Nurses & midwives should be careful in accepting gifts, favours and hospitality to avoid causing conflicts of interest and potentially jeopardising their fitness to practise.
The Nursing and Midwifery Council’s (NMC) Code states (at section 21.1) that all nurses and midwives must refuse all but the “most trivial gifts, favours and hospitality”. Nurses & midwives should be careful in accepting gifts, favours and hospitality to avoid causing conflicts of interest and potentially jeopardising their fitness to practise.
What is a conflict of interest?
In a joint statement, ‘conflict of interest’ is defined as
“Conflicts can arise in situations where someone’s judgement may be influenced, or perceived to be influenced, by a personal, financial or other interest.”
NMC Code & Guidance
The NMC’s Code states at section 21.1 that all nurses and midwives must refuse all but the most trivial gifts, favours and hospitality. It states:
To achieve this, you must:
21.1 refuse all but the most trivial gifts, favours or hospitality, as accepting them could be interpreted as an attempt to gain preferential treatment.
Nurses and midwives must take care when following other guidance, particularly if this might put them in conflict with the NMC Code. This for example could include the NHS’ guidance on gifts, favours and hospitality. Ultimately, the NMC Code should take precedence.
The NMC previously indicated:
“Stating in this guidance that gifts up to the value of £50 can be accepted without declaration may not only undermine our Code but may also lead to a two-tier approach where nurses and midwives would feel bound by their Code to refuse such gifts whereas other healthcare professionals may feel that they are able to accept them.”
In a joint statement, the NMC set out the following principles that nurses and midwives should follow to avoid conflicts of interests:
- Put the interests of people in their care before their own interests, or those of any colleague, business, organisation, close family member or friend.
- Maintain appropriate personal and professional boundaries with the people they provide care to and with others.
- Consider carefully where conflicts of interest may arise – or be perceived to arise – and seek advice if they are unsure how to handle this.
- Be open about any conflict of interest they face, declaring it formally when appropriate and as early as possible, in line with the policies of their employer or the organisation contracting their services.
- Ensure their professional judgement is not compromised by personal, financial or commercial interests, incentives, targets or similar measures.
- Refuse all but the most trivial gifts, favours or hospitality if accepting them could be interpreted as an attempt to gain preferential treatment or would contravene your professional code of practice.
- Where appropriate, ensure that patients have access to visible and easy-to-understand information on any fees and charging policies for which you are responsible.
What is meant by “trivial”?
Ultimately, each case will be determined in its individual merits. Whilst the Code does not give any specific examples or explanation of “trivial”, the NMC indicated in its response to an NHS consultation on “Managing Conflicts of Interest in the NHS” that:
“We agree that all cash gifts should be refused… We would suggest that £50 is not a ‘trivial’ sum, and that a gift or series of gifts worth £50 could not be regarded as a ‘trivial’ gift.”
The above is not indicative of the NMC’s position on ‘trivial gifts, favours and hospitality’ but serves as a general indication of the level or threshold of the NMC’s position on gifts, favours and hospitality.
Case Study – Ann Goodfellow
Ann Goodfellow was working as a registered nurse at Drummond Grange Care Home, near Edinburgh, when she was given £100 cash from a relative in May 2020.
In October 2022 Ms Goodfellow was struck off the NMC in a case that generated a lot of debate amongst healthcare professionals concerning the proportionality and fairness of the decision.
The debate however focussed less on the elements of dishonesty that were found proved by the fitness to practise panel. It was proved that Ms Goodfellow failed to declare the gift and was dishonest about the actual amount(s).
This case demonstrates the relevance and significance of both the receipt of the actual gift, but also the significance of being honest about it. The NMC clearly takes these matters seriously.
Conflict of Interests & Fitness to Practise
A nurse or midwife’s fitness to practise will be called in to question where there is evidence that their judgement was influenced, or perceived to be influenced, by a personal, financial or other interest. What this looks like in practice will depend on the individual circumstances.
This might manifest itself as the acceptance of a gift, favour and/or hospitality considered beyond ‘trivial’ or actions influenced by these that are perceived to have influenced the actions or decisions of a nurse or midwife.
Either way, great care and careful judgement should be given to any gifts, favours and/or hospitality. Some nurses or midwives may choose to respectfully decline any form of this, but this is not strictly necessary.
Where gifts, favours and/or hospitality is accepted, this should be clearly and honestly declared.
NMC Defence Barristers
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Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.