The Nursing and Midwifery Council has made “significant improvements” in its performance in the past year but has been told by the body that oversees it to speed up its handling of fitness to practise cases, especially in light of the “unacceptable” delay to those related to Morecambe Bay midwives.
This year’s assessment by the Professional Standards Authority found the NMC had met 23 of the 24 core standards relating to guidance, education, registration, and fitness to practise. In last year’s review it only achieved 19 out of 24.
“We are concerned by evidence of developing delays to case progression at both its initial and final stages”
Professional Standards Authority
After reviewing all areas of the NMC’s work in 2015-16, the PSA said it still needed to tackle delays at several stages of the FtP process.
“We are concerned by evidence of developing delays to case progression at both its initial and final stages.
“Continued delays in investigating cases, combined with the NMC’s failure to schedule a consistently high proportion of final hearings with sufficient time to enable them to conclude, has the potential to cause a backlog of cases awaiting conclusion,” it said.
“Such delays can lead to a loss of public confidence in the fitness to practise process,” it added.
“The events giving rise to these [Morecambe Bay midwife] hearings took place in 2008 and the delay in bringing them to a final conclusion is unacceptable”
Professional Standards Authority
The PSA noted that the NMC had only just begun FtP hearings against midwives from the University Hospitals of Morecambe Bay NHS Foundation Trust, despite the incidents having taken place around eight years ago.
“The events giving rise to these hearings took place in 2008 and the delay in bringing them to a final conclusion is unacceptable,” it said.
The PSA said that, while it recognised inquests and police investigations will cause delays, “there might have been opportunities for the NMC to consider whether to re-visit these cases at an earlier stage”.
It said it had also received “concerning feedback” relating to the treatment of witnesses who were the parents of a baby who died nine days after being born at the trust’s Furness General Hospital in November 2008.
University Hospitals of Morecambe Bay Foundation Trust
A failure in communication meant the matters discussed with the witnesses prior to them giving evidence against two midwives were not adequately understood by those in the hearing room, said the PSA.
“As a result, some matters were not managed with due sensitivity during the hearing, causing the witnesses a great deal of unnecessary additional distress,” it said.
In its report, the PSA later said it would be appropriate for the NMC to review its management of two of the cases the body had concerns about.
Earlier this month, the NMC said it would carry out an assessment of lessons it could learn from its involvement in investigations into care failings at the trust that led to the deaths of several babies.
However, in a year that saw the introduction of revalidation, the start of a review of pre-registration nurse education, and changes to European law, the PSA also found several improvements across the other standards the NMC is expected to meet.
The PSA noted the NMC’s joint guidance with the General Medical Council on the duty of candour, and the information it produced for European nurses about new laws that may require them to take an English language test before joining the register.
It also highlighted the NMC’s removal of time limits for completing degrees and its ongoing review of pre-registration nurse education standards.
While the PSA said it received third-party feedback from two organisations stating the NMC’s post registration standards were outdated and required review, the body said it would “monitor action taken to update [them] in the future”.
There were delays to the NMC’s processing of registrations at the start of 2016 due to a significant increase in applications from European Union nurses prior to the introduction of language testing, noted the PSA.
“Significant improvements have been made to our fitness to practise function this year”
But it said it was aware the NMC was now developing forecasting tools to improve all areas of its registration activity and to better predict changes in demand.
Meanwhile, positive feedback had been received about the NMC’s engagement with stakeholders ahead of introducing revalidation, said the body.
Last year the PSA was concerned about the lack of information about the cost and benefits of revalidation, but this year it noted an independent review had taken place to address this.
While concerns had also previously been raised by the PSA about the “one size fits all” model for revalidation, it said it was aware that the impact of the new system would be formally assessed by the NMC.
“We would expect that any problems experienced by particular registrant groups should be identified through that process,” it said.
NMC chief executive and registrar Jackie Smith said: “This is our most successful PSA review to date. It is pleasing to see that the report recognises all that has been achieved this year, including the introduction of revalidation, which has proved very successful.
“Significant improvements have been made to our fitness to practise function this year with further improvements planned over the coming year,” she said.
“I recognise there is still more work to be done in order to meet all of the standards in the future. We are committed to a programme of work to improve the timeliness of the FtP process through changes to our existing legislation, meaning that we will be able to conclude cases earlier in the process,” she added.