Fewer fitness to practise hearings will be held in public in the future under a series of plans drawn up by the Nursing and Midwifery Council that will see most cases resolved in private, as well as a greater emphasis on the context surrounding an incident.
The regulator said there was evidence the current approach by regulators to dealing with FtP concerns, via public hearings, had unintentionally led to “a culture of blame and denial” and that changes were therefore needed.
“We should enable registrants to remediate regulatory concerns at the earliest opportunity”
NMC council papers
Public hearings, which the regulator described as “costly and time-consuming”, would only need to take place in “exceptional circumstances,” when there is a dispute, according to the NMC’s proposals.
The draft plans stated that a case could be handled without a full hearing, even if a concern about a registrant’s practice was so serious they may need to be removed from the register, or if they were still considered a risk to patient safety.
The NMC is already able to resolve cases without a hearing. But only around 25% are concluded in this way, by either a decision being made on paper at a meeting, a registrant agreeing to voluntary removal from the register, or a nurse or midwife agreeing to a sanction with a panel without witnesses involved.
Under its latest proposals, the regulator wants all cases in which nurses and midwives agree with the regulator’s assessment of events to be dealt with on paper at a private meeting – which would not require registrants or witnesses to be present.
“We should only take regulatory action if the concern has already been raised with and investigated by the employer”
NMC council papers
The process would remain “transparent and accountable”, said the NMC, because it plans to publish the panel’s reasons for the decision, which would allow the public to see the concerns and outcome.
In addition, the NMC said it intended to start publishing details of voluntary removals to improve transparency.
In draft consultation documents released this week, the regulator described its current approach of taking most cases to full hearings as “adversarial” and having a negative impact on witnesses, employers, and registrants.
“To ensure that registrants who are referred to us can practise safely and effectively, we should enable registrants to remediate regulatory concerns at the earliest opportunity and, if needed, reach an agreed position with us as to how the concern should be dealt with,” said the NMC.
The regulator added that it wanted to improve the way it takes context into account when a patient safety incident occurs. Currently, the circumstances in which a registrant does something wrong are considered by the NMC on a “case-by-case basis”.
“[The NMC] will set out very clearly for employers what we expect from a referral”
NMC council papers
In the future, it intends to introduce guidance setting out why context is relevant and how it should be taken into account when the regulator makes decisions. It will also introduce a standard approach of assessing context and will pass on intelligence to employers and regulators.
Meanwhile, in cases where a nurse or midwife has made an error, but is deemed no longer a risk to the public because they have corrected any issues with their practice, the NMC said it may not be necessary for it to investigate the case.
The regulator wants to see employers taking a greater role in dealing with complaints and helping staff to remediate their actions.
As reported over recent years by Nursing Times, managers have previously been accused of referring nurses to the regulator for performance issues that they should be sorting them out themselves, contributing to a spike in workload facing the regulator.
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“We think that employers are usually in the best position to resolve concerns immediately, and we should only take regulatory action if the concern has already been raised with and investigated by the employer…unless there is an immediate risk to patient safety that we have to deal with,” said the NMC in its draft consultation.
The regulator said it will in the future pass on complaints it receives from the public to employers for them to investigate first. It will also “set out very clearly for employers what we expect from a referral”, which it will expect to be signed off by a senior manager.
The draft proposals will be discussed at an NMC council meeting next week on 28 March. If approved, a consultation will be launched on 3 April and changes would be brought in from 2018-19.