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NMC audit exposes 'significant weaknesses'

"Significant weaknesses" found in an audit of the Nursing and Midwifery Council (NMC) fitness to practise (FTP) process risk "undermining both public and professional confidence" in the regulator, it is claimed.

In July 2011, the Council for Healthcare Regulatory Excellence (CHRE)  audited 100 of the 1,532 cases closed by the NMC during the previous five months.

The CHRE acknowledged evidence of improvement in its report following its audit on the initial stages of the NMC's FTP process, but claims it remains "concerned about the extent of the weaknesses identified."

Worryingly for the CHRE, some such "weaknesses" were found to have happened "relatively recently" ie after the NMC had initiated its current improvement programme.

The CHRE found delays in the progression of cases, which it argued were due to: ineffective case management by the NMC; human error by NMC staff, and/or inadequate oversight of investigations undertaken by NMC investigators.

It claims some of the delays were of a "significant length" and noted an example of three cases in which a referral to an interim order committee ran into 16,17 and 27 months respectively.

"These delays caused potential unfairness to the complainants, witnesses, registrants and employers, and could impact on patient safety, and also potentially damage public confidence in the NMC as a regulator," said the CHRE's audit report.

"We are concerned that these registrants had been able to practise unrestricted for significant periods of time before the interim orders were imposed, as the result of the NMC's failure to apply for interim orders promptly after receiving the complaints."

The CHRE also found an "inadequate" risk assessment was undertaken by the NMC "throughout the lifetime of each case".

While it recognises evidence of improvement of risk assessment since the NMC adopted a new approach in January 2011, it claims to have uncovered "an ongoing lack of consistency" in some cases that were opened both before and after January 2011.

It argues this meant that appropriate action was not necessarily taken once new information came to the attention of the NMC.

Professor Dickon Weir-Hughes, Chief Executive and Registrar of the NMC, called the audit report "discouraging".

"The CHRE is aware that it will take time for the effects of initiatives [to address issues identified in the audit report] to be fully realised across our processes," said Professor Dickon Weir-Hughes.

"So while it is a little discouraging that the audit over-emphasises weaknesses that we are already dealing with, we will take steps to tackle the points raised.

"CHRE colleagues are well aware of some of the obstacles that we face. Our legal framework is cumbersome and prevents us from introducing processes that would radically improve the speed and efficiency of our case handling systems.

"We are pleased that the Department of Health is working with us on changes to our legal framework that will help us to develop a modern, responsive and efficient service. This will make a real difference to public protection."