000 days

since the NMC committed to investigate its ‘established procedures’. We’re still watching!

Complicit regulation

Jan 7, 2023 | Appeals, Fitness to Practice, Opinion, Regulation

Everyone is painfully aware of the state of the current situation with our Healthcare service. It is described as being at breaking point and that we are amidst the biggest staffing crisis that we have seen, with the NHS seemingly imploding. Hospitals running out of oxygen – unions reporting system being near to collapse, and doctors explaining what that collapse actually means.

Listening to BBC Radio 4 at the weekend there was a great sharing of ideas about why this is. Funding is an obvious first, but retention of staff is central to the debate. One lady interviewed had not practiced since 2000, and had tried to get back on the register. She described her efforts to secure a Return to Practice course, what this would mean in terms of studying versus working, and how at the end of it when she did return, she would be back at a Band 5 with no recognition of her previous experience, skills and expertise. She said she just couldn’t afford to do it under those terms. Another said that she can earn more working in a supermarket than returning to practice, and another retired community nurse talked about how the face of the services has changed throughout his career and make it unlikely that he would ever recommend joining the profession to his children or others.

An article appeared in a national paper about my local hospital and its particular response to the lack of bed capacity. It suggested they could deploy field-type hospitals as a genuine consideration. I remembered the efforts I had made to join Bedford’s bank recently – I went for the face-to-face approach and offered my CV (old school!), saying I would like to explore working bank shifts. Surely my 30-year experience across oncology, palliative, infusion services in both community and hospital settings, in both private and public sectors, would mean I would be grabbed with gusto.

The admin lady, who I am sure does a very good job, informed me that I would have to wait until an advert appeared on NHS jobs and apply in the usual way. However, she did then ring me this week to inform me the advert had gone out and would I be applying?

“What grade/band are you offering?” I asked; her response was the standard “band 5”.

I asked if there was any flexibility due to my experience and she categorically stated no and that all bank nurses were band 5. Whilst I understand the need for fairness across the board, and the fact that finances are limited,  does this not show the real problem? Automatroms, ticking boxes and ensuring the checklists are complied with, but not looking at the person sitting in front of them, finding out about them, and looking at how they can be brought on to the team. With staffing as it is, I was shocked and it confirmed that as much as I would like to assist my ailing local unit, my existing role as a bank in a private unit in London, in reality, was going to pay the bills and this was not.

You used to be able to go to a unit, have a look around, meet the team on an “informal visit” and both parties get a feel for each other; see if they would both fit. Now it seems just getting through the mire of online application forms is no mean feat in itself. Once you have set aside a number of hours to fill in all the boxes – often again and again as none of the recruitment sites cross-reference, before you have even got to “reasons why” or a personal statement, you have lost the will to live. How many are put off before they start? How much skill are we losing?

Our work at NMCWatch rings alarm bells and many of my previous blogs talk about the impact these investigations have, even on the nurse or midwife that clears their name or gets their case closed down in the early stages. But recently the work has also witnessed other complications which again raise alarm bells about our regulator being complicit in making working as a nurse or midwife extremely difficult.

Revalidation

We get so many queries over whether a nurse or midwife who is under investigation can revalidate and have to help them navigate with the NMC to get clarity on this point. Generally, the rule is that whilst your case is ongoing your revalidation does not occur – thus placing you in a state of limbo. Once the case is closed you can continue your revalidation but then opens up a mess of logistics through which you have to navigate. Your registration will be placed as “lapsed” because you have in effect not revalidated and yet the process itself has caused it to lapse. Ordinarily, this wouldn’t be an issue if it were just a question of a day to get it changed over, but some are waiting many weeks for this to occur as the departments within the NMC struggle to communicate with each other.

Over the last 3 months we have had a number of nurses approach us having been referred to an investigations committee following issues with revalidation applications. From unpicking these it appears that they have all been due to simple mistakes, a misunderstanding over what is required or a misinterpretation of what is presented. Again if there had been a one-to-one discussion with the registrant and a clinician at the NMC, all of the issues could have been resolved quickly and without cost. This is, in theory, what the confirmer’s role should be. However many confirmers will not explain the “process” to the registrant and will not sit with them whilst they press send on the submission.

Re-entry to the register

It is possible to come back to the register if you have had a period of absence, as long as you can show you have prior to that absence done the required numbers of clinical hours and hours of CPD. Simple, one may think. But one of our members recently found that a miscalculation of these hours can lead to a long-winded investigation and being removed from the register for potentially 18 months unless she appealed. Prior to completing the reentry application, her PIN showed as “lapsed” but in the guise of a Little Britain sketch the computer said “no”, and once that button was pressed the only way to undo it was to go through an investigation, including a panel hearing. At the end of this joyous process, she was left wondering if she really wanted to return to a profession that makes it so difficult to work for before she even set foot on a ward!

Returning to the register following appeal

Overturning a strike-off order is no easy task but it has been done. Imagine the elation of a nurse or midwife, who finally clears his or her name and is able to come back to the profession they love…

In order for this to happen the NMC have to “agree” with what the esteemed High Court Judge has determined in the appeal. A formality most probably but they can choose to ignore it if they wish and the registrant would then have to appeal again. But nonetheless, this formality has to be scheduled to be heard in front of a Substantive Order Review hearing panel which takes time and is unlikely to be arranged quickly.

By the way, a panel of 3 plus a legal assessor, secretary, case presenter et al, costs approximately £1,500 for the panel alone and most likely a further £195/hr for the case presenter.

The convening of the SOR panel will take time to arrange but the registrant can hope it is done around 6-12 weeks following their successful appeal. Enough time for the wind to be taken out of their sales from the “win” and the reality to hit that you really have to be determined to return to the nursing register! Once in front of the panel, they will give their decision and if they agree that you can have your PIN returned, will sign the matter off.

Does this mean I can practice the next day then?

No! You will have to navigate through the restoration teams and ensure they communicate with the Fitness to Practice teams, which can take up to another 6-8 weeks before your PIN is activated.

So in a nutshell, the much-promised “person-centred” approach that the NMC has promised us, doesn’t seem to be applying to the registrants’ experience. One of our group did an FOI request to the NMC to see if her case was isolated or if this was generally common – the stats are quite concerning (the request took nearly 3 months to complete – according to the ICO it should be done within 20 working days).

Freedom of Information (FOI) info:

Q: The number of nurses under FtP investigation following revalidation applications from April 2020-April 2022.

A: 1,839

Q: The number of midwives under FtP investigation from April 2020-April 2022 

A: 104

Q: The number of nurses under FTP investigation following re-registration applications from April 2020-April 2022

A109

Q: The number of midwives under FtP investigation following reregistration applications April 2020-April 2022 

A: 3

 

There is no disputing that these numbers are huge and it begs the question why are so many nurses being put through an FtP investigation following revalidation or re-registration? Is it because they are dishonest, have veered away from the code of conduct or just haven’t followed process correctly?

The number of registrants under FtP investigation – nearly 2,000 nurses and midwives following revalidation and 112 following re-registration – indicates that something is going wrong.

Surely if the process is causing questions over an individual’s ability to practice safely, then

a) why is it only during revalidation that this is being picked up?

b) why have their colleagues confirming their practice, in the case of revalidation, not picked up on the issues?

c) why is the online application process so fraught with creating issues and

d) who is monitoring the costs associated with this and auditing correct spending of registrants fees which pay for Fitness to Practice investigations?

If a nurse was putting a process or policy in place that was failing or causing safety issues, we would expect them to come under scrutiny. So why does our regulator not have to perform to the same standard?

The NMC are a registered charity, and yet all “donations” are from those it governs (nurses and midwives) as registration fees – it receives no charitable donations. Most charities are expected to ensure they spend wisely any monies received and ensure spending is scrutinised ensuring they benefit the majority rather than the few.

The NMC has its own council that: “sets our strategic direction, takes key decisions and makes sure we fulfil our duty to protect the public.”

And yet they seem to allow continued failings including those which have been pointed out annually by the Professional Standards Authority in their annual inspections of the NMC for the last 5 years.

The NMC are yet to be brought under any scrutiny by parliament despite reporting to them through The Privy Council.

More Nurses and midwives are leaving the profession than ever before. They feel undervalued, unrespected, stressed and burnt out. While struggling to keep going, having impossible barriers put up by our own regulator, must feel like the last straw. Our regulator says they are trying to be more person-centred. An independent review that can ensure a proper and thorough examination of the impact FtP has on the retention of staff in the profession is essential. There is no follow-up from the NMC after FtP – no impact statements, no assessment of how long it takes registrants to get back to work. No analysis of whether they return to the same level or lower. There is no signposting to other organisations who can assist. There is no risk assessment of the impact that the process may have had on mental health and any PTSD that results.

It is essential that our regulator steps up and behaves as professionally as it expects us to.

It is essential that our regulator is held to account for its failings and that those failings are addressed and resolved urgently.

 

In the last financial year the NMC spent £43 million on Fitness to Practice investigations – all from annual fees from those they regulate!

  • Our profession is not failing.
  • Our regulator is failing and has been failing for many years.
  • 25% of our group who received a N0 Case to Answer result did not return to the profession.
  • Why do the NMC not gather this data and the real impact on the profession?

It’s time to change – regulatory reform work continues to not take priority with no end date in sight.

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