Written by Penny Ballinger.

Remember the old woman who lived in a shoe? So many children she didn’t know what to do. Well, spare a thought for Manchester University NHS Foundation Trust. It’s in a similar situation, one of the largest acute care trusts in the UK and it has been stalling since February this year on my freedom of information request for the numbers of nurses and midwives it has referred to the Nursing and Midwifery Council in each of the years 2019 to 2023. 

The Nursing and Midwifery Council advises that employers should have clear internal processes and governance for the completion and submission of fitness to practice referrals and that one senior nurse should have oversight of the process for signing off and submitting referrals and communicating with the NMC. 

Manchester University NHS Foundation has however finally admitted to the Information Commissioner’s Office that it doesn’t bother with that! Anybody can have a shot at referring and the trust just doesn’t have a clue about the numbers of its nurses and midwives whose lives are being shattered by such referrals. Fitness to Practice referrals have always been ‘managed’ (if that is the appropriate descriptor) at site or department level. It doesn’t bother keeping a central record of the number of registrants put through this process. It doesn’t care that this is an important performance indicator, a proxy for its management style and culture that should be monitored to check that this sanction is not being abused.

I was a student nurse at a London School of Nursing in the eighties and it became apparent the Black students in the nursing sets under the aegis of a particular white South African tutor were failing their internal exams and being encouraged either to leave or change to the shorter enrolled nurse courses. As we, newly radicalised trade unionists, challenged on a case-by-case basis it became startlingly apparent that the reason was this particular tutor and her belief that Black young women were just not ‘suitable’ to be registered nurses. This clear racial prejudice had apparently gone on unchallenged for years in the school of nursing until the numbers and the evidence forced the school to finally take action and dispense with this tutor’s services.

Would Manchester University NHS Foundation Trust notice if the NMC referral process was being misused within one of its sites or departments? No of course not! And while it continues to claim it would be too difficult and costly to audit the use of this sanction it continues to leave its nursing and midwifery staff at risk of malicious unjust referrals by managers who abuse their power. 

Transparency and accountability are all that we are asking for. We know the old woman who lived in the shoe soundly whipped her children; what possible safeguarding issues can be happening to our Manchester nursing and midwifery colleagues if the trust doesn’t produce the information we have requested! 

NMCWatch recommendations for Manchester University NHS Foundation Trust:

1. Ensure all staff know that Head of Nursing (HON) / Head of Midwifery (HOM) needs to have sight of the issue
2. Adopt NMC’s recommendations of HON/HOM signing off any referrals from staff.
3. Add to staff survey – “Have you been referred? Can we help?”
4. Encourage an “employer first” approach to support and mentor staff to avoid Fitness to Practice issues arising
5. Leadership training for all heads of department to ensure your staff are fit to practice
6. Lead by example – ensure accurate data on referrals is recorded and accessible according to GDPR law.