The head of the Nursing and Midwifery Council has promised to go “back to basics” to tackle the mounting backlog of fitness to practise cases – but warned it could take up to three years and a fee rise could not be ruled out.
Speaking following the launch of the interim report of the Council for Healthcare Regulatory Excellence’s strategic review of the regulator, NMC acting chief executive Jackie Smith said they would be pausing or stopping all non-essential work to focus on tackling the backlog of around 4,000 cases.
She accepted the report’s findings that projects such as campaigning for the regulation of healthcare assistants had “distracted the NMC from its core functions”.
“The report reflects the fact that the NMC had lost its way and perhaps focused on non-core priorities. The NMC has a problem; that problem is fitness to practise and until we sort it out we should not be focusing on activity that deflects us from that functions… We need to get back to basics,” she said.
The review was ordered by the Department of Health in January following the departure of chief executive and registrar Professor Dickon Weir-Hughes, a registered nurse. He had been an outspoken campaigner for HCA regulation.
The NMC has also stopped plans for a student index, designed to keep track of individuals who have moved between universities, and halted its critical standards intervention programme, which was set up in the wake of high profile nursing care scandals to look for systemic failure in organisations. It is also looking at reducing the amount of guidance and advice it issues.
However, Ms Smith was unable to guarantee there would not need to be a hike in registration fees to cover the costs of bringing the FtP backlog under control, something she estimated could take “between two and three years”.
“Fitness to practise requires a significant amount of money. We are reviewing our resources practically on a daily basis and will be taking a financial strategy to our council in June… The strategy will have to look at fees.”
The CHRE’s interim report was critical of the relationships between the NMC’s chief executive and his team, council members and NMC staff, some of whom reported they were reluctant to approach the chief executive with concerns. The report also criticised former chair Tony Hazell, who resigned three weeks ago, for failing to provide necessary leadership.
The report recommended the posts of chair and chief executive be filled on a permanent basis “swiftly”. But it said there was no need for either of them to be registrants, which is likely to fuel fears about the loss of professionally led regulation. Both Unison and the Royal College of Nursing have previously signalled their concerns over the issue.
However, the report also recommended that the NMC consider splitting the role of chief executive and registrar into two.
CHRE chief executive Harry Cayton said there was “no reason” the posts should not be held by a nurse or midwife, but it was “not necessary” to do the job.
He said: “Professionally led regulation has been dying for some time. It’s about shared regulation between the professions and the public. I’m certainly not suggesting that there shouldn’t be 50% of the council from the nursing profession.”
In addition the report recommended that the NMC’s 14 member ruling council be reduced in size.
Unison head of nursing Gail Adams said the NMC needed to be in a “strong position” to ensure it was “fit to carry out the vital role of self regulation for nursing”.
“The interim management team have done a good job but the appointment of a permanent CEO and chair will give the NMC stability and impetus to help make progress,” she said.
She added that Unison “recognised the hard work” done by NMC staff but said there had previously been a “lack of effective focused leadership at the very top”, which in turn had “undermined their ability to deliver the essentials of regulation”.
“The CHRE make some strong criticisms and we want the NMC to improve its transparency. It should be the norm there as it is in other organisations, for decisions to be deliberated and decided upon in public.
“To date they have carried out many of their deliberations behind closed doors and, while the public may have been able to read about outcomes, they have not been able to question those decisions.”