The Nursing and Midwifery Council (NMC) states that a nurse or midwife is fit to practise when they have the skills, knowledge, health and character to do their job safely and effectively. The NMC will consider referrals the following areas:
In recent years, the NMC has made changes to how it handles fitness to practise cases. This is referenced in the 2017-18 annual report (NMC, 2018a) as in response to criticism of the NMC following a review into the handling of cases involving midwives at Furness General Hospital. The NMC's new strategic direction in this area, ‘Ensuring patient safety, enabling professionalism’ (NMC, 2018b), focuses on reducing risks to patients by encouraging openness and learning, working more closely with employers, and considering the context in which incidents occur, recognising the complexity of the current practice environment.
With 4 in 10 referrals to the NMC coming from employers, there is a responsibility on us to consider our internal processes and ensure that they are fit for purpose. In 2018 a report undertaken by Verita (an independent investigation consultancy for regulated organisations) was commissioned by Imperial College Healthcare NHS Trust (Seale et al, 2018). The investigation focused on the management of the Trust's disciplinary process resulting in the dismissal of Amin Abdullah. Mr Abdullah had worked on a ward in the Trust for nine weeks up to September 2015, when concerns raised by a patient prompted an investigation. In October 2015, the investigator recommended that the case progress to a disciplinary hearing. In October 2015, Mr Abdallah's union representative asked the Trust to make an urgent referral to occupational health for him. In December 2015 Mr Abdullah was dismissed, in late December he served a notice of appeal, and he submitted a letter of appeal in January 2016. In February 2016, Mr Abdullah took his own life.
There were a number of recommendations from the Verita review that the Trust accepted in full. Subsequently, NHS Improvement established a ‘task and finish’ advisory group to consider to what extent the failings identified in that case were either unique to the employing Trust, or more widespread across the NHS. Most importantly, it sought to identify what learning could be applied nationally. The group also considered a number of historical cases, the outcomes of which had attracted criticism in employment tribunals, and sought to identify examples of good practice that could be shared. In May of this year, the Chair of NHS Improvement, Baroness Harding, wrote to all NHS trust chairs and chief executives to share the opportunities to learn lessons nationally (Harding, 2019). Key themes highlighted were:
The letter also asked the chief executives and chairs to consider how the trust board is assured of its internal processes, and encloses guidance relating to the management and oversight of local investigation and disciplinary procedures:
There is a significant personal impact on individuals when they are referred to the NMC, and as employers, we have a responsibility to ensure that our internal processes are fit for purpose. Of the 5509 new referrals made to the NMC in 2017–2018, it closed 3081 cases after initial assessment either because it was unable to identify a nurse or a midwife on the register, or because the concerns raised were not serious enough to require regulatory action (NMC, 2018a). In the same year, 923 nurses and midwives received a sanction ranging from a caution through to being struck off. My personal reflections are that strong senior professional oversight from both chief nurses and HR professionals is required, to consider if current local polices are fit for purpose. The application of these policies needs to be delivered by competent professionals, with consistency and proportionality. In addition, the monitoring and oversight of these processes needs to be robustly undertaken with assurance to trust boards of all cases.