The nursing regulator’s effectiveness has been called into question by a damning report that concluded it failed to properly investigate 17 former nurses at Mid Staffordshire Foundation Trust.
The mauling came less than week after the Nursing and Midwifery Council opted to consult over unpopular plans to raise the annual registration fee to £120.
In its report, the Professional Standards Authority said it had “serious concerns” that the “wrong decisions” may have been made by the NMC to stop investigations into the nurses at an early stage.
The report, published on Monday, examined 100 fitness to practise cases that were closed early by investigators and revealed a catalogue of errors and mistakes – some of which the PSA said could have put patients at risk.
Among the 100, the PSA audit specifically looked at the investigation into 19 nurses who worked at Mid Staffordshire, with 17 of the cases related to poor care covered by the inquiries by Robert Francis QC.
In nine of the Mid Staffordshire cases the PSA said there was no evidence of a risk assessment ever being carried out by the NMC and that it did not investigate concerns or carry out proper investigations to find out more information from sources such as the coroner, the trust or the inquiry itself.
In one example a case was closed on the basis there were no complaints about the nurse – despite there being two complaints “clearly on the NMC file”.
In another instance no attempt was made to get evidence from patients and in another case the nurse’s registration was allowed to lapse because the investigation did not start for four months.
The PSA, which oversees the activities of the nursing regulator, also singled out another occasion when the NMC closed an investigation solely on the basis of an unsigned positive reference about a nurse on letter headed paper. The PSA said no attempt to check its accuracy was made.
“Either the wrong decision was made or the decision made was based on unsound or inadequate reasons”
PSA audit report
“Our audit identified a number of serious concerns about the relatively limited extent of the investigation that the NMC conducted,” the PSA report stated.
“The evidential basis for some of the decisions made by NMC staff and the [investigation committee] was inadequate. This meant that either the wrong decision was made and/or the decision that was made was based on unsound or inadequate reasons.”
The report said the errors were particularly serious given the level of public concern over poor care at the Mid Staffordshire organisation.
Elsewhere the PSA identified delays in applying for interim suspension orders to prevent nurses working unsupervised while under investigation in five cases. The delays ranged from 10 months up to three years.
It said: “We consider there is a real possibility the delays…may have exposed the public to unnecessary risk as they left the registrants concerned free to practise unrestricted and this regulatory failure has the potential to damage public confidence.”
The report added: “We are concerned about the inadequacies in the investigation of these cases and the impact that might have should any of the individuals concerned seek readmission to the NMC’s register in future.”
As well as a string of administrative blunders, incorrect decisions and delays, the PSA also highlighted examples where the NMC had not considered the public interest and in one case advised someone not to make a complaint about a nurse due to the nurse’s age.
“This raises a concern that NMC staff are dissuading potential complainants from raising concerns about NMC registrants for inappropriate reasons,” the report said. As a result, it urged the NMC to improve its staff training.
It did note improvements in some areas. However, the PSA said it identified seven cases in particular which “call into question [the NMC’s] effectiveness as a regulator.”
These included a failure to investigate a complaint for nine months by which time the nurse’s registration had lapsed as well as a failure to share information with other professional regulators about an individual under investigation.
Other errors involved data breaches, premature closure of an investigation and doubt over whether decisions made were actually lawful.
“We know that there is still more we need to do”
NMC chief executive and registrar Jackie Smith said: “We know that there is still more we need to do.
“However, it recognises the progress we have made and confirms the commitment we made to improving performance.”
At its latest council meeting, held last Wednesday, NMC confirmed plans to consult nurses over proposals to increase registration fees from £100 to £120, which it says is needed to prop up its struggling financial position.
The consultation will run from May to July, with the NMC council considering the outcome in October. If agreed, the NMC would then seek to introduce the fee rise from February 2015.
The decision prompted anger from unions and registrants, with Unison head of nursing Gail Adams describing it as “disproportionate and adding insult to injury” on top of the government’s attempts to restrict pay