Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 20 November 2018 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Elizabeth Anne Deane 86E0193E Part(s) of the register: Registered Nurse Sub Part 1 Adult July 1989 Registered Midwife Midwifery February 1993 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Nursing and Midwifery Council: Mrs Deane: England Misconduct Eileen Skinner (Chair, lay member) Lynne Grundy (Registrant member) Richard Bayly (Lay member) Monica Daley Roshani Wanigasinghe Represented by Ruth-Anne Cathcart, Case Presenter Present and represented by Laura Bayley instructed by Thompsons Solicitors Order being reviewed: Outcome: Conditions of Practice Order for 12 months Conditions of Practice Order varied 12 months Page 1 of 10
Decision and reasons on review of the current order: The panel decided to vary the conditions of practice order imposed. This order will come into effect immediately in accordance with Article 30 (2) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the second review of a conditions of practice originally imposed by a panel of the Conduct and Competence Committee on 11 November 2016 for 12 months. A panel of the Fitness to Practise Committee reviewed the Order on 10 November 2017 and made another conditions of practice Order for 12 months. The current order is due to expire on 15 December 2018. The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved by way of admission were 1, 3a, 3b and 4. In addition, the substantive hearing panel found charges 2a, 2b, 5a, 5b, 6a, 6b and 7 proved. The charges which resulted in the imposition of the substantive order were: That you: 1) On 26 August 2014, did not record in a telephone note the time and date of your telephone conversation with Patient A. 2) On 26 August 2014, in relation to Patient B, did not request a doctor review: a) following a non-reassuring CTG; and/or b) following a second non-reassuring CTG. 3) On 29 September 2014: a) did not document a home visit to Patient C on the patient's maternity progress sheet. Page 2 of 10
b) did not document a home visit to Patient D on the patient's postnatal chart. 4) On 24 November 2014, did not complete Patient E's fluid balance chart. 5) On 16 September 2015, in relation to Patient F: a) did not document a discussion you had with the patient regarding her transfer from the Birth Centre at Royal Bournemouth Hospital to Poole Hospital's Maternity Unit; b) did not record the fetal heart rate with sufficient regularity, particularly, but not limited to, between 16.00 and 16.36. 6) On 20 November 2015, did not: a) record the date and time on Patient G's Bilirubin chart. b) sign Patient G s Bilirubin chart. 7) On an unknown date, did not date an entry made in Patient H's patient records; AND in light of the above, your fitness to practise is impaired by reason of your misconduct. The first reviewing panel determined the following with regard to impairment: The panel considered whether your fitness to practise remains impaired. In relation to insight, the panel noted that you have submitted a lengthy reflective piece using a recognised model. This specifically detailed each of the failings in your practice, as considered by the original substantive hearing panel. The panel noted that you have recognised your failings, the risk of harm that was caused to patients as a result of your actions and how you would act differently in future, as well as displaying significant remorse for your actions. The panel noted that you Page 3 of 10
have gone to great lengths to obtain a placement within a midwifery setting, and in your attempts to do so you have been open and honest about your failings. The panel therefore considered that you are committed to addressing and remedying your failings, and you have demonstrated a significant level of insight. In relation to remediation, the panel noted the significant attempts you have made to address the failings in your practice, by attempting to obtain a position as a midwife whilst working under direct observation, and in order to comply with the current conditions of practice order. The panel considered that as you have been unable to obtain such a placement, you have not been able to fully remedy your misconduct, whilst acknowledging the significant attempts you have made to remediate. The panel noted that you are currently working as a Healthcare Assistant, and therefore considered that you have not had full opportunity to test your midwifery skills in a clinical setting, in order to demonstrate that you are capable of safe practice. It therefore considered that whilst you have made extensive efforts to remediate, you would need to show further evidence of remediation in order to demonstrate that you are capable of safe practice. The panel therefore considered that there remains a real risk of repetition of the original misconduct in this case, and determined that a finding of continuing impairment is necessary on the grounds of public protection. The panel bore in mind that its primary function is to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is required. For these reasons, the panel finds that your fitness to practise remains impaired. The first reviewing panel determined the following with regard to sanction: The panel considered that there should be a variation to this condition, and noted that have booked to attend training courses in CTG, new-born life support and Page 4 of 10
obstetric emergencies. The panel considered, based on the concerns identified by the original substantive hearing panel that it would be important for you to undertake the courses identified in condition 1 below, and develop your clinical skills in these areas before returning to practise as a midwife, even whilst being subject to direct observation. The panel considered that this would ensure a safe level of practice, particularly given the fact that you have not practised as a midwife since 2014. The panel determined that this condition should be a precursor to the other conditions, as you would need to undertake such training before obtaining any employment as a midwife. The panel considered that imposing this condition would clarify what was intended by condition 8, imposed by the previous substantive hearing panel. Accordingly, the panel determined, pursuant to Article 30(1) (c) of the Order, to make a conditions of practice order for a period of 12 months, which will come into effect on the expiry of the current order. The panel considered that this period of time is sufficient to enable you to undertake the training courses, which you are booked to attend, and to work towards complying with the rest of the conditions of practice order. Page 5 of 10
Decision on current fitness to practise The panel has considered carefully whether your fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. The panel has kept at the forefront of its mind, its duty to protect the public, maintain confidence in the profession and uphold proper standards of conduct and behaviour. The panel has had regard to all of the documentation before it, including the bundle, testimonials and a number of training certificates, you provided. It has taken account of the submissions made by Ms Cathcart on behalf of the NMC and those made by Ms Bayley, on your behalf. Ms Cathcart outlined the background of this case to the panel. Ms Cathcart submitted that the conditions placed on you on 10 November 2017 still remain unfulfilled as you have not been able to find a midwifery position. Ms Cathcart noted that the NMC acknowledged all the training courses undertaken by you. She submitted that it was for the panel to decide whether your fitness to practice remains impaired and, if so, what the appropriate sanction is. Ms Bayley on your behalf requested the panel formulate conditions of practice which would be workable and enable you to find employment. She submitted that since the conclusion of the substantive order on 11 November 2016 you have found it increasingly difficult to find work as potential employers have been put off by the conditions placed on you. She further noted that you have not been working for the past 2 years as a midwife. Ms Bayley submitted that you have been continually applying for midwifery roles and constantly being rejected and it has now taken its toll and as a result is affecting your confidence. She further stated that you have engaged with the NMC throughout the proceedings. Ms Bayley noted that you are therefore not in a Page 6 of 10
positon to remediate the areas identified in the conditions of practice Order. She submitted that you have completed the training courses identified by the conditions. Ms Bayley further stated that your level of insight has further developed and that you accept entirely the errors you have previously made. She stated that you have been absolutely honest with your employers and prospective employers, expressed remorse, and admitted that there are still gaps in your practice. Ms Bayley submitted that you are an experienced midwife, who has identified weaknesses in your practice and are doing everything possible to return to safe practice. Ms Bayley submitted direct supervision is not necessary. She stated that there had been no actual harm to any patients. She proposed a shorter fixed period of supervision to enable you to obtain employment as a midwife. The panel heard and accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel considered whether your fitness to practise remains impaired. The panel accepted that you have demonstrated remorse and insight. However, in relation to remediation, you have still not been able to remedy the concerns relating to your misconduct as you have been unable to obtain employment as a midwife. Accordingly you have not been able to fully comply with the current conditions of practice order and therefore there remains a risk of repetition. The panel further noted that you have not practised as a registered midwife since November 2014. The panel therefore decided that there remains a real risk if it were to allow you to return to unrestricted practice. However, the panel took into account the steps you have taken to remedy your failings, through training courses and independent reading. Page 7 of 10
The panel therefore determined that your fitness to practice remained impaired on public protection grounds alone, the public interest having now been satisfied. Determination on Sanction The panel therefore determined that a sanction was necessary and that this should be no more than was appropriate or proportionate to allow you to return to safe practice. The panel considered the NMC s Sanctions Guidance and determined that given its findings, that taking no action or imposing a caution order is not appropriate as the public will not be protected. The panel was satisfied that the imposition of a conditions of practice order remains sufficient to protect the public and would be an appropriate and proportionate sanction. The panel was of the view that to impose a suspension order or a striking off order would be disproportionate at this time and would not be a reasonable response in the circumstances of your case. The panel noted that these sanctions would not give you an opportunity to address the clear and identifiable areas of your practice which it considered are remediable. As such the following conditions are imposed; 1. At any time that you are employed or otherwise providing midwifery services you must place yourself under the supervision of a registered midwife of band 6 or above who is physically present in or on, the same ward, unit, floor or home that you are working in or on, until you are signed of as competent by your line manager or mentor in the following areas; a) Interpretation of CTGs using national and local guidelines b) Planning care using CTGs including appropriate escalation c) Planning care in labour following local and national guidelines with particular attention to care in the second stage of labour d) Appropriate documentation of the care provided across the full spectrum of maternity and neo natal records Page 8 of 10
e) Appropriate record keeping for all interactions with service users and the maternity and obstetric care team 2. Within one month of return to practice you must successfully undertake and pass the local maternity mandatory update, including CTG interpretation. 3. You must send a signed report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your performance and your progress in relation to 1(a) to (e) above, to the NMC at least 14 days before any NMC review hearing or meeting. 4. You must allow the NMC to exchange, as necessary, information about the standard of your performance and your progress with your line manager, mentor or supervisor (or their nominated deputy) and any other person who is or will be involved in your retraining and supervision with any employer, prospective employer, and at any educational establishment 5. You must tell the NMC within 14 days of any nursing or midwifery 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 tell the NMC about any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 14 days of you receiving notice of them. 7. a) You must within 14 days of accepting any post of employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. b) You must within 14 days of entering into any arrangements required by these conditions of practise provide the NMC with the name and contact details of the individual/organisation with whom you have entered into the arrangement Page 9 of 10
8. You must immediately tell the following parties that you are subject to a conditions of practice order under the NMC s fitness to practise procedures and disclose the conditions listed at (1) to (7) above, to them a) Any organisation or person employing, contracting with or using you to undertake nursing or midwifery work b) Any agency you are registered with or apply to be registered with (at the time of application) to provide nursing or midwifery services c) Any prospective employer (at the time of application) where you are applying for any nursing or midwifery appointment d) 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 a course (at the time of application) This decision will be confirmed to you in writing. There will be a review before the expiry of the order. That concludes this determination. Page 10 of 10