Nursing and Midwifery Council (NMC) Lawyers Glasgow
ALL nurses in the UK must be registered to work – which means any threat to that registration is a threat to their livelihood. Increasingly, the Nursing and Midwifery Council (NMC) are using their legal powers to strike off or suspend nurses from the register after complaints. Employment solicitor Stephen Smith, who has represented clients at NMC hearings, explains what is involved:
WHO ARE THE NMC?
The Nursing and Midwifery Council is the regulator for nurses and midwives for England, Wales, Scotland, Northern Ireland and the Islands. There are currently more than 670,000 registered nurses and midwives. In comparison, the General Medical Council (GMC) has around 240,000 doctors on its register.
WHAT RIGHTS DO THEY HAVE?
It is illegal to work as a nurse or midwife without being on the NMC register. In order to be on the register, nurses and midwives must pay a yearly fee (currently £100) and demonstrate that they have kept their skills and knowledge up-to-date. The NMC have the power to impose sanctions on a nurse's practice, including removing from the register or "Striking Off."
HOW MANY CASES DO THEY DEAL WITH?
In 2012-13, the number which proceeded to a final outcome before a Panel was 1,535 compared to 911 the previous year. However, that is still less than a quarter of one per cent of all those registered.
HOW OFTEN DOES STRIKING OFF HAPPEN?
More than 1000 nurses a year have sanctions imposed on them by the Nursing and Midwifery Council. The last figures published, for 2012-3, showed that 589 Striking-off Orders were granted, a substantial increase from 365 the previous year. The NMC also granted 242 Suspension Orders (up from 136), which mean the registrant can't practise for a set period of time, 160 Conditions of Practice Orders (up from 51), which restrict a nurse's practice for up to three years, and 163 Caution Orders, or reprimands (up from 98).
WHO IS TOLD ABOUT THESE?
The NMC publish online a list of those nurses who have been asked to attend hearings about their registration, which include the name of the nurse or midwife (but not the address) and the type of hearing. They also publish the outcome after the hearing. This can be searched by anyone, and remains online long after the hearing. The cases are regularly noted and reported on by local newspapers and other media.
WHAT TYPE OF THINGS DO THE NMC INVESTIGATE?
Their remit is to look at "Fitness to Practise" which is a person's suitability to be on the NMC register without any restrictions. Allegations that Fitness to Practise is impaired can relate to allegations of misconduct, incompetence, criminality, or physical or mental health problems. The allegation can also be about behaviour outwith work, and any conviction for crimes of violence or dishonesty would normally result in an investigation, as well as any sexual offence.
WHERE DO THEY GET THEIR INFORMATION?
The allegations can come from patients and their families, the general public, from other regulators (such as the Care Inspectorate), or from employers. They can be made anonymously. The registrant can also ask to come off the register voluntarily – for example, if they are not working due for health reasons. However, where the NMC is investigating a serious misconduct issue, they may not accept this, and insist on reaching a funding.
WHAT RIGHTS DOES THE NURSE HAVE?
Nurses and Midwives have the right to defend themselves against any allegations, to put forward any evidence that contradicts the allegations made and to question any witnesses. They are also allowed to be represented by a solicitor at hearings, who will be able to make submissions before any decisions are taken. However, the NMC also have their own lawyers, and frequently use barristers or advocates at hearings.
WHAT HAPPENS DURING AN INVESTIGATION?
Initially, the NMC will investigate the matter to determine whether there is a case to answer. At this stage, the registrant is not entitled to a hearing. However, if the NMC decide there is a case to answer, the registrant will be informed and have the right to comment, via correspondence initially. The NMC may take steps to impose an Interim Suspension Order which would remove the nurse or midwife from the Register until the outcome of the case. To obtain an Interim Suspension Order, the NMC must persuade a Panel of experts drawn from the profession that this is necessary for the protection of the public. This takes place at a hearing and the NMC will usually be legally represented.
WHERE DO THE HEARINGS TAKE PLACE?
In Scotland, most take place at the NMC's offices in George Street in Edinburgh, although other venues can be used.
HOW LONG DO THEY TAKE?
Usually a full day, as the usual NMC format is that, once both sides and their legal representatives have presented their case, the expert panel will retire and discuss its verdict, and this will then be typed up before being delivered.
WHAT TYPE OF THINGS ARE TAKEN INTO ACCOUNT?
The NMC has published guidelines on the type of things panels should consider when they are deciding if a sanction should be imposed. These include:
- is there evidence of harmful deep-seated personality or attitudinal problems?
- are there areas of the nurse or midwife's practice which need retraining?
- is there evidence of general incompetence?
- is there a willingness to respond positively to retraining?
- does the nurse or midwife accept they have a health problem and are prepared to agree to abide by conditions on medical treatment and supervision?
- will patients be put in danger either directly or indirectly?
- can the nurse or midwife's future actions be monitored?
IS THERE A RIGHT OF APPEAL?
Any appeal would have to go to the Court of Session, within 28 days, but usually it will only be if the panel has made a legal error that this type of challenge can be made. Any finding the panel make about the registrant's credibility or suitability is very difficult to challenge. However, if the registrant's situation should change or they have some new evidence, this can be discussed at a subsequent panel Review hearing.
HOW LONG DO ANY SANCTIONS LAST?
After five years, a nurse or midwife who has been struck off can apply to go back on the register. Lesser sanctions can be reviewed at subsequent Review hearings, which take place at least once a year until the period during which any conditions imposed lasts. Caution Orders stay on the registrant's record for up to five years.
CAN I GET ANY HELP WITH LEGAL FEES?
Union members are usually only entitled to advice from a solicitor of the union's choice, although in some cases the registrant can obtain funding for specialist representation. Many home and car insurance policies now offer "legal cover" which mean legal fees will be met for pursuing a case by the insurance company. If the registrant is on a low wage or not working, some funding through Legal Aid may be available, although this will depend on circumstances and is not available for representation at hearings.
IF I CAN'T GET ANY HELP, WHAT WILL I HAVE TO PAY?
Initial advice on an active investigation tends to cost £400-£600, depending on the history and amount of paperwork. Fee quotations will always be given in writing before any work starts. An initial payment of £200 is required at the outset, and we can allow invoices to be paid up over a period of months. However, there is no charge at all for us responding to your initial telephone or e-mail inquiry.
Read Stephen Smith's latest blog posts on the NMC:
- MPs say UK law is failing to protect whistleblowers
- NMC backs Whistleblowing campign
- Courts taking tougher line on NMC delays
- NMC brings in new registration rules for overseas nurses
Contact our Nursing and Midwifery Council (NMC) Lawyers Glasgow
The Glasgow Law Practice regularly advised Registrants regarding Fitness to Practice cases. We offer fixed rate packages so you know exactly how much you will pay at the outset. The Glasgow Law Practice's employment solicitors are Stephen Smith ([email protected]) and Louise Bain ([email protected])