The Council for Healthcare Regulatory Excellence, the super-regulator which has been investigating the NMC at the request of health minister Ben Bradshaw, published its report earlier this week.
It said it had identified ‘serious weaknesses in the NMC’s governance and culture, in the conduct of its council, its ability to protect the interests of the public through the operation of fitness to practise processes and its ability to retain the confidence of key stakeholders’. It identified:
the absence of an IT-based case management system;
delays in dealing with cases and poor quality of correspondence which could be insensitive and misleading;
concerns about delays in setting up systems for the assessment of fitness to practise panel members;
inappropriate conduct of council members and lack of strategic leadership;
lack of confidence from key stakeholders.
Specifically on the conduct of its council, the CHRE says: ‘We have seen and heard evidence of inappropriate and aggressive language by council members, between each other and towards staff, and have heard accounts of emotional or aggressive behaviour in meetings. This behaviour is undoubtedly experienced as bullying by many people involved.’
As a result of its findings, the CHRE has recommended that the government strip the regulator of its function to adjudicate in fitness to practise and conduct cases.
The adjudication role should pass to the new Office of the Health Professions Adjudicator, the CHRE said. This new body, which is due to be created by legislation currently progressing through parliament, is already expected to take over the adjudication of doctors.
The CHRE also called for current plans to create a new NMC governance structure, which was appointed rather than elected, to ‘proceed as soon as possible’.
The CHRE investigation was sparked by allegations made in parliament by Livingstone MP Jim Devine in March, as first revealed by NT. Mr Devine said the regulator had an ‘ingrained culture of bullying and racism’ (NT News, 26 February, p3).
The CHRE said it had found no evidence of racism but Jim Devine said it was ‘clearly a damning report’.
A second investigation by the Charity Commission will focus on financial management of the NMC.
CHRE recommendations to the NMC
Work towards more effective governance. This should include reviewing its committee and accountability structure and agreeing on the level of detail of reporting to meetings. It should also include introducing and enforcing an effective statement of organisational values and code of conduct for council members and staff, and appraisals for all council members. Collectively and individually office holders and other council members accepting responsibility for the current difficulties and for future resolution.
Introduce an IT-based case management system in fitness to practise as a matter of urgency and direct necessary resources to this. It must improve its service to the public and registrants in fitness to practise processes.
Examine stakeholder relations and communications strategy so that it is clear the NMC exists to protect public and that it has effective and mutually respectful relationships with interested parties to achieve this. Improving communication needs to include communication with patients, the public and registrants.
CHRE feedback to the government
We recommend that plans to create a new governance structure for the NMC should proceed as rapidly as possible and sooner than currently planned. There should be no representative members on the new council and no reserved places for interest groups. All members, whether registrant or public should be appointed against defined competencies and be subject to appraisal. The president should be appointed not elected.
We recommend that consideration be given to the relevant responsibilities of the NMC’s Conduct and Competence Committee being transferred to the new Office of the Health Adjudicator at an early stage, thus allowing the NMC to concentrate its resources on investigations and the efficient management of cases.
NMC responds to recommendations
In response the NMC said the report made ‘tough reading’.
‘We are acutely aware that there is still a big job to do at the NMC,’ a statement said.
‘We have already identified fitness to practise, better customer service and a modern IT infrastructure as areas for sustained attention and activity. We are confident that we can deliver the improvement.
‘We disagree with CHRE’s findings on our relationships with stakeholders. We believe that generally, our relationships with our stakeholders are good.
‘We will take time to reflect and will offer further comment once we have had an opportunity to examine the recommendations in detail and have informed the CHRE how we intend to respond,’ it added.