By Caroline Flint

We often say it when we hear about someone going before the Professional Conduct Committee or sometimes we only think it very quietly so that no one else will know `There but for the grace of God go I'. But is this what we really should be thinking? When I walk past the Old Bailey, or even for that matter when I walk past my local Coroners Court do I think `There but for the grace of God go I'? Do we say to ourselves `Thank goodness I haven't mugged any old ladies recently', or `I'm relieved that I have restrained myself from committing any frauds in the last few months', or `Thank goodness I've managed to avoid murdering anyone this year'? Of course not, we don't have to restrain ourselves from mugging old ladies or from committing violent crimes because they are something that is totally outside our normal behaviour - we don't say `There but for the grace of God go I' because the sort of behaviour that comes before the courts is totally outside normal behaviour and is outside our sphere of experience. Actions which come before a court of law, a Criminal Court, are not those we would contemplate in our everyday lives.

But does the same principle hold for our professional Conduct Committee? Should it be possible for me to think when I hear about the behaviour of a fellow nurse, midwife or health visitor who is facing censure and trial from the Professional Conduct Committee `There but for the grace of God go I'? Because if it is possible for me to say that to myself, it must surely mean that the mores of the Committee are too severe? If I can see exactly how a certain professional was able to do what he/she did, indeed I could have been there myself, surely we are not talking about totally unreasonable behaviour? Are we not talking about the sort of behaviour that any reasonable professional might exhibit under the stresses experienced by the professional at that time?

Is it right for our professional conduct machinery to be trying those professionals who are acting in a way that is not totally unreasonable? Surely this means that if any one of us makes an error in clinical judgement, or if any one of us makes an inadvertent slip, or if any one of us makes a genuine mistake we could be up before the Professional Conduct Committee and fighting or our professional lives? It is right and just that the professional conduct machinery should protect the public because nurses, midwives and health visitors have a duty to their clients to give safe and professional care, but if they never ever make a mistake surely the standard set is perhaps too high?

The reasoning behind the philosophy that no-one should ever make a mistake also gives too much power to the managers of that particular health professional - `Now Nurse Roberts, you've given the wrong drug to Baby Jones - I won't report you THIS time but from now on I want to hear no more complaints about how my ward is run. You don't have a leg to stand on any more.' A farfetched suggestion? Probably, but I'm sure you can fill in the scenario yourself, if every health professional is afraid of making even the tiniest mistake, and even more if every health professional is afraid of having even the tiniest mistake discovered - this encourages dishonesty, a reluctance to admit to a misdemeanour, subterfuge, surely not healthy in a profession which is trying to be more and more accountable?

The other thought I would like you to explore is which professionals usually come before the Professional Conduct Committee - it is not the manager, nor is it the educationalist - it is invariably the clinician. Now this may seem obvious because it is the actions of clinicians which have the most immediate effect on the population at large but does this mean that to ensure that I don't come before the Professional Conduct Committee, it is essential that I leave clinical practice? Is it right? Should I be more vulnerable as a clinician? Or is my vulnerability inevitable'? It does seem rather hard that as a clinician I not only receive less salary than a manager or educationalist, but also I am more likely to be involved in professional conduct machinery which is always stressful, always painful, always time consuming, and which leaves the professional involved with a stigma for ever - even if she is vindicated. Actually she is never vindicated, she is `Let off' - she is referred to the rules, or the judgement on her case is postponed, or she is told that there is no case to answer. Notwithstanding the effects are felt by her professionally for the rest of her career. `There's the midwife who was up before the UKCC two years ago' is whispered as she walks by. Mud sticks and even if she has had an exemplary career and on one occasion only, she inadvertently slipped up and the Professional Conduct Committee does not think it is right to pursue this, she is seen as being `Let off' rather than a good professional who did what could happen to anyone. She belongs to a profession which must never make a mistake. Is this reasonable? Is this just? Is this right?