Dishonest Midwives


Dishonest Midwives

Health care professionals are often under the mistaken belief that conduct which questions their fitness to practise only relates to matters that directly affect patient care. This is a mistaken belief. A midwife’s fitness to practise does not escape being investigated just because a patient has not been harmed.
The Nursing and Midwifery Council has to consider not only patient safety, but the public’s perception of the midwifery profession as a whole. It is important to maintain the reputation of the profession and to uphold the high standards expected by the public.
The public holds midwives in high regard. Pregnant women put their trust in their midwife. For that reason honesty and integrity is fundamental to the midwifery profession.
All midwives should be aware of the Nursing and Midwifery Council’s ‘Code, Professional standards of practice and behaviour for nurses and midwives’ 2015 which states:

20.2 act with honesty and integrity at all times,

21.3 act with honesty and integrity in any financial dealings you have with everyone you have a professional relationship with, including people in your care

A midwife has to be aware that their conduct not only as a practitioner but outside of their practice could be subject to scrutiny. This includes any acts of dishonesty. Dishonest conduct fails to maintain the trust pregnant women have in midwives. Who wants to be cared for by a dishonest midwife?
But what do we mean by acting dishonestly? Dishonest conduct can be anything from claiming to be sick when working elsewhere to criminal activity such as theft or fraud.

Some acts of dishonesty or so obviously dishonest it needs no consideration but others may be debatable. The test for dishonesty must exclude other explanations like mistake or negligence which does not have the dishonest intent.

The legal test in relation to dishonesty is constantly evolving. However, it is important for midwives to have a basic understanding of what a Nursing and Midwifery Panel will be asked to consider when determining whether a midwife has been acting dishonestly.

The test for dishonesty is derived from the criminal case of R v Ghosh, referred to as the ‘Ghosh test.’ It is a two limbed test which states that a person is acting dishonestly if the general public would think that the actions were dishonest and that the person must have known that those actions were dishonest browse around this site. “In determining whether the prosecution has proved that the defendant was acting dishonestly, a jury must first of all decide whether according to the ordinary standards of reasonable and honest people what was done was dishonest. If it was not dishonest by those standards, that is the end of the matter and the prosecution fails. If it was dishonest by those standards, then the jury must consider whether the defendant himself must have realised that what he was doing was by those standards dishonest …”

However, this is a criminal test and the standard of proof is higher in a criminal setting, ‘beyond or reasonable doubt.’ In a Nursing and Midwifery Council fitness to practise hearing the standard of proof which is applied is the civil standard, the ‘balance of probabilities.’ That means the Panel has to be satisfied that the conduct ‘probably’ occurred.

The courts have grappled with the difference in the test for dishonesty as applied to the civil setting and have modified it to be more applicable to disciplinary hearings. The test now appears to be that “…the disciplinary tribunal must be persuaded on the balance of probabilities first that what was done was dishonest by the standards of reasonable and honest people, and secondly, that the person in fact realised that what he or she was doing was dishonest by those standards. That is the test in Ghosh modified to remove the criminal standard of proof which is embedded in the formulation of the subjective element in that case.”

Dishonesty will always be viewed as very serious by a Panel of the Nursing and Midwifery Council and often attracts the most serious sanction if the facts and impairment are found proved.

In order to avoid the most serious sanction a midwife will have to show that she has accepted that the conduct was dishonest and then reflected on the dishonest conduct. Failing to accept that not being honest can have a serious impact on patient safety.

For example, a midwife applies for a job and declares that she has qualifications which she has not actually got, a ‘little white lie?’ She may not think that such a claim will have any impact on patient safety. However, there is a potential for patient harm. Looking at it in a broader context, a midwife who makes false claims may be compromising patient safety if the midwife is asked to undertake a practice that she has not been trained in.

A midwife must show that she appreciates the risk to patients by acting dishonestly even if it is conduct outside her practice xxlrfdk. This will show the Panel that the midwife has insight and may show not only that her fitness to practise is not impaired or if it is, a more lenient sanction is appropriate.

Article by Penny Maudsley

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