Brownlie v Four Seasons Group
The Nursing and Midwifery Council (NMC) has updated the Code that sets out the professional standards of practice and behaviour expected from nurses and midwives. The revised Code will come into effect from 31 March 2015 and will replace the previous code, published in May 2008.
The revised Code is over twice the length of the 2008 Code. This is because, while the Code retains the concept of four high-level principles (in a simplified form as explained below), there is significantly more detail in relation to how these principles apply in practice. The requirements have been expanded upon and added to in a way which reflects recent changes in what is expected of registered professionals.
Simplification of key principles
The wording of the four key principles which underpin all of the detailed requirements of the Code has been significantly simplified. For example, the first principle of the 2008 Code required nurses and midwives to “make the care of people your first concern, treating them as individuals and respecting their dignity”. The equivalent principle in the new Code is succinctly put as “prioritise people”. Similarly, the second principle in the 2008 Code “work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community” is now covered by the much paired down requirement to “practise effectively”.
This change reflects a trend towards the simplification of the key principles that underpin good and compliant practice in regulatory settings. The GDC for example, in its revised Standards for the Dental Team (2013), captures the measures of acceptable professional conduct in nine simple core principles.
While the wording of the principles in the NMC’s revised Code has been simplified, there is far more detail in relation to what these principles will mean in practice. This makes the new Code more practical in its application than the 2008 code. For example, the 2008 Code requires registrants to “treat people as individuals and respect their dignity” without giving any guidance on how to apply this high-level principle in practice. The new Code has addressed this by specifying what registrants must do to comply with this principle, such as delivering effectively the “fundamentals of care”, which includes “nutrition, hydration, bladder and bowel care, physical handling and making sure those receiving care have adequate access to nutrition and hydration…”.
Similarly, the previous Code referenced the need to whistle-blow where necessary by requiring registrants to “act without delay if you believe that you, a colleague or anyone else may be putting someone at risk”, but there is now greater detail about how to comply with this requirement in practice. There is also a specific reference to the professional duty of candour recommended in the Francis Report. The duty of candour will require registered persons to act in an open and transparent way in relation to the care and treatment provided to service users from 1 April 2015, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Until 1 April 2015, this obligation is placed on “health service bodies”, rather than on individual registrants.
Within the Code, registrants are reminded that “the professional duty of candour is about openness and honesty when things go wrong” and are told to raise and escalate any concerns about patient or public safety or the level of care people are receiving in a healthcare setting in line with the NMC’s guidance and registrants’ local working practices.
While it would be impossible (and indeed undesirable) to produce a code that would act as a manual to give specific guidance on how a nurse or midwife should act in any particular situation, the new Code at least attempts to provide greater clarity as to what is expected of registrants.
As well as simplifying the key principles and providing more detailed and practical guidance on applying these, the revised Code introduces some new requirements. Notable among these is a new requirement for registrants to be able to communicate clearly and effectively in English. This reflects the Law Commission’s thinking on the introduction of a new statutory ground of failing to meet the adequate language requirements. End of life care is the subject of a specific new standard, requiring registrants to “recognise and respond compassionately to the need of those who are in the last few days and hours of life”.
The new Code also gives greater direction in relation to clinical issues. For example, there is a new section on supplying, dispensing and administering medicines. This more specific clinical guidance is similar to the approach of the Health and Care Professions Council (HCPC), which publishes specific standards of competency (separate to the general standards of conduct, performance and ethics) for each regulated profession.
In summary, the new Code offers more clarity to nurses and midwives as to exactly what is required of them and should therefore be of more use as a practical reference guide. The challenge for any busy professional is having the time to read, assimilate and embed the new code.
Kingsley Napley provides training to individuals, Trusts and other organisations on their regulatory responsibilities. Please contact Julie Norris or Lucy Williams if you would like to discuss your needs.
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