The outgoing chief executive and registrar of the Nursing and Midwifery Council has said it is “absolutely essential” for the regulator to take more account of registrant views during cases.
In an interview with Nursing Times, Jackie Smith agreed that the NMC must do more to listen to the views of registrants “on the receiving end” of fitness to practise cases.
Her comments followed the NMC’s latest council meeting on Wednesday, which largely focused on the way it handled fitness to practise cases linked to the Morecambe Bay maternity scandal.
During the meeting NMC council members expressed their “shock”, “sadness” and “shame” at the failures identified last month in the Professional Standards Authority’s Lessons Learned report.
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Key failings identified by the PSA included the fact that the NMC did not listen to families or treat them with respect. NMC chair Philip Graf opened the meeting with an apology to the families.
“Today was quite rightly about the families – there was no other approach that was acceptable and did justice to them,” said Ms Smith in relation to those affected by the scandal at Furness Hospital.
“In fitness to practise, if we take too long, if it is very adversarial”
However, she acknowledged that fitness to practise cases could often be “extremely distressing” all round and affected the lives of both complainants and the nurse or midwife concerned.
“In fitness to practise, if we take too long, if it is very adversarial, if we don’t listen to people, it is extremely distressing,” she noted.
“It doesn’t matter whether you are making the complaint or on the receiving end of it, it is really difficult and it affects people’s lives,” she told Nursing Times.
“I have said that right throughout my time as chief exec. Here and now, it is more important than ever, which is why we launched the FtP strategy,” she said, highlighting work underway in the area. There have got to be better ways of dealing with this than taking everyone to a hearing.
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“We want to encourage registrants to engage with us early on so they can admit they made mistakes, remediate from those and then carry on practising where appropriate,” she said. “It is absolutely essential that we take account of the views of registrants as well.”
When it came to the mental health and emotional needs of people involved in FtP cases, she highlighted that the NMC’s new Public Support Service and existing Witness Liaison team were in place to support families and those giving evidence.
Meanwhile, she said some work was being done by the NMC’s fitness to practise department to look at the NMC’s role in supporting registrants specifically when it came to the mental health of those going through the FtP process.
“I think the organisation has taken a hit, but I think it absolutely can recover”
On improving early intervention, one idea raised this week at the council meeting was the idea of staging some form of “risk summit” at organisations where there were warning signs of poor practice, which would look at the views of families, staff and others.
“It is an interesting idea. What they’re saying is if you deal with things at the outset, they don’t become the monster they are by the time they come to us,” said Ms Smith.
She highlighted that making such an idea work was a question of solving the “challenges and practicalities” around setting it up.
She said: “How do we get employers to support it, get registrants to support and get patients and the public to support it? What is our role in it at that point, and whatever we say and do then – does that affect things later on?
“So, I think there are complications but we shouldn’t dismiss it out of hand, because I think it is a really interesting idea,” she said.
During the meeting, Helen Shallow had claimed the NMC owed midwives and nurses, as well as the families, an apology over the way it handled fitness to practise cases linked to the Morecambe Bay maternity scandal.
Meanwhile, Ms Smith, who leaves the NMC on 31 July, confirmed there would be an interim chief executive following her departure and the process of finding a permanent replacement was likely to start later this month.
“Finding a permanent chief executive takes some time so there will be something of a hiatus and it is about making sure we keep business going during that period,” she said.
She added that she remained “extremely proud” of what she had achieved in her six and half years at the NMC. “I think the organisation has come a long way though there are always things we can do better,” she said.
“Today was a salutary lesson about the stuff we need to do better,” she said. “My bit of advice to anyone coming in here is – don’t do it unless you are really passionate about making a difference to nurses, midwives, patients and the public.”
But Ms Smith said she had “absolutely no doubt” the NMC would be able to move on from the PSA’s critical report and continue to improve.
“I have absolutely no doubt the organisation will recover its reputation, get over this and move on. The reason for that is because the people round the table today were absolutely passionately committed to learning the lessons,” she told Nursing Times.
She also referred to the PSA’s report on the NMC’s performance during 2016-17, which was published earlier this week. “The other thing is – as the PSA said themselves on Monday – we are meeting 23 of the 24 standards so we are not talking about an organisation that is broken.
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“A lot of what was spoken about today was about our behaviour and responses some time ago but that doesn’t mean to say that we shouldn’t build on the progress that we have made and make sure we don’t get complacent,” she said.
“I think the organisation has taken a hit, but I think it absolutely can recover because it is in a good place,” she added.
NMC officials promised more detail on the NMC’s response to the Lessons Learned review at the next NMC council meeting in July, including plans to review and update its complaints policies and update guidance for staff to ensure the organisation was “as open as transparent as we can be”.