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Regulation reform set to make fitness to practise procedures 'fairer'

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The government has set out plans to change the law to give healthcare regulators like the Nursing and Midwifery Council more freedom and enable reform to “outdated” fitness to practise procedures.

The hope is the long-awaited changes will not only help speed up drawn-out FtP processes but also free up regulators to provide better support to the professions that come under their remit.

“These changes will allow regulators to dedicate more of their resources to supporting professionals”

Stephen Hammond 

Meanwhile, the proposed legislation would place a new onus on the NMC and others to consider the impact of their policies and processes on the wider workforce.

The plans are outlined in the government’s response to a major consultation on regulatory reform, which ran from October 2017 to January last year.

More than 900 organisations and individual healthcare professionals and members of the public shared their views with the majority in favour of change.

In light of this the UK government and devolved governments in Northern Ireland, Scotland and Wales have said they will now push ahead with drawing up draft legislation designed to make healthcare regulation fairer and more accountable.

stephen hammond

stephen hammond

Source: Department of Health and Social Care

Health minister Stephen Hammond

The government said it would prioritise changes to regulators’ FtP processes and operating frameworks as these would “realise the greatest benefits for regulatory bodies, registrants and the public”.

Under the plans the UK’s nine regulatory bodies would get broadly similar powers to handle FtP cases in “a more responsive and proportionate manner”.

“Fitness to practise concerns will be concluded more quickly, proportionately and fairly, replacing the current bureaucratic, time consuming processes that are burdensome and can be stressful for patients, their families, registrants and employers,” said the document.

According to the document, the need to press ahead with reform has been thrown into sharp focus by a series of reports including the Lessons Learned Review into the way the NMC handled concerns about midwives’ FtP in the wake of the Morecambe Bay maternity scandal.

It also flagged up the independent report into deaths at Gosport War Memorial Hospital, which criticised delays in the NMC’s FtP procedures and the way the regulator dealt with families.

Under the plans all regulators would be able resolve FtP cases without the need for a full panel hearing where the registrant and regulator agree on the findings and appropriate outcome or sanctions.

The NMC has already introduced a system where case examiners look at complaints and - where appropriate - resolve them on a consensual basis, allowing cases to be dealt with more quickly without the need for a costly, adversarial hearing that can be distressing for all concerned. 

“I’m really glad the response set out today will enable us to operate with greater flexibility and autonomy”

Andrea Sutcliffe 

Under the proposals the government will look at whether such “consensual disposal decisions” could be challenged if there are concerns the result does not sufficiently protect the public.

It will consider whether the Professional Standards Authority - which has the right to appeal FtP panel decisions – should also have powers to review consensual decisions.

The changes would also give regulators the power to automatically remove registrants from their register if they have been convicted of a very serious criminal offence such as rape, child abuse and sexual exploitation.

According to the government, making FtP more efficient should free up regulators’ resources to “better support the professionalism of all their registrants” ideally helping to stop problems occurring in the first place or getting worse.

Nearly three quarters – 74% - of those who took part in the consultation said they felt regulators did have a role in supporting wider professionalism rather than mainly dealing with FtP concerns.

Nursing and Midwifery Council

Andrea Sutcliffe

Source: NMC

Andrea Sutcliffe

Under the plans the NMC would be expected to do more to ensure nurses and midwives “have and maintain the right knowledge, skills and expertise to deliver safe, high quality care to patients”.

The changes should also support the speedier regulation of new and emerging roles in health and social care, enabling regulators to respond “more quickly to changes in healthcare delivery and workforce developments, ensuring professionals are not only fit to practise but remain fit for purpose”, said the document.

Meanwhile, there would a new duty on regulators to consider the impact of their work on the wider workforce.

“The NHS Long Term Plan and the Interim People Plan have emphasised the importance of the whole system working together to deliver improvements in health and care. We will introduce a new duty on the regulators to consider wider workforce implications when developing their policies and processes,” said the document.

Crucially, the plans will give the NMC much more flexibility when it comes to changing the way it works.

Previously, the regulator has complained it has been hampered in efforts to reform its systems and processes because this would require changes to legislation.

Under the proposals the overarching framework for the regulation of healthcare professionals would still be set by Parliament but the NMC and others would be able to make changes to their day-to-day operating practices without the need for a change in the law.

“We are pleased to see the move to a less punitive, more efficient and more supportive system of regulation”

Bronagh Scott

The changes will also mean “enhanced requirements” for openness and transparency with all regulators presenting annual reports to each of the national governments they serve.

The plans also require changes in governance with all governing councils to become boards comprising executive and non-executive directors “appointed on the basis they have the skills, knowledge and expertise to ensure the regulator discharges its functions effectively”.

Health minister Stephen Hammond said the government was delivering on a commitment to modernise professional regulation.

“These changes will allow regulators to dedicate more of their resources to supporting the professionals working in our NHS and contribute to safe, high quality patient care,” he said.

“Our long-term plan sets out how we will make the NHS a sustainable, 21st century employer and having a dynamic, flexible and responsive system of professional regulation is an important part of that.” 

NHS England

Bronagh Scott

Bronagh Scott

The plans were welcomed by NMC chief executive and registrar Andrea Sutcliffe, who said the new freedoms would enable the regulator to deliver a better service.

“People using health and care services have every right to experience the best and safest care possible. It’s therefore vital that procedures affecting how we support and regulate nurses, midwives and nursing associates – the largest group of health and care professionals across the UK – don’t get in the way of that,” she said.

“Employees and employers will welcome steps to make the fitness to practise process quicker, fairer and effective”

Danny Mortimer 

“I’m really glad the response set out today recognises that and will enable us to operate with greater flexibility and autonomy – shaping our regulatory requirements more easily through guidance and policy, rather than detailed rules – which will be so much better for everyone involved,” she added. 

Bronagh Scott, interim director of nursing policy and practice at the Royal College of Nursing, said making quicker decisions in FtP cases would benefit both patients and nursing staff.

She added: “We are also pleased to see the move to a less punitive, more efficient and more supportive system of regulation.

“While the protection of patients must remain the overriding goal of the regulatory system, the fairer approach outlined will make the whole process and experience for patients and staff more bearable - quicker resolution will benefit all involved”.

Employers have also welcomed the move.

danny mortimer

danny mortimer

Danny Mortimer

“Employees and employers will welcome steps to make the fitness to practise process quicker, fairer and effective; they will also look forward to further reform, which will allow the regulation of new roles and professions to support their full deployment to care for our patients,” said Danny Mortimer, chief executive of NHS Employers.

The draft legislation will be consulted on.

Meanwhile, the government has said it will continue to look at other areas for reform including whether there is a need to reduce the overall number of healthcare regulators and the potential to improve other regulatory functions around registration, standards and education.

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