1 Tuesday, 31 May 2011
2 (10.00 am)
3 MR MACAULAY: Good morning, my Lord. The next witness is
4 Mrs Annette Jeanes.
5 MRS ANNETTE JEANES (sworn)
6 Examination by MR MACAULAY
7 MR MACAULAY: Good morning, Mrs Jeanes.
8 A. Good morning.
9 Q. Are you Annette Jeanes?
10 A. I am.
11 Q. Can I begin by asking you to have in front of you your
12 CV, please?
13 A. I have.
14 Q. This is INQ01770001. You have it in front of you, and
15 I think we have it on the screen.
16 A. Yes.
17 Q. Can you tell the Inquiry what position or positions you
18 hold at present?
19 A. I am a Consultant Nurse in Infection Prevention and
20 Control and the Director of Infection Prevention and
21 Control at University College Hospital London.
22 Q. If we look to the CV, we can see that you set out your
23 qualifications at the very top. Do we see that?
24 Perhaps you can help me with some of the abbreviations.
25 I think we know what RGN is. SCM?
1
1 A. I am a registered general nurse. I qualified as a state
2 certified midwife, but I don't practice. ENB 100 was
3 intensive care nursing. Then ENB 934 was care of HIV
4 patients, and 998 was teaching and assessing. Diploma
5 in Nursing was a diploma, and then I have a Diploma in
6 Infection Control, which I got in Glasgow, and then
7 a Masters in Science, which I got in infection control.
8 Q. If we look to the bottom of the list of the posts that
9 you have held, we can see that you were a student nurse
10 in 1972 to 1975 and then you were a staff nurse first in
11 1976.
12 Can you tell me when you last worked full-time on
13 a ward as a senior nurse?
14 A. That would be in 1992, when I stopped doing that
15 full-time to become an infection control nurse
16 specialist, but actually the nurse specialist role is
17 very clinically based anyway, so I would be on a ward
18 too.
19 Q. In your present position as an infection control nurse
20 specialist, how much time would you spend on the ward?
21 A. In the consultant nurse role, I'm supposed to spend
22 50 per cent of my time clinically focused, and that
23 wouldn't necessarily always be on a ward. It is mostly
24 on wards, but can be, for example, as a couple of weeks
25 ago, I was in the radiology department looking at chest
2
1 X-rays and advising there.
2 Q. You then set out some major professional activities. Is
3 it fair to say that your focus, as we can see by looking
4 at this, is on infection control?
5 A. Yes, it is.
6 Q. If we turn on to the second page of the CV, you set out
7 a number of other activities that you have been involved
8 in, including being a visiting lecturer at Kings College
9 London; is that correct?
10 A. That's correct.
11 Q. You also say that you do expert witness and consultancy
12 work; is that right?
13 A. I have done some, yes.
14 Q. Moving on to the third page of the CV, you set out
15 a number of publications, moving on for the next few
16 pages, that you have made contributions to?
17 A. I have done even more than that recently. I haven't
18 updated this. But yes.
19 Q. In connection with the work that you have done for this
20 Inquiry, I think I am right in saying that you have
21 looked at a number of individual patients' records and
22 prepared reports?
23 A. I have looked at ten sets of patients' records and
24 prepared reports, yes.
25 Q. Have you also prepared a summary report having regard to
3
1 what conclusions you came to, having looked at the ten
2 patients' records?
3 A. Once I completed those reports, I then wrote a summary
4 report.
5 Q. Have you ever been to the Vale of Leven Hospital?
6 A. No, I have never been there.
7 Q. Have you worked in Scotland?
8 A. The only time I came to Scotland associated with
9 healthcare was when I did my diploma in infection
10 control. Otherwise, I have not worked in Scotland.
11 Q. In relation to the setup at the Vale of Leven, were you
12 given some information to assist you to develop some
13 feel for what the hospital was about?
14 A. I was given some information, which was information for
15 doctors who were coming to work at Vale of Leven, and
16 I understand that it is a 180-bedded hospital which has
17 a range of patients coming there, including surgery and
18 medical patients, and serves the local community.
19 Q. Perhaps we can just focus on the source of that; that is
20 at GGC21720001.
21 Do you recognise this as the document that you were
22 given to give you some sort of idea as to what the
23 hospital was about?
24 A. Yes, I was actually given two documents. This was one
25 and then I think there was an updated document.
4
1 Q. We heard earlier in the Inquiry that all registered
2 nurses have to register with the regulatory body, and
3 that is the Nursing & Midwifery Council; is that
4 correct?
5 A. That's correct.
6 Q. Is there a Code of Practice that is produced by the
7 regulatory body for the benefit of nurses?
8 A. There is a Code of Practice, which is regularly updated,
9 and I believe for this period we are looking at the one
10 which was updated in 2004.
11 Q. Could you look, please, at INQ01970001. Is this the
12 code that you made mention of a moment ago?
13 A. This is, yes.
14 Q. If you could turn to page 3, please, of the document, do
15 we see there a section headed "The NMC Code of
16 Professional Conduct: Standards for Conduct, Performance
17 and Ethics"?
18 A. Yes.
19 Q. We see what has been set out. Towards the bottom, are
20 we told:
21 "These are the shared values of all the
22 United Kingdom healthcare regulatory bodies."
23 A. That's correct.
24 Q. Do you understand that the principles set out in this
25 code apply throughout the country, the United Kingdom?
5
1 A. Yes, they are shared by the whole profession.
2 Q. If you turn to the next page, which I think is page 4 of
3 the document, under the heading "Introduction", if we
4 just focus on that, at 1.2, are we told that:
5 "As a registered nurse, midwife or specialist
6 community public health nurse, you must:
7 "Protect and support the health of individual
8 patients and clients."
9 A. That's correct.
10 Q. And at 1.3, the instruction is:
11 "You are personally accountable for your practice.
12 This means that you are answerable for your actions and
13 omissions, regardless of advice or directions from
14 another professional."
15 A. It is, yes. That's correct.
16 Q. Is 1.4 an important provision?
17 A. 1.4 is important, in that you have a duty of care to all
18 your patients, and you have a duty and responsibility to
19 ensure that that is safe and competent, so that is the
20 norm for the profession.
21 Q. If you turn to page 9 of the document, which is
22 section 6, is there a section there instructing the
23 nurse to keep up to date with the nurse's knowledge and
24 skills?
25 A. Yes. It is the responsibility of nurses in general
6
1 to -- it says there "to maintain your professional
2 knowledge and competence".
3 Q. If you look at 6.2:
4 "To practise competently, you must possess the
5 knowledge, skills and abilities required for lawful,
6 safe and effective practice."
7 A. I haven't got 6.2.
8 Q. It should be on the screen. Page 9, I think I said.
9 I think we are on the same wavelength now. Do you have
10 that?
11 A. Yes.
12 Q. Paragraph 6.2.
13 A. Yes.
14 Q. Just to go to that again:
15 " To practice competently, you must possess the
16 knowledge, skills and abilities required for lawful,
17 safe and effective practice without direct supervision.
18 You must acknowledge the limits of your professional
19 competence and only undertake practice and accept
20 responsibilities for those activities in which you are
21 competent."
22 Is that important?
23 A. It is important, because nursing covers a wide range of
24 areas, and it may be that you would be asked to do
25 things that were not within your area of competence.
7
1 Q. If you go back to section 4, and in particular 4.4, on
2 the same page, page 6, there is a provision there
3 dealing with healthcare records:
4 "Healthcare records are a tool of communication
5 within the team."
6 Let's just look at that. How important is that
7 provision?
8 A. The healthcare records are vital because nurses are
9 accountable for the care that they deliver, so having an
10 accurate record of what happened to the patients is
11 important in communicating with the team and ensuring
12 consistency. It means that you can then provide
13 evidence subsequently of what actually happened and
14 demonstrate what you did and why you came to decisions
15 and who delivered it. So it is important for everyone
16 that you do keep an accurate record.
17 Q. If you move on to page 7 of the document and, in
18 particular, if we look to 8 and 8.1:
19 "As a registered nurse, midwife or specialist
20 community public health nurse you must act to identify
21 and minimise the risk to patients and clients."
22 Then if we can highlight 8.1:
23 "You must work with other members of the team to
24 promote healthcare environments that are conducive to
25 safe, therapeutic and ethical practice."
8
1 Do you see that?
2 A. I can see that. It is an important point, because you
3 have to identify what risks are possible or present and
4 act in the best interests of the patient to minimise
5 those risks and make the environment and the therapeutic
6 environment as safe as possible.
7 Q. Go back again to section 4 on page 6, section 4.6, if
8 that could be highlighted, if I just read that:
9 "You may be expected to delegate care delivery to
10 others who are not registered nurses or midwives. Such
11 delegation must not compromise existing care but must be
12 directed to meeting the needs and serving the interests
13 of patients and clients. You remain accountable for the
14 appropriateness of the delegation, for ensuring that the
15 person who does the work is able to do it and that
16 adequate supervision or support is provided."
17 Can I just look at that? In a ward, you would have
18 the registered nurse. Would there also be in the ward
19 unqualified staff? Would this provision be relevant to
20 the relationship between the registered nurse and the
21 unqualified staff?
22 A. It is an important relationship, because often you
23 delegate duties to people who are not qualified nurses,
24 but you are still responsible for the care that they
25 deliver, so you delegate that duty, but you retain the
9
1 responsibility.
2 So, therefore, you have to supervise them and ensure
3 they are capable of doing it, and then monitor what
4 happens subsequently and intervene if necessary, and you
5 may actually have to take over or you may have to
6 provide support or education or training. So it is an
7 important duty, but you can't just delegate something
8 and leave someone to get on with it. You have
9 a responsibility.
10 Q. Is the converse of that, if you go to 6.3, we have been
11 looking at delegation, but is this the converse:
12 "If an aspect of practice is beyond your level of
13 competence or outside your area of registration, you
14 must obtain help and supervision from a competent
15 practitioner until you and your employer consider that
16 you have acquired the requisite knowledge and skill."
17 A. There are occasions when you are expected or asked to do
18 something which is beyond your ability or competence,
19 and the expectation is that you would make that clear,
20 that you are not able to do that, and you would then
21 seek assistance or help. But you would not step outside
22 the boundaries of your competence or ability, because
23 that would be putting patients at risk.
24 Q. Your specialism, I think, is in infection control.
25 A. Yes.
10
1 Q. Would that be an area where the registered nurse might
2 seek advice from the infection control team if the nurse
3 thought there was a difficulty?
4 A. I think, generally, you would always seek advice and
5 help from experts in the area because you may learn
6 something that you didn't know before, so, yes, you
7 would expect people to seek advice from infection
8 control team, because they are local experts and they
9 will probably have information available that you do not
10 have, so they may know about new things which are
11 happening or that you may not be completely up to date