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Is the NMC fit for purpose?

  • 3 Comments

What is the role of regulation – and is it really protecting the public?

  • Should a handful of bad apples be taking the lion’s share of registrants’ fees?
  • Is public flogging really necessary to keep the public safe?
  • We need the NMC to change to preserve the profession and protect the public

What exactly is the purpose of health professional regulation – and are we getting it right? That was the debate at the first of five meetings organised by the Department of Health with regulators, employers, unions and other healthcare bodies at the Nursing and Midwifery Council’s headquarters, which I attended this week.

”A number of high-profile care scandals concerning many professional groups has led to a bit of navel gazing in the healthcare regulation world”

The meeting was stimulated by a desire to know if the regulation of health professionals was dynamic or static, and ultimately fit for purpose. A number of high-profile care scandals concerning many professional groups has led to a bit of navel gazing in the healthcare regulation world, with many wondering if it’s really doing the job it’s supposed to – and that the public expect it to.

So it wasn’t so much a timely discussion as a long overdue debate. The high-profile cases that have failed the public or the professionals involved indicate that regulation is probably not doing the job the public would want it to, or indeed the regulators would like it to.

”Much of registrants’ fees is spent on paying for a relatively small percentage to be removed from the register”

NMC chief executive Jackie Smith has been vocal in the past in calling for the council’s legislation to be updated so that it can deal with fitness to practise cases more quickly and efficiently. You can see her point. Much of registrants’ fees is spent on paying for a relatively small percentage to be removed from the register. Her argument is that it would be better spent on producing a set of clear and comprehensive education standards that ensures the right people are on the register in the first place, and guiding them in the right values and behaviours and updating their skills once they are on that register.

Publication of the revised Code of Conduct and introduction of revalidation are good moves towards that, and it’s notable that both happened under Jackie’s leadership, while she’s also steered the NMC back to a situation where it has virtually no historical backlog of cases, according to the latest report from Public Standards Authority – the regulators’ regulator.

“The NMC takes every registrant whose fitness to practise is questioned through a costly and long-winded public hearing”

But the fact remains that current legislation demands that the NMC takes every registrant whose fitness to practise is questioned through a costly and long-winded public hearing. Ms Smith has also pointed out that there is no allegation against a registrant that should require a public NMC hearing – any in which criminal charges are involved will be public as they go through criminal legal proceedings.

The fitness to practise procedures for all regulators seem designed to put registrants through a painful, drawn-out period, ending possibly in a public flogging. If their fitness to practice is not impaired, and they remain on or return to the register, they probably do so with more than a few scars. And in the current nursing shortage, can we afford to have people suspended from the register or with question marks over their performance for months on end– when in the end there really was no case to answer?

“Greater agility is paramount if you want to help avoid those high-profile scandals”

The government has previously deprioritised changing the NMC’s regulatory powers, but as the meeting on Monday concurred, greater agility is paramount if you want to help avoid those high-profile scandals where the NMC gets its wrong or seems to be dragging its heels.

If the NMC’s role is to ensure a few bad apples are removed – and it genuinely is just a few because most nurses and midwives are excellent, high-quality individuals – then surely its ability to do that quickly and cost-effectively is safer for the public and better for the profession it’s regulating? Why aren’t we giving the NMC the tools to do its job well? Is it because the government just doesn’t care enough about nurses and patients to get it right for them?

 

  • 3 Comments

Readers' comments (3)

  • Again and again, staff who contact www.suspension-nhs.org who have been referred to the NMC, describe the delays, the inefficiency (papers getting lost, delays with meetings) and the severe distress experienced through it all, not to mention deskilling, loss of confidence and severe financial hardship, being unable to work until their case is heard.
    I expect that the NMC gets it right sometimes? I’ve yet to learn that it has functioned well for any of the people contacting us. Most people seem to experience the sense that they are guilty and have to prove their innocence.
    For a long time now I have been saying that the NMC is not fit for purpose for many people wrongly accused. I hope that one day, someone will have the time to look at this more closely to research processes and outcomes and prove me wrong! Julie Fagan, founder member of CAUSE – Campaign Against Unnecessary Suspensions and Exclusions UK

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  • The low esteem in which many nurses and midwives hold the NMC has multiple causes.

    One is certainly the ponderous process around fitness to practice which means that the mere act of referral is a punishment.

    Another is the apparent refusal of the NMC to acknowledge that NMC referral may be used (and is) as an act of retaliation against staff who raise concerns and are then ruthlessly scrutinised by their employer until some (alleged) misdeed is found.

    Another is the perceived unwillingness of the NMC to fail to address the disproportionate referrals of BME registrants .

    The perceived failure to question the treatment of whistleblowers and of BME registrants is not a neutral act. It is can easily be seen as colluding in victimisation and discrimination.

    Those who have tried to engage constructively with the NMC on these issues believe they have failed - feeling ground down by inactivity or, in some cases take the view that they have been met with what seems to be wilful blindness.

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  • As someone who underwent an 11 month long investigation at the hands of the NMC, only for there to be no case to answer, I wholeheartedly agree that the NMC is not fit for purpose. The process was stressful, upsetting and over long. Whenever I contacted them for updates, I was fed misinformation or no information at all. The investigation process is disgraceful; the NMC provided me with no support whatsoever and provided the person who referred me with confidential information about me, to which she had no right. Their apology did little to alleviate my distress. The person who reported me had herself been fired for gross misconduct and had also referred a number of other registrants. She is now to go before a hearing herself as her own fitness to practice is questionable. She continues to try and sling mud in every direction to deflect attention to her own actions. The whole investigative process needs an overhaul.

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