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Peter Carter and Jackie Smith debate reform of regulation

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Jackie Smith thinks we need to agree on the real purpose of regulation and achieve meaningful reform, while Peter Carter says regulation will never be an alternative to effective performance management

Nt editorial jackie smith

‘Without reform, we are stuck with an adversarial system’

I believe effective professional regulation makes an important contribution towards maintaining public confidence in the nursing and midwifery professions. Does that mean our current system of regulation is perfect? No, far from it. A gulf exists between public expectations about the purpose of regulation and what legislation actually allows us to deliver.

On the one hand, there are those who believe regulation should be about punishing nurses and midwives who fall short of the standards the public expects. Equally, others believe regulation should focus on supporting the professions through learning and remediation, rather than apportioning blame.

At the moment there is no clear consensus, and that leads to confusion and frustration among the public and the professions. The time is right for a debate on the purpose of regulation so we can create a clear agreement between government, professionals and the public.

The system of professional regulation provides an important safeguard, but that is only part of the overall picture. Our fitness to practise (FTP) process is narrowly defined in that it focuses on determining whether a nurse or midwife’s FTP is impaired. Despite the understandable wishes of many, it is not equipped to investigate and resolve the entire circumstances around often complicated events involving multiple agencies.

The Nursing and Midwifery Council’s legislation is hopelessly out of date. Any debate about the future purpose of regulation needs to go hand in hand with fundamental reform so we have fit-for-purpose legislation that supports, rather than impedes, our mission to protect the public.  

Without reform, we are stuck with an expensive, adversarial system that undermines our ability to be the modern, flexible and dynamic regulator everyone wants us to be. What does that mean in practice? Currently, if a nurse or midwife receives a criminal conviction they still have to go through the full FTP process to be removed from the register. In the case of a serious criminal conviction, shouldn’t the regulator have the right to automatically strike the registrant off without the need for a hearing? This is one example among many where time, cost and confusion could be reduced with sensible changes.

Regulation can balance the needs of both the public and the professions – ensuring nurses and midwives meet the high standards we all expect while supporting best practice.

So let’s start the conversation, agree on the real purpose of regulation and achieve meaningful reform that strengthens our ultimate priority of protecting the public.

Jackie Smith is chief executive and registrar of the Nursing and Midwifery Council

Nt editorial peter carter

‘Regulation is vital but it is not a panacea that prevents failings’

Regulation is essential for holding individuals and organisations to account and ensure they discharge their professional responsibilities in a manner that users of their services would expect, but it is not a panacea that prevents organisational failures or misconduct by individuals. Examples of industries that use regulation effectively include the Civil Aviation Authority, law society and the medical Royal Colleges, but there are also copious industries for which regulation has little effect in ensuring high ethical standards. Most notable in recent times has been the banking sector where regulation failed to prevent the abuse that triggered the worldwide financial collapse.

The Nursing and Midwifery Council has a difficult job providing public protection, but it lacks the authority to protect a workforce that in turn would do much to safeguard patient care. The emphasis of regulation falls too much on the conduct of individual registrants as opposed to an equal focus on employers.

Take for example the aviation industry. Planes will not take off if there is insufficient cabin crew. In addition, the working hours of cabin crew are prescribed, as are adequate meal breaks and rest days.

This is not the case for nurses and midwives across the UK. Nurses frequently miss meal breaks, rarely go off duty on time and are left to their own discretion to decide any additional hours they work via agencies, often to make ends meet.

The NMC has a huge number of referrals that silt up the system. There are too many examples of employers referring to the NMC without in the first instance going through internal processes, ensuring only appropriate cases are referred to the NMC. Steve Ford of Nursing Times reported in 2012 concern that too many employers are hiding behind the NMC, that is getting the NMC to address issues that they should.

In their annual Fitness to Practice Report 2014-15 the NMC reported that 1,117 out of 2,207 cases (53%) had no case to answer. Regulation will never be an alternative to effective performance management. The mindset must change and regulation should be an accompaniment, not a solution.

I admire the way Jackie Smith has addressed the challenges she has faced since becoming CEO at the NMC. To enable Jackie and her colleagues to discharge their role more effectively, they should be given greater authority in not only setting standards for registrants but also for employers in relation to working hours, staffing levels and terms and conditions.

Dr Peter Carter is an independent management consultant, and the former chief executive of the Royal College of Nursing

Jackie Smith will be presenting the case for regulation and Peter Carter will be considering the impact of regulation on individual practitioners in a debate at London South Bank University on 6 October, 6-8pm. Visit the site to book your place

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