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NMC failing to meet core fitness to practise standards, says watchdog

The Nursing and Midwifery Council (NMC) is failing to meet core standards relating to fitness to practise cases, according to the healthcare regulator watchdog.

The Professional Standards Authority’s (PSA) review into the NMC’s performance in 2017-18 found that the nursing regulator had met all of the Standards of Good Regulation for three domains – guidance and standards, education and training, and registration.

But the NMC failed to meet two of the 10 core fitness to practise standards: standard 5, relating to transparency and fairness, and standard 7 - also not met by the NMC last year - relating to keeping all parties within a fitness to practise case updated as to its progress.

The PSA highlighted cases where the NMC had not presented ‘important evidence’ at fitness to practise hearings such as medical records, expert evidence and relevant policy documents.

It also reviewed seven cases where the NMC had decided to offer ‘no evidence’ to fitness to practise committees where it felt continuing proceedings was not in the public interest, finding three of these decisions ‘insufficient to protect the public’ and successfully appealing two.

Issues raised by the PSA also included the handling of complaints about registrants who have conducted Personal Independent Payment (PIP) assessments. These look at the eligibility of people with long-term disabilities or conditions that impact on their daily life for benefit payments.

The NMC’s own figures show that only two concerns out of 83 relating to PIP assessments progressed to the investigation stage. However, the PSA reviewed 28 of these cases and in 24 of those ‘determined that the handling of the case might undermine confidence in the NMC’.

In particular, the PSA audit noted that the NMC did not systemically consider all concerns raised by complainants, relied on the findings of employers without proper scrutiny and did not obtain all relevant evidence.

The PSA stated: ‘We considered that these issues created a barrier to vulnerable people raising potentially serious concerns. The NMC is reviewing how it handles these cases.’

The PSA said it can ‘draw parallels’ between the audit findings and last year’s Lesson Learned review (LLR) into the NMC’s handling of cases brought against midwives at Morecambe Bay Hospitals, where it found that ‘the NMC did not recognise the value that patient or family evidence provides’.

The NMC subsequently did not meet standard 7 in its 2016-17 performance review, with the PSA urgently calling for improvements in its approach to transparency and interactions with patients and families.

The 2017-18 performance review acknowledges that the NMC had made progress in addressing the PSA’s concerns, including setting up a public support service, looking at the tone of voice it uses and introducing a new enquiries and complaints team.

However, the PSA concluded that much of this work is still in progress and its impact remains to be seen, meaning the NMC met one fewer core standard than in 2016-17.

In a statement, the PSA said: ‘We recognise that the NMC accepts the concerns that we have identified about its approach to fitness to practise cases and is undertaking work which aims to address them.’

NMC chief executive and registrar Andrea Sutcliffe said it is encouraging that the report acknowledges the ‘significant progress’ made in recent years, including the introduction of its public support service.

But she went onto apologise that ‘our approach to a small number of PIP related cases fell short of what is expected’.

She continued: ‘Our failure to fully address the concerns of some people making complaints and the lack of clarity in our decision making was not good enough. Since 2018 we have taken action. This includes additional training for those making and communicating case decisions, as well as a new quality assurance approach to the way we initially review cases.’

She also said the report highlighted the positive impact of ‘key initiatives’ including the development of new education standards and the review of overseas registration requirements.

However, she said the NMC was not ‘complacent’.

Ms Sutcliffe continued: ‘We’re grateful to the PSA for carrying out this review and for their feedback. We will continue to address the issues raised in this report and the PSA’s lessons learned review and build on the good progress that has been made over the last twelve months as we embark on the development of new five-year strategy.’