‘Hung, drawn and quartered’

One registrant told us she lost her house after being suspended and had to move back in with her parents and ask them for help to pay for legal representation, which affected her professionally, emotionally and mentally. She has been on interim suspension since 2021 awaiting an FtP panel hearing.

She says: ‘My experience was of getting hung, drawn and quartered. It was guilty before proven innocent.’

Another nurse was referred to the regulator by an anonymous source 12 months ago and suspended from work after she raised concerns about her employer. She is yet to have her case heard and says she has been left feeling she no longer wants to be a nurse.

‘Like many others, I just wanted to die,’ she says. ‘I breathe being a nurse and they have taken that away from me. I cannot go through it again. When I think about stepping back into the world of work I get palpitations.’

In May, the NMC announced it would invest £30 million in the FtP process over the next three years in a bid to tackle the huge backlog of cases. It failed to meet a commitment to reduce the caseload to 4,000 cases by March 2024. As of the end of March, there were 5,992 open cases.

The report of the NMC culture review by former chief prosecutor Nazir Afzal found a deep-rooted toxic culture was leading to skewed and failed FtP cases. It called for an urgent turnaround plan, which the regulator has accepted.

Good nurses are being lost

The founder of action and support group NMC Watch, Cathryn Watters, a registered nurse specialising in cancer care who has herself been through the FtP process, says: ‘We are losing what this is supposed to be about, which is patient safety and good practitioners.

‘We are losing good nurses and midwives through this process because they are mentally, physically and emotionally destroyed by the unacceptably long waits for their hearings, but also from this adversarial process.

‘Registrants are assumed to be disengaged or have little insight into their actions if they fail to engage with the FtP process, but many have become so overwhelmed or disillusioned, then can’t participate.’

Picture credit: iStock

Long-drawn-out process

The NMC has come under fire for the length of time it is taking to process FtP cases. Its own regulator the Professional Standards Authority (PSA) found in its 2022-23 monitoring report that the median time for cases to reach a final hearing had risen to 154 weeks, or three years, from initial referral. This was up from 143 the previous year, and nearly double the 80-week figure from 2018-19. And of the 5,577 ongoing cases, 729 had been open for at least three years, compared with just 74 in 2018-19.

An FtP determination published as recently as May 2024 considered a case that went as far back as 2018.

One nurse, Kenny Brady, says it took five years for him to have his case finalised when he was struck off the register in 2012 for issues related to alcohol. While he does not contest the fact he should have been struck off, he says the process left him dehumanised and isolated.

‘The values of being kind, tolerant and compassionate and assuming the best in people that are central to nursing and we are expected to practise – these are not values held at the NMC,’ says Mr Brady, who has now returned to the register after going through a restoration process with the regulator in 2018.

‘Often nurses have been suspended by their employers during an investigation and they have been isolated for months. You haven’t been able to work. My marriage had broken down, my life was ruined and I was drinking like a fish. What we don’t talk about enough is when they take away your job, they are taking away part of the fabric of your identity.’

Impact on mental health

RCN Counselling Service co-ordinator Tanja Koch says anxiety and suicidal ideation are not unusual for someone who goes through an NMC referral.

‘Members often feel quite powerless,’ she says. ‘Obviously, the length of times that cases are taking is not good for psychological health.

‘A lot of our members feel nursing is part of their identity, so when there is an NMC referral, that comes with shame and stigma. It immediately threatens their identity. They are catastrophising that they are going to lose their PIN.’

Tina (not her real name) qualified as a nurse in 2020 during the pandemic and started working on a respiratory ward in north west England.

She was referred to the NMC shortly after she qualified and faces four charges, including an allegation she asked a patient for money, a charge she vehemently denies. Tina waited 12 months to have her preliminary hearing, but says she had no idea what to expect before the first meeting.

‘I didn’t have any legal representation and I had no idea what was going to happen,’ she says. ‘I understand the NMC have a duty to protect the public, but what about their duty to help me as a new nurse?’

Tina, who is under a interim-suspension order while she waits for her panel hearing says her parents have paid £3,000 for her legal representation and she is back living with them because she cannot afford her bills.

She had suicidal thoughts as a result of how the process has affected the family.

‘It’s like having a tag on your leg,’ she says. ‘I have to go round to everybody and tell them what these accusations are, bearing in mind I have admitted to one but the other three of them are not true. I felt like they (the NMC) wanted to destroy me.

‘There needs to be more support from the NMC. People lose their mental health and consider suicide. They really need to seriously do better.’

‘It felt like being in court’

Nurse and midwife Kathryn Weymouth endured a 10-week hearing concluding in March 2020 that resulted in a ruling of no clinical misconduct case to answer, costing the NMC an estimated £194,000, says NMC Watch.

An FtP referral, and the length of the subsequent process, can induce feelings of isolation and fear

Picture credit: iStock

But Ms Weymouth said the adversarial nature of the hearing shocked and intimidated her.

‘What really shocked me was that our regulator isn’t saying, “let’s sit down and find out the truth”. Instead it was presented like a prosecution in a court case. It seemed to me there must be a better way of doing that.’

She believes the NMC employs lawyers who ‘just care about winning and finding you guilty’ rather than finding the truth, something she describes as ‘really wrong’.

Ms Weymouth describes how her hearing was set up in a conference room, with three people on the panel, a legal assessor and legal representation on both sides. For the first four weeks, she was not permitted to say anything because the NMC was presenting its case.

‘You just to have to sit there and listen while all these things are being said, horrible things really,’ she says.

Rather than a fact-finding exercise, such as an inquest, the nurses that spoke to Nursing Standard agree the process mirrors that of a criminal court, where they are the defendant.

‘Some of the charges were actually laughable,’ Ms Weymouth says. ‘One was involving a patient that wasn’t in my care. It’s laughably incompetent.’

Ms Koch agrees many registrants feel daunted.

‘There are lawyers there and it can be intimidating and distressing. Sometimes it is so distressing that people can’t engage with it, it’s as simple as that.’

Support for nurses

The RCN Counselling Service offers members six telephone counselling sessions over a six-month period to support them through challenges, including FtP referral.

While Ms Koch agrees the process can be traumatic for registrants, she argues the most effective change would come from employers, who are the source of around one in four (26%) FtP referrals.

She says: ‘The biggest difference could be made by the employer: have they done their investigations properly? Have they done their due diligence? Have they got to a point where they really think “actually this needs to be referred to the NMC”, or can it be resolved internally?

‘This could wash out a number of unnecessary cases.’

Find out more about the Afzal review into the culture of the NMC rcni.com/Afzalreview