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Regulator highlights progress but admits room for improvement

  • 10 Comments
  • Referrals to the NMC have gone up 10% since 2013-14, with significant increase in referrals from members of the public
  • The regulator missed its target for 90% of investigations completed within 12 months but hit its target for first hearings.
  • Two big research projects regarding FTP cases, covering data and allegations and whether processes are fair 

The Nursing and Midwifery Council is making “excellent” progress in improving the way it handles fitness to practise cases, despite criticism from the body overseeing its work, says its chief executive.

Jackie Smith was adamant the regulator had made huge strides in the past year, as the body’s annual fitness to practise report revealed another surge in referrals.

“The NMC is on the radar now and that’s a positive thing”

Jackie Smith

It shows the number of new referrals increased by 10%, from 4,687 in 2013-14 to 5,183 in 2014-15.

The report also shows a significant increase in the number of patients and members of the public going direct to the NMC to report concerns about the conduct and competence of nurses and midwives.

The total number of referrals from members of the public increased by 47% on the previous year following a similar increase the year before.

Ms Smith said she expected the total number of referrals to continue to rise in the next 12 months, with a further 10% increase likely.

“The NMC is on the radar now and that’s a positive thing,” she said. “Members of the public are obviously aware of us and more inclined to complain to us about the quality of the treatment they are receiving and the whole debate around healthcare and the quality of nursing and midwifery care is just very much out there.

“It is a combination of awareness of who we are and what we do, public expectation and an increase which all regulators are seeing across the board,” she told Nursing Times.

Overall in 2014-15, the report shows hearings panels considered 1,732 cases, of which 1,343 resulted in a sanction including 493 nurses and midwives being struck off.

 

NMC defends record on case handling

Its publication comes just days after the NMC’s own regulator, the Professional Standards Authority (PSA), released a critical review of the way it handles fitness to practise cases.

“The PSA said it was mathematically impossible for us to achieve that target but we did it by sheer hard work, determination and focus”

Jackie Smith

The PSA said it was “disappointed” with the results of an audit of 100 cases, closed at the initial stages of the fitness to practise process, which found “weaknesses in the gathering of information and evidence” and other inadequacies that had led to several examples of “unfairness”.

However, Ms Smith said the NMC was already aware of the problems highlighted and the situation had moved on since the audit, which involved cases from the first six months of last year.

“We are aware we still need to improve in some areas – there’s no doubt about that,” she said.

“However, those cases were terribly old and there was a significant delay in the report being published,” she said. “They looked at cases which were opened at the beginning of 2014. What use is that to the public and profession now almost two years on?

“It was only 100 cases and frankly there wasn’t anything in that report we didn’t already know about,” she added.

“We are on the up. We’re not here to be liked but we are here to be respected”

Jackie Smith

Instead, Ms Smith highlighted the NMC’s success in hitting key performance targets including a goal of ensuring 90% of cases where there is a case to answer proceed to a full hearing within six months.

The body achieved this target in December 2014. The report shows 97% of new cases referred by an investigating committee or case examiner since the beginning of July 2014 proceeded to a hearing within six months.

“No one believed we would do it,” said Ms Smith. “The PSA said it was mathematically impossible for us to achieve that target but we did it by sheer hard work, determination and focus and I think that is absolutely excellent.”

The report shows the NMC also exceeded its target for imposing interim orders restricting a nurse or midwife’s practice – where there could be a risk to the public – within 28 days.

However, it narrowly missed its target to conclude 90% of initial investigations into misconduct allegations within 12 months.

Jackie Smith

Jackie Smith

Jackie Smith

Overall, it managed to progress 86% of cases within the 12-month timeframe.

The report stresses the NMC is “committed to reducing the time taken to resolve cases” and the body has started assessing performance against a target of completing cases from start to finish within 15 months.

Ms Smith revealed that already 70% of cases are “done and dusted” within that 15-month timescale.

She said it was too early to assess the impact of a new system of case examiners introduced in March last year, but she expected this to have a positive impact on performance detailed in the next annual report.

“I think it’s working really well,” she said. “It’s still very early days – they are only six months in and it takes a lot longer to evaluate the effectiveness. But what we are looking for here is speed and quality decision-making and the early results are promising.”

In the meantime, she said the NMC would continue to press for key legislative changes that would enable further measures to streamline processes. “We can only be quicker if people give us the tools to be quicker,” she said.

She said the body was also working closely with employers across the four UK nations to give advice and ensure referrals were appropriate.

 

Two major new research projects to begin next year

As part of efforts to improve, the NMC will carry out two major research projects in 2015-2016. The first will look in detail at the types of allegations made against nurses and midwives and those most likely to progress to a fitness to practise hearing.

Another project will assess a number of fitness to practise cases “to determine whether our processes are fair and equitable, particularly with regards to BME [Black and minority ethnic] registrants”.

“There are groups who feel the processes disproportionately affect BME groups,” said Ms Smith. “We have no control over who makes a complaint because we treat every complaint in exactly the same way at face value. But what we have to do is establish our processes are fair and unbiased.”

Both these research projects should be finished by the end of the financial year.

“We have no control over who makes a complaint because we treat every complaint in exactly the same way”

Jackie Smith

The NMC will also look at ways to ensure any whistleblower is treated fairly in the light of a report published by the General Medical Council, which found evidence doctors who raise concerns at work may suffer reprisals from their employer colleagues or their employer.

The report by Sir Anthony Hooper made a series of recommendations, including that employers should have to declare in writing whether the person they are referring had previously raised concerns.

Sir Anthony said it was important to understand the background to cases and the regulator should also take into account whether concerns had been investigated.

While Ms Smith said misconduct cases involving a whistleblowing element were “not commonplace”, she said the body would “seriously consider” its approach.

“Complaints don’t come in to us marked ‘whistleblower’,” she said. “You only realise someone night be in that category much later on. We want to think seriously about the way in which we tackle this.”

 

Revalidation and new education standards

Alongside the fitness to practise report, the NMC published its annual report and accounts for 2014-15 and plans for the future including the roll-out of revalidation.

Ms Smith said she felt “extremely buoyant” about the launch of revalidation.

“It is the biggest single regulatory change in the history of nursing and midwifery,” she said. “It’s absolutely what the professions want, it’s what the public deserves and I am thrilled we have introduced this. It will make a difference.

“We have to make sure we are ready – we’re confident that we are – and we have to make sure that people are aware so we’re doing a huge amount of work on our awareness campaign,” she told Nursing Times.

The NMC’s plans also include publishing and implementing new standards for nursing education including completing an evaluation of pre-registration education standards.

The body will also set up a student forum and survey students to find out more about the current picture of education and practice.

The report mentions the “difficult decision” to increase registration fees to £120 as of February this year.

“We understand the significant hardship nurses and midwives face in making a lump sum payment in difficult economic times,” said the report, which confirms nurses and midwives will be able to pay the registration fee in instalments by the start of next year.

Ms Smith told Nursing Times there were no imminent plans to increase fees.

NMC building, Portland Place, London

“There are no immediate plans to raise fees – none at all,” she said. She said she was very keen for all nurses to claim the tax relief they are entitled to on the fee. The report shows just 30% do so at the moment.

Overall Ms Smith said the regulator had come a long way and was doing “brilliantly”.

“Let’s not forget where we were just three years ago,” she said. “We have performed brilliantly. We have introduced a fantastic code that everyone is behind, we’ve introduced revalidation that nobody believed we could do, we have achieved a really challenging adjudication key performance indicator in fitness to practise.

“We are on the up. We’re not here to be liked but we are here to be respected,” she added.

  • 10 Comments

Readers' comments (10)

  • they "treat every complaint in the same way" what if someone phones up to complain a nurse was seen going out for a meal , no improper behaviour , just relaxing with her partner would that be dealt with in the same way a serious complaint would be ?

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  • 'The NMC is on the radar now'.
    The more I read that, the less sense that sentence makes. Really, what DOES that sentence mean?

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  • Jackie Smith and her rose-coloured blinkers!
    One has only to look through the referrals to the NMC to suss out those that are made by spiteful colleagues and those that have trivialities added to bulk up the case. Luckily I worked for the majority of my career with supportive co-workers who realised that a mistake was a mistake and not a sign of incompetence. Heaven help those who work in a toxic atmospere and either don't 'fit-in' or put their heads above the parapet.
    So happy to be away from it all.
    Miserable job.

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  • What planet is Jackie Smith from!! Through blaming the individual nurse, the NMC's sole purpose is to deflect public attention away from the real causes of poor care: lack of resources, inadequate training and ineffective management. It creates a climate of fear, in which nurses are fearful to speak out about unsafe or dangerous practices for fear of retribution from a spiteful manager who can cite failing to sign for a paracetamol or completing a risk assessment as evidence of a nurses incompetence. As for revalidation, it is prompting many experienced nurses, myself included, to consider finishing their career early. How is that going to benefit patients at a time when there is a shortfall of nurses Jackie? And by the way, the NMC should consider relocating outside the capital and selling its expensive London property to reduce its extortionate fees.

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  • Jackie Smith speaking from her ivory tower. Shift the blame on to the nurse who has had to work in dangerous conditions. E.g. Acute surgical ward of 34 patients, 6 back from theatre, 5 requiring TPN feeds that involve long meticulous aseptic procedures to administer, Iv drugs, medicine rounds, documentation, 4 patients demented trying to climb over bed rails and to be the only trained member of staff on duty, accountable for all that?? is it any wonder highly trained experienced staff leave the UK?

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  • Jackie Smith speaking from her ivory tower. Shift the blame on to the nurse who has had to work in dangerous conditions. E.g. Acute surgical ward of 34 patients, 6 back from theatre, 5 requiring TPN feeds that involve long meticulous aseptic procedures to administer, Iv drugs, medicine rounds, documentation, 4 patients demented trying to climb over bed rails and to be the only trained member of staff on duty, accountable for all that?? is it any wonder highly trained experienced staff leave the UK?

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  • Agree with 13/11 5.30pm. I was reported by an ex colleague (who, unknown to me, had been dismissed for gross misconduct and who reported multiple registrants at the same time.) None of the allegations involved patient care and yet after almost a year, it is still up in the air. Trying to get information at the initial stage was like trying to get blood out of a stone; misinformation was commonplace and when I complained the woman I spoke to saud she realised it was 'a tedious process'. Only when I became profoundly distressed did she realise the effect of the process. The cost to my mental health has been enormous and yet I still have to work every day. Fortunately, my employer has been extremely supportive. Jackie Smith has given power to spiteful individuals whose main aim is to cause maximum suffering to their target which only serves to demean the process for those whose conduct really does need addressing.

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  • “The NMC is on the radar now and that’s a positive thing,...”

    "...the whole debate around healthcare and the quality of nursing and midwifery care is just very much out there."

    “We are on the up. We’re not here to be liked but we are here to be respected,”

    “done and dusted”

    "...we did it by sheer hard work, determination and focus and I think that is absolutely excellent.”

    "...awareness of who we are and what we do..."

    *****
    What an appalling load of meaningless, vacuous, middle-management drivel! Was she just trying to sound "hip and with it" or is this really the best she can do? Perhaps Ms Smith should sit the IELTS Academic test and see if SHE can achieve 7.0 on the writing and speaking parts using "empty" language like this.

    By the way, where is the NMC's evidence on which it bases statements like "It’s absolutely what the professions want, it’s what the public deserves" (referring to revalidation)? Methinks the NMC have fallen into the "Health & Safety" trap, thinking they can justify absolutely anything by simply invoking the grossly-overused "public safety" excuse.

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  • We live in a society where blame is apportioned for pretty much anything. I am certain that there are nurses out there who fully deserve to be reported to the NMC. However, there are those who are reported that definitely do not and where it is evident that no harm has befallen anyone. Unfortunately, the current system does not recognize the difference until the individual concerned has suffered greatly. There has to be a modicum of common sense applied when complaints are received. Ms. Smith's comments that the NMC is now on the radar and that patients are now more inclined to complain about the care they receive is very telling. It seems that we are guilty until proven innocent in the eyes of the NMC with the process that has to be followed a destructive one. The nurse who has done nothing treated the same way as a nurse who has caused irreparable harm. Shameful.

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  • I had a malicious allegation made against me by a bitter colleague - I was accused of taking thick and easy - they investigated me for 22 months before I got a letter telling me there was no case to answer. I was given little support, little advice and little information throughout the process. I felt like an outcast in the profession as you have to disclose your under investigation and nothing stays private for long in care environments. The person that made the allegation had also made allegations against every nurse that worked in that home but not once did you get the feeling the NMC took a step back to consider why. They spend a fortune on buildings for headquarters, middle(wo)men who have no knowledge of what the job entails on a daily basis, develop pretty colourful guides and codes and espouse how nurses should all be Mary Poppins and have everything practically perfect in every way. Whilst I have no issue with the concept of revalidation it feels like it's been pushed through as quickly as possible just so the NMC can justify their role as a regulator. Oh and little things like what happens if your late with your renewal fees coming into force last November but very little info given to those that really need to know - the nurses on the ground. I agree a regulatory body is required but I would like to see one that was there to support the nurses and promote best practice by example not paperwork and punishment all the time! Rant over, sorry.

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