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Nurses: Removal From Professional Register

Volume 596: debated on Wednesday 3 February 1999

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3.1 p.m.

Whether nurses sacked for gross misconduct in the NHS should be free to seek employment elsewhere in the health service.

My Lords, any nurse dismissed for gross misconduct should be referred by the previous National Health Service employer to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) to decide whether he or she should be removed from the professional register. The UKCC can impose an interim suspension from the register, pending a full hearing. While nurses who remain on the professional register are entitled to seek alternative employment, we expect all NHS employers to check thoroughly the employment records of prospective recruits. It would be highly unusual for a nurse sacked for gross misconduct to be offered employment with another NHS employer.

My Lords, I thank the Minister for that reply. However, is it not unacceptable that the present situation allows nurses such as those sacked from Beech House and St. Pancras Hospital for hitting and giving cold baths to elderly and confused patients to slip through the net? Is this not merely the latest in a series of inquiries calling for effective government action? Is the Minister prepared to consider either greater powers for the UKCC—for instance, the civil standard of proof—or the mandatory transfer of employment records to a new employer, which does not presently happen? Will the Minister examine either of those more effective solutions?

My Lords, the noble Baroness is right to draw to the attention of the House the very serious failures in care that occurred in those circumstances. Equally, she is right to draw attention to the difficulties that can arise when the proof available to a regulatory body such as the UKCC in terms of removal from the register is not up to the standard demanded under the current regulations in relation to criminal case standards of evidence. I understand that the UKCC's original advice was that there was not enough evidence to proceed with a case against those nurses. The council is now reviewing its advice in the light of the report that has since been published.

There are great difficulties in imposing restrictions on the ability to earn a livelihood of those who remain on a professional register. However, the noble Baroness rightly identifies areas in which we must make sure that professional regulation is married up with protection of the public. I am sure that during our debates on the health Bill we shall explore some of these issues.

My Lords, put shortly, does the Minister agree that this is not a matter for Government at all? What is proposed?—establishing a register of sacked nurses, with details of their serious misconduct? It is an incredible idea.

My Lords, the protection of the public is absolutely an area in which the Government should take responsibility. We must be responsible for ensuring that NHS employers exercise due diligence in reviewing those whom they appoint. There is a difficult area, referred to by the noble Baroness, where there are concerns serious enough to reflect on patient safety but not such as to deliver removal from the professional register. A revised system, agreed with the BMA, the postgraduate deans and regional directors of public health, of "grey alerts" has been in operation for public protection in regard to doctors and dentists. We are currently considering whether such a system could be extended to nursing and professions allied to medicine. As I said earlier, there is a balance to be struck between the rights of employees and protection of the public. We must get that balance right.

My Lords, does my noble friend agree that one way forward may be to give the health services ombudsman a right of appeal against such decisions, as in these cases they have clearly been unsatisfactory?

My Lords, my noble friend refers to the decisions of the regulatory bodies. Concern has been expressed in a number of areas as to how regulatory bodies function. A report into the workings of the Nurses, Midwives and Health Visitors Act is due to be published. It should shed some interesting light on some of the areas about which concern was expressed.

My Lords, in view of the Minister's very clear replies in relation to the UKCC, will she venture a view as to whether it was appropriate for the UKCC to engage as a consultant a chief nurse at Ashworth Hospital who was then under investigation by the Fallon Inquiry?

No, my Lords, I shall not venture a view on that. When we discussed the Fallon Inquiry report in this House, I said that in each case where NHS employees were criticised in the report that criticism was drawn to the attention of their current employers, who will consider what action, if any, needs to be taken in the light of the inquiry's comments. Where those criticised in the report have left the National Health Service but work as independent consultants in the health and social services sector, it must properly be for the organisation contracting the services to consider their suitability in the light of information that is publicly available.

My Lords, when a nurse is sacked for gross misconduct, is that fact reported to the UKCC, enabling it to advise a potential future employer when that employer checks with the UKCC on the nurse's pin number—which I understand should always be done?

My Lords, when any nurse is sacked for gross misconduct, that fact is referred to the UKCC so that it can then take advice—and, as in this case, legal advice—as to whether to proceed against that member and remove his or her name from the register. I am not certain as to whether that fact is on the record that is passed to an employer checking on registration. I shall find out and write to the noble Lord.