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Regulatory news

How we work in practice

Covid-19 and fitness to practise hearings

As we mentioned in our June newsletter, the pandemic has had a significant impact on the regulators’ ability to hold panel hearings, including having to postpone or cancel them. In July, some of the regulators did resume in-person hearings, but this will most likely be affected by the rise in Covid-19 cases. Therefore, virtual hearings will continue to be held to avoid a backlog. We have been looking at the concerns surrounding virtual hearings and, following a consultation, we have now published guidance. You can read the full guidance on our website.

Reviewing the regulators: scrutinising fitness to practise decisions

New/ongoing appeals

Since the last newsletter in June 2020, we have lodged one appeal.

There are seven ongoing appeals (including the most recent appeal mentioned above). They relate to:

  • one GMC decision
  • one NMC decision
  • five HCPC decisions.

Cases concluded

Three cases have been settled by consent. 

A case involving an NMC registrant who failed to take action when an assault on a care home resident was reported 

This was an appeal against an NMC decision to impose a caution. The registrant in this case was told by a healthcare assistant that a colleague had assaulted a resident at the home in which they all worked. The evidence suggests that the registrant told the healthcare assistant not to tell anyone else about the assault; she then told the alleged perpetrator that the assault had been reported to her; and that she failed to take appropriate action to address this report of abuse (and that her motive in not reporting it was malign). The healthcare assistant reported a further assault on the same patient by the same colleague sometime later. We appealed the decision on the grounds that the allegations put forward by the NMC did not address the full extent of the concerns apparent from the evidence. We were also concerned that the NMC panel hearing the case did not make adequate inquiry into the case. The parties agreed to dispose of the matter by consent whereby the original caution was quashed, and the case remitted for reconsideration with additional charges addressing our concerns.

A case involving an NMC registrant and a vulnerable patient in her care

This was an appeal against an NMC panel decision to impose a 12-month suspension order with a review. This case concerns the registrant’s care of a vulnerable patient, who had presented with autism, learning difficulties and a history of challenging (including violent) behaviour. The allegations centre around a single incident, when the registrant failed to follow the resident’s Individual Support Plan. This led to the resident becoming agitated, threatening to attack the registrant and ultimately having to be restrained. The healthcare assistants who witnessed the incident were concerned by the registrant’s failure firstly, to heed their advice as the resident became increasingly agitated and secondly, to express any regret after the incident. They believed that if she had listened to them, the resident’s agitation could have been avoided and/or de-escalated. Instead, he became distressed, and they were all placed at risk of physical harm. The registrant failed to engage with the fitness to practise proceedings. She neither appeared nor was represented at the hearing, nor did she submit any evidence or response to the charges other than brief written submissions in which she denied everything. The parties agreed to dispose of the matter by consent. The original suspension order was quashed and an erasure order was substituted in its place, meaning that the registrant will be removed from the NMC’s register.

A case involving an NMC registrant who tried to cover up a failure to complete observations

This was an appeal against an NMC review panel decision to impose no further sanction in respect of a nurse who failed to complete observations then attempted to cover this up by subsequently inserting information into the records. The substantive panel had suspended the registrant for 12 months and made recommendations for evidence to be produced at the review hearing as they had concerns about the registrant’s insight. The review took place as a meeting rather than hearing. The registrant was not present but provided testimonials and a reflective piece. 

We took the view that based on the evidence before them it was not open to the panel to conclude that the registrant was no longer impaired. The panel itself had identified concerns about the written evidence but then appeared to disregard those concerns without a rational explanation. The parties agreed to dispose of the matter by consent. The finding of no impairment has been quashed and the case remitted for a complete re-hearing before a panel. 

There have been no hearings at the High Court in this period. 

Upcoming hearings 

Our appeal against the decision of the Medical Practitioners Tribunal in relation to Dr Dighton was heard on 22 October 2020. This was conducted as a virtual hearing and the Court reserved its decision after submissions had been made.

Reviewing regulators’ performance

Our approach to performance review

Now that we are embedding our new Standards of Good Regulation, we have begun looking at the approach we take to performance reviews. We want to ensure that it utilises our resources as effectively as possible, focuses on and addresses the appropriate issues and is proportionate. We have sought initial feedback from regulators and wider stakeholders on our general approach and how we present our findings. We have also reviewed the approaches used by a number of other inspection, accreditation and quality assurance schemes within and outside of healthcare to see how others approach similar functions. 

We will be reviewing potential options for the approach we take, consulting on these with stakeholders and then developing operational processes around any changes we make to the approach. We will also be looking at our processes more widely to make quality improvements. We expect any changes to the overall approach and processes to come into effect in time for the 2022 cycle. We will be consulting formally later in the year and would welcome feedback at any point on our approach, the processes we use within this and how useful stakeholders find our reports.

Recent reviews published

Since the last newsletter, we have published four performance reviews:

  • The Pharmaceutical Society of Northern Ireland – the PSNI’s performance review was the last review to be published using the 24 Standards of Good Regulation. The PSNI met 22 out of 24 of the Standards – you can read the full report or a summary in our snapshot
  • The General Osteopathic Council’s review was the first to be published using our 18 New Standards of Good Regulation – they met all of the Standards. You can read the full report of the snapshot to find out more.
  • The General Chiropractic Council met 17 out of the 18 Standards. You can read the full review or a summary in our two-page snapshot.
  • The General Pharmaceutical Council met 15 out of 18 of the Standards. You can read the full report here or a summary in our two-page snapshot.

Reviewing the regulators in 2019/20

We have also published our annual report since the last newsletter. The Coronavirus pandemic has of course cast much of the previous year into shadow. However, you can find out our key stats for reviewing the regulators in 2019/20 in this infographic, read through a summary or the full report.