The Nursing and Midwifery Council has launched a consultation on proposals to change its rules governing fitness to practise processes, which it says will speed up its handling of cases while maintaining public protection.
For a number of years the NMC has been seeking to make changes that would allow it to make decisions faster and agree undertakings with nurses who accept their practise may be impaired, without the need to hold an expensive hearing – but until now has been frustrated by parliamentary procedure.
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The new proposals state that case examiners – who assess evidence from investigations into registrants’ practice to decide if they should be reviewed by a hearing panel – should be given a number of new powers to conclude some cases instead of referring them on to a full hearing.
“[These] new powers [will allow us] to resolve some less contentious matters more simply and quickly”
The NMC said the proposals would ensure the final adjudications process was only reserved for “the most serious cases and those where there is an actual dispute over what happened”.
The new powers would allow case examiners to come to an agreement with nurses or midwives whose practice indicates they are a low-level risk to patients so that they can return to work as long as they comply with certain measures or restrictions.
This process is known as an “undertaking” and measures could include retraining or working under supervision, according to the proposals, which also suggest the fact a registrant is subject to restrictions should be made publically available on the NMC register.
“Undertakings may be appropriate for cases where the concerns include repeated failings in specific areas of practice, or health conditions which are serious enough to affect the ability of a nurse or midwife to provide safe care,” said the NMC’s consultation document.
The regulator noted that undertakings would not be recommended where “the concerns are so serious there is a real prospect of a panel imposing a striking off order”.
“It currently takes too long and costs too much to conclude cases”
It added that it would monitor compliance with undertakings so case examiners could decide whether they needed to be altered and when they could be lifted.
If registrants failed to comply with undertakings, case examiners should have the power to send the original allegation to a hearing panel, said the proposals.
Meanwhile, according to the NMC, in instances where registrants did not pose a current risk to patients and concerns about their past conduct were not serious enough to require the strongest sanctions, case examiners should be able to issue warnings.
The warning would be a public declaration by the NMC that the registrants’ past conduct represented a serious breach of professional standards and the NMC code of conduct, and would stay on their record for 12 months.
Currently, case examiners are always required to refer such cases onto a full hearing because there is no way to mark their concerns publically.
Lastly, the NMC has proposed that if case examiners decide there is no case to answer – meaning they believe that either the facts of the allegation could not be proved, or that it would not lead to a conclusion that the registrant’s fitness to practise is currently impaired – they should be able to provide advice to nurses and midwives.
The advice, which would not be made public, would “remind nurses and midwives to reflect on their professional obligations and areas of the code that are relevant to the concerns that were investigated”, said the NMC.
“Advice may be suitable for concerns that amount to a minor breach of professional standards under the code,” said the regulator in its consultation document.
It stressed that both warnings and advice would not be used in instances where the nurse or midwife disputed the incident that caused the concern.
Nt editorial jackie smith
NMC chief executive and registrar Jackie Smith said: “I have maintained for a long time that our current legislation is outdated and in need of major reform. We know, and accept that it currently takes too long and costs too much to conclude cases.
“The launch of this consultation is a crucial step towards modernising our processes, which will better enable us to protect the public,” she said.
The NMC’s consultation is open until 19 December and follows a separate consultation by the Department of Health over the summer, which looked at changes to the NMC’s wider legislation, including the regulations surrounding fitness to practise.
“We have worked closely with the Department of Health on these proposed changes which will allow us to develop a more proportionate approach to cases, with new powers to resolve some less contentious matters more simply and quickly, taking only the most serious cases to a full hearing,” added Ms Smith.
The consultation launch follows positive words from the health secretary regarding the reform of the professional regulators.
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In a recent interview, Jeremy Hunt criticised the regulators for the speed they dealt with issues brought to their attention, but accepted that the government had so far failed to find parliamentary time to make changes necessary to help improve the situation.
Following the 2013 Francis report into poor care at Mid Staffordshire, former prime minister David Cameron pledged to “sweep away the Nursing and Midwifery Council’s outdated and inflexible decision making processes”.