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”
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”
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.”