Response to article in the Independent about screening decisions and colleague concerns

Published on 19 October 2023

On 19 October 2023, The Independent published an article about the number of referrals the NMC has closed at screening – the initial assessment stage of our fitness to practise process. It also includes details of concerns raised by colleagues about issues including speaking up, discrimination, and high workloads.

Our response to the concerns raised by colleagues 

Regarding the concerns raised by colleagues about our culture, Andrea Sutcliffe, NMC Chief Executive and Registrar, said: 

"I'm very sorry to any colleagues who haven't felt safe at work, or who have experienced racism or sexism. We want everyone to feel supported, safe, and able to thrive in the workplace. 

“An external investigation will look into our culture and working environment. This will be shaped by a diverse internal advisory group of colleagues, which we have now established. They will share their experiences and suggestions with our executive team and Council. We've also brought in specialist counselling support for colleagues who feel they would benefit from it.” 

Regarding concerns raised by colleagues about workload pressures in relation to the high fitness to practise caseload, Andrea added:

"We've been open and transparent about our high fitness to practise caseload since it increased significantly after the early days of the pandemic. We’ve increased resources and support for our teams, and we know colleagues are working extremely hard. We have, for some time, been working on our detailed plans to further reduce the caseload safely and swiftly. We’ll discuss those plans further with our teams and Council over the coming weeks." 

Our response to The Independent’s headline 

The article is headlined, ‘Thousands of complaints against nurses rejected without probe amid concerns rogue [nursing and midwifery] staff going unchecked’. 

This is potentially misleading. Every fitness to practise referral to the NMC is assessed in line with our published screening guidance, which can be found on the NMC website. 

Our response to The Independent’s presentation of NMC screening data 

Andrea Sutcliffe said: 

"We aim to progress cases swiftly and safely, to reduce distress for people involved and enable us to focus on the most serious, evidenced concerns. We do not close cases unless it is the right thing to do, and we have a process to review decisions where needed. 

“Our approach to screening has been shaped by the strategic approach to fitness to practise agreed by our Council in 2018 following a full public consultation. This includes giving professionals the chance to strengthen their practice to address a concern, as well as looking at where employers are better placed to manage concerns, and giving more consideration to contextual factors when care goes wrong. 

“Last year an independent review of a sample of cases closed at screening confirmed that these decisions were appropriate and proportionate. We’ve also seen a reduction in case closures later in our process, indicating that we’re fulfilling our aim to make fitness to practise more proportionate and fairer for all involved. 

“Our teams are working extremely hard to resolve cases safely and swiftly. I’m grateful to them for their dedication and commitment to our core purpose of protecting the public.” 

Additional explanatory information 

The NMC explained to The Independent that when a professional is referred to the NMC, our role is to determine whether there is a risk to the public and, if so, to take the necessary regulatory action to restrict someone's practice. However, not everyone who is referred to the NMC does pose a risk to the public that requires regulatory action. 

There are a number of points in our process where we can make a decision that the referral doesn't require any further action from us as the regulator. The first is the initial assessment stage, called screening. 

Since 2021 there has been an increase in the number of cases that are resolved at initial assessment, which is the result of a new approach to screening implemented in May 2021 with an update to our screening guidance. It gives decision makers more flexibility when making their preliminary enquiries, before deciding whether to close a referral or forward it on to the next stage of the process for further investigation. 

The new screening guidance has ensured that cases are not progressing through an unnecessary regulatory investigation only to be closed with no case to answer.  

Our data shows the extent to which Case Examiners are now making fewer ‘No case to answer’ decisions about concerns that have progressed from screening. In 2020–2021, the year before the new screening guidance was introduced, the proportion of case closures at the Case Examiner stage of our processes was 53.1 percent. In 2021–2022 following the introduction of the new screening guidance, this fell to 46.7 percent, and in 2022–2023 it fell further to 34.0 percent. Therefore since the introduction of the new screening guidance, case closures at the Case Examiner stage have fallen by 19.1 percentage points.

This is beneficial for everyone. For the professionals on our register, it means fewer people spending lengthy periods under investigation, which can be distressing, only to be told they have no case to answer. For referrers, it means a decision and closure on their concern at the earliest opportunity. And for the NMC, it means our investigation teams are focused on the most serious, evidenced concerns which are more likely to require regulatory action. 

To ensure there were no unintended consequences arising from the new guidance, we commissioned an independent review of 50 screening closure decisions. Overall, this found that decisions were appropriate and proportionate, and there were no concerns that we were failing to meet our duties to protect patient safety and uphold the wider public interest. 

Additionally, our oversight body, the Professional Standards Authority, reported in its monitoring of our performance in 2021-2022 that:

‘Closing cases at the earliest appropriate stage has benefits for all concerned, and we have not seen evidence of increased concerns about how the NMC is making decisions in fitness to practise cases. It is important that the NMC is able to identify the cases it needs to investigate further to identify and address any risks to public protection. It is appropriate for the NMC to check how its revised guidance is working, and we will continue to monitor its work in this area.’ 

The full report can be found on the PSA’s website here 

The NMC publishes data about decisions taken at screening every year in our fitness to practise annual reports. 

Our response to The Independent’s presentation of NMC caseload data 

The Independent reported that 2,153 referrals to the NMC have yet to reach screening. All referrals to the NMC move straight into screening, and the figure is actually the number of cases that were pending a screening decision in August 2023. We have asked The Independent to correct this. 

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