Consultation on remediation guidance

The aim of the guidance is to help decision makers at all stages of the fitness to practise process when considering whether a nurse or midwife has addressed concerns raised about them. It consolidates existing decision-making principles but does not introduce any new test or criteria.

We developed and consulted on this guidance to codify our existing practices and seek agreement from key stakeholders that it addresses common issues in demonstrating and providing evidence of insight. We sought confirmation that the terminology, criteria and examples within the guidance are clear and that it takes account of different circumstances.

We received 56 responses to our online survey which included four stakeholder contributions and 52 individual responses which came mostly from nurses and midwives. We also held a targeted listening event which was attended by the Professional Standards Authority, the main nursing and midwifery representative organisations, public and patient groups, and an NHS employer.

The vast majority of the respondents found the guidance helpful, particularly in how it set out specific expectations around practical matters and assisted the nurse or midwife to provide a written response to the allegations. This was thought to be especially important to those who are unrepresented.

One respondent commented,

“It provides all practitioners with clear guidance on what is expected of them during duties as health practitioners, including procedures on various issues regarding conduct whilst an employee of the National Health Service.”

In relation to the guidance on demonstrating insight, we were asked to specify the level of the harm suffered by the patient before the professional duty of candour applies. In order to be consistent with our other guidance, for example, The Code: Standards of conduct, performance and ethics for nurses and midwives (NMC, 2008) and Raising concerns – Guidance for nurses and midwives (NMC, 2013), we have retained the term ‘risk of harm’ and not provided any further qualification on the harm suffered.

We have revised our guidance on whether the conduct complained of is remediable and has been remedied. We did this to put the emphasis on the task which faces the nurse or midwife to demonstrate that they have remedied the concerns, rather than referencing the likely thought process of the decision maker. We have also clarified how much weight decision makers should attach to assertions of insight when a nurse or midwife makes a late admission. The guidance also explains that there may be valid reasons why an earlier admission was not made.

The finalised guidance was implemented on 21 July 2014.