Andrea Sutcliffe, CEO The Nursing and Midwifery Council

23 Portland Pl, London W1B 1PZ

Thank you for your statement to nurses, midwives and nursing associates published on the 11.1.23 and also for your joint letter with the UK’s Chief Nursing officers and the CQC on how you support professionals.  We were pleased to see you acknowledge the extremely difficult situations we are all working in currently and that the NMC is committed to capturing this context in any referrals they may receive through the Fitness to Practice departments. We were also pleased to hear you highlight the importance of taking responsibility for personal well-being and health whilst working in these circumstances and have been encouraged by the contextual form that is now being sent to registrants to complete. 

On reading the following we were somewhat confused : "...may need to depart from established procedures to care for people, we understand some could be fearful that they will be referred to your regulator. Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision-making in all circumstances" . In a workplace that is stressed, under resourced and uncertain, individuals are at  high risk of making mistakes. There is a high probability that when these individuals escalate concerns about the workplace environment that those responsible will blame the individual rather than review the process.  How will you get to the true root of the problem? All cases we have observed over the last few years have orientated about how the practitioner has diverted or potentially diverted from their code of conduct. The Code is a blunt tool which is difficult to flex around context and cases as recent as the last few months have not shown any difference in this approach. It is unrealistic to suggest a nurse leave her workplace for example, if they feel the workplace is unsafe, their duty of care will always override their ability to safeguard themselves. They may feel unable to escalate those concerns to management or colleagues for fear of reprisals and so for many of them, disclosing to yourselves is the first time they have felt able to do so. Therefore we know that the NMC is has a pivotal role to play in gathering intelligence about workplace culture and we feel that not enough is being done to address this. 

The NMC teams have  a long way to go in not being complicit to the poor workplace culture that currently exists in some units. As our regulator it is imperative that your teams are receptive when registrants disclose to you, as per Duty of Candour, aspects of their workplace that may have contributed to their issues arising, or when managers have ignored them raising concerns have led to vexatious referrals. We are encouraged to hear you are monitoring the numbers of referrals from each source but in the ethos of transparency would encourage publication of this data, so that registrants can consider this when seeking employment and making employment decisions. We also believe it would then encourage those who refer frequently to review why this is and put in positive change to address why. The BBCs news night program on Friday 13th January 2023 discussed this issue in so far as 26 doctors being referred to the GMC being found to have no case to answer. We would go further to say that any regulator has a duty to. monitor referrals and track themes. Many nurses and midwives will not be in a union so have the potential to have worse outcomes than any colleagues who are represented. The correct outcome should not rest solely on whether someone has representation, it should be based on fact finding and truth. 

We were also encouraged to read the response from the NMC on vexatious referrals, sent by Alex Urquart to NMCWatch recently, but again this current guidance falls short of what really is required. From discussing with those we are supporting, many claim that they have indeed been the only ones to provide robust information on the referral and yet are finding many months, if not years to wait for the case to be closed as promised in the following document. The contextual forms have been used routinely for some time now and yet many of these cases have continued with those themes since these forms have been introduced. 

Finally we are getting a large number approach us who are not in unions. We would encourage you to return to the stance of 3 years ago where registrants could be informed about our voluntary peer to peer support group. We have shown that by giving support, registrants engage with the process more positively and ultimately we help reduce the fear, isolation and anxiety that they experience during FtP. 

We are asking for you to urgently examine the following 10 aspects:

1.     The numbers of referrals received with no supporting evidence on initial receipt of referral

2.     The numbers of referrals not supported by additional evidence for allegations by 3months from referral

3.     The numbers of referrals not supported by additional evidence for allegations by12months from referral

4.     How many cases have been closed in the last 12months due to context provided by the registrant

5.     Numbers of cases in the last 2 years that have closed at hearing through either lack of evidence or lack of engagement of witnesses

6.     Numbers of cases in the last 2 years where a registrant unrepresented and not present has NOT been struck off. 

7 . Publication of employers and their referral numbers to Fitness to Practice, regardless of final outcomes. 

8. Publication of lessons learnt and education pieces on those "top" referral centres. eg Barchester Healthcare

9. A robust vexatious referral policy ( such as Social work England have in place )

10. Signposting to NMCWatch: registrant care CIC so that no registrant is alone in the FtP process

Yours sincerely

Members & Supporters of NMCWatch: registrant care CIC

(email support@nmcwatch.org.uk)