- 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”
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”
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”
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.
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”
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.