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Exclusive: NMC considers using patient impact statements in FtP trials


The Nursing and Midwifery Council is exploring the introduction of “personal experience statements” to enable people to communicate the impact of substandard care on their life and wellbeing in a radical move that could see the body “treading new ground for a regulator”.

The regulator confirmed to Nursing Times it was looking at how such statements – similar to “impact statements” for victims of criminal offences – could be used as part of its new approach to fitness to practice.

“Not withstanding some of the difficulties of doing it I believe if we can it will make a huge difference”

Jessie Cunnett

“One of things we have been exploring is how we can work differently with people so that we can help them to share their experience of care and the impact that the experience has had on them and how we can include this as part of the process of investigating or looking into what happened and then ultimately in coming to an outcome, a decision about whether or not the nurse should remain on the register or not,” explained NMC head of public support Jessie Cunnett.

Speaking at conference organised by law firm Leigh Day on the experiences of people with learning disabilities and autism of the justice system, she said the new statements could be an exciting step forward for the regulator.

She stressed they would not be exactly the same as victim impact statements, which are written or oral statements usually presented to a criminal court at the sentencing of a defendant. 

jessie cunnett

jessie cunnett

Source: Emap

Jessie Cunnett, head of public support at the Nursing and Midwifery Council, gives a presentation at the A Fair Hearing? conference

“It isn’t quite the same and won’t work quite the same – because we are not the same as a criminal setting - but it is like that and we are exploring how we can introduce something along similar lines that makes sure that the impact of the events have some weight and some value when we’re thinking about the outcome,” said Ms Cunnett.

She said the NMC had already discussed the concept with a “large range of people” including people with learning disabilities and autism.

“We understand that it’s a quite a complicated thing to do and there are different opinions,” she said.

“We are just in the process of drawing together all of the findings from different conversations that we had and they included conversations with people who are lawyers and decision-makers as well as organisations representing different types of people,” she added.

Ms Cunnett said she was “really excited” to see a report on the outcome of these initial discussions and looking forward to the next steps.

“The process is supposed to be about assessing future risk and not punishing for past mistakes”

NMCWatch spokeswoman 

The NMC confirmed to Nursing Times it had staged a series of focus groups to explore the idea of personal experience statements and help draw up more detailed proposals.

The next stage would be to gather feedback on these more fully developed proposals from various groups including the public, nurses and midwives, registrants who had been through FtP processes, NMC staff and leaders, union and legal representatives and patient organisations.

Ms Cunnett suggested that if the concept was eventually approved and adopted the NMC would be leading the way among regulators for health and care professionals.

“If we can manage to do something like that as an organisation we would be treading new ground for a regulator and not withstanding some of the difficulties of doing it I believe if we can it will make a huge difference,” she said.

Campaign group NMCWatch, which has been pushing for reform to FtP, told Nursing Times it was aware of the concept.

Personal experiences statements had the potential to “give the panel further context to the allegations”, said a spokeswoman.

However, she said the NMC would need to proceed with caution to ensure the use of such statements was fair.

“We must not forget that the process is supposed to be about assessing future risk and not punishing for past mistakes – according to the NMC – and so this would need to be presented with caution otherwise the emotion of the case may over-ride the ability to assess the true risk that individual nurse or midwife may or may not pose,” she said.


She said currently nurses and midwives were often criticised in FtP hearings for not having considered the full impact of their actions or shown enough remorse and there was a risk statements would tip the balance against them.

The government recently published its plans to reform legislation governing how regulators like the NMC operate and said it wanted to see more support for professionals.

“It’s so important that we truly understand the impact of their individual situation”

Andrea Sutcliffe 

The NMCWatch spokeswoman said it “would only be fair” to allow a nurse or midwife to present their own statement setting out the impact of misconduct allegations on them.

She said key questions included exactly when and how personal experience statements would be used, if and when they would be made available to the nurse or midwife in question so they could formulate a response, and who would decide if statements were relevant or required.

Nursing and Midwifery Council

Andrea Sutcliffe

Source: NMC

Andrea Sutcliffe

NMC chief executive and registrar Andrea Sutcliffe told Nursing Times the NMC was striving to become “a more human and caring professional regulator” particularly when it came to FtP.

“People are at the heart of the NMC’s values and behaviours, which is why when someone has been affected by poor care, it’s so important that we truly understand the impact of their individual situation and consider what it would be like to be in their shoes,” she said.

“To help embed this further in our work, we are currently exploring how the use of personal experience statements could be used as we continue to develop our new approach to fitness to practise in the months ahead,” she added.

She confirmed the NMC had not yet decided whether personal experience statements would definitely be part of its FtP reforms.

“We have not yet made a final decision about the use of personal experience statements and will take all views into careful consideration in agreeing the way forward,” said Ms Sutcliffe.


Readers' comments (6)

  • I can’t really see how “impact statements” could be anything *but* a bad move!
    In a criminal court, they are read out after a verdict in order to influence the sentence (punishment).

    There’s PLENTY of opportunity for patients/relatives/referrers to say how whatever-it-was has affected them during the investigation and there should be.
    It is how the nurse/midwife/nursing associate responds to that during the investigation/hearing that demonstrates insight, remorse and *current* fitness to practise.
    These kinds of statements are used in criminal proceedings to try to maximise the punishment. There’s no place for them in deciding a *non-punitive* sanction from the NMC 🙁

    Or have I misunderstood something?

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  • one of our members is unable to comment on this link and so here is her comment: "So long as they don’t go looking for negative statements or are ‘selective’ what statements are disclosed!!"

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  • But even in cases where nurses/midwives have fupped up, and caused harm...these kinds of statements are used in criminal proceedings to try to maximise punishment. There’s no place for them in deciding a *non-punitive* sanction from the NMC

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  • I read this earlier. In Mental Health settings in particular, patients don't always want the treatment they receive. Having an impact statement from patients who were given treatment which they didn't want but which was considered in their best interests is always going to be a bad idea.

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  • Victim impact statements would take the objectivity out of FtP. One person might experience a nurses mistake and be very forgiving whereas the next might be trapped in anger and bitterness. The character of the patient could potentially alter the outcome for the nurse, which isn't how assessing future risk should work.

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  • Another of our group is unable to sign in here - her is the comments they wish to post: "Have given this considerable thought post reading, initial reaction horror, now absolutely against, I feel impact statements should remain in the domain they were intended in criminal court, that is what they are designed and implemented for. The referer or any person whom has had a negative impact by a registrants actions or omission has opportunity and is already asked about this in the referral form to be submitted and continued in the statements and evidence used in hearings. The subject of the impact of alleged and proven charges are repeatedly discussed and written throughout the NMC process and on final decision letters. It is not the role of the NMC to be the platform for the voice of the damage or impact to individuals, for good reason that is the role of courts and personal injury claims. A can of worms does not adequately describe what formally implementing this to an already unjust process would do. I would argue on the other hand that aallowing impact statements on registrants whom have had unjust allegations and made against them by referees whom themselves are registrants, and suffered negative impact, should have this investigated and have impact statements used in the process. I believe this does come under the NMC role as assessing the fitness to practice of all registrants , referees or subjects and their fitness to implement safe care is the NMC s number one function to uphold their priority aim of protection of the public. Registrants whom are voraciously or wrongly referring other registrants are directly breaching the CODE and reducing protection of the public.Whilst of course the NMC should show empathy with anyone whom has been negatively impacted by any registrant, it is not the NMC s role to assess that or apportion blame of any individual to it. The role is to identify breaches of standards of code , policy or care in many cases where irrelevant to any harm caused, and to assess subsequently to fitness to practice. All nurses know that even the slightest error of communication or documentation may lead to devastating consequences, the impact on someone is not necessarily related to their ftp, but could certainly impact unfairly on the registrant if read out in their hearing. I think it's fair to say I am not in favour of the proposal"

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