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Nurses must accept concerns earlier to quicken FtP, says NMC chief


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”

Jackie Smith 

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”

Jackie Smith

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.

Jackie Smith

Jackie Smith

Jackie Smith

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.” 


Readers' comments (18)

  • Now it is evident that the NMC has absolute privilege under law. So as far as I can understand it. A complainant can report you for anything even providing deliberate falsehoods.
    As a nurse 1. you have to acknowledge these complaints as factual 2. even if you prove them to be false you cannot prove defamation
    This is my answer
    1.The law must change to provide much more protection for nurses from malicious complaint
    2. until that happens en masse we should refuse payment of our fees to this awful persecutory body

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  • I complained in 2010 about a forensic hospital that had for years been secluding patients as routine management for pitifully minor behavioural infringements. It even secluded calm patients to enable staff meal breaks. The hospital immediately suspended me then conducted a fake internal investigation in 2011 following my meeting with the trust CEO who ordered it. The ‘data based’ internal investigation not surprisingly declared its seclusion practices as 'lawful'. Subsequent local CQC and LA Safeguarding ‘investigations’ were equally useless declaring 'nothing to be found'. I was the 'fired' in 2012 for having legitimately accessed the 2010 seclusion victims clinical file which was held to be confidential to her specific ward (nonsence). On appeal this was reluctantly changed to accessing the file for too long or “excessive time-volume” nevertheless still held as ‘gross misconduct’. I was promptly referred to the NMC who hired a solicitor from their contracted 'firm' to return to the hospital and who then spent 2013 cobbling together a case that merely resurrected the initial rubbish that the hospital was previously forced to drop. I was 'convicted' in February 2014 on all counts of course and moreover of breaching the 2010 seclusion victims 'confidentiality' and placed on exacting 'practice conditions' whereby I remained on permanent surveillance thus alerting any employer for good or ill to know that the NMC remained poised as a certain ally on the end of a phone line. During 2013 I continued pestering national CQC with my seclusion complaints and finally a level 2 investigation was ordered. A month after my NMC conviction in March 2014 the CQC mounted a special three-day seclusion-focussed 'raid' of the hospital (Roseberry Park, Middlesbrough) and found everything that I’d complained about i.e calm innocent patients locked into un-time-limited seclusion whilst not knowing why they were there coupled with hopelessly inadequate policies and paperwork. Ironically the authors of the original internal seclusion investigation, i.e. the manager who fired me and the consultant who had ordered the original 2010 seclusion of the girl were given responsibility to head up the hospitals six month turn-around programme! (cf CQC report July 2014 Roseberry Park Hospital). The lead inspector who planned and led the three day ‘raid’ happened to hear about my case and rang me in May 2015. He thanked me for persisting at national level and explained that he had nothing to do with ‘local’ CQC inspectors original visits. I told him about the NMC case and was helpfully advised to "find a good lawyer". Three months before the call I had secured a short term job temporarily managing a nursing home whilst the manager had back surgery. I took it because I urgently needed the cash and my 'conditions' severely impeded my choices. It quickly turned out the worst I had ever seen for various reasons but crucially it appeared on friendly terms with the local CQC. The last accurate CQC report was November 2013 from an outside inspector before being handed back to usual friends. Indeed, two recently appointed cooks walked out the day I started having previously written to the owner and authorities with no action taken. In fact one complaint was immediately sent back to the manager by the current local CQC inspector with "Hi XXXX take a look at this and get back, bye!" The manager handed it around the dining room for all to read. I did what I could, complaining on her return, then walked". I was immediately referred back to the NMC who dispatched yet another solicitor who concocted along with a bunch of rogue 'carers' six unrelated allegations immediately brought by the NMC as charges and for which I was promptly struck off last August. I sat incredulously in the hearing room in August 2016 not knowing whether to explode with anger or simply to laugh as all six charges were declared 'proven' in turn. I had nothing left so published an anonymised photograph I'd carefully taken at the home of one elderly lady receiving toileting care sitting in her wheelchair with the carer typically wearing no protective equipment with door typically wide open along with some key data facts about recent death-clusters in respect of non-specific infections, and mentions of earlier written complaints in relation to poor basic hygiene, various accounts both personal and recorded of bad practices and concurrent chronic weight losses that I had managed to stop and even reverse in one case by +6.5% during the short five weeks I was there. (One allegation was that I fed this resident in a 'headlock'. I was using Zeiler & Jervey style prompting and fading which I legitimately demonstrated and taught to staff). I promptly received a referral to the DBS relating to this photograph and the legitimate accessing the original seclusion girls file in 2010 but whose lawyers have created a similarly hard worked all-round case with acres of barely relevant but effectively confusing paperwork in order to ‘shuffle’ me through as posing a global threat to the ‘confidentiality’ of vulnerable adults and children complete with a 10 year ban thus completing a comprehensive professional discrediting to any remaining threat that my truths might pose to the NMC. My unstructured observations of the NMC made as an ENB705-trained nurse behaviour-therapist tells me that the NMC represents a circus of lawyers and attached careerists whose single apparent purpose whether directed or not is merely to 'successfully prosecute' cases by whatever means. I know for a fact that there are barristers who refuse to prosecute because of the NMC's poor prosecution standards. Under the personal and professional limitations of its current senior management the NMC has simply lost its former UKCC common-sense and, it has to be said (given some of the eye-watering and blatantly corrupt prosecution offerings) its former UKCC common decency. I fear that Jackie Smith's hypnotherapy diploma skills have merely resulted in self-hypnosis. She believes her own drivel. Replace her with a competent properly qualified nurse like Vesanta Suddock.

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  • Above anonymous
    You have clearly been subjected to an intolerable level of harassment and bullying from a variety of organisations and I detect the result of hyper vigilance in the details you provide.
    All nurses( and where the RCN is in this appears to be on the side of the NMC ) should be very disturbed and concerned at the antics of this awful organisation. one way of attacking it is a mass refusal to pay our fees to it.
    I would like to know the following regarding Jackie Smith
    1. what level law degree did she obtain
    2. Sigma 6 ,what a load of old cobblers what use is that?
    3 a diploma in hypnotherapy, well yes ,us nurses are governed by evidence based practice. This obviously does not apply to Jackie Smith

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  • I was referred to the NMC maliciously
    After 9 months it was finally decided that I had no case to answer.
    It was demonstrated that falsehoods had been presented against me.
    I attempted to refer my referrer(who was my manager at the time protecting her own worthlessness) to the NMC for presenting falsehoods.
    Nothing came of this as it could not be proven that it was deliberate.
    Basically someone can tell lies about you and you have to answer for them.
    What the NMC wants now to speed things up is for a referred nurse to admit guilt and get a warning to save them the effort of proving guilt (which of course most of the time they cannot because the referred nurse is guilty of nothing). All this to save money.
    I can tell them how to save money.
    1. cut the CEO's pay by half (perhaps she can hypnotise herself into thinking shes had a pay rise).
    2. stop these second rate legalists getting their snouts in the trough
    3. change the law so that malicious, false referrals can themselves be charged.That will cut down referrals massively if they know they can be penalised.

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  • I too was referred maliciously and endured a 9 month investigation, after which I was informed there was no case to answer. To add insult to injury, the NMC asked me the following year to be a witness at a tribunal for the individual who had referred me! He received a 5 year sanction. My referral of him for maliciously pursuing me to the point of threatening ex colleagues with referral themselves and blackmail fell on deaf ears. They said whilst unpleasant, it did not constitute a threat to the public and to contact police if he did it again. Apparently, nurses do not count as members of the public and 9 months of stress and having my name and reputation blackened in a vain attempt to conceal his own actions did not count either.
    The NMC is a shameful organization.

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  • Presumably if the nurse refuses to accept there is a problem, they have to investigate. As I read it, they can only issue a warning if the nurse admits there is an issue. The answer is - don't admit anything, ask for a full and frank investigation and get a solicitor.

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  • It sounds as though the Spanish inquisition would have been no match for the NMC, all of the above cases sound like witch trials. No wonder morale in the NHS is at rock bottom when staff seem to be encouraged to denounce their colleagues like Nazis. People who want to make trouble for someone they dislike/have a grudge against/are jealous of, will file a complaint because they can with impunity.

    Time and again commentators say nurses should stop paying the NMCs excessive subs which are used to persecute their colleagues, but they won't, will they? They're all too scared of victimisation to step out of line, they can't organise themselves and they don't support a colleague in trouble - and this is what a bullying organisation like the NMC relies on.

    Where is this petition? I'll sign it, and while you're at it, why don't you start one for the abolition of the NMC?

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  • (1) - The NMC CEO alleges that the regulator spends £20m a year on FtP activities at the moment..... HMMM ???? I believe this figure was relating to 2009-2010.....The FtP NMC annual accounts reports 2015, 2016, 2017 confirms a key driver of an increase in expenditure related to Fitness to Practise to £66.4 million in 2016–2017 (£58 million in 2015–2016).................. I may be wrong but I cannot find any figures alleging “£20m at the moment” or since 2010..............It would seem that the Department of Health/NMC are more focused on financial expenditure rather than exploring innocence of the registrants.

    (2) - Ms Smith acknowledged that warnings could be issued by the regulator without agreement from the registrant..........BUT.......... then alleges that registrants would be able to have their case reviewed “on limited grounds” if they were issued with an undertaking, warning or advice. So the NMC are breaching Article 6 (right to a fair trial/hearing) & article 8 (reputation) of HRA 1998 by precluding the registrant to a full hearing. Yet again, the registrant inadvertently has to accept undertakings, warnings without any type of trial, am I correct? And innocent registrants are publicly berated, am I correct?

    (3) - So under the NMC Rules Order 2001 & 2004, there is no way of challenging such decisions at the Administrative High Courts which can be done if struck-off or served with an interim/suspension order.

    (4) - HOWEVER, I wonder if the NMC could be challenged via a Judicial review such as Johnson & Maggs v Nursing and Midwifery Council [2013] EWHC 2140 (Admin) - “Because no action was taken by the NMC in respect of their registration, the usual right of statutory appeal was not open to the registrants. However, as the registrants were nevertheless left with findings of misconduct against them, they challenged the decision by way of judicial review. (Human Rights Act – Article 6 as it took 8 years)......Accordingly Mr Justice Leggatt could not accept that the evidence adduced by the Committee could support its findings of misconduct and therefore could not see how the Committee could reasonably have found the charges against the registrants proved.  The findings of misconduct against the registrants were therefore quashed”............Maggs & Johnson had 1 year to challenge this


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