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EDITOR’S COMMENT

'It’s time for the NMC to put its house in order'

Everywhere in the health service, both private and public sector organisations are being asked to deliver efficiency savings.

Nurses often bear the brunt of that drive to the lowest cost - in the NHS many are taking the hit by taking on more work and yet at the same time, effectively taking a pay cut to reduce the cost of providing care.

Everyone is trying to do much more with much less. Every organisation, it seems, except the Nursing and Midwifery Council.

While nurses are coming to terms with not receiving a 1% pay rise, the NMC wants them to pay an extra £20 for their registration fee, which it proposes should rise to £120 from February 2015 (page 2).

Here is an organisation running the biggest nurse register in the world, with a guaranteed annual income. The NMC knows exactly how much money it will receive each year, yet it cannot manage toend a financial year without being millions of pounds in deficit.

Surely it’s time to take a long hard look at how the council is run and consider whether its operations should be streamlined? Every other organisation in healthcare is having to change the way it runs its service, so isn’t it reasonable to suggest the NMC reflects the landscape it operates in and fi nds ways of doing more for less?

Every organisation in healthcare is having to change the way it runs its service, so isn’t it reasonable to suggest the NMC finds ways of doing more for less?

The Professional Standards Authority’s audit of the NMC has found several concerns in the regulator’s own staff’s compliance with its procedures, avoidable delays in progressing cases and poor practice in handling of reviews of interim orders. What’s worrying too is that the NMC failed to identify the serious issues raised by the PSA in its own internal review of its handling of cases involving registrants employed by Mid Staffs. The NMC lacks the ability to be critical of its own organisation, and be objective about what it does or more importantly identify what it could do better. Is it a real leap to suggest that it may lack the capacity to judge its own efficiency?

The consultation on the fee rise will run from May to July, and I don’t expect a single nurse to be in favour, yet the profession seems resigned to the fact that the NMC will carry on regardless. And sadly, it probably will.

It’s neither sustainable nor appropriate to ask the government to throw money at the NMC every time the regulator finds itself in trouble. But neither should the NMC constantly look to nurses to bail it out of fi nancial difficulty.

It is time for the NMC to put its house in order. It must look at where money can be saved and how it can protect the public without costing nurses the earth. Surely it can’t be that difficult to cut its cloth according to its means? After all, everyone else is having to do it.

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (19)

  • It is time the registrant council members took some responsibility for this embarrassing organisation . If the NMC was a nurse or midwife they would be struck off for bringing the profession into disrepute. It is a complete anomaly that registrants have very little influence on the organisational behaviour of the body that we fund through our mandatory fees . The NMC seems to lack any proper governance, is constantly criticised and yet there never seems to be any sanctions.

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  • NMC Annual Report & Accounts 2012-13 :

    The principal capital project undertaken during 2012–2013 was the conversion of leased office premises at 20 Old Bailey to a dedicated Fitness to Practise hearing venue with 12 hearing suites. The net cost of this project was £1.3 million.

    Papers for Council Meeting 26 th March 2014 :

    The budgeted capital spend for 2014-2015 ... £1.3 million represents the fit out of a leased building to replace the FtP hearing premises at Old Bailey. The lease on this expires in November 2014, and alternatives are currently being actively considered.

    I.e. NMC spent £1.3 million fitting out hearing rooms at Old Bailey November 2012, for which lease expires November 2014 (2 years use), and NMC now plans to spend a further £1.3 million fitting out another venue !

    Good use of our registration fees ?

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  • At least 30 hearings a day each with two £500 a day prosecution lawyers plus a defense lawyer (if the registrant has union support and doesn't have to sell their house to finance one) plus an army of administrators determining the fates of hapless nurses who due to the impossible pressures of modern task obsessed paper-trail "nursing" where there is no longer the option to delegate to enrolled nurses forgot to sign a MAR sheet whilst increasingly assuming the role of employer and encouraging direct complaints via an informant culture. Welcome to nursing you're going to love it.

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  • In response to the aboves rather colourful comment, the NMC indeed pays very large sums of money for a tribunal type system using barristers and solicitors for each of the many cases it deals with both interim and substantive. For an arguably minor case instigated by malevolent managers or for whatever reason a nurse can find themselves on very restrictive practice orders for eighteen before her case even comes before a substantive hearing whilst the NMC typically uses a externally contracted lawyer to return to her employment file with the apparent purpose of writing a prosecutors case and using any information that might be available including the views of anyone that managers might point them towards. The nurse must then defend herself via her trade union or professional body. The effect of all this is to severely curtail her career for the immediate future whilst remaining under uncomfortably close scrutiny which could become permanent at the whim of the regulator who functions on the principle of probability balance as determined by itself. The result is the possibility of injustices occurring as demonstrated in similar circumstances by Dr Helen Bright's Doctors for Justice organisation

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  • I agree with Jenni's assessment of the NMC but disagree that it's house can be put in order or should even be attempted. Personally, I'd go round there, smash the windows and shove a dog turd through its letterbox!

    Sometimes you just have to cut your losses, give up and start again. The NMC has failed on every single part of its 'brief' and I believe it would be criminal to allow it to go on. It's not protecting the public, it's not successfully removing nurses from its register that ought not be there and it's failing to work within its means as these huge over-spends demonstrate so clearly.

    The government should cut the cord and it's losses and bring to an end the embarrassment that is the NMC - Not Much Cop

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  • Anonymous | 2-Apr-2014 10:21 pm

    and clearly you talk shit.

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  • On this particular point you are correct. Here is not the place to express such humour and demeans the subject matter. I have therefore asked the moderator to remove. However there are some very important issues to be discussed in regard to this excellent article.

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  • The NMC/GMC should both relocate out of London to somewhere in the middle of the United Kingdom, for example Sheffield. Should Scotland become independent and the NMC/GMC are no longer responsible for the registering of nurses/physicians in Scotland, then they should relocate to somewhere like Coventry.
    These all have good transport links and properties are nowhere near as expensive as London.
    Rooms could be hired on an as required basis for hearings, no need for purpose built buildings. The NMC, GMC and the other healthcare regulatory bodies could all share the same premises, perhaps on an industrial estate on the fringes of the relevant city.

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  • You could run the NMC from a few rooms in a small office complex in any town or city in the UK. You don't need the huge amounts of staff on eye watering salaries, you just need a cheap computer programme that allows nurses to pay their fees monthly or quarterly. A 16 year old GCSE student could sort that out for them!

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  • Unions and defense lawyers commonly agree that the NMC is a very unpredictable organisation to deal with. 'Tricky' is a description from one QC. Too often, nurses who should receive significant sanctions effectively walk free e.g. Francis, whilst for many nurses the converse is the case sometimes in respect of minor and it has to be said even contrived allegations, for example malicious referrals from hostile employers or indeed anyone proffering unsubstantiated allegations given the NMC's increasing readiness to listen and involve itself directly, more in the manner of an employer. The constants are the colossal prosecution costs but most significantly the guaranteed personal agonies of registrants as the NMC proceeds in its characteristically inexorable and ultra slow-motion formality. Its tribunals often appear chaired by individuals apparently appointed as much for their strident personalities than concern-driven wisdom. The contributions of colleague panelists can be reduced as a result of an organisation built upon absolute compliance, particularly as timely interventions are more usefully received from the sitting solicitor and prosecution QC. Thus the fate of registrants can and perhaps often is determined by the inclination or whim of the chairperson working directly with the heavyweight backing of two on-the-spot high ranking lawyers. Given the virtual life or death decisions at stake the responsibility involved in such chairmanship is very considerable. The readiness of some to assume such responsibility whether within interim or substantive cases but with perhaps limited or relevant experience, unknown training and even poor personal qualities particularly given the mere balance-of-probability standard under which they determine cases must be a cause for concern. The perspective from the registrants viewpoint of having to endure such an extended ordeal that can literally continue for years and even for the rest of there working lives depending upon the sanction imposed is simply appalling. Some eventual case decisions are apparently made with nearly as much haste as consideration. The likelihood of the average hard working nurse finding themselves in such a predicament I would say is disturbingly high particularly given the nature of modern memory intensive, task orientated nursing that crucially relies increasingly upon the consistent and positive support of managers. The Doctors for Justice organisation has demanded to know from the GMC exactly how many doctors have committed suicide during or subsequently as a result of procedural ordeals or following excessive or undeserved sanctions. The DFJ organisation has campaigned consistently and has voiced their concerns in front of the Parliamentary Health Select Committee. Perhaps it is time for nurses to consider the same as it is very certain that similar injustices do occur and in some cases perhaps with similar consequences. The NMC notwithstanding its regular references to protecting the public often appears not to share similar concerns for the safety of its own registrants by at least ensuring better consistency in its decision-making that is resulting in both incidents of failures to counter malpractices but also causing serious injustices to many undeserving nurse registrants many of which according to the various accounts both from unions and individuals can have serious consequences both for the registrant nurses' short and long term well being, health, and safety.

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  • Regulatory fees.....

    NMC = £94
    Health & Care Professionals Council = £65
    GMC = £360
    General Dental Council = £301
    Gen Pharmaceutical Council = £195
    Gen Optical Council = £317
    Gen Osteopathi Council = £573
    Gen Chiropractic Council = £817

    Nobody wnats the fees to go up but maybe if the fees were increased they could attract some qulity people into the NMC to sort the mess out!

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  • why do the quacks pay much higher fees than the professionals. they must earn a lot more?

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  • Scrap them all, if the Health & Care Professionals Council = £65 then why cant the rest. Combine them all and economies of scale. They have failed to regulate effectively with the courts doing most of the running for some cases anyway. They have let off people who any sane person would have struck off.

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  • one regulatory body, one fee for all, top management from the best unprejudiced managers paid reasonable salaries and who are dedicated to those they serve and the core values and principles of high standards of patient care and those who provided.

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  • Anonymous | 5-Apr-2014 9:33 am
    Not a bad idea, but the NMC would never be able to recognize a "best unprejudiced managers" if the selected individual bit the NMC on the nose.

    I concur with all the opinions above, about the Hearings systems of the NMC and add that they are so arrogant they ignore the advice of the registrant about what evidence is required to provide information about the case in question. And flatly refused(openly) to obtain the data from the complainant Manager.

    So without the prerequisite information sending the complaint through 4 committees over 2-3 years all serving no useful purpose is simply a waste of time. and leaving the nurse cruelly dangling. Do as you would be done by, NMC!

    To add to the £500/ hour lawyers you can add the £300/day registrant who is the sole "representative" Nurse in a room of non clinical people on issues which are often clinical. How does this provide a fair hearing? There is no record of their qualifications or experience which sets them up to be an "expert" in all the different cases they sit in on anyway. the hearing records does not demonstrate any comment on this individuals wisdom or lack of it.

    As for the NMC's guide lines for hearings is "Fair, Just and timely". They should all be sacked, tried and disqualified. Because they have failed to meet their own targets and standards.

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  • I recall commenting before the last rise in NMC fees and I made a suggestion then, which was-one way the NMC could cut costs would be to MOVE their headquarters out of the most expensive area in the country i.e. Portland Place, London. The rental and utility costs must be phenomenal, and our fees are paying for them. Why does the NMC have to be based in London? I'm sure there are nicer and cheaper areas in the country.

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  • Anonymous | 8-Apr-2014 8:43 am

    According to the NMC the rent on Portland Place is £250pa.

    But they(NMC) are shockingly unable to work out what is good value and how not to waste money. Why should they? They will just bleed the cash cow.

    They have just spent £3mil doing up a suite of rooms in Old Bailey for which they only have 2 years of lease anyway! One has to question the wisdom of this. And who benefited the most from the contract, too?

    At Hearings, a swanky catering company provides delicious buffet style meals with tremendous waste. Which make one wonder how on earth the NMC justify this... do they qlso provide meals for the staff, and if not, is it equivalent to eating off the food trolley in the wards?

    The provision of so much food is surely unnecessary, unless it is a good meal for the condemned Nurse, before they are sent into the wilderness. As though the individual hasn't been forced to be in the wilderness waiting for years, while the NMC have ponderously and blockheadedly " done their best NOT to investigate" any aspect of the nurses case, lest evidence be found to undermine the decision to proceed in the first place. For this process there are innumerable staff.

    Though the NMC has a
    staff attrition Rate of 1/4 to 1/3 of its entire staff, every year, and that must cost an arm and a leg to replace too.

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  • Good the see the NT engaging and promoting honest, transparent discussion although fear induced PIN-loss anxiety neurosis remains widely evident but is confirmation of the need for change.

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  • £500 an hour lawyers? Solicitors AND barristers presenting a case? Prosecution QCs? Swanky catering company providing buffet meals? Really? Where have these details been plucked from?

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