The NMC, which is the largest regulator in the world, regulating over 685,000 nurses and midwives across the UK, has released statistics which make for very interesting reading. It has reported:
- An overall increase of over 10% in complaints it has received about nurses and midwives. In 2013/2014 it received 4,689 complaints. This figure rose to 5,183 in 2014/2015. With the exception of 2012/2013, the number of new referrals has increased each year since 2010.
- A huge increase of 47% in the number of referrals made by members of the public in 2014/2015. The biggest referrers to the NMC, comprising 40% of NMC complaints, were employers. Patients and members of the public were the second most common referrer, accounting for 29% of complaints.
- A steep increase over the past 5 years in the percentage of referrals in relation to allegations of misconduct, from 51% in 2011/2012 to 80% in 2014/2015.
- A decline in striking-off orders, which made up 48% of the adverse findings in 2011/2012, but now account for 28% of sanctions at final hearings.
Perhaps the most noteworthy of the above statistics is the huge increase in referrals from members of the public. This of course begs the question: what is the reason behind this striking increase?
NMC awareness campaigns
Perhaps one explanation for the increase is that the NMC has dedicated additional time and resources to raising awareness of its disciplinary function. Following the recommendations in the Health Select Committee’s 2013 report, the NMC increased its spending on marketing to £1.7 million. In 2014/2015, the NMC attended more events and heightened its engagement with stakeholders, particularly in relation to revalidation following the Mid-Staffordshire crisis.
There has also been heightened media attention in relation to perceived misconduct by nurses and midwives. In the last few weeks alone, one tabloid referred to incidents of nurses administering incorrect and fatal dosages of prescription drugs, “hurting and humiliating elderly patients” and a midwife “deliberately drugging” 15 pregnant women. At the same time, another tabloid reported that a nurse in Scotland “terrified” a patient by her “lewd” and aggressive behaviour.
The considerable media interest in the behaviour and subsequent disciplining of nurses and midwives across the UK may well be linked to the increase in referrals as a whole. In particular, the reach of this publicity has penetrated beyond the professional spheres and into the public domain.
While we’d like to say that the increase is purely due to heightened awareness and press interest, it may be that there have been more instances of mistakes and errors being made by nurses and midwives in the past year. The pressures of cuts and short-staffing may well have impacted on the ability of some nurses and midwives to carry out their duties to the same high standards. These concerns have also been well-publicised. For instance, it was recently revealed that nine out of 10 hospitals in England are reporting dangerous shortages of nurses on their wards, and even that higher death rates had been directly caused by a drop in neonatal nurses.
The dramatic increase in referrals received by the NMC may be an indicator of the problems facing health and care services in the UK, but it also points to the NMC’s much stronger presence in the public eye. This may be the result of a growth in the public appetite for news stories about misbehaving professionals.
If this increase in referrals continues, it could result in nurses and midwives feeling that they are under constant threat of a complaint. Indeed, registrants may start to treat patients in a “defensive manner”, being more concerned about the threat of litigation than the care of the patient and focussing on recording their actions in the notes rather than talking with or caring for the patient.
Mistakes will happen and not every mistake should result in a nurse or midwife being reported to their regulatory body. Moreover, with 53% of the referrals to the NMC’s Investigating Committee being closed on grounds of there being “no case to answer” and 23% of final hearings resulting in a finding of no impairment, practitioners should be reassured that a complaint will not inevitably result in a sanction.
The NMC must get the balance right between protecting the public and recognising that the majority of nurses and midwives in the UK provide excellent patient care and should be given the freedom to continue to do so. Does this increase in the number of complaints from members of the public indicate that it is time for a review of the types of cases that the NMC is bringing?