|
I have an indefatigable indicator of the temperature of the NHS.
What's what. What's to worry over.
It’s as accurate as a canary in the mine. What is this barometer, this guage…
… it’s my inbox.
People are kind enough to find the time to write to me and tell me when I’m right and when I’m wrong, and…
... more apposite for this morning. about their facts, figures, worries and concerns.
Hence our topic this morning… my inbox has started to fill with messages; 'did you know', 'what do you think about this'...
... all about the Nursing and Midwifery Council.
Not from dangerous nurses trying to escape scrutiny. From frightened, exhausted professionals trapped in it.
The NMC’s fitness-to-practise process is supposed to protect patients, maintain standards and uphold confidence in nursing and midwifery.
It’s doing something else as well. It’s damaging people.
Since 2018, the NMC says 18 nurses and midwives have died by suicide while going through its fitness-to-practise process.
To be absolutely accurate, it does not prove the NMC caused every death. Suicide is complex and coroners must establish the facts, but…
… it proves something is very wrong when a regulator knows people in its machinery are dying and the machinery still takes years to reach a decision.
The independent review led by Nazir Afzal heard of nurses waiting four or five years. One case had been going for nearly ten.
Yes, ten years.
Long enough to lose a job, an income, a reputation, a home, a marriage and hope. By then, the process is no longer investigating a possible punishment…
… the process is the punishment.
This is not simply a story about being too hard on nurses. The NMC has managed to fail in the opposite direction as well.
The Professional Standards Authority’s latest review found it met only nine of the 18 Standards of Good Regulation. It met just two of the five standards covering fitness to practise.
In a targeted examination of 42 higher-risk cases closed at the screening stage;
- six appeared to have been closed prematurely.
- Safeguarding records were poor.
- Investigations and adjudications were still taking too long.
- People were not being kept properly informed.
Then came the discovery that health and criminal-conviction declarations had not always been referred for the required senior decision over a period of 12 years.
The NMC reviewed 18,060 cases, sought more information about 421 registrants and concluded that around 15 may never have been suitable for admission to the register.
There's the whole failure in miniature.
Some potentially dangerous cases were not pursued properly. Other nurses, not yet found guilty of anything, were left hanging for years.
The wrong cases closed. The wrong cases dragged on.
Neither swift nor sure.
The NMC says it’s improving. There's new leadership, a safeguarding hub, additional support for vulnerable professionals and £30m committed to fitness-to-practise reform.
The proportion of cases completed within 15 months has risen from 61% to around 74%... an unimpressive 13%.
That's sort of progress, but look again. It still means about one case in four takes longer than 15 months. The overall caseload grew from 6,357 to 6,725 as referrals outpaced completed cases.
The queue is moving faster, but it is still getting longer. Someone at the NMC needs to have a look at queue-theory and Little's law.
From October, legally qualified chairs will lead some hearings. Sensible, perhaps, but a lawyer at the end of a five-year queue is not a rescue plan.
The NMC now needs firm external control of its recovery;
-
Published monthly figures showing the age of cases at every stage;
-
A named person responsible for every case;
-
Automatic independent review when deadlines are breached;
-
Proper clinical involvement in decisions; and …
…an independent examination of every suicide or serious self-harm occurring during proceedings.
In fourteen years, the NMC’s fee income has doubled and its own workforce has more than trebled. Its register has grown, but only by about 29%.
The NMC is asking nurses and midwives to pay nearly a fifth more to register…
… not after demonstrating regulatory excellence, but after its independent overseer found that it met only half the standards expected of it.
From October registration goes up to £114.40, regardless of band and after tax. An old survey indicated 70% of nurses don't claim tax relief.
Here's how to do it.
Nurses may reasonably ask whether they are being charged more for better regulation, or being made to pay for the consequences of institutional failure.
Nurses and midwives need protection from an incompetent process that can consume their careers before deciding whether they did anything wrong.
'Fitness to practise' is the question the NMC asks of nurses.
It's time Parliament asked; is the NMC fit to practice.
| 
