A guide for Community Mental Health Nurses when making arrangements for covering workload vacancies and excessive workloads
July 2006

1. This paper will provide guidance to members when planning for the safe provision of services where resources have been reduced but workload remains the same.
2. The current jobs crisis in the NHS may lead to a situation where members are being required to manage excessive workloads. This lends urgency to the need to have a strategy at local level to combat this depressing trend that will have severe consequences for Amicus-MHNA members.
3. This paper should be read in conjunction with the MHNA guide to caseload management.

Definition

4. Firstly, a definition of an excessive workload should be agreed locally. It could be due to staff vacancies or frozen posts whilst awaiting the implementation of newly designed service, such as skill mix teams. Possible causes of reduction in service provision/how we have reached this situation

5. The change in resources may have occurred for a variety of reasons. It may be a temporary situation where, with negotiation, a satisfactory plan to manage the situation in the short term is agreed. However, in England for example, we have seen increasingly the effect of service reviews since the then Chief Executive of the NHS, Sir Nigel Crisp's letter of July 2005. This followed the policy document 'Creating a Patient-led NHS' published by the Department of Health in March 2005. The outcome of this flurry of activity has meant services to the public have essentially been cut with a devastating effect on morale.

6. Although this example relates to England we are very aware that there are similar situations in existence throughout the United Kingdom.

7. The challenge now is for members to ensure that the services they provide are safe, meet required NHS standards and are acceptable to the public. While achieving this situation, community mental health nurses (CMHNs) must not compromise or fail to meet the requirements of the regulatory body,

8. Where members have concerns and are not able to reach local agreement within their respective teams or organisation they will need to take action. This may lead to Invoking the grievance procedure and Amicus-MHNA workplace representatives and Amicus regional officers can advise on the procedure.

Action

9. Excessive workloads will create difficulties for practitioners that may lead to health problems and stressful working conditions. Any employing organisation which allows this is in breach of its duty of care to employees. Therefore before such a situation develops, or where it exists, members are advised to raise this formally with their line manager, pointing out the employer's legal obligations and insist that action is taken to reduce the excessive workload. If the situation is not resolved then members will need to pursue a more formal route.

10. If there are also concerns relating to clinical governance issues members are advised to remind employers of their duty of care to clients and their responsibilities as described in 'The NMC Code of Professional Conduct: Standards for Conduct, performance and ethics'; 2004.

11. CMHNs are advised to work with their Amicus-MHNA workplace representatives; informing them of the situation and progress made at each step and to call for assistance and advice should problems occur. It will be necessary to inform the Amicus Regional Officer responsible for the relevant primary care organisation.

Good Practice

12. Before the situation where workloads become excessive there should be:
• A plan for reviewing and recruiting to the vacancy or service change with estimated time scales for activity that should be determined and agreed locally.
• Once this has been agreed, a letter confirming responsibilities and actions should be shared with personnel/individuals involved.
• Clients should be informed of changes by the organisation and be clearly signposted to where they can access services.

13. These guidelines will provide CMHNs and their service managers’ direction in the management of workloads. The overall aim of the document is to enable the provision of a community mental health nursing service universally available to the given population, with flexibility to allow for provision to be targeted at those individuals or families identified as the most vulnerable.

Conclusion

15. We hope that, in many cases, the actions described here will lead to a safe and satisfactory renegotiation of the workload situation, Practitioners are required to report excessive workloads which make their practice unsafe and should be able to demonstrate why this is the situation.

16. If after reading this you require further information, please contact your regional office where you can obtain the contact details for your Amicus-MHNA workplace representatives and Regional Officer

17. A list of Amicus regional offices can be found on the Amicus website www.amicustheunion.org