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Current fitness to practise process creates ‘fear and lacks transparency’, claims nurse


A nurse has launched a petition calling for fundamental change in the way fitness to practise (FtP) cases are handled by the Nursing and Midwifery Council, after she was struck off in a decision described as “excessive and disproportionate” by a High Court judge.

Cathryn Watters, who has been a nurse for 27 years, specialising in cancer care, was accused of dishonesty and struck off by the NMC in February this year for allegedly altering the date on a training certificate she submitted as part of a job application – a charge she has consistently denied.

“It is like a roller-coaster – up and down, panic attacks, not sleeping, stressed beyond belief”

Cathryn Watters

However, the striking off order was overturned on appeal by a judge who said the sanction was “disproportionate and excessive”, and ruled in favour of a two-month suspension.

Ms Justice Cheema-Grubb said: “This was a one-off fault in the context of a life-long career of public service of a high standard. It was wholly out of proportion for the panel to conclude that suspension was not a suitable penalty.”

The suspension was later revoked with immediate effect at a review hearing in August. The NMC review panel noted it was in the “public interest that a skilled and specialist nurse should be allowed to return to practise”.

Ms Watters, who has previously worked on inspection teams for the Care Quality Commission, told Nursing Times the whole experience had been “horrendous”.

“It is not only the thought you can never work in your profession again, it’s the shame of it all,” she said.

“When you have been nursing as long as I have, it’s not just your job it is who you are – it is your identity – it is everything you have done, it is your whole being,” she said. “I was devastated.”

“There were literally no jobs I could do that were health-related. I was in despair”

Cathryn Watters

Ms Watters, who has four children aged under 14 and is the main breadwinner for her family, said she and her husband feared they would lose their home.

“We were just like, oh my God, we’re going to lose the house and if we lose the house we’ll never get another mortgage, because my husband is self-employed and I’m not working,” she said.

“You look at all the jobs out there and even the ones that aren’t patient based require a registration number,” she said. “There were literally no jobs I could do that were health-related. I was in despair.

“It is just this roller-coaster – up and down, panic attacks, not sleeping, stressed beyond belief,” she told Nursing Times.

While she admitted submitting the training certificate and copying the date onto her application, she has always denied altering the date on the original document.

She concedes that she should have checked her paperwork more thoroughly and would have accepted a caution but, having enjoyed a long and successful career in oncology nursing, was horrified to be struck off for what she considered a relatively minor mistake.

“When you go in there you are so vulnerable – I cried the whole three days”

Cathryn Watters

Her petition claims the current FtP process creates “fear and a lack of transparency”. Ms Watters admitted she even considered confessing to something she claims she did not do, simply to increase her chances of a lighter penalty.

“At one point with my lawyer when we were preparing, I said: ‘Would I be in a better position if I actually said I had done it?’ And she said: ‘Well, did you do it?’ and I said: ‘No’ and she said I had to tell the truth.”

“After I was struck off, I wondered if it would have been better to say that I had changed it [the certificate] and that I was really sorry,” she said. “I probably would not have been struck off, but it would have been a lie just to get the outcome I wanted.”

Ms Watters also revealed that she very nearly did not appeal against being struck off because she had been so traumatised by the process and hearing itself.

“When you go in there you are so vulnerable – I cried the whole three days I was there,” she said. “They said my evidence was unconvincing and without substance. Of course it was. I could barely speak!

“I was so mortified at being there in front of them,” she said. “There was no duty of care over my psychological state at the time.”

She said: “When I walked in for that hearing I felt worse than a criminal – you are cross-examined like in criminal law and it is just horrendous. I can see why a lot of people get to that and say ‘you know what – I’m just walking away’.”

“The current process does not protect either the public or the profession and is damaging to both”

Petition statement

Even on the day of the appeal, where she represented herself, she considered withdrawing despite being encouraged to fight by other nurses who had been through the process.

Her petition has been signed by more than 650 people so far, including many fellow nurses. “The current process does not protect either the public or the profession and is damaging to both,” states her petition, which is based on the website

“We are constantly struggling to retain experienced nurses in the profession and should be ensuring these nurses with irreplaceable experience are not thrown away,” it adds.

Since launching the petition, Ms Watters said she had been inundated with messages from other nurses who said they had endured similar experiences.

She said the support she had received showed she was not the only nurse to have been sanctioned harshly, or been unnecessarily lost to the profession through FtP processes.

Together with some of the nurses that contacted her, she is forming a campaign group to call for the FtP system to be changed and “made fairer”. It is expected to meet for the first time early next year.

One of the key issues highlighted in her petition is a lack of consistency in the way FtP cases are handled. The judge who heard her appeal called for the NMC to look again at the Indicative Sanctions Guidance that panels use to decide what sanctions to impose.

This echoed a previous call from another judge Mr Justice Kerr. He criticised the guidance for lumping thieves, criminals and fraudsters together with someone who may have committed a much more minor infraction, such a breaking a contract, and concluded it needed to be more “nuanced”.

Ms Watters, who is now back on the register and has a job lined up with an employer that has supported her throughout the NMC investigation, hearing and appeal, said the new campaign group would be calling for the guidance to be structured better, less vague and “open to interpretation”.

She also said they would like to see further checks and balances before the decision to strike someone from the register and more nurses serving on panels who could relate to the experience of nurses in practice and the impact of removing them from the profession.

“If you are going to get to something as severe as striking someone off, there needs to be another check and balance in there, because you are talking about destroying someone’s livelihood and their life really,” she said.

“Yes, there are nurses out there who should not be on the register, but there’s a lot more out there who are no longer on the register and could have been helped to maintain their registration,” she said. “At the end of the day, what is our profession about? It is about caring and we should be caring for our professional colleagues as well – and the NMC needs to lead in that.

“Our whole profession is about openness, honesty, duty of candour, but actually the processes in a hearing don’t promote you telling the truth almost – it is almost encouraging people to say what they need to say to get through it,” she added.

“Our current processes are too adversarial and do not give us the flexibility we need”

NMC spokesman

The NMC told Nursing Times that it had listened to the comments of the judge in Ms Watters’ case and had already fed this into new guidance.

“In the case of Ms Watters, the judge agreed with the independent panel’s findings of fact and that the fitness to practise of Ms Watters was impaired,” said a spokesman for the regulator.

“The judge decided that the striking off order imposed by the panel was excessive and replaced it with a two-month suspension order,” he said. “It is important to recognise that openness and honesty are key to patient safety, and dishonesty and cover up are things that we have to take extremely seriously.

“In coming to his conclusion, the judge made some extremely helpful comments about our guidance,” he said. “We’ve taken these comments on board and they have been reflected in our new guidance in this area.”

The spokesman stressed that the NMC was keen to update its FtP processes, but this would require further changes to the law to be agreed by government.

“Recent changes to our legislation has gone some way to help modernise our fitness to practise arrangements, but we are clear that these changes fall far short of what’s required,” he said.

“Our current processes are too adversarial and do not give us the flexibility we need to react to changes in the external environment,” he said.

“That’s why the government must deliver real reform in this area. In the meantime, we will continue to explore ways in which we can improve our processes within our restrictive legislative framework,” he added.


Readers' comments (8)

  • The NMC is an atrocious body
    It has one aim
    To cram as much money from nurses pockets into theirs as fast as they can get away with it
    I had 9 months of hell having been referred(falsely) and finally being found to have no case to answer
    It should have taken 9 minutes
    The reason is in plain sight. It is not in the NMC barristers interests to quicken decisions , they will lose money.
    The NMC are a bunch of worthless crooks and us nurses should have an en masse decision to cease paying our fees to these disgusting second rate legalists who have no comprehension of nursing.

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  • After commenting I am going to sign that petition! Lets talk about the new guidelines shall we. The new guidelines is encouraging nurses to admit fault in order to reduce the time it takes to arrange a hearing. My advice to any nurse who is referred to the NMC is DO NOT ADMIT to anything especially if you are in the right ask for a hearing let the NMC do some work and investigate and let the referrer justify their reason for referral if possible go the whole hog and get witnesses to come to the hearing. The whole hearing process is like watching an episode of "law and order" but at least in law and order you're innocent until proven guilty but with the NMC you're guilty and if proven innocent you still cannot work as a nurse because there is the stain of the referral in the first place! Because in an interview they ask have you ever been referred to the NMC this I think should never be on an interview question if a nurse's registration is deem "effective"

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  • Like you said Cathryn, civil standards can base charges on probabilities of 51% "more likely than not" as opposed to criminal proceedings which requires them to prove beyond reasonable doubt but the NMC failed to liaise with a handwriting analysis expert who could and would have proved you never falsified any such training certificate.

    Probability is extremely dangerous, especially when the panel ignored your evidence and made no attempt to clarify who had falsified your training certificate. This is why the NMC need to return to operating under criminal rather than civil

    The NMC spokesman said “Our current processes are too adversarial and do not give us the flexibility we need to react to changes in the external environment,” The first CCC panel did possess flexibility to impose a striking off order against you but also possessed the power to confirm "No Case to Answer". Unfortunately they chose the first and not the latter. This panel unfortunately chose to speculate without any evidence. Therefore the NMC do possess flexibility.

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  • What a cop-out for the NMC to say they need the government to effect change in their procedures! This case sounds like it should have been dealt with at a local level and never have come near the NMC! Poor woman. I always thought the NMC was there to protect the public from the Beverly Allitts of the world not destroy peoples lives over small indiscretions. We all make mistakes, we're human, but the NMC seems to be staffed by inhuman beaurocrats! I have signed the petition.

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  • I agree that NMC should review their fitness to practice rules and regulations because there will be nurses who will be discourage to carry on with their profession due to the stress that they are going through during the process of being referred to NMC. I have been referred to NMC and the length of waiting was very long which can cause distressed to the registrant. In addition to that, it is truly hard for nurses to loose their profession because this is their image, this is who we are. It is very hard to accept that you loose this career for only one or two mistake which can be resolve by training and experience. As no one is perfect and everyone can make mistake.

    I have experience at work that I was labelled due to my mistake. I was told off everyday because I was so nervous when I was supervised. I have experience that instead of being supported I was intimidated and even receive a comment from my manager that I am good as to be a healthcare assistant. I was very devastated and broken and even giving up my profession due to this bad experiences from the workplace. I hope NMC will know how to handle those nurses who are going through this stressful proceedings and hearings.

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  • Thank you Cathryn for speaking out. It is devastating to be referred & to hear the Lies told by referrers and the lies told by the NMC witnesses.
    I was also referred by my employer, the regional manager who referred me was the manager I raised a grievance with, along with another regional manager who was the NMC witness!.These two had made an bad working environment positively unsafe & they reduced staffing levels to dangerous levels. The NMC 'one of the gang' suspended me for 12 months. Despite a family bereavement 3 days prior to the hearing (for which the NMC asked for proof) the NMC would not reschedule.
    The panelist registrant in my case, a manager of an ITU and deputy Director of Nursing for a county didnt even know the drug classification of an every day medicine. She said 'guilty'
    I appealed through the high court. The judge overturned the NMC decision and stated, amongst other things, the unsafe working environment along with dangerous staffing levels made working conditions positively intolerable for staff.
    My advice to anyone going through the hell & psychological abuse of the NMC is
    Dont admit anything you haven't done. Insist on attending every hearing, asking for NMC for financial assistance to attend.
    Appeal against any decision that is unfair and unjust and inconsistent with other similar cases.
    Appeal removes the case from the NMC into the hands of the judiciary and is subject to the impartial scrutiny of the judicial system.
    Dont forget the buzz words, insight, remorse and reparation. Write the rubbish they want to see, any way they want it.
    Barristers working Pro Bono may be able to assist you through the appeal, as at this point the RCN disappear.
    Nurses & midwives must have a regulatory body but not the corrupt organisation we have at present. An organisation more interested in exploiting RNs & RMs
    There are some barristers who have refused to work on behalf of the NMC because of some of their practices. The NMC ignore The Law, making new ones as they go along. They ignore the ECHR Art 6 especially, as most nurses do not get a fair trial, they are not allowed to question witnesses and the NMC uses hearsay as evidence.
    There are many good nurses who are not working because of the power mad lawyers of the NMC who are in charge. The unethical fee hunting advocates who represent the NMC
    I have now retired so the petition doesn't affect me apart from getting so angry at the injustice.
    PLEASE Sign The Petition

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  • There is always flaw in Law making . One should be honest with oneself, you must be fit to perform the job you are assigened to do despite of how old you are.
    I have passed my penion age, yet I am still carring out nursing duties and administrative works, ten hours per shift.

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  • The NMC does not need a review
    It needs to be disbanded and the barristers that work for it charged with theft.
    This is an organisation that steals nurses wages, crams as much of it as possible into their pockets as fast as they can get away with it
    Strikes nurses off for trivial matters
    Destroys lives and of course these hearings have led to the deaths of nurses
    All us nurses en masse must refuse to pay our imposed fees to this disgusting bunch of malicious crooks

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