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Audit finds ‘disappointing weaknesses’ in NMC case handling


Weaknesses in evidence gathering, inadequacies in case handling and deficiencies in evaluation have been identified by an audit of the Nursing and Midwifery Council’s performance.

The Professional Standards Authority, which oversees the performance of the NMC, audited 100 cases handled by the NMC and that were closed at the initial stages of the fitness to practise process.

“If the approach taken in these cases was adopted more widely, there would be the potential to adversely affect public confidence in the NMC”

PSA report

The audit took place between July and September 2014 and involved cases during the period 1 January to 31 July 2014.

The PSA acknowledged there had been an “exceptional delay” between the report being published on its findings and the end of the actual onsite audit.

The regulator stated that it was “disappointed” that its audit had identified problems in three key areas of the NMC’s case handling.

It noted “weaknesses in the gathering of information and evidence”, which it had not found in same audit the previous year.

“While we recognise that the inadequacies we identified did not create any public protection risks, nevertheless we consider that it is unacceptable for decision makers not to be provided with relevant evidence,” said the PSA report.

“A pattern of such failings could lead to a loss of confidence in the regulatory process,” it warned.

In addition, the report highlighted “inadequacies” in the handling of six cases and concerns about the operation of the NMC’s process that it considered led to “unfairness” to one or more individuals in a further six.

“We considered that if the approach taken in these cases was adopted more widely, there would be the potential to adversely affect public confidence in the NMC’s system of regulation,” said the PSA.

NMC building in Portland Place

Meanwhile, it also warned of “deficiencies” in the NMC’s evaluation and decision making processes and in some decisions or the reasons for them.

“We have not yet seen sufficient levels of improvement, despite the steps the NMC has taken such as making procedural changes, providing training and staff and amending its guidance,” it said.

The PSA added that it had identified evidence of some improvement in the NMC’s approach to its handling of voluntary removal cases, but concluded that the NMC had “not successfully addressed” all of the concerns identified about the area in the 2013 audit.

The report said: “We have recommended that the NMC reviews our concerns in relation to its handling of cases closed by voluntary removal, and considers whether further amendments to its guidance or processes are needed.”

However, the PSA report did note some positives in comparison to its last audit in 2013.

There were “some areas” where the NMC continued to perform well, such as documenting risk assessments, record keeping and customer care by the screening team.

There were also areas where the NMC had maintained good performance since 2013, although it was not consistent across all of the cases audited – for example, inconsistent compliance with internal procedures and “inconsistent improvement related to timeliness”.

But there were some areas where the PSA said it was unable to identify “much improvement” compared to the 2013 audit.

”We will carefully review all of the audit findings and recommendations and take action to continue to strengthen our FtP process”

NMC spokeswoman

Such areas included record keeping, avoidable delays in case progressing leading to the need to apply to the High Court for interim orders, and inadequacies in the handling of the process for the reviewing of interim orders.

An NMC spokeswoman said: “We are pleased to note that the PSA has identified a number of areas where we have continued to perform well and maintained the good performance they found in their 2013 report.

”We will carefully review all of the audit findings and recommendations and take action to continue to strengthen our fitness to practise process,” she said. ”Many of the cases referred to were concluded almost two years ago.”


Readers' comments (3)

  • Eileen Fegan

    This was a really shocking and disappointing report to read. As an organisation who nurses trust the NMC is tasked with ensuring that standards and levels of nursing care are maintained to a high level This report however, has left thousands of nurses wondering if the NMC is as squeaky clean and professional, as it has always tried to lead us to believe. I was involved in an NMC case 2 years ago and the fear, dread, worry and concern that any involvement with the NMC puts you under, is distressing. To find out that the NMC is itself failing, is frustrating and causes a huge loss of trust in our main body of governance. Where do we go now ?

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  • I agree with all of the above ..Nmc can do better .Nurses has never supported their own Those of us suffering think of this......your values does not decrease based on someones inability to see your worth.

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  • David Dickinson

    Well I am involved in no less than THREE cases all of which have been handled incompetently and ineptly by the NMC. In 2012 the learning disability hospital, Roseberry Park dismissed me two years after I had complained about their abusive extended use of blood-smeared seclusion rooms to "manage wards" (CQC report July 2014 Roseberry Park Hospital). I have 40 years specialist experience from elsewhere and know what I was talking about. The reason given was breaching secluded patients confidentiality by looking at their clinical files. However this is expected in a forensic hospital so was adjusted to "looking for too long". The hospital referred to the NMC citing original and subsequently disproven allegations whose hired solicitor eagerly created a new charge.. "complaining without the abuse victims consent" and "writing my complaint on my laptop". The CQC mounted a special visit to the hospital at the time of my hearing and confirmed everything complained about. They were aware of the NMC fiasco and even rang me with advice! I was found guilty although I had NOT breached confidentiality and had submitted my complaint directly to managers in line with the NMC's Code of Practice section 5.4 and local NHS policy. I was placed on career crushing practice conditions. Three years later still on conditions I desperately needed a post and found myself taking temporary charge of a near empty nursing home that had been severely criticized by the CQC and former staff alike. I found neglect with chronic weight losses poor feeding and hydration and very poor levels of dignity. Along with other former staff I complained to social services and the CQC, even visiting the owner. The manager referred me alleging malicious trivia in the face of my serious complaints. The NMC sent another solicitor back to 'investigate' or rather create a case. Three months later I got a staff nurse job at a MH rehab unit. They were frog-marching distressed residents into bedroom seclusion and after eight weeks I complained and already had positive conduct records but was immediately dismissed and referred for subsequently contrived trivia. The NMC solicitor tampered with conduct records to reverse their highlighted sections by photocopying. The service was told to complete an internal inquiry and they accepted that one support worker should not have corridor marched and inserted the distressed patient into lone bedroom seclusion and they were submitted for additional training. The NMC declared that the internal inquiry had not found anything amiss and that no action was required. It asserted that the marching restraint was planned as "guidance" for patients although the facts are clearly described in the NMC's own evidence. I am a Rampton trained management of violence instructor and frog-marching a patient gripping the back of his neck is abuse. I have countered the charges and am now suspended for 'failing to follow policies and procedures' and for having an 'attitudinal' problem. The NMC has been repeatedly dishonest and I have told them that I reserve the right to speak out in the public interest. My complaints have revealed serious abuses on the parts of services about which the NMC is completely disinterested preferring to spend months and months and thousands of pounds prosecuting lies and trivia that even if true should be of interest to a line manager not a national regulator. NMC fitness to practice has shown itself to be dishonest and incompetent.

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