Chapter 7: The Nursing and Midwifery Council
The Preliminary Proceedings Committee hearing into the five complaints
The PPC members were provided with a bundle of documents prepared on behalf of the NMC: Professor Ford’s report; the CHI report; an investigation overview provided by Hampshire Constabulary; relevant transcripts from the inquests and the GMC hearing, as well as copies of the letters of complaint; and clinical notes and drug charts and nursing notes (where available) in respect of each of the five patients whose cases were being considered (NMC100325, p33). The PPC members were provided with responses prepared on behalf of each of the nurses (NMC100191).
The PPC members were also provided with a copy of a report prepared by Clare Strickland setting out the background to the referrals, the history of complaints at Gosport War Memorial Hospital and the police investigations, as well as the inquests and GMC proceedings (NMC100325, pp11–32). The report set out the evidence on misconduct and the conclusions on whether there was a case to answer.
The nurses faced the following allegations.
The relevant nurse
“In respect of Patient A (Alice Wilkie):
Failed to maintain accurate patient records:
On 17 August 1998, by writing a note suggesting that her daughter, Mrs Jackson, had agreed to a syringe driver for Patient A and that active treatment was not appropriate;
On 21 August 1998, wrote in Patient A’s clinical notes that her family had been present when she had died when they had not been;
On 20 August 1998, failed to ascertain the level of pain Patient A was in;
On 21 August 1998, failed to monitor Patient A appropriately and keep her family informed of her condition;
On 21 August 1998, failed to monitor Patient A appropriately and keep her family informed of her condition.” (NMC100325, p7)
“In respect of Patient B (Dulcie Middleton):
- Failed to ensure that meals were provided within her reach and on an occasion on an unknown date, without cutlery;
- Failed to ensure that her alarm bell was within her reach so that she could call for assistance;
- Failed to ensure that Patient B was kept warm;
- Failed to ensure that Patient B received basic nursing care or was treated with dignity.” (NMC100325, p7)
“In respect of Patient C (Stanley Carby)
- Was negligent in the care provided to Patient C.” (NMC100325, p7)
The relevant sister on the ward
“In respect of Patient D (Eva Page)
- Failed to act in the interests of Patient D.” (NMC100325, p8)
“In respect of Patient E (Elsie Devine)
- Failed to act in the interests of Patient E by failing to remove a fentanyl patch from her until three hours after the morphine syringe driver has started;
- Failed to provide accurate information to Patient E’s family when you telephoned that morning, in that you said that while she was confused you denied there was any urgency in family members attending;
- Returned clothes provided by Patient E’s family by saying that they were ‘too good’ for a hospital stay (as they were dry clean only);
- Failed to ensure accurate patient notes were maintained for Patient E in that there was an incorrect statement in the notes on 3 November 1999 that she could not climb stairs. A kidney infection was diagnosed and antibiotics started, but this was not written up in the notes.
At a subsequent independent review meeting relating to the care provided to Patient E:
- Suggested that she was agitated on the morning of 19 November 1999, but none of the family had ever seen her agitated.
- Made an unprofessional comment about tension between Mrs Reeves and her sister-in-law.” (NMC100325, p9)
The relevant staff nurse
“In respect of Patient D (Eva Page)
- Failed to act in the interests of Eva Page.” (NMC100325, p9).
“In respect of Patient E (Elsie Devine)
- Failed to provide the family of Patient E with any explanation about her medication.
- Failed to adequately account to Patient E’s family for her sudden deterioration.” (NMC100325, p9)
The relevant nurse
“In respect of Patient C (Stanley Carby)
- Failed to maintain accurate patient records in respect of Patient C, in that you failed to record the time in entries on the contact record.
- Was negligent in the care provided to Patient C.” (NMC100325, p9)
The relevant nurse
“In respect of Patient C (Stanley Carby)
- Was negligent in the care provided to Patient C.” (NMC100325, p9)
The relevant nurses
“Named as part of Anne Reeves’ complaint against the nursing care provided to her mother, Elsie Devine.” (NMC100325, p10)
In respect of all the allegations against each of the nurses concerned, the PPC declined to proceed (NMC100150). In respect of certain allegations, the PPC found that even if the facts were proven, it would not lead to the removal of the nurse from the register. In respect of other allegations, the PPC considered that the alleged behaviour was “not capable of amounting to misconduct”.
In addition to the matters set out in the list of allegations, the PPC also considered certain nurses’ actions in commencing patients on syringe drivers. The PPC found that, in respect of each of these allegations, the conduct of the nurses was not capable of amounting to misconduct and, therefore, declined to proceed with the matter (NMC100150).
On 1 June 2010, the Senior Case Officer wrote to the various complainants (NMC100207, NMC100208, NMC100233, NMC100234, NMC100235) and nurses (NMC100144, NMC100156, NMC100177, NMC100186, NMC100189, NMC100151, NMC100147) informing them of the decision reached by the PPC not to proceed with any of the allegations and of the reasons given by the PPC in support of its decision.
A further complaint: Mr Cunningham
In June 2009, Charles Stewart-Farthing gave evidence at the GMC proceedings involving Dr Barton regarding the treatment of his stepfather, Mr Cunningham. On 24 June 2009, Mr Stewart-Farthing wrote to the NMC suggesting that the relevant sister and nurses “all had a hand in [Mr Cunningham’s] demise” (FAM102585, p1).
The NMC responded by stating that the case would undergo an initial screening assessment and then requested further information (NMC100304, NMC100302). In October 2009, Mr Stewart-Farthing completed a consent form that allowed the NMC to disclose to the nurses concerned the information that a complaint had been made against them (NMC100295).
Five months later, on 30 March 2010, the NMC again wrote to Mr Stewart-Farthing requesting evidence specifying what the relevant nurses had done wrong. The NMC specifically asked for Mr Stewart-Farthing’s stepfather’s “medical notes, or anything else (e.g. witness statements) which depicts the actual actions of the nurses with regards to the treatment of your step-father” (NMC100301, p1).
On 18 May, the NMC wrote to Mr Stewart-Farthing in these terms:
“As no response was received from you and due to the lack of direct evidence, the decision has been made to close this case. This is because without specific evidence regarding each nurse, the case is ‘not in the form required’ to enable progression to our panel.” (NMC100294, p1)
In dismissing Mr Stewart-Farthing’s complaints about the role played by nurses in the death of his stepfather Mr Cunningham, the records show no evidence that the NMC investigated his complaint. The Panel is surprised by the NMC’s approach to the complaint raised by Mr Stewart-Farthing. Requests were made of Mr Stewart-Farthing for evidence upon which potential allegations could be made. However, the matters that were being raised by Mr Stewart-Farthing related to events that took place nearly a decade earlier. Furthermore, Clare Strickland had received evidence in relation to Mr Cunningham from the police and had, in March 2007, been able to identify criticisms of individual nurses made by Mr Cunningham’s family.