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”
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.