Lead from the top

This week has seen a hearing of a senior nursing professional hit the headlines and it has brought about lots of discussion re the NMC Fitness to Practice decision making process.

MP, Rosie Cooper has been highly critical stating that the NMC needs to be replaced;

"I think striking off would have been the only safe decision,"

"This decision has the brought the NMC's reputation into complete disrepute."

She is now calling for the NMC to be:

"replaced with a body which can instil confidence into the profession for both nurses and the public".

The panel concluded that as Ms Lockett had an otherwise unblemished 30-year nursing career:

"it was not in the public interest to permanently remove such an experienced and respected nurse from the practice."

From reading the hearing notes there are many aspects that could be questioned.  Ms Lovett's barrister is one we have had been able to witness represent a member of NMCWatch and can certainly vouch for her integrity and determination to establish fairness. However even she in her defence highlighted;

"...nine areas of concern that may interfere with fair process... abuse of process... poor presentation of additional evidence which gave little time to prepare due to a “drip feeding of evidence”

She went on to challenge when the NMC called for adjournment as they wished the panel to consider new evidence which had been forwarded to them by an external source to the investigation who had done an FOI. This was of particular interest as on one case of an NMCWatch member FOI information was attempted to be submitted in order to cast doubt over the local trust investigation and key witness for the NMC. The panel gave this little weight as they felt it bore no major interest on the case and yet with the case of Ms Lockett FOI evidence was allowed as well as adjournment to consider it, despite strong objection by the defence. One can't help but feel that the rules seem to shift depending on which side you are on...

We have learnt when reviewing both media coverage and documented hearing notes of cases on  the NMC website that they both need to be read with a degree of caution and scepticism as invariably there is a whole other side not reported that gives further context to a registrant's case. However, reading the hearing notes of this case it is tricky to rationalise how the panel reached the conclusion they did when in other cases of less serious disrepute registrants are not given such care.

The latest blog from the NMC discusses their recognition in having to balance context around charges and examine how context may have influenced the failings of the registrant they see before them. This is encouraging as we all know invariably a mistake made is usually made following a catalogue of other issues which have contributed. However, an area of concern around this case is the key issue that during FtP registrants have frequently tried to escalate evidence which shows other registrants at fault and some of these may include their managers. But all of those that have discussed this issue have told us that their concerns were not taken seriously and infact they were made to feel by the NMC panel or investigation teams that they were trying to deflect the blame from themselves by blaming others by doing so. However here we are with a manager, who holds ultimate accountability, infront of her regulator and being given more leniency than lower grade registrants have been given in recent hearings.

Indeed, we can not complain when a senior manager is finally held to account for clear failings and lack of accountability for ignoring key concerns of staff but it must be recognised that the registrants that have come before her have suffered enormously, many have been sanctioned on less evidence and some have been struck off for areas that do not concern patient safety but are "attitudinal".

The question is how can we be assured that one panel will assess a case the same as the next panel? Is it a clearly defined process, with clear assessment tools and criteria that ensures parity of outcomes? Likely it is more in its need to be "independant decision making"  subject to the same human error that those systems for which registrants are before it are being judged?

The NMC clearly recognised that this was a nurse with a long standing and "unblemished career" - how is "unblemished" defined? Does the mere absence of previous investigations means so? The average length of service of those in our group is 26years. Why is it ok to consider removing them from practice over allegations that revolve around no serious harm, and yet with this case there has undoubtably been serious harm and she has the potential to remain on the register?

According to Ms Rosie Cooper's interview, this registrant:

  " engaged in a "three-year reign of terror which ended in her receiving a £25,000 payoff."

For her this will no doubt of assured she did not suffer the severe financial hardship that many other nurses and midwives suffer when waiting for hearing to concludes.  Some of these get to end of their lengthy process with a no case to answer or no sanction, but as our survey showed still suffer long term consequences. as nearly two-thirds (63%) said their career was negatively impacted afterwards. 24%  said they returned to work at a lower position,22%  decided to leave the profession and 18%  remained on the register but have not worked since.

As we have heard in a high profile case of a celebrity death this week, having your case tried in the public forum can have devastating effects on your mental health.  The scrutiny that comes both privately and professionally when accused of issues that you are impotent to fight back against are debilitating. Since 2015, a total of 15 nurses or midwives have died before their investigation was completed with 4 being recorded as death by suicide from April 2018 to April 2019.

Sadly this case has created further distrust of a QUASI Judicial process that seems to give little public confidence that decisions are robust and getting to the true route cause of patient care complexities, but continue to cause harm regardless of which side of the process you are on.

The NMC needs to listen to those that have experience of the process. They must acknowledge in order to be the "arbiter of the law" and to be trusted to regulate safely and effectively that their own processes must be robust and without fault. They should no longer be able to say that certain processes are not in place because their infrastructure is not up to date or IT systems not robust enough. Millions are spent on FtP every year and still we have successful appeals overturning their panel's decisions and registrants leaving the profession even when cleared of any misconduct.  The NMC Deputy Director of Fitness to Practice has told us they have robust  safeguarding policies  in place to ensure that no one who comes into contact with the NMC suffers harm and yet we hear time and time again when this is indeed what occurs with no consequences to the regulator as it is done in the ethos of "protecting the public".

Patient concerns get ignored... Relatives concerns get ignored... nurses and midwives try to explain what is really going on in their workplaces and they are ignored... "Scandals" happen which generate Government led reports, lengthy and costly and yet a few years later there is need for another...

The NMC have to be brave and lead from the top to show best practice and improve patient care - but first a lot of work needs to be done to restore faith in them rather than fear.

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