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News Analysis: Judgement delivered on NMC

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The NMC finds its remit under threat in the wake of a scathing report. Helen Mooney looks in detail at the ‘significant weaknesses’ identified

The verdict on the NMC has been delivered and it is pretty damning. Last week chief executive Sarah Thewlis announced her intention to resign as did president Nancy Kirkland after the organisation was found to have ‘serious weaknesses’ in its governance and culture (NT News, 17 June, p3).

In its review of the NMC – requested by health minister Ben Bradshaw – the Council for Healthcare Regulatory Excellence issued a strong statement. The report identifies ‘serious weaknesses in the NMC’s governance and culture, in the conduct of its council, its ability to protect the interest of the public through the operation of fitness to practise processes and its ability to retain the confidence of key stakeholders’.

The CHRE has not minced its words. In a statement the super-regulator’s chief executive Harry Cayton said: ‘We have serious concerns about the inadequate operation of the NMC’s fitness
to practise processes, governance framework and lack of strategic leadership.’

The report concluded that the regulator was failing to fulfil its statutory functions to the standard that the public had the right to expect. It made clear that the executive must accept accountability for these failings and to that end it seems that the positions of Ms Thewlis and Ms Kirkland became untenable.

Last week Mr Bradshaw welcomed the report and accepted its recommendations on behalf of the government. He also welcomed the intended resignation of the chief executive and the president and is clearly also expecting the resignation of vice-president Moi Ali.

‘It is our view and that of the CHRE, the trade unions and other stakeholders that it would be in the best interests of the NMC and the individuals involved if all three senior figures stepped down from their current positions,’ he told parliament.

So what did the CHRE report really find out?

It says that ‘internal strife’ was hindering the NMC’s ability to function. It also found evidence of bullying, though no evidence of racism – an allegation in the original Commons debate that sparked government calls for an investigation (NT News,
18 March, p2).

‘We have seen and heard evidence of inappropriate and aggressive language by and between council members and between council members and the executive,’ the report says.

‘We have also heard accounts of emotional and aggressive behaviour in meetings. This behaviour is undoubtedly experienced as threatening and bullying by many council members and staff involved,’ it adds.

It appears that the original claims of bullying made public by Livingstone MP Jim Devine in March have been upheld. Prior to the CHRE’s investigation Mr Devine told the Commons that the regulator appeared to ‘employ a bullying strategy’ – accusations that were strongly denied by the NMC.

The report added that the NMC had misled the public in a press statement on 14 March 2008.

At the time the NMC stated: ‘At no stage has any council member raised any formal concerns regarding the use of the NMC’s finances on legal fees’.

Last month NT uncovered evidence that this was not the case (NT News, 10 June, p2).

The CHRE report confirmed this. ‘We have seen evidence of repeated attempts by a council member to elicit the details of the legal costs, and have been told by others of the unwillingness to disclose these costs in meetings,’ it concluded.

The report also raised other concerns. It is alarmed that nurses still have to wait two-and-a-half years on average for fitness to practise hearings to be concluded and has instructed the NMC to introduce an IT-based case management system to help reduce waits.

The report identifies six areas of ‘significant weaknesses’:

  • The absence of an IT-based case management system;

  • Delays in dealing with cases;

  • Poor quality of correspondence which is sometimes insensitive, misleading and/or discourages people from making complaints about registrants’ fitness to practise;

  • Quality, comprehensiveness and variability of information and statistics provided by the executive to council members on fitness to practise cases;

  • Delays in setting up systems for the assessment of fitness to practise panel members and decisions to extend the terms of office of existing panellists;

  • Delays in providing agreed training for panellists on child protection issues.

The report has left no doubt that these issues must be addressed by the NMC as soon as possible and that the organisation will be the focus of ongoing analysis until they are.

Furthermore, the investigation found that although the NMC’s register records when conditions have been imposed on registrants, it does not inform members of the public what those conditions are. The report concludes that this situation
is unsatisfactory.

It is also critical of the way in which the regulator deals with those who make complaints about nurses. ‘The NMC does not always provide a good level of service to complainants… our biggest concern is that some complainants or potential complainants might be put off from pursuing legitimate concerns about registrants. This cannot be in the public interest,’ it says.

With regards to the regulator’s governance framework, CHRE criticism includes concerns about its policies, committees, decision-making and organisational behaviour. It also focuses on a lack of confidence among many stakeholders with the conclusion that the regulator has ‘not always managed to get its communication strategy right’.

The CHRE wants to see the NMC reduce the 13 committees it currently has in place to deal with different aspects of the organisation’s work. ‘The numerous committees obscure the lines of accountability for decisions and inhibit strategic oversight,’ the report states.

The verdict is clear, the NMC must change. The CHRE has said that it will closely monitor the organisation to see that its recommendations are implemented over the next year. Having accepted these recommendations, the Department of Health has also said that it will be watching the regulator closely to see that necessary measures are taken.

The Charity Commission is still considering whether to investigate the sums the NMC has spent on legal fees.

The NMC must change and quickly to restore public confidence. As the RCN, Unison and Unite said in a joint statement: ‘This must be a number one priority.’

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