Concerns have been raised that plans by the Nursing and Midwifery Council to introduce a new system of public warnings for registrants who have breached professional standards may result in “gratuitous” use of the sanction.
The regulator wants to have the option of using the new sanction when there are serious concerns about an individual’s past conduct, but they are thought to no longer present a risk to the public – meaning there is “no case to answer”.
“It is not a slap on the hand. It is declarable to future employers, to agencies, and can have a reputational impact”
Instead of taking the person through to a full fitness to practise hearing in front of a panel the NMC has proposed that a case examiner, who carries out an assessment following investigation, will instead issue a warning.
Under the NMC’s plans, the warning will be public and stay on the registrant’s record for 12 months.
The proposal is part of major changes being brought in by the NMC to speed up its handling of fitness to practise cases.
The vast majority of people responding to an NMC consultation, which was published last week, supported the changes put forward, but around one in five disagreed with the regulator’s approach to publishing warnings.
At an NMC meeting last week, some members of the council questioned why 21% of the 41 organisations and 17% of 91 individuals taking part in the consultation did not agree with the approach.
NMC director of fitness to practise Sarah Page told the meeting there was “perhaps a fear of warnings being used gratuitously”, and also because the sanction would be published.
Currently, if an FtP panel finds there is “no case to answer”, due to the individual no longer posing a risk to patients, there is no public mark on their registration.
“It does seem rather odd that in cases that might have previously gone through to a full hearing and ended up with no case to answer, that they then still get a warning”
“The introduction of warnings is a new sanction and we need to strike the right balance between the public protection element against the registrants’ own interests,” she said.
“A warning will be used in a case where, because of the registrants’ insight and demonstration of understanding of the issue, we are able to close the case. Whereas currently we would take them to a full hearing,” she said.
“A warning will enable us as a regulator to mark the seriousness, while not restricting the practice of the registrant,” she added.
She said the challenge was to ensure what the NMC published was “sufficient to mark our role as regulator, but doesn’t go too far”.
Ms Page said the NMC believed the balance could be struck by only publishing the warning and a summary of the reasons behind it for a period of a year.
Later at the meeting, representatives from nursing and midwifery unions also voiced their concerns about the same issue.
“The issue of warnings is a very serious matter. It is not a slap on the hand. It is declarable to future employers, to agencies, and can have a reputational impact,” said Unison’s head of nursing Gail Adams.
“It is also very difficult in a small summary to convey information that is proportionate and doesn’t set hares running, that in any way unnecessarily undermines the reputation of the registrant, but at the same it fulfils public protection,” she added.
Registrants should have to provide their consent before a warning could be issued, said Ms Adams.
Royal College of Midwives’ director of midwifery Louise Silverton added: “Our main concern is that warnings will only really take place when changes have been made and there’s been some remediation and learning [by the registrant].
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“It does seem rather odd that, in cases that might have previously gone through to a full hearing and ended up with no case to answer, they then still get a warning when they feel they have put everything to right,” she said.
The council agreed in principle to all the changes it had proposed to improve FtP processes. It includes allowing case examiners to issue warnings, give advice and recommend undertakings – when registrants who are a low-level risk to patients agree to return to work as long as they comply with certain measures or restrictions.
In January, the Department of Health published findings from its own consultation on the FtP changes and confirmed it would go ahead with plans to alter legislation.