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Nursing Times speaks to Professor Tony Hazell about the rehabilitation of the NMC

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Professor Tony Hazell is charged with the rehabilitation of the NMC, and hopes that nurses will soon see it as supportive. For a start, he tells Alastair McLellan, nurses don’t need revalidation

Professor Tony Hazell will take his place in one of the health service’s hottest seats when he takes over as the chairperson of the NMC Council on 1 January.

He comes to the regulator at a time when it faces major change – not least as it embarks on developing the system of fitness to practise checks known as revalidation.

The government white paper Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century, published in February 2007, stated: ‘Revalidation is necessary for all health professionals, but its intensity and frequency needs to be proportionate to the risks inherent in the work in which each practitioner is involved.’

From autumn 2009, doctors will be required by the General Medical Council to undergo revalidation every five years. And last month the NMC launched its own consultation on revalidation for nurses and midwives, who were asked to complete a survey.
Among the questions posed were whether annual appraisal should be a requirement to maintaining registration and if nurses and midwives should have to undergo revalidation every three or five years.

But, despite the government’s determination to impose revalidation on the health professions, Professor Hazell said he was ‘not convinced it was necessary’ – although he acknowledged that the debate ‘needed to be had’.

While emphasising he was expressing a personal view, he said: ‘We’ve got a long way to go in the debate, before we come to any conclusions. My own view is that we need to ask questions like “what will revalidation achieve, what is the risk out there” and, very importantly, “what would the cost be?”

‘I’d like to think the NMC can demonstrate that we’re doing as much as is needed to safeguard the interests of the public without overlaying the system with yet another. We must be very, very careful that we don’t take a sledgehammer to crack a nut,’ he said in his first interview with Nursing Times since being appointed chairperson (designate) of the NMC’s new 14-member ruling council.

Revalidation is but one of many challenges Professor Hazell faces in his new role. But he has a long career in health and social care, education and regulation.

His most recent day job was as assistant principal at the University of Wales Institute in Cardiff. For much of this decade he served as chairperson of Velindre NHS Trust in the same city – a unique organisation that runs a tertiary cancer centre alongside countrywide screening, blood and public health services. He has also spent six years as a lay member of the Health Professions Council – the independent body that sets and maintains standards for allied health professionals.

As NMC council chairperson, Professor Hazell will spend approximately three days a week at the NMC and be paid an annual allowance of £48,000.

His appointment is a key step in the regulator’s rehabilitation. In March, Livingston MP Jim Devine used a House of Commons debate to make allegations of bullying, racism and financial mismanagement against it, prompting the government to order a review.

Subsequently in June, the Council for Healthcare Regulatory Excellence – the body responsible for monitoring the NMC’s performance – issued a highly critical report. CHRE chief executive Harry Cayton said: ‘We have serious concerns about the inadequate operation of its fitness to practise processes, governance framework and lack of strategic leadership.’

Within days of the report both the NMC’s president and chief executive announced their intention to step down. The regulator has since produced an action plan in response to the CHRE’s criticisms.

One of those criticisms was that the NMC took too long to deal with complaints brought against nurses and midwives. The NMC has responded by following the CHRE’s recommendation that it introduce a computer-based case management system. It is also recruiting more staff to handle complaints and moving its fitness to practise division to a purpose-built facility.

The NMC is committed to reducing the average length of time taken to resolve all but 10% of the most complicated cases to 15 months. It has promised to achieve this target, ‘sometime in the new year.’ But Professor Hazell is equivocal as to what exactly this timeframe means.

‘I was asked in my interview, whether I would expect to turn around that situation [on complaint delays] within six months and I said “I’m not a gambling man, I couldn’t guarantee six months”.’ However, he added: ‘I would be very disappointed if I wasn’t able to detect significant improvement within 12 months.’

Quizzed on whether the 15-month target was the best the NMC could do, he said: ‘[There are] very few regulators that could claim to do things in under that time. I would want all cases to be dealt with as swiftly as possible, but at the same time appropriately and professionally – and that takes time.’

Professor Hazell also said he thought it was ‘impossible’ to say what a reasonable length of time to resolve a case might be. ‘There will be some situations you can deal with very, very quickly because they are straightforward, but if you’re going to ensure that all parties are dealt with fairly then, sometimes, you have to take time.’

He added: ‘We shouldn’t rush – speediness shouldn’t be the prime objective. [However] we must do everything possible to minimise the detrimental effect these hearings have on everybody involved.’

From 1 January 2009 until December 2011, Professor Hazell will lead a newly constituted NMC council which, for the first time, will have equal representation of lay and professional members.

The CHRE review of the NMC claimed of the existing council that ‘it appears to us that decisions have sometimes been influenced by the interests of professionals rather than the public interest’.

Professor Hazell’s statement accompanying his appointment appeared to sympathise with these sentiments: ‘The emphasis [of regulation] is now much more on the interests of patients and the public rather than professional interests,’ he said.

However, further enquiry reveals that he thinks the problem is largely one of perception rather than reality. He told Nursing Times he did not share the belief that healthcare regulators have prioritised professional over public interest in the past.

‘I recognise that concern has been expressed many times by governments and other bodies,’ he said. ‘Within healthcare regulation there has been a perception that there has been more concern about the protection of the individual, or the professions, rather than the protection of the public. Perceptions are very important, but they don’t tell you the
whole picture.’

He added: ‘We’d be foolish [however] if we did not take account of those perceptions and do what we can to change or modify them.’

Professor Hazell’s most immediate priority, along with appointing the new council’s members, is to find a chief executive for the organisation – the position is currently being filled on an interim basis by management consultant Graham Smith. Professor Hazell said the successful candidate would need experience of regulation, but not necessarily come from an existing position within a regulator.

He thought it ‘unlikely that somebody without an understanding of the health sector could effectively lead an organisation of this nature’ but ‘wouldn’t totally rule it out’.

By coincidence Nursing Times interviewed Professor Hazell on the day the report of the investigation into Haringey Council’s handling of the Baby P case was delivered.

He said he wanted the regulator to be mainly ‘proactive’ in developing guidelines for practice, but acknowledged that it would also have to be ‘mindful of the concerns of society’.

He said: ‘It is likely that [care of children] is an area we will have to look at very carefully to ensure we are doing what we can to address the needs of nurses and midwives – especially in regard to initial training, so that people when they come on
to a register have an adequate level of understanding [of what is required].’

He added that similar concerns were likely to inspire further work on the care of older people.

Asked how he would like nurses and midwives to view the ‘new’ NMC, Professor Hazell said ‘as the body that assists them in providing the best possible care’.

The NMC can achieve this goal in a number of ways, he said, but singled out its role in protecting the integrity of the profession by dealing appropriately with the ‘tiny’ number of practitioners who do not operate ‘to the required standards’. Professor Hazell said he was confident the NMC could meet that challenge.

But what about the regulator’s own internal challenges? Mr Devine alleged the NMC was ‘fundamentally dysfunctional’ with an ‘ingrained culture of bullying and racism’. The CHRE said there had been ‘a breakdown of confidence and trust between some members of the council and the executive. These problems are long-standing and show no sign of immediate resolution’.

Professor Hazell seemed sure that these difficulties were largely in the past and the NMC was ready to take up its role as a pioneer of the new approach to healthcare regulation set out in the 2007 white paper.

Morale is ‘very, very positive’, he said. ‘Every single one of the senior staff is very positive about the opportunities that lie ahead.’

Click here to read ‘Nurses do not need revalidation to prove safe practice, says NMC chair.’

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