21/10/24
In July 2024, The Independent Culture Review criticised the Nursing and Midwifery Council’s (NMC) processes regarding individuals' fitness to practise, particularly focusing on the mental health impact on nurses and midwives under investigation. The NMC has the authority to impose restrictions, suspend, or remove individuals from the register if their ability to practise is compromised. However, recent concerns highlight how these procedures may negatively impact those under investigation, particularly with regard to mental health.
What Led to the Recent Criticism?
The NMC came under intense scrutiny following reports that at least 16 nurses have tragically taken their own lives since 2018, with six suicides occurring in the past year alone. Families and colleagues of the deceased have voiced concerns that the pressures of the fitness to practise investigations may have contributed to these outcomes. The very process designed to ensure patient safety has been accused of exacerbating stress and placing healthcare workers under severe psychological strain.
The Independent Culture Review confirmed these concerns, describing the regulatory environment as "toxic." It highlighted failures in supporting nurses and midwives under investigation, pointing to a lack of mental health resources and the long duration of investigations as key areas for reform. While patient safety must remain paramount, the system has been putting the mental health of nurses at risk.
The Fitness to Practise Process
When the NMC receives a complaint, it launches an investigation to assess whether the nurse or midwife is fit to practise. Depending on the complexity of the case, this process can take months or even years to conclude. During this time, the individual may be suspended or face restrictions on their ability to work. The prolonged investigations have led to criticism that healthcare professionals are left in a state of limbo, often facing financial strain, emotional distress, and professional stigma. Many nurses have described feeling "humiliated" and "hopeless" as their cases drag on without resolution.
A particularly heart-wrenching example is a case in which a nurse took her own life after feeling overwhelmed by the investigation process. Her family revealed that she felt there was no end in sight and was deeply affected by the uncertainty surrounding her professional future. This is not an isolated case—numerous other families have echoed similar experiences, leading to a growing call for reform.
Voluntary Removal Process (Pre-April 2023)
Up until April 2023, nurses under investigation by the NMC often found themselves trapped in a difficult situation where they would have no option but to make an admission of guilt if they wanted to come off the register. This was a source of criticism, as many nurses felt pressured into signing voluntary removal agreements, effectively ending their careers without a full investigation or formal conclusion. These agreements required nurses to acknowledge wrongdoing as a condition for their removal, even when they contested the allegations. This
practice placed undue pressure on healthcare professionals, many of whom felt forced to sign in order to escape the lengthy and stressful investigation process.
Agreed Removal Process (Post-April 2023)
In April 2023, the voluntary removal process was scrapped and the agreed removal process was introduced. Under this new guidance, nurses no longer need to admit guilt to be voluntarily removed from the register. While the process remains voluntary, the removal will be accompanied by a note on the register indicating an “outstanding fitness to practise question.” and may be disclosed to potential employers in the public interest. This allows individuals to leave the register without admitting to wrongdoing but with potential reputational consequences. While this provides some relief, nurses must be aware of the long-term impacts, especially on future employment.
The imbalance of power between the NMC and the nurses is still a significant concern. The financial, emotional, and reputational toll of ongoing investigations leaves many nurses feeling they have no other option but to sign the agreements, even when they believe they have done nothing wrong. There is a feeling that there is a sense of coercion which is compounded by a lack of transparency. Without proper support, nurses can be left vulnerable, agreeing to terms that severely impact their professional standing.
Recommendations for Reform
In response to public outcry and the findings of the Independent Culture Review, the NMC has stated it is committed to reviewing and reforming its fitness to practise procedures. Key recommendations include faster resolutions, better mental health support, and improved communication and transparency. The NMC has introduced some changes, such as new guidelines allowing investigators to impose Interim Suspension Orders earlier in the process, provided there is "cogent" evidence of a threat to public safety. These changes aim to streamline procedures, with the NMC targeting interim orders for 80% of cases within 28 days.
Final Thoughts
The 2024 review of the NMC's fitness to practise procedures has exposed significant flaws in the system, particularly in the treatment of nurses and midwives under investigation. The process remains stressful, and the voluntary removal agreements, while improved, still carry significant reputational risks. It is imperative that individuals under investigation are aware of their rights and the procedural changes that may affect them. Nurses should seek legal advice before signing any agreement. By instructing Roe Lawyers, you can ensure that you are aware of all the options available to you if you are being subject to a fitness to practice process or are considering withdrawing yourself from the register.
Contact us if you or someone you know needs advice on this.