The NMC is not failing and the planned fee rise could be worse, insists its chief executive Jackie Smith, who tells Shaun Lintern the regulator needs more time and money.
The Nursing and Midwifery Council is not a failing regulator, its chief executive and registrar has told Nursing Times, following recent criticism of its performance and financial management.
In an exclusive interview with Nursing Times, Jackie Smith defended the NMC against criticisms of its controversial proposal to increase the annual registration fee for nurses and midwives by £20, claiming it could have been much higher.
As widely predicted, the regulator decided last month to launch a consultation on increasing the annual fee for registrants from £100 to £120, due to the “unsustainable” position of its finances. The consultation will take place from May to July, with any subsequent fee rise expected to be introduced in February 2015.
Ms Smith insisted a fee rise was necessary so soon after the last increase from £76 to £100 in February 2013. But she said the NMC was making improvements financially and planned to make almost £30m of efficiency savings – warning that, otherwise, the increase could have been as high as £150.
She also defended the regulator’s decision-making on early fitness to practise cases, which came under the spotlight last month.
“We are not complacent. We know we still have a lot to do”
As reported by Nursing Times, the Professional Standards Authority – the body that oversees professional regulators, including the NMC – published a largely negative report on the subject on 31 March.
It highlighted numerous errors in the 100 fitness to practise investigations that were included in the audit. Among these were concerns that “wrong decisions” had been made in 17 cases relating to poor care at the Mid Staffordshire Foundation Trust.
Asked whether the report by the PSA showed the NMC was a failing regulator, Ms Smith said it did not. “If you look back at previous audit reports this represents considerable improvement. It is a significant step forward,” she said.
The PSA’s previous report from June last year, concluded the overall performance of the NMC had not improved over 2013, but there were signs of progress in some areas. It judged the regulator had not met, or inconsistently met, eight out of 24 key performance standards for the second year running.
In December, a report from the Commons health select committee said the NMC had made improvements in its performance during 2013 but progress “remains fragile”. MPs said they were disappointed the number of cases over two years old had only fallen from 572 to 428.
The NMC, Portland Place, London
“We are not complacent. We know we still have a lot to do,” said Ms Smith. “Fitness to practise is a bit like turning an oil tanker – it is vast and complicated and it takes time to see real change. I think the PSA report has enough in it for people to be assured we are making the necessary changes and are on the right road.”
She refused to accept the failures highlighted by the PSA could have put the public at risk, citing the words of the PSA itself, which said it had no public protection fears.
When pressed over delays in applying for interim orders against nurses, where one delay was as long as three years, she accepted there “is a theoretical risk in every case where there is a delay”. But she said she would not speculate over whether the NMC had allowed unfit nurses to continue practising.
“If you get a report which clearly and conclusively says in this number of cases we have no issues of public protection given that is our role as an organisation we must take confidence from that,” she told Nursing Times.
Ms Smith said it was “disappointing” mistakes had been made in cases involving nurses from Mid Staffordshire, but she added that the context around the cases was important.
“I think our record on Mid Staffs shows just how seriously we have taken registrants and their actions”
She highlighted that the NMC had looked at a total of 55 registrants at Mid Staffordshire, striking off five and taking action against four others.
“The NMC proactively went through the first [Mid Staffordshire Foundation Trust] inquiry report and identified a number of lines of enquiry,” she said. “It’s disappointing, because I think our record on Mid Staffs shows just how seriously we have taken registrants and their actions.”
The PSA audit also found concerns in all 21 cases it examined where nurses were allowed to voluntarily remove themselves from the nursing register, under a new mechanism introduced in January 2013. Voluntary removal allows a nurse or midwife who admits that their fitness to practise is impaired, and who does not intend to continue practicing, to apply to be permanently removed from the register without a full public hearing.
The PSA report said it was “disappointed to see an absence of proper consideration of the wider public interest in deciding whether or not to grant voluntary removal applications”.
Ms Smith said that, while she accepted the PSA concerns, it was important to remember that removal from the register did effectively result in the public being protected from that individual. She said she would seek to strengthen the process of voluntary removal with new guidance that would be taken back to the NMC’s council for approval.
However, Ms Smith said the mistakes highlighted in the PSA report were not a resource issue. And therefore were not linked to its unpopular decision to consult on plans to increase the registration fee.
She said: “I do understand how people feel, but when we went out to consultation in 2012 we said we needed a fee of £120. That hasn’t changed. The only reason it went to £100 then was the £20m grant from government.”
The Department of Health has made no offer of a similar grant this year, but Ms Smith stressed the NMC was making almost £30m of efficiency savings over three years to 2015-16 – in the face of a 15% increase in fitness to practise referrals.
“The worst thing we can do is make promises we can’t keep”
She said current the rules governing how the NMC approached fitness to practice procedures largely hampered it from reducing operational costs.
“Had we not done any of that we’d probably be going out to consultation on a fee rise of £150,” she told Nursing Times. “We are under tremendous pressure to keep costs down, but we are working with a legal framework that does not allow us to do so, because we have to take most of our cases to a hearing.”
Currently the NMC is holding up to 30 hearings a day, more than any other regulator, Ms Smith claimed. “As a business model it is not sustainable,” she said, noting that recent proposals from the Law Commission could give the NMC the flexibility to deal with cases without a hearing.
The commission published a draft bill on 2 April, which – if introduced by the government – would introduce a single, more streamlined legislative framework for all nine healthcare regulators.
Ms Smith said: “I do understand people want to see change happen immediately, but sometimes that is not possible and the worst thing we can do is make promises we can’t keep.”