Preliminary consideration of allegations guidance
Introduction
1.
The Nursing and Midwifery Council (NMC) regulates nurses and midwives in
England, Wales, Scotland and Northern Ireland. We exist to ensure the safety
and wellbeing of people who rely on the care provided by nurses and midwives
on our register. 1
2.
We consider allegations about the fitness to practise of nurses or midwives 2. We
also consider allegations about whether the entry of an individual nurse or
midwife on our register may be incorrect, or may have been made as a result of
fraud. Our statutory powers to carry out investigations are limited to these two
kinds of allegation 3. This guidance focuses on allegations about the fitness to
practise of nurses and midwives; guidance on our decision-making in cases of
potentially fraudulent or incorrect register entries can be found on our website.
Dealing with allegations about the fitness to practise of nurses
and midwives
3.
When we receive allegations which could equally affect a nurse or midwife's
entry on the register and their fitness to practise, we will prioritise the allegation
of incorrect or fraudulent entry. Only where we decide, after we have assessed
the case, that there is no allegation of incorrect of fraudulent entry, will we then
consider whether the case might involve an allegation of impaired fitness to
practise. This is because of the public interest in ensuring the integrity of our
register.
4.
This guidance explains how we assess which cases require us to carry out a full
investigation. The thresholds we set are not intended to act as a barrier to
referrals, but rather to ensure we focus our resource on cases which most need
our involvement. Our function in investigating fitness to practise cases is not to
resolve disputes between employers, individuals or other organisations and
nurses or midwives. We do not provide redress against nurses or midwives, or
impose punishment on them.
5.
We must act to protect the public when we receive concerns about nurses or
midwives which could involve risks to the safety of patients, or which could
damage the public’s confidence in the nursing and midwifery professions. To
1 Article 3(4) Nursing and Midwifery Order 2001 states the over-arching objective of the NMC’s Fitness to
Practise (FtP) function is to protect the public. Article 3(4A) states that this is achieved by undertaking to:
a) protect, promote and maintain the health, safety and well-being of the public; b) promote and maintain
public confidence in the professions regulated under this Order; and c) promote and maintain proper
professional standards and conduct for members of those professions.
2 Specifically, whether the fitness to practise of a nurse or midwife is ‘impaired’ because of one of the five
grounds set out in article 22(1)(a) of the Nursing and Midwifery Order 2001.
3 Nursing and Midwifery Order 2001, article 22(1).
ensure we can do this effectively, we must act proportionately. Our ability to take
considered and effective regulatory action will be lessened if we expend resource
investigating cases which do not involve serious concerns about patient safety or
public confidence in the nursing and midwifery professions. 4
Fitness to practise proceedings
6.
Under Article 22(1)(a) of the Nursing and Midwifery Order 2001 (the Order) a
nurse’s or midwife’s fitness to practise may be impaired by reason of any or all of
the following.
6.1
Misconduct.
6.2
Lack of competence.
6.3
A conviction or caution in the United Kingdom for a criminal offence, or a
conviction elsewhere for an offence which, if committed in England and
Wales, would constitute a criminal offence.
6.4
Physical or mental health.
6.5
Not having the necessary knowledge of English.
6.6
A determination by a body in the United Kingdom responsible under any
enactment for the regulation of a health or social care profession to the
effect that the nurse’s or midwife’s fitness to practise is impaired, or a
determination by a licensing body elsewhere to the same effect.
The four stages of preliminary consideration
7.
Our preliminary consideration of allegations, and our assessment of whether a
case requires a full investigation, involves the following four stages, which are
intended to work in sequence. If our assessment about a case at the first stage,
for example, is that the facts of the case do not appear to be serious enough to
affect the fitness to practise of the person concerned, our decision will be that the
case does not require investigation. We would not then proceed to the second,
third or fourth stages.
8.
Our approach is set out in the following sections of this guidance:
8.1
Whether the apparent facts of the case are serious enough to raise
concern that the fitness to practise of a nurse or midwife may be currently
4 We consider that the principle of right-touch developed by the Professional Standards Authority
(http://www.professionalstandards.org.uk/policy-and-research/right-touch-regulation) is helpful in
emphasising the need to identify, quantify and understand risk, assess whether regulation is the right way
to address it, and be proportionate and targeted in regulating the risk (applying only the right amount of
‘regulatory force’, having regard to the desired outcome of public protection). This guidance also aims to
assist us in meeting the Standards of Good Regulation, and in particular ensuring that our fitness to
practise process is transparent, fair, proportionate, and focused on public protection.
Page 2 of 15
impaired, as a result of any risk to members of the public, or the public
interest (paragraphs 9-51 below).
9.
8.2
Whether the referral to us meets our formal requirements (paragraphs 5263 below).
8.3
Whether we will be able to obtain credible evidence to support the
allegation (paragraphs 64-71 below).
8.4
Whether there is evidence that the nurse or midwife has addressed the
concerns involved and whether we can be confident that any risk affecting
patient safety or the public interest has been met without the need for
regulatory intervention (paragraphs 72-75 below).
This guidance will also explain the effect of decisions not to refer cases for
investigation (paragraphs 76-78 below).
Stage one: allegations sufficiently serious to affect fitness to practise
10.
Firstly, we assess whether the facts involved are so serious that they call into
question the fitness to practise of the nurse or midwife concerned. This is what
we mean by an allegation that the fitness to practise of a nurse or midwife may
be impaired.
11.
Impaired fitness to practise means more than a suggestion that a nurse or
midwife has done something wrong or failed to do something that they should
have. It means a concern about their conduct, performance, health or knowledge
of English, which is serious enough to raise doubts about whether they should be
allowed to continue to practise as a registered professional, either with some
form of restriction on their practice, or at all.
12.
We focus on current impairment of fitness to practise. Our process does not exist
to punish nurses or midwives or provide redress for past incidents, although it
does take into account past acts or failings in assessing current fitness to
practise. In some cases the seriousness of past events means a finding of
impairment is required to protect the public interest 5, even where any clinical
concerns have been addressed and the nurse or midwife’s practise no longer
presents a risk of harm to patients.
13.
The fitness to practise of a nurse or midwife may be impaired by reason of one of
six statutory grounds, which are set out in more detail below. 6
5
Council for Healthcare Regulatory Excellence v (1) NMC (2) Grant [2011] EWHC 927 (Admin).
Under article 22(1)(a) Nursing and Midwifery Order 2001, these are (i) misconduct; (ii) lack of
competence; (iii) convictions or cautions in the UK or abroad (for offences which would constitute a
criminal offence if committed in England and Wales); (iv) physical or mental health; (v) not having the
necessary knowledge of English; or (vi) determinations by other health or care professional bodies in the
UK, or licensing bodies elsewhere.
6
Page 3 of 15
Misconduct
14.
Misconduct refers to conduct which falls short of what would be proper in the
circumstances. The Code presents the professional standards that nurses and
midwives must uphold, whether they work in a clinical, managerial, teaching or
research role.
15.
Conduct which takes the form of breaches of discipline between employer and
employee such as poor timekeeping, or failures to follow local policy, will not
require our regulatory involvement, unless it could affect patient safety, the
upholding of professional standards or public confidence in the professions. An
isolated clinical error or incident, unless it is particularly serious, is unlikely to call
into question a nurse or midwife’s fitness to practise.
16.
Misconduct can involve issues outside of professional or clinical performance.
This includes the conduct of a nurse or midwife away from their working
environment, but only where it could affect the protection of patients, undermine
public confidence or the expectations of the standards of conduct and behaviour
to be followed.
Lack of competence
17.
We recognise that nurses and midwives sometimes make mistakes or errors of
judgement. It would not promote our objective of protecting the public or
upholding public confidence in the professions if nurses or midwives felt that
every minor lapse would lead to their regulator intervening in their practice, since
this could lead to an overly defensive approach to delivering care.
18.
Unless it was exceptionally serious, a single clinical incident would not indicate a
general lack of competence on the part of a nurse or midwife. Substandard care
that calls into question a nurse or midwife’s competence would usually involve an
unacceptably low standard of professional performance, which could put patients
at risk, judged on a fair sample of the nurse or midwife’s work. The core issue is
a lack of knowledge, skill or judgement to be capable of safe and effective
practice.
Criminal convictions and cautions
19.
Not every criminal conviction referred to us will raise a fitness to practise concern.
We will only take cases forward where the conviction raises a risk to patients or
the reputation of the professions. In assessing the potential effect on the
professional standing of a nurse or midwife having been involved with the
criminal justice system, we need to apply a number of different considerations
and acknowledge a variety of legal circumstances. Our approach to these
features is set out in this guidance.
20.
We will seek police information to verify the scope and nature of any offending
referred to us. We will do this only once we have made the decision that the
conviction, and any information we have gathered about the surrounding
circumstances, would be sufficiently serious to call into question the nurse or
midwife’s fitness to practise.
Page 4 of 15
Referring serious convictions directly to the Conduct and
Competence Committee
21.
If a nurse or midwife has been sentenced to immediate imprisonment or where
the offences would have formerly have been a ‘serious arrestable offence’, or
involved hate crime or child pornography, we may pass the case directly to the
Conduct and Competence Committee for determination 7. We do this because the
nature of these convictions intrinsically affects the reputation of the professions
and a finding of impaired fitness to practise will be required to protect the public
interest.
Informing the NMC of convictions or cautions
22.
Anyone applying to join our register must declare any cautions or convictions at
the time of their application. Nurses or midwives renewing their registration are
also required to make the same declaration. If convictions or cautions are not
disclosed during these applications, the entry on the register of the nurse or
midwife concerned may be called into question. Any evidence that the nurse or
midwife was dishonest in an application to join our register or renew their
registration will inevitably mean we will need to carry out a full investigation into
the circumstances.
23.
Not informing us of a conviction or caution is a clear breach of the Code. If we
decide that a failure to inform us of convictions or cautions does not call into
question a nurse or midwife’s entry on our register, we will usually need to carry
out a full investigation into any possible misconduct.
24.
We will need to perform these assessments regardless of whether the offending
itself was serious, because of our clear expectation that nurses or midwives
should be candid with their regulator about any criminal offending they are
involved in.
Conditional discharges, absolute discharges and admonitions
25.
Where a nurse or midwife has received a conditional discharge, an absolute
discharge, or an admonition in Scotland, there is no basis for an allegation that
the nurse or midwife’s fitness to practise is impaired by reason of that conviction.
In appropriate circumstances, however, we may investigate the underlying
misconduct that led to the conviction. We will do this where the facts suggest
particularly serious misconduct, including dishonesty, violence, or sexual
offending, especially where it relates to a nurse or midwife’s professional
practice.
Protected cautions and convictions
26.
We will not investigate allegations that the fitness to practise of a nurse or
7
Article 22(5)(b)(ii) requires us to refer allegations (as soon as reasonably practicable after they are
received in the form required) to a Practise Committee. This includes referral directly to the Conduct and
Competence Committee without consideration by our Case Examiners.
Page 5 of 15
midwife is impaired due to a conviction or caution which has become ‘protected’. 8
Once the relevant time period has passed since the date of a single caution or
conviction it will become protected. At this point it does not need to be disclosed
to us, as it cannot be considered as part of a fitness to practise allegation.
27.
In England and Wales, a caution is protected if six years have elapsed since the
date of the caution (or two years if the person was under 18 at the time of the
offence).
28.
A conviction in England and Wales is protected if:
28.1
eleven years have elapsed since the date of conviction (or five and a half
years if the person was under 18 at the time of the offence);
28.2
it is the person’s only offence; and
28.3
it did not result in a custodial sentence.
29.
Where a nurse or midwife mistakenly discloses a conviction or caution which is
protected, we will not refer the case for investigation, unless it appears that the
nurse or midwife did not disclose the caution or conviction to us before it became
protected. The nurse or midwife would have remained under a duty to disclose
the caution or conviction until the time period relevant in their case (as described
above) came to an end.
30.
Protected convictions are defined differently under Scots law, in the
Rehabilitation of Offenders Act 1974 (Exclusions and Exceptions) (Scotland)
Order 2013 9. We will treat Scottish convictions which are protected the same way
as we treat protected convictions and cautions in England and Wales. The
concept of protected convictions does not exist in Northern Ireland.
Driving offences and penalty fares
31.
32.
We will not investigate referrals based on convictions for offences that are not
sufficiently serious to impact upon a nurse or midwife’s fitness to practise.
Examples might include:
31.1
Parking and other penalty charge notice contraventions.
31.2
Fixed penalty (and conditional offer fixed penalty) motoring offences.
31.3
Penalty fares imposed under a public transport penalty fare scheme.
We will assess other motoring offences on a case by case basis. We would
generally be unlikely to carry out a full investigation unless serious driving
offences are involved, or there is evidence of the public or patients being put at
risk (for example, by failing to stop or leaving the scene of a road traffic collision,
or dangerous driving).
8 As defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013).
9 We will shortly be adopting specific guidance for protected convictions in Scotland.
Page 6 of 15
33.
34.
We consider that drink-driving offences are more likely to call into question a
nurse or midwife’s fitness to practise where:
33.1
the offence occurred either in the course of a nurse or midwife’s
professional duties, driving to or from those duties, or during on-call or
standby arrangements;
33.2
there are aggravating circumstances connected with the offence (including
failing to stop or only doing so following a police pursuit, failure to provide
a specimen, obstructing police, and so on); or
33.3
it is a repeat offence.
Where a nurse or midwife has been convicted of a drink-driving offence, our
preliminary consideration of seriousness would include any available information
on the background to the offending. We may also seek information from the
nurse or midwife’s employer, general practitioner or occupational health
department, if it appears that we need to explore any underlying alcohol issues
that could mean that the nurse or midwife’s fitness to practise is impaired
because of their health.
Police investigations resulting in no conviction
35.
Where the police have carried out an investigation into possible criminal activity
by a nurse or midwife, and the case ends in no further action being taken or the
nurse or midwife being acquitted in court, we will need to consider whether we
should then carry out our own investigation on the basis of possible misconduct.
36.
In cases where the alleged conduct took place in a care setting, the alleged
victims were patients or service users, or the conduct was directly connected with
the nurse or midwife’s professional practise in some other way, we will usually
need to assess whether the facts are serious enough to support an allegation of
misconduct. This is because different considerations apply in criminal law.
37.
It may not have been possible to prove all of the elements of a particular offence
(such as assault, neglect or manslaughter) to the criminal standard, but it may
still be more likely than not that the nurse or midwife was responsible for conduct
which put patients at risk of harm, or impacted on the reputation of the
professions. This prospect could involve different questions about clinical
standards or professional practise which would not have been considered in the
criminal context.
38.
In cases without any direct connection to professional practise as a nurse or
midwife, different considerations apply. We do consider that professional
misconduct can involve conduct that is unrelated to clinical practice, if the
conduct could bring the reputation of the profession into disrepute, for example
by showing an intention to cause harm.
39.
However, where incidents which did not occur in professional practise have been
investigated by the police, and have resulted in no prosecution or the nurse or
midwife being found not guilty, there is less justification for our intervention in rePage 7 of 15
investigating the facts and re-adjudicating on matters which have been
considered fully by the criminal justice system.
40.
Unlike incidents about patient care, a further factual investigation in these
circumstances would not benefit from the specialist knowledge of regulatory
investigators or Case Examiners, or the broader regulatory approach of our
hearings before the Conduct and Competence Committee. The potential
unfairness to a nurse or midwife of facing a second investigation and hearing
process after an unsuccessful prosecution is less likely to be justified by our
statutory purpose of protecting the public, and the reputation of the professions,
where the facts involved do not relate directly to practise as a nurse or midwife.
Health
41.
We often receive referrals alleging that a nurse or midwife has a health condition.
We will not normally need to intervene in a nurse or midwife’s practise due to illhealth unless there is a risk of harm to patients and a related risk to public
confidence in the profession. We recognise there are likely to be only extremely
limited circumstances where a nurse or midwife who has (or used to have) a
health condition, but is currently able to practise safely without any risk to
patients, could be found impaired on the basis of public confidence in the
professions alone.
42.
A nurse or midwife may have a disability or long-term health condition but be
able to practise with or without adjustments to support their practice. Equally, a
nurse or midwife may be signed off as ‘unfit for work’ due to ill health, but this
does not necessarily mean their fitness to practise is impaired. Cases of ill-health
are likely to be better managed with the support of an employer to safely reduce
any risk to patients, and not require a regulatory investigation where:
42.1
The nurse or midwife has demonstrated good insight into the extent and
effect of their condition.
42.2
The nurse or midwife is taking appropriate steps to access treatment and
is following any advice from their treating health professionals.
42.3
Occupational health (where available) is providing support through the
employer.
42.4
The nurse or midwife is managing his or her practise appropriately, for
example by taking sickness absence.
43.
Referrals which indicate long-term, untreated (or unsuccessfully treated), or
unacknowledged physical or mental health conditions will be of particular
concern if they suggest a risk to public protection.
44.
Even where a health condition appears to be well-managed, the nurse or midwife
may be at risk of relapse, which could affect their ability to practise safely. In
such cases some form of restriction may be required to ensure there is no risk of
harm to patients or others.
Page 8 of 15
45.
We would usually carry out preliminary enquiries to determine whether a full
investigation is required. Our decision to do so will always balance our duty to
protect the public with the nurse or midwife’s right to privacy. We will consider the
nature of the referral and whether there is sufficient evidence to justify seeking
further information from third parties, such as the nurse or midwife’s GP or
occupational health department.
Not having the necessary knowledge of English
46.
When assessing the seriousness of a referral about a nurse or midwife’s lack of
knowledge of English, the central question will be whether the lack of knowledge
could place patients at potential or actual risk of harm.
47.
Examples of language concerns that could place the public at risk of harm
include:
48.
47.1
Poor handover of essential information about patient treatment or care to
other health professionals because of an inability to speak English.
47.2
Serious record keeping errors or patterns of poor record keeping because
of an inability to write English.
47.3
Serious failure(s) to provide appropriate care to patients because of an
inability to understand verbal or written communications from other health
professionals (or patients themselves).
47.4
Drug error(s) caused by a failure to understand or inability to read
prescriptions.
Not every language concern raised will trigger the need for us to carry out an
investigation. For example, if the concern relates to solely to poor spelling without
any suggestion of clinical impact, or difficulty in understanding regional slang or
English colloquialisms, the referral is unlikely to amount to an allegation of
impaired fitness to practise.
Determinations by other health or social care bodies
49.
Nurses and midwives may also be registered members of other health or social
care professions, which are regulated by different statutory bodies in the UK, or
may be registered with licensing bodies overseas. We sometimes receive
referrals suggesting a person registered with us as a nurse or midwife has been
found to be impaired in their practise in a different health or social care
profession, or in a different country.
50.
Our assessment of such referrals focuses on whether a finding that the fitness to
practise of a nurse or midwife in a different health or social care profession (or
their practise in another country) is impaired, or could affect their nursing or
midwifery practise in the UK.
51.
We will consider the scope and nature of the other body’s determination and the
factual background. We will assess the closeness of any connection between the
Page 9 of 15
practise of nursing or midwifery in the UK and the underlying facts or issues
giving rise to the finding. We will consider whether, in light of these questions, the
nurse or midwife could present a risk to members of the public by continued
nursing or midwifery practice, or whether the other body’s finding could affect
public confidence in the nursing or midwifery professions.
52.
We will usually carry out a full investigation in such cases unless it is clear to us
there is no current clinical risk to people relying on the services of nurses or
midwives, and no potential impact on the public interest (including public
confidence and the need to declare and uphold proper standards).
Stage two: formal requirements
53.
We are committed to operating a fair and transparent process. Before we can
begin our preliminary consideration, any referral must:
53.1
Be written, in a letter or an email, even if it was initially made by phone.
53.2
Provide sufficient detail about the individual nurse or midwife so we are
able to identify them on our register. We recognise that this is not always
easy, but knowing a first name, the date and care setting in which the
events took place is helpful;
53.3
Come from a person or organisation identifying themselves by name and
address, with consent to us disclosing their referral to the nurse or midwife
concerned. This is because we believe the nurse or midwife has the right
to know the details of the concern and the source of the complaint, so they
have the opportunity to provide a full response.
53.4
sets out the nature of the allegation and the events and circumstances
giving rise to it, in enough detail for the nurse or midwife concerned to be
able to understand and provide a response.
In writing
54.
In order to consider intervening in the practise of a nurse or midwife, we need to
be confident that we are dealing with a sufficiently precise and clear expression
of the concerns involved.
55.
Where we receive a first contact by other means, we will advise the person
contacting us of the requirement that any allegations should be made in writing,
and where necessary we will provide assistance to ensure this can be done.
Consent to disclose and anonymous referrers
56.
We will only rarely investigate an anonymous allegation. We would only usually
do so if there would be a real risk of harm to patients if the nurse or midwife
concerned was allowed to practise unrestricted.
57.
We recognise, however, that our core function is to protect members of the public
who rely on the services of nurses and midwives. For this reason, there will be
Page 10 of 15
cases which are so serious that it will be necessary for us to investigate, even
when the person making the referral wishes to remain anonymous, does not
agree that details should be disclosed to the nurse or midwife concerned, or is
unknown. 10
58.
Similarly, we avoid investigating referrals that could prejudice an ongoing police
investigation, unless the potential risks to patients are such that we need to seek
an interim order. In those circumstances, we would consider very carefully how
what forms of information we put before a panel, so that we can ensure public
protection without jeopardising the investigation.
Identifying nurses or midwives on our register
59.
We can only investigate allegations against an identified nurse or midwife who is
currently on our register. 11 We must be confident that we have correctly identified
the Personal Identification Number (“PIN”) of the nurse or midwife who is the
subject of a referral. We often receive complaints about care delivered to a
particular patient, which tell us only that nurses on a certain ward, unit, or
particular setting need to be investigated.
60.
In cases where we need to investigate in order to identify any individual nurses or
midwives concerned, we will usually ask employers or healthcare providers to
supply us with documents and information (such as rotas or timesheets) from
which we will be able to conclude that the referral relates to an identified nurse or
midwife on our register, or more than one. We will treat cases involving a number
of nurses or midwives from a particular healthcare setting (who we cannot
immediately identify) as a single referral as we gather information to identify the
individuals causing concern.
61.
If after taking reasonable steps we cannot link the referral to an identified nurse
or midwife on our register, we will not be able to investigate further.
62.
We will usually not investigate concerns or incidents which took place before the
nurse or midwife was registered with us, unless the concern is about criminal
convictions which the nurse or midwife received before they came onto our
register, but did not disclose to us when they applied for registration, meaning
that the correctness of their entry on our register may have been affected. There
may also be exceptional cases of conduct which occurred before a nurse or
midwife registered with us which, on its later discovery, may be so serious as to
appear to be incompatible with continued registration, where we would carry out
an investigation.
10 Article 22(6) of the Nursing and Midwifery Order 2001 gives us the power to carry out an investigation
into the fitness to practise, or entry in the register, of a nurse or midwife where an allegation is not made
to us under article 22(1) but it appears to us that there should be such an investigation. Accordingly, for
the reasons set out in section, we may decide to carry out an investigation in the absence of an identified
referrer, or consent to disclose the allegation to the nurse or midwife.
11 Article 22(1) of the Nursing and Midwifery Order 2001 refers to allegations against ‘a registrant’, which
is defined in Schedule 4 as ‘a member of the profession of nursing or midwifery who has been admitted to
the register…’
Page 11 of 15
63.
Where a referral does not relate to a nurse or midwife who is currently on the
register, but the person concerned appears to be registered with another
healthcare regulator, we will advise the person who referred the case to us that a
referral to a different regulator may be appropriate. We will disclose the referral
and any relevant documents to that regulator ourselves if we are asked to do so,
or if we consider that this may be necessary to protect patients or others from
harm.
64.
Similarly, where a referral does not raise concerns about the fitness to practise of
a nurse or midwife, but appears to raise serious issues of patient harm which
should be investigated by another body (such as a systems regulator or
ombudsman), we will provide that body with the appropriate information and
advice. This may include disclosure of the referral and any documents to assist
with consideration of the case.
Stage three: obtaining credible evidence
65.
Once we are satisfied that the referral discloses concerns that are sufficiently
serious to be treated as an allegation of impaired fitness to practise (or of
incorrect or fraudulent register entry), we will consider the evidence supporting
the referral.
66.
There needs to be enough evidence supporting an allegation to justify a full
investigation. We assess whether it is possible to obtain credible and admissible
evidence to support the allegation. This is particularly relevant where potential
witnesses wish to remain anonymous or tell us they do not wish to cooperate
with our investigation.
67.
This does not mean that we weigh the evidence in the same way as a Practice
Committee dealing with a final hearing, and our preliminary consideration does
not involve us deciding the facts of the case. It is the Case Examiners’ function to
decide whether a nurse or midwife has a case to answer at the conclusion of the
investigation, and the function of our Practice Committees at final hearings or
meetings to make findings of fact.
Disciplinary investigations not complete
68.
Where employers are yet to complete their disciplinary investigation we would
not generally pursue an investigation at that stage. Sources of evidence may not
have been identified and are, in fact, unlikely to be in a form that would allow us
to make a confident judgement about the case. However, we will always assess
the seriousness of what has been alleged at this early stage. If the nurse or
midwife appears to pose such an imminent risk to patients that an interim order is
needed to restrict or suspend their practice, we would commence an
investigation.
69.
Where the concerns referred before the local investigation is complete do not
result in us seeking an interim order, we will generally indicate that we do not
intend to investigate at this stage, but ask that the employer make a new referral
to us when their investigation is complete.
Page 12 of 15
70.
We emphasise, however, that we strongly encourage effective engagement with
employers, and we aim to work with senior employer stakeholders to improve
awareness of our referrals process. Our Employer Link Service 12 provides advice
for employers on making referrals in a way which best allows us to investigate
cases promptly and effectively. Employers who need guidance on referrals are
encouraged to contact the team using the details below.
Examples of useful supporting evidence
71.
72.
We require an indication of the sources of potential evidence, or other lines of
inquiry. During our preliminary consideration, we will make initial enquiries and
may contact referrers and other sources such as healthcare settings or
employers. Useful supporting evidence will usually include:
71.1
A clear and logical narrative explaining the conduct which is being alleged.
71.2
Dates of the incident(s) (including exact time and dates if possible).
71.3
Locations where the incident(s) took place (including name and address of
the organisation, and specific wards or departments where possible).
71.4
Details of who was present (including patients, colleagues or any other
witnesses).
71.5
Copies of contemporaneous notes and statements of anyone who
witnessed the events alleged.
71.6
Copies of medical records, MAR charts, prescriptions, which should be
provided with the informed consent of the patients concerned if possible,
or a clear indication as to why this has not been possible.
71.7
Local policies.
71.8
Details or documentary records of any admissions made by the nurse or
midwife.
71.9
Where the evidence that can be provided by the referrer is limited, details
of other sources of evidence in support of the allegation.
Where allegations are made anonymously by an individual who is the only
witness to the alleged events, or where the only direct witness is not willing to
cooperate with our investigation, more evidence will be required in order to
substantiate the allegation. In the absence of any indication that other admissible
evidence is available, we will not be able to continue with an investigation.
12 Employer Link Service can be contacted on [email protected] and the advice line is
(020) 7462 8850.
Page 13 of 15
Stage four: remediation and references
73.
Sometimes we receive information we receive about the nurse or midwife’s
current practise which indicates that steps have been taken to alleviate the
fitness to practise concerns since the incidents which led to the referral.
74.
Where we have decided that a referral raises issues which are sufficiently
serious to call into question the fitness to practise of the nurse or midwife, and
there is a real prospect of obtaining credible evidence, we will gather information
to determine whether the nurse or midwife has taken appropriate steps to
mitigate the risks presented by the case.
75.
If the nurse or midwife has professionally reflected on the issues raised in the
case, and there is evidence of relevant retraining or learning, we may decide that
they no longer present any risk to patients or members of the public.
76.
In all cases, we will also need to assess whether the nature of the past events
are so serious that one of our Practise Committees would be required to make a
public declaration about the nurse or midwife’s fitness to practise to protect public
confidence in the professions, or to uphold of proper standards of conduct and
behaviour. If we consider that the past incidents are not so serious that a public
hearing is required, and the steps the nurse or midwife has taken satisfy us that
there is no longer a risk to public protection, we will not need to refer the case for
further investigation.
Cases not referred for further investigation
77.
Our preliminary consideration of allegations will often mean we do not refer a
case for a full investigation. This will often be where the matters included in the
referral do not amount to an allegation of impaired fitness to practise, it is not
possible to identify an individual nurse or midwife, or it is not possible to obtain
credible evidence. Before we come to such conclusions, we will ensure we have
obtained sufficient material to enable us to understand the full seriousness of the
allegation.
78.
Once we have decided that the referral is serious enough to be considered as an
allegation of impaired fitness to practise, we will take the steps necessary to
identify whether there are possible sources of credible evidence. We will
consider, where appropriate, the use of our powers to require a person to provide
us with information. 13
79.
Where new information emerges about a case that we have not referred for
investigation, we will review the new material and consider, together with any
material that we have retained, whether our assessment of the seriousness of
the case or of the availability of credible evidence has changed. This will inform
our decision as to whether a new investigation is required.
13 Nursing and Midwifery Order 2001, article 25(1). Our powers of investigation do not include powers of
entry, search, confiscation, or other investigative methods which are reserved for the police or other
prosecuting bodies.
Page 14 of 15
Approved by Director of Fitness to Practise 28.01.16
Effective from 1.03.16
Updated version approved by the FtP Director on 24.06.16
Effective from 26.09.16
Page 15 of 15