New legislation changes, designed to speed up fitness-to-practise cases, will only succeed if nurses and midwives accept concerns about their conduct and engage with new rules early on, the head of the regulator has warned.
The changes, which come into force today, include a controversial new measure that will allow the Nursing and Midwifery Council to issue public warnings to registrants who have breached professional standards.
Other new options available to the regulator include agreeing restrictions of practice with registrants – known as undertakings – or, for the least severe cases, issuing private advice to nurses and midwives.
“They [registrants] have to acknowledge there are ongoing issues, there has to be acceptance. That is a very important part of this”
The reforms, brought in under a Section 60 order, will enable case examiners to resolve issues earlier on in the FtP process and will mean the NMC only has to take the most serious cases through to a full hearing.
But the changes will only achieve their aim of speeding up FtP if registrants are willing to accept problems and agree to improve their practice from the outset, said NMC chief executive and registrar Jackie Smith.
She told Nursing Times this was particularly relevant for undertakings – public formal binding agreements between the regulator and the registrant that set conditions of practice for a period of time, such as training or working under supervision.
This will occur where the registrant poses a low-level risk to patients and there is, therefore, a “case to answer”, she said.
“They [registrants] have to acknowledge there are ongoing issues, there has to be acceptance. That is a very important part of this,” she told Nursing Times.
“A warning can be given where they [registrants] don’t necessarily accept the concerns, but it will be for 12 months”
However, Ms Smith acknowledged that warnings could be issued by the regulator without agreement from the registrant - though the nurse would have to have accepted there was a concern about their practice.
Warnings will stay on the registrant’s public record for 12 months and will be given out when there are serious concerns about past conduct, but they are thought to no longer present a risk to the public – meaning there is “no case to answer”.
Currently, if an FtP panel finds there is “no case to answer”, due to the individual no longer posing a risk to patients, there is no public mark on their registration.
Concerns have been raised in recent months that the new system may result in “gratuitous” use of warnings, and that they may disadvantage staff in future employment.
Nursing Times asked Ms Smith whether the new system of warnings represented a tightening of the rules by the regulator.
“I don’t see it as a tightening of rules… it is the regulator putting down a marker, because this is about confidence in the profession, maintaining standards, and the public having that assurance that as a regulator we are maintaining those standards.
“You can go to a full hearing and be given a caution – a warning is similar, but it will be for 12 months. Cautions can last up to five years right now,” said Ms Smith.
She acknowledged that some unions had concerns about the use of warnings, which she expected to be “controversial”, and said there would be a “healthy debate” during the first case.
The NMC later confirmed to Nursing Times that registrants would be able to have their case reviewed “on limited grounds” if they were issued with an undertaking, warning or advice.
“As a regulator, we want registrants to remediate where they can without going to a hearing because there is that agreement, acknowledgment and acceptance there is a concern,” she said.
“And our desire is to really reduce the number of hearings we have,” said Ms Smith, noting the doctors’ regulator the General Medical Council had been operating under the same legislation for over a decade.
Department of Health estimates show the NMC is expected to save around £60m over the next decade due to the legislation changes, which also include a series of other reforms, including relating to midwifery supervision – largely due to fewer costly hearings.
But the NMC chief executive was unable to say how quickly money could be saved and whether that estimation was correct. She noted the regulator spends £20m a year on FtP activities at the moment.
“This is a new process, there are going to be teething problems and people anxious, not sure what it means,” she said. “I do not expect in the first six months to see a radical shift in the number of hearings. It will take longer than that.”