The Nursing and Midwifery Council has continued to meet nearly all of its core standards but there are still concerns over the way it handles some aspects of fitness to practise cases.
The latest annual performance review of the NMC found it had achieved 23 out of 24 key standards for good regulation – the same number as last year.
“We identified a number of concerns about the way in which the NMC dealt with families”
The review findings were published today by the Professional Standards Authority for Health and Social Care (PSA), which oversees the work of professional regulators.
However, it found the NMC had failed when it came to the way it supported complainants, an issue recently thrown into the spotlight by an investigation into the regulator’s handling of FtP cases linked to the Morecambe Bay maternity scandal.
Key concerns, which were spelt out in a separate Lessons Learned review published last month, included the way the NMC dealt with patients and relatives involved in FtP cases, after the PSA found bereaved families were not taken seriously or treated with respect.
Meanwhile, communication was described by the review as often “sporadic and confusing” and the information available was poor.
“We identified a number of concerns about the way in which the NMC dealt with families which are ongoing and apply beyond the relatively small number of cases that we looked at as part of the review,” said the PSA in its report on the NMC’s performance during 2016-17, which was delayed to take into account the Lessons Learned findings.
As a result, the PSA said it “cannot be satisfied” that the NMC met the standard to ensure all parties in FtP cases were kept updated and were supported to participate effectively.
“The issue has significant implications for the fairness of the fitness to practise process”
However, it said it hoped that a new Public Support Service currently in the process of being set up by the NMC would lead to change.
Overall, it found improvements in the handling of FtP cases, including “some positive developments in timeliness”, but noted there were some ongoing issues.
While the PSA found the NMC was generally meeting the core standard around fairness and transparency, it voiced concerns about a small minority of cases.
This included failure to ensure all panels making decisions at final FtP hearings were aware of the views or personal circumstances of the nurse or midwife concerned – which could go some way to explaining or mitigating potential misconduct – due to admin errors.
“Last year we highlighted the NMC’s failure to provide panels at final fitness to practise hearings with representations by registrants in five cases (two of which were linked) as a result of administration errors,” said the report.
“This year similar failings have been identified in four cases,” it said. “We accept that this is a very small proportion of the NMC’s caseload. However, we remain of the view that the issue has significant implications for the fairness of the fitness to practise process.”
It said the NMC should review the circumstances that had led to the errors to ensure they did not happen again.
“In the last year we’ve been working hard to protect the public, and this has been recognised today”
Last year, the PSA found the NMC had failed to ensure FtP cases were dealt with as swiftly as reasonably possible and expressed concern that a backlog of cases was building up.
However, it found there had been improvements since then and the nursing regulator was now meeting this core standard.
This progress included an improvement in the proportion of final hearings that were only half-finished. While the proportion of adjournments remained stable at 6%, the number of part-heard hearings reduced from 19% in 2014-15 to 14% in 2016-17, the report shows.
“The proportion of hearings running part-hard has been a concern over a number of years and the reduction this year is to be welcomed,” said the report.
The PSA also found the NMC had significantly reduced the number of older cases it was dealing with. At the end of 2015-16, the NMC was dealing with 1,437 cases that were over a year old but this had dropped to 1,170 in 2016-17.
“The available data on timeliness in fitness to practise indicates that the concern expressed in our last performance review that a backlog of cases may be developing has not been borne out,” said the report.
There was a slight improvement in the average time taken from the NMC receiving a case to the investigating committee or case examiners deciding whether or not there was a case to answer – although this was still nearly a year at 51 weeks.
Data provided by the NMC showed that, in the period from April 2016 to March 2017, the shortest time taken to get to a case to answer was seven weeks, while the longest case took 401 weeks – nearly eight years.
The official timescale for getting to a case-to-answer decision was 52 weeks, but this was due to be reduced to 39 weeks in December 2017.
Meanwhile, the report showed that the time taken to get to a final hearing increased slightly from 83 weeks to 87 weeks in 2016-17.
“This remains low by comparison to other similar sized regulators,” said the report, which nevertheless said the situation should be “monitored closely”.
NMC data shows the shortest amount of time taken was 25 weeks, while the longest was 395 weeks – more than seven and a half years.
While the NMC achieved all four key standards for registration, the report revealed hundreds of nurses may have accidentally let their registration lapse because the regulator failed to send out a final reminder email.
The report also showed the number of registration appeals has more than doubled since 2013-14, from 51 to 105, with half being upheld.
However, the report found the NMC was meeting its deadlines for processing registration applications from nurses from the UK and Europe.
The report also found work to develop new standards for nurse training and education were on track and concluded that “revalidation has been successfully implemented in its first year”.
Other key developments flagged up in the report included that the NMC had agreed to take on regulation of the new nursing associate role and embarked on a two-year programme to ensure it was ready to register the first associates in 2019.
The PSA said it was pleased with its findings, although it stressed it had not looked at all the NMC’s processes this time round.
NMC chief executive and registrar Jackie Smith, who is due to step down at the end of next month, said the report reflected the regulator’s hard work over the past year, as well as ongoing challenges.
“In the last year we’ve been working hard to protect the public, and this has been recognised today,” she said.
“But the report identifies that we need to improve the way we support those going through fitness to practise cases, echoing the findings of the PSA’s Lessons Learned review,” she said.
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“We take the findings of both of these reviews extremely seriously. In recent years we have made significant improvements to the way we work but we know that there’s much more to do,” noted Ms Smith.
In particular, she said the NMC was “committed to reaching out to the families who have lost loved ones or suffered in other ways in the Morecambe Bay cases”.
Ms Smith said this commitment was illustrated by the fact the Lessons Learned review will be the focus of the NMC council’s next meeting tomorrow.
“We will continue to build on the work of recent years as we change and improve to better support those involved in FtP cases,” she added.