It has been a year of change for the Nursing and Midwifery Council’s fitness to practise process. There is now a single Fitness to Practise Committee, replacing both the previous Conduct and Competence Committee and the Health Committee.
New powers and strategic direction
Since July 2018 new powers allow case examiners to close cases by issuing a warning, by giving advice or by agreeing undertakings. Previously, case examiners could only either close a case with no further action or refer for a hearing.
A new strategic direction, ‘Ensuring patient safety, enabling professionalism’, is being implemented. It endeavours to shift a culture of blame to one of learning from mistakes. Such themes have also been echoed in the Health and Social Care Committee meeting held last month when consulting on the Williams review into gross negligence manslaughter in healthcare.
Fitness to Practise Annual Report
Earlier this month, the NMC published its Fitness to Practise Annual Report for 2017-2018. This year, 5,509 new concerns were raised with the Council; broadly similar to the number of concerns raised in 2016/17. Of the 5,509 referrals, 40% were from employers, whilst 27% resulted from patient/public complaints.
Of the total concerns raised this year, 3,081 were closed after initial assessment, amounting to a closure rate of 56%. This compares to a closure rate of 60% in 2016-2017. Case examiners’ powers to issue warnings, give advice and issue undertakings resulted in fewer cases progressing to a hearing than last year: 37% in 2017-2018 as against 57% percent in the previous year.
The report also notes an increase in the proportion of cases closed by case examiners with no further action. This is up to 57% from 43% of cases in the preceding year. The NMC says it will continue to monitor the closure rate carefully, and has not identified any particular trends in relation to these cases.
When it comes to the outcomes of panel hearings, the panels made 1,207 final decisions on cases in 2017/18, with 23% of those finding the registrant’s fitness to practice is not impaired. This compares favourably to last year when 278 cases outs of 1,513 resulted in a finding of no impairment. This an absolute increase of 5% in the proportion of cases in which a finding of no impairment was made. The NMC notes that this ‘may reflect better engagement with registrants at the hearing stage and a greater willingness on their part to provide evidence of remediation and insight.’
The changes being implemented by the NMC fitness to practice process are significant. As well as promising significant costs savings (an estimated £2 million between August 2017-March 2018), as the number of hearings reduces, there will be a significant impact on registrants, patients and members of the public who do not have to go through the stress of a substantive hearing.
The case examiners’ new powers bring the NMC in line with many other healthcare regulators such as the GDC and GMC. It is hoped that this pragmatic and proportionate approach to case disposal will ensure that the most serious cases progress to a substantive hearing.