This editorial, where it can avoid it, will not be discussing the former neonatal nurse – enough will be written about her elsewhere. Consequent to events, the Nursing and Midwifery Council (NMC) is now putting in place actions to have her name removed from the register.
The first edition of the Code of Professional Conduct was published in 1983 by the United Kingdom Central Council, predecessor to the NMC. This brief document made clear that:
‘Each registered nurse, midwife and health visitor shall act, at all times, in such a manner as to: safeguard and promote the interests of individual patients and clients; serve the interests of society; justify public trust and confidence and uphold and enhance the good standing and reputation of the professions.’
This was a clear proclamation as to how nurses, midwives and health visitors must act at all times. The first edition and the current revised Code (NMC, 2018) apply to all registrants, which includes patient-facing, hands-on practitioners, as well as anyone in managerial positions, in research or teaching. The Code offers registrants an extended definition of the phrase ‘professional accountability’ and emphasises the primacy of the interests of patients and clients. It is key the professions maintain good standing and reputation to maintain the trust and confidence of the public.
‘As a registered nurse, midwife or health visitor, you are personally accountable for your practice. It should be noted that accountability is not an optional extra, the nurse cannot choose to be accountable for some aspects of practice but not others.’
Pyne, 1994
This sobering observation from Pyne highlights that the notion of accountability should never change: there is no need for it to change because it is what defines us.
Recommendations that followed the Shipman Inquiry (Smith, 2005) and the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis, 2013), which looked into previous scandals, are in many ways only just being fully implemented. So it is imperative that recommendations arising from the newly announced inquiry into the circumstances behind the murders and attempted murders of babies at the Countess of Chester Hospital NHS Foundation Trust are implemented rapidly – and that they are monitored with regards to efficacy and compliance.
This will be a non-statutory independent inquiry, deemed to be the most appropriate option. It will build on the approach taken previously, focusing on lessons that can be learnt quickly. While it may be easy or convenient to portray this as a Countess of Chester problem, regrettably it is a UK health problem – and we all have to work to solve this. The inquiry's terms of reference must be far reaching. In addition to considering the circumstances surrounding the deaths and incidents, it will need to investigate how concerns raised by clinicians were dealt with. If paediatricians were silenced, how much more difficult it would have been for other nurses on the unit to raise the alarm.
For any healthcare provider (individual or organisation) to be effective in safeguarding the public, it is critical to retain public confidence. We need to work to regain that confidence now. The constant drive for neat solutions, positivity, airbrushing unpleasant situations and trying to keep a lid on things does not impact on the day-to-day realities experienced by most staff. The PR mantra of promoting positive public images and damage control must never ever be allowed to trump governance and safeguarding care.
Initials were used in place of naming the babies in this vile case, but these were not anonymous cases to their families: they were daughters, sons, brothers, sisters and grandchildren. Such children are our patients, for whom we have the absolute privilege to care, and we – all of us, sharp-end practitioners, managers, researchers and teachers – owe them a duty of care.