A licence to abuse patients: They've attacked and stolen from the vulnerable in their care. But why are so few rogue nurses struck off?

A licence to abuse patients: They've attacked and stolen from the vulnerable in their care. But why are so few rogue nurses struck off?

• Official regulator the Nursing and Midwifery Council (NMC) has often allowed nurses found guilty of crimes to remain in charge of patients
• One nurse was sacked for hitting a patient and was charged with assault but was allowed to carry on working
• Today the NMC's overseer said in a damning report that patients are being let down because of 'failings at every level'
• It pointed to weak leadership, huge backlog of cases, bad morale and poor standards among staff
  
• NMC apologises for its 'substantial failings' and said the report was 'difficult reading'
  

By John Naish

PUBLISHED: 16:43 EST, 2 July 2012 | UPDATED: 04:52 EST, 3 July 2012

Worry: Watchdog the CQC reported that almost half of all care homes and treatment centres in England are failing to protest the welfare of vulnerable adults

Rogue nurses who have been found guilty of threatening or abusing patients, stealing from them or being drunk on duty are being allowed to continue working, a Daily Mail investigation has revealed.

The nursing profession's official regulator, the Nursing and Midwifery Council (NMC) is repeatedly letting nurses go back to work despite being found guilty of a catalogue of offences, including just being dangerously incompetent.

Today, the regulator’s overseer, the Council for Healthcare Regulatory Excellence, has released a hard-hitting report demanding fundamental changes in the way the NMC is run after concluding that patients are being let down because of 'failings at every level'.

As a Daily Mail investigation reveals, this is not before time.

For not only has the body failed in important cases to protect vulnerable patients from rogue staff, it has run its administration system so badly that, even when such nurses have been disciplined, the sanctions against them did not go on their professional records for employers to see.

This occurred in at least 500 cases, of which around 100 were ‘of major concern’.

Never before has there been such worry over the safety of our relatives and loved ones in care homes and hospitals.

Today, Jackie Smith, the NMC's acting chief executive and registrar, apologised for what she called its 'substantial failings'.

She said in a statement: 'It is clear that the NMC has not delivered effective and efficient regulation, and we are committed to putting that right.'

Meanwhile, Harry Cayton, chief executive of CHRE, said the regulator needed new leaders, and must address its 'serious organisational problems'.

He said: 'The NMC must finally leave its troubled past behind and apply itself to protecting the public and rebuilding confidence in regulation.

'New leaders must be appointed who are competent, credible and capable of addressing the NMC's very serious organisational problems and transforming the NMC into the regulator that the public, nurses and midwives deserve.'

Sorry: The Nursing and Midwifery Council's offices in Portland Place, London. Today, the acting chief executive Jackie Smith apologised for what she called its 'substantial failings' following a hard-hitting report

Last week, patient-care watchdog the Care Quality Commission (CQC) reported that almost half of all care homes and treatment centres in England are failing to protect the welfare of vulnerable adults.

Its report comes in the wake of the shocking abuses uncovered by BBC’s Panorama at the Winterbourne View home near Bristol.

Unannounced inspections by the Care Quality Commission were carried out at 145 care homes and hospitals in England.

Nearly half did not meet required standards.

Meanwhile, the nurses’ regulator, the Nursing and Midwifery Council, has seemed concerned less with protecting patients from harm than with saving the careers of nurses who have seriously transgressed the laws of their profession and the basic tenets of human decency.

The body is responsible for the regulation of the 670,000 nurses and midwives currently registered in the UK.

Last month, for example, a nurse who was sacked for hitting a patient and charged with common assault by the police was allowed by the NMC to remain working.

The council’s disciplinary panel heard how Maureen Yoliswa Booi, a Registered Mental Nurse, struck a resident in her care at an NHS-run unit.

The incident was witnessed by a colleague, the hearing was told.

Ms Booi was dismissed by her employer and has since been charged with common assault.

Abuse: The Care Quality Commission (CQC) report comes in the wake of the shocking abuses (pictured) uncovered by BBC's Panorama at the Winterbourne View home near Bristol

But instead of being struck off, she was placed under a ‘conditions of practice order’ for 18 months, which stipulates that Ms Booi must not, at any time, be the sole registered nurse on duty, and that she must tell the Nursing and Midwifery Council of the outcome of her pending prosecution for assault.

This means she is free to apply for a job with any employer, though the NMC requires that she tell them that there is an ‘order’ on her record.

This is perturbing enough as an isolated judgment, but it has remarkable similarities to another case heard last month, of Loveness Makombe, a registered nurse working at the Bupa-run St Christopher’s Care Home in Hatfield, Hertfordshire.

The NMC panel found her guilty of ‘shouting aggressively’ at a confused elderly patient, as well as verbally threatening the woman, who had dementia, and dragging her out of a room ‘in a manner that caused her to become distressed’.

Rather than cracking down on this abuse, which bears disturbing similarities with the sort of intimidation exposed at Winterbourne View, the disciplinary panel said it ‘does not believe there is an under-lying attitudinal or behavioural problem with the nurse’.

Change: A screen grab of an incident between a resident and a care worker at Winterbourne View. Today the NMC's regulator overseer is demanding fundamental changes in the way the NMC is run

The sanction it handed down amounted to a regulatory slap on the risk â€" it placed only a ‘caution’ on her record for a three-year period.

Similarly, in May, Beverley Cooney, 40, was allowed to continue nursing by an NMC disciplinary panel after it had heard from her manager, Susan Holliday, head of clinical services at a private East Yorkshire hospital, how Cooney had told a vulnerable woman patient: ‘If you don’t go to sleep I will fetch a rubber hammer from my car and hit you on the head with it.’

Cooney was also found guilty of repeatedly swearing at other members of staff, and regularly swearing about patients when discussing them with staff.

As a result of these transgressions, Ms Cooney was sacked by her employer, the Spire Hospital in Anlaby, Hull.

Nevertheless, she was allowed by the NMC to continue nursing after the disciplinary panel decided the complaints were about her ‘attitude and behaviour’ rather than ‘clinical abilities’.

She was placed under a conditions of practice order, which required her to work with a mentor and take an anger management course.

In fact, the NMC has repeatedly been warned about its soft-touch approach before these recent judgments were made.

Shocking: A nurse who was sacked for hitting a patient and charged with common assault was allowed by the NMC to remain working (file picture)

In September, the Council for Healthcare Regulatory Excellence (CHRE), issued a bulletin that outlined cases held in the past two years where it had to tell the NMC panels to improve their performance.

The bulletin says that in one case, a nurse named only as O’Reilly had been physically violent to a vulnerable elderly patient, as well as shouting abuse at them, at an unidentified hospital.

But the NMC panel had put only a caution on the nurse’s professional record.

This is because, though nurses should be struck off for harming patients, the panel interpreted ‘harm’ as physical. 

The Council for Healthcare Regulatory Excellence says the patient appeared to have suffered psychological harm, as she was left seriously distressed after the incident â€" as, indeed, anyone would be when attacked by someone who is supposed to be in charge of their care.

It said it had given the NMC panel specific guidance on not repeating this error.

In another alarming case cited by the CHRE, a nurse named only as Mrs Marshall had illegally cashed a number of large cheques from an elderly resident at a care home where she worked over a period of two years.

Though the panel found the nurse’s fitness to practise was ‘impaired’, it only put a caution on Mrs Marshall’s professional record.

This was after it concluded that she had not been dishonest.

The CHRE describes this as ‘wrong’, adding that the nurse ‘had behaved in a way that most people would regard as dishonest’.

Once again, the NMC panel had decreed that the patient had suffered no harm, because she had not suffered actual physical injuries.

Most damningly, in September Harry Cayton, chief executive of the CHRE, harshly criticised some panels for siding with nurses in blaming patients as the cause of their malpractice.

He cited one case where the nurse had received a police caution for battery of a patient.

‘The NMC panel’s determination commented on the “very challenging behaviour” of the patient, who was elderly and had dementia.’

PATIENTS ARE LET DOWN BECAUSE OF 'FAILINGS AT EVERY LEVEL'

Patients are being let down by the Nursing and Midwifery Council (NMC) because of 'failings at every level', the report has found.

A root and branch overhaul is required for the NMC to fulfil its key duty to protect the public, the review by the CHRE found.

But a succession of weak leadership has failed to created the modern, effective and efficient regulator that the public, nurses and midwives need and deserve, the review found.

Despite a 'strong passion for public protection' among staff, the report found problems 'at every level, in every system'.

The report revealed that the number of cases being dealt with by the NMC had risen by almost 50 per cent since 2009, to more than 4,000 cases.

But delays in investigating complaints caused a backlog, and 1,500 are yet to be heard.

About a third of cases carry forward into the next year, and some cases take up to five years to close.

Bad morale has led to resignation and acceptance of poor standards among staff and almost a third of them leaving within the last year.

The report outlines 15 recommendations in which it says new leadership is vital to 'provide and sustain clear direction' to ensure public protection and public confidence in the NMC, and to challenge its culture of 'resigned resilience'.

Jackie Smith, the NMC's acting chief executive and registrar, apologised for what she called its 'substantial failings'.

She said: 'The strategic review report and annual performance review report together make difficult reading for the NMC.

'They highlight substantial failings in the delivery of our regulatory functions and in the management of our organisation.

'We recognise the failings that CHRE have set out in their reports, and we are sorry. It is clear that the NMC has not delivered effective and efficient regulation, and we are committed to putting that right.

'We look forward to the appointment of the chair and chief executive later this summer. Change is already under way and will continue, to ensure the NMC's focus is wholly on public protection.'

Louise Silverton, deputy general secretary of the Royal College of Midwifery, said the report should be 'a wake-up call'.

She said: 'We agree that the NMC must focus on its core regulatory functions and responsibilities, notably protecting the public and ensuring it maintains its confidence and that of the profession it regulates.

'We are pleased that the CHRE recognises that the NMC must acknowledge the difference in the way it regulates the two professions of nurses and midwives.

'The RCM looks forward to working with the NMC through this process and through our work on developing advice, standards and guidance for midwives. We need to find a way forward that embraces change.'

The union Unison, which represents nurses and midwives, welcomed the report but criticised an increase in its members' registration fees to £120 to 'help pay for its mistakes'.

Gail Adams, Unison head of nursing, said: 'It is perverse to demand that registrants should bail out organisations who are in trouble as a result of their own financial mismanagement - particularly nurses and midwives who have had to endure a two-year pay freeze in increasingly difficult financial times.

'We fail to see why nurses and midwives should have to bail the NMC out of a financial crisis of its own creation.'

Meanwhile, Unite, which represents other health service workers, said the fee hike should be withdrawn.

Unite's lead professional officer, Obi Amadi said: 'The CHRC report is a searing indictment that highlights a dysfunctional organisation which appears not to be fit for purpose in regulating the nursing professions and ensuring that the public has confidence in the regulatory framework'.

Public Health Minister Anne Milton said: 'Strong regulation of nurses and midwives is crucial to ensure public protection, and effective leadership within the Nursing and Midwifery Council is key to this.

'We would like to thank the Council for Healthcare Regulatory Excellence for its work and we expect to see the NMC implementing all of the recommendations contained within this report.

'In light of these recommendations I have requested urgent assurance about the process for the appointment of the NMC chair.'

In another case he cited, a nurse who physically threatened a patient who had suffered a stroke.

The panel said the patient was ‘difficult and time-consuming’.

Such comments ‘appear to take the side of the nurses rather than promoting dignity and respect for the vulnerable patients whom they ill-treated,’ Mr Cayton warned.

‘The panels’ decisions should have made it crystal clear to nurses and to the public that patients’ “difficult” behaviour can never excuse abuse.’

Moreover, he stresses: ‘“Challenging” behaviours in those with mental incapacity are a symptom of their condition and are exacerbated by bad care.

‘The regulator’s panels need to remember that if health professionals can’t cope with caring for people who exhibit “challenging” behaviour, they should choose another area of care.’

Perhaps we should just point out the principal function of the NMC, as set out in 2001: ‘The main objective of the council in exercising its functions shall be to safeguard the health and well being of persons using or needing the services of the registrants (or nurses, to put it in layman’s language)’.

Katherine Murphy, of the Patients’ Association, laments the problems with NMC decisions: ‘Patient safety must be the priority of any healthcare professional.

'Clearly in some of these instances there are examples of appalling care that should never have been allowed to happen,’ she says.

‘Individuals such as these do a disservice to the thousands of dedicated nurses who work incredibly hard in difficult conditions.

‘To be allowed to continue on the register is disappointing. We hope another patient is not made to pay a heavy price for these decisions.’

The reticence within the nursing profession to crack down on members’ misconduct explains why the CHRE is calling for a change in the law, so practising nurses or midwives are barred from taking the top job at the Nursing Midwifery Council.

The CHRE also recommended that there should be more laypeople than nurses on the NMC’s ruling council.

The aim, clearly, is to rid the NMC of the kind of professional self-interest that can prompt soft-touch disciplinary procedures.

Mr Cayton has said ‘serious problems’ have emerged because the council had ‘seen itself as a body to rep resent nurses rather than a body there to protect the public’.

Certainly, something radical needs to be done with the troubled regulator.

In its new, highly critical report published today, the CHRE says the council has been riven by infighting, with ‘dysfunctional relationships among its former chair, council and chief executive’.

The NMC is being run by a temporary chief, after its chairman and chief executive departed abruptly in recent months.

Meanwhile, the disciplinary procedures are dogged by a significant backlog of cases.

The new CHRE report says about 1,500 cases are still awaiting investigations and hearings.

These could take between two and three years to clear, the NMC’s interim chief executive, Jackie Smith, warned in April.

On top of this, the NMC is facing a growing number of nurses being referred to it for disciplinary investigation.

Last week, it s aid it had received 4,407 referrals in 2011 â€" up nearly 50 per cent from 2009.

It says many of these are frivolous, citing the case of a nurse referred for taking two paracetamol off a drugs trolley, and another nurse removing a banana from a patient’s locker.

Given the loss of trust in the NMC’s disciplinary procedures, though, the council may have trouble convincing patients and professionals that its disciplinary panels appreciate the difference between frivolous and serious.

In 2010, 164 nurses were removed from the NMC register â€" around 0.02 per cent of the 671,000 listed.

As the CHRE report today says: ‘The NMC is not inspiring confidence in the professions or in regulation.’

Just as worryingly, the regulator recently admitted IT errors on an admin system called WISER had left hundreds of nurses and midwives with inaccurate registration records, in some cases involving cautions and striking-of f orders.

So employers may, in good faith, have taken on nurses whose records seemed spotless, but should, in fact, have revealed serious disciplinary dangers.

When the NMC revealed the problem in May, it told the journal Nursing Times it had found 400 mistakes, of which 100 were of major concern and were being urgently rectified.

It expected to find more mistakes before its audit of the problem was completed.

The Nursing and Midwifery Council declined to comment on how many more mistakes had been found on its record.

Nor would it comment directly on the recommendations about its need for restructure, on the cases cited as lenient by the CHRE or on what it is doing to tackle the backlog of disciplinary cases.

The NMC would point only to the fact that today’s CHRE’s report recognised: ‘The NMC’s response to our review is encouraging.

'It has co-operated fully and there has been c onsiderable activity recently under the direction of the interim chair and chief executive.’

As today’s CHRE report concludes: ‘The NMC must finally leave its past behind and transform itself into a modern, effective regulator that protects the public well and so inspires public and professional confidence.’

For the sake of all vulnerable patients and their worried relatives, we can only hope it does

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