NMC moving away from “remediation”

The NMC are moving away from using ‘remediation’ to ‘strengthening practice’, a more “positive and accessible terminology” to “better encourage” professionals to engage early on with their fitness to practise process.

What is ‘strengthening practice’ that ‘remediation’ is not, and what does this change in terminology mean for registered nurses and midwives?

The Nursing and Midwifery Council (NMC) does not officially provide a definition of ‘strengthening practice’ but it said ‘strengthening practice’ is encapsulated by registrants engaging with them during their fitness to practise process and reflecting on their practice, learn and improve.

This was previously  referred to as ‘enabling remediation’.  Whilst ‘enabling remediation’ and ‘strengthening practice’, in practice, seeks to achieve the same outcome (i.e. addressing concerns), there is a subtle difference.  Remediation might focus insight in to a narrow context (i.e. the specific circumstances that lead to an incident), whereas through ‘strengthening practice’, the NMC wants nurses and midwives to take a more holistic view to ensure insight is in the whole practise context and not limited to just the individual circumstances that caused the alleged impaired fitness to practise.

New approach to fitness to practise

‘Strengthening practice’ is an aspect of the NMC’s new approach to fitness to practise, which is said is focussed on “how we can move away from a culture of blame when things go wrong in health and social care – and instead develop other ways of working that better support the safety of people using services.”

“…in many cases, people can put things right by being open and honest about what happened, showing insight into what went wrong, and taking steps to improve their practice. In these sorts of situations where someone can demonstrate they’re safe to practice, we think they should have the opportunity to continue with their professional career.”

Updated guidance

‘Strengthening practice’ is reflected in updated guidance, which includes guidance on assessing:

• insight
• whether the steps taken are sufficient enough to address the concern
• the evidence.

Updated guidance states:

“Evidence of the nurse, midwife or nursing associate’s insight and any steps they have taken to strengthen their practice will usually be central to deciding whether their fitness to practise is currently impaired.”

When assessing evidence of the nurse, midwife or nursing associate’s insight and the steps they have taken to strengthen their practice, the NMC will take into account the following questions:

1. Can the concern be addressed?

That is, are there steps that the nurse, midwife or nursing associate can take to address the identified problem in their practice?

Where concerns are difficult to put right, especially where it has resulted in harm to a patient, the NMC guidance makes clear that focus should be on whether the outcome can be put right, decision makers should assess the conduct that led to the outcome, and consider whether the conduct itself, and the risks it could pose, can be addressed by taking steps, such as completing training courses or supervised practice.

Examples of conduct which may not be possible to address, and where steps such as training courses or supervision at work are unlikely to address the concerns include:

• criminal convictions that led to custodial sentences
• inappropriate personal or sexual relationships with patients, service users or other vulnerable people
• incidents of harassment, discrimination or victimisation that have taken place either inside or outside the workplace
• dishonesty, particularly if it was serious and sustained over a period of time, or directly linked to the nurse, midwife or nursing associate’s practice
• violence, neglect or abuse of patients.

2. Has the concern been addressed (demonstrating insight)

A nurse, midwife or nursing associate who shows insight will usually be able to:

• step back from the situation and look at it objectively
• recognise what went wrong
• accept their role and responsibilities and how they are relevant to what happened
• appreciate what could and should have been done differently
• understand how to act differently in the future to avoid similar problems happening.

See also: Duty of Candour and Fitness to Practise

Evidence of steps sufficient to address the concern will depend on the merits of each case, however key indicators include whether the steps taken are:

• relevant to the nature of the concern(s)
• measurable
• effective, addressing the concerns and clearly demonstrating that past failings have been objectively understood

3. Is it highly unlikely that the conduct will be repeated?

NMC guidance states that the likelihood of the conduct being repeated in the future may be reduced where:

• The nurse, midwife or nursing associate has demonstrated sufficient insight and has taken appropriate steps to address any concerns arising from the allegations.
• The behaviour in question arose in unique circumstances. While this may not excuse the nurse, midwife or nursing associate’s behaviour, this may suggest that the risk of repetition in the future is reduced.
• The nurse, midwife or nursing associate has an otherwise positive professional record, including an absence of any other concerns from past or current employers and of any previous action by us or another regulatory body.
• The nurse, midwife or nursing associate has engaged with us throughout our processes.

Engaging with your case and the importance of legal advice

Central to the NMC’s ‘strengthening practice’ process is early engagement with them.  The NMC said “Strengthening practice doesn’t provide an alternative route through the fitness to practise process, but it’s central to encouraging engagement”.

The NMC’s fitness to practise guidance makes clear the expectation is that nurses and midwives should engage with the NMC “as early as possible and at every stage of the fitness to practise process” providing them with the following information:

• whether they’re currently employed and any steps their employer may be taking to manage any risk
• information about the context in which the incident occurred
• evidence of any steps they’ve taken to address the concerns raised about their fitness to practise (such as completing courses or retraining)
• evidence of any insight they have or any reflection they’ve undertaken so far about the concerns raised (we recognise that insight and reflection can develop over time, and may also depend on how any investigation progresses).

Providing this information is not mandatory and nurses and midwives can decide not to do so, or delay providing this information.

Engaging with expert legal advice at an early stage in the process can prove invaluable.  We can provide you with advice and guidance on when and how to respond to the NMC.  In addition, we can advice you the right approach to insight and how you can provide evidence of this.

We pride ourselves on complete transparency and all quotations are given with fixed fees for preparation and representation, agreed in advance and payable in stages. No hidden costs ever.

If you are facing fitness to practise investigation, speak to one of our expert barristers today for a free, no obligation case assessment.