Nursing board ‘swamped’ by fitness-to-practise cases

Members of the board of the regulatory body for the nursing profession were “swamped” with work pressures arising from handling fitness-to-practise cases “limiting their available time to consider other matters relating to governance” of the organisation, according to a new report.

The report by consultants Crowe Horwath, commissioned by the regulatory body itself – the Nursing and Midwifery Board of Ireland (NMBI) – says that while fitness-to-practise arrangements appear to be generally well-organised by executive management, the workload is extremely resource-intensive and very expensive from the perspective of legal fees.

It says cases have to be dealt with using two different pieces of legislation. “All board members involved in considering fitness-to-practise matters must commit very large amounts of time to this activity, and are also required to read very substantial amounts of documentation (sometimes in excess of 1,000 pages). Board members – all of whom are involved on a part-time, non-executive basis – reported to us that they routinely spend between 30 and 50 days per annum on NMBI business, sometimes in blocks of days at a time. There is a general sense from many board members who we have interviewed that they are ‘swamped’ in such material, limiting their available time to consider other matters relating to governance of NMBI.”

Backlogs and delays

The registration process for dealing with applicants seeking to work as nurses and midwives in Ireland, the report adds, is experiencing significant backlogs and delays. The report also warns the NMBI’s financial position is “of serious concern”.

A row with nurses and midwives last year over a planned rise in the annual retention fee, later reversed, resulted in a position in which income was substantially less than expenditure. "Our initial probing of this issue suggested that there was an internal expectation within the NMBI that the Department of Health would make up the shortfall, but we did not get the impression that this matter was being addressed urgently within the NMBI."

The Crowe Horwath report was commissioned by the nursing board last August and was finalised in November. The NMBI did publish recommendations but refused to release both this report and a separate report on remuneration and procurement practices in the organisation by another group of consultants, BDO.

The Irish Times has fought for access to the documents under Freedom of Information legislation for the last six months.

The report in its overall finding says the NMBI is failing to discharge many of its statutory responsibilities, is dysfunctional and in need of significant reform and investment.

“To some extent the problems faced by the NMBI may be systemic. In particular, the legislation underpinning the management of fitness-to-practise cases and the corporate governance of NMBI appears to be a major contributor to the current problems, and is in need of urgent review.”

The report says there is no published strategic plan for the organisation and no clearly articulated vision for the future: “There is no effective planning process in place.”

The report says that, over the last few years, the nursing board did not have a “productive working relationship with the Department of Health”.

At executive level within the NMBI, it maintains that some relationships have not been “productive or collegiate” and in some cases “appear to have broken down beyond repair”.

Informed decisions

Separately, the report also says the NMBI board “would appear not to have been supplied with information in sufficient detail or on a sufficiently timely basis to enable it to make informed decisions, as required under the code of practice. Good governance within NMBI depends upon having productive and cohesive working relationships between the president, board and CEO, and an effective line of communications with the Department of Health under whose aegis NMBI operates. This does not appear to have been the case within the NMBI over the last few years, and it does not appear that the accountability of the CEO to the board operated in line with the framework.”

The report says that accountability within the NMBI at executive level is unclear and is not documented.

“Internal relationships between the recently departed CEO and members of the senior management team over the last few years do not appear to have been productive or collegiate, and some relationships appear to have broken down beyond repair.”