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NMC launches raft of new fitness to practise procedures

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The nursing and midwifery regulator has begun introducing a new approach to fitness to practise, which it believes could result in up to 20% fewer cases going to a full public hearing.

It hopes the new arrangements will help to eradicate the “blame culture” in the health and care system and improve patient safety by encouraging staff to be honest when problems arise.  

“This is the best way for nurses to learn from mistakes and prevent them from happening again”

Matthew McClelland

Under the overhaul, nurses and midwives subject to a complaint may not have their practice restricted if they can show they have learnt from their mistake and are safe to continue working.

The Nursing and Midwifery Council has said it wants more cases to dealt with behind closed doors. Currently, around 80% of cases that require adjudication go to a hearing held in public in front of a panel in which witnesses are called.

While no fixed targets have been set, Matthew McClelland, director of fitness to practise at the NMC, told Nursing Times that studies had suggested around 10-20% of these cases could be diverted private meetings, or “hearings on the papers”, in 2019-20.

In these meetings, decisions are still made in the same way but all evidence is submitted via writing.

Addressing concerns previously raised about future transparency, Mr McClelland said the results of all cases that required adjudication would continue to be published on the NMC website, whether they were held in private or public.

Mr McClelland said going through a full fitness to practise hearing had an “enormous impact” on all those involved and was often a “complex” and “expensive” process.

In addition, the regulator wants more complaints to be dealt with in-house by employers and it will be offering them more guidance on when to refer cases.

“There’s no reason for us to get involved in something if an employer knows what the issues are and is working with the nurse and midwife to put things right,” Mr McClelland said.

Acknowledging the daily pressures and challenges facing the UK’s health and care workforce, the NMC has also vowed to take greater account of the “context” in which an incident occurs,

From now on, Mr McClelland said the NMC would only restrict people’s practice if “that is the only way to guarantee public safety” and it would instead focus on helping to drive improvements.

“For a long time in healthcare, there’s been a tendency to focus on blame and punishment when things go wrong”

Matthew McClelland

The regulator has shaped its new procedures using views from a public consultation it held about its fitness to practise regime.

More than nine out of 10 respondents, including members of the public, nurses and midwives and other health professionals, agreed that encouraging staff to learn from mistakes would improve the process.

Mr McClelland said: “For a long time in healthcare, there’s been a tendency to focus on blame and punishment when things go wrong. But we know that this can mean nurses and midwives are less likely to be open about what happened.

“Our new approach puts people at the heart of what we do and encourages a culture of openness and honesty. This is the best way for nurses, midwives and the wider health and care system to learn from mistakes and prevent them from happening again,” he said.

He added: “If we can get to a culture where people are willing to be open about what’s gone wrong that helps patient safety.”

The regulator will also be providing improved support and information to patients and members of the public making complaints as part of its ambition to take a new “person-centred approach” to fitness to practise.

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