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A string of misconduct charges against three former managers within Liverpool’s community services have been dismissed – no doubt leaving some red faces at the Nursing and Midwifery Council.

Debbie Moore, Paul Lawrance and Deborah Dickerson all worked within Liverpool Community Health’s prison services, where an independent review found some appalling examples of poor care and governance.

In the wake of the scandal, the three were accused of multiple failures to take action or escalate concerns, failing to investigate deaths, and discouraging staff from reporting incidents at HMP Liverpool.

But, after sitting for almost three months, a fitness to practise panel has found “no case to answer” on all the charges, meaning they did not even have to present a defence.

Ms Moore, who was head of healthcare at the prison, allowed the findings in her case to be published, and they won’t make for comfortable reading at the NMC.

On several occasions, the NMC argued the persistence of problems at the prison suggested Ms Moore had failed to take adequate action.

But the panel repeatedly found that Ms Moore did escalate concerns and attempted to tackle problems, but they were ultimately outside of her control.

The panel cited many of the trust-wide issues that were highlighted in the Kirkup Review last year; that the trust was determined to obtain foundation status and pursued aggressive cost savings at the expense of patient safety to do so.

But rather than being a part of this, the panel found Ms Moore had vocally opposed the cost cutting internally, and had written to bosses to raise concerns over severe staffing shortages.

It is difficult to reconcile these findings with the NMC’s decision to follow through with the case against Ms Moore.

Wider factors

Regardless of the rights and wrongs of the individual cases, there were clearly wider factors that contributed to the situation at HMP Liverpool, and which most likely have not disappeared.

One of these factors could be the way prison services are commissioned by NHS England and the levels of funding available. Among the recommendations from Bill Kirkup in February 2018 was for the national body to review the arrangements for commissioning these services nationally to ensure they are safe and effective.

HSJ asked NHSE for the outcome of this review earlier this year and was told it would be available in April 2019. We’ve asked again in the last month and had no clear answer on whether it’s been completed, or when it will be published.

To be continued

The case of Helen Lockett, the trust’s former executive nurse and director of operations, will resume in November. The allegations against her include bullying, dishonesty, and seeking to minimise concerns that were being raised.

Espousing integration

The borough of Tameside in Greater Manchester prides itself on the levels of integration achieved between acute, community and social care services.

It is frequently cited as an exemplar on the integration agenda, with its work thought to be a significant factor in its standout performance against the four-hour emergency target.

So, a recent coroner’s letter to Tameside and Glossop Integrated Care Foundation Trust will be cause for a degree of embarrassment.

One of the trust’s community nurses told an inquest that it was common not to receive timely referrals for patients discharged from hospital, which the coroner said was “a matter for particular concern” given the integrated care model the organisation “purports to espouse”.

The trust said the concerns had been reviewed and it was found that untimely or late referrals were not a common occurrence.

In a letter back to the coroner, it said: “Communication between the trust’s acute and community nursing teams is generally very robust and is not currently an area of concern or a highlighted trend from its analysis of reported clinical incidents.”