They stated:
“This is because this information is not recorded centrally, but on individual personnel files.”

See our FOI and the trust’s responses

Our CEO, Cathryn Watters, gives her reaction.

Other trusts have tried similar tactics, so Gloucestershire is not unique in this respect. The difference is that these others have eventually capitulated and provided the data, and then, crucially, stated they have highlighted that they need to amend the way they hold information moving forward. Small wins!

Our next step was to initiate an internal review of Gloucestershire, via the Information Commissioner’s Office. While waiting, we approached the NMC to see if they had the data. Their response was ‘13 nurses and 5 midwives’.

Following the internal review, Gloucestershire then came back with further refusal. They added that the response to us was reviewed by the Chief Nurse and Director of Quality, who advised that:

“Organisations do not refer registrants to the NMC, individuals do, therefore strictly the answer to the question asked is 0.”

This rather pedantic response was interesting and further demonstrates the documented issues about the trust’s general attitude to culture and transparency. This has been heavily criticised over the last 2 years in both the media and the recent CQC inspection, where the trust was stepped down from “good” to “requires improvement”.

Chief, what?

So, is the Chief Nurse suggesting she has not referred anyone or that it’s not part of her role? Surely, she is not suggesting that our wording of the request had wriggle room to avoid supplying the information? 

The tone of the response made me feel quite angry. It felt as if we were being told we were stupid for requesting data in the way we were, and it seemed to be trying to tell us how the FtP referral system works. 

The email continued:

“Anyone is able to refer a registrant to the NMC, this includes members of the public or staff, and referrals do not need to be associated with a formal HR process.” 

They continued, saying that sometimes the only way they know about a referral is if the NMC contact them.

This is odd. They say that not only do they not hold the information centrally in any way, but also that the Chief Nurse does not have some ownership over this process. With such an important element of nursing being Fitness to Practice, surely a Chief Nurse should prioritise knowing or at least having oversight of whether they have an issue with the competency of their nursing staff. The clue’s in the name.

In the NMC’s own guidance and work done on the employer link service, they established that referrals can be more efficiently dealt with when there has been a clear and transparent escalation to a senior leader prior to referral. If employers deal with issues themselves, investigate them and action-plan any next steps, then, and only if there is ongoing concern, refer them for a FtP concern. 

Over 2 years, the employer link service managed to reduce referrals by 50% by educating and supporting employers to help them resolve issues internally. The NMC guidance states the key principle of assigning one senior person (Chief Nurse or Head of Nursing / Midwifery) to be responsible for nursing and midwifery staff and to have oversight of the referral. 

The employer link service also gave this information:

“We also offer inductions about fitness to practise; these are for senior members of your nursing and midwifery teams, such as Chief Nurses, or Directors or Heads of nursing and midwifery.”

So the question has to be asked – did this chief nursing officer not get the memo?!

When a hospital trust is sued for clinical negligence because, for example, an amputation has taken the wrong limb, is it the organisation who is responsible or the surgeon?!

If Chief Nurses are not willing to take ownership over their teams when it comes to Fitness to Practice, then what hope do those nurses have?  Leaders need to lead by example with best practices and compassion. A leader who has such a blasé attitude to gathering intelligence on staff competence is rather concerning, but sadly not unique, to this organisation. 

Make trusts take responsibility

Perhaps someone should impose rules rather than guidance on the data that trusts must collect to ultimately assess the potential implications of patient safety, and staff training and retention.

Gloucestershire Hospital NHS Foundation Trust got a poor outcome at its 2022 CQC inspection, with its previous “good” rating being reduced to a “requiring improvement” order. Inspectors raised concerns about surgical safety, bullying and racial discrimination at its two main hospitals.

“Not all leaders were visible and approachable for patients and staff, and not all staff felt respected, supported and valued”.

The Health Service Journal also reported that the trust was described as having “palpable cultural problems and staff at all levels have described an acceptance of poor behaviours”.

Early this year, Cheltenham MP Alex Chalk said that hospital bosses must change and staff safety fears needed to be listened to after the BBC’s concerns about maternity services were raised in their Panorama program. Midwives at this hospital raised serious concerns about poor culture and staff shortages leading to baby deaths that could have been avoided. 

We know that introducing legislation to sanction leaders who try to silence whistleblowers is currently high on the agenda for the government. We also know that whistleblowers are at high risk of referral to the NMC. If the NMC delved more into these aspects when identifying whistleblowers during their FtP referral, perhaps some real change could finally occur to stop this punitive process and move towards a real Just Culture.