Conduct and Competence Committee Substantive Hearing

Transcription

1 Conduct and Competence Committee Substantive Hearing 12 September 2013 Nursing and Midwifery Council, 61 Aldwych, London, WC2B 4AE Name of Registrant Nurse: NMC PIN: Mrs Manjit Summersbee 78I2746E Part(s) of the register: Registered Nurse - Sub-Part 1 Adult Nursing (December 1981) Health Visitor (October 1991) Community Practitioner Nurse Prescriber (April 2000) Nurse Independent Prescriber (September 2002) Nurse Independent/Supplementary Prescriber (July 2003) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Representation: Nursing and Midwifery Council: Peterborough Misconduct Ms Jane Everitt (Chair/ Lay member) Mr Franklyn Baker (Lay member) Ms Kathryn Bergmanski (Registrant member) Mr Leighton Hughes Miss Bose Kayode Mrs Summersbee was present and represented by Mr Richard Williams, Thompsons Solicitors. Represented by Ms Krystle Fonyonga, counsel, instructed by NMC Regulatory Legal Team. Facts proved by way of admission: (1)a, (1)b, (1)c, (1)d and (2) Facts not proved: Fitness to practise: N/A Impaired 1 of 14

2 Sanction: Interim Order: Caution Order three years (By way of consensual panel determination) N/A 2 of 14

3 Charges: That you whilst employed as a registered nurse and Health Visitor by Cambridgeshire and Peterborough NHS Foundation Trust ( the Trust ): 1. On 22 September 2010, having been made aware that Child A may have sustained possible non-accident related injuries, failed to appropriately respond in that you: a. Did not immediately report the matter to Child A s social worker; b. Did not establish whether Child A s mother had already contacted Child A s social worker; c. Did not seek advice from a colleague at the Trust; d. Did not arrange for Child A to receive a medical examination without delay in order to establish the nature of the condition or injury; 2. On 30 September 2010 disclosed confidential information during a case conference in that you used the name of one family in the presence of another family And in light of the above, your fitness to practise is impaired by reason of your misconduct. 3 of 14

4 Consensual Panel Determination: The panel heard from Ms Fonyonga, on behalf of the Nursing and Midwifery Council (NMC) and from Mr Williams on your behalf that a provisional agreement on a consensual panel determination had been reached between you and the NMC. The agreement, which was put before the panel, sets out your full admission of the facts of all the charges; that your actions amounted to misconduct and you also accept that your fitness to practise is currently impaired by reason of that misconduct. It is further stated in the agreement that an appropriate sanction in this case would be a caution order for a period of three years. The panel has considered the agreement which was signed by you on 7 August 2013 and by Ms Fonyonga on behalf of the NMC on the 15 August 2013 as amended today and set out below. The provisional agreement reads as follows: The Nursing and Midwifery Council and Manjit Summersbee, PIN 78I2746E ( the parties ) agree as follows: 1. Manjit Summersbee admits the following charges: That you whilst employed as a registered nurse and Health Visitor by Cambridgeshire and Peterborough NHS Foundation Trust ( the Trust ): 2. On 22 September 2010, having been made aware that Child A may have sustained possible non-accident related injuries, failed to appropriately respond in that you: a. Did not immediately report the matter to Child A s social worker; b. Did not establish whether Child A s mother had already contacted Child A s social worker; c. Did not seek advice from a colleague at the Trust; 4 of 14

5 d. Did not arrange for Child A to receive a medical examination without delay in order to establish the nature of the condition or injury; 2. On 30 September 2010 disclosed confidential information during a case conference in that you used the name of one family in the presence of another family And in light of the above, your fitness to practise is impaired by reason of your misconduct. Facts: 2. The facts are as follows: Ms Summersbee was employed as a Health Visitor at the Trust from October She qualified as an adult nurse in 1981 and specialist community public health nurse in October During the course of her role she had regular supervision at 3 monthly intervals. In 2010 Ms Summersbee had also attended a number of training courses including Safeguarding Children from Abuse and Neglect and Child Protection Enquiry which she had attended on 23 June Allegation 1 4. On 23 September 2010, concern was raised by a social worker at the Trust who had on that day been contacted by Ms. Summersbee. Ms. Summersbee had requested that a child that she had met the previous day be referred to social services. The social worker expressed concern about the delay in referral as the child had been seen in clinic the previous day. No action had been taken on the day of the visit itself. 5 of 14

6 5. On 22 September 2010 Mother A had attended Ms. Summersbee s clinic with her child (Child A). A nursery nurse at the clinic had requested that Ms. Summersbee see Mother A and her child. Child A had a small linear bruise to her buttocks and a rash in her vulva area which was reportedly sore. Ms. Summersbee was aware of the history of sex offending by members of Child A s extended family. She was also aware of previous neglect by the mother and that other children from the family had been taken into care. Child A had been designated as a Child in Need and had an allocated social worker. 6. Mother A reported that the injury had occurred whilst the child was with her father (the ex-partner of Mother A). Child A had reportedly fallen and bumped herself. The mother also explained that the rash had been caused by the father using a different brand of wipes. The mother reported that she had already spoken to her social worker about the events. Ms. Summersbee examined Child A however did not take any further action as she considered that the matter was already being dealt with by the relevant social worker. 7. A G.P appointment should have been secured by Ms. Summersbee so that a proper assessment of the physical presentation could have been undertaken. In addition Ms. Summersbee should have immediately sought to contact the social worker that Mother A has allegedly contacted in order to verify that social services were aware of the incident. 8. It subsequently materialised that social services were not aware of the above matters until Ms. Summersbee contacted them on 23 September A child protection medical that was subsequently carried out concluded that the child had thrush and that the bruising could have been caused by a fall. The delay in the referral however led to Child A having a more intrusive medical examination than had she been seen by a GP on 22 September of 14

7 Allegation 2 9. On 30 September 2010 Ms Summersbee was present at a case conference which had been arranged to discuss how best to manage a particular family in the future. During the course of the meeting at which the family were present, Ms. Summersbee inappropriately mentioned the first names of another family. The family that were present acknowledged that they knew that other family. This constituted a breach of confidentiality. Misconduct and Current Impairment: 10. Ms Manjit Summersbee admits that the facts amount to misconduct because her conduct fell short of what would be reasonably expected of a nurse in all the circumstances (Roylance v General Medical Council [2000] 1 AC 311). More specifically she accepts that she acted in a manner contrary to the following provisions: The Code: Standards of conduct, performance and ethics for nurses and midwives (2008): You must provide a high standard of practice at all times (preamble) You must work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community (preamble) You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support (paragraph 4) You must respect people s right to confidentiality (paragraph 5) You must consult and take advice from colleagues when appropriate (paragraph 26) 7 of 14

8 You must make a referral to another practitioner when it is in the best interests of someone in your care (paragraph 28) You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk (paragraph 32) You must uphold the reputation of the profession at all time (paragraph 61) In addition to the above, it is acknowledged that the role that Ms Summersbee was employed in was at the forefront for the identification of risk of abuse and potential harm in children: Health visitors are trained to recognise risk factors, triggers of concern, and signs of abuse and neglect as well as protective factors. Using this knowledge, they can concentrate their activities on the most vulnerable families. Through their preventative work, they are often the first to recognise that the risk of harm to children has escalated to the point that safeguarding procedures need to be implemented (National Institute for Health and Clinical Excellence (NICE) Guidance 89 When to suspect child maltreatment). 11. Ms. Summersbee admits that her fitness to practise is impaired by reason of misconduct because the concerns within the charge relate to fundamental aspects of nursing care which could have placed a young child at significant risk of continued harm and led to Child A s needs not being immediately met as they should have been. The delay in referral also led to a more intrusive examination needing to be undertaken. In addition the disclosure of confidential information could have resulted in a lack of confidence by patients in the services that they were engaging with. 12. In her fifth report from Shipman (also referred to in the case of Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant 8 of 14

9 [2011] EWHC 927 Admin) Dame Janet Smith referred to the following as relevant to any assessment of impairment: Whether the registrant has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or Whether the registrant has in the past brought and/or is liable in the future to bring the professions into disrepute; and/or Whether the registrant has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the professions; and/or Whether the registrant has in the past acted dishonestly and/or is liable to act dishonestly in the future? 13. In this case factors 12.1 to 12.3 are relevant. In addition the following is also relevant to the assessment of impairment: Ms Summersbee has expressed deepest regret for incidents that have occurred and is deeply sorry for the distress I may have caused these families. As a result, Ms Summersbee referred herself to the NMC. Ms. Summersbee has reflected upon the incidents. In relation to the first incident she acknowledges that she made an error of judgement, and did not follow the Trust policy on safeguarding. She endeavour(s) to ensure that this event remains fresh in (her) mind so that (she) could recognise any warning signs of any similar situations in the future. On 5 December 2012 Ms. Summersbee completed child protection (level 3) training and has submitted a certificate of attendance to support this. In relation to the second incident, Ms Summersbee acknowledges that she did not think before using the family member s name and had been heavily involved with both of the families at the time. Ms. Summersbee recognises the importance of maintaining patient confidentiality and asserts that she 9 of 14

10 has again familiarised herself with guidelines and protocols about patient confidentiality and data protection. Since October 2011, Ms Summersbee has been employed as a nurse prescriber at the Thistlemoor Medical Centre. Numerous references from those that she currently works with and for attest to her current abilities as a nurse including but not limited to the following: o I have found Ms Summersbee to be a dedicated practitioner who is committed to learning and has sound clinical acumen. As a practice we have not received any complaints regarding Ms. Summersbee and have been impressed by her dedication to the job. (Dr. 1, Senior Partner Thistlemoor Medical Centre, Peterborough 18/3/13) o I was assigned her supervisor about a year ago and had a chance to work with her more closely. I found her to be competent and skilful, particularly when it comes to dealing with children, which seems to be her forte...manjit is an asset to the surgery Having made her regrettable error in judgement, Manjit is more reflective in her approach and has demonstrated that she has learned from her mistake. She would be a great loss to the surgery and the nursing profession if her ability to practice were to be affected (Dr 2, General Practitioner, Thistlemoor Medical Centre, Peterborough 7/3/13) o I have noted that Manjit will ask about the welfare of the children that I have vaccinated who are on Child Protection Plans. She routinely updates the alerts on the computer system for children who are on Child Protection Plans and families where there have been incidents of domestic violence As the named Nurse for Safeguarding, I know that I can always rely on Manjit for advice as she is very cautious and knowledgeable when it comes to safeguarding issues (Miss 3, Practice Nurse, Thistlemoor Medical Centre 7 March 2013). 10 of 14

11 14. Notwithstanding the above references and no evidence of further repetition of further concerns, Ms. Summersbee accepts that a finding of impairment is necessary in order to uphold proper professional standards and public confidence in the profession and that if a finding of impairment were not made such confidence would be undermined. Sanction: 15. The appropriate sanction in this case is a caution order for a period of three years. Ms. Summersbee has admitted the facts of the allegations, appears to demonstrate insight into her failures and there has been no repetition of the concerns raised. Her current employers have provided positive references in support of her abilities as a nurse. 16. This sanction is appropriate as it will mark that the conduct was unacceptable and must not happen again. A conditions of practice order would not be appropriate as Ms. Summersbee has undertaken further training relevant to the most serious of the allegations and there are no identified areas within her practice that now require further assessment. A suspension order would be disproportionate in the circumstances. 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 set out at section 1 above, and the agreed statement of facts set out at section 2 above, may be placed before a differently constituted panel that is determining the allegation. 11 of 14

12 Panel decision: The panel heard and accepted the advice of the legal assessor, who reminded it that in reviewing the proposed settlement the panel should have regard to the general advice that is tendered in these circumstances in respect of both impairment and sanction. In summary, impairment should be current impairment, consideration of sanction should be made with regard to the NMC Indicative Sanctions Guidance, and the process should be to consider the least restrictive sanction first. The legal assessor also referred the panel to the guidance given by Lord Bingham MR in Bolton v The Law Society [1994] 1 WLR 512 to the effect that the reputation of a profession is more important than the fortunes of any individual member. The panel considered whether the implementation of the provisional agreement would be in the public interest. This means that the outcome must ensure an appropriate level of public protection, maintain public confidence in the professions and the regulatory body, and declare and uphold proper standards of conduct and behaviour for nurses and midwives. In this case you have admitted that your fitness to practise is impaired. The panel took into consideration that in every case this is a matter of judgement for the panel. The panel acknowledges that there is merit in cases being resolved by consent if appropriate. The panel accepted that in this case the admission of impairment demonstrates a high level of insight in your practice. The panel considers that you pose no real risk to the public at today s date. Nevertheless, the panel has borne in mind its responsibility regarding the public interest which includes the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour amongst members of the profession and the NMC as a Regulator. Accordingly, it finds that your fitness to practise is impaired by reason of your misconduct; to find otherwise would undermine public confidence in the profession and in the regulatory process. 12 of 14

13 The panel considered what sanction if any would be appropriate and decided that to take no further action in this case would not adequately reflect the nature of your misconduct and would be insufficient to maintain public confidence in the nursing profession, and in the NMC as its regulator. The panel next considered a caution order. This case relates to two unrelated incidents within a long nursing career spanning over 30 years. You are of previous good character and your current employers have no concerns in relation to your practice since you commenced employment there in October There has been no repetition of the misconduct that brought you before this panel. Your self referral to the NMC indicates considerable insight on your part. You made full and early admissions of your errors, and have shown remorse and evidence of your reflection particularly around the wider public protection issues and the maintenance of public confidence in the profession. The panel also considered the steps you have subsequently taken in the remediation of your failings, including attending relevant training courses and the positive references from your current employer. Accordingly the panel is confident that there is no risk to the public or to patients which require your practice rights to be restricted. For these reasons, the imposition of a caution order is the appropriate and proportionate sanction in this case. The panel was satisfied that a caution order for three years, as proposed by both parties, was in the public interest, in that it is sufficient to protect the public, to maintain public confidence in the profession, and to declare and uphold proper standards of conduct and behaviour for nurses. The panel did consider a conditions of practice order. However, in the circumstances of this case it was of the view that a conditions of practice order would be disproportionate and unnecessary given the fact that there are no longer identified areas in your practise that require further assessment and/or retraining. 13 of 14

14 The panel has therefore decided to make the order set out in the provisional agreement, as amended. 14 of 14