Misconduct cases against nurses may be held in secret

‘Even if failings resulted in the death of a patient, it is not always necessary to impose sanctions’

NURSES and midwives 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 Nursing and Midwifery Council (NMC) wants to replace “cumbersome and adversarial” fitness-to-practise processes with a system in which most cases would be heard behind closed doors.

Under the draft strategy, nurses who may now expect to be struck off could continue working if they admitted failings early and convinced the watchdog that they had learnt their lessons.

Such an approach would apply even in the most grave cases, including those which resulted in patient deaths, the regulator’s head said.

Jackie Smith, the NMC chief executive, said that the plans to hold full hearings “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.

The proposed system – which is due to go to public consultation – would put patient safety first, she stressed.

Last night, however, patients’ safety campaigners described the move as “shocking” and as a “step back for openness”.

The watchdog receives more than 5,000 referrals a year from hospitals, patients and the public.

Around six in 10 cases are closed after initial assessment, with around 1,500 public hearings held annually. Latest figures show that in 2016-17, 23 per cent of those facing such hearings were struck off, with 28 per cent suspended and 18 per cent subject to conditions, such as only working under supervision or undergoing retraining.

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.

Next week, the NMC’S board will consider proposals to greatly expand this

system, saying that the current approach encourages “a culture of blame and denial”. Ms Smith told The Daily Telegraph: “For a long time we and others have been saying that the fitness-to-practise process is distressing and adversarial and cumbersome.”

She questioned whether there was any point in having public hearings if the nurse or midwife had admitted their failings, and shown willing 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 asked.

Such changes could also save money Ms Smith said, with three-quarters of the watchdog’s £85 million budget spent on fitness-to-practise processes. Even if clear failings by nurses had resulted in a patient’s death it was not always necessary to impose sanctions.

“It depends on whether the nurse recognises what they have done and learns from it,” she said, stressing any sanctions would be publicly on the record, even with no public hearing.

Ms Smith acknowledged that the proposals, which go out to 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 thinks.”

Peter Walsh, chief executive of Action against Medical Accidents, warned that the “shocking” new proposals would rely too much on the honesty of individual hospitals and could lead to further cover-ups.

♦ NHS staff are set for a 6.5 per cent pay rise over three years as a cap on wages will be lifted today. A source close to Jeremy Hunt told The Telegraph: “It is £4.2bn deal – it had previously been written up that staff would lose a day’s annual leave, but Jeremy has taken that option off the table [it] includes a 30 per cent increase for some of the lowest paid.”