• Professional Standards Authority criticises deficient NMC investigation and panel decisions
  • Morecambe Bay midwives cleared despite relevant evidence not being presented
  • James Titcombe calls for government intervention to overhaul professional regulation

WORKFORCE: The Nursing and Midwifery Council has been criticised for its “deficient” handling of the case against two Morecambe Bay midwives who were cleared of misconduct after a baby’s death.

The Professional Standards Authority, which was considering whether to challenge the NMC’s decision at the High Court, issued a statement on Wednesday attacking the nursing watchdog’s decision not to present relevant evidence to a fitness to practise panel. However, the PSA added it was barred by law from challenging the outcome.

Harry Cayton

Harry Cayton

Harry Cayton said ‘the NMC’s investigation and its panel’s decisions were deficient’

HSJ previously reported that the PSA was considering the handling of the case against midwives Gretta Dixon and Catherine McCullough after evidence was not shared with the panel, which decided to clear both women over alleged misconduct linked to the death of baby Joshua Titcombe in 2008.

Joshua’s father, James Titcombe said the NMC’s handling of the case and the PSA’s inability to challenge the decision made it clear a major overhaul of the professional regulatory system was needed and the government should intervene.

Contemporaneous evidence made when Joshua was alive, as well as medical opinions and transcripts of a 2011 inquest, were not submitted to the NMC fitness to practise panel. In its conclusions about Gretta Dixon the panel wrongly said no other evidence was available apart from Ms Dixon’s own patient notes.

The PSA said on Wednesday the NMC decision not to supply evidence to the panel was “deficient but not wrong in law”.

It said that while the withheld evidence “may have been of relevance to resolving” issues in the case, its omission “was not so material that it could be said to be wrong in law”.

PSA chief executive Harry Cayton said: “We have carefully considered these cases, it is regrettable that all the evidence the NMC held was not put before the panel. We have found that the NMC’s investigation and its panel’s decisions were deficient but not insufficient in law. We will be writing to the NMC to raise our concerns.”

Mr Titcombe, a former patient safety adviser to the CQC who campaigned to expose failings at the University Hospitals of Morecambe Foundation Trust, said families affected by poor care were still waiting for action and it was time for the government to step in.

He said: “The findings of the Morecambe Bay inquiry [chaired by Billed Kirkup] were stark and revealed serious concerns about missing records, covering up the truth and repeatedly failing to learn.

“This is the reason why recommendation 19 of the Kirkup report was for the professional regulators to undertake their own detailed investigations into the conduct of individuals.

Jackie Smith

Jackie Smith

Jackie Smith admitted the fitness to practise process is ‘not as it should be’

“It’s clear that a major overhaul of the professional regulatory system is urgently needed.

“It’s hard to see how anyone involved can find closure or be assured that lessons have really been learned if everyone turns a blind eye to this problem. If necessary, the government need to intervene to oversee an appropriate process that adequately addresses recommendation 19.”

NMC chief executive Jackie Smith has already admitted the fitness to practise process is “not as it should be” and was not designed to resolve complaints but identify only whether a nurse or midwife was safe to work.

In a statement on Wednesday Ms Smith did not address the criticism from the PSA and claimed the NMC had not been provided with its view. HSJ specifically asked the NMC if it accepted its handling of the cases was deficient.

She said the PSA reviews all NMC decisions but did not comment on the fact the authority had decided to convene a panel to consider this case because of specific concerns it had.

Ms Smith said the NMC had received a notification letter on Friday that the PSA review had been completed and would not be referred to the High Court.

She added: “I have met with some of the families affected by the tragic events at Morecambe Bay and apologised for the time it has taken to conclude these cases, which have taken longer than any of us would have wanted. However, this has been a complex investigation involving multiple agencies and individuals. We are committed to concluding the remaining cases as quickly as possible.”

A spokeswoman for the Department of Health told HSJ that fitness to practise cases were about establishing the fitness of an indvidual and not to establish necessarily the cause and effect in any one case.

She added: ”The NMC plays a vital role in ensuring patients receive the very best care and we expect the NMC to carefully consider the issues raised by the Professional Standards Authority. 

“In order to make the NHS the safest healthcare system in the world, we must ensure that the voices of patients and their families are heard and acted upon quickly. That’s why we continue to work towards making sure professional regulation is as robust and efficient as possible, and we are committed to consulting on proposals later this year.”

The DH added that it was content that both the NMC and GMC were implementing recommendation 19 of the Kirkup report.