The NWC suggests that concerns relating to its members' fitness to practise must first be reported to the employer of the nurse or midwife concerned. However employers, the police, or indeed anyone can make such a report to the Council. Such a report must include permission for disclosure of the complaint by the Council to the nurse or midwife. Working through a "fitness to practise" complaint can be protracted. The Council aims to complete an investigation within 65 weeks.
A "triage team" considers a complaint and takes a preliminary view of whether there are grounds for an investigation. If they do feel that there are grounds, the matter is passed to a case progression team. This gathers all the relevant evidence and the nurse or midwife concerned is given an opportunity to respond in writing to it. All the information is then referred to an Investigating Committee panel. This is made up of nurses/midwives and lay people. It meets in private and considers whether there is a case to answer. Before doing so it may ask for expert advice or for further investigation. It may instruct solicitors to investigate, identify witnesses and to gather relevant evidence.
If the investigating committee determines there is a case to answer it will refer the case to the Conduct and Competence Committee or the Health Committee. These committees too are composed of nurses/midwives and lay people.
The Council lists the kinds of matters it will consider when it is adjudicating on "fitness to practise” as including dishonesty, patient abuse, lack of competence, failure to maintain a adequate records, incorrect administration of drugs, neglect and basic care, unsafe clinical practice, failure to collaborate with colleagues, colleague abuse, failure to report incidents, failure to act in an emergency, accessing pornography, and violence. Conduct and competence cases are generally heard in public whereas health cases are generally in private. Nurses and midwives are encouraged to be represented and parties and witnesses are subject to questioning.
Decisions are made according to the civil law standard of proof, i.e. the balance of probabilities (i.e. 51%). The committee will consider three questions. Are the facts proven or not proven? Is the fitness to practise of the nurse or midwife impaired? What actions are required to protect the public?
If action is necessary, in considering what action to take the committee will take into account factors such as previous disciplinary action taken and how the nurse or midwife in question has responded to this, the availability of training and support, staffing issues which may have affected a nurse or midwife's performance (such as bullying, victimisation or insufficient staffing), or unreasonable role demands.
Orders the committee may make include the following:
- cautions, which may last for between 1 & 5 years;
- conditions restricting the practice of the nurse or midwife for 1 to 3 years. These are used when the nurse or midwife is considered capable of improvement. They may for example restrict the scope of the work done by the nurse or midwife or require it to be done only under supervision;
- suspension for up to 1 year;
- striking off.
The nurse or midwife may appeal to the High Court against an order of the committee, as may the Council for Healthcare Regulatory Excellence in the event that it considers the order to be unduly lenient.
If you are the subject of an investigation you should take advice at the earliest opportunity. It may be that your professional association or insurer will assist you. With their approval or if you wish to choose your own source of legal advice and assistance, we can advise you in these processes and can represent you in any proceedings.
