Failings by the Nursing and Midwifery Council have resulted in fitness to practise cases being closed even where this has left the public “at serious risk of harm”, a highly critical audit has revealed.
Investigations of case notes between April 2008 and March 2009 revealed “very poor file and case management, with poor control of delegated decision making and poor practices in gathering and analysing information”.
However, new systems being introduced are expected to raise standards, says the report by the Council for Healthcare Regulatory Excellence, which body that oversees the performance of the NMC and nine other healthcare profession regulators.
The Fitness to Practise Audit Report, due to be published yesterday by the CHRE, sets out a series of issues that the super-regulator believes should continue to be addressed “as a matter of priority”.
This includes the fact that some cases have been closed “without sufficient information to assure the NMC that the registrant is not a risk to patients”.
It also says there was a lack of clear or comprehensive guidance for staff on how to deal with cases and an absence of proper audit trails of who made decisions, when and why. This meant “staff could close a case in which there was a serious risk of harm”.
There were “serious inadequacies in information management” during the period audited, which “undermined the integrity of the casework system”, the report says.
The NMC also provided poor explanations to complainants and others involved in cases.
The audit notes that substantial measures have been taken to address serious problems highlighted in a CHRE report published in June 2008. That report was ordered by former health minister Ben Bradshaw and preceded the resignation of former NMC president Nancy Kirkland.
The NMC’s new computerised casemanagement system came into operation last December. The regulator has also started to address its “seriously deficient” document retention practices.
New caseworker posts have been created, as well as new supervisory roles to provide support and guidance. In January the NMC appointed a quality assurance manager.
However, the regulator has “continued to have administrative difficulties in its new archiving process”.
The report suggests a series of recommendations for further work. For example, the NMC should develop detailed guidance on the criteria to use in reaching decisions and how to gather and assess information.
In particular, it must review how it handles information, such as drink driving convictions, which may suggest registrants have a substance misuse problem. This will involve an exploration of “whether there is a need to seek medical examinations of registrants in more cases.”
Staff also need to have access to expert advice on acceptable nursing and midwifery practice, the audit says.
An NMC spokeswoman said: “This covers a period up to March 2009 and raises issues which have already been covered in the CHRE Special report to the minister in 2008.
“Since March 2009 we have made a number of significant improvements to our fitness to practise systems. These have included the introduction of an electronic case management system, decreasing the length of time between receiving an initial complaint to a hearing taking place and significantly reducing the backlog of cases.”
The average amount of time cases take to progress through the regulator’s fitness to practise process has dropped from 20.3 months in April last year to 13.1 months. This means 68.4 per cent of cases are now being completed within 15 months.
The spokeswoman added: “We are not complacent, however, and have a number of programmes in place to further improve our service in fitness to practise. We believe that future audits and performance reviews will demonstrate the progress we have made”.
Failings identified by the CHRE:
- Closure of some cases without sufficient information to assure the NMC that the registrant is not a risk to patients
- A lack of clear or comprehensive written guidance and procedures for staff and investigating committee members on how to deal with cases
- A lack of formal systems for gaining advice on appropriate nursing and midwifery practice
- Poorly defined guidance to staff on powers to close cases
- Poor explanations given to complainants and others involved
- Lack of proper audit trails of who made decisions, when and why