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NMC made 'wrong decisions' on Mid Staffs nurses

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.

Mid_Stafford_hospital_sign

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”

Jackie Smith

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.”

Jackie Smith

Jackie Smith

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

Readers' comments (18)

  • tinkerbell

    We know that there is still more we need to do”

    Jackie Smith


    Probably the only thing we can all agree on!

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  • The standard of fair investigatory practice is not only to look for evidence of wrong doing but also balanced investigation of non wrong doing. The NMC screening process of fitness to practice cases needs to improve and in some cases employers do a little more in house by using its own internal procedures after which due notice is given to the NMC with respect to public protection as this is the primary purpose of the NMC for which most of the registration fees goes towards.

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  • I'd be interested to know how the NMC compares with the GMC in terms of its handling of the Midstaffs complaints (initially there were 41 complaints about doctors reported and 29 nurses)

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  • So we pay more to prop up a service which isnt fit for purpose- if it was a ward we would close it.

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  • With all respect and from an outsider point of view (i´m foreing) a guilty culture isn´t going to improve the public health system. We don´t need guilty people, we need solutions . I don´t mean a nurse is not responsible for her acts as every citizen .The main conclusion i get of all this is tha obedience culture is over.

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  • rocio aguilar | 1-Apr-2014 1:22 pm

    this is Britain you are talking about where their ideas on everything are rather unique!

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  • you are not so unique, belive me ;-)

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  • Anonymous | 1-Apr-2014 3:14 pm

    rocio aguilar | 1-Apr-2014 1:22 pm

    eccentric then!

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  • The NMC pays very large sums of money for a tribunal type system using barristers and solicitors for each of the many cases it deals with both interim and substantive. For an arguably minor case instigated by malevolent managers or for whatever reason a nurse can find themselves on very restrictive practice orders for eighteen before her case even comes before a substantive hearing whilst the NMC typically uses a externally contracted lawyer to return to her employment file with the apparent purpose of writing a prosecutors case and using any information that might be available including the views of anyone that managers might point them towards. The nurse must then defend herself via her trade union or professional body. The effect of all this is to severely curtail her career for the immediate future whilst remaining under uncomfortably close scrutiny which could become permanent at the whim of the regulator who functions on the principle of probability balance as determined by itself. The result is the possibility of injustices occurring as demonstrated in similar circumstances by Dr Helen Bright's Doctors for Justice organisation.

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  • wouldn't it be simpler and cheaper if employers dealt with staffing issues and any criminal cases went through the normal judiciary system, with perhaps a special branch dedicated to healthcare workers or to the NHS? Surely this is what happens in other countries. It seems far too many layers and nobody knowing what anybody else is doing is the problem.

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  • The externally contracted lawyers prosecution charges can be hostile and need not involve the matter for which the nurse was referred. There is a strong argument therefore that the use of externally contracted lawyers is neither in the interests of nursing justice nor public finances.

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  • Anonymous | 2-Apr-2014 7:24 am

    but surely that is the same for anybody facing a court of law or is there some sort of bias towards healthcare professionals which should not exist?

    obviously from you comment it is not feasible but if ever it was to be considered, as i mentioned above, it would indicate a need for a specialised department, it that was a possibility, rather as the NMC has now although I am not sure of their legal powers.

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  • In reference to the NT story the point is that the NMC uses significant resources to prosecute arguably minor offences and applying often very significant sanctions whilst occasionally (or often depending upon your point of view or experience) ignoring clearly important cases that are very much in the public interest and safety. This is important as the NMC exists to protect the public from poor practice and incompetence. The issue of bringing the profession into disrepute as a charge requires some consideration as what might seem disreputable to one might not be seen as such by another particularly in cases that involve applications of opinion such as is seen in those that are now commonly known as "whistle blowing".

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  • Jesus wept. How many more chances will this failed organisation get? How many more reports do we need detailing its failings? How many more patients must be put at risk and how many more times will the fees have to go up until someone pulls the plug on this failed organisation?

    As others have said: if the NMC were a nurse she would've been struck-off years ago. If it were a dog it would've been put down. If it were a hospital or a private company it would've been closed.

    It's a popular misconception that you can't polish a turd...

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  • Your manner of expression is unusual but I think we reasonably glean your sentiment.

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  • Ms Smith's tiresomely overworked comment..

    “However, it recognises the progress we have made and confirms the commitment we made to improving performance.”

    ..is somewhat typical of the side stepping rhetoric that we have all come to expect and live with in the face of abject public health service failures.

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  • Anonymous | 2-Apr-2014 5:16 pm

    such self praise is rather expensive 'side-stepping rhetoric' perhaps they need to make an effort to earn some praise from those who pay them.

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  • Record number 228 Administrative reform

    "It is of concern that the administration of the Nursing and Midwifery Council, which has not been examined by this Inquiry, is still found by other reviews to be wanting. It is imperative in the public interest that this is remedied urgently. Without doing so, there is a danger that the regulatory gap between the Nursing and Midwifery Council and the Care Quality Commission will widen rather than narrow".

    Francis Inquiry recommendation

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