Conduct and Competence Committee Substantive Hearing. 27 September Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE

Transcription

1 Conduct and Competence Committee Substantive Hearing 27 September 2016 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant Nurse: Helen Natasha Harvey NMC PIN: 92J1534E Part(s) of the register: RNA, Registered Nurse (sub part 1) Adults (16 October 1995) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: England Misconduct Nicholas Cook (Chair Lay member) Janet Leonard (Registrant member) Sue Wadham (Lay member) William Hoskins Nour Shaheen Ms Harvey: Nursing and Midwifery Council: Not present and represented by Roderick James, counsel, instructed by Royal College of Nursing. Represented by Chris Scott, counsel, instructed by NMC Regulatory Legal Team. Outcome: CPD accepted 24 month conditions of practice order & 18 month interim conditions of practice order. 1

2 Details of charge: That you, whilst employed as the Home Manager of Moorwood Cottage Nursing Home, ( the Home ) between 16 September 2013 and 14 May 2014: 1. Did not ensure that there were adequate infection control measures in place at the Home, or alternatively, did not ensure that infection control measures were being complied with by staff at the Home; 2. Did not ensure that there were adequate fire safety measures in place at the Home, or alternatively, did not ensure that fire safety measures were being complied with by staff at the Home; 3. Did not ensure that as at 4 May 2014 each resident who required a sling had their own sling; 4. Did not ensure that staff at the Home were properly and/or adequately trained; 5. Did not provide proper and/or adequate supervision to staff at the Home; 6. Did not carry out any or any adequate monthly medication audits in that as at 20 February 2014: 6.1. There were no PRN protocols in place; 6.2. There was no care plan guidance and/or there were no review dates in place in relation to covert administration agreements; 6.3. Explanations as to alterations were not recorded on the back of MAR charts; 6.4. MAR charts did not record the administration of cream to residents; 6.5. The administration of Resident E s paracetamol was wrongly treated as PRN medication; 6.6. You did not enforce good practice in relation to the signing, counting and/or auditing of temazepam; 2

3 7. Between 20 February 2014 and 12 March 2014 you did not ensure an improvement in medication management in that: 7.1. Medication that was no longer in use inappropriately remained on residents MAR charts; 7.2. You did not put in place and/or enforce PRN protocols; 7.3. You did not ensure that the administration of cream was recorded on MAR charts; 7.4. You did not conduct any or any adequate medication audit in that you did not identify and/or respond to gaps on MAR charts; 7.5. You did not ensure that explanations for the non-administation of medication was always recorded on the back of MAR charts; 7.6. You did not ensure that medication boxes were dated when opened; 7.7. You did not ensure that medication stock rotation was managed effectively; 8. Did not ensure any or any adequate weight management of residents as at 20 February 2014, in that you: 8.1. Did not demonstrate that you had conducted weight monitoring audits and/or prepared action plans; 8.2. Did not ensure that Resident G s weight was being adequately monitored; 8.3. In relation to Resident H, did not ensure that: There was a nutritional care plan in place; Weight loss was being recorded; The MUST tool was updated; 8.4. Did not ensure that Resident I s weight loss was being adequately managed and/or recorded; 8.5. Did not ensure that referrals were made to a GP and/or dietician, and/or appropriate care plans were in place in respect of the following residents: Resident R who had lost 6.4kg in one month when seen on 28 April 2014; Resident S who had lost 2kg in April 2014; Resident T who had lost 3kg in April 2014; 3

4 Resident U who had lost 3.6kg in April 2014; Resident V who had lost 2.2kg in April 2014; 9. At or around 12 March 2014, did not demonstrate that you had carried out a care plan audit and/or ensured that care plans were up to date in that: 9.1. Care plans did not include a photograph of the residents; 9.2. Care plans did not include a complete evaluation and summary section; 9.3. You did not ensure that residents skin assessments had been reviewed since December 2013; 9.4. You did not ensure that residents had signed informed consent forms; 9.5. You did not ensure that care plans included sufficient detail; 9.6. You did not ensure that all residents needs had been assessed; 9.7. You did not ensure that all entries in care plans had been signed in full; 9.8. You did not ensure that care was planned effectively for residents with high level medical conditions; 9.9. You did not ensure that there were accurate recordings of fluid intake on residents fluid charts; You did not ensure that air mattress checks were being completed twice a day; You did not ensure that residents weights were being recorded on the air mattress sheets 10. Did not ensure that Resident J was provided with an adequate standard of care in that: Between 25 October 2013 and 28 April 2014, you did not ensure that there was a care plan in place for Resident J in respect of: Fluid intake; Mouth care; On 4 May 2014, Resident J was found to have a grade 3 pressure sore on her shin and/or pressure sores to her sacrum and thighs 4

5 11. On 28 April 2014 you incorrectly signed Resident J s MAR chart to confirm medication had been administered; 12. Allowed daily monitoring charts to be completed retrospectively; 13. Did not ensure that call bells were in reach of residents and/or answered by staff in that on 28 April 2014: Resident K s call bell was not in easy reach when it was wrapped around a call bell box; Resident L s call bell was not in easy reach when she needed to use the toilet; Resident M s call bell was not in answered in less than 45 minutes when he needed to empty his catheter bag; Resident N s call bell was not in easy reach; Resident O s call bell was not responded to promptly; Resident Q s call bell was not in easy reach; 14. Did not ensure that residents were provided with adequate nutrition and hydration in that: On 5 March 2014 Resident R was found to be thirsty with dry lips; In April 2014 you did not ensure that Resident U had been referred to the Community Mental Health Team in relation to her failure to eat AND in light of the above, your fitness to practise is impaired by reason of your misconduct. 5

6 The parties agreed that this was a case which was potentially suitable for disposal by way of consensual panel determination, and the text of the provisional agreement follows. The panel was informed that the referrer in this case agreed with the proposed order. Background agreed facts 1. Miss Harvey was employed as a Home Manager at the Moorwood Cottage Nursing Home ( the Home ). The Home was owned and operated by Orchard Care Homes Limited ( Orchard ). The Home housed around 36 residents with various nursing needs. Miss Harvey was employed as the Home Manager between 16 September 2013 and her dismissal on 6 June She was registered with the Care Quality Commission ( CQC ) as the Home s Registered Manager on 27 January She was suspended on 14 May As the Home Manager Miss Harvey had overall responsibility for ensuring the proper operation of the Home, that systems, policies and procedures were in place and being adhered to, ensuring staffing levels and training was appropriate and ensuring that patient care and wellbeing was being maintained. 3. A number of inspections were carried out at the Home. It is the concerns raised during those inspections which give rise to the allegations referred to the NMC. 4. The CQC had concerns with standards at the Home in March 2013, prior to the Miss Harvey s employment at the Home. In May 2013 prior to her having taken over the management of the Home, the CQC carried out another inspection and found that the Home had complied with earlier improvement plans. 5. Ms 1, a Registered Nurse and Compliance Officer at Orchard, inspected the Home on 20 February 2014, where she judged the Home s amber status not to have changed. She carried out a medication review of seven residents and had concerns 6

7 with issues such as weight management, infection control, fire safety etc. She inspected the Home again on 12 March 2014 and again considered that the amber level should remain due to similar concerns being apparent. This meant that there were outstanding issues that needed addressing, and there was an expectation that the Home Manager, Miss Harvey, would be supported by Orchard s operational team, with an action plan and she would be monitored in relation to the required improvement. 6. Ms 2, a Social Worker, and Senior Practitioner / Assistant Team Manager with the Older Persons Disabilities Team in Eastleigh for Hampshire County Council inspected the Home on 28 April 2014, after colleagues had carried out similar safeguarding inspections at the Home on 3 and 10 March 2014, 9, 14, and 16 April 2014 during which serious concerns about the care being provided to a number of residents had been raised. The inspection on 28 April 2014 was significant as it led Ms 2 and her colleague, Ms 3, to draft a report which outlined their immediate concerns about the residents welfare at the Home and this led to what Ms 2 refers to as a Large Scale Investigation. She also conducted another visit to the Home on 4 May Although Miss Harvey was still in post as the Home Manager on this date, Orchard had already sent three members of senior staff to the Home to support her. Miss Harvey did not consider that she had operational management of the Home. Again, she noticed serious concerns affecting the safely and welfare of the residents. 7. Ms 2 discussed her concerns following her visit on 28 April 2014 with Ms 4, a CQC Inspector. As a result of this conversation, Ms 4 took legal advice as to whether an urgent closure of the Home was necessary. A safeguarding meeting was also arranged for 30 April Ms 4 conducted a CQC inspection herself on 1 May 2014.Ms 5, a Registered Nurse and CQC Registration Manager, also attended. During the inspection, Ms 4 spoke directly with Miss Harvey. Ms 4 and Ms 5 raised concerns about the care provided to 7

8 residents, and they also felt that staff training and support were major issues at the Home. 9. As a result of the CQC inspection on 1 May 2014 Ms 4 issued a Code B Notice pursuant to the Police and Criminal Evidence Act 1984 to obtain care documentation from the Home. The Notice was issued in relation to the following CQC outcomes under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Outcome 4 (Regulation 9) Care and welfare of people who use services; Outcome 5 (Regulation 14) Meeting nutritional needs; and Outcome 7 (Regulation 11) Safeguarding people who use services from abuse. 10. On 2 May 2014, Ms 4 documented plans to potentially move some residents from the Home. Ms 4 and Ms 5 attended a management review meeting on the same day and it was decided to inspect the Home again on 5 May 2014 because of concerns that the residents would be at risk over the bank holiday period. Ms 4 and Ms 5 carried out the inspection, along with another CQC inspector, Ms 6. Another management review meeting took place after the inspection of 5 May 2014 where again serious concerns about the care being delivered to the residents were discussed. At this stage, it was the CQC s belief that the Home should be closed and so a meeting with the Home s providers was arranged for 8 May Miss Harvey was one of the attendees at this meeting. 11. The issues that the CQC raised at the meeting on 8 May 2014 included the following: call bells, the use of agency staff, competency of permanent staff, medication, nutrition and hydration, infection control, accessible information in relation to care plans for residents, dignity and comfort of residents, weight loss and quality assurance processes. 12. Following concerns being raised by the CQC, Miss Harvey was suspended on 14 May

9 13. At a disciplinary hearing on 4 June 2014 Miss Harvey was dismissed. Following her dismissal, Miss Harvey sought to appeal the decision. She was informed by Orchard that there was no right of appeal and her dismissal remained in place. 14. As a result of the CQC s concerns with the standard of care provided at the Home and its failure to comply with the CQC standards, a Notice of Proposal was served on Orchard on 11 August This was a Notice of Proposal to remove a condition of registration at the Home in relation to the following regulated activities: diagnostic and screening procedures; treatment of disease, disorder or injury; and accommodation for persons who require nursing or personal care. 15. A Notice of Decision was then served on Orchard as the CQC had found that the Home had failed to comply with Regulations 9-14, 17, 18, 22, and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations All of the residents were moved out of the Home and it has now been closed. Offering no evidence on Charges 1-4 and The NMC offers no evidence on these charges pursuant to Rules 24(7) and (8) of the Nursing and Midwifery (Fitness to Practise) Rules 2004 for the following reasons: Charges 1 and These allegations raise concerns with Miss Harvey s ability to manage non-clinical matters in a care home and therefore do not have the same bearing on Miss Harvey s fitness to practise as a nurse as the clinical management failings. Further Miss Harvey has demonstrated some insight into these concerns in her proof of evidence (Appendix 1). Accordingly these charges will have no impact on whether Miss Harvey s fitness to practise is impaired and no impact on the decision on sanction. Charge 3 9

10 18. Miss Harvey has stated that she did not have operational management of the Home from 2 May Orchard have confirmed to the NMC that three members of staff were sent to the Home to support Miss Harvey. This was an isolated equipment concern and in the circumstances it is agreed that it does not amount to misconduct. In any event, this charge is one of a number of charges concerning Miss Harvey s management of the Home and accordingly would have no impact on whether her fitness to practise is impaired and no impact on the decision on sanction. Charge Miss Harvey has demonstrated insight by recognising that there were concerns with training and explaining her difficulties with organising training. This charge is one of a number of charges concerning Miss Harvey s management of the Home and accordingly would have no impact on whether Miss Harvey s fitness to practise is impaired and no impact on the decision on sanction. Charge This charge is based on the fact that Ms 4 (CQC) saw charts being completed at the end of the shift and that Miss Harvey admitted to her that this occurred. There is no evidence that Miss Harvey allowed this to occur, instead she was aware of this concern and acknowledged it to a CQC inspector. Miss Harvey s denial of the charge and her explanation is evidence that was not before the Case Examiners. Admitted Charges 21. Miss Harvey admits all remaining charges. Charge Ms 1 visited the Home on 20 February and 12 March 2014 and she says in relation to staffing that she found: Staff supervisions were taking place but not all were up to date and there was no supervision/appraisal matrix,- staff require support meeting with their line manager however these were not being completed, there was no 10

11 matrix in use to identify dates of completion and no appraisals had been completed for staff for some time. The manager is responsible for ensuring that staff receive supervisions/appraisals and for creating a matrix to monitor this. Accordingly it is agreed that Miss Harvey s supervision was neither proper nor adequate. Charge Ms 1, when she inspected the Home on 20 February 2014 conducted a medication review. Ms 1 noted the concerns set out at charges Miss Harvey accepts that these concerns arose because she did not carry out monthly medication audits. Charge Ms 1 highlighted her concerns with medication management to Miss Harvey following her inspection on 20 February 2014, however when she returned to the Home on 12 March 2014 she found that Miss Harvey had not ensured any improvement in medication management, as particularised at charges Charge Ms 1 inspected the Home on 20 February 2014 and noted the concerns with weight management. Miss Harvey accepts that there was no monthly audit of weight monitoring and that this ought to have been undertaken. Miss Harvey accepts that there were no action plans in relation to weight management. Miss Harvey accepts that as a result of her failures to oversee weight management at the Home that there were specific concerns in relation to three residents, as particularised at charges In April 2014 Ms 2 noted weight loss in five residents had not been referred to a GP or dietician and was not reflected in care plans. Miss Harvey accepts that as the manager of the Home, she should have ensured that appropriate care was provided to these residents. Charge 9 11

12 27. Ms 1 inspected the Home on 12 March 2014 and noted multiple concerns with care plans, particularised at charges Miss Harvey accepts that she was responsible for these wide ranging issues and that she should have conducted care planning audits. Charge Resident J was admitted to the Home on 25 October 2013, however by 28 April 2014 there was no care plan in place to address fluid intake or mouth care. These were significant concerns for Resident J, who suffered from oral infections frequently and appeared dehydrated on a number of occasions. Miss Harvey accepts that she was responsible for these long-standing and serious shortcomings in the care provided to Resident J. 29. Further concerns in relation to Resident J s care arose on 4 May 2014 when it was noted during an inspection that Resident J had a grade three pressure sore on her shin and pressure sores on her sacrum and thighs. As no previous concerns had been raised with Resident J s skin integrity, Miss Harvey accepts that there was a serious failing in Resident J s care for which Miss Harvey is responsible. Charge Ms 2 also noted on her visit of the 28 April 2014 that Miss Harvey told me that [Resident J] was in pain but had refused her medication in the morning and at tea time that day. When I asked Ms Harvey to show me the MAR chart for [Resident J], Ms Harvey had signed to say that this medication had been administered. Ms Harvey advised me that she had forgotten to cross out the medication when [Resident J] had refused this. I was concerned by the false documentation contained within [Resident J s] MAR chart as prepared by Ms Harvey. The MAR chart should not have been signed had the medication not been administered. Ms Harvey to me (sec) that she had forgotten to cross out the medication, which is an admission that she had been completing the documentation before actually administering the medication. This would not be best practice, as medication should only be signed for 12

13 following its administration. It was clear that following this error no pain relief had been offered or given to [Resident J] as a result of the poor record-keeping by Ms Harvey. This had a large detrimental effect on [Resident J] as she was in pain and without this necessary medication. Any nurse considering the chart would believe that [Resident J] had received the pain relief and could receive no more, when this was not the case. Charge Ms 2 says that she inspected the Home on 28 April 2014 noting that Resident K was calling for a nurse as she entered the room and he told her that he needed to use the toilet. The call bell was on the other side of the bedroom wrapped around the call bell box. This was a potentially dangerous situation as the resident was not able to call staff when he needed to. 32. Ms 2 also noted that Resident L s call buzzer was out of reach when she needed to use the toilet. Resident M had to wait 45 minutes for a call bell to be answered to empty his catheter and that Resident N s call bell was out of reach. Resident O s call bell was not responded to promptly and Resident Q s call bell was out of reach. 33. Miss Harvey accepts that the scale of the concern noted on 28 April 2014 is a serious matter and that these failings are attributable to her. Charge Ms 4 says that she inspected the Home on 1 and 5 May 2015 and noted the concerns in relation to nutrition and hygiene which are set out at charges 14.1 and Misconduct 35. Miss Harvey admits that the facts, as set out above, amount to misconduct. She accepts that her actions fell seriously short of what would be expected of a 13

14 registered nurse in the particular circumstances of the case (Roylance v General Medical Council [2000] 1 AC 311) and that her conduct amounted to a serious departure from the NMC s Code of Conduct Standards of conduct, performance and ethics for nurses and midwives (2008) ( the Code ). 36. In particular Miss Harvey accepts that her conduct fell far below the following provisions of the Code: Preamble The people in your care must be able to trust you with their health and wellbeing. To justify that trust, you must: o make the care of people your first concern, treating them as individuals and respecting their dignity o work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community o provide a high standard of practice and care at all times Numbered paragraphs 1. You must treat people as individuals and respect their dignity. 3. You must treat people kindly and considerately. 28. You must make a referral to another practitioner when it is in the best interests of someone in your care. 30. You must confirm that the outcome of any delegated task meets the required standard. 31. You must make sure that everyone you are responsible for is supervised and supported. 35. You must deliver care based on the best available evidence or best practice. 42. You must keep clear and accurate records or the discussions you have, the assessments you make, the treatment and medicines you give, and how effective these have been. 14

15 61. You must uphold the reputation of your profession at all times. 37. Miss Harvey accepts that there were serious failings in her clinical management of the Home. The failings are wide ranging and go to the heart of the care provided to the residents. The failures led directly to the standard of care falling beneath the standard required and caused harm to residents. 38. Miss Harvey failed to carry out the responsibilities and requirements of her position as Home Manager. Her role was to ensure that the required systems were in place, that staff were properly supervised, and that residents were safe and protected in having proper and adequate provided to them. Miss Harvey also failed to address the concerns raised by internal and external bodies. Impairment 39. Miss Harvey accepts that her fitness to practise is currently impaired by reason of her misconduct according to the principles laid down by Dame Janet Smith in the Fifth Shipman Report, and reaffirmed in CHRE v (1) NMC and (2) Grant [2011] EWHC 927 (Admin). In particular, Miss Harvey accepts that she: a. Has in the past acted and is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and b. Has in the past brought and is liable in the future to bring the profession into disrepute; and c. Has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession; 40. Miss Harvey accepts that her failures to ensure that adequate care was provided in a number of basic and fundamental areas put all residents in the Home at risk of unwarranted harm and caused actual harm to Resident J. Miss Harvey accepts that as Home Manager she was in a position of considerable trust and responsibility and 15

16 her serious and wide-ranging failures in management brought the profession into disrepute. Miss Harvey accepts that she breached a fundamental tenet of the profession in failing to provide a high standard of care at all times. 41. Miss Harvey has not held a management role since working at the Home, and has therefore not remediated her management failings. However Miss Harvey has worked as a nurse assessor for Arden and Great East Midlands Commissioning Support Unit since May Miss Harvey has provided positive references from this employment (Appendix 2) and it is evident that she has been able to maintain and improve her nursing knowledge and skills through this position. 42. Miss Harvey has demonstrated some insight into her misconduct, by her admissions and detailed statements in her proof of evidence. Miss Harvey has demonstrated some understanding of why these issues arose in her practice, but does not take full accountability for actions and places blame on both her staff and Orchard (Appendix 3): I would not put myself in the position of being responsible for the actions of a staff group again. I am confident in my own practice as a nurse, but now would not trust others to complete delegated tasks fully. I have observed staff delivering care correctly under my direct supervision, but when I have not been present, they have chosen not to. This experience has taught me not to accept verbal confirmation that a task has been completed, I will check for myself. As a Manager I worked with the resources available, and was expected to run an effective, efficient service with maximum occupancy and income. This did not sit comfortably with me as a nurse, but was expected by the Provider. Their promises of things will get better, regarding resources etc., was another verbal confirmation I should not have accepted. I will not give any provider the benefit of the doubt in future, as I realise these are stalling tactics. I would also follow up any conversations with an confirming the details discussed. 16

17 43. Miss Harvey accepts that in the absence of full insight and remediation, there is a real risk of repetition of future management failings and a finding of impairment is required for the protection of the public. Miss Harvey also accepts that the severity of her misconduct requires a finding of impairment in order to maintain public trust and confidence in the profession. Sanction 44. The appropriate sanction in this case is a 24 months Conditions of Practice Order, taking into account the NMC s Indicative Sanctions Guidance, the public interest, principle of proportionality and the aggravating and mitigating features. 45. The mitigating features of the case can be listed as follows: a. The engagement of Miss Harvey with the proceedings and her cooperation with the NMC; b. Miss Harvey s admissions and insight; c. Miss Harvey s current good practice; d. There are no previous NMC findings against Miss Harvey during her long nursing career; 46. The aggravating features of the case are: a. Miss Harvey put residents at a real risk of serious harm; b. The misconduct related to basic care, was serious, wide-ranging and took place over several months; c. Concerns were highlighted to Miss Harvey, but not addressed. 47. The full range of sanctions has been considered by the parties. It is agreed that the facts are so serious that the taking of no further action or the imposition of a caution order would not be a proportionate and or appropriate response, particularly given the risk of repetition. 17

18 48. It is agreed that the only appropriate and proportionate response to the seriousness of the charges is to impose a conditions of practice order. The public interest must be at the forefront of any sanction. The public interest includes the protection of members of the public (including patients), the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour within the profession. 49. The parties agree that there are conditions which could be imposed which would sufficiently protect patients and the public interest. There are identifiable areas of remediation within Miss Harvey s practice, she has demonstrated a willingness to improve her practice, and there are workable conditions that could be formulated that would adequately protect to the public. 50. There is only concern in relation to the care provided directly by Miss Harvey (charge 11). This itself is not sufficiently serious to warrant restriction on her practice. Miss Harvey has provided testimonials (Appendix 4) which demonstrate her previous good practice. The risk in this case relates to Miss Harvey s practice as a manager, and accordingly it is agreed by Miss Harvey that she should not hold a management position. 51. Miss Harvey accepts that her failings concern basic nursing practice. A personal development plan and oversight by her manager will mitigate risks in relation to these matters in her provision of direct nursing care. Accordingly the conditions of practice order agreed is a minimum order necessary in order to protect the public. 52. The proposed 2 Years conditions of practice order are as follows; 1. You must confine your practice to working in a non-managerial role. 2. You must work with your line manager, mentor or supervisor (or their nominated deputy) to formulate a Personal Development Plan specifically designed to address the deficiencies in the following areas of your practice: Medications management Nutrition, hydration and weight management Care planning. 18

19 3. You must meet with your line manager, mentor or supervisor (or their nominated deputy) at least every 6 weeks to discuss the standard of your performance and your progress towards achieving the aims set out in your personal development plan. 4. You must send a report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your performance to the NMC prior to any NMC review hearing or meeting. 5. You must notify the NMC within 7 days of any nursing appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 6. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 7 days of you receiving notice of them. 7. You must within 7 days of accepting any post or employment requiring registration with the NMC, or any course of study connected with nursing, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. 8. You must within 7 days of entering into any arrangements required by these conditions of practice provide the NMC with the name and contact details of the individual/organisation with whom you have entered into the arrangement. 9. You must immediately inform the following parties that that you are subject to conditions of practice order under the NMC's fitness to practise procedures, and disclose the conditions listed to them: a. Any organisation or person employing, contracting with, or using you to undertake nursing work. b. Any agency you are registered with or apply to be registered with (at the time of application). c. Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply to take such a course (at the time of application). 19

20 53. A suspension or a strike-off order would not be an appropriate and proportionate response, due to Miss Harvey s insight and remediation. The purpose of sanctions is not to punish. The conditions of practice order in the terms outline above reflects the gravity of the misconduct and provides the necessary degree of protection, and provide the necessary safeguarding framework in which Miss Harvey s practice could resume. It is acknowledged that there is a public interest in allowing an otherwise good nurse to return to practise. 54. The public interest in maintaining public trust and confidence in the nursing profession and in the NMC is adequately met by preventing Miss Harvey from taking a management position and placing other restrictions on her practice as a nurse. Accordingly the conditions of practice order is in the public interest. A period of two years marks the seriousness of the misconduct and will allow Miss Harvey to demonstrate further insight and remediation. 55. It is also necessary for the protection of the public and otherwise in the public interest for there to be an interim condition of practice order of 18 months to cover the appeal period should an appeal be lodged. The interim conditions of practice should be the same as set out above 56. The parties understand that this provisional agreement cannot bind a panel, and that the final decision on findings impairment and sanction is a matter for the panel. The parties understand that, in the event that a panel does not agree with this provisional agreement, the admissions to the charges and the agreed statement of facts may be placed before a differently constituted panel that is determining the allegation, provided that it would be relevant and fair to do so. Panel determination: The panel considered the provisional CPD agreement between Miss Harvey and the NMC. It took into account that the CPD contained a submission from the NMC that it 20

21 was appropriate to offer no evidence in respect of charges 1, 2, 3, 4 and 12. The NMC submitted that these charges related mainly to managerial shortcomings and did not add significantly to the seriousness of the case. In relation to charge 12, the NMC indicated that, in its view, this charge would be difficult to prove and in light of fresh evidence, there is no longer a realistic prospect of proving that charge. The panel noted the submissions and took into account that the CPD contained admissions to the remaining charges and an admission that Miss Harvey s fitness to practise is currently impaired. The panel accepted the advice of the legal assessor. The panel exercised its own judgement in reaching its decision on impairment and sanction. The panel found the facts of the case proved by way of admission as contained within the CPD. It considered that Miss Harvey s full admissions and acceptance of the CPD agreement demonstrated insight into the charges. The panel considered that the CPD properly reflected the fact that Miss Harvey s fitness to practise is impaired as a result of her failings. The panel considered that a finding of current impairment was necessary, both to protect the public, and to maintain public confidence in the profession. The panel considered there to be a continuing risk of repetition based on the incomplete insight into some areas of Miss Harvey s misconduct. However, it took into account Miss Harvey s assurance that she has no intention of undertaking a managerial role again in the future, and noted that the proposed order prevented Miss Harvey from occupying a managerial role. The misconduct in this case was very largely confined to the way in which she discharged her managerial responsibilities. With the exception of one charge, Miss Harvey s clinical practice was not an issue, and the various testimonials submitted showed that she was generally considered to be a competent nurse. 21

22 The panel first considered whether to take no action, but determined that, in the light of the misconduct, this would not be sufficient to protect the public, nor would it satisfy public interest. The panel then considered making a caution order but found that allowing Miss Harvey to return to practice, without restriction, to be inappropriate and not proportionate as it would not provide adequate public protection or satisfy the wider public interest. The panel considered that a conditions of practice order was the appropriate and proportionate sanction in this case. There are identifiable areas of Miss Harvey s clinical practice in need of remediation. The panel has determined that she has demonstrated significant insight through her admissions and by way of her reflective piece. Miss Harvey is an experienced nurse whose clinical practice was not the focus of these charges. She displays no evidence of attitudinal problems or general incompetence, and indicates that she is willing to respond to conditions placed on her practice. There is a clear public interest in allowing her the opportunity to address the deficiencies in her practice, under such supervision as may be required to protect those in her care whilst she does so, and thereby returning to unrestricted practice when deemed safe to do so. Having considered the terms of the conditions of practice order suggested, the panel concluded that the order was appropriate, subject to one minor amendment, which involved adding the words and weight management to the words nutrition & hydration in condition 2. The panel was informed that the parties agreed with the proposed amendment and the panel has accordingly incorporated this amendment into the draft agreement. The panel also considered that a future reviewing panel would be assisted by provision of an updated reflective piece to demonstrate the further development of insight and remediation, following the conditions of practice order. 22

23 The panel considers that a period of 24 months sufficiently offers Miss Harvey an appropriate opportunity to address the deficiencies in her practice. In the particular circumstances, a more restrictive sanction is not required to protect the public, nor to satisfy the wider public interest, and accordingly, a suspension order, would in the panels view, be disproportionate. The panel has determined to accept the amended provisional CPD agreement, which includes an interim conditions of practice order for 18 months. That concludes this determination. 23