An inquiry was established into the Allitt case, headed by Sir Cyril Clothier QC, to report on the circumstances that allowed a seriously mentally ill nurse to be employed and remain in her post. That report was due this week, but has been delayed. The Warner report on improving staffing practices in children's homes was published last November.
Many of the Warner recommendations for recruitment policy were no more than good management practice which should have been standard. These included using relevant job descriptions and person specifications, appointing officials through open competition, and being wary about the use of agencies for care staff.
The report also proposed that systems for obtaining and providing references be tightened up, that preliminary interviews be standard for children's home staff, and that interview procedures be improved, with all interviewers adequately trained. More contentiously, the Warner report also came out in favour of structured personality tests for some posts, after hearing evidence from the British Psychological Society and the Institute of Personnel Management.
Leicestershire County Council, which employed Beck, maintains that its problems were related more to bad management than weak systems. Bob Parker, divisional manager for Leicestershire, says: 'We have stronger managers now who have a background in child care. There were obvious problems with the management at that time.'
Recruitment for care workers in children's homes will always be problematic, Mr Parker believes. 'We need people who can deal with extreme violence, but who are also supportive carers. We are looking for saints and generally not paying them very much.'
The council has yet to install a formal appraisal system for staff, and other changes are under consideration. A working group is bringing forward suggestions to improve recruitment, which is likely to propose the introduction of personality testing, also known as psychological or psychometric testing. This is still treated with scepticism by some - Brian Jones, assistant secretary of Social Services, of the Association of Metropolitan Authorities, says: 'We feel a little mixed over psychometric testing, it's a bit of a red herring really.'
The Allitt case has led to a similar discussion within the NHS. Ray Rowden, director of the Institute of Health Services Management, says: 'Recruitment is very ad hoc for nursing and other professions. We should be looking to see what motivates an individual to enter a profession. Some employers just do 20 minutes on what a person did in a pony club.'
Mr Rowden is a strong adherent of more stringent testing of applicants. He believes that better appraisal systems during training, continuing into employment, would pick out unsuitable employees.
Creating minimum recruitment standards across the health service could be positive, Mr Rowden believes. 'The NHS Management Executive would be within their rights to create a national framework. It would make us better employers. It would make a lot of sense to have more standardisation, and I don't think the service would mind.'
Barbara Knight, health sector manager of PA Consulting which advises many hospitals, says the creation of purchaser/provider splits, and breaking down the health service into clinical units, helped with recruitment.
There was a move towards greater specialisation by nurses and consultants, welcomed both by GP fundholders and patients, although often not popular with staff. By focusing on the required outcome, it may even be possible to recognise that it was a computer - not a nurse - that was required, Mrs Knight says. PA are working with employers to improve managers' interviewing and other skill levels, and designing practical skill exercises for job applicants. Tests might include asking nurses how they would help a particular patient, or questioning potential managers how they would tackle a full in-tray.
Angela Baron, policy advisor at the Institute of Personnel Management, was one of the witnesses to the Warner inquiry. 'Psychological testing is a generic term. It includes all sorts of things from IQ tests, ability tests to personality questionnaires, giving a profile of personality, and whether (a person is) a team player with good inter-personal skills or works alone.' The key is that they can be systematically scored, so that applicants can be tested against each other.
'There are good personality tests, and bad ones. Some are well validated and reliable, but they are not infallible.' Ms Baron says. Bad ones might, for example, be discriminatory against women. Providing a good system is used, it can add to the overall picture of an applicant.
What is important, says Ms Baron, is that personality testing is used as appropriate, and only conducted by people who are skilled to use them. Even the strongest advocates of personality tests do not suggest that they will provide an infallible solution in themselves. Mrs Knight says: 'Munchhausen sufferers (such as Allitt) are very clever - I wouldn't criticise anyone for not spotting one.' Or as Mr Rowden puts it: 'There is no means known to man that can stop a psychopath getting into the system if determined to.'
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