NMC referral response (draft)

2. Our Screening team considered the referral at that time. On 11 January 2019,
they wrote to Mr. X to say they’d decided not to investigate further. That
decision explained that, despite a number of attempts to contact Mr. X they’d been unable to obtain further information from him and didn’t have his agreement to share the information he’d provided.

3. On 30 October 2020, Mr. X provided agreement to share his information.

The Screening Team’s Decision
4. Having received Mr. X’s agreement to share as well as further information from him, the Screening team considered the concerns again.

5. Before making a decision, the Screening team contacted CHDA. They provided a response on 3 December 2020 that included information about Nurse Parry’s employment history and their response to Mr. X’s concerns. On 8 February 2021, CHDA provided the Screening team with a copy of Nurse Parry’s report along with a transcript of the assessment.

6. On 25 February 2021, Nurse Parry provided the Screening team with a response, a reflection and a clinical reference.

7. On 21 May 2021, the Screening team wrote to Mr X to say they’d decided not to investigate further at that time. The decision said:
‘As the concerns raised by Mr X don’t engage any of our three categories of seriousness they don’t pass this stage of our screening process. We understand and acknowledge Mr X’s concerns and the impact that they’ve had on him.
We would also like to make it clear to Mr X that our decision does not mean that this matter itself is not serious, however Mrs Parry’s actions in isolation, which appears to have been errors, don’t suggest that they’re serious enough to require our involvement as a regulator.

NMC claims my referral and evidence existing of a nurse lying on a multitude of occasions does not pass their three categories of seriousness. Therefore, a nurse who deliberately and blatantly lies in a report is not considered to be serious by the NMC. 

Based on the information we’ve received we don’t consider that this matter
suggests that Mrs Parry is a danger to those in her care, or that her practise
should be restricted in some way in order to maintain confidence in the
professions. We therefore won’t be investigating any further at this time.’

Concerns raised about the decision not to take any further action at this time
8. On receiving the decision, Mr X contacted the NMC. He said he didn’t agree with the statement that the concern was an isolated incident. He said Nurse Parry made several mistakes within the report and the decision referred to a prior complaint.

9. A decision at the Screening stage that a case doesn’t need to be referred to the case examiners means we’ve decided not to take further action at that time. If there’s new information or concerns about our decision not to refer, we can carry out a review.

10.This review is carried out by an Assistant Registrar in the Quality of Decision Making team. As an Assistant Registrar, my role is to review the decision made by the Screening team to check whether there were any problems with how the decision was made and to consider whether a different decision should be made.

11.I can decide that:
• no further action is needed at this time
• the case should be sent to the Screening team for further enquiries and a fresh decision to be made based on all of the information, including any new information obtained.
• a case where the concern is about someone’s fitness to practise should be referred to the Case Examiners

Guidance we followed when reviewing this case
12.I’ve applied the guidance in our Fitness to Practise library when carrying out this review. Our guidance is available on our website at www.nmc.org.uk/ftp-library
13.In particular, I’ve taken account of:

• Aims and principles for fitness to practise (www.nmc.org.uk/ftp-
library/understanding-fitness-to-practise/using-fitness-to-practise)

• How we determine seriousness (www.nmc.org.uk/ftp-library/understanding-fitness-to-practise/how-we-determine-seriousness)

• Screening – Our overall approach (www.nmc.org.uk/ftp-library/screening/our-
overall-approach)

• The Three stages of a Screening decision (www.nmc.org.uk/ftp-
library/screening/our-overall-approach/the-three-stages-of-our-screening-
decision)

Do you really rely on your audacity to imply that my concern of a nurse deliberately lying is not serious?  My opinion is that the NMC essentially has BLOOD ON ITS HANDS in relation to discriminating against vulnerable people.
May I remind you about the “DWP Death Figures”,  whereby people have actually killed themselves because your nursing colleagues have again lied in their report.
The actions of these nurses and the assessment is widely reported via some media outlets. In addition to the number of people who have either died as a result of the nurses actions, or have committed suicide because of the nurses actions.
https://www.disabilitynewsservice.com/dwp-figures-reveal-sharp-rise-in-secret-benefit-death-reviews/  Is an excellent article concerning the deaths / suicides of people who have suffered at the hands of the nurses who lie.

• If we don’t refer as case (www.nmc.org.uk/ftp-library/screening/our-overall-
approach/if-we-dont-refer-a-case)

• Explaining how and why a nurse or midwife presents a regulatory concern

(www.nmc.org.uk/ftp-library/screening/regulatory-concerns/identifying-and-
explaining-regulatory-concerns)

• Misconduct (www.nmc.org.uk/ftp-library/understanding-fitness-to-
practise/fitness-to-practise-allegations/misconduct)

• Lack of competence (www.nmc.org.uk/ftp-library/understanding-fitness-to-
practise/fitness-to-practise-allegations/lack-of-competence)

• Insight and strengthened practice (www.nmc.org.uk/ftp-library/understanding-
fitness-to-practise/insight-and-strengthened-practice)

Our Decision
14.I’ve considered whether something went wrong with how the Screening team
made their decision. I’ve also considered whether there’s any new information
that could change the decision.

15.On 10 May 2021, our screening guidance was updated to a three-stage process.
The letter sent to Mr X on 21 May 2021 with the reasons for the original decision attached, referred to the previous four-stage process. This had the potential to cause confusion, but I don’t consider it means something went wrong with the decision itself, which referred to the correct process.

16.Mr X’s concern about Nurse Parry’s fitness to practise originally arose because he identified a number of inaccuracies between what he said during the assessment with Nurse Parry on 8 February 2018 and what Nurse Parry wrote in her report. The assessment was recorded and a transcript produced, a copy of which was obtained and considered by the Screening team.

17.Before making the decision, the Screening team contacted Mr X to ensure they’d identified and understood the full scope of the concern. They produced a table of concerns that they shared with Mr X. In emails dated 22 and 23 April 2019, Mr X expressed concerns about what the Screening team had written in relation to a concern about medication. He reiterated his concern is that Nurse Parry lied by documenting that he wasn’t taking any medication whatsoever. He confirmed the rest of the table was accurate.

NMC table of findings contained some, but not all of the inaccurate data.
Within the table of findings, NMC attempted to again provide fiction over fact by stating that the nurse recorded my medication. The fact is that the nurse did not state this, she stated I do not take any medication whatsoever. 

18.The information available to the Screening team raised a concern about two
different, albeit linked areas of practice:
• clear and accurate record keeping,
• honesty and integrity.

19.The original decision identified differences between the transcript of the
assessment and Nurse Parry’s report. However, it said ‘it appears that this matter is an instance of poor record keeping rather a deliberate intention to mislead.’

Poor record keeping would suggest a few mistakes.
In this instance, the entirety of the report contained inaccuracies, the nurse cherry picked information and twisted information in her report in addition to ignoring any pertinent elements.
It is for this reason that DWP overturned the decision after they gave regard to what I had said rather than what the nurse said.

In light of the above, the fact that the whole report was inaccurate,  cherry picked information,  twisting of facts and downright lies showed a clear intention to mislead.

For the NMC to be aware of the above and claim that the nurse did not have any intention to mislead and was not dishonest is at best a pathetic response. 

The decision went on to say ‘there’s no indication that what (sic) Mrs Parry was
dishonest or that the report was written with the intention to mislead. The
information that we’ve received does not suggest a serious underlying issue with Mrs Parry’s professionalism or attitude towards patient safety which could be more difficult to put right.’

20.In other words, the original decision concluded that the difference between the transcript and Nurse Parry’s report was a clinical issue in a discrete area of practice.

21.When we look at concerns about clinical issues, a pattern of incidents is more likely to show there’s a risk. We recognise people can make mistakes and for that reason, a clinical error that’s not part of a pattern of errors is unlikely to show there’s a risk of harm to people in the future. It’s also easier to put clinical concerns right through things like training, supervision and evidence of continued safe practice.

22.Our guidance doesn’t define how many incidents amounts to a pattern. This will usually depend on the setting or context in which the nurse, midwife or nursing associate was working at the time, how they responded, the risk of harm in what happened on each occasion and what the evidence says about why it happened.
Our context commitments say building up an accurate picture of someone’s practising history can help with this. For example, it can be useful to know whether the nurse, midwife or nursing associate had encountered a similar
situation or carried out a similar task before, knew what to do and would usually do it safely and effectively.

23.Sometimes a single incident can involve multiple errors, but that doesn’t automatically mean it’s part of a pattern. For example, if a nurse becomes distracted and forgets to administer medication to a single patient, we wouldn’t describe this as a pattern solely on the basis that it involved a number of different types of medication.

24.Patterns can be less relevant for other types of concern, such as those about
someone’s honesty and integrity. The reason for this is that these types of
concerns could show there’s a problem with the nurse, midwife or nursing
associate’s attitude. Attitudinal concerns are more difficult to put right and are
capable of affecting the public’s trust in all nurses, midwives and nursing
associates. In these kinds of cases, it may not be possible for the nurse, midwife
or nursing associate to address the concern and may mean we need to take
restrictive regulatory action.

I have in my opinion above proved that a pattern clearly exists. However, I now turn to your assertion that patterns can be less relevant if in relation to the nurses honesty and integrity.
Details as to why the nurse was not honest and not showing integrity can be seen from my fitness to practise referral alone. Clearly, the nuses actions in this element of a multitude of inaccurate data,  skewing facts,  cherry picking information and failing to record other pertinent elements shows it is far from an isolated incident,  it shows it is a pattern,  ultimately it shows that the nurse acted dishonestly and with no integrity.

25.For this reason, an allegation about deliberately recording inaccurate information is a very serious one. Mr X is firm in his view that the differences between the transcript and the report means Nurse Parry lied. However, our guidance says we’ll always make an objective assessment of the evidence, rather than rely on an individual’s interpretation.

26.We need a clear foundation before we accuse a nurse, midwife or nursing
associate of being dishonest. On its own, I don’t consider the differences
between the transcript and Nurse Parry’s report justifies accusing Nurse Parry of such a serious allegation. Having carried out a review, I’ve not identified any
other evidence or sources of evidence that could support a concern about Nurse
Parry’s honesty and integrity.

Deliberately lying, deliberately omitting key pertinent elements, deliberately skewing information and cherry picking information in order to disallow my claim, – in addition to deliberately ignoring the struggles i reported with evidence –  and the NMC claims this does not mean the nurse is not dishonest not acting with integrity.

27.In his correspondence, Mr X has referred to reports from whistle-blowers saying that CHDA staff are pressured to lie, alter or fabricate reports. However, I’ve not identified any evidence or any sources of evidence that could show Nurse Parry was under pressure to do this or had any other reason to lie in the report she produced. Therefore, the original decision was right to view the concern as one about a discrete area of clinical practice. This means it was relevant to take account of whether there’s evidence of a pattern of similar concerns. In the context of Nurse Parry’s role, this would mean whether there’s
evidence that Nurse Parry hadn’t made accurate records on other occasions and that any inaccuracies were significant enough to mean there’s a risk of harm.

28.It was also relevant to take account of:
• Nurse Parry’s response to the concern,
• the action CHDA had taken as Nurse Parry’s employer,
• the evidence of Nurse Parry’s practising history,

29.The information available to the Screening team doesn’t indicate a pattern of
similar concerns. Even though Mr X raised multiple issues, they all relate to a single report. CHDA provided information about another complaint in 2018, but there’s no record of any similar complaints since. Nurse Parry continues to work in the same role, provided a reflection and a positive clinical reference from her line manager. The clinical reference refers to weekly quality assurance of Nurse
Parry’s work, comments positively on her professionalism and ability to learn from feedback.

None of the report was accurate. All of the report was inaccurate, this to any reasonable person would suggest a pattern. A pattern of a multitude of errors albeit within one assessment.
In regards to the nurses ability to learn from feedback, clearly this is not the case as no lessons have been learnt as the same nurse has received two complaints of similar nature.

30.The evidence available doesn’t show Nurse Parry’s practice presents a risk to patients or members of the public in the future.

As a concern about clinical practice that’s capable of being addressed, it doesn’t require us to take action solely to maintain public confidence or uphold standards. Therefore, it was right for the original decision to decide not to investigate further at that time.

31.In an email dated 21 May 2021, Mr X said the original decision, and specifically the reference to an isolated incident, goes against the Equality Act.
He also said the NMC treats concerns from vulnerable people differently, ignoring those involving the DWP. When we develop our guidance and policies and when we make decisions we do so in accordance with equality law and we are required to consider how our decisions, guidance and policies might affect people with protected characteristics. I’ve considered Mr X’s comments but
have concluded that the decision applied our guidance correctly.

Hopefully the PSA will intervene in your derisory unfit for purpose approaches again when in relation to referrals linked with DWP.  Afterall, NMC is already guilty of this discrimination earlier which caused PSA intervention.

32.In his communication, both before and after the original decision was made, Mr X raised a specific issue about Nurse Parry’s record of the medication he was taking and how the NMC have dealt with this. I’ve reviewed Mr X’s emails, including those dated 11 February 2021, 22 April 2021 and 8 October 2021 that touch on this issue. I’ve also reviewed the transcript of the assessment and the ESA85 medical report form.
33.These documents show that Mr X told Nurse Parry he wasn’t taking any medication (other than sleeping tablets) at the time of the assessment. However, he did say that he was due to start taking new medication. Nurse Parry recorded this on page 3 of the report. However, this information wasn’t included in the assessment summary on page 18 and Mr X said it didn’t form part of the DWP’s decision-making process.

34.Mr X believes the original screening decision attempted to ‘water down’ or ‘negate’ this area of his complaint because it referred to what Nurse Parry wrote on page 3 of the report. While Mr Xis entitled to his view, I don’t consider this means something went wrong with the original decision. We’re not in receipt of evidence to show that, having recorded it earlier in the report, Nurse Parry was also required to include information about medication Mr X was due to start
in the assessment summary section. Even if there was, this doesn’t indicate the
screening team failed to consider the full seriousness of the concern. As a
concern about clinical practice and in the absence of a pattern of similar
concerns, there’s no evidence of a serious concern that could require us to take
regulatory action to protect the public.

Conclusion
35.For the reasons above, I don’t consider anything went wrong with how the original decision was made. I’ve not identified any new information that could change the decision.