.
The complainant has the right to approach the NI Commissioner of Complaints if they remain dissatisfied with the outcome of the relevant complaints procedure above.

Complaints from Children

In the event that a complaint about the company comes from a child, the complaint will be dealt with in accordance with The Representations Procedure (Children) Regulations (NI) 1996. These Regulations set out the procedures to be used by HSS Trusts in dealing with complaints and representations about the way they are carrying out their functions under Part IV of the Children Order (services to support children and their families).

Complaints about Candidates: Reporting and Recording procedure

When a complaint is reported to the company concerning a candidate, the following steps are completed:

i.   A complaints case file is opened using NREC 11.1 ‘Complaint Records’, with an entry on the Complaint Log created alongside a separate file folder in which to store documents specific to the complaint;
ii.  The complaint is reported to the Nursing Manager who is responsible for overseeing follow-up and close-off in collaboration with the candidate, Direct Medics staff service users and/or regulatory bodies as appropriate;
iii. All relevant documents are stored in the appropriate case file folder, and a log of contacts and close-off is stored in the Complaint Log;
iv. At close-off, the candidate’s appraisal and supervision schedule is reviewed by the Nursing Manager, with any adjustment to the schedule in light of the complaint, in addition to any enhancement to quality monitoring, at the Nursing Manager’s discretion.

Good record keeping is a vital part of effective communication in nursing and integral to promoting safety and continuity of care for patients and clients.

Agency staff need to be clear about their responsibilities for record keeping in whatever format records are kept.

Key principles

• Records should be completed at the time or as soon as possible after the event.
• All records must be signed, timed and dated if handwritten. If digital, they must be traceable to the person who provided the care that is being documented.
• Ensure that you are up to date in the use of electronic systems in your place of work, including security, confidentiality and appropriate usage.
• Records must be completed accurately and without any falsification and provide information about the care given as well as arrangements for future and ongoing care.
• Jargon and speculation should be avoided.
• When possible, the person in your care should be involved in the record keeping and should be able to understand what the records say.
• Records should be readable when photocopied or scanned.
• In the rare case of needing to alter a record, the original entry must remain visible (draw a single line through the record) and the new entry must be signed, timed and dated.
• Records must be stored securely and should only be destroyed following your local policy.
• Countersigning
• Record keeping can be delegated to health care assistants (HCAs), assistant practitioners (APs) and nursing students so that they can document their care.
• As with any delegated activity, the nurse needs to ensure that the HCA, AP or student is competent to undertake the activity and that it is in the patient’s best interests for record keeping to be delegated.
• Supervision and a countersignature are required until the HCA, AP or student is deemed competent at keeping records.
• Registered nurses should only countersign if they have witnessed the activity or can validate that it took place.

Always follow your local policy. Further guidance can be found within the document “NMC Record keeping for nurses and midwives”.

The Data ProtectionAct 1998 defines a health record as “consisting of information about the physical or mental health or condition of an identifiable individual made by or on behalf of a health professional in connection with the care of that individual”.

The principles of good record keeping apply to all types of records, regardless of how they are held. These can include:

• handwritten clinical notes
• emails
• letters to and from other health professionals
• laboratory reports
• x-rays
• printouts from monitoring equipment
• incident reports and statements
• photographs
• videos
• tape-recordings of telephone conversations text messages

Failure to maintain records could potentially cause considerable difficulties in respect of any legal proceedings, e.g. an allegation of negligence. Information is essential to the delivery of high quality evidence-based health care on a day-to-day basis. Records are a valuable resource because of the information they contain. This information can facilitate clinical decision making, improved patient care through clear communication of the treatment rationale and progress, and facilitate a consistent approach to team working. However, a record is only of use if it is correctly recorded in the first place, regularly up-dated, and easily accessible when it is needed. Everyone working in healthcare that records, handles, stores, or otherwise comes across information, has a personal common law duty of confidence to comply with this.

All patient attendance, non-attendance, and refusal of treatment and advice must be noted. It is advisable to note when telephone contacts are made. It is imperative that the agency worker dealing with a particular patient on a specific day can be identified; this means the patient’s attendance is dated and signed either in the agency workers records or on a register, or both. All patient records should be kept confidential in line with the Date Protection Act 1998.

Records Management

You must treat information about patients and clients as confidential and use it only for the purpose for which it was given. You must guard against breaches of confidentially by protecting information from improper disclosure at all times. Where there is an issue of child protection you must act at all times in accordance with national and local policies.

All records relating to the provision of our service are to kept for a period of eight years. Each client has an absolutes right to confidentiality and privacy regarding the services they are receiving in accordance with Data Protection Act 1998 and Human Rights Act 1999 and your agreement with the Company. Any concerns you may have regarding confidentiality can be discussed with our Nursing Manager.

As a nurse or midwife, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately. To achieve this, you must:

5.1  respect a person’s right to privacy in all aspects of their care;
5.2 make sure that people are informed about how and why information is used and shared by those who will be providing care;
5.3 respect that a person’s right to privacy and confidentiality continues after they have died;
5.4 share necessary information with other healthcare professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality, and 5.5 share with people, their families and their carers, as far as the law     allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand.

A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence. This duty of confidence is derived from:

• common law – the decisions of the Courts
• statute law which is passed by Parliament.

The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it was given and will not be disclosed without permission. This covers situations where information is disclosed directly to the nurse or midwife and also to information that the nurse or midwife obtains from others. One aspect of privacy is that individuals have the right to control access to their own personal health information.

It is not acceptable for nurses and midwives to:

• discuss matters related to the people in their care outside the clinical setting
• discuss a case with colleagues in public where they may be overheard
• leave records unattended where they may be read by unauthorised persons.

All nurses and midwives need to be aware of the following pieces of legislation relating to confidentiality:

The Data Protection Act 1998: This Act governs the processing of information that identifies living individuals. Processing includes holding, obtaining, recording, using and disclosing of information and the Act applies to all forms of media, including paper and electronic.
The Human Fertilisation and Embryology Act 1990: Regulates the provision of new reproductive technology services and places a statutory ban upon the disclosure of information concerning gamete donors and people receiving treatment under the Act. Unauthorised disclosure of such information by healthcare professionals and others has been made a criminal offence.
The National Health Service Venereal Disease Regulations (SI 1974 No.29): This states that health authorities should take all necessary steps to ensure that identifiable information relating to persons being treated for sexually transmitted diseases should not be disclosed.
The Mental Capacity Act (2005): This provides a legal framework to empower and protect people who may lack capacity to make some decisions for themselves. The assessor of an “individual’s capacity to make a decision will usually be the person who is directly concerned with the individual at the time the decision needs to be made” this means that different health and social care workers will be involved in different capacity decisions at different times.
The Freedom of Information Act 2000 and Freedom of Information (Scotland) Act 2002: These Acts grant people rights of access to information that is not covered by the Data Protection Act 1998, e.g. information which does not contain a person’s identifiable details.
The Computer Misuse Act 1990: This Act secures computer programmes and data against unauthorised access or alteration. Authorised users have permission to use certain programmes and data. If the users go beyond what is permitted, this is a criminal offence.

Confidentiality after death

The duty of confidentiality does continue after death of an individual to whom that duty is owed.

Information disclosure to the police

There is no obligation placed upon any citizen to answer questions put to them by the police. However, there are some exceptional situations in which disclosure is required by statute. These include:

• the duty to report notifiable diseases in accordance with the Public Health Act 1984
• the duty to inform the Police, when asked, of the name and address of drivers who are allegedly guilty of an offence contrary to the Road Traffic Act 1998
• the duty not to withhold information relating to the commission of acts of terrorism contrary to the Terrorism Act 2000
• the duty to report relevant infectious diseases in accordance with the Public Health (Infectious Diseases) Regulations 1998.

Police access to medical records

The police have no automatic right to demand access to a person’s medical records. Usually, before the police may examine a person’s records they must obtain a warrant under the Police and Criminal Evidence Act 1984. Before a police constable can gain access to a hospital, for example, in order to search for information such as medical records or samples of human tissue, he or she must apply to a circuit judge for a warrant. The police have no duty to inform the person whose confidential information is sought, but must inform the person holding that information.

The Police and Criminal Evidence Act (1984)

This Act allows nurses and midwives to pass on information to the police if they believe that someone may be seriously harmed or death may occur if the police are not informed. Before any disclosure is made nurses and midwives should always discuss the matter fully with other professional colleagues and, if appropriate consult the NMC or their professional body or trade union. It is important that nurses and midwives are aware of their organisational policies and how to implement them. Wherever possible the issue of disclosure should be discussed with the individual concerned and consent sought. If disclosure takes place without the person’s consent they should be told of the decision to disclose and a clear record of the discussion and decision should be made as stated above.

Nurse or midwife acting as a witness in a court case

If a nurse or midwife is summoned as a witness in a court case he/she must give evidence. There is no special rule to entitle the nurse or midwife to refuse to testify. If a nurse or midwife refuses to disclose any information in response to any question put to him/her, then a judge may find the nurse or midwife in contempt of court and may ultimately send him/her to prison.

Risk or breach of confidentiality

If a nurse or midwife identifies a risk or breach of confidentiality they must raise their concerns with someone in authority if they are unable to take affirmative action to correct the problem and record that they have done so. A risk or breach of confidentiality may be due to individual behaviour or as a result of organisational systems or procedures. The Code states “You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk”. Nurses and midwives have a professional duty to take action to ensure the people in their care are protected and failure to take such action could amount to professional misconduct on their part.

As appropriate registration with the Nursing and Midwifery Council is a pre-requisite for nurses to secure work assignments in the United Kingdom, registration with Direct Medics is subject to verification of professional membership. This will include contacting the Nursing & Midwifery Council to verify the ongoing registration of each nurse. This is carried out at several stages, namely:

i.   When a nurse first applies to register with Direct Medics, as part of our initial pre-employment checks;
ii.  When a nurse asks to be put forward for consideration for a job opportunity, and
iii. Periodically during any assignment to ensure the ongoing registration and suitability of each nurse for their assignment.

Consent is defined as “permission for something to happen or agreement to do something” (Oxford English Dictionary). In relation to health care, it is a general legal and ethical principle that valid consent must be obtained before commencing an examination, starting treatment or physical investigation, or providing care.
This principle reflects the rights of a person to determine what happens to their own bodies or what shapes the care and support they receive. It is fundamental to good practice. The Nursing and Midwifery Council (NMC) professional practice document for nurses and midwives, The Code (NMC, 2015) states that registered nurses must:

(4.1) “balance the need to act in the best interests of all people at all times with the requirement to respect a person’s right to accept or refuse treatment”, and
(4.2) “make sure that you get properly informed consent and document it before carrying out any action”.

Registered nurses who do not respect this principle may be liable to both legal action by the person in their care and action by the NMC.

The requirement to gain consent has two purposes, one legal and the other clinical (Richardson V, 2013). The legal purpose is to provide those delivering treatment with a defense to a criminal charge of assault or battery or a civil claim for damages for trespass to the person.

The clinical purpose comes from the fact that in most cases the co-operation of the person and the person’s confidence in the treatment is a major factor in their consenting to the examination, treatment or physical investigation, or the provision of care.

What is meant by “valid consent”?

For consent to be valid, it must be given voluntarily and freely, without pressure or undue influence, by an appropriately informed person who has the capacity to consent to the intervention in question. Some people may
feel pressurised, by relatives or carers for example, to accept a particular investigation or treatment.

Registered nurses should be aware of this, and of other situations in which people might be vulnerable, for example, those resident in a care home, or in prison. In these situations it is essential to ensure that the person has considered the available options and has voluntarily reached their own fully informed decision.

Emergency situations

In emergency situations, the need to initiate immediate treatment may limit the quantity of information necessary for the patient to give an informed consent.

However, due care should be exercised to ensure that any legally binding wishes of the patient, expressed in advance of the emergency, are not overlooked. If the patient is well enough and has the sufficient capacity to understand the situation he/she has the right to refuse treatment, even if this decision may have a negative impact on health or wellbeing.

Such decisions should be recorded in the patient’s care plan and reflect the involvement of the patient in the decision-making process. If the patient is unconscious, or an emergency occurs when a patient is under general anesthetic, staff may act in his/her best interests without consent in order to protect life and future health.

On occasions, staff may need to seek legal advice before initiating treatment or care, although this may not always be practicable in an emergency situation.

Obtaining consent

What is meant by “informed consent”?

Several recent and less recent judicial reviews and rulings by the Supreme Court have confirmed that the need for “informed consent” is a legal requirement.

Many interventions are not a simple “yes/ no” situation; it is not enough to provide adequate information to ensure consent for the examination, treatment and/or care.

Sufficient evidence based information must be provided to the person to enable them to make a balanced and informed decision about their care and treatment. As well as a general explanation of the procedure there is also a duty to explain the risks inherent in the procedure and the risks inherent in refusing the procedure.

Information must also be provided regarding alternatives to the proposed intervention. This will assist the person to make the decision to consent to, or refuse consent for a particular intervention, whilst respecting their right to autonomously decide what happens to them.

Failing to meet this legal duty can give rise to an action in negligence if the person is subsequently harmed.

Obtaining consent is a process rather than a one-off event. When a person is told about proposed treatment and care, it is important that the information is given in a sensitive and understandable way. The person should be given enough time to consider the information and the opportunity to ask questions if they wish to. You should not assume that the person in their care has sufficient knowledge, even about basic treatment, for them to make a choice.

The NMC Code supports involving people in the care giving processes. It clearly states: “You must uphold people’s rights to be fully involved in decisions about their care.” It is essential that they are given sufficient information to enable them to determine whether or not to accept or decline treatment and care. This right is supported in the Code where it states: “You must respect and support people’s rights to accept or decline treatment and care.”

If a person feels the information they have received is insufficient, they could make a complaint to the NMC or take legal action. Most legal action is in the form of an allegation of negligence. It is therefore essential that nurses and midwives ensure that they: “…share with people, in a way they can understand, the information they want or need to know about their health.” In exceptional cases, for example, where consent was obtained by deception or where not enough information was given, this could result in an allegation of battery. However, only in the most extreme cases is criminal law likely to be involved.

Forms of consent

The validity of consent does not depend on the form in which it is given. Consent can be expressed in writing, verbally or non-verbally.

In most cases completion of a consent form is not a legal requirement, (exceptions being prescribed forms associated with mental health legislation Act 2000, Mental Health (Northern Ireland) Order 1986, Mental Capacity and the Human Fertilisation and Embryology Act 1990).

Although written forms serve as evidence of consent, the completion of any consent form or documentation must meet with the requirements that constitute valid consent, i.e. the person has the capacity to make the decision, sufficient information has been provided to ensure that consent was “informed”, and that consent has been freely given.

Where a person is illiterate or unable to fully complete their signature, but is able to provide valid consent, they may be able to make a mark on the form to indicate consent. It is good practice to have the mark witnessed by another clinician. If consent has been validly given, the lack of a completed form is no bar to treatment or care.

Consent for sharing information

There is a requirement in the NMC Code (NMC, 2015) at paragraph 5, which explicitly requires nurses to respect a person’s right to privacy and confidentiality.

When a person discloses personal health information to a health or social care professional, it is generally accepted that care cannot continue unless it is shared with other staff involved in their care. This could include both health and social care staff and administrative staff.

Registered nurses must ensure that implied consent to sharing of information is not assumed in these circumstances and that any disclosure of information to others is absolutely essential for the provision and continuation of care, and in accordance with the requirements of the Data Protection Act (1998) and the Human Rights Act (1998). The duty of confidentiality applies to both adults and children and young people (as clarified in the Gillick principle).

Circumstances and that any disclosure of information to others is absolutely essential for the provision and continuation of care, and in accordance with the requirements of the Data Protection Act (1998) and the Human Rights Act (1998). The duty of confidentiality applies to both adults and children and young people (as clarified in the Gillick principle).

Should the person state that they do not want information to be shared with anyone, a registered nurse has no permission to do so.

There is however a recognition that the duty of confidentiality is not absolute. In certain situations a registered nurse could be required to disclose information without the consent of the individual involved.

These circumstances may exist where there is a real and serious risk of danger to the public or an identifiable individual, or in the case of a child/young person or where a person with capacity is considered vulnerable. The onus will be on the registered nurse to provide evidence that the absence of consent and a breach of confidentiality meets these specific requirements.

Children and young people

It is particularly important that registered nurses working with children and young people understand the laws around capacity, and child and parental consent, including giving and refusing consent for the implementation of any treatment or intervention.

In Northern Ireland the legal age of capacity is 18. However, under section 4 of the Age of Majority Act (Northern Ireland 1969) young people aged 16 -17 are entitled to provide consent for their own medical treatment in the same way as adults this provides a legal basis for a young person under the age of 16 years to consent on his or her own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending them, they are capable of understanding the nature and possible consequences of the procedure or treatment. These provisions need to be considered in conjunction with the rights of those with parental responsibility and human rights law.

In other circumstances, current case law is based on the view that persons aged under 16 years, may be competent to make decisions about their care and treatment when provided with sufficient information in a suitable format.

This is sometimes referred to as “Gillick” competence. This principle recognises the concept of emerging capacity in children and young people. Cognitive and emotional skills are acquired differentially throughout adolescent development. Whilst decision-making is primarily dependent on information retention and processing, emotional maturity is needed

To make balanced, unwavering decisions and to cope with the consequences of those decisions. It is important to assess the child or young person’s maturity and understanding on an individual basis, and to remember that the severity of the consequences of the decision should be taken into account.

Gillick competent young people can consent to or refuse care, treatment and/or interventions. However, refusal to provide consent can be over- ridden by a person with parental responsibility or a court in certain circumstances. If more than one person has parental responsibility for the young person, consent by any one such person is sufficient, irrespective of the refusal of any other individual.

Where a child or young person lacks capacity to consent, any one person can give consent on his or her behalf with parental responsibility,  or by the court. As is the case where individuals are giving consent for themselves, those giving consent on behalf of the child or young person must have the capacity to consent to the intervention in question, be acting voluntarily, and be appropriately informed.

The power to consent must be exercised according to the “welfare principle”: that the welfare or best interests’ of the child or young person must be paramount. Even where the child or young person lacks capacity to consent on their own behalf, they must be involved as much as possible in the decision making processes.

Where necessary the courts can, as with competent children and young people, over-rule a refusal by a person with parental responsibility. It is recommended that certain important decisions, such as sterilisation for contraceptive purposes should be referred to the courts for guidance, even if the person with parental responsibility has consented to the procedure.

Consent of people who are mentally incapacitated

Relevant mental health legislation and capacity legislation Mental Capacity (Act 2005) Mental Health (Northern Ireland) Order 1986, Mental Capacity Act Northern Ireland (2016), make provision for the possibility of detention/deprivation of liberty and/or treatment for a mental disorder and its complications without the consent of the adult, or a young person aged under 18 years.

If an adult has been assessed as lacking the capacity to make a specific decision then there are formal legislative processes that allow for a decision about care, treatment or support to be made on their behalf.

These are commonly known as “best interests’ decisions”. Best interests are not confined to best medical interests. Most organisations will have established protocols based on legislative requirements and recognised good practice principles.

Registered nurses must adhere to these protocols when assisting with making best interests decisions proposed for a person who lacks capacity. Whether a formal assessment of capacity,  or in some cases a legal opinion, is required depends on the seriousness and/or the potential consequences of the proposed intervention. These situations are guided by legislation and organisational policies and procedures.

Professional accountability

Professional accountability means being personally answerable to the law of the land for all actions or omissions (including what is written or is not written, what advice/ information/communication is given or is not given) while fulfilling a contract as a health and social care employee.

Registered nurses must act first and foremost to care for and safeguard those in their care. Registered nurses must display a personal commitment to the standards of practice and behaviors set out in the NMC Code. NMC states that registered nurses must “show professionalism and integrity and work within recognised professional, ethical and legal frameworks” (NMC, 2015).

When an alert letter is received by Direct Medics Ltd. from either DHSSPS or NMC and relating to a nurse on the company register, the following will apply:

1. A presumption of innocence is made relating to the nurse under investigation during the course of the relevant enquiry;
2. A notification is made to the Registered Manager as to the presence and nature of the alert;
3. The Recruitment Director is responsible for checking the company register to confirm whether the nurse under investigation is registered for work; for for recording candidate's alert number, name and date of alert on the company Alerts record; for saving the alert letter in the company Datastore and, for any candidates currently registered, for recording the following as an Alert on the candidate file, "Inform Recruitment Director if candidate asks to be considered for work". In the event that the candidate asks to be considered for work, the Recruitment Director is responsible for following the directions contained in the Alert notice;
4. Any changes to the nurse’s NMC and resulting restrictions must be carefully considered by the Registered Manager in the context of booking the nurse for assignments during the course of the investigation. All changes to NMC registration as a result of a live investigation must be made explicit to the client organisation when putting the nurse forward for consideration for an assignment, and no nurse under suspension is permitted to be booked for an assignment;
5. The company’s Nursing Division Compliance Officer is responsible for checking new registrations within the nursing division against the company’s Alert list. If an alert is in existence, the Recruitment Director is informed, who in turn is responsible for recording an Alert on the candidate file as per above;
6. When an Alert cancellation notice is received, the Recruitment Director is responsible for deleting the original Alert notice letter, removing the Alert from the candidate record (if applicable) and removing the Alert from the Alerts spreadsheet.

Disclosure means the giving of information. Disclosure is only lawful and ethical if the individual has given consent to the information being passed on. Such consent must be freely and fully given. Consent to disclosure of confidential information may be:

• explicit
• implied
• required by law or
• capable of justification by reason of the public interest

Disclosure with consent: Explicit consent is obtained when the person in the care of a nurse or midwife agrees to disclosure having been informed of the reason for that disclosure and with whom the information may or will be shared. Explicit consent can be written or spoken. Implied consent is obtained when it is assumed that the person in the care of a nurse or midwife understands that their information may be shared within the healthcare team. Nurses and midwives should make the people in their care aware of this routine sharing of information, and clearly record any objections.

Disclosure without consent: The term ‘public interest’ describes the exceptional circumstances that justify overruling the right of an individual to confidentiality in order to serve a broader social concern. Under common law, staff are permitted to disclose personal information in order to prevent and support detection, investigation and punishment of serious crime and/or to prevent abuse or serious harm to others. Each case must be judged on its merits. Examples could include disclosing information in relation to crimes against the person e.g. rape, child abuse, murder, kidnapping, or as a result of injuries sustained from knife or gun shot wounds. These decisions are complex and must take account of both the public interest in ensuring confidentiality against the public interest in disclosure. Disclosures should be proportionate and limited to relevant details.

Nurses and midwives should be aware that it may be necessary to justify disclosures to the courts or to the Nursing & Midwifery Council and must keep a clear record of the decision making process and advice sought. Courts tend to require disclosure in the public interest where the information concerns misconduct, illegality and gross immorality.

Disclosure to third parties: This is where information is shared with other people and/or organisations not directly involved in a persons care. Nurses and midwives must ensure that the people in their care are aware that information about them may be disclosed to third parties involved in their care. People in the care of a nurse or midwife generally have a right to object to the use and disclosure of confidential information. They need to be made aware of this right and understand its implications. Information that can identify individual people in the care of a nurse or midwife must not be used or disclosed for purposes other than healthcare without the individuals’ explicit consent, some other legal basis, or where there is a wider public interest.

Upon registration new candidates will receive communication from the following individuals:

i.   Their assigned Recruitment Consultant to discuss work opportunities and preferences;
ii.  Their assigned Compliance Officer who acts in an advisory capacity in terms of pre-employment checks;
iii. The company’s Nursing Manager who will carry out an interview aimed at ascertaining the skills and suitability of applicants

Once booked, it is our aim to ensure that all nurses are completely satisfied with assignments, it is within the range of their skills and it is everything expected. Our contact during assignments may include:

i.   Arrival calls on the first day (to confirm your safe arrival and first impressions);
ii.  Service calls during the assignment (to check that the assignment is proceeding as expected);
iii. Records maintenance calls (to update documents that may be due to expire during the assignment).

The company’s Nursing Manager can be contacted by telephone or email and is available for face-to-face meetings on request. Contact will be facilitated by the assigned Recruitment Consultant. In the event that the Nursing Manager is not immediately available, the Recruitment Director or Registered Person will assist if possible.

Infection control is the name given to a wide range of policies, procedures and techniques intended to prevent the spread of infectious diseases.

The 2010 Changing the Culture action plan from DHSPSNI defines two core principles that underpin effective infection prevention and control, namely:

i.   Infection prevention and control is an integral part of safe healthcare. It is not an add-on: it is as much a part of healthcare as arranging diagnostic tests, prescribing drugs or dressing a wound.
ii.  Infection prevention and control is everyone’s business. It is not just a matter for doctors, nurses, cleaners and managers, but for everyone involved in the planning and delivery of healthcare. Visitors to hospitals and patients themselves have their part to play in keeping infections at bay.

The work of our healthcare staff involves the risk of exposure to communicable diseases. General principles of infection control include effective handwashing:

• Use liquid soap and water or an alcohol-based hand rub when washing hands – make sure it comes into contact with all areas
• Remove nail varnish, wrist and hand jewellery at the beginning of each shift where you will be regularly decontaminating your hands. A plain wedding band may be worn.
• Wear disposable gloves and aprons when attending to dressings or dealing with blood and body fluids (sterile gloves should only be worn when performing aseptic techniques)
• Dispose of gloves and aprons after use ensuring you use the correct clinical waste bins.
• Cover cuts or breaks in your skin or those of patients / clients with waterproof dressings

The Northern Ireland Regional Infection Prevention and Control Manual sets out in detail both the basic principles of infection prevention and control, and protocols to follow in specific circumstances. All nurses are expected to be conversant with the content of the manual and apply its principles throughout the course of their work.

Application to the agency register for staff requires the declaration of any communicable diseases. Good practice requires that staff also disclose any subsequent contraction of, or exposure to, such disease using the company’s occupational health review form. Having an infectious disease will not be grounds for refusal or termination of assignments, but may make agency staff temporarily unsuitable for certain assignments through the Company or restrict the types of work to which they may be assigned, both in their own interest and that of clients/patients.

It is the responsibility of agency staff to take adequate precautions to protect themselves from communicable diseases. If unsure of the appropriate steps to be taken, agency staff should discuss the assignment with the immediate Line Manager at the assignment location. All information regarding a Client’s condition or circumstances will be treated as confidential.

To avoid risks of cross infection, it is essential that all incidents that may result in the spreading of a disease be reported. Incidents in a hospital, nursing home, or other institutional setting should be reported in accordance with the policies of that institution.

All incidents should also be reported to our Nursing Manager who will give advice on any appropriate further action.

Direct Medics Ltd. request that all agency workers should:

• At all times, observe high standards of hygiene to protect themselves and their service users from the unnecessary spread of infection. Adhere to our clothing guidance and use disposable gloves and disposable aprons which are provided by clients for workers at risk of coming into direct contact with body fluids or who are performing personal care tasks.
• Attend training on infection control when organised by the agency.

In line with the terms of registration with the Regulation and Quality Improvement Authority and relevant framework agreements, Direct Medics Ltd. operates under an ethos of openness and transparency. To that end, the company will facilitate any requirement to audit or inspect the company’s operation and will make available any and all resources required by the relevant authority in order to facilitate such audits or inspections. This includes (but is not limited to):

i.   A complete copy of the company’s policies and procedures;
ii.  A copy of relevant staff records (e.g. pre-employment checks);
iii. Access to a qualified member of staff to answer any queries

Agency Insurance Arrangements

The company recognises its responsibility to indemnify itself and its staff against all eventualities in the course of assignments. As such, the company holds and maintains the following levels of insurance:

i.    Employer’s Liability: £10million
ii.   Public & Products Liability: £1million
iii.  Professional Indemnity: £5million

Agency staff requirements

In line with EU legislation which took effect in October 2013 and subsequently adopted by the UK government, professional indemnity insurance is mandatory for all healthcare professionals. It is therefore a pre-requisite to registering with Direct Medics that all applicants have suitable arrangements in place to meet this requirement.

Direct Medics Ltd. is committed to ensuring ethical recruitment through its adherence to the UK Code of Practice (CoP) for International Recruitment. As such, Direct Medics Ltd. appears on the NHS Employers list of healthcare organisations involved in the international recruitment of healthcare professionals, indicating the company’s commitment and adherence to the UK Code of Practice, and provides a dedicated support service to NHS organisations to help them follow the guiding principles of the Code in their recruitment activities.

The guiding principles that underpin the code of practice are as follows:

1. International recruitment is a sound and legitimate contribution to the development of the healthcare workforce.
2. Extensive opportunities exist for individuals in terms of training and education and the enhancement of clinical practice.
3. Developing countries will not be targeted for recruitment, unless there is an explicit government-to-government agreement with the UK to support recruitment activities.
4. International healthcare professionals will have a level of knowledge and proficiency comparable to that expected of an individual trained in the UK.
5. International healthcare professionals will demonstrate a level of English language proficiency consistent with safe and skilled communication with patients, clients, carers and colleagues.
6. International healthcare professionals legally recruited from overseas to work in the UK are protected by relevant UK employment law in the same way as all other employees.
7. International healthcare professionals will have equitable support and access to further education and training and continuing professional development as all other employees.

Direct Medics adheres to the above by providing equality both in terms of opportunities provided to international candidates and in the probity that takes place prior to any placement by the company; procedures for pre-employment checks in line with national and regional guidelines would include but not be limited to health assessment in conjunction with Occupational Health guidelines, and confirmation with NMC that the candidate’s experience and qualifications have been validated.
Prior to placing any international staff, Direct Medics provides comprehensive information to the new staff member, including (but not limited to):

i. HSC and independent sector employment;
ii. minimum terms and conditions of employment;
iii. job and person specification;
iv. adaptation programmes;
v. professional associations and trade unions;
vi. NMC registration process;
vii. geographical area and the cost of living in the area to which they will be moving;
viii. all other costs that they might incur, for example, accommodation, uniform and transport costs.

The company does not charge fees to international candidates to be considered for recruitment or placement.
As is the case for all healthcare workers placed through Direct Medics Ltd. international staff will receive regular communication from the company during their assignment(s) to ensure that they have received all the assistance necessary to settle well into their new post and area.

Direct Medics is committed to providing a quality service in the provision of locum and permanent staff and the ancillary services needed to support our customers. The company assesses the quality of our service through a series of management procedures and continual improvement measures which are directly in line with the requirements of the Regulation and Quality improvement Authority:

• Document audits: the Registered Manager reviews a selection of candidate files weekly, based on those placed to work on a date selected by the Manager. The results of this audit are disclosed on the monthly monitoring;
• Quality monitoring: the Recruitment team obtains verbal or written feedback for each candidate, at each clinical setting in which they are placed. This information is checked monthly to ensure all clinical settings have been covered, with the results disclosed on the monthly monitoring;
• Supervision and Appraisal: all supervision and appraisal records are securely and centrally located. A review of supervision and appraisal activities is disclosed on the monthly monitoring;
• Complaints and incidents: all complaints and incidents are securely and centrally located. A statement as to the current status of active complaints and incidents is disclosed on the monthly monitoring

In addition, the nursing division takes part in company-wide quality monitoring activities which form part of our Quality Management System in maintenance of ISO 9001:2008 certification. Activities include:

• Quality targets for each team and core process grouping;
• Monthly management meetings which monitor the improvements being made and operational duties
• Quarterly reviews which review the targets for the previous quarter and planned improvements for the following quarter
• Bi-annual management reviews which take the findings for the preceding two quarterly reviews and ensure that we are continually improving our quality of service
• Annual internal audit of each company department against ISO 9001:2008

In addition to the above in line with the company’s ISO 9001:2008 certification, the company adheres fully to the minimum standards set out by the Department of Health, Social Services and Public Safety including co-operation with and inspection by the Regulation and quality Improvement Authority.

Direct Medics is committed to providing a quality service in the provision of locum and permanent staff and the ancillary services needed to support our customers. The company assesses the quality of our service through a series of management procedures and continual improvement measures which are directly in line with the requirements of the Regulation and Quality improvement Authority:

• Document audits: the Registered Manager reviews a selection of candidate files weekly, based on those placed to work on a date selected by the Manager. The results of this audit are disclosed on the monthly monitoring;
• Quality monitoring: the Recruitment team obtains verbal or written feedback for each candidate, at each clinical setting in which they are placed. This information is checked monthly to ensure all clinical settings have been covered, with the results disclosed on the monthly monitoring;
• Supervision and Appraisal: all supervision and appraisal records are securely and centrally located. A review of supervision and appraisal activities is disclosed on the monthly monitoring;Complaints and incidents: all complaints and incidents are securely and centrally located. A statement as to the current status of active complaints and incidents is disclosed on the monthly monitoring
• Complaints and incidents: all complaints and incidents are securely and centrally located. A statement as to the current status of active complaints and incidents is disclosed on the monthly monitoring

In addition, the nursing division takes part in company-wide quality monitoring activities which form part of our Quality Management System in maintenance of ISO 9001:2008 certification. Activities include:

• Quality targets for each team and core process grouping;
• Monthly management meetings which monitor the improvements being made and operational duties
• Quarterly reviews which review the targets for the previous quarter and planned improvements for the following quarter
• Bi-annual management reviews which take the findings for the preceding two quarterly reviews and ensure that we are continually improving our quality of service
• Annual internal audit of each company department against ISO 9001:2008

In addition to the above in line with the company’s ISO 9001:2008 certification, the company adheres fully to the minimum standards set out by the Department of Health, Social Services and Public Safety including co-operation with and inspection by the Regulation and quality Improvement Authority.

Management Structure & Responsibilities for Direct Medics Nursing:

REGISTERED PERSON:

• Ensures registered nurse oversees recruitment of staff
• Deals with alert letter and issues around competence of staff
• Ensures appropriate levels of insurance in place

REGISTERED MANAGER

• Reports issues to Registered Person
• Reviews complete file for each applicant to the register and confirms suitability for placement
• Reviews the ongoing suitability of nurses being placed in assignments annually

RECRUITMENT DIRECTOR (reports to Registered Person):

• Prepares monthly monitoring figures and audits service delivery in adherence with procedures

DIVISION HEAD & RECRUITMENT CONSULTANTS (report to Recruitment Director):

• Liaises with Registered Manager to confirm suitability of applicants for roles
• Confirms assignment for candidates in line with recommendation of Registered Manager.

COMPLIANCE OFFICERS (report to Recruitment Director):

• Complete and maintain all checks required by NHS Employment Check Standards and RQIA

The service contracts held by Direct Medic Ltd. are instigated via procurement exercises and as such, the expected performance level for any resulting service contracts is explicitly defined. The company manages service contracts using the following methods:

1. Effective bid management: At the point of tender issue, the assigned Bid Manager examines the specification of the requirement and carries out a ‘Bid/No Bid’ exercise based on the company’s ability to fulfil the requirements of the resulting service contract. The final decision as to whether to bid would be dependent upon factors such as human resource planning, marketing activities, management information requirements and the current business objectives;
2. Tender Management: In the course of completing a tender bid, the team also identifies what resources not already in place are required in order to perform effectively under the resulting service contract;
3. Contract Instigation Plan: Upon notification of a contract award, the resources and reporting required in order to service the contract are notified to the Board for approval;
4. Performance Monitoring: During the course of the service contract, close monitoring of the team’s performance takes place for several reasons:

i. To ascertain the company’s performance relative to any Key Performance Indicators on the service contract;
ii. To identify issues relevant to contract performance and take remedial action aimed at service improvement;
iii. To safeguard against any detriment to the company in the event that the service contract is renewed.

Nurses engaged in assignments through Direct Medics Ltd. are booked only with the express approval of the Registered Manager. The type of assignment permitted for each nurse is dependent upon the demonstrable skills and qualifications of the individual, ascertained at interview stage by the Registered Manager. The company uses a Skills List to support the interview, aimed at identifying any areas for development at interview stage.  After interview, the Registered Manager advises the Nursing team as to:

i. Whether the applicant can be accepted for work through Direct Medics Ltd.;
ii. The skills, experience and qualifications held by the applicant relevant to their application, and
iii. The type(s) of work the Registered Manager would permit through the company.

Using the input of the Registered Manager, the applicant’s information is input onto the company software which is designed to match vacancies to applicants based on grade, specialty, specific skills or a combination of all three if required. The accurate input of the data is a quality target for the Compliance team within the company, with effective performance in this area monitored by the Compliance Manager on a monthly basis. The data input includes mandatory training modules in line with the requirements of RQIA and relevant Framework agreements.

The email alert system for nurses is built into the company software and is based upon specific searches, meaning that only those nurses meeting the criteria for each vacancy is informed about the post and given the opportunity to apply. Any applicants to a specific vacancy are subject to further document checks by a Recruitment Consultant before being put forward for consideration.

The above ensures that, at point of registration, all nurses wishing to book assignments through Direct Medics Ltd. are matched appropriately to vacancies according to their skills and expertise. This system is maintained and updated as new information becomes available as to the skills and expertise of nurses registered with the company (see “Policy on Reviews and Reassessment of Nurses”).

The Quality Management System (QMS) for Direct Medics applies a succinct method of monitoring and controlling the quality of the company’s processes by means of the procedures outlined in this manual as per the requirements of the ISO 9001:2008 standard for Quality Management Systems.

Quality Procedures

The Quality Management System is implemented using the following procedures:

• Monitoring meetings – one per month, with stakeholders including the Nurse Manager and Registered Owner (or his proxy) in attendance. The monitoring meeting includes a review of the previous month’s performance using the following indicators:

i.   New registrations in preceding month;
ii.  Interviews completed in preceding month;
iii. Service users engaged in preceding month;
iv. An outline of any incidents/complaints received and the outcome if closed off;
v.  A review of the quality monitoring log for the preceding month (with any quality monitoring found not to have been completed carried over to the following month as a priority);
vi. A review of the Supervision and appraisal log for the preceding month;
vii. A review of an RQIA Nursing Agencies Minimum Standard, and any outstanding QUIP items;

• Management review meetings - one approximately every 6 months. The main objective of the meetings include Improving on the current processes; Annual targets progression, and resource planning;
• Annual review: The quality of services provided is evaluated on an annual basis by collating the content of monthly monitoring meetings and involving the comments of key stakeholders including service users and nurses;
• Annual internal audit - conducted against the ISO9001:2008 QMS standard requirements, aimed at ensuring that the quality management system is effective, against the requirements of the standard and planned procedures of the QMS. Areas for improvement are identified using non-conformities as triggers for corrective action and subsequent preventive action;
• Departmental Quality Targets - financial targets set by the Managing Director annually, and the Recruitment Director in conjunction with the Division Head will create quality objectives that will be based on the pursuit of those financial targets.

Direct Medics Ltd. recognises its responsibility to ensure that all reasonable precautions are taken to provide and maintain working conditions which are safe, healthy and compliant with all statutory requirements and codes of practice.

Direct Medics Ltd. recognises moving and handling as the transporting and supporting of loads by hand or by bodily force without mechanical help. This includes activities such as lifting, carrying, shoving, pushing, pulling, sliding or nudging heavy objects. In particular, it covers the lifting or moving of service users by staff.

Direct Medics Ltd. is committed to ensuring the health, safety and welfare of its staff, as far as is reasonably practicable, and of all other persons who may be affected by our activities including service users, their visitors and contractors. As all of these moving and handling activities carry a risk of injury if they are not performed carefully, it is a pre-requisite to registration with Direct Medics Ltd. that all nursing staff are fully trained in moving and handling and attend update training as required.

Staff duties

Staff are required to comply with the risk assessment requirements set out in the Management of Health and Safety at Work Regulations 1999 as well as the requirement in the Manual Handling Operations Regulations 1992 (as amended) (MHOR) to carry out a risk assessment on manual handling tasks.

In addition, employees have duties to take reasonable care of their own health and safety and that of others who may be affected by their actions. They must communicate with their employers so that they too are able to meet their health and safety duties.

Employees have general health and safety duties to:

• follow appropriate systems of work laid down for their safety
• make proper use of equipment provided for their safety
• co-operate with their employer on health and safety matters
• inform the employer if they identify hazardous handling activities
• take care to ensure that their activities do not put others at risk

In addition, no person shall intentionally or recklessly interfere with or misuse anything provided in the interests of health, safety and welfare in pursuance of any statutory provisions.

Employer duties

The client organisation's duty is to avoid Manual Handling as far as reasonably practicable if there is a possibility of injury. If this cannot be done then they must reduce the risk of injury as far as reasonably practicable. If agency worker is complaining of discomfort, any changes to work to avoid or reduce manual handling must be monitored to check they are having a positive effect. However, if they are not working satisfactorily, alternatives must be considered.

The regulations set out a hierarchy of measures to reduce the risks of manual handling. These are as follows:

i.    avoid hazardous manual handling operations so far as reasonably practicable;
ii.   assess any hazardous manual handling operations that cannot be avoided;
iii.  reduce the risk of injury so far as reasonably practicable.

Risk assessment for manual handling by staff

i.    Staff should consider each task for risk of injury;
ii.   If a risk is identified, staff should next consider whether there is a way to eliminate the need for moving manually altogether. For instance, can equipment be used instead?
iii. If the moving and handling task cannot be eliminated altogether, the specific risks involved must next be assessed. This is done in a similar way to any other health and safety risk assessment but the assessment does not need to be recorded provided it is easy to repeat;
iv. Where a specific risk to injury is identified and moving and handling is unavoidable, then measures to reduce the risk must be introduced; e.g. the use of mechanical aids, changing the task to minimise the risk or altering the work environment to make moving and handling less awkward;
v.  Any measures taken to ensure moving and handling safety must be in proportion to the risk and cost-benefit involved.

Staff injured at work

Moving and handling accidents are covered by RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurances Regulations 1995). According to RIDDOR all moving and handling accidents and injuries should be recorded and also reported especially if they result in staff being absent from work for three days or more or involve faulty equipment.

All staff injured at work will receive appropriate support any staff injured as a result of moving and handling should see their GP as soon as possible.

The successful implementation of this policy requires total commitment from all staff. Each individual has a legal obligation to take reasonable care of their own health and safety, and of the safety of other people who may be affected by their own acts or omissions.

Service Users

Monitoring service user satisfaction is considered to be an important indicator as to whether the company is achieving its objectives in delivering a quality care service. The company will attempt to monitor this through the use of feedback reports, either verbal or written which will be requested within one month of a nurse being assigned in a particular clinical area. Feedback is retained on the staff file and provided to the company’s Nursing Manager as input into annual appraisal. In the event that the feedback provides information pertaining to a complaint or skills need, this information will be provided to the Nursing Manager for immediate attention and action under the relevant policy.

Staff

When Direct Medics staff members are confirmed for assignments it is our aim to ensure that they are completely satisfied with the assignment, that it is within the range of their skills and it is everything expected. Our contact with our staff during assignment may include:

i. Arrival calls on the first day (to confirm safe arrival and first impressions);
ii. Service calls during the assignment (to check that the assignment is proceeding as expected);
iii. Records maintenance calls (to update documents that may be due to expire during the assignment).

Whilst clients provide feedback during and after assignments to allow us to maintain a record of performance for all placements, feedback is of course a two-way process and the company encourages all staff to provide relevant information on the assignment, the setting etc to enable us to enhance our service to our staff and to their colleagues moving forward.

Furthermore, the company encourages feedback from its staff on its own performance; a feedback exercise is carried out monthly, with staff booked in the previous month asked to provide feedback via an online survey as to the performance of the company’s Recruitment and Compliance teams. Staff are encouraged to suggest improvements and all feedback is used within the company’s performance management programme for its internal staff.

Absence Notification & Certification

If a staff member is absent from their assignment due to illness or any other reason, they must comply with the company’s absence notification and certification procedure, the principles of which are as follows:

If you are going to be absent from an assignment for any reason, you must notify your Recruitment Consultant at least one hour before the beginning of your shift time; the more notice the company receives as to your absence, the better the chance that an alternative member of staff can be provided to the client to ensure continuity of care. It is not sufficient to leave a voicemail or to send an email or text message; in the event that your Recruitment Consultant is unavailable you must ask to speak with the Recruitment Manager or Managing Director. During sick absence it is vital that you, or in exceptional circumstances a member of your household, maintains regular contact with management to advise of your condition and the date when you are likely to resume work. This will enable the Employer to plan effective cover for the duration of your absence.

For staff working in roles meeting the Agency Worker Regulations’ 12 week qualifying period, the Company reserves the right, on giving notice, to insist on evidence from your doctor for the payment of Statutory Sick Pay, for any sickness absence. A statement of fitness for work is required for all sick absences of 8 days or more (including weekends) and, if sickness continues, at consecutive intervals thereafter.
All staff must complete a return to work interview with their Recruitment Consultant, to ensure fitness to return to normal duties or, if relevant, what adjustments may be required in order to accommodate any new restrictions.

Work restrictions for staff with infectious conditions

All staff must have appropriate training in the control and handling of infections. This will include an appreciation of the need to prevent an infection that an employee may contract spreading to service users and other staff. All staff are required to report and occurrences of infection to their immediate supervisor on their assignment. Employees returning to work after taking holidays in high-risk locations are required to complete an update health declaration.
Each case of infection reported to Direct Medics Ltd. as per the above will be reviewed individually. The action taken will depend upon the following factors:

i. The nature of the disease/infection;
ii. The likely routes of transmission of the infection;
iii. The persons most likely to be infected;
iv. The staff member’s particular job role
v. The staff member involved, specifically the degree of susceptibility to infection;
vi. training records and the expected compliance of the staff member with these policies.

Depending upon the circumstances and in consideration of the above, staff members may be re-deployed to job duties which pose less of an infectious risk to hygiene, health and safety. Such re-deployment would be considered temporary until such time that the infection has cleared. If this is not possible, the staff member may be excluded from duties altogether until the infection has cleared.
In cases such as the above, the period of exclusion or amended duties will be determined by the company’s independent Occupational Health provider, pending an update health declaration. Proof must also be obtained in the form of a fit note from a GP.

Registering with Direct Medics

The team structure of Direct Medics is designed to ensure that registering and working with the company is as straightforward and simple as possible. As a responsible recruiter we take our legislative obligations seriously and as such, there are several elements to our registration procedure designed to fulfil these obligations. We offer several options to complete pre-employment checks and our Compliance team provides any information new registrants may require.

Initial contact with Direct Medics may take several different forms; most applicants will submit an online registration via www.directmedics.com or email a copy of their latest CV. Immediate steps taken by Direct Medics upon receipt of a registration enquiry are as follows:

1. New registrants are assigned a Compliance Officer who will send an introductory email outlining the company’s pre-employment checks;
2. The Compliance Officer will add new registrant’s details to relevant contact lists to allow them to receive information on job opportunities immediately (it is however made clear that no booking can be made until all checks are completed);
3. New registrants are assigned a Recruitment Consultant who carries out an introductory interview (this can take place either in person or via videoconferencing) where any preferences for job opportunities are confirmed;
4. New registrants receive an advisory telephone call from their Compliance Officer aimed at ensuring full understanding of the registration procedure and receipt of all relevant documents. At this point, agreement will be made as to the preferred method to complete the necessary checks;
5. The compliance officer will guide through the remaining compliance checks.

Depending upon circumstances the above steps can take as little as one week to complete, pending outside factors such as processing times with outside bodies.

The NHS Employment Check Standards (2012)
The NHS Employment Check Standards are a set of six documents developed by NHS Employers in conjunction with the Department of Health, and set out the obligations of employers across the NHS pre-employment assessments that must take place for permanently-employed NHS staff. As a responsible recruiter of healthcare staff, Direct Medics adhere fully to each of the checks enshrined in the Standards for all staff employed through the company, and provide full guidance as to the actions required from new staff to meet these obligations. The checks required are as follows:

1. Verification of Identity
2. Right To Work
3. Employment History & References
4. Criminal Record and Barring Checks
5. Occupational Health
6. Professional Registration & Qualifications

In addition to the above checks, new staff members are required to commit to undertaking mandatory training modules, and maintain their validity.

Direct Medics in conjunction with Healthier Business Compliance, offer free online training modules to all registered workers in the following areas as required:

• Basic Life Support
• COSHH (Control of Substances Hazardous to Health regulation)
• Epilepsy
• Equality, Diversity & Inclusion
• Fire Safety
• Food Hygiene
• Handling Medication
• Handling Violence & Aggression and Complaint Handling
• Health and Safety
• Infection Control
• Information Governance
• Training for workers in a lone environment
• Manual Handling
• Mental Capacity Act 2005
• RIDDOR (Reporting of Injuries, Diseases & Dangerous Occurrences Regulations)
• Safeguarding Vulnerable Adults (SOVA) and Child Protection (SOCA) Level 2
• Safeguarding Vulnerable Adults (SOVA) and Child Protection (SOCA) Level 3

Additional practical training is also required in areas such as life support and moving and handling; the specific requirements are advised to staff upon registration. All staff involved in transfusion activity (i.e. sampling, collection or administration) to complete training and competency assessment in line with the Right Patient Right Blood circular.

Completion of Registration with Direct Medics

Upon completion of our pre-employment checks, files are referred to the company’s Nursing Manager, who will review all available information and contact new registrants to arrange a suitable time for a final interview. The interview may take place in person or, in exceptional circumstances via Skype and is aimed at ensuring your complete understanding of our procedures, suitability to work in chosen area(s) and the presence of specialty-specific skills. You will be booked for work through Direct Medics only with the express approval of the Nursing Manager.

Please note, in the event that a Skype interview must be accommodated, new registrants will be required to meet in person with the Nursing Manager on arrival in the United
Kingdom.

Booking an Assignment

Upon completion of registration, the assigned Recruitment Consultant will make contact by SMS, email and telephone to discuss potential placements, particularly if staff regularly update their Consultant regarding availability. This is an opportunity to be informed about jobs first so it is important that regular contact is kept; this is especially important in the event of a change to location, grade or specialty.

When staff members are interested in booking an assignment, they must contact their Recruitment Consultant as soon as possible. They will be referred to their Compliance Officer in the event that registration documents have expired, otherwise their details will be put forward immediately for consideration. If selected, the company will confirm the details verbally and follow up with a written confirmation by email. The confirmation will include all relevant information about the assignment, including reporting instructions, any travel and accommodation arrangements and instructions on payment for the assignment. Any queries upon receipt of your confirmation should be addressed immediately to allow for a smooth start to assignments.

Payment

Different pay rates apply to different assignments. Before commencing an assignment staff members are informed both verbally and in writing, the rate of pay applicable to the assignment. Payment is made to staff on submission of a timesheet without exception. All information given must be accurate and timesheets must be completed in full and every shift must be authorised with an appropriate signature. The position / grade worked must also be identified. Payroll takes place weekly, with all timesheets submitted by 11am on Monday paid to arrive by the following Monday. Payment will be made by Banker’s Automated Clearing Services (BACS) directly into bank/building society accounts, with a pay slip emailed. Staff members must advise of any change to personal circumstances, e.g. change of address, email address or bank account.

The Company is required by law to deduct PAYE and Class 1 National Insurance Contributions. Therefore, staff members are required to pay income tax on earnings (if they exceed the threshold for the current financial year). The rules affecting people working through agencies are contained in Section 134 TA 1988 (formerly section 38, Finance (No.2) Act 1975). Dependent upon earnings, staff members may also be eligible for auto-enrolment onto the company’s pension scheme (which can be opted out of if they so wish).

Any queries relating to pay must be directed to the Finance team at Head Office; email queries should be directed to finance@directmedics.com.

Removal from the Company’s Register

Staff may be removed from the register in the following circumstances:

i.   Where a member’s conduct or standard of work has seriously fallen below the level required by the Company or the NMC Code: Standards of Performance and Ethics for Nurses and Midwives
ii.  If it is believed that a member has acted in an unprofessional manner, the company reserves the right to remove you from your assignment and not re-assign until the matter has been investigated and resolved.
iii. If a member has a reason to be put onto the Group Clinical Alert Register;
iv. If a company has been altered by NMC, RQIA or other regulatory bodies with regard to practicing clinicians.

Examples of such conduct are as follows. This list is not exhaustive:

i.   Failure to attend a Client having accepted an engagement, or repeated lateness.
ii.  Failure to provide care in a fashion consistent with the member’s professional code of conduct or in a caring and appropriate manner, e.g. sleeping on duty, non adherence to clinical instruction etc.
iii. Failure to carry out reasonable instructions of the Client.
iv. Breach of trust involving the Company or the Client.
v.  Disclosure of confidential information to a third party relating to either a Client or the Company.
vi. Misconduct, affecting either the Client or the Company. This includes being under the Influence of alcohol or any substance that will adversely affect your performance, theft, abusive or violent behavior, harassment, criminal conviction etc.

All staff are advised to read the Staff handbook in full, to ensure full understanding of what is required.

Induction and orientation for agency staff takes two different forms; induction into Direct Medics, which involves instruction on the company’s operational arrangements etc. and induction into any organisation into which agency staff are placed on assignment. All newly-appointed agency staff will receive information pertaining to the full company induction checklist in the first instance. This includes:

i.   A copy of the staff handbook which all staff are strongly advised to read and query if necessary. Staff sign a declaration confirming receipt of the staff handbook within the company registration form;
ii.  The company’s statement of purpose which includes a flowchart depicting the operational responsibilities of all members of the nursing team at Direct Medics Ltd.;
iii. Terms and conditions of engagement with the company;
iv. Access to a complete set of all relevant policies and procedures in line with the company’s RQIA registration for review, with particular attention to be drawn to absence notification and certification, Occupational Health arrangements etc.
v.  Access to the company’s HR policies and procedures including disciplinary and grievance and equal opportunities policies.

The company relies on relevant induction information being made available by each client to its staff, relevant to the duties of the role assigned. Typically this will include information such as meals facilities; toilets/lockers/cloakrooms; protective clothing specific to the role; fire regulations/drills/evacuations onsite; first aid arrangements and accident reporting. Part of the booking procedure also involves requesting that, upon arrival on assignment all staff receive an introduction to their immediate supervisor and fellow employees; an introduction to working arrangements within the setting and the opportunity to gain some familiarity with the working practices.

To ensure that staff are aware of the induction information they may be expected to know, the company provides all new registrants with an induction checklist card, which is to be stored in a lanyard along with their identity card and taken to each assignment.

The purpose of carrying out pre-employment health checks is for the protection of both healthcare worker and patient to:

a. ensure that prospective staff are physically and psychologically capable of doing the work proposed, taking into account any current or previous illness
b. identify anyone likely to be at excess risk of developing work-related diseases from hazardous agents present in the workplace;
c. ensure, as far as possible, that the prospective employee does not represent a risk to patients and that they will be doing work that is suitable and safe for them.

The procedures in place at Direct Medics to carry out pre-employment health checks and verify the health screening process constitute a three-step process:

1. Serology reports: New registrants must provide stamped and signed screening information appropriate to the work they are seeking; for all applicants this would involve original printed Pathology report showing correct name, date of birth and date of test. Reports will include:

Hepatitis B surface antibody level
Evidence of a BCG scar viewed by a suitably trained and experienced Occupational Health Nurse or Dept
Evidence of either 2 MMR immunisations or a positive antibody for Rubella and Measles
Proof of a positive antibody or evidence of two doses of the Varicella vaccine

In addition, anyone seeking work in an exposure-prone setting must provide identity-validated reports relating to

Hepatitis C
HIV
Hepatitis B Surface Antigen status

New registrants will normally have received copies of each of these reports from the Occupational Health department at their most recent place of employment. If, for any reason, the required reports cannot be provided your Compliance Officer will put you in touch with either a local Occupational Health service or a postal pathology service to obtain the relevant screening information. Please note we can only proceed with booking assignments when health status has been verified and confirmed

2. Health Declaration: a questionnaire detailing travel history, full screening history and general health questions provided by the Compliance Officer for completion. The health declaration must be completed no more than three months in advance of completing registration with the company;

3. Fit Slip: For anyone seeking hospital work in Northern Ireland, Scotland, Wales and England. Serology reports and health declaration are submitted to Healthier Business, our independent Consultant-led Occupational Health service. Healthier Business will verify suitability to work in either an exposure-prone or non exposure-prone setting. The fit slip will detail any adjustments required to enable registrants to undertake the duties required.

Policy Aim

We all have a responsibility to safeguard and promote the welfare of vulnerable people. Safeguarding adults includes activity which prevents harm from occurring and activity which protects adults at risk where harm has occurred; Safeguarding children is about protecting children from harm as well as helping to ensure they meet their potential and grow up in a safe and caring environment. The intention of this policy is to ensure safeguarding arrangements for vulnerable groups who are at risk of harm from abuse, exploitation or neglect for the purpose of reducing the prevalence of harm.

Safeguarding is a broad spectrum of activity. It ranges from the empowerment and strengthening of communities, through prevention and early intervention, to risk assessment and management, including investigation and protective intervention. At all stages, safeguarding interventions aim to provide appropriate information, supportive responses and services which become increasingly more targeted and specialist as the risk of harm increases.

Company procedures for protecting vulnerable groups are in accordance with the Safeguarding Vulnerable Groups (Northern Ireland) Order 2007 (as amended by the Protection of Freedoms Act 2012). As such, DHSSPS guidance, regional protocols and procedures issued by HSC Trusts are adhered to, including:

“Adult Safeguarding: Prevention and Protection in Partnership” (2015); and
“Protocol for Joint Investigation of Adult Safeguarding Cases” (NIASP 2016)

Adult Safeguarding Champion

The company’s Adult Safeguarding Champion is the Nurse Manager

Their key responsibilities include:

1. To provide information, support and advice for staff and/or volunteers on adult safeguarding within the organisation;
2. To ensure that the organisation’s adult safeguarding policy is disseminated and support implementation throughout the organisation;
3. To advise the organisation regarding adult safeguarding training needs;
4. To provide advice to staff or volunteers who have concerns about the signs of harm and ensure a report is made to HSC Trusts where there is a safeguarding concern;
5. To support staff to ensure that any actions take account of what the adult wishes to achieve – this should not prevent information about risks of serious harm being passed to the relevant HSC Trust Adult Protection Gateway Service for assessment and decision making;
6. To establish contact with the HSC Trust Designated Adult Protection Officer (DAPO), PSNI and other agencies as appropriate;
7. To ensure accurate and up to date records are maintained detailing all decisions made, the reasons for those decisions and any actions taken;
8. To compile and analyse records of reported concerns to determine whether a number of low level concerns are accumulating to become more significant. These records must be available on request for inspection or by way of service level agreements or contract review meetings.

Preparing staff for work

Provision of healthcare services falls within the scope of ‘Regulated Activity’ in relation to adults and children, as defined in the Safeguarding Vulnerable Groups Order 2007 (SVGO) and as amended by the Protection of Freedoms Act 2012 (PoFA). Procedures for protecting vulnerable adults and safeguarding children are therefore included in the induction of all staff proposed to register with the company by:

1. having proposed staff complete an enhanced AccessNI Disclosure;
2. having proposed staff complete training on protecting vulnerable groups (training will include protection from abuse; indicators of abuse; responding appropriately to suspected, alleged or actual abuse; and reporting suspected, alleged or actual abuse). This training is refreshed every three years as a minimum.

Recognising signs of abuse

Candidates assigned for work through Direct Medics must always be aware of their responsibilities in respect of safeguarding, and alert to the signs of abuse, which can take many forms. For example:

• Verbal / psychological abuse: such as using demeaning language or name calling, provoking or frightening the service user or subjecting them to witness unpleasant acts. The service user may appear frightened, nervous, irritable or withdrawn;
• Physical abuse: such as rough handling, slapping, punching or burning. Look for marks and bruises that cannot be explained. The person may wince or withdraw from you when you approach them;
• Sexual abuse: people who have been sexually or indecently assaulted may have soreness or bleeding in the genital area;
• Financial abuse: such as using someone’s credit card to steal money without their knowledge, or stealing valuable or sentimental items. The person may appear worried or withdrawn;
• Neglect/Deprivation: such as the withholding of basic rights or comforts such as food, light, heating, medication or personal hygiene. The person may appear dirty or be inappropriately dressed for the time of year.

Additional forms of abuse will interface with Safeguarding, such as:

• Domestic violence or abuse: defined as ‘threatening, controlling, coercive behaviour, violence or abuse (psychological, virtual, physical, verbal, sexual, financial or emotional) inflicted on anyone (irrespective of age, ethnicity, religion, gender, gender identity, sexual orientation or any form of disability) by a current or former intimate partner or family member’. The response to any adult facing this situation will usually require a referral to specialist services such as Women’s Aid or the Men’s Advisory Project. In high risk cases a referral will also be made to the Multi- Agency Risk Assessment (MARAC) process;
• Human trafficking/modern slavery: Involves the acquisition and movement of people by improper means, such as force, threat or deception, for the purposes of exploiting them. It can take many forms, such as domestic servitude, forced criminality, forced labour, sexual exploitation and organ harvesting. Victims of human trafficking/ modern slavery can come from all walks of life; they can be male or female, children or adults, and they may come from migrant or indigenous communities. The response to adults at risk experiencing human trafficking/modern slavery will always be to report the incident to the Police Service;
• Hate crime: Any incident which constitutes a criminal offence perceived by the victim or any other person as being motivated by prejudice, discrimination or hate towards a person’s actual or perceived race, religious belief, sexual orientation, disability, political opinion or gender identity. The response to adults at risk experiencing hate crime will usually be to report the incident to the Police Service.

At each new client, staff should familiarise themselves with any policies and procedures relating to safeguarding and be aware of the signs that may indicate abuse or neglect.

Reporting suspected, alleged or actual abuse

All suspected, alleged or actual incidents of abuse are to be reported both to the Company and to the Gateway Service at the Health and Social Care Trust within which the suspected, alleged or actual abuse has taken place. The relevant contact details are as follows:

THE OUT OF HOURS NUMBER FOR ALL TRUSTS IS 028 9504 9999

The Company will take a statement from the person reporting the suspected, alleged or actual abuse for use in any resulting investigation, either by the relevant Health and Social Care Trust, the PSNI and/or any other relevant organisations. The Company will keep written records of all such investigations, including the outcome and any action taken by the Company. Where shortcoming in Company systems are highlighted as a result of any such investigation, procedures will be reviewed with a view to adding safeguards.

Allegations of abuse against Company Staff

Allegations of abuse or neglect against candidates working through Direct Medics will be taken very seriously. If we receive complaints of this sort against a member of staff, the following will take place:

i.  The Registered Manager will inform the candidate whether the company will be able to offer work whilst the allegation is being investigated;
ii. Advice will be sought from the Nursing & Midwifery Council as to whether a referral is appropriate, whilst the allegation is investigated

In the event that the Protocol for Joint Investigation of Adult Safeguarding Cases is invoked, company investigation will cease save for an initial statement until the external investigation is concluded. Following this, and in the event that allegations are proven, the following may take place:

i.   The candidate is subject to the company disciplinary procedure;
ii.  The candidate may have their registration with the company removed;
iii. The candidate may be referred to the Disclosure & Barring Service;
iv. The candidate may be referred to the nursing & Midwifery Council (if a referral was deemed unnecessary by NMC at the outset of the investigation).

The overarching quality standard to be met by Direct Medics is the specification of its contracts with various NHS organisations. The company holds ISO 9001:2008 certification alongside REC and NRF memberships and its service is maintained in adherence with this, and inspection reports generated by the Regulation and Quality Improvement Authority. An ongoing series of management procedures and continual improvement measures take place at a senior level within the company including:

i.    Quality targets for each team: for example, targets for Recruitment relate to response, fill and conversion rates for vacancies whilst Compliance staff are monitored on their handling of new registrants and other doctors available for locum work. Targets for each team are reviewed and increased quarterly with results contributing to performance management;
ii.   Monthly management meetings at which a summary is provided by each member of the management team as to quality targets and progress on business improvements are discussed alongside operational matters;
iii.  Quarterly reviews which review the targets for the previous quarter, areas for development and planned improvements for the following quarter;
iv.  Bi-annual management reviews which take the findings for the preceding two quarterly reviews and special improvement projects undertaken by each member of the management team;
v.   Annual internal audit of each of the company’s departments against ISO 9001:2008 by the company’s BSI-qualified Internal Auditor, supported by an Assistant Auditor;
vi.  Annual external audit of the company by BSI for ISO 9001:2008 re-certification;
vii. Monitoring meetings – one per month, with stakeholders including the Nurse Manager and Registered Owner (or his proxy) in attendance. The monitoring meeting includes a review of the previous month’s performance using the following indicators:

New registrations in preceding month;
Interviews completed in preceding month;
Service users engaged in preceding month;
An outline of any incidents/complaints received and the outcome if closed off;
A review of the quality monitoring log for the preceding month (with any quality monitoring found not to have been completed carried over to the following month as a priority);
A review of the Supervision and appraisal log for the preceding month;
A review of an RQIA Nursing Agencies Minimum Standard, and any outstanding QUIP items

The quality control systems of Direct Medics are in accordance with ISO accreditation with systems aimed at assuring that risk is minimised for the company’s clients. Ongoing improvement is achieved via review of company documents, processes and training materials in line with service specifications, and refresher training provided as an ongoing programme overseen by team leaders. The company’s quality control systems focus on both legal compliance and excellent customer service for healthcare workers; processes in place include the following:

i.    All healthcare workers are assigned a Compliance Officer to advise on documents and a Recruitment Consultant to advise on opportunities according to skills;
ii.   Regular communication takes place to ensure compliance and to meet client needs;
iii.  System alerts to Compliance staff about outstanding documentation and reference reports or items due for renewal are embedded in the company’s bespoke software;
iv.  Post-booking checks by senior management with failure to adhere to protocols treated under the company’s disciplinary procedure;
v.   Regular document checks during assignment and advice to current workers on same;
vi.  Monthly audits: results are examined to identify any training needs and to commend those who meet the requirements;
vii. The company's response, fill and conversion rates are monitored via monthly internal audit which identifies areas of need and feeds into ongoing attraction strategies.

Direct Medics Ltd. as a professional organisation recruits staff for the delivery of its services in line with the core competencies of specific roles and in full consideration of all relevant employment legislation. The company follows a clear and transparent process aimed at selecting and retaining individuals most suited to the job role in question and most likely to deliver the team and company objectives for each target market, which are set annually.#

1. The process for recruiting new staff to Direct Medics Ltd. is as follows:
   Job Description: specifying what the person will have to do;
2. Person Specification: specify the knowledge, experience and skills required for the tasks listed on the job description, which is used to formulate criteria for the role (both essential and desirable);
3. Advertise: reflecting the criteria and specifying correct application route (e.g. CV or application form);
4. Shortlist against criteria: using evidence available on paper;
5. Interview against criteria: exploring experience and assessing skills;
6. References: a final check for suitability for a role against criteria
7. Appoint new staff member: agree induction dates, a training programme with the relevant team leader and assessment criteria to ensure understanding of training.

This policy details the process for reporting, recording and notifying accidents, incidents, infectious diseases and deaths that occur when agency staff are on assignment. Learning from incidents is a vital part of maintaining the safety of patients, staff and visitors in order that the Agency ensures safe standards of care are maintained. Agency staff are reminded also to check the corresponding policy at the client organisation to ensure that any additional requirements at the location of the assignment are adhered to.

RIDDOR

The Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (Northern Ireland) 1997 is the law that requires employers, and other people in control of work premises, to report and keep records of:

i.     work-related accidents which cause death;
ii.    work-related accidents which cause certain serious injuries (reportable injuries);
iii.   diagnosed cases of certain industrial diseases; and
iv.   certain ‘dangerous occurrences’ (incidents with the potential to cause harm).

Serious accidents, building incidents and certain work related diseases in accordance with the Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (Northern Ireland) 1997 must be reported to the Health and Safety Executive NI. This includes serious injury, over 3 day injuries, specified work related illnesses and serious building related problems.

Accidents

Any injury - including minor injuries – resulting from an accident whilst on assignment should be recorded both in the 'accident book' at the employing client and in the agency’s ‘accident book’. This is mainly for the benefit of agency staff as it provides a useful record of what happened in case they need time off work or need to claim compensation later on. Recording accidents also helps the agency and employing client to see what's going wrong and take action to stop accidents in future.

Incidents

In the ‘Incident and Near Miss Reporting Policy and Procedure’ (September 2011) An incident is defined by the Heath and Social Care Board as, ‘Any event or circumstances that could have or did lead to harm, loss or damage to people, property, environment or reputation’. The Board goes on to list the following occurrences that would typically be regarded as ‘incidents’:

i.       Security Incident: Patient or Service user absence; theft of HSCB property and/or staff personal property; malicious damage; removal of non-prescribed substances and alcohol; removal of offensive weapons; restraint and any other issue which poses a threat to services users, staff or visitors;
ii.      Fire Incident: any incident no matter how small, involving fire or fire warning systems (including false alarms);
iii.     Vehicle Incident: any incident involving a vehicle e.g. Road traffic accident, excluding vandalism or theft which would be classified as a security incident;
iv.     Violence, Abuse or Harassment Incident: any incident involving verbal abuse, unsociable behaviour, racial or sexual harassment or physical assault, whether or
not injury results;
v.      Personal Accident or Injury Incident: any accident, no matter how small, which did or could have adversely affected any person;
vi.    Ill health incident: any case of known or suspected work or environment related ill health;
vii.   Clinical Incident: any incident, except medication error, directly related to patient treatment or care which did or could have resulted in adverse outcome (e.g. Treatment, medical equipment failure etc);
viii.  Medication Incident: any medication incident which did or may have caused actual or potential harm to patient(s):
ix.    Environmental Incident: Environmental incidents are those which have resulted in damage or danger to the natural environment. This may include damage to water courses or land or emissions to the air as a result of accidental pollution e.g. spillage, leakage or uncontrolled discharge of substances, emission to air of gas, dust, fumes or other pollutants, escape or improper storage or disposal of waste, etc.

All incidents listed above must be reported to the Nursing Agency and RQIA. The agency will record all notifications and any further information or advice received from RQIA in respect of such incidents. In addition, dependent upon the circumstances surrounding the incident itself, further notifications may be necessary, including:

Health and Safety Executive Northern Ireland:

Serious accidents, building incidents and certain work related diseases in accordance with the Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations (Northern Ireland) 1997 must be reported to the Health and Safety Executive NI. This includes serious injury, over 3 day injuries, specified work related illnesses and serious building related problems.

PSNI:

In the event of instances such as burglary, theft, fraud, assault etc. the PSNI should be informed.

All agency staff have a responsibility to:

i.     Report to the agency any incident or near miss they are involved in (the agency will require full factual information to notify RAIQ);
ii.    Attend any education and training sessions available in relation to incident reporting and management;
iii.  Co-operate with any subsequent investigation.

Infectious Diseases

Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans. Under the Health Protection (Notification) Regulations 2010, there are 35 ‘notifiable’ diseases (ie those which must be treated under RIDDOR). All agency staff should be familiar with diseases are notifiable and take necessary steps within the setting of their assignment to ensure that statutory obligations in this regard are adhered to.

Deaths

1. Death of a service user following palliative care
   i.    The service user’s GP will be notified immediately;
   ii.   If the family/next-of-kin were not present at time of death, they will be notified as soon as possible. Upon arrival, the family will be allowed time with the deceased if they so wish, and consulted as to the type of burial required and preferred funeral director;
   iii.  The GP will certify death and provide the appropriate death certificate, which is then passed to the family with a cremation form if required;
   iv.  A note of the time and death must be made in the service user’s clinical notes, and the care plan is consulted to confirm any religious/ethnic/cultural considerations to be observed before handling the body.
2. Sudden death of a service user
   i.    Under no circumstances is the body to be moved or touched;
   ii.   The service user’s GP will be notified immediately who, in turn, will notify the coroner/Procurator Fiscal;
   iii.  The family/next-of-kin will be notified as soon as possible. Upon arrival, the family will be allowed time with the deceased if they so wish, and consulted as to the type of burial required and preferred funeral director;
   iv.  The GP will certify death and provide the appropriate death certificate, which is then passed to the family with a cremation form if required;
   v.    A note of the time and death must be made in the service user’s clinical notes, and the care plan is consulted to confirm any religious/ethnic/cultural considerations to be observed before handling the body.

All accidents, incidents, communicable diseases and deaths occurring where a nurse has been supplied are reported to the Regulation and Quality Improvement Authority and other relevant organisations in accordance with legislation and procedures above.

The responsibilities of registered person for the company are numerous and far-reaching, with a full understanding of legal responsibilities at the forefront. The registered person holds ultimate responsibility for ensuring that the company is run in accordance with legislative requirements, DHSSPS minimum standards and other standards set by professional regulatory bodies and standard setting organisations and as such, it is imperative that reporting arrangements are appropriate to allow them to carry out their role effectively.

The nursing division team has been structured with effective checking and reporting in mind, and the responsibilities of each individual are understood. The management structure of the division members is as follows:

Each member of the team is briefed on the importance of reporting anomalies or points of note to the Registered Person for their consideration and action. The Registered Person is then responsible for taking any and all action necessary in accordance with relevant legislation and obligations on behalf of the company. The information of interest to the Registered Person will come in the main from the Recruitment Manager via audit reports and analysis of complaints etc. and the Registered Manager (who in turn receives relevant information from all other team members).

REGISTERED PERSON

• Ensures registered nurse oversees recruitment of staff effectively
• Ensures appropriate levels of insurance in place

REGISTERED MANAGER

• Reports issues to Registered Person
• Reviews complete file for each applicant to the register and confirms suitability for placement
• Reviews the ongoing suitability of nurses being placed in assignments annually

RECRUITMENT DIRECTOR (reports to Registered Person):

• Prepares monthly monitoring figures and audits service delivery in adherence with procedures
• Deals with alert letter and issues around competence of staff

RECRUITMENT CONSULTANTS (report to Recruitment Director):

• Liaises with Registered Manager to confirm suitability of applicants for roles
• Confirms assignments for candidates in line with recommendation of Registered Manager

COMPLIANCE OFFICERS (report to Recruitment Director):

• Complete and maintain all checks required by NHS Employment Check Standards and RQIA

All policies and procedures are viewed by Direct Medics Ltd. as ‘live’ documents. As such, updates and amendments take place on an ongoing basis in line with factors such as:

i.    Legislative changes;
ii.   Procedural amendments as instructed by procurement bodies;
iii.  Advances in best practice knowledge; and
iv.   Requirements laid down in inspection reports from RQIA

As a minimum, all company policies and procedures are reviewed in preparation for the company’s annual external audit in line with ISO 9001:2008 accreditation.

The Service Users’ Guide viewed by Direct Medics Ltd. as a ‘live’ document, designed to inform and advise the users of the company’s services as to how best to access all aspects of the service and to guide as to the correct course of action in the event of a problem. As such, updates and amendments take place on an ongoing basis in line with factors such as:

i.    Legislative changes;
ii.   Procedural amendments as instructed by procurement bodies;
iii.  Advances in best practice knowledge; and
iv.  Requirements laid down in inspection reports from RQIA

As a minimum, the Service Users’ Guide is reviewed in preparation for the company’s annual external audit in line with ISO 9001:2008 accreditation.

At point of registration, all nurses wishing to book assignments through Direct Medics Ltd. are matched appropriately to vacancies according to their skills and expertise (see “Matching Skills and Expertise of Nurses to the Requirements of Placements”). The aim of reviewing and reassessing nurses on an ongoing basis is to maintain and update the company’s records as new information becomes available as to the skills and expertise of nurses registered with the company, thus amending records as to the suitability of individual nurses for specific vacancies and providing assurances as to the ongoing suitability of individual nurses for roles originally deemed suitable for them at the point of registration.

The following reviews and reassessments typically take place:

1. Prior to booking an assignment: Each time a nurse requests that an assignment be booked for them, their Recruitment Consultant performs a check with the Nursing and Midwifery Council’s Online Confirmation Service, which is an enhanced checking service designed to provide up to date information as to registration status. This check identifies any stipulations or restrictions on the nurse’s registration which may affect a booking;

2. During/after assignments: Each nurse will receive a call from their Recruitment Consultant to confirm verbally that the assignment is within the scope of their skills and that they are comfortable with the duties expected of them. On a monthly basis, the agency checks company software for any candidates working in a clinical setting for the first time and contact the Client for feedback which may be given verbally or in writing. Feedback is recorded on the company software. Any areas of concern raised are reported to the Registered Manager and feedback is subsequently delivered to the nurse, with a development plan put in place if required aimed at improving upon the areas of concern. The plan would include required actions with agreed timescales for completion and are closed off in a timely and realistic manner;

3. On an ongoing basis: The company software is designed to issue reminders to Compliance staff as to the expiry dates of all relevant documentation for nurses, including items such as AccessNI disclosures, mandatory training modules, professional indemnity, NMC registration. The Compliance team works with nurses to update and maintain their files thus ensuring ongoing suitability and update of knowledge particularly with regard to training modules. Likewise, in the event that a nurse obtains additional qualifications or has the opportunity to develop particular skills, these are reported to the Registered Manager who advises the team as to any amendments to be made to the company software to impact upon the roles suitable for that nurse;

4. Six months after the first booking, and annually thereafter: The Registered Manager invites all candidates to take part in clinical supervision, provided they have carried out at least sixty shifts in the previous six months. The supervision exercise is an opportunity for candidates to raise any concerns and provide feedback on clinical settings. Actions required to improve outcomes will be identified and reported to relevant staff at the company. Any specific support required will be identified and documented. Progress against these actions will be reviewed and documented at follow up supervision sessions.

5. Twelve months after the first booking, and annually thereafter: The Registered Manager invites each nurse to an annual appraisal. Preparation for the appraisal meeting would include a review of all work undertaken through Direct Medics Ltd. in the preceding year and corresponding exit reports; any recommendations made to the nurse throughout the year and subsequent actions and reviews (including a record of any conclusion drawn by the Registered Manager throughout the year as to the nurse’s ongoing fitness for work specified). The appraisal meeting itself is aimed at reconfirming the conclusions of the Registered Manager following the initial interview at registration stage, updating the information available to reflect the nurse’s current preferences and suitability for work and to identify any desired areas for development. The outcome of the appraisal meeting is a Personal Development Plan for each nurse identifying their learning and development objectives for the coming year in agreement with the Registered Manager.

The Direct Medics Ltd. statement of general policy relating to health and safety is:

i.     to provide adequate control of the health and safety risks arising from our employees work activities;
ii.    to consult with our employees on matters affecting their health and safety;
iii.   to ensure that our clients provide and maintain safe plant and equipment;
iv.   to ensure safe handling and use of substances;
v.    to provide information, instruction and supervision for employees;
vi.   to ensure all employees are competent to do their tasks, and to give them adequate training;
vii.  to prevent accidents and cases of work-related ill health;
viii. to maintain safe and healthy working conditions; and
ix.   to review and revise this policy as necessary at regular intervals.

Risk Management

Risk management is recognised within the organisation as an integral part of good practice. It is the ultimate goal of this policy that the effective management of risk is an integral part of everyday practice.

Incident reporting is a fundamental tool of risk management, the aim of which is to collect information about adverse incidents, including near misses and hazards, which help to facilitate wider organisational learning. Incidents and their consequences, if not properly managed, may result in loss  of public confidence in the organisation, loss of assets and unnecessary proliferation of loss.

The following arrangements are aimed at providing a comprehensive and reporting system within Direct Medics Ltd.:

i.     A designated senior person within the organisation with responsibility for the local complaints procedure;
ii.    The arrangements for making complaints are publicised to service users;
iii.   All staff receive training and guidance on the complaints procedure to enable them to deal with complaints on the spot;
iv.   The organisation has an effective system for the recording of complaints;
v.    The organisation monitors how it, or those providing care on its behalf, deals with, and responds to, complaints;
vi.   The organisation learns from complaints and improves services as a result
vii.  All reported complaints are graded according to severity as well as potential future risk to users and/or to the organisation;
viii. Information on complaints is reported to and considered by the management team.

Examples of Verification:

i.      Complaints policy/procedure;
ii.     Compliance with the standards for complaints handling;
iii.    Evidence of dissemination of learning within the organisation and use of the Equality Good Practice Review on the handling of complaints;
iv.    Management meeting minutes;
v.     Training programmes;
vi.    Training evaluation forms;
vii.   Induction programme;
viii. Customer feedback;
ix.    Independent review reports (including those from RQIA and BSO).

The organisation must be aware of its risk profile across its entire range of activities. Specific risk assessments may be undertaken but in order to prioritise action an annual organisation-wide review is necessary to ensure that all exposures are duly considered.

Key Risks

“Key risks” (those which have significant potential to impair or affect the operational or financial ability of the organisation to deliver services and meet objectives, and may be strategic or operational in nature) themselves require a comprehensive assessment of risks, creating a continuum of risk assessments across the length and breadth of the organisation, encompassing all risks.

Examples of Verification:

i.      Risk management strategy;
ii.     Risk identification tools;
iii.    Risk assessment tools and forms;
iv.    Completed risk assessments;
v.     Risk treatment options;
vi.    Evidence of risk treatment;
vii.   Business plans;
viii. Annual report;
ix.   Risk registers;
x.    Management meeting minutes;
xi.   Monitoring and review procedure;
xii.  Incident and complaints analysis.

The above contributes to the organisation’s risk management culture, which needs to be embedded at all levels throughout the organisation. An appropriate training programme is an important means of achieving competence and helps to ensure compliance with safe working practices. All job descriptions for employees within the organisation should contain reference to their risk management responsibilities.

Independent Review

Reviews by independent bodies assist the organisation in demonstrating performance, and also in highlighting areas that need to be addressed. This gives the organisation assurance that controls are working satisfactorily and that local and national targets are being met.

The following aspects of company practice provide assurance that Direct Medics Ltd. could meet the requirements of an independent review:

i.    The role of the Audit Committee in reviewing and providing assurance on the risk management systems in place is clearly defined;
ii.   The role of the internal audit function in reviewing and providing verification on the systems in place is clearly defined;
iii.  The internal audit function carries out periodic reviews to provide assurances to the organisation that a suitable risk management system is in place and working properly taking into consideration reviews by other review bodies;
iv.  The organisation has a system in place to ensure that reviews carried out by external agencies are effectively co-ordinated and any recommendations implemented within the context of available resources;

Examples of Verification

i.    Internal Audit reports;
ii.   Audit minutes;
iii.  Minutes of the management meetings;
iv.  Reports from RQIA and other review bodies;
v.   Reports from external audit.

Smoking

This policy has been designed to protect all agency staff and service users from exposure to second-hand smoke. Under the terms of The Smoking (Northern Ireland) Order 2006, all work premises are smoke-free (no-smoking) areas. Classed as a place of work, enclosed premises are strictly smoke-free as are any semi-enclosed premises, semi-enclosed or enclosed premises leading to an entrance or any open structure located on the premises.

i.   The term ‘semi-enclosed’ in this context refers to any porch, veranda, balcony or stairwell that is located on work premises;
ii.  The term smoking covered under the terms of The Smoking (Northern Ireland) Order 2006 refers to “smoking tobacco or anything which contains tobacco, or smoking any other substance; and (b) smoking includes being in possession of lit tobacco or of anything lit which contains tobacco, or being in possession of any other lit substance in a form in which it could be smoked.”

Any individual who wishes to smoke must first exit the premises and locate to the designated smoking area. Designated disposal points must be used for the disposal of waste while smoking, whether smoking related or otherwise.

Local and/or company disciplinary procedures will be followed if a member of staff does not comply with this policy. Those who do not comply with the Health Act may also be liable to a fixed penalty fine and possible criminal prosecution.

Alcohol and Substances

This policy is based on the following aims:

i.    To maintain a safe and healthy environment for all service users and staff;
ii.   To minimise drug and alcohol related injuries to persons or property;
iii.  To comply with applicable laws and legislation;

The use of drugs and/or alcohol by members of staff is strictly prohibited at all times and under all circumstances.

The company recognises its duty as an employer to provide and monitor for employees, so far as is reasonably practicable, a working environment which is reasonably suitable for the performance of their contractual duties and this includes providing a drug and alcohol-free environment. However, the company makes a distinction between patterns of alcohol or drug misuse which point to addiction in staff, such as drinking or drug taking to excess continually, regularly or in intense episodes and, on the other hand, random instances of drug taking or excessive drinking which effect work.

The company regards alcohol and drug misuse of the first kind as first and foremost a health problem and its approach will be informed by this understanding. Other forms of drink and drug consumption that affect work will be treated as conduct or performance issues and dealt with according to the disciplinary procedure. This includes cases where employees attend work under the influence of drugs or alcohol. In all such circumstances, where a member of staff either attends work under the influence of drugs or alcohol or uses drugs or alcohol while at work:

i.    The member of staff will be sent home;
ii.   The disciplinary procedure will be applied;
iii.  The police will be informed (in the case of drug use)
iv.  As far as is practicable, job security will be maintained for any member of staff participating in treatment and/or counselling in an attempt to deal with drug or alcohol abuse. Where a member of staff has to be away from work to undergo treatment, their job will be held in accordance with contractual sickness procedures. However, it must be accepted that, in the long-term, job security must depend upon work returning to an acceptable level;
v.   Drug or alcohol abuse will not in itself constitute grounds for dismissal, unless the staff member’s actions or performance reached an unacceptable level. Such cases will be dealt with under normal disciplinary procedures.

GENERAL PRINCIPLES

The following general principles will apply to the Disciplinary, Dismissal and Grievance Procedures for agency Nursing, AHP and Healthcare assistant staff.

Each step and action will be taken without unreasonable delay. Employees should be aware that timelines may vary to those set out in this policy, due to (for example) the volume or complexity of the allegations being considered, or the availability of appropriate members of staff to conduct each stage of the process
Whenever the employee is invited by the Company to attend a meeting, the employee must take all reasonable steps to attend.
At all stages of the procedure (except any investigation meetings) the employee will have the right to be accompanied by a trade union representative or a work colleague of your choice. If the employee’s choice of companion is unreasonable (e.g. because they are unavailable for a prolonged period of time or because of a conflict of interest) the Company may ask the employee to choose someone else. If a companion is unable to attend any such meeting the employee may suggest an alternative date, provided it is within 5 working days of the original date.

• Timing and location of meetings must be reasonable.
• Meetings will be conducted in a manner that enables both the Company and employee to explain their case.
• For appeal hearings following a decision the Company will as far as reasonably practicable, be represented by a more senior manager than attended the first meeting (unless the most senior manager attended that meeting).
• If the employee has difficulty at any stage of the procedure because of a disability they should discuss with HR as soon as possible.

DISCIPLINARY, DISMISSAL AND GRIEVANCE PROCEDURES

PURPOSE

The Disciplinary, Dismissal and Grievance procedures are designed to help and encourage all employees to achieve and maintain appropriate standards of conduct, attendance and job performance. The aim is to ensure consistent and fair treatment for all in the organisation.

PRINCIPLES

• No disciplinary action will be taken against an employee until the case has been fully investigated. The amount of investigation required will depend on the nature of the allegations and will vary from case to case.
• Direct Medics may remove agency staff without pay while an investigation takes place. Such a suspension will be reviewed as soon as possible and will aim to not normally exceed 10 working days. Suspension of this kind is not a disciplinary penalty and does not imply any decision has been made about the allegations.
• Misconduct will generally fall into two categories, namely “general” misconduct (in respect of which the general disciplinary action procedure described below applies) and “gross” misconduct, which is of so serious a nature that it justifies instant dismissal for a first offence. Listed below are examples which would normally be considered to be either general misconduct or gross misconduct. However, it should be recognised that neither list can be regarded as complete to meet every case, and also that action described as general misconduct may amount to and be treated as gross misconduct if the circumstances or the manner of the misconduct are such as to warrant serious disciplinary action.

These lists should be regarded therefore as being illustrative rather than exhaustive.

Examples of “gross” misconduct:

Summary dismissal (i.e dismissal without notice or pay in lieu of notice) may be necessary in cases of gross misconduct. For guidance, the following are examples of the offences which may be regarded as gross misconduct and will normally result in summary dismissal. It is emphasised that this is not an exhaustive list:

• Unauthorised use or disclosure of confidential information or business matters relating to the Company, its clients, temporary workers or applicants.
• Unauthorised amendments to the Company’s profile pages on any networking site or Networking Site as defined in the Company’s Email, Telephone, Computer Facilities and Social Media policy or website.
• Acts of violence, including physical assault, unlawful discrimination, drunkenness, taking of non-prescribed drugs in such a way as to impair the ability to carry out work or conduct of any kind which endangers the health and safety of others.
• Any bullying or harassment of fellow employees, clients, candidates or any other person including via the company’s facilities or any Networking Sites (as defined in the Email, Telephone, Computer Facilities and Social Media Policy).
• A criminal offence committed at work other than a minor road traffic offence committed in the course of the employment, or an offence committed outside work which is incompatible with the employee remaining in the Company’s employment.
• Falsification of information or references on appointment.
• Theft or fraudulent activity.
• Unauthorised absence or gross negligence in the performance of duties.
• Breach of the Company’s Anti-Bribery and Corruption Policy.
• Any conduct tending to bring the Company, or the employee into disrepute or which results in the loss of custom of a client, temporary or applicant or a loss of business.
• Working for or assisting a competitor of the company or seeking to establish a business which is likely to compete with the company or divulging confidential information concerning the company and its business.
• Serious insubordination or refusal to obey a lawful instruction in connection with the employment.
• Deliberate and serious damage to property or causing any loss, damage or injury through negligence.
• Serious misuse of the Company’s property or name.

Examples of “general” misconduct

The following may be regarded as reasons for disciplinary action in that they deviate from accepted standards and constitute general misconduct. The employee’s first offence will usually result in a written warning. Repetition of offences following a warning could lead to a final written warning as appropriate. Thereafter any repetition will result in dismissal. It is again emphasised that this is not an exhaustive list:

• Poor job performance.
• Poor time-keeping.
• Failure to comply with the conditions of your employment contract.
• Unseemly or disruptive conduct.

DISCIPLINARY ACTION

The following is the disciplinary action that may be taken against an employee in cases of misconduct or unsatisfactory performance:

STAGE 1 – FORMAL WRITTEN WARNING

If an employee’s conduct or performance is unsatisfactory, they will be given a formal written warning. This written warning will include the reason for the warning and a note that, if there is no improvement after a specified period, a final written warning will be given. A copy of the written warning will be given to the employee and a copy will be placed on their personnel file. The warning will be disregarded after 6 months satisfactory service.

STAGE 2 – FORMAL FINAL WRITTEN WARNING

If following a written warning, conduct or performance remains unsatisfactory, or if a serious incident occurs, a final written warning will be given making it clear that any recurrence of the offence or other serious misconduct within a specified period will result in dismissal. A copy of the written warning will be given to the employee and a copy will be placed on their personnel file. The warning will then be disregarded after 12 months satisfactory service.

STAGE 3 – DISMISSAL OR OTHER SANCTION

If there is no satisfactory improvement in conduct or performance, or if further serious misconduct occurs within 12 months, the final step in the procedure may be dismissal, either with or without notice or payment in lieu of notice, or some other action short of dismissal such as disciplinary suspension or transfer to another department or job. Stage 3 may also apply to any gross misconduct (even if there are no active warnings on file) or any misconduct during your probationary period.

DISCIPLINARY PROCEDURE

Informal Discussion

Minor breaches of discipline, misconduct, poor time-keeping, etc may result in an informal discussion with the employee’s contact within Direct Medics.

Although an informal warning will not be formally recorded for the purposes of any future disciplinary hearing, a note of the conversation may be kept on the employee’s personnel file.

It is expected that in most cases an informal discussion will resolve most difficulties. Where an employee commits a more serious act of misconduct or fails to improve and maintain that improvement with regard to conduct, behaviour or job performance, the formal steps detailed below may be taken.

Formal Discussion

Step 1 - Written Statement

The Company will inform the employee in writing of the alleged conduct or characteristics, or other circumstances, which lead the Company to contemplate dismissing or taking disciplinary action against the employee. This shall be done promptly after becoming aware of the circumstances, and the employee shall be invited to attend a meeting to discuss the matter, once any necessary investigations have been conducted to establish the facts of the matter. The Company will provide a copy of any relevant documents which will be used at the disciplinary meeting to the employee in advance of the meeting.

Step 2 – Meeting

The meeting will take place before any action is taken.

The meeting will not take place unless:

• the Company has informed the employee of the ground or grounds for contemplating disciplinary action or dismissal; and
• the employee has had a reasonable opportunity to consider his response to that information.

The employee has the right to be accompanied at the meeting by a work colleague or a Trade Union representative.

After the meeting, the Company will inform the employee in writing of its decision as soon as reasonably possible (but normally within one week of the meeting) and notify him of the right to appeal against the decision if he is not satisfied with it.

Step 3 – Appeal

If the employee does wish to appeal, s/he must inform the Company within 5 working days of receiving the decision, and on doing so the Company will invite him/her to attend a further meeting.

The appeal meeting may not necessarily take place before the dismissal or disciplinary action takes effect but it will be arranged within a reasonable period of time.

The appeal will be dealt with by a more senior manager than at the Step 2 meeting. Where this is not practicable, the company will hear the appeal and decide the case as impartially as possible.

After the appeal meeting, the Company will inform the employee of its final decision in writing, as soon as reasonably possible (but normally within one week of the meeting). The Company may uphold or revoke the original decision or substitute a different penalty.

GRIVANCE PROCEDURE

If an employee has a problem or concern about their work, working conditions or a relationship with a colleague, they should aim to settle their grievance informally.

If an employee’s grievance cannot be settled informally, or a formal approach is preferable, the employee should raise it formally with management by following the procedure below.

Step 1 - Written statement

The employee must set out their grievance in writing and send this statement to their within Direct Medics unless your grievance concerns their line manager in which case the grievance should be submitted to the Recruitment Manager. Include facts, dates, a chronology and names of individuals, as appropriate. The subject heading should be marked as “Formal Grievance”.

Step 2 – Meeting

The company will invite the employee to attend a meeting to discuss the grievance, normally within 5 days, but longer where it is necessary to undertake an investigation to establish the facts or it is otherwise impracticable.

The meeting will not take place unless:

• the employee has informed the Company of the basis for the grievance in writing; and
• the Company has had a reasonable opportunity to consider its response to that information

After the meeting the Company will inform the employee of its decision, as soon as reasonably practicable (but normally within one week of the meeting), and the Company will notify the employee of his right to appeal if he is not satisfied with it.

Step 3 - Appeal

If the employee does wish to appeal, he must inform Brian Byrne, Human Resources within 5 working days of receiving the decision, and on doing so the company will invite him to attend a further meeting. After the appeal meeting, the Company will inform the employee of its final decision as soon as is reasonably practicable (but normally within one week of the meeting). The Company’s decision is final.

This policy relates to and applies to those staff engaged by Direct Medics Ltd. for the purpose of providing operational support in any capacity, in the registration, supply and support of healthcare staff registered with the company.

Induction to the company takes place in stages:

1. HR induction: HR presentation which includes reference to all relevant policies and procedures and where to locate them for reference (e.g. disciplinary, dismissal and grievance policy; absence notification policy; health and safety; DM workplace values etc.);
2. Completion of relevant documents: including contract of employment; work commencement pro forma; personal information form);
3. Introduction to all staff members and overview of:

i.    The role of each staff member;
ii.   The team structure of the company;
iii.  How each role complements others within the team.

Immediately following induction, all new staff members commence training which includes a mixture of classroom-based training and on-the-job learning. The focus and schedule of the training is agreed in advance between the relevant team leader and the Recruitment Manager, with each new team member taking part in ‘live’ work within 1-2 days of arrival. Core training for all staff will include:

i.    Full overview of Eclipse, followed by more intensive training on parts of the system relevant to the role;
ii.   Full overview and access to all documents relevant to the role (e.g. for a Recruitment Consultant in the Nursing division this would mean access to the nurse handbook; statement of purpose; service users guide and all policies and procedures pertaining to the supply of nursing staff).

The team structure at Direct Medics Ltd. is designed to make roles, responsibilities and lines of communication explicit. As such, communication between staff members relevant to the supply of nursing staff is frequent and comprehensive. The role of Registered Manager has been designed and agreed to ensure involvement in each placement as far as is practicable (and the Registered Manager has responsibility for ongoing supervision and review of each member of the nursing staff); the Responsible Person, however, is less involved in the day-to-day running of the agency function. The company’s monthly monitoring meeting is therefore designed to provide a comprehensive overview of the agency’s functions to both the Registered Person and Registered Manager, with monitoring involving all members of staff directly or indirectly involved in the supply of nursing staff. This would include (but is not limited to):

i.    Responsible Person;
ii.   Registered Manager;
iii.  Recruitment Director;
iv.  Nursing Recruitment Consultants;
v.   Nursing Compliance Officers

The general aims of staff meetings are:

i.    To keep the Responsible Person apprised of developments in the division;
ii.   To discuss new registrants coming onto the agency books and their suitability;
iii.  To receive any relevant information from the Registered manager relating to queries or concerns around agency staff;
iv.  To agree plans for the development of the division;
v.   To plan for scheduled inspections and/or audits.

The retention and proper management of personnel files is not only important for the organisation; in many cases it's a legal requirement. In the event of a dispute, records can prove incredibly useful in providing demonstrable evidence that the company was following established procedures. Also, retaining accurate records of staff pay, holidays, pension contributions and other entitlements helps to prevent disputes with staff. Finally, good record keeping also has a practical benefit in terms of monitoring staff. Accurate records allow the company to assess levels of performance and productivity, and identify trends in absence levels, sickness, lateness and disciplinary issues. This enables the company to take swift action to resolve any problems identified before they become endemic in the business.

Like the company’s service users, staff records are kept in a secure fashion and are constructed, maintained and used in accordance with the Data Protection Act 1998 and other statutory requirements.

The company is registered under the Data Protection Act 1998 and all storage and processing of personal data held both in manual records or on computers within the company should comply with the regulations of the Act. The company understands that, according to the Data Protection Act 1998, personal data should:

i.     Be obtained fairly and lawfully;
ii.    Be held for a specific and lawful purpose;
iii.   Be processed in accordance with the person’s rights under the DPA;
iv.   Be adequate, relevant and not excessive in relation to that purpose;
v.    Be kept accurate and up-to-date;
vi.   Not be kept for longer than is necessary for its given purpose;
vii.  Be subject to appropriate safeguards against unauthorised use, loss or damage;
viii. Be transferred outside the European Economic Area only if the recipient country has adequate data protection.

Documents the company is required to keep by law:

i.    Information relating to income tax and NI returns, income tax records and correspondence with the Inland Revenue (should be retained for not less than three years after the end of the financial year to which they relate);
ii.   Records related to working time (should be retained for two years from the date on which they were made);
iii.  Records of holiday entitlement and holidays taken;
iv.  National Minimum Wage records (should be kept for three years after the end of the pay reference period following the one that the records cover);
v.   Wage and salary records including overtime, bonuses and expenses (should be kept for six years);
vi.  Statutory Maternity Pay records (should be retained for three years after the end of the tax year in which the maternity period ends);
vii. Statutory Sick Pay records (should be retained for three years after the end of the tax year to which they relate)

There are many statutory retention periods relating to workplace accidents and injuries. These periods vary widely and advice should be sought prior to destroying these records.

There are also a number of organisational records which the business is advised to keep to assist with HR management. For many of these records there is no definitive statutory retention period and it is a matter of judgment as to how long these records are kept for.

Documents that it is advisable to retain for HR planning:

i.    Recruitment and selection procedures;
ii.   Discipline, including dismissals and grievance;
iii.  Training and career development;
iv.   Induction procedures;
v.    Termination of employment;
vi.   Equal opportunities issues.

This list is not an exhaustive list of the company’s obligations but rather the key areas to be covered. This area of law is vast and liable to change.

Direct Medics Ltd. believes that staff development and learning should be an integral part of the organisation’s strategic planning so that staff can perform their individual jobs effectively and, in doing so, ensure that the organisation achieves its objectives. The central aim is therefore to provide an environment where continuous development can take place and where staff are supported and enabled to meet the changing demands and priorities of the company and its service users.

To achieve this aim, learning and development needs will be regularly reviewed and internal staff will be encouraged to play an active part in identifying their own learning needs, selecting appropriate learning methods and in assessing the outcomes and effectiveness of their learning.

Options for learning and development may include:

i.   On the job learning / learning from others in the organisation
ii.  Internal workshops / learning for groups or teams
iii. Self-paced learning / open learning books, videos
iv. Off-job courses
v.  Mentoring

Induction

All new staff will take part in an induction programme including an introduction to all other staff, company targets, equal opportunities policy, working practices and procedures.

Coaching in immediate work processes and tasks and for inducting new staff into the
organisation will be the responsibility of the appropriate member of the management team.

Performance Development Reviews

Individual staff learning needs will be identified with their Team Leader during regular supervision sessions and a six-monthly appraisal process. Collective learning needs may be identified within staff groups or teams and discussed with the appropriate Team Leader.

Each Team Leader has the lead responsibility for the development of their staff, for assessing their learning and development needs and identifying suitable learning methods.

Recording, monitoring and Evaluation

The Recruitment Manager has responsibility for ensuring that a clear procedure is in place for recording, monitoring and evaluating learning activities. Team Leaders will ensure that the procedure is followed for each learning activity.

i.   Details of each learning activity will be received on a form that will include: a description of the learning; agreed objectives; method of learning; resources needed; evaluation of outcomes;
ii.  The staff member will complete the learning form with their Team Leader who will also be responsible for ensuring that the learning is monitored and that the outcomes and effectiveness of the learning are fully discussed and recorded.

The form will be kept within the Personnel records to provide a clear record of learning for review and evaluation.

Learning Requests

All learning requests will be considered sympathetically. However, the availability of learning resources will depend on factors such as budgetary constraints, work commitments and learning priorities necessary to fulfil the organisation’s objectives. In practice, there may be occasions when a learning request is postponed or refused due to other priorities.

A further budgetary consideration will be the extent to which skills acquired through learning can be applied within the organisation, within a reasonable time period. Individual staff members may be interested in obtaining accreditation or a nationally recognised qualification. The company will be sympathetic to requests of this sort, where the learning has a demonstrable relevance to company objectives, and in co-operation with the staff member will seek to provide appropriate support and assistance.

Reimbursement of Learning Costs

Where Direct Medics Ltd. contributes towards enabling an employee to study for a qualification to meet company forward plan commitments, reimbursement of costs by the employee will be required in the following situations:

i.   All fees would be reimbursed to direct Medics Ltd. if the employee left during the period of study or did not complete the study programme;
ii.  50% of fees would be reimbursed to Direct Medics Ltd. if the employee left within a period of 12 months following completion of the period of study;
iii. Monies owed to Direct Medics Ltd. will be deducted from the employee’s salary payment or other money due to the employee.

Time off for learning, reimbursement of travel costs and payment of membership fees will be at the discretion of the Managing Director. Direct Medics Ltd. will not usually contribute to the costs of textbooks.

Registering with Direct Medics

The team structure of Direct Medics is designed to ensure that registering with the company is as straightforward and simple as possible, thus providing service users with a constant supply of additional nurses where possible. As a responsible recruiter the company takes its legislative obligations seriously and as such, there are several elements to our registration procedure designed to fulfil these obligations and provide assurances to service users. We offer several options to complete pre-employment checks in partnership with the company’s Compliance team. The following sequence of events must be followed before a nurse is considered ready to supply to a service user:

1. New nurses are assigned a Compliance Officer who will send an introductory email outlining our pre-employment checks and add their details to relevant contact lists;
2. New nurses are assigned a Recruitment Consultant who carries out an introductory interview where any preferences for job opportunities are confirmed, followed by an advisory telephone call from their Compliance Officer aimed at ensuring full understanding of the registration procedure and receipt of all relevant documents;
3. The compliance officer guides the new nurse through the remaining compliance checks in line with NHS Employment Check Standards and any other relevant requirements such as mandatory training and evidence of PI insurance.

The NHS Employment Check Standards (2012)
The NHS Employment Check Standards are a set of six documents developed by NHS Employers in conjunction with the Department of Health, and set out the obligations of employers across the NHS pre-employment assessments that must take place for permanently-employed NHS staff. As a responsible recruiter of healthcare staff, Direct Medics adhere fully to each of the checks enshrined in the Standards for all staff employed through the company, and provide full guidance as to the actions required from new agency staff to meet these obligations.

The requirements of the NHS Employment Check Standards are as follows:

1. Verification of Identity Checks
2. Right To Work
3. Employment History & References
4. Criminal Record and Barring Checks
5. Occupational Health
6. Professional Registration & Qualifications

Upon completion of our pre-employment checks, files are referred to our Registered Manager, who will review all available information and conduct a final interview aimed at ensuring complete understanding of our procedures and suitability to work in the chosen area. You will be booked for work through Direct Medics only with the express approval of the Registered Manager.

Booking an Assignment

Upon completion of your registration, agency staff are made aware of all job opportunities fitting their profile as and when they arise. Candidates are put forward for consideration by the agency following instruction from the candidate and pending confirmation that their documents remain valid. If selected, the company provides a booking form to the client organisation and a conformation with the agency staff both verbally and by email. The confirmation will include all relevant information about the assignment, including reporting instructions, any travel and accommodation arrangements and instructions on payment for the assignment. Agency staff are advised to raise any queries they may have upon receipt of the confirmation immediately to allow for a smooth start to the assignment.

Contact During the Assignment

It is aim of the company to ensure complete satisfaction with assignments, that it is within the skill set of the agency staff and it is everything expected. Our contact with agency staff during assignments may include:

i.   Arrival calls on the first day (to confirm your safe arrival and first impressions);
ii.  Service calls during the assignment (to check that the assignment is proceeding as expected);
iii. Records maintenance calls (to update documents that may be due to expire during the assignment).

Clients are asked to provide feedback during assignments and complete a company assessment form at the end to allow us to maintain a record of performance for all placements as far as reasonably practicable. Feedback is of course a two-way process and we encourage agency staff to provide us with relevant information on the assignment, the setting etc to enable us to enhance our service to them.

Definition: Abuse

“Abuse is a violation of an individual’s humans and civil right by another person or persons.”

Direct Medics Ltd. aims to provide a safe environment for children and vulnerable adults within healthcare and for the healthcare staff we provide to care for our service users. All candidates will attend mandatory training on Safeguarding of Children and Young People.

Every candidate has a responsibility to ensure that children and vulnerable adults are protected and to know what to do if there are any concerns surrounding a child or vulnerable adult’s s welfare and safety.

It is important to:

• Understand what constitutes abuse
• Know different forms of abuse. Physical, emotional, neglect and sexual abuse.
• How to recognise the signs of abuse
• What to do if you have concerns of abuse
• Familiarise yourself with local policies/procedures

Types of Abuse:

Abuse may be:

• Physical, including hitting, slapping, pushing, kicking, misuse of medication, restraint or inappropriate actions. Sexual abuse, including rape and sexual assault or sexual acts without consent.
• Psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, intimidation, coercion, verbal or racial abuse, isolation or withdrawal from services or supportive networks.
• Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance transactions, or the misuse or misappropriation of property, possessions or benefits.
• Neglect and acts of omission, including ignoring medical or physical care needs, failures to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.
• Multiple forms of abuse may occur in an ongoing relationship or an abusive service setting to one person, or to more than one person at a time, making it important to look beyond single incidents or breaches in standards, to underlying dynamics and patterns of harm.
• Abuse can be seen if an employee falls asleep on duty whilst caring for a vulnerable client.

Cases of suspected abuse of adults are dealt with in line with ‘Safeguarding Vulnerable Adults Regional Adult Protection Policy and Procedural Guidance, July 2015’
The agency recommends that all cases of suspected domestic abuse are dealt with in line with NICE Public Health Guideline – PH50, “Domestic violence and abuse: multi-agency working”.

All cases of suspected abuse should be reported to our Nursing Manager (who can be reached on 02890590077; in the event that the Manager is not immediately available, speak with either the Recruitment Manager or Managing Director and make it clear that the Nursing Manager should get in touch urgently). The Nursing Manager will refer to and liaise with relevant departments and other appropriate agencies (including where appropriate but not limited to, the designated officer for the local HSC trust’s Gateway Team; the PSNI; RQIA) who will investigate to:

i.    Ensure the safety of the service user
ii.   Establish matters to fact
iii.  Access the needs of the child or vulnerable adult for protection, support and redress
iv.  Decide what sanctions are necessary with regard to the perpetrator
v.   Decide what action should be taken if the service or its management have been culpable, ineffective or negligent.

A properly coordinated joint investigation will achieve more than a series of separate investigations, it will ensure that evidence is shared, repeated interviewing is avoided and will cause less distress for the person who may have suffered abuse. Any relevant staff members at Direct Medics Ltd. are expected to participate fully in case reviews and meetings where required and the overall aim of the investigation is not only protecting a vulnerable person in one case but to take on opportunities for further staff training, reflection and learning.

When reporting an incidence of suspected abuse the following detail must be provided in writing:

• Name and address of the child or vulnerable adult
• Information about the clients such as age, disability, environment, genders, ethnicity and living arrangements
• Whether or not the person is already known to any agency, particularly social services, or whether it is a new referral (if known)
• Information about the suspected abuse perpetrator
• Type of suspected abuse
• Setting in which abuse took place
• Time and frequency of suspected abuse
• Whether or not there is imminent danger to the victim

Bullying

Direct Medics Ltd. operates in the belief that all agency staff should be able to attend their assignments without fear of humiliation, intimidation, sexual or racial harassment, oppression or any form of bullying. It is the responsibility of management both at the agency and its client organisations to ensure that agency staff can work in a caring and protective atmosphere.

To achieve this, the company will do the following:

i.     Ensure that there is a procedure to follow if there is an incident of bullying;
ii.    Ensure that victims are given the required support in order to prevent a recurrence of the behaviour;
iii.   Inform relevant staff of the action being taken, why it is being taken and what they can do to reinforce and support that action;
iv.   Ensure the incident is handled sensitively at all times;
v.    Assist the bullied person to record the event, in writing, with dates if appropriate;
vi.   Ensure that the alleged bully has the opportunity to record their version of events;
vii. Encourage all agency staff to be aware of the danger signs of abuse and bullying amongst their colleagues and pass on any worries they may have about a colleague.

Agency staff should always:

i.    Watch for signs of distress in their colleagues;
ii.   Pass concerns to the Nursing Manager who will record all incidents

All instances of alleged harassment or bullying are investigated and if necessary, are dealt with under the company’s disciplinary procedure.

Direct Medics Ltd. will provide all nursing staff with a tunic for use during assignments. Staff are expected to supply their own trousers and shoes, which must be clean and suitable for purpose on arrival at each assignment. Long hair must be tied back, and no jewellery other than plain gold wedding rings may be worn, unless next to the skin and covered by the uniform.

All staff are provided with an agency identification badge upon registration, which must be displayed clearly at all times whilst on assignment. An induction checklist card will also be provided; this must also be stored within the lanyard supplied alongside the identification badge and used as a reference to the information required when entering a clinical setting for the first time.

Clinical Staff who wear a uniform should change into & out of uniform at the workplace. Anyone permitted by the client to wear a clinical uniform to and from work should have it covered completely when travelling. A clean uniform should be worn for each shift.

Staff must change as soon as possible if uniform or clothes become visibly soiled or contaminated with blood or body fluids.

Whistleblowing is defined in the Public Services Reform (Scottish Public Services Ombudsman) Healthcare Whistleblowing Order 2020 as:

"when a person who delivers services or used to deliver services on behalf of a health service body, family health service provider or independent provider (as defined in section 23 of the Scottish Public Services Ombudsman Act 2002) raises a concern that relates to speaking up, in the public interest, about an NHS service, where an act or omission has created, or may create, a risk of harm or wrong doing."

This includes an issue that:

• has happened, is happening or is likely to happen
• affects the public, other staff or the NHS provider (the organisation) itself.

People also often talk about ‘raising concerns’ or ‘speaking up’.  These terms can also refer to whistleblowing.  The issue just needs to meet the definition above, whatever language is being used to describe it.

Risks can relate to a wrongdoing, patient safety or malpractice which the organisation oversees or is responsible or accountable for. In a health setting, these concerns could include, for example:

• patient-safety issues
• patient-care issues
• poor practice
• unsafe working conditions
• fraud (theft, corruption, bribery or embezzlement)
• changing or falsifying information about performance
• breaking any legal obligation
• abusing authority
• deliberately trying to cover up any of the above.

A whistleblowing concern is different to a grievance.  A grievance is typically a personal complaint about an individual’s own employment situation.

Healthcare professionals may have a professional duty to report concerns.  Managers and all staff (including students and volunteers) must be aware of this, as it can affect how and when concerns are raised.  However, the processes for handling concerns should be the same for any concern raised.

WHO CAN RAISE A CONCERN?

Anyone who provides services can raise a concern, including current (and former) employees, agency workers (and others on short or insecure contracts such as locums and bank staff), contractors (including third-sector service providers), trainees and students, volunteers, non-executive directors, and anyone working alongside NHS staff, such as those in health and social care partnerships.  A person raising a concern has usually witnessed an event, but they may have no direct personal involvement in the issue they are raising.

More than one person can raise the same concern, either individually or together.  Anyone receiving a concern must make sure they understand who wants to achieve what, and whether everyone wants to be kept informed and updated on the progress of any investigation.

It is important for everyone involved in this procedure to be aware that some people may feel at greater risk than others as a result of raising a concern. For example:

• employees whose employment may be less secure, such as agency staff or those who need a visa to work in the UK
• students and others who are due to be assessed on their work
• people from any of the recognised equalities groups.

Anyone raising a concern may want to have someone to support them at meetings, or throughout the process. This could be a union representative, friend or colleague. If it is a friend, relative or colleague, their role is to support the person raising the concern rather than to represent them or respond on their behalf. Union representatives can be more involved in discussions, although it is best if the person raising the concern openly shares the information they have.

EMPLOYER’S DUTY OF CARE

Employers have a duty of care to their employees and must take all reasonable steps to protect their health, safety and well-being. They must do everything that is reasonable in the circumstances to keep their employees safe from harm. They also have a moral and ethical duty not to cause, or fail to prevent, physical or psychological injury.

Under their duty of care, employers may have to ensure, so far as is reasonably practicable, a safe work environment, and provide adequate training so that employees can safely carry out their designated role.

Employees also have a responsibility to take reasonable care for their own health and safety at work. For example, they should be able to refuse to do work that would be unsafe for them, without fearing disciplinary action. An employee also has a duty to take reasonable care for the health and safety of other employees who may be affected by their acts or omissions at work. In the context of raising concerns, this means that the organisation will have systems in place to protect from detriment anyone who raises a concern.

LEGAL PROTECTION FOR THOSE RAISING CONCERNS

The Public Interest Disclosure Act 1998 (PIDA) is often called the ‘whistleblowing law’. It is there to protect all ‘workers’, who have made a ‘protected disclosure’ from being treated unfairly as a result of raising a concern.

A concern is considered a ‘protected disclosure’ when the person raising it must reasonably believe that it is in the public interest to raise a concern, and that the information available shows that the following has happened, is happening or is likely to happen. For example, a criminal offence; an act that creates a risk to health and safety; an act that damages the environment; a miscarriage of justice; a breach of any other legal obligation not being met; or concealment of any of the above being covered up. It is important to note that making a ‘protected disclosure’ does not mean that the concern must be raised or investigated in a certain way. It provides legal protection for workers who suffer detriment after raising concerns.

THE INDEPENDENT NATIONAL WHISTLEBLOWING OFFICER

The Independent National Whistleblowing Officer (INWO) will approach each case on the basis that it is better for the organisation involved to identify the learning and improvements that are needed. However, they can agree to accept concerns direct if they do not feel it is reasonable to expect the person to use their employer’s whistleblowing procedure. They will decide whether to do this case by case, but could take into account, for example, whether the organisation is very small or the issue involves very senior staff. In limited circumstances the INWO may be able to help make sure concerns are dealt with appropriately. This may include monitoring the progress of an investigation

WHO TO RAISE A CONCERN WITH

The Direct Medics Ltd. Whistleblowing Champion (contact hr@directmedics.com confidentially for referral).

THE NATIONAL WHISTLEBLOWING STANDARDS: TWO-STEP PROCEDURE

Direct Medics Ltd. will adhere to the requirements of The National Whistleblowing Standards (2021) Two-Step Procedure when concerns are raised. Full details as to the Procedure itself may be found here.

Section 1: Introduction, Purpose, Definition, and Scope

1.1          Social media platforms offer powerful new ways to express and share ideas. Their use presents Direct Medics and its staff with new and exciting opportunities; but it also introduces potential risks that must be managed.

1.2          The purpose of this policy is to protect the Agencies candidates, staff, reputation, and values while supporting the effective use of social media to benefit the work of the Agency.

1.3          In this policy, the term social media is used to describe a broad range of technology platforms, which allow the creation, and sharing of content across a virtual community. Examples include well known services such as Facebook, Twitter, LinkedIn, YouTube, Instagram, WhatsApp, and Snapchat; as well as smaller services such as personal blogs and discussion forums.

1.4          This policy applies to all staff, including individuals who have an honorary contract with Direct Medics, temporary workers, agency staff, and individuals engaged with the agency on a self-employed contract basis

Section 2: General principles

2.1          Staff must never use their personal social media to engage with patients. For example, staff should never send a “friend” request to a patient on Facebook, nor accept such a request from a patient, and staff should never chat with patients over WhatsApp or via Twitter direct message (DM).

2.2          Use of social media must at all times be consistent with other Direct Medics policies, such as the Data Protection policy.

2.3          In order to protect the Company’s students, staff, reputation, and values, care must be taken:

• Not to breach confidentiality
• Not to do anything that could be considered discriminatory against, or bullying or harassment of any individual
• Not to breach copyright or other intellectual property laws
• Not to bring Direct Medics into disrepute

Section 3: Official Direct Medics social media accounts

When contributing to Direct medics social media activities you are representing the agency and must at all times follow the guidelines for use of official agency social media.

Section 4: Using personal social media accounts

4.1          Staff must ensure there is always a clear separation between work use and social use within their social media accounts.            

4.2          As a member of staff your activity on social media is likely to be associated with the Agency, regardless of whether you are acting in a professional or personal capacity, and whether you are using a using an official Direct Medics social media account or a personal one.

4.2          Therefore when using a personal account in a professional capacity it is important to make it clear that you are acting on behalf of yourself and not the Agency. In particular:

• Do NOT use account names that suggest the account is an official Direct Medics Account
• Do NOT use the Direct Medics Logo without official authorisation.
• Where your personal social media account indicates your association with Direct Medics, consider using a disclaimer.

Section 5: Online Safety

5.1          To protect yourself online, follow these key guidelines:

                Limit the personal information you post on social media.

• Publish as little personal information as you can.
• Remember that it is often possible to link your individual social media accounts and so build up a wider picture of your social media footprint. So as well as considering how much personal information you publish on any single site, consider how much personal information you have published across all sites
• Never publish your address or financial details on social media.
• Be aware of location services accidentally giving away personal information. Some social media platforms include your location with every new post. Posting from a mobile phone, in particular may include a precise GPS location. Smartphones and many cameras may also embed location data in digital photographs.
• Avoid allowing social media apps access to your contacts list or address book – in general, don’t give them information they don’t need.
• Watch out for Fraud - use the same caution when clicking links or opening documents from social media that you would for emails - social media is increasingly being targeted by phishers and other fraudsters.

Section 6: Social Media and the Law

6.1          Any illegal or unlawful acts that can be committed using words or images can equally be committed using social media.

6.2          Posts on social media that violate the general principles listed in section 3 of this document could potentially be in breach of legislation such as:

• The Communications Act 2003
• The Contempt of Court Act 1981
• The Data Protection Act 2018
• The Defamation Act 2013
• The Malicious Communications Act 1988
• The Offences Against the Person Act 1861
• The Protection From Harassment Act 1997
• The Sexual Offences Act 2003

Section 7: Disciplinary action over Social Media use

All employees are required to adhere to this policy. Any breaches may lead to disciplinary action. Serious breaches of this policy, for example incidents of bullying of colleagues or social media activity causing serious damage to the organisation, may constitute gross misconduct and lead to summary dismissal.