Senior Shropshire nurse suspended over poor record-keeping and failing to disclose conflict of interest

Nicola Anne Diamond was working for the Shropshire Clinical Commissioning Group (SCCG) as head of complex care when concerns were raised.

In 2018, a deputy director of performance and delivery was asked to review the processes in the department managed by Mrs Diamond.

It was identified there were a number of issues including a significant financial deficit.

Mrs Diamond also failed to maintain record-keeping standards, including amending a patient’s records while on secondment to another role, and did not disclose a potential conflict of interest.

By September 2018, Mrs Diamond was suspended pending an internal investigation, which commenced two months later.

However, a Nursing and Midwifery Council (NMC) hearing wasn’t held until November 2023.

Further adjournments arose, with the outcome finally being issued last week.

The NMC’s Fitness to Practise Committee found a number of charges were proven.

They stated that between 2017 and 2018 while working as head of complex care at SCCG, she abused her position in that she 'failed to disclose a potential conflict of interest in that she held a service agreement for work as a consultant with another company', 'failed to disclose a potential conflict of interest in that she failed to declare that you had set up a business, NAD Healthcare Limited', 'coached and/or provided advice to external providers to assist them in applying for CCG contracts', and 'undertook personal work/tasks for NAD healthcare during SCCG working hours'.

The committee also concluded that between 2016 and July 2018, Mrs Diamond demonstrated poor record-keeping and management of patient records in a number of areas.

They found she 'failed to ratify care packages in a timely manner which led to a backlog of assessments to be completed', and 'approved care packages for one or more patients who did not exist (“ghost patients”) on the Broadcare system (“Broadcare”) or in the alternative failed to update Broadcare to reflect assessments were carried out'.

Other findings included that 'in respect of patient 9146, failed to add the patient and/or their healthcare package on to Broadcare until August 9, 2018, when the patient started receiving funding from June 7, 2018', 'in July 2018, incorrectly inputted patient review assessment dates for one or more patients who had not had a review, or in the alternative you failed to upload any documentation to evidence an assessment had taken place'.

For another patient the committee concluded that 'on June 21 and 22, 2018, refused to ratify a care package as CHC (full funding) without following the correct procedures or recording a clear rationale in Broadcare', 'on July 16, 2018, ratified the care package without a new assessment or additional information being provided as requested on June 21 and 22, 2018', and 'failed to provide a clear rationale for actions'.

Other counts included that Mrs Diamond 'backdated the date of the ratification of the care package to March 23, 2018, when she ratified the decision on July 16, 2018', that she 'did not ratify the care package within the 28 calendar days in accordance with the Framework’s guidance', and 'amended the patient’s records whilst on secondment to another role'.

In respect of a further patient she 'failed to ratify the care package within 28 calendar days of October 25, 2017, or in the alternative did not update the records in Broadcare until July 10, 2018', and 'did not attach any clinical documentation to support that a patient assessment was carried out on October 25, 2017'.

For a further patient the committee found she 'failed to ratify the care package within 28 calendar days of October 25, 2017, or in the alternative did not update the records in Broadcare until July 10, 2018', 'did not attach any clinical documentation to support that a patient assessment was carried out on October 25, 2017', and 'failed to adhere to NHS/CCG policies and procedures in recruitment and termination of staff members in that she: Employed staff without carrying out the necessary pre-employment checks, authorised pay increases for her personal assistant without following the prescribed processes of the NHS and/or CCG.

It also concluded the did not 'process the resignation of Colleague A in a timely manner which led to Colleague A receiving overpayments'.

However, the panel concluded that Mrs Diamond did not fail to approve or increase payment uplifts for one or more Section 117 patients in order to save SCCG costs; that in July 2018 she retrospectively amended one or more patient records (excluding patient 3750); and that her poor record keeping and management of patient records were dishonest in that she attempted to create a misleading impression that patient assessments were carried out when they were not.

Mrs Diamond’s fitness to practice was deemed to be impaired, and she was handed a 12-month suspension.

However, to cover any potential appeal, an interim suspension order of 18 months was imposed.