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?