18th October 2019
This month has seen a mixture of nurses and midwives sharing their experiences of the NMC Fitness to Practice process with us. We have had a larger number of people request to join our support group so whilst it’s great that people are hearing of us it is tinged with a mix of sadness that they need us.
In the last week, we have seen the long-awaited Registrant Support Service which is a very positive step by the NMC to recognise the need for more to be done to support those going through FtP. The care line is being run as a pilot and advertises that it offers 24hour support that “offers advice on general concerns, as well as signposting professionals to other appropriate health or wellbeing services that can help with their individual needs” Nurses and midwives accessing the line will be “Choosing from either Freephone, LiveChat or Email, professionals can contact specially trained counsellors, anonymously if preferred, who are experienced in handling sensitive topics.”
This sounds extremely positive, however, some of our members have attempted to use the service and have found it in reality to offer less than what is promised:
- Mixed messages: The opening message whilst waiting for your call to be answered is “all calls are recorded for training purposes”. Despite the NMC assuring that no information will be given to them from the line, confidentiality respected, those who are undergoing FtP are very wary to hear this. Paranoia and fear is a frequent effect of the process and despite desperately needing support they are unlikely a service if conversations are recorded
- Immediate psychological support: Careline staff will take details and pass on for referral to the counselling service – many calling will be calling with an urgent need in order to get some immediate support, they are able to access counselling via GP for longer-term support but accessing a service such as is offered gave hope that a more immediate support line would be available for an acute crisis.
- Lack of clarity: On calling the line you have to explain what it is you are needing which can be difficult when you are not clear about what the line can offer!
- Careline staff lack experience: in previous years the nurse’s welfare service was in place by the NMC but this was disbanded, as no longer seen as a necessary part of the regulator’s role. However, feedback from those who experienced this service say it was staffed by experienced nurses who were able to help the callers navigate and get the right signposting. The current team seem unaware of the type of calls and queries they are likely to get which is a shame considering the support service has been promised for over a year.
Hopefully, during the pilot the NMC will review the service and adapt it to fulfil the expectations of the callers – it would be interesting to see how they audit the calls and if they ask for feedback from those using it ( or not using it ) to see how it can improve, otherwise the risk is it just becomes another tick box exercise but doesn’t actually do what it is advertised as doing.
Also in the last few weeks, we have seen encouraging engagement from the CEO Andrea Sutcliffe. She talked candidly in blogs about her own personal experiences around suicide and fertility during campaign weeks for suicide prevention and baby loss awareness. This gives real encouragement that there is at last someone at the head who cares and is attempting to bring the organisation back to a more humane approach as she has promised she will.
Two members in the last couple of weeks have shown us that there is still a long way to go, however.
Case Study 1:
“Bessie” suffered ill health over a period of a few years which led to some poor decision-making and custodial sentences. Once a final diagnosis was given she got the much-needed treatment to resolve her issues, which included the dramatic decision to have a termination and hysterectomy to resolve her symptoms. This decision indeed resolved her issues and she was able to start to engage again to show she could remediate and continue to be part of the profession. She attempted to engage with the NMC, accepted all charges against her, put herself on a self-imposed removal from the clinical workplace in 2016 as she recognised she was “very poorly”. She suggested ways she could now work with the NMC by being given a suspension and then during the period of suspension show them she could return to work safely. Whilst waiting for her hearing, she built a role in clinical support work and became valued in this area of specialist work as a highly professional and competent member of the team. At her hearing she was not legally represented as could not afford it so appeared on her own in front of the panel, acknowledging her past mistakes but asking for them to put her on suspension as opposed to a strike-off order so she could continue to work towards returning to the nursing that she loved. She provided a plethora of testimonials from work colleagues and patients to show how well she was doing, all of whom were aware of her past. She suggested a plan of action that would maintain public safety but still allow her to continue her recovery. As many of us who have been through the process have done so before her, she put herself to the mercy of the panel and asked for their support. Like many of us before, she trusted that the panel would adopt the “new approach” of being person-centred, considering context and not punishing for past mistakes. She was hopeful that her regulator would safeguard her, take regard for her past mental and physical health issues and help her move forward positively. The hearing lasted only over 4 days on 2 occasions and at no point were any psychiatric assessments requested by the NMC or other medical reports or testing to show the past events had not reoccurred for some years.
Sadly none of this happened and “Bessie” was struck off the nursing register on public interest grounds only. Despite showing clear evidence to the panel that her behaviour was largely caused by her condition they chose to determine that although in part contributed, there was also an “attitudinal” element. However, they also said that there were no public protection elements in any way and the sanction was purely put as striking off due to public interest only. Her past behaviour is described as being far removed from the expectations of someone in the profession.
“Bessie” considered appealing in the High Court as a self-litigant with the support of those of us who have managed to do so successfully, but she is beaten by the process and can not risk the potential of it not ending positively. She can continue in the support worker role she has carved for herself but will never be a nurse again. She feels let down by her regulator who she thought would help her as she tries to recover, like any other unwell patient, from a long history of ill health. Is our profession so restrictive that it is unable to consider our healthcare professionals as members of the public needing protection also? Do we automatically leave our “member of the public” remit at the door when we qualify as a nurse or midwife? Is the FtP system so inflexible that it can look deeper and see the potential of rehabilitation? It seems so and despite all the publicity of new ways of working all it can do and will ever do is punish those who make mistakes and are trying to heal. ” Bessie” will I have no doubt come through this stronger. She will heal and will continue with her professional life down a different route than before. But she will not be able to change what is written for all to see – what is written that doesn’t reflect the whole story but only the part of the picture that supports the FtP outcome.
Case Study 2:
Toni was a newly qualified staff nurse when she ran into issues. She found herself in a workplace that exposed her to poor working conditions and gave lip service to their own preceptorship policy of supporting newly qualified staff such as herself. Toni was given a Conditions of Practice Order, which meant that she could continue to nurse whilst the investigation continued by the NMC but under guidance set out by their conditions. Toni has applied for nearly 60 jobs in a 2-year period, all of which despite being successful at many have not transpired into employment because the employer either can a) not support the COP, b) not support a newly qualified nurse with COP or c) can not employ whilst an investigation is being carried out. Toni finally secured work as a support worker, which meant that she had some clinical experience but none that can count towards her fulfilling her COP. She continues to apply for jobs as a nurse, despite the multiple knockbacks. She has also spent time studying and undergoing many courses and online modules to show the NMC that she has addressed the concerns, in the absence of being able to address them on the clinical floor. Her investigation has been ongoing for over two years. The NMC applied for an extension of the interim order to The High Court which was granted but with the notation from the judge that the investigation should be concluded within the 4-month period that the extension was set for. The investigation did not conclude and this week a second extension application was made to the High Court.
The process is supposed to be about “Current” risk – it is somewhat of a catch-22 if the nurse can not prove she is no risk if she can not get work as a nurse and if the process can’t conclude because they can’t assess her risk on current information provided. It will be interesting to see how the NMC conclude. However, for this newly qualified nurse, she may not nurse again whatever the outcome as she is disillusioned with how she has been treated.
At NMCWatch we completely appreciate that we may only hear about the extreme cases – we have many members who tell us about final conclusions reaching a ” no case to answer” and some getting thrown out in the early stages. However even for them there are long term effects and the reality is that many of them do not return to the roles they were in before and are waiting for the time they can choose another profession to avoid repeating the trauma. Someone posted on our survey this week
“It’s so easy to be referred but very hard to find any kind of help or support & the whole process is complicated”
and by another…
”After my first Ftp investigation which was no case to answer took 7 months, I was told by the NMC that there was a new system starting to help speed up investigations. 2 years later, another unrelated Ftp. Now told by the NMC that if it’s not resolved in 15 months then get in contact with them. The NMC process is a joke and not a very funny one for the nurses being investigated. It is no wonder there is a national shortage and so many nurses are giving up the profession. Why am I guilty before proven innocent?”
”I was told by my barrister that a piece of evidence was inadmissible as it related to a previous referral that was thrown out at the first stage of investigation. The NMC barrister still presented it to the panel in order to show my “inherent character flaw” and ” repeated characteristics”. The legal assessor reminded him that it was inadmissible but it was already out there – hearsay and collateral damage all to win the case. There’s no consequence that’s the problem they can do what they like…”
The reality is there will be many we don’t hear from who just decide enough is enough. Whilst the blogs, tweets and articles by Andrea Sutcliffe are more than encouraging and give hope that change will come, the reality is that for many it will come too late, the legal teams are still pursuing “old-style” and the real context is being missed.