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NMC advised to take into account system failure in FtP cases


The Nursing and Midwifery Council should consider the wider context that nurses are working within when assessing their fitness to practise, according to Robert Francis QC.

Regulators need to take into account the systematic failures that could have contributed to errors by individual clinicians, said the former chair of the inquiry in care failings into Mid Staffordshire Foundation Trust.  

Sir Robert said “quite a lot” of professional conduct cases were “symptomatic of some system failure,” a factor that he considered was not usually addressed in the disciplinary process.

“I’m not sure we currently capture system failures in our disciplinary process for nurses and doctors”

Robert Francis

If system failures were taken into consideration some cases would not proceed to a full hearing, said Sir Robert, who is currently chairing a inquiry into whistleblowing for the government.

“Even if they did, they would proceed with an understanding of the context in which the practitioner is performing, which must – I thought – always be relevant,” he said.

He added: “I’m not sure we currently capture [system failures] in our disciplinary process and the reason for that is that the professional discipline is currently a rather binary process.

“There is an allegation about the professional and the regulator reacts by investigating that professional, when actually something wider might need to be taken into account,” he said.

Sir Robert was speaking at the launch of draft joint guidance by the NMC and the General Medical Council on the responsibility of individual staff to be honest with patients, colleagues and employers when a mistake is made.

The joint proposals on the so-called “duty of candour” for each healthcare worker include guidelines around apologising to patients and learning from errors so as to avoid similar problems in the future.

Sir Robert urged senior nurses, doctors and managers to encourage their staff to speak up when mistakes occurred and said those that voiced concerns should be praised and valued.

The introduction of a legal duty of candour on both individuals and NHS organisations was recommended by Sir Robert in his report on Mid Staffs in February 2013.

However, the government agreed to introduce a legal duty on organisations, but not on individuals, instead asking regulators to build on existing requirements for candour in professional codes.

The NMC and GMC joint guidance is open for consultation until 5 January 2015.


Readers' comments (14)

  • Surely, surely, surely context must be considered in all disciplinary cases. How can it not be so? Anybody worth their salt would consider context. Surely, it does not take a QC to remind us?

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  • michael stone

    I do like Sir Robert - he explains issues very clearly, which is more than I can say for a lot of people !

    'He added: “I’m not sure we currently capture [system failures] in our disciplinary process and the reason for that is that the professional discipline is currently a rather binary process.

    “There is an allegation about the professional and the regulator reacts by investigating that professional, when actually something wider might need to be taken into account,” he said.'

    QUITE ! Although I think he could have expressed the point, without using the word 'binary', which is rather 'jargon-like'.

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  • Well said Sir Robert! We should also consider the impact of work based stress on behaviors as well as clinical performance... The number of NMC cases I see where a clinician has behaved inappropriately where the person under investigation is treated as being 'of bad char actor' is ridiculous. People under extreme stress can become withdraws, or aggressive, can self medicate.... its a symptom of the environment NOT of the individual. It needs to be treated through appropriate counselling and therapy. Instead the NMC takes people out of practice for years and puts them under further stress! No wonder staff are leaving in droves!

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  • I tell you what, I reckon that once a few Trusts get some home truths about their own systems and processes that have contributed to getting Registrants into bother the number of referrals to the NMC by employers will drop.

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  • What is the NMC? It is an private company whose players are put in place by politicians (Privy Council) It appears their main aim is to extract £120 a year from 670,000 every year. They are an ad hoc bunch of shape shifters who are professional non execs from various areas i.e Nat Archives, Lottery, Life skills teacher et al some with MBA All controlled by the Government
    The NMC should be associated with the NHS or be a separate Government dept
    They claim to protect the public but where is their evidence. All their cases are post event. Some are ridiculous some so serious and should be police matter. Most of the nurses who end up in front of the NMC are guilty before they even get there. Just look at the cases over the last year
    Recently a midwife caused the death of a mother and baby through neglect but using a high powered barrister (possibly with connections) who was able to fight her case got 3 months supervision. Others are struck off for far, far less.
    I have been a whistle blower for 24 years and have experienced many times the hell we go through for protecting our patients.
    The NMC needs to be disbanded and reformed with health professionals the same as other professional bodies.
    How many non execs are on the GMC? They would balk at the thought of a non professional judging them. How many non professional are on council of SoB or Pharmacists, Physio
    The NMC is not fit for purpose and should go
    Nurses could then trust them

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  • Absolutely agree !

    Get many Directors of Nursing to explain the "context" in which they expect the junior slaves to provide "excellent" care" whilst being understaffed and unsupported.

    Poor care originates from the Top! Lets clean it up .

    Report these "Directors" for their failings.

    A few "struck off" may persuade others to change their behavior toward "junior" colleagues.

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  • For me the crucial thing is that Francis is SAYING this. If mid-Staff's was a watershed in healthcare and it was Francis' job to establish what went wrong and if all I've been hearing about in the media subsequently is that mostly it was a problem with (largely) nursing ("and thus" nurses), the regulators will of course seek to scrutinise nurses and certain other health workers at all times and in all places and hold a vice-like grip on nurse training. The hope would be that within this regime the least that both regulators could do would be to remember what Francis is saying here: "'quite a lot' of professional conduct cases (at mid-Staffs) were 'symptomatic of some system failure.'"

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  • Might "near miss" forms be used to report system failure accidents that didn't quite happen? So that the authority can prevent problems.

    Currently this is a silly suggestion as it is the authorities who are the problem plus lack of candour by nurses understandably trying to hang on to their jobs. But bear it in mind for the future..

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  • Oliver, stop reading whatever rag you subscribe to, and read the Full Two enquiries, as suggested by Sir Robert when he very first announced the results way back in 2012. "Only then will you grasp a full understanding" of what he was talking about!

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  • I totally agree with Jenny Jones!
    We should clean the system from the top and replace them with health professionals. If we find some valuable workers for the job it is better.

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