The recent case of a Welsh nurse who was referred to the Nursing and Midwifery Council (NMC) has reignited the debate about consistency in NMC fitness to practise decisions. 

In the case, a Welsh nurse used patient’s vagina as ventriloquist’s dummy ‘to amuse colleagues’.  According to news reports on the incident, nurse William Kennedy ‘pulled the patient’s labia apart and said: “Hello, my name is Patient A” as he examined the vulnerable care home resident. 

In light of the incident, the nurse was convicted of ill-treating a patient who lacked capacity at Gwent Magistrates Court on February 20 last year and given a community order. 

A NMC fitness to practise panel determined an 18 month Interim Conditions of Practice was appropriate in this case.  Whilst Mr Kennedy was allowed to continue working as a nurse some of the conditions placed on him include barred from carrying out intimate examinations or clinical procedures, he cannot be the nurse in charge of any shift, he will have to remain under direct supervision at all times when working and he must report to a line manager once a month to discuss his professionalism. 

Reaction to the outcome of this case has been very critical of the NMC’s fitness to practise process pointing out that fitness to practice hearing outcomes vary widely depending on the panel you may come across. 

Why is this the case?

There are a number of reasons why there is such an apparent disparity in NMC fitness to practice hearing outcomes.

Membership

The NMC’s Fitness to Practise and Investigating Committee is made up of three people.  It is possible for two of the three panel members to be lay people (i.e. not a registered nurse or midwife).  

Since the majority representation on a committee can be lay people, this opens the door to a wide array of interpretation of facts and standards set by the NMC.

NMC sanctions guidance

Each fitness to practise case heard by the NMC must be determined on its merits taking into account the individual circumstances of the case.  The NMC has sanctions guidance should be followed but of course is open to interpretation by individual panels. 

It is quite possible for panels to hear cases with similar circumstances but different outcomes.

 Representation

A nurse or midwife can be represented before a Fitness to Practise Committee. Legal representation is a determinative factor in the outcome in fitness to practise cases.  Nurses represented will often receive less serious sanctions compared to those who are not represented (or represented adequately).