Whether the Nursing and Midwifery Council should be run by a nurse in future will be one of the questions considered by the “wide-ranging” review of the regulator’s structure, financial management and leadership.
Details of the strategic review to be carried out by the Council for Healthcare Regulatory Excellence have emerged after the plans were first revealed by nursingtimes.co.uk two weeks ago.
The review, formally announced by health minister Anne Milton last Thursday, follows a report by the CHRE last November that found continued weaknesses with the regulator’s fitness to practise procedures.
CHRE chief executive Harry Cayton told Nursing Times the review would be “a forward look at how the NMC can shape itself to be more of an effective regulator than it has been up to now”. But he added: “We can’t look at the future without understanding where the NMC got to where it is, as an organisation.”
As previously reported by Nursing Times, the NMC’s chief executive and registrar Dickon Weir-Hughes and director of standards and regulations Roger Thompson have both left within the past two months.
This follows a string of senior departures in recent years. Concerns have been raised about the lack of nursing expertise at the top of the organisation.
Mr Cayton said terms of reference for the review were still being finalised. However, he said: “It’s important we look at the skills and competencies that are needed in the leadership.”
Although Professor Weir-Hughes was a former nursing director, Mr Cayton said: “It seems to me that it’s neither necessary or unnecessary for that person to be a nurse. None of the other regulators have chief executives from the profession that they regulate.”
However, he said it was important there were nurses on the NMC council and the CHRE would “want to hear people’s opinions” on the issue.
Royal College of Nursing chief executive and general secretary Peter Carter welcomed the review and said it was “crucial that the NMC has a strong professional voice in its leadership”.
Ms Milton told parliament the “wide ranging” review will also look at the NMC’s “organisational structure, resource allocation and operational management”. It will establish “what further action is needed to ensure that the NMC is effectively carrying out its duties to promote high standards of conduct and practice in order to protect the public”. The CHRE is due to report to ministers “by early summer”.
A separate consultation on the shape and size of the NMC’s ruling council will also be carried out, “with a view to further strengthening the NMC’s leadership and governance,” Ms Milton said.
Currently, the council has 12 registrant and lay members, in addition to chair Tony Hazell. The members of the senior management team, including interim chief executive and registrar Jackie Smith, also attend council meetings.
Papers brought to the most recent council meeting last Thursday show the organisation is predicting an £8.9m deficit by the end of the year. Part of this is fuelled by an increasing number of fitness to practise referrals, which is making it more difficult to clear case backlogs.
The regulator has struggled to get to grips with the backlog, despite its leadership model being restructured in 2009 following major review sparked by serious allegations about its performance and organisational culture.
Between 1 April to 30 November last year, there were 2,986 new referrals – a 10% increase compared with the same period in 2010. As of December, cases were taking an average of 16 months to investigate, against a target of 12 months.
Ms Milton said: Regrettably, the rate of improvment in fitness to practise falls below the standard that the public and registrants have the right to expect.”
Unison head of nursing Gail Adams said she hoped the review would improve the way the NMC dealt with cases and leave “no stone left unturned”.
In a statement, Professor Hazell said the NMC had made “significant improvements in the last few years, particularly in the handling of fitness to practise referrals”.
He said: “A key outcome from this review is that it must be demonstrably clear to all concerned that the NMC’s priority is public protection.”
An internal review had already prompted “some important questions about the wide ranging nature of some of our work streams and the contribution that they make to our core business,” he said.