For the first time in its history or the history of its predecessors, the Nursing and Midwifery Council (NMC) of the United Kingdom has issued new guidance ‘Freedom of expression and Fitness to Practise‘ which is purportedly “designed to allow nurses to express their beliefs while adhering to the code“. “The code” is the ‘Professional standards of practice and behaviour for nurses, midwives and nursing associates’. These are the standards “that nurses, midwives and nursing associates must uphold in order to be registered to practise in the U.K.”
As someone who was recently under investigation, on the basis of an anonymous complaint, by the NMC for spreading misinformation and undermining public confidence in nursing, I have more than a passing interest in how my professional body views freedom of speech. I had and continue to publish copiously on the harms of lockdown, the ineffectiveness of face masks and the lack of efficacy and demonstrable harms of the COVID-19 vaccines. One co-authored article in particular, the basis of the complaint, published in the Daily Sceptic also referred to the selfishness of nurses in demanding such a high pay rise following the Covid years given that, unlike workers in many other sectors, they had been fully employed and well paid throughout lockdown.
I was lucky, in a sense, that after eight months the NMC found I had no case to answer. I reported this outcome in these pages along with links to my letter of defence and paying tribute to the various individuals and bodies which had supported me, including the Free Speech Union, the Health Advisory and Recovery Team and the Workers of England Union.
I was not alone among Registered Nurses in being reported to the NMC and I know that some nurses, reported earlier than me for precisely the same issue, still await an outcome. It seems, regardless of the outcome, the process is at least part of the punishment.
According to the NMC the guidance was stimulated “following a number of reported cases around protected beliefs and freedom of expression”. The initial section of the guidance tries to distinguish between situations where comments made outside of work are either related to or unrelated to the registrant’s status as a nurse, midwife or nursing associate. Thus, expressing support for a political party or criticising a line manager (without making, for example, a racial slur) would not lead to regulatory action. Good to know.
On the other hand, for example, advising a cancer patient even outside of work that “extensive prayer” may help them would lead to regulatory action. A definition of “extensive prayer” is not provided and there is no indication about what the extensive prayer is aimed at. Is it aimed at curing the cancer or merely providing comfort to the person being addressed? While it is not advisable for many reasons to suggest that a person prays, surely they are as free to ignore the advice as the nurse, midwife or nursing associate is to issue it, inside or outside of the workplace.
The next example posits that “a registered nurse posts a public tweet comparing medical professionals delivering a vaccine to ‘angels of death’ and explaining that vaccination is ‘a plan to kill off the elderly’”. Here, the NMC says that it would take regulatory action. While ‘angels of death’ is, admittedly, strong language where would the NMC sit if someone said, for example, that nurses had participated — however unwittingly — in a programme of unnecessary experimental vaccination that, without much benefit, has led to widespread and demonstrable harms? That is my position in a nutshell so, perhaps, we may not have long to wait.
The next three examples deal with the issue of transgenderism and involve either expressing a general view on legislation making transition easier or making ad hominem comments, including “deliberately” misgendering someone. The NMC is “unlikely” to take regulatory action for a general expression of views but will take regulatory action in the case of inappropriate comments made to an individual. This does not entirely support freedom of expression around transgender issues as such and the line between accidental and deliberate misgendering is likely to be blurred in favour of “deliberate” in the case of a misgendered transgender person who feels offended.
The final examples refer to vaccination. A nurse, whose ethical beliefs lead him or her to dissuade parents from vaccinating their child will most definitely face regulatory action. However, given the demonstrable harms of the COVID-19 vaccines, this scenario remains to be tested. When a “nurse has doubts about the efficacy or safety of a vaccine that is being widely administered as part of a nationwide public health campaign” and he or she “refuses to be vaccinated on this basis and tells colleagues about his or her misgivings” the NMC position is that “there is no evidence at any point that the nurse has acted contrary to the Code”.
That the NMC has decided to issue guidance on freedom of speech is welcome and, undoubtedly, the guidance will continue to evolve. Nevertheless, while we have ‘case law’ to suggest that a nurse can publicly express concerns about major U.K. government public health policies, including COVID-19 vaccination, the new guidance does not make that explicit. Until it does, as more nurses become aware of exactly what took place during the COVID-19 years, more nurses are likely to be caught in the snare of anonymous complaints and lengthy investigations by the NMC.
Dr. Roger Watson is Academic Dean of Nursing at Southwest Medical University, China. He has a PhD in biochemistry. He writes in a personal capacity.
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