LEGAL
Accountability in district nursing practice: key concepts Richard Griffith
Senior Lecturer in Health Law, College of Health Science, Swansea University
Defining accountability Batey and Lewis (1982) defined accountability as:
‘the fulfilment of a formal obligation to disclose to reverent others the purposes, principles, procedures,
ABSTRACT
Public trust and confidence in district nurses is essential to the nurse– patient relationship that underpins effective care and treatment. That trust and confidence has even greater focus for district nurses who care for patients in their own homes. Those patients need to be able to count on the professionalism and probity of their district nurses. The professionalism and probity of district nurses is based on their accountability, which protects the public by imposing standards on district nurses and holds them answerable for their acts and omissions. This is the first of a series of articles on accountability in district nursing practice to mark the introduction of the revised Nursing and Midwifery Code on the 31 March 2015. This month’s article considers the key concepts of accountability.
KEY WORDS
w Professionalism w Probity w Accountability w Duties w Standards
146
relationships, results, income and expenditures for which one has authority.’ This reveals the fundamental nature of accountability. It shows that accountability has its basis in law as there is a formal or legal relationship between the district nurse and the higher authorities that hold them to account. The extent of the scrutiny goes beyond conduct and encompasses the district nurse’s competence, integrity and probity. To be accountable is to be answerable for one’s acts and omissions. This is the approach adopted by the regulatory body, the Nursing and Midwifery Council (NMC), whose revised Code sets out the professional standards of professional practice and behaviour required of district nurses. The Code (NMC, 2015) states that good nursing practice puts the interests of patients and service users first, is safe and effective and promotes trust t hrough professionalism.
Accountability versus responsibility Accountability and responsibility are often used interchangeably by health professionals as though they have the same meaning. Accountability means being answerable to a higher authority for your actions. Responsibility means to have control or authority over someone or something. District nurses are responsible for their practice. They decide how to practise and what interventions are in the best interests of the patients in their care. However, district nurses do not have control or authority over who holds them to account or what they are accountable for. District nurses are required to work within the law and in accordance with the NMC’s Code (2015). The authorities that hold district nurses to account can demand they justify their actions. They bestow the level of accountability necessary to protect the public and patients from harm.
Case study A registered nurse was struck off the Nursing and Midwifery Council’s register after an incompetent catheter fitting left a patient needing hospital treatment.The experienced nurse made a number of mistakes while performing the procedure on the older man and the catheter was not inserted into the bladder. The nurse then failed to ensure that urine was discharged after its insertion and made a
© 2015 MA Healthcare Ltd
D
espite its common usage, the term ‘accountability’ is frequently misunderstood in practice. A study by Savage and Moore (2004) found the term elusive and ambiguous, and there is little evidence that the term is understood any more clearly some 11 years later. This may be due to meaningless phrases such as ‘transparent accountability’, ‘bottom-up accountability’ and ‘structural accountability’ being developed by policy-makers and featuring in the literature (Griffith and Tengnah, 2013). Accountability is fundamental to the protection of the public and individuals in the care of district nurses. Recent reports into the care and treatment of vulnerable patients arising from the Winterbourne View Report, Francis Report and Berwick Report in England and the Andrews Report in Wales highlights the importance of accountability in district nursing (Department of Health, 2012; Francis, 2013; National Advisory Group on the Safety of Patients in England, 2013; Andrews and Butler, 2014). It is essential that the term is clearly understood as it is the means by which the law imposes standards and boundaries on professional practice.
Email: [email protected]
British Journal of Community Nursing March 2015 Vol 20, No 3
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
LEGAL number of failings over making notes for the procedure in the man’s records. The patient was left in significant distress and had to be admitted to hospital for treatment (Magill, 2013).
To provide maximum protection for the public against the misconduct of district nurses, four areas of law form the pillars of accountability and can act individually or collectively to hold nurses to account (Figure 1).
The purpose of accountability
Accountable to oneself
The aim of holding district nurses accountable for their actions is to ensure that the public and patients are not harmed by their acts and omissions, and to provide redress to those who have been harmed. To achieve that aim, accountability has the following functions.
District nurses often argue that they are accountable to themselves for their acts and omissions. Such an argument is characteristic of the altruistic nature of the profession. There is no question that a district nurse who harms a patient will feel remorse and will reflect on their practice to prevent a recurrence. However, this cannot be regarded as a district nurse truly holding themselves to account, since they cannot apply sanctions and provide any redress to the person who has been wronged.
Protective function The purpose of accountability is to protect the public from the acts or omissions of district nurses that might cause harm. You can be called to account for your conduct and competence if it is thought that you have fallen below the standard required of you in law.
Deterrent function The sanctions available to the authorities that hold district nurses to account protect the public and patients by discouraging them from acting in a way that would be considered misconduct or unlawful. A district nurse must act at all times in a manner worthy of a registered nurse—in work, in public and in their private lives.
Regulatory function By making nurses accountable to a range of higher authorities the law regulates nurses’ behaviour. District nurses are rightly seen to be working autonomously and are able to decide what care and treatment a patient requires. That autonomy is not unfettered, however. District nurses have to inform their decisions by reference to their regulatory framework. This makes it clear what standard of conduct and competence district nurses are required to comply with.
© 2015 MA Healthcare Ltd
Educative function District nurses who are called to account and asked to justify their actions have their cases heard in public with a view to reassuring patients that only the highest standards of practice will be tolerated. This public scrutiny of a district nurse’s conduct allows other members of the profession to learn from the mistakes and misconduct of others. The case of a district nurse whose name was removed from the register served as an important reminder to all district nurses about the importance of keeping records confidential. The nurse left the records of a patient open in full view on the rear seat of his car. The fitness to practice panel held that that action had put the patient at risk of harm, brought the profession into disrepute and breached fundamental tenets of the profession (Topping, 2014).
Pillars of accountability District nurses have a formal obligation to justify their actions to a range of higher authorities. If they fail to satisfy those requirements, then sanctions may be applied.
British Journal of Community Nursing March 2015 Vol 20, No 3
Pillars are not mutually exclusive The pillars of accountability are not mutually exclusive. They can individually or collectively impose sanctions on district nurses who fail to meet the required legal standard. Where misconduct is particularly serious, then all four pillars of accountability can come crashing down on the nurse. A district nurse, who was not a prescriber, wrote himself prescriptions for diazepam and midazolam and tried to fraudulently exchange them for the drugs. The nurse lost his job, was given a 5-year caution by the Nursing and Midwifery Council and was convicted of attempted fraud (Lavelle, 2011).
The fifth sphere of accountability District nurses in England are subject to a fifth pillar of accountability that sits between the employer and the profession. In response to concerns over the safety and quality of health services, the Health and Social Care Act 2008 was enacted, thereby creating: w A health-care regulator, the Care Quality Commission (CQC) w Regulations for organisations providing health and adult social care services w Regulations for the health and social care workforce. At the heart of the regulations is the requirement for service providers, including district nursing services, to be registered with the CQC, which has the authority to impose essential standards of quality and safety (NHS England et al, 2009). Everyone working in health and social care (including district nurses) is expected to contribute to the achievement of these standards. Where there is a risk of failing to meet the standards, it must be raised to the appropriate person so that remedial action can be taken. The CQC has far-reaching powers to take action against those who do not meet these standards (CQC, 2009).
CQC The CQC is the independent regulator of health and social care in England.The commission regulates health and adult social care services provided by the NHS, local authorities, private companies and voluntary organisations. Its main
147
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
LEGAL
Accountable to S O C I E T Y
P A T I E N T
E M P L O Y E R
Criminal law
Civil law
Contract law
P R O F E S S I O N Nursing and Midwifery Code (2015)
District nurses Figure 1. The four pillars of accountability in district nursing
KEY POINTS
w Public trust in nursing is underpinned by the accountability of practitioners w District nurses are accountable for their acts and omissions to society, their patients, the profession and their employers
w District nurses have no choice regarding to whom they are accountable or what they are accountable for since the level of accountability is established by law
w Professional standards of practice and behaviour are set out in the revised Code from the Nursing and Midwifery Council, which comes into force on 31 March 2015
148
Registration with the CQC Under the Health and Social Care Act 2008, all providers of health and services, including district nursing services, have to register with the CQC if they are undertaking regulated activities as defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (UK Government, 2010). All service providers must submit evidence, including evidence from people who use the services, confirming that each standard and outcome imposed for the regulated activity is complied with Health and Social Care Act 2008 (Regulated Activities) Regulations, 2010 (UK Government, 2010). These include personalised care, treatment and support; safeguarding and safety; suitability of staff; quality and suitability of management; involvement of service users and information about health-care provision. Where a service provider does not meet the required standard, it must be declared and an action plan submitted with the reasons for non-compliance and how they will be achieved.
CQC and health-care regulators The roles of the CQC and health-care regulators are likely to clash given the nature of their function. The CQC is the regulator of health care in England, while the Nursing and Midwifery Council (NMC) regulates nurses and midwives. To ensure that the regulatory systems do not come into conflict both bodies signed a memorandum of understanding in September 2010 outlining areas of cooperation. Where the NMC or CQC encounters concerns that it believes
© 2015 MA Healthcare Ltd
statutory duty is to protect and promote the health, safety and welfare of those who use health and adult social care services in England. To meet that duty, the CQC has the power to formulate policies and standards that health and adult social care services have to comply with, including (CQC, 2009): w Registration of health services to ensure that required standards of safety and quality are being met w Monitoring of health providers to check that they are meeting essential standards of safety and quality w Using enforcement powers to take fast, effective action where services are not to required standards w Carrying out periodic reviews of services to assess how those providing and arranging services are performing w Offering advice and making recommendations to help improve services.
British Journal of Community Nursing March 2015 Vol 20, No 3
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
LEGAL may fall within the remit of the other, they will convey the concerns with supporting information to a named officer with relevant responsibility at the other organisation (Care Quality Commission and Nursing and Midwifery Council, 2010). The CQC can convey its concerns about a district nurse’s fitness to practice to the NMC. Similarly, the NMC can convey any concerns about nursing services that may call into question their registration with the CQC. The CQC required a community health NHS trust to make improvements to comply with national standards of quality and safety following unannounced inspections at the district nursing and community equipment services. The inspections were carried out in response to information reported to the CQC. District nursing services were lacking detailed handover information about patient care. Furthermore, they had a high reliance on agency staff together with high staff sickness rates and poor staff skill mix that could impact on the service’s ability to ensure that patients’ needs were fully met. There was a lack of clinical supervision taking place in the district nursing service and not all staff had received up-to-date mandatory training. The CQC issued two formal warnings to the community health trust, requiring improvements in the assessment and monitoring of the quality of service provision and supporting workers. The Trust has also been told that action is required to address all other areas of non-compliance identified (Care Quality Commission, 2014).
Conclusion Accountability underpins the professionalism, integrity and probity of district nurses. It holds district nurses answerable for their acts or omissions to a range of higher authorities and binds the nurse to their rules and regulations. Generally, four areas of law are drawn together to provide maximum protection to the public from the harmful acts or omissions of district nurses. By making nurses accountable, the law regulates practice and deters them from conduct that might pose a threat to the public. Nurses in England are subject to a fifth pillar of accountability under the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (UK Government, 2010). To practise safely and to avoid being held to account for their actions, nurses must inform their practice with the
requirements of the criminal, civil and contract law and ensure that their practice and behaviour at all times meets the standards of professionalism set out in the recently revised NMC Code (2015). The Code will be the topic of next month’s article. BJCN If you are interested in finding out more about the legal cases noted in this feature, please email the editor at [email protected] Andrews J, Butler M (2014) Trusted to Care: An Independent Review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board. University of Sterling, Stirling Batey MV, Lewis FM (1982) Clarifying autonomy and accountability in nursing services: part 1. J Nurs Adm 12(9): 13–18 Care Quality Commission (2009) Guidance about Compliance: Essential Standards of Quality and Safety. CQC, Newcastle Care Quality Commission (2014) CQC requires improvement at Liverpool Community Health NHS Trust. http://bit.ly/1LBjemi (accessed 24 February 2015) Care Quality Commission, Nursing and Midwifery Council (2010) Memorandum of understanding between the Care Quality Commission and Nursing and Midwifery Council. CQC & NMC, London. http://bit.ly/1A2RbUe (accessed 24 February 2015) Department of Health (2012) Transforming care: a national response to Winterbourne View Hospital. Department of Health Review: Final Report. DH, London. http://bit.ly/1qvKbAQ (accessed 24 February 2015) Francis R (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry: Final Report. Mid Staffordshire NHS Foundation Trust Public Inquiry, London. http://bit.ly/1bbgTtO (accessed 24 February 2015) Griffith R, Tengnah C (2013) Law and Professional Issues in Nursing, 3rd edn. Learning Matters, Exeter Lavelle C (2011) Nurse escapes being struck off after helping himself to prescriptions. Deadline News, January 17. http://bit.ly/1wjiTRX (accessed 24 February 2015) Magill P (2013) Accrington nurse struck off after botched catheter fitting. Lancashire Telegraph, January 24. http://bit.ly/1MOnT67 (accessed 24 February 2015) National Advisory Group on the Safety of Patients in England (2013) A promise to learn, a commitment to act: Improving the safety of patients in England. Department of Health, London NHS England, Social Care England, Public Health England (2009) Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112). http://bit. ly/1LyFGeb (accessed 24 February 2015) Nursing and Midwifery Council (2015) Professional standards of practice and behaviour for nurses and midwives. http://bit.ly/1DNCzQc (accessed 24 February 2015) Savage J, Moore L (2004) Interpreting accountability: an ethnographic study of practice nurses, accountability and multidisciplinary team decision-making in the context of clinical governance. Research Report. Royal College of Nursing, London Topping K (2014) Perthshire nurse struck off for ‘dishonest behaviour’. The Courier, 17 November. UK Government (2010) Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (SI 2010/781). http://bit.ly/1DiT7wA (accessed 24 February 2015)
BREAKING NEWS:
© 2015 MA Healthcare Ltd
Community nurses, join in the conversation online ‘Like’ us on Facebook (www.facebook.com/communitynursing)
Follow us on Twitter (@BJCommunityNurs)
Join our community nurses group on LinkedIn (www.linkedin.com, then search British Journal of Community Nursing)
and stay in contact with us with your views or ideas ([email protected])
www.magonlinelibrary.com/toc/bjcn/current British Journal of Community Nursing March 2015 Vol 20, No 3
149
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
Accountability in district nursing practice: key concepts Richard Griffith
Senior Lecturer in Health Law, College of Health Science, Swansea University
Defining accountability Batey and Lewis (1982) defined accountability as:
‘the fulfilment of a formal obligation to disclose to reverent others the purposes, principles, procedures,
ABSTRACT
Public trust and confidence in district nurses is essential to the nurse– patient relationship that underpins effective care and treatment. That trust and confidence has even greater focus for district nurses who care for patients in their own homes. Those patients need to be able to count on the professionalism and probity of their district nurses. The professionalism and probity of district nurses is based on their accountability, which protects the public by imposing standards on district nurses and holds them answerable for their acts and omissions. This is the first of a series of articles on accountability in district nursing practice to mark the introduction of the revised Nursing and Midwifery Code on the 31 March 2015. This month’s article considers the key concepts of accountability.
KEY WORDS
w Professionalism w Probity w Accountability w Duties w Standards
146
relationships, results, income and expenditures for which one has authority.’ This reveals the fundamental nature of accountability. It shows that accountability has its basis in law as there is a formal or legal relationship between the district nurse and the higher authorities that hold them to account. The extent of the scrutiny goes beyond conduct and encompasses the district nurse’s competence, integrity and probity. To be accountable is to be answerable for one’s acts and omissions. This is the approach adopted by the regulatory body, the Nursing and Midwifery Council (NMC), whose revised Code sets out the professional standards of professional practice and behaviour required of district nurses. The Code (NMC, 2015) states that good nursing practice puts the interests of patients and service users first, is safe and effective and promotes trust t hrough professionalism.
Accountability versus responsibility Accountability and responsibility are often used interchangeably by health professionals as though they have the same meaning. Accountability means being answerable to a higher authority for your actions. Responsibility means to have control or authority over someone or something. District nurses are responsible for their practice. They decide how to practise and what interventions are in the best interests of the patients in their care. However, district nurses do not have control or authority over who holds them to account or what they are accountable for. District nurses are required to work within the law and in accordance with the NMC’s Code (2015). The authorities that hold district nurses to account can demand they justify their actions. They bestow the level of accountability necessary to protect the public and patients from harm.
Case study A registered nurse was struck off the Nursing and Midwifery Council’s register after an incompetent catheter fitting left a patient needing hospital treatment.The experienced nurse made a number of mistakes while performing the procedure on the older man and the catheter was not inserted into the bladder. The nurse then failed to ensure that urine was discharged after its insertion and made a
© 2015 MA Healthcare Ltd
D
espite its common usage, the term ‘accountability’ is frequently misunderstood in practice. A study by Savage and Moore (2004) found the term elusive and ambiguous, and there is little evidence that the term is understood any more clearly some 11 years later. This may be due to meaningless phrases such as ‘transparent accountability’, ‘bottom-up accountability’ and ‘structural accountability’ being developed by policy-makers and featuring in the literature (Griffith and Tengnah, 2013). Accountability is fundamental to the protection of the public and individuals in the care of district nurses. Recent reports into the care and treatment of vulnerable patients arising from the Winterbourne View Report, Francis Report and Berwick Report in England and the Andrews Report in Wales highlights the importance of accountability in district nursing (Department of Health, 2012; Francis, 2013; National Advisory Group on the Safety of Patients in England, 2013; Andrews and Butler, 2014). It is essential that the term is clearly understood as it is the means by which the law imposes standards and boundaries on professional practice.
Email: [email protected]
British Journal of Community Nursing March 2015 Vol 20, No 3
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
LEGAL number of failings over making notes for the procedure in the man’s records. The patient was left in significant distress and had to be admitted to hospital for treatment (Magill, 2013).
To provide maximum protection for the public against the misconduct of district nurses, four areas of law form the pillars of accountability and can act individually or collectively to hold nurses to account (Figure 1).
The purpose of accountability
Accountable to oneself
The aim of holding district nurses accountable for their actions is to ensure that the public and patients are not harmed by their acts and omissions, and to provide redress to those who have been harmed. To achieve that aim, accountability has the following functions.
District nurses often argue that they are accountable to themselves for their acts and omissions. Such an argument is characteristic of the altruistic nature of the profession. There is no question that a district nurse who harms a patient will feel remorse and will reflect on their practice to prevent a recurrence. However, this cannot be regarded as a district nurse truly holding themselves to account, since they cannot apply sanctions and provide any redress to the person who has been wronged.
Protective function The purpose of accountability is to protect the public from the acts or omissions of district nurses that might cause harm. You can be called to account for your conduct and competence if it is thought that you have fallen below the standard required of you in law.
Deterrent function The sanctions available to the authorities that hold district nurses to account protect the public and patients by discouraging them from acting in a way that would be considered misconduct or unlawful. A district nurse must act at all times in a manner worthy of a registered nurse—in work, in public and in their private lives.
Regulatory function By making nurses accountable to a range of higher authorities the law regulates nurses’ behaviour. District nurses are rightly seen to be working autonomously and are able to decide what care and treatment a patient requires. That autonomy is not unfettered, however. District nurses have to inform their decisions by reference to their regulatory framework. This makes it clear what standard of conduct and competence district nurses are required to comply with.
© 2015 MA Healthcare Ltd
Educative function District nurses who are called to account and asked to justify their actions have their cases heard in public with a view to reassuring patients that only the highest standards of practice will be tolerated. This public scrutiny of a district nurse’s conduct allows other members of the profession to learn from the mistakes and misconduct of others. The case of a district nurse whose name was removed from the register served as an important reminder to all district nurses about the importance of keeping records confidential. The nurse left the records of a patient open in full view on the rear seat of his car. The fitness to practice panel held that that action had put the patient at risk of harm, brought the profession into disrepute and breached fundamental tenets of the profession (Topping, 2014).
Pillars of accountability District nurses have a formal obligation to justify their actions to a range of higher authorities. If they fail to satisfy those requirements, then sanctions may be applied.
British Journal of Community Nursing March 2015 Vol 20, No 3
Pillars are not mutually exclusive The pillars of accountability are not mutually exclusive. They can individually or collectively impose sanctions on district nurses who fail to meet the required legal standard. Where misconduct is particularly serious, then all four pillars of accountability can come crashing down on the nurse. A district nurse, who was not a prescriber, wrote himself prescriptions for diazepam and midazolam and tried to fraudulently exchange them for the drugs. The nurse lost his job, was given a 5-year caution by the Nursing and Midwifery Council and was convicted of attempted fraud (Lavelle, 2011).
The fifth sphere of accountability District nurses in England are subject to a fifth pillar of accountability that sits between the employer and the profession. In response to concerns over the safety and quality of health services, the Health and Social Care Act 2008 was enacted, thereby creating: w A health-care regulator, the Care Quality Commission (CQC) w Regulations for organisations providing health and adult social care services w Regulations for the health and social care workforce. At the heart of the regulations is the requirement for service providers, including district nursing services, to be registered with the CQC, which has the authority to impose essential standards of quality and safety (NHS England et al, 2009). Everyone working in health and social care (including district nurses) is expected to contribute to the achievement of these standards. Where there is a risk of failing to meet the standards, it must be raised to the appropriate person so that remedial action can be taken. The CQC has far-reaching powers to take action against those who do not meet these standards (CQC, 2009).
CQC The CQC is the independent regulator of health and social care in England.The commission regulates health and adult social care services provided by the NHS, local authorities, private companies and voluntary organisations. Its main
147
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
LEGAL
Accountable to S O C I E T Y
P A T I E N T
E M P L O Y E R
Criminal law
Civil law
Contract law
P R O F E S S I O N Nursing and Midwifery Code (2015)
District nurses Figure 1. The four pillars of accountability in district nursing
KEY POINTS
w Public trust in nursing is underpinned by the accountability of practitioners w District nurses are accountable for their acts and omissions to society, their patients, the profession and their employers
w District nurses have no choice regarding to whom they are accountable or what they are accountable for since the level of accountability is established by law
w Professional standards of practice and behaviour are set out in the revised Code from the Nursing and Midwifery Council, which comes into force on 31 March 2015
148
Registration with the CQC Under the Health and Social Care Act 2008, all providers of health and services, including district nursing services, have to register with the CQC if they are undertaking regulated activities as defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (UK Government, 2010). All service providers must submit evidence, including evidence from people who use the services, confirming that each standard and outcome imposed for the regulated activity is complied with Health and Social Care Act 2008 (Regulated Activities) Regulations, 2010 (UK Government, 2010). These include personalised care, treatment and support; safeguarding and safety; suitability of staff; quality and suitability of management; involvement of service users and information about health-care provision. Where a service provider does not meet the required standard, it must be declared and an action plan submitted with the reasons for non-compliance and how they will be achieved.
CQC and health-care regulators The roles of the CQC and health-care regulators are likely to clash given the nature of their function. The CQC is the regulator of health care in England, while the Nursing and Midwifery Council (NMC) regulates nurses and midwives. To ensure that the regulatory systems do not come into conflict both bodies signed a memorandum of understanding in September 2010 outlining areas of cooperation. Where the NMC or CQC encounters concerns that it believes
© 2015 MA Healthcare Ltd
statutory duty is to protect and promote the health, safety and welfare of those who use health and adult social care services in England. To meet that duty, the CQC has the power to formulate policies and standards that health and adult social care services have to comply with, including (CQC, 2009): w Registration of health services to ensure that required standards of safety and quality are being met w Monitoring of health providers to check that they are meeting essential standards of safety and quality w Using enforcement powers to take fast, effective action where services are not to required standards w Carrying out periodic reviews of services to assess how those providing and arranging services are performing w Offering advice and making recommendations to help improve services.
British Journal of Community Nursing March 2015 Vol 20, No 3
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
LEGAL may fall within the remit of the other, they will convey the concerns with supporting information to a named officer with relevant responsibility at the other organisation (Care Quality Commission and Nursing and Midwifery Council, 2010). The CQC can convey its concerns about a district nurse’s fitness to practice to the NMC. Similarly, the NMC can convey any concerns about nursing services that may call into question their registration with the CQC. The CQC required a community health NHS trust to make improvements to comply with national standards of quality and safety following unannounced inspections at the district nursing and community equipment services. The inspections were carried out in response to information reported to the CQC. District nursing services were lacking detailed handover information about patient care. Furthermore, they had a high reliance on agency staff together with high staff sickness rates and poor staff skill mix that could impact on the service’s ability to ensure that patients’ needs were fully met. There was a lack of clinical supervision taking place in the district nursing service and not all staff had received up-to-date mandatory training. The CQC issued two formal warnings to the community health trust, requiring improvements in the assessment and monitoring of the quality of service provision and supporting workers. The Trust has also been told that action is required to address all other areas of non-compliance identified (Care Quality Commission, 2014).
Conclusion Accountability underpins the professionalism, integrity and probity of district nurses. It holds district nurses answerable for their acts or omissions to a range of higher authorities and binds the nurse to their rules and regulations. Generally, four areas of law are drawn together to provide maximum protection to the public from the harmful acts or omissions of district nurses. By making nurses accountable, the law regulates practice and deters them from conduct that might pose a threat to the public. Nurses in England are subject to a fifth pillar of accountability under the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (UK Government, 2010). To practise safely and to avoid being held to account for their actions, nurses must inform their practice with the
requirements of the criminal, civil and contract law and ensure that their practice and behaviour at all times meets the standards of professionalism set out in the recently revised NMC Code (2015). The Code will be the topic of next month’s article. BJCN If you are interested in finding out more about the legal cases noted in this feature, please email the editor at [email protected] Andrews J, Butler M (2014) Trusted to Care: An Independent Review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board. University of Sterling, Stirling Batey MV, Lewis FM (1982) Clarifying autonomy and accountability in nursing services: part 1. J Nurs Adm 12(9): 13–18 Care Quality Commission (2009) Guidance about Compliance: Essential Standards of Quality and Safety. CQC, Newcastle Care Quality Commission (2014) CQC requires improvement at Liverpool Community Health NHS Trust. http://bit.ly/1LBjemi (accessed 24 February 2015) Care Quality Commission, Nursing and Midwifery Council (2010) Memorandum of understanding between the Care Quality Commission and Nursing and Midwifery Council. CQC & NMC, London. http://bit.ly/1A2RbUe (accessed 24 February 2015) Department of Health (2012) Transforming care: a national response to Winterbourne View Hospital. Department of Health Review: Final Report. DH, London. http://bit.ly/1qvKbAQ (accessed 24 February 2015) Francis R (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry: Final Report. Mid Staffordshire NHS Foundation Trust Public Inquiry, London. http://bit.ly/1bbgTtO (accessed 24 February 2015) Griffith R, Tengnah C (2013) Law and Professional Issues in Nursing, 3rd edn. Learning Matters, Exeter Lavelle C (2011) Nurse escapes being struck off after helping himself to prescriptions. Deadline News, January 17. http://bit.ly/1wjiTRX (accessed 24 February 2015) Magill P (2013) Accrington nurse struck off after botched catheter fitting. Lancashire Telegraph, January 24. http://bit.ly/1MOnT67 (accessed 24 February 2015) National Advisory Group on the Safety of Patients in England (2013) A promise to learn, a commitment to act: Improving the safety of patients in England. Department of Health, London NHS England, Social Care England, Public Health England (2009) Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112). http://bit. ly/1LyFGeb (accessed 24 February 2015) Nursing and Midwifery Council (2015) Professional standards of practice and behaviour for nurses and midwives. http://bit.ly/1DNCzQc (accessed 24 February 2015) Savage J, Moore L (2004) Interpreting accountability: an ethnographic study of practice nurses, accountability and multidisciplinary team decision-making in the context of clinical governance. Research Report. Royal College of Nursing, London Topping K (2014) Perthshire nurse struck off for ‘dishonest behaviour’. The Courier, 17 November. UK Government (2010) Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (SI 2010/781). http://bit.ly/1DiT7wA (accessed 24 February 2015)
BREAKING NEWS:
© 2015 MA Healthcare Ltd
Community nurses, join in the conversation online ‘Like’ us on Facebook (www.facebook.com/communitynursing)
Follow us on Twitter (@BJCommunityNurs)
Join our community nurses group on LinkedIn (www.linkedin.com, then search British Journal of Community Nursing)
and stay in contact with us with your views or ideas ([email protected])
www.magonlinelibrary.com/toc/bjcn/current British Journal of Community Nursing March 2015 Vol 20, No 3
149
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
