Why the NMC was right to lift some FtP sanctions during the pandemic
Regulator chief defends early reviews of nurse suspensions in response to COVID-19 crisis
Nursing and Midwifery Council (NMC) chief executive and registrar Andrea Sutcliffe responds to an opinion piece published by Nursing Standard on the regulator’s approach to early review hearings for a small number of fitness to practise orders during the pandemic:
I’d like to thank Trish Morris-Thompson for her acknowledgement of the NMC’s actions to support the UK response to the COVID-19 pandemic and the progress we’re making to do the best job we possibly can.
Criticisms of some recent decisions
I also understand why questions might be raised following the recent report about one aspect of our fitness to practise (FtP) work in the pandemic, when a small number of suspension orders were reviewed early.
I’m glad to have this opportunity to explain what we have done more fully.
Patient safety was prioritised
In a pre-COVID world, it was already standard practice for us to prioritise early interim and substantive order review hearings where new information comes to light that may suggest there’s new risk, or that restrictions on a registrant’s practice could be eased.
Consequently, at the start of the emergency period these hearings were identified as one of our priority services to continue. Our focus was to manage risk effectively with a proper process, in the interests of people using services.
At the outset of the emergency response we decided to take a proactive look at existing substantive orders to see whether there were registrants who had restrictions on their practice that might be removed safely.
At the time, there were 118 cases, and we identified 12 live suspension orders that had previously been imposed on a public interest only basis.
Early reviews were made after careful consideration
After careful consideration, we brought four of these orders before an early review hearing based on the following criteria:
- Risk A suspension had originally been imposed where there was no risk of harm to people using services.
- Public interest The assessment of where the public interest rested took account of relevant, wider and changing circumstances of the pandemic and the steps being taken to mobilise the response at the time.
- New evidence Registrants had engaged with our fitness to practise process, had demonstrated fresh and sufficient information on reflection, insight and remediation, and support was expressed from the employer.
The independent panels that make decisions at review hearings have the safety of the public as their overriding concern.
Restrictions should only be lifted, varied or eased if the panel is satisfied it is safe to do so.
‘Honesty and integrity do matter, as shown by the decisions of the panels to apply a caution order to three of the registrants whose suspensions were lifted’
Equally, panels are expected to consider the need to promote and maintain public confidence in the professions and proper professional standards and conduct. These expectations always apply, pandemic or no pandemic.
In relation to the circumstances of these cases, our published guidance makes clear: ‘Where COVID-19 is identified as a relevant factor, the panel should bear in mind that any change to the original sanction imposed (such as the lifting of a suspension order) may have a long-term impact after the immediate crisis of the pandemic has passed.’
Upholding professional regulation as the NHS begins to recover
The decisions we took when we reviewed these cases were made independently, without external interference. The small number presented to panel hearings indicates the care the team took to ensure we were not lowering our standards.
Honesty and integrity do matter, as shown by the decisions of the panels to apply a caution order to three of the registrants whose suspensions were lifted.
Cases like these, where a major crisis event is the main or sole reason for an early review taking place, are relatively rare. We don’t expect there to be any further early reviews where COVID-19 is cited in this way.
We are now moving cautiously from pandemic crisis to recovery, seeking to increase public access to our virtual hearings and restore some substantive hearings in person by early September.
Our core regulatory role in protecting the public and promoting public confidence in nursing and midwifery remains as vital as ever and will always guide our actions, now and into the future.