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

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UPDATED:

22:08 GMT, 2 July 2012

Just what does it take for a rogue nurse to be struck off from their professional register

Any reasonable person would surely believe that committing offences such as threatening or abusing confused patients, stealing from frail, elderly people, being drunk on duty or just being dangerously incompetent should be right at the top of the list.

But too often the profession’s official regulator, the Nursing and Midwifery Council (NMC), has decreed otherwise.

The Nursing and Midwifery Council seem more concerned with saving the careers of nurses who have seriously transgressed the laws of their profession

The Nursing and Midwifery Council seem more concerned with saving the careers of nurses who have seriously transgressed the laws of their profession

Instead, it has allowed nurses found guilty of such crimes to remain in charge of patients.

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.

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.

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.

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

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

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.

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.

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, Herts.

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’.

The sanction it handed down amounted to a regulatory slap on the risk — 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.

The Nursing and Midwifery Council is facing a growing number of nurses being referred to it for disciplinary investigation

The Nursing and Midwifery Council is facing a growing number of nurses being referred to it for disciplinary investigation

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 — 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.’

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 represent 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 said it had received 4,407 referrals in 2011 — 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 — 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-off 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 considerable 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.