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HomeMedico-LegalFuture UK nurse misconduct hearings could be behind closed doors

Future UK nurse misconduct hearings could be behind closed doors

NursesNurses and midwives in the UK will rarely be subject to public misconduct hearings and could avoid any sanctions for errors if they admit blunders early, under controversial new plans. The Daily Telegraph reports that the Nursing and Midwifery Council (NMC) wants to replace “cumbersome and adversarial” fitness to practice processes with a system that could mean most cases being heard behind closed doors.

Under the draft strategy, nurses who might currently expect to be struck off could continue working if they admit failings early and convince the watchdog that they have learnt their lessons.

Such an approach will apply even in the most grave cases, including those which resulted in patient deaths. Jackie Smith, NMC CEO, said the plans, which would mean full hearings held “only in exceptional circumstances,” were an attempt to protect patient safety without “punishing” nurses and midwives for mistakes. “This is not about doing deals behind closed doors,” she insisted, adding that the proposed system – which is due to go to public consultation – would put patient safety first.

However, the report says, patient safety campaigners described the moves as “shocking” and a “step back for openness”.

The watchdog receives more than 5,000 referrals a year from hospitals, patients and the public. Around six in ten cases are closed after initial assessment, with around 1,500 public hearings annually. Latest figures show that in 2016/17, 23% of those facing such hearings were struck off, with 28% suspended and 18% subject to conditions, such as only working under supervision or undergoing retraining.

The report says in theory, nurses can already be subject to sanctions without a hearing in public, if they admit their errors, but just 11 “consensual panel determinations” take place each month. The NMC's board will consider proposals to greatly expand this system, saying the current approach encourages “a culture of blame and denial”. The board papers suggest the new approach would mean “an improved customer experience” for the nurses subject to misconduct hearings, as well as to those who refer cases of concern. This would mean “enabling nurses and midwives to remediate regulatory concerns” while “holding full hearings only in exceptional circumstances,” the documents state.

Smith is quoted in the report as saying: “For a long time we and others have been saying that the Fitness for Practice process is distressing and adversarial and cumbersome.” She questioned whether there was any point having public hearings if the nurse or midwife had admitted their failings and shown willingness to learn from them.

“If you have a registrant who says 'yes it happened, it shouldn't have happened' and they reflect on it then what is the purpose of the hearing?” she said. “It is distressing for everyone especially the witnesses because it is so adversarial.”

If facts were disputed, a public hearing would be required, she said. Otherwise a panel would consider the case, and impose any sanctions, without any meetings in public. Such changes could also save significant funds she said, with three quarters of the watchdog's £85m budget spent on fitness to practice processes. Even if clear failings by nurses had resulted in the death of a patient, it was not always necessary to impose sanctions, she said. “It depends on whether the nurse recognises what they have done and learns from it,” stressing that any sanctions would be publicly on the record, even if there was no public hearing.

According to the report, the regulator said in a briefing document: “Under our new strategy, where a nurse or midwife makes a clinical mistake – even a mistake which causes serious harm – but they admit to it early, engage with us, and demonstrate learning, we may no longer need to impose a more restrictive sanction – such as a long-term suspension or conditions of practice. If they remediate properly and learn from their mistakes, this may be enough to protect the public. We want to resolve as many cases as possible by consent with the nurse or midwife – that is without the need for a full hearing.”

The NMC CEO acknowledged that the proposals – which will go to public consultation next month, if agreed by their board – could be met with a public backlash. “This is a consultation,” she said. “If other organisations come back and say this doesn't look right we will take that seriously. The key thing for us is what patients' groups think, what the public think. We want to get this right, we know there will be different views.”

Smith said she had been interested in recent statements from the Health and Social Care Secretary, who raised concerns over the case of Dr Hadiza Bawa-Garba, who was struck off by the General Medical Council over the death of a six-year-old boy. Jeremy Hunt had warned off “unintended consequences” if medics were unable to reflect openly on their mistakes.

Peter Walsh, CEO of Action against Medical Accidents, warned the “shocking” new proposals would place too much reliance on the honesty of individual hospitals and which could lead to further cover-ups.

“It’s a step back for openness – dealing with concerns behind closed doors without systematic public scrutiny is not in the public interest,” he is quoted in the report as saying.

James Titcombe, who has campaigned for better NHS accountability since losing his baby son Joshua in the Morecambe Bay maternity scandal, said: “The NMC hasn’t been a fit for purpose organisation for some time. Rather than moving to a more closed and secretive approach, the NMC urgently needs a change in leadership and top to bottom reform.”

[link url="https://www.telegraph.co.uk/news/2018/03/20/nurse-midwife-misconduct-hearings-may-held-secret/?WT.mc_id=e_DM715407&WT.tsrc=email&etype=Edi_FAM_New_AEM_Recipient&utm_source=email&utm_medium=Edi_FAM_New_AEM_Recipient_2018_03_21&utm_campaign=DM715407"]The Daily Telegraph report[/link]

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