Introduction
This guidance was developed in collaboration with the investigation education team at the Healthcare Safety Investigation Branch (HSIB).
The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety events, for the purpose of learning and improving patient safety. The framework recommends that learning response leads move away from a reliance on documentation and written statements to listening to the views of those affected through interviews and discussions.
Many healthcare organisations already interview those affected by patient safety events, but this practice is not always consistent. Sometimes those affected don’t feel they are heard during the interview and can even feel the interview compounds harm (National learning report: Support for staff following a patient safety incident; Reading the signals: maternity and neonatal services in East Kent – the report of the independent investigation).
This guidance supports staff to conduct empathetic, supportive interviews during learning responses. This approach to interviewing is central to the compassionate involvement described in Engaging and involving patients, families and staff following a patient safety incident, which should be read in conjunction with this guidance
Those affected by patient safety events must be offered appropriate support. This guidance does not cover how to provide support, but it does prompt staff to consider if the correct support mechanisms are available and, where necessary, the need to signpost patients, families, carers and staff to other professionals, agencies or groups, so that they are ‘supported’ through a learning response process in accordance with their personal needs.
What is the purpose of an interview?
An interview may be defined as a conversation with a purpose. In relation to learning responses, the purpose is to understand what happened and how. Specifically, the interview helps explore the system interactions that may have influenced a particular outcome. It is not to determine causes, apportion blame or assess liability.
The term ‘interview’ may cause concern due to its perceived connotations and organisations may choose to use conversation, meeting or discussion instead. We use the terms ‘interview’ and ‘interviewee’ in this guidance for clarity as they are recognised terminology.
A framework for interviews
A framework helps structure the interview process. This guidance is structured according to the evidence-based framework ‘PEACE’ (A national evaluation of PEACE investigative interviewing — University of Portsmouth), which was developed in the early 1990s by the police and leading psychologists in England and Wales. It is particularly useful for interviews that are non-adversarial in approach, such as those used as part of a learning response.
PEACE stands for:
- Planning and preparation
- Engage and explain
- Account (conversation)
- Closure
- Evaluation
The following sections detail the considerations and practical activities for the interviewer during each stage of this framework.
Planning and preparation
Thorough planning and preparation is the foundation to conducting a good interview. It is likely that an interview will include testing and/or clarifying information already gathered, gaining deeper understanding of care issues and processes, and seeking new information on particular areas.
Decide who to interview
You may want to interview several people to gather information about a patient safety event. These people will vary in terms of their involvement or knowledge about what happened.
You may want to interview those with direct and those with indirect involvement in the patient safety event, as well as subject matter advisors:
- direct involvement: may include healthcare staff as well as the patient and their family/carers
- indirect involvement: those not involved in the patient safety event but who may have knowledge about the factors associated with the event (ie clinicians, device manufacturers, supervisors, administrators)
- Subject matter advisors: those who have specialist knowledge about the event or factors associated with the event (ie clinicians, device manufacturers, supervisors, administrators).
You may also want to hold group interviews or debriefs as part of a learning response. There are pros and cons to these. For example, these may be more cost and time effective, and participants may find it supportive to share their, and hear others’, perceptions of events. However, one individual’s recollection may influence others’ recall of the event and bias the information collected; some in the group may dominate the conversation more than others, and hierarchy can have an impact.
Create the interview plan
This will be based on the information already known, and the terms of reference for the learning response. The interview plan should:
- Contain questions and topic areas for discussion. These will be based on the specific issues related to the event and relevant system focused questions. Appendix 1 gives example questions to ask staff, and Appendix 2 to ask patients, families and carers, to probe system factors. Some questions may look similar; these are asking a question in different ways to glean more information about a topic. Questions can be reworded to make them more relevant to the event.
- Identify whether one or two interviewers will conduct the interview.
Prepare the interview space
It is important to provide a relaxed, safe and supportive environment:
- Ideally the space should be away from the interviewee’s place of work and where the patient safety event occurred.
- The room should be set out informally with refreshments (water, tea or coffee) and tissues available.
- The risk of interruptions should be minimised (eg turn mobile phones off whenever possible; use a ‘do not disturb unless essential’ sign).
- Staff should be able to attend the interview in work time and their line manager may need to be asked to accommodate this.
- Depending on the nature of the event, or the interviewee’s personal involvement, the interviewee may find recounting events upsetting or disturbing. the interviewer will need to have information to hand on relevant support/counselling.
- The interviewer should ensure they have all relevant documentation available at the interview.
- Ideally interviews should be recorded to ensure information in any written report is accurate and transparent. If audio is used, check the recording equipment is working before the interview.
- Adjustments may need to be made to the interview space following engagement with the interviewee.
Engage and explain
Invite the interviewee to attend for an interview
The interviewee’s preference and needs, as well as the sensitivity of the interview content, will guide whether the interview will take place face to face, virtually or by telephone.
In advance of the interview, interviewees need to be informed of:
- the purpose of the interview (ie for learning and not to criticise or blame)
- the details of the patient safety event to be discussed
- the time, place and estimated duration of the interview
- who will be conducting the interview and their roles
- how the interview will be captured (ie whether audio recorded and/or notes taken)
- the ability to have a friend/family member or, in the case of staff, a colleague with them for support (but it should be made clear that a friend/family member/colleague will be there to provide support only, not to answer questions, and the requirement for confidentiality)
- what will happen after the interview
- how data is stored and protected.
Patients, families and staff should be given this information verbally and in writing. Learn Together has produced for staff, patient and family information booklets for NHS organisations to use and amend as appropriate.
Third-party attendees, such as a friend/family member, colleague and/or interpreter, should also be made aware of the above details about the interview and learning response process. The requirement for confidentiality in the process must be explained and documented.
Extra considerations are required when inviting a person with vulnerabilities for an interview. Such vulnerabilities include, but are not limited to, age (under 18 years, or older age), mental health, learning disabilities and cognitive impairment. In such circumstances, further advice should be sought from relevant teams or departments, such as the mental health team, safeguarding team, learning disabilities team or patient advocates.
Any advice received, subsequent actions, additional support arranged, and rationale for why an interview did or did not proceed should be documented.
Account – conducting the interview
Before the interview, the interviewer should be aware of their own emotions and how they may impact on the interview. They should share their concerns as appropriate with the second interviewer, where one is available, and agree a handover strategy in case this is necessary.
Opening the interview
The interview should be conducted in a way that fosters trust and rapport. It should be a conversation, not an interrogation, with the interviewee doing most of the talking.
- Those present in the room (either in person or virtually online) should be introduced and their roles explained.
- Explain the sequence of the interview, its approximate length and that the interviewee can ask for breaks (toilet, refreshments or emotional) at any time.
- Remind the interviewee about the learning response process and how long (approximately) the learning response is expected to take.
- Reiterate the purpose of a learning response, noting that it is for learning and improvement, and remind staff that the interview is not part of a disciplinary process.
- Explain that notes may be taken as a record of what was discussed. If the interview is audio recorded, explain how the recording will be stored and at what point it will be destroyed.
- Advise the interviewee that the learning response report will be written with due anonymity to staff and the patient (unless the patient wishes to be named), and that a draft copy will be shared with them for comment.
Asking questions
Different types of questions that should be asked as the interview progresses. The interviewer should use the following structured hierarchy of questions to gather the interviewees account.
- Free recall: breadth of information
- Open prompt questions: depth of information
- Focused prompts: 5 WH + 1 H questions
- Specific/option posing prompts: closed questions
- Closed questions: used for finer clarification.
Free recall
All interviews should begin with free recall, during which the interviewee should be allowed to talk freely at their own pace, and without interruption.
To initiate free recall, the interviewer can ask the interviewee an open question such as “Please can you tell us everything you recall about (the event)….?”.
The interviewer can encourage the interviewee to keep going with their free recall using minimal encouragers such as:
- nods
- “mmm”
- “and then”
- “is there anything else you can tell me?”
Interviewers need to be aware of how they are using tone of voice and body language to impart empathy.
Careful repetition of a phrase said by the interviewee can also be used to demonstrate active listening and show empathy.
The interviewer should not rush to fill silences. Recollecting events requires mental effort and concentration, and the interviewee will need time, space and silence to process their thoughts.
The interviewer should be mindful that some people have better memory than others, and also that memory is fallible and can be skewed by, for example, conversations with others and past experiences. Furthermore, the longer the time that has elapsed since the event, the less the interviewee can be expected to remember.
When the interviewee has finished their free recall, thank them for sharing their recollections and check they are okay to continue.
Open prompt questions
Open prompt questions are used to encourage a person to provide further detail on or clarify information given during free recall. They can also be used to elicit information on a specific area or issue identified for discussion in the interview plan, eg elements of the system that may have contributed to the event.
The acronym TEDS/PIE is an aide memoire for how to ask open prompt questions:
- Tell me…
- Explain…
- Describe …
- Show me…
- Precisely…
- In detail…
- Exactly…
Focused prompt questions.
Focused prompt questions are used to gain precise detail. These are commonly known as the ‘5 WH + 1 H’ questions.
- Who….?
- What….?
- Where….?
- When….?
- Why….?
- How….?
Specific posing prompt questions
Specific posing prompt questions can be used where some ambiguity remains: “Did X happen before Y?”
Closed questions.
Although closed questions are often not needed, they can be used where a specific detail still needs to be clarified: “Did you say the ward round started at 10.15 am?”
When an interviewee does not give a response to a question, or refuses to answer a question, this should be explored but not in an adversarial manner. The interviewer should ask the interviewee if they have a specific concern about answering the question, so that they can respond appropriately.
Closure
It is important to formally end an interview. This should be done by:
- Thanking the interviewee for their time and the information they provided.
- Asking the interviewee if there is anything else they want to say before switching off the interview recording and end the interview.
- Confirming the interviewee’s contact details and, if appropriate, asking for permission to contact them again should any matters that need clarification come to light later in the learning response.
- Signposting to support options relevant to the interviewee’s needs.
- Clarifying next steps regarding the learning response and giving the interviewee contact details should they have questions or require further information.
- Giving the interviewee the option to take a break before returning to their workplace or driving, etc, to allow them time to process the conversation.
Evaluation
Evaluation of the information shared during the interview will allow the interviewer to identify:
- any action needed immediately, eg escalation of a safety or safeguarding concern
- how the information fits with information already gathered
- new lines of enquiry
- other individuals who should be interviewed
- system elements to be further explored.
When two interviewers have conducted an interview, evaluation should include interviewer performance and any opportunities for improvement.
Information security
Evidence gathered during interviews (recording/notes, etc) should be stored in line with local policies and DPA/GDPR requirements.
Appendix 1: System focused questions for staff
About the organisation
Work schedules and assignments; management and incentive systems; organisational culture; training; policies; resource availability
Local policy
- Please tell me about the local policy for X. Can you talk me through what that policy is?
Follow up questions:
Can you tell me about adherence or otherwise to that policy? (If not) Explain to me why some may not adhere to that policy.
Can you suggest any suitable amendments to that policy to make it more effective?
- Please tell me about your understanding of the local policy for X.
Support from other departments
- Please tell me about available support from other departments? (eg IT, HR, porters, estates or clinical).
Follow up question: How would you describe that support?
Leadership
- How would you describe the leadership here?
Follow up question: Please tell me more about X? (opportunity to explore their description)
- How would you describe your interactions with your supervisor?
Follow up questions:
How often do you meet?
Please tell me about your supervisor’s information sharing and communication to those in your work area.
Do you feel comfortable speaking to your supervisor about different issues?
- Who would you say is the ‘leader’ of your team?
Follow up questions:
Is the leader role clearly defined/established?
Is there always one leader of does this position change at a certain point/time in a procedure?
How does the leader assert authority or guide the team/work?
Would you consider the leader more a facilitator or a commander?
- Please describe how the ‘team’ philosophy is supported in your team.
Follow up question: How well does the team leader express teamwork values, resolve conflicts or provide feedback about team behaviour?
Safety culture
- How would you describe safety culture?
Follow up question: Please tell me about management attitude towards safety.
- Please tell me how conflicts are managed in your workplace.
Follow up questions:
Please can you tell me whether managers engage in conflict resolution?
Reporting culture
- How would you describe the culture of your clinical area in relation to patient safety?
Follow up question: What (dependent on response) impact does that have on patient safety?
- Please tell me about the methods of reporting issues if you have concerns.
Follow up question: What normally happens when these methods are used? Are they effective?
- Do you feel that when concerns are raised they are listened to?
Follow up question: Please can you provide any examples?
- Please tell me about any feedback process that is in place when issues are raised.
Follow up question: Is that feedback process effective?
Just culture
- How would you describe the culture here?
Follow up question: Can you offer examples of ….? (dependent on response)
Learning culture
- Are recommendations or suggestions for improvement acted on?
Follow up questions: How are they acted on? Can you provide examples?
- Does the organisation make efforts to learn from patient safety incidents?
Follow up questions: How do they learn? Can you give examples?
- Please describe any other past incidents that are similar to the event currently being investigated.
Follow up questions: What happened? Was the problem fixed? How was the problem fixed?
- Please describe any other problems with equipment or staff performance related to the current patient safety incident that were previously known.
Follow up questions:
How often did these problems occur?
What prevented these problems from being adequately addressed?
Staffing
- Please describe the make-up of the team or unit you work in.
Follow up question: Are there any particular roles/qualifications that require more/fewer people?
- Please can you describe the staffing at the time of the incident?
Follow up questions:
Were the staffing levels sufficient to meet the workload at the time?
Was there the right mix of staff?
- Please describe the work schedules at the time.
Follow up questions:
How many shifts were staff working?
Were they given enough time to rest?
How frequently did they take breaks?
Shift patterns/working hours
- What are your typical working hours?
Follow up questions:
How do you find those hours?
How many days do you work consecutively?
Training
- Please tell me about the training you received for the job/role/task you had to perform.
Follow up question: Do you feel adequately prepared?
- Were the staff involved in the patient safety incident qualified or trained to perform their tasks or use the equipment?
Follow up question: What process is used to assign staff to perform their duties or operate certain equipment?
- Do you use simulation training?
Follow up question: Are facilities available for simulation training?
Internal/physical environment
Lighting; noise; vibration; temperature; air quality; physical layout and available space
Room layout
- Please can you describe the layout of the area in which you work?
Follow up question: Does the layout/location of the room affect your ability to perform certain tasks?
Equipment layout
- Please can you describe the layout of equipment?
Follow up question: Does the layout/location of the equipment affect your ability to perform certain tasks?
- Are you able to see equipment and patients as and when you need to?
- Is there adequate space for completing your tasks?
Follow up questions:
Please describe the space available.
Please tell me more about…(dependent on responses) any impact the space available has on your ability to perform your role/task?
Is the work area designed to support the function it is being used for?
Environmental conditions
- Please describe the environmental conditions in the area in which you work.
Follow up questions:
Please tell me about the lighting.
What are/were noise levels like? Did anything interfere with your ability to see or hear important information?
- How would you describe the situation?
Follow up questions:
Please tell me more about…?
(dependent on responses) Were there any distractions/interruptions?
Were you able to concentrate on what you were doing?
Rest facilities
- Please describe the staff room.
- Do you have adequate places to rest/take breaks?
About the external environment
Societal, economic, regulatory and policy factors outside an organisation.
National policy
- Please tell me about the national policy for X.
Follow up questions:
Can you tell me about adherence or otherwise to that policy? (If not) Explain why people would not adhere to that policy.
Can you suggest any suitable amendments to that policy to make it more effective?
- Please tell me about your understanding of the national policy for X.
Tools and technology
Characteristics such as: usability, accessibility, familiarity, level of automation, portability and functionality
Documentation
- How easy is it to find the documents you require?
Follow up question: Tell me more about…? (dependent on response)
- How easy are the documents you require to follow?
Follow up question: Is the information clear?
- Can you describe what the documentation contains?
Integration
- Was the equipment effectively integrated into the workflow?
Follow up questions:
What, if any, extra work was required to locate and retrieve the equipment?
Was its use smoothly integrated with the clinical activities or procedures related to the incident?
Did it easily fit within the workspace?
Equipment/devices (including instruments/tools, PPE, communications equipment, IT, checklists, packaging)
- Please tell me about the availability of equipment when you need it.
Follow up question: (If not readily available) How does this impact on your ability to perform the task?
- Please describe the quality and suitability of equipment for the tasks you perform.
Follow up question: (If not of good quality or suitability) How may that impact on your ability to perform the task?
- Is equipment adequately serviced?
Follow up question: What is the process for maintaining equipment like?
- Describe or show me how you use X equipment/device/machine.
Follow up question: How do you know to use it that way?
- What is X like to use?
- What’s good/bad about the design of this equipment/device?
Follow up question: (Dependent on response) What do you think would make the design better?
- Are you aware of any common errors staff make when using this equipment/device?
Follow up questions:
Please tell me more about… (dependent on responses).
Have these been reported, and if so are you aware of any outcomes of those reports?
- Was there anything wrong with the equipment being used at the time of the incident?
Follow up questions:
Were the displays, controls, alarms working properly?
Was any of the equipment outdated, poorly maintained or malfunctioning?
Tasks
Specific actions within larger work processes. Includes task attributes such as: difficulty, complexity, variety, ambiguity and sequence
Procedures/processes
- Are there occasions when policy or procedure could hinder the effective performance of a task?
Follow up questions:
If so, why?
Have you used any ‘workarounds’ to overcome any hinderances? If so, can you describe what they were?
- Are you aware of any procedures/policies in place that relate to your activities or use of equipment at the time of the event?
Follow up questions:
Are they easy to follow?
Do you feel that these are strict rules or simply recommendations/guidance? Are they commonly followed/enforced?
- Do you believe that these procedures/policies applied to what you were doing at the time?
Follow up questions:
Are you given adequate time to complete your tasks?
Do you feel under time pressure?
Task design
- Please can you describe how you do X task?
Follow up question: How do you know to do it that way?
- What’s good/bad about the design of this task?
Follow up question: (Dependent on response) Do you have any suggestions for how to improve the task design?
- Was there anything different about the task this time?
Follow up question: Was there any reason why your typical action in this situation wasn’t effective?
Complexity of tasks
- Please describe the difficulty or ease of performing this task.
Follow up question: (Dependent on response) Is there anything that makes it harder or easier for you to perform this task?
Workload/pressure/number of tasks
- Please tell me about your workload.
Follow up question: What factors can/did impact that workload?
- Please tell me about any pressure you feel under to complete tasks.
Follow up question: What is causing that feeling of pressure?
- What is your workload like on X tasks?
Follow up questions:
Are you given adequate time to complete your tasks?
Do you feel under time pressure?
- Please tell me about any competing demands.
Follow up question: How do you manage those demands?
- Please tell me about any duties additional to your main role/job.
Follow up questions:
How many?
What do those duties involve?
Please can you tell me about how those duties impact on your main role/job?
Is there any support for these additional duties?
- Please tell me about any distractions you experience when doing X task.
Follow up question:
Please can you tell me more about those distractions?
How can those distractions be managed?
Familiarity
- What opportunities do you get to practise X task?
Follow up question: Do you feel you have a suitable practise rate?
Person
Individual characteristics: age, preferences, goals, knowledge, physical strength and needs
Collective characteristics: team, cohesiveness and structure
Physiological state
- Please tell me about how you were feeling physically at the time of the event.
Follow up questions:
Were you feeling physically fatigued/hungry/dehydrated/suffering a cold/illness?
(Dependent on response) Was there any opportunity/support to mitigate you feeling ………….?
- Do you have any injuries or limitations, such as eyesight or hearing problems, that impact on your work?
Follow up question:
Do you wear glasses/contact lenses/hearing aids?
Were you wearing them at the time of the patient safety incident?
- What was your tiredness/fatigue level at the time?
Follow up question: (Dependent on response) Please can you explain why you were ….?
Cognitive factors
- Please describe what you were thinking of at the time of the patient safety incident.
Follow up question: What was going through your mind?
- Was there anything confusing about what was going on?
Follow up questions:
Did you have all the information you needed at the time?
Were things going as expected?
- Please tell me when you first realised there was a problem.
Follow up questions:
What were the indicators?
What did you think was happening?
- Please tell me what you decided to do once you realised there was a problem.
Follow up questions:
How well did it work?
Did you try anything else?
- Was there anything that you planned to do but didn’t?
Follow up question: Did something distract you, making you forget your intentions?
- How would you describe your workload on the day of the incident?
Follow up questions:
Did your workload that day impact on your abilities?
If so, can you describe what those impacts were?
Confidence
- How confident are you in doing your work?
- How confident are you in doing X task?
Health and fitness
- What is your general health like when at work?
Follow up questions:
Were you feeling well at the time of the incident?
- Is anything going on outside work that might affect your ability to perform at your peak while on duty?
Follow up question: Are you working a second job/going to night school/overwhelmed with family obligations?
Team structures
- Please describe the skill mix you have in your team.
Follow up question: What impact on performance and/or wellbeing does this skill mix have?
- What is the balance of senior and junior staff?
Team work
- To what extent do people in your workplace work as a team?
- How do you work as a team?
Follow up question: Do you work with the same team/people each day?
- How would you describe how staff work together here?
Follow up question: What does that look like?
- How do you co-ordinate between team members?
Follow up questions:
Do you conduct team huddles/briefings?
How are roles and responsibilities assigned or clarified?
- What are communications like within the team you work in?
Follow up question: Please can you describe an example of that?
- How would you describe the process for ensuring that communication/information is understood among your team or patients?
Follow up questions:
Do you use standard vocabulary?
Do you use read backs or repeat backs to confirm shared information/ communication?
- What sort of non-verbal communication do you use?
Follow up questions:
Do you use hand gestures or other non-verbal communication when carrying out a task?
Are all team members clear on the non-verbal communication gestures used?
- Please describe how your team support each other or assist in performing their work.
Follow up questions:
How do you monitor or back up each other?
Do you conduct debriefs?
- How would you describe the composition of your team?
Follow up questions:
Would you consider your team is homogeneous (that is, like minded) or heterogeneous (that is, from multiple schools of thought)?
Are team members static or drawn from multiple areas? Do they rotate? (and if so) how frequently?
Clinical/physical condition of patient
- Please describe the clinical condition of the patient.
Follow up question: Were there any additional factors you had to consider when treating this patient? (eg age, nutrition, hydration, weight, sleep, abnormal physiology)
- Please describe the mental/psychological condition of the patient.
Follow up question: What impact did this have?
Patient interpersonal relationships
- What were communications like with the patient/family?
Patient culture, language, lifestyle
- Did you have to consider any particular factors when dealing with this patient?
Follow up question: For example, language, culture, personality traits, lifestyle?
Involvement in care
- Was the patient involved in their care?
Follow up question: How was the patient involved in their care?
Appendix 2: System focused questions for patients and families
Organisation
Work schedules and assignments; management and incentive systems; organisational culture; training; policies; resource availability
Experience of organisation
- Please tell me about your experience with X organisation both before and after your incident.
Follow up question: Please can you describe what made it good/bad?
Supervision
- Please describe what you noticed about supervision?
Follow up question: Please tell me more about……? What was good/bad?
Internal/physical environment
Lighting, noise, vibration, temperature, air quality, physical layout and available space
Layout
- Please can you describe the layout of the room you/the patient was in?
Follow up question: What, if any, impact on your care did that layout have?
- Please can you describe the layout of equipment?
Follow up question: What, if any, impact on your care and treatment did that layout have?
Environmental conditions
- Please can you tell me about the environmental conditions in the area you were in?
Follow up question: What were the temperature, noise (alarms, voices), light (visibility) and ventilation like?
Tools and technology
Characteristics such as: usability, accessibility, familiarity, level of automation, portability and functionality
Documentation
- Did you observe staff using any documentation?
Follow up question: Please can you tell me about the documentation you saw staff using?
Equipment
- Please can you describe what equipment staff were using?
Follow up question: Please can you describe any issues staff were having using the equipment?
Tasks
Specific actions within larger work processes. Includes task attributes such as: difficulty, complexity, variety, ambiguity and sequence
Scheduling/management plan
- Please describe how your care and treatment was managed.
Follow up questions: Were there delays in your care?
Distraction
- Did you notice any distractions for staff?
Follow up question: What were those distractions?
Procedures/processes
- Did you observe staff doing X task?
Follow up: Please can you walk me through what they did?
Communication
- Please can you describe what the communications were like between staff?
Interactions
- Please can you tell me about the interactions you have had with X unit?
Follow up question: How have these been?
- Please can you describe what the communications were like with X unit?
Person
Individual characteristics: age, preferences, goals, knowledge, physical strength and needs
Collective characteristics: team, cohesiveness and structure
Workload
- Please can you describe what the staff workload looked like?
Follow up question: Do you know what was driving that level of workload?
- Please can you tell me about how busy staff seemed?
Teamwork
- Please can you describe the teamwork you observed?
Morale
- Please can you describe how staff morale seemed?
Publication reference: PR00103