Drafting charges in health cases

Reference: HEA-1f

Last Updated 28/07/2017

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Health allegations where nurse or midwife appears responsible for incidents

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In cases where the concern about the nurse or midwife’s practice involves their physical or mental health, how we draft the charge will depend on how their health condition has presented a risk to patients. It is important that we are able to provide detail of why we say the health condition is a source of concern, by referring to specific examples of risk. If:

  • the nurse or midwife has done things as a result of their health condition,
  • there is strong evidence about the incidents themselves, and
  • sound medical evidence that the incidents would not have happened if the nurse or midwife did not have the health condition,

then the incidents should be detailed as part of that health charge. Pleading the detail of any incidents that happened as a result of the health condition shows clearly to the nurse or midwife, and the panel of the Fitness to Practise Committee hearing the case, why we say the nurse or midwife’s health is a risk to patients or the public.

In cases of this nature, our regulatory concern is about the way in which the health condition causes risks, rather than about the nurse or midwife’s personal culpability. This means that the appropriate response for us is to frame the charge in terms of impaired fitness to practise by reason of health.

Separate concerns in cases involving health

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If a case involves a regulatory concern about a nurse or midwife’s conduct, competence, criminal offending, knowledge of English, or determination by another body, and there is also a separate concern about their fitness to practise because of an unrelated health condition, then both heads of impairment could be considered on the same charge as part of the same hearing.

In these circumstances, there would be two different regulatory concerns based on two different factual backgrounds.

Exceptional cases: health-related conduct incompatible with continued registration

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In exceptional cases, where the alleged incidents are so grave that there would be a real risk to the public’s confidence in nurses and midwives if there was not an immediate striking-off order, the allegation should be one of misconduct, even if the incidents would not have happened had the nurse or midwife not had a particular health condition. This threshold is about conduct which is self-evidently incompatible with continued registration as a nurse or midwife, and is likely to involve only the gravest conduct, such as the deliberate infliction of harm on patients.

It is important that the nurse or midwife’s health condition is contained within a private schedule so that it is not published on the NMC website.

Where a nurse or midwife has not co-operated with our investigation into their physical or mental health, where the evidence supports it, we should consider alleging that the nurse or midwife has refused to submit to a medical examination. This may be taken into account by the Fitness to Practise Committee when it determines whether or not the nurse or midwife’s fitness to practise is impaired by reason of physical or mental health.1

Rule 31(5)(b).