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Scrutinising final fitness to practise decisions

We have concluded three cases related to our power to appeal fitness to practise panel decisions if we believe the original determination is insufficient to protect the public. The cases involved Nursing and Midwifery Council (NMC) decisions.

Two nurses who failed to assess a vulnerable patient who went on to complete suicide

This appeal relates to the NMC’s Fitness to Practise Committee decision to impose cautions on two registrants who had undertaken an inadequate mental health assessment of a vulnerable patient who then went on to complete suicide. The two registrants lied about their assessment during both the Trust’s internal investigation and the Coroner’s inquest. Unknown to the registrants, the patient had recorded the assessment and this recording showed how inadequate their assessment had been. The NMC conceded the appeal in respect of both registrants. A consent order was agreed in respect of one registrant substituting suspension for six months with a review. Our appeal in respect of the other registrant was heard in the High Court on 6 February and the decision was delivered on 9 May 2019. We argued five grounds of appeal that the NMC’s panel:

  • was wrong in assessing clinical failings as only being capable of impairing fitness to practise on public protection grounds
  • was wrong in assessing dishonesty as only being capable of impairing fitness to practise on public interest grounds
  • failed to have regard to the sanctions guidance, dishonesty guidance and relevant aggravating features
  • irrationally found the dishonesty to be at the lower end of the spectrum
  • failed to provide adequate reasons for its decision.

The Authority’s appeal was allowed, the original NMC committee’s sanction decision to impose a three-year caution was quashed and the case has been remitted to the NMC for re-determination and to address the deficiencies highlighted in the appeal. 

A nurse who was involved in a sexual relationship with a vulnerable patient

This was an appeal against a decision of the NMC’s Fitness to Practise Committee to suspend a registrant for nine months with no review in respect of her sexual relationship with a vulnerable patient which continued for over 16 months. The registrant denied the sexual relationship but this was found proved. Impairment was found only on public interest grounds although the registrant did not give further evidence after the findings of fact. Both respondents (the NMC and the registrant) conceded aspects of the appeal and a consent order was agreed imposing the sanction of nine months’ suspension with a review in place of the original sanction and setting out the basis upon which the review panel should consider current impairment, which was approved after a short hearing.

A nurse who was convicted and received a prison sentence for injuring a baby

This was an appeal against an NMC decision to suspend a registrant for seven weeks with no review hearing in respect of her conviction for wounding/inflicting grievous bodily harm to a baby in her care. She received a sentence of eight months’ imprisonment suspended for 14 months as a result of the injury to the baby which happened when she was changing a nappy. The registrant escalated the possibility of injury and a fracture was diagnosed. The NMC did not produce the expert reports upon which the registrant’s guilty plea was based and the panel did not consider there was any ongoing public protection concern about the registrant’s competence and simply imposed the suspension to mark the conviction. The NMC and the registrant conceded the appeal and a consent order has been approved by the Court. The original decision was quashed and substituted with a six-month suspension order with review and the review panel are required to consider whether a number of documents including the expert report referred to above and whether there are any public protection concerns.

Cases waiting to be heard by the Court

There are currently six appeals (submitted under Section 29) awaiting hearing before the High Court.

CanadaTowards the end of 2018 we were asked by the Saskatchewan Registered Nurses Association (SRNA) to carry out a review of their complaints, investigations and discipline functions. We made a total of 33 recommendations to help them improve in the report. You can find out more about this review in our Research and Policy update.



Performance reviews

Our most recent performance reviews published are for the Nursing and Midwifery Council and the Pharmaceutical Society of Northern Ireland:

Nursing and Midwifery Council

The NMC has met 22 out of 24 of our Standards of Good Regulation. The Standards not met relate to the transparency and fairness of its fitness to practise processes and keeping parties updated. This is our first review of the NMC since we published our lessons learned review (May 2018). We are pleased that the NMC has instituted a plan of work to address the concerns we outlined in our review. However, we also had concerns about how the NMC handled complaints raised about registrants who have conducted Personal Independence Payment (PIP) assessments. We considered that the NMC did not systematically consider all the concerns raised by complainants, relied on the views of employers for reasons to close cases without proper scrutiny, and did not obtain sufficient evidence to reach its decisions. We considered that these issues created a barrier to vulnerable people raising potentially serious concerns. The NMC agreed with our findings and is taking steps to address the concerns. You can read the full report or a summary in our snapshot.

Pharmaceutical Society of Northern Ireland

The PSNI met all 24 of our Standards of Good Regulation for the third consecutive year. Find out more in the full report or read a summary in our two-page snapshot.

Look out for our next performance review - we will be publishing the General Dental council's latest review towards the end of May.

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