Unite the Union (in Health) Professional Team
128 Theobald’s Road, Holborn, London, WC1X 8TN
T: 020 7611 2500 | E: healthsector@unitetheunion.org
Unite the Union Response to:
NMC Consultation on revalidation and the Code
This response is submitted by Unite. Unite is the UK’s largest trade union with 1.5 million
members across the private and public sectors. The union’s members work in a range of
industries including manufacturing, financial services, print, media, construction,
transport, local government, education, health and not for profit sectors.
Unite represents in excess of 100,000 health sector workers. This includes eight professional
associations - British Veterinary Union (BVU), College of Health Care Chaplains (CHCC),
Community Practitioners and Health Visitors’ Association (CPHVA), Guild of Healthcare
Pharmacists (GHP), Hospital Physicists Association (HPA), Medical Practitioners Union (MPU),
Mental Health Nurses Association (MNHA), Society of Sexual Health Advisors (SSHA).
Unite also represents members in occupations such as allied health professions, healthcare
science, applied psychology, counselling and psychotherapy, dental professions, audiology,
optometry, building trades, estates, craft and maintenance, administration, ICT, support services
and ambulance services.
Len McCluskey
General Secretary
www.unitetheunion.org
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1. Introduction
1.1. Unite welcomes the opportunity to respond to the Consultation on revalidation and the
Code.
1.2. As part of this response, Unite has used its on-going routes throughout the organisation to
hear back the views of members who are registered with the NMC and these have
informed our response.
2. The Code: C1
How would you rate the draft revised Code on each of the following?
2.1. Language and tone: very good.
2.2. Easy to read: neither good nor poor.
The existing Code is 8 pages in length which facilitated practitioners in knowing the
content. We note that the new Code is in its current form 26 pages long and consider that
this will make it less likely that practitioners will remember the content. It also appears to be
repetitive.
2.3. Easy to understand: good.
2.4. Easy to apply to different roles, settings and scope of practice: neither good nor poor.
Our members would prefer to see an explanation at the beginning of the Code that
describes the different parts of the register and the different scopes of practice. It should
then indicate that nurses, midwives and Specialist Community Public Health Nurses
(SCPHNs) will be referred to as registrants.
3. The Code: C2.
The draft revised Code includes a number of additions or changes to the current Code that was
issued in 2008. Overall, to what extent do you agree or disagree that it is appropriate to include
each of the following…?
3.1. The new section on patient and public expectations: tend to disagree.
Whilst our members appreciate that this section contains important information on what the
patients and the public expect of nurses and midwives, they suggest it would serve its
purpose better if it were separate guidance written specifically for patients and the public.
3.2. The new paragraph on “Duty of Candour” in professional accountability: tend to agree.
With the evidenced culture of secrecy that exists within the NHS our members consider
there needs to be an awareness raising campaign to reassure registrants that the systems
to support the duty of candour at both the individual and organisational level are in place.
Without adequate investment in training and clinical supervision the blame and secrecy
culture could continue. Our members consider that this section should also include a line
about the need for managers to treat their staff in the same manor that registrants should
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treat their patients “You must treat people (staff you manage) kindly, respectfully and
compassionately”
In addition, paragraph 105 would be better included in this section.
3.3. The new paragraphs on the fundamentals of care: tend to disagree.
The Code should contain the ‘high level’ principles and standards for nursing, midwifery
and SCPHN practice. We consider therefore that these paragraphs contain too much
detail. The risk of this is that if an element of fundamental care, for example, care of the
mouth, is not included, then it may not be considered to be a part of fundamental care. The
Code has to be applicable to all nurses, midwives and SCPHNs in a whole range of
settings and scopes of practice. This section appears to apply more to those involved in
direct patient care and appears to focus on care of older patients.
3.4. The amended section on maintaining clear professional and sexual boundaries: tend to
disagree.
Our members consider paragraph 43 needs greater clarity.
3.5. The new paragraphs on prescribing and medicines management: tend to agree.
Our members suggest that this section should refer to undertaking a thorough assessment
to identify over the counter medications, drug/treatment, interactions, ensuring
patient/client is given information on how to take the medication, side effects, dosage etc.
There needs to be recognition that information concerning over the counter medications
depends on whether patient/client tells the prescriber
3.6. The amended paragraphs on raising concerns: tend to agree.
Our members consider that this appears too weighted on the frontline practitioner taking
action and not on the responsibility of managers who are registrants.
3.7. The new paragraph on when to take emergency action: strongly agree.
3.8. The new paragraph on social networking: tend to disagree.
Colleagues/organisations are referred to frequently in for example tweets?
We consider it would be sufficient to state - ‘You must ensure that you use social
networking sites and other forms of electronic communication responsibly and in line with
our guidance and omit ‘in particular by not referring to employers, colleagues or past or
current people you have cared for’. This would allow for a more realistic approach to the
rapidly changing world of information technology.
4. The Code C3
4.1. How well, if at all, do you feel the draft revised Code addresses the recommendations
raised in the Francis report relating to nursing and midwifery practice?
Not very well; our members consider it is ignoring the gap between policy and reality.
4.2. In which one of the following ways, if any, would you prefer to be able to access the
revised Code when it is published?
A downloadable, printable copy.
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5. Additional comments
5.1 Paragraph 89: “You must ensure any entries you make in all paper records are clearly and
legibly written and signed, dated and timed, and do not include abbreviations, jargon or
speculation”. These should also apply to electronic record keeping.
5.2 Glossary: This makes mention of the four fields of nursing but our members consider this
should say something on about a whole part of the register.
6. Getting information
In order to revalidate, nurses and midwives will need to get confirmation from a third party that
they are fit to practise.
6.1. To what extent do you agree or disagree with the proposed model for who should provide
confirmation for a nurse or midwife?
Tend to disagree.
6.2. Based on what you understand of who would provide third party confirmation and how it
will work with appraisals, please provide any comments you have on the proposed
revalidation model, for example any improvements or suggestions you may have.
The proposed model falls very short of a preferred model based on clinical supervision.
Using the appraiser as the confirmer could pose many problems. For example if a
nurse/midwife/SCPHN has repeatedly raised concerns to their line manager (also their
appraiser and confirmer) for example regarding the size of their caseload particularly due
to the number of safeguarding issues. They would be abiding by the Code under
Paragraph 63, 65, 66, 68, 69. Given the evidenced culture of blame and secrecy that exists
within the NHS it seems ludicrous that this same line manager/ appraiser will now be a
registrant’s confirmer. Such a situation is bound to lead to a degree of conformity placed
upon the employee/ registrant; especially where there is an authoritarian style of leadership
at the micro as well as macro level within the organisation. Insidious bullying does exist
within some areas and decisions affecting all within are often taken without adequate staff
consultation.
There is a stark difference between the policies in place to protect whistleblowers and how
individuals are actually treated in practice. Unite members consider that the NMC should
make a stand and ask for the duty of candour for registrants to be delayed until it is fully
implemented at the organisational level. Without adequate training for everyone at all
levels it is only going to be the most assertive and courageous frontline staff raising
concerns and even then it is likely that this will only be to individual managers who are
open. Many employers do not communicate how the concern will be dealt with, sometimes
dismissing employees concerns and offering no support. For example our CPHVA
members indicate that many health visitors have a workload that is dominated by
assessments with little time left to address all the needs identified. This can gradually
become normalised and when faced with a manager/ appraiser/ confirmer who ignores or
dismisses concerns, the health visitor back’s down and accepts they are unable to do
everything. How then can the individual fulfil their own duty of candour?
Until adequate systems are in place and there is an evidenced culture shift it would be
unfair to apply the duty of candour to individuals who feel compromised having to rely on
their line manager to act as their confirmer.
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Unite members suggest that a system whereby clinical supervisors confirmed would offer
greater support and empower registrants to be more open.
7. Using feedback
7.1. As part of the proposed revalidation model, a nurse or midwife will be required to provide a
minimum of five reflective accounts over three years. Do you think this is too many or too
few or about the right number?
Our members consider that it should be more about the quality of the reflections rather
than a particular number. If clinical supervision was used registrants would be getting
feedback during the process as immediate feedback is the most beneficial form of
feedback.
7.2. As part of the proposed revalidation model, the person who provides confirmation will
need to discuss with the nurse or midwife any feedback that they have received. To what
extent do you agree or disagree with this approach?
Tend to disagree if the proposed model is adopted – For the same reasons cited in 5.2. It
is not a sufficiently robust system to protect registrants who feel compromised.
8. Declaring continuing professional development
8.1. In order to revalidate, a nurse or midwife will be required to complete 40 hours of CPD
over a three year period. Do you think this is too many, too few or about right?
Neither agree nor disagree.
There is no evidence to suggest that undertaking the number of CPD hours stated by the
NMC will enhance a registrants practice and therefore our members consider it is difficult
to say either way!
8.2. In general, to what extent do you agree or disagree with the inclusion of a participatory
element to CPD?
Our members suggest it needs to be made clear what is meant by participatory. For
example, will an online community of practice suffice? Face to face continues to be
regarded as the most popular way to learn.
8.3. Do you think the requirement for at least 20 hours of the required 40 hours to be
participatory CPD is too many, too few or about right?
Again our members are not clear if online courses with discussion forums will count as
participatory. They report that these are being used more and more and therefore consider
they should be.
8.4. The proposed model requires that all CPD undertaken must be linked directly to the Code
and the nurse or midwife’s scope of practice. To what extent do you agree or disagree with
this?
Agree. Our members agree that it should be up to individuals to demonstrate how their
CPD relates to their nursing practice.
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8.5. Overall to what extent do you agree or disagree that the proposed revalidation model will
help to ensure CPD undertaken by a nurse or midwife is of the right level of quality to
assure their fitness to practise?
Tend to disagree. Unless the confirmer has an understanding of educational standards
they may not know valuable certain CPD activities are.
9. Practice hours
9.1. To what extent do you agree or disagree with the proposed model of SCPHN practice
hours counting towards those required for revalidation as a nurse or midwife?
Tend to agree. However, our CPHVA members suggest that a SCPHN registrant must be
supported and expected only to be competent within their own scope of practice. Asking
staff to take on supervisory nursing roles in times of crisis commensurate with their SCPHN
grade should be discouraged.
11 August 2014
This response is submitted on behalf of Unite the Union by:
Rachael Maskell
Unite, Head of Health
For further information on this written response, please contact:
Jane Beach, Unite Professional Officer for the Health Sector
Jane.beach@unitetheunion.org
Tel: 07919324716
Unite the Union
Unite House
128 Theobalds Road,
Holborn, London, WC1X 8TN
Response submitted to: consultations@nmc-uk.org
Submitted by: Jane Beach
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