We have been looking at all of the sanctions published on the NMCWebsite showing the outcomes of hearings. The way the data was collated in the Annual Fitness to Practice reports changed this year as did the push to reduce the number of hearings. Those   nurses and midwives who are willing to accept all of the charges against them can have an agreed outcome by agreeing terms at  a consensual panel determination and avoid a full hearing.

However for some this may not be the right option, they may not have union or legal representation to advise them or even with may be encouraged to accept an agreed outcome as this may reduce the risk of a worse sanction. The issue being that they may be able to disprove allegations against them if the case goes to full hearing so in some specific cases it may not be in there best interests to do so.

Most NMC investigations will conclude within 15months of referral, for some the prospect of reaching an agreed outcome before that time may be “a quick fix” to “get it over quickly, put it behind me or just let me move on”. These are all reasons people have given NMCWatch for accepting them.  However, some have contacted us having agreed an outcome, but felt rushed or coerced into making the decision and then realised that this may not actually have been the best route for them. Unions will not necessarily continue representation if the nurse or midwife does not follow their advice, for example, so this is not really an option but more likely the only option.

According to outcomes published on the NMC Website each month, there have been 1177 sanctions published this year that we have looked at. The sanctions we looked at are Caution Order, Interim Conditions of Practice, Conditions of Practice, Interim Suspension Order, Suspension Order and Strike Off Order. These figures do not include those cases that have been brought over from the previous year or that have not concluded this year. They do not include those cases of restoration or refusal of restoration, cases where the registrant has requested voluntary removal from the register, or cases where sanctions have been allowed to lapse

The annual FtP report for last year stated

From the figures published on the NMCWebsite it looks like there may be higher numbers this year.

 Out of these sanctions 714 have been removed from the work environment through either Strike off Order, Suspension Order or Interim Suspension Order.

A further 429 have had Conditions of Practice Orders (COP) or Interim Conditions of Practice Orders (ICOP) placed on them. We are aware that many registrants find it difficult to secure employment with COP’s or ICOP’s but can not estimate their numbers. A survey on our members showed from those that responded and got a “no case to answer” outcome 25% of them struggled to gain employment.  The impact of FtP is far reaching and has huge consequences for both the nurse or midwife but also the workforce.

The questions are:

• How many of those removed from practice had legal representation or advocacy – would their outcomes have been different?
• Would another panel have reached a different conclusion?
• What is the real impact of FtP – how many registrant leave the profession following investigation?
• What is the average length of service of those going through FtP?

The mental health impact of FtP has also been well publicised, few come through the process unscathed. The last financial year was the first to see the numbers of suicides during FtP recorded and Freedom of Information requests have found startlingly figures:

• Figures by the ONS showed 300 nurses in England and Waled took their own lives by suicide between 2011 & 2017
• 4 registrants (nurses /midwives) have died by suicide between April 2018 – 19 according to data published for the first time in the 2019 Annual FtP report
• 15 nurses have died by suicide before the conclusion of their FtP case  from 2015/16 to Feb 2019

We are struggling to attract nurses and midwives to the profession, it is in crisis point with safe staffing headlines hitting our press almost daily.

2016 figures from the NMC showed that 4 out of 5 nurses struck off the register were over the age of 40.  Anecdotal evidence from our group’s membership certainly seems to point to nurses and midwives with long service going through the process.  The FtP Annual report for 2019 also supports this and showed that those aged 31–40 and the 61 and over have higher proportions of striking off orders, with over one-third of cases for these groups receiving this sanction. The report also showed that male nurses and midwives had a higher proportion of cases that received a striking off order (33 percent) compared with female nurses and midwives (21 percent of women). This is likely to be related to the fact that men make up a higher proportion of people who are referred to fitness to practise.

The NMC has a strong role to play in leading the way forward to assist nurses and midwives to continue as positive members of the workforce through empowering, and mentoring. It needs to be mindful of not feeding the fire of blame that often precipitates referral but look at a more positive restorative approach which might help to encourage learning and retain the experience that we are currently losing.

One thing is for sure if the numbers are increasing – the current system is adding to the workforce problem not easing it.