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Nurses should be banned from top NMC job, says super regulator

  • 45 Comments

Practising nurses and midwives should be banned in future from the top job at the Nursing and Midwifery Council, according to the body responsible for overseeing the troubled regulator.

The council’s senior executive holds the joint post of chief executive and registrar, and is responsible for both running the organisation and managing admission to the NMC register. 

The NMC’s last permanent chief executive and registrar, Dickon Weir-Hughes, was a registered nurse, though his interim replacement Jackie Smith is not.

But the Council for Healthcare Regulatory Excellence has called for the law to be changed to “prohibit” the appointment of a registrant as registrar, in order to avoid conflicts of interest.

It argues that the registrar has “considerable power” and their “integrity and independence from the profession should be beyond question”.

The CHRE has also recommended that lay members should form the majority over registrants on the NMC’s ruling council.

The CHRE’s comments come in response to proposals from the law commissions of England and Wales, Scotland, and Northern Ireland to restructure the way the NMC and other regulators operate. Its views are likely to be highly influential on the commission’s final recommendations to ministers.

However, the proposed move away from professionally led regulation is likely to be unpopular with nurses. A Nursing Times survey earlier this year found 71% of respondents though it was vital a nurse or former nurse was either chief executive or chair of the NMC.

Unison and the Royal College of Nursing have indicated that they would like to see at least one of the top positions held by someone with a nursing background.

But CHRE chief executive Harry Cayton said: “Regulation is solely and only about protection of the public. It is not about the promotion or enhancement of the status of any profession; that’s the domain of the professional associations and royal colleges not the regulator.”

The CHRE also backed the commissions’ proposals to introduce “financial penalties” for misconduct or failure to comply with fitness to practise proceedings, which were revealed in March.

  • 45 Comments

Readers' comments (45)

  • michael stone

    Fine, so long as the top job at the GMC cannot be held by a practising doctor.

    Exactly equivalent conflict of interests.

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  • I'm a brand spanking new Staff Nurse and I think that by the time I would be ready to hold such a post if I chose to, I shouldn't be stopped just because I'd have decades of experiences in the profession that the NMC is supposed to regulate.

    Who better to work on new policy than someone who knows how those policies directly affect the way a Nurse carries out their duties.

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  • Im not against the idea. I'll be happy if someone can do a good job. As a profession we seem to be very unlucky with our leadership. Maybe it's a reflection of the quality of our profession, and our leaders in particular.

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  • Interestingly, the interim CEO was in charge of the major failing department - fitness to practise so how is that a good idea. I think personally, the best person for the job should be appointed but how anyone can regulate nurses without some sort of insight into what we do and the system then I am not sure who you would choose? Let's hope it is not some ex-Health Minister?

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  • Anonymous | 11-Jun-2012 11:19 am

    just be thankful that Mr. Lansley is not yet an ex.

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  • Maybe its time for all regulators to be funded by the state as it is there for the protection of the public and we are all members of the public.
    The NMC should not be called a professional body anymore, it should just be a regulatory body. There should be a very senior, experienced + competent nurse at the top. We also don't need a super regulator for healthcare, just amalgamate all the healthcare regulators + cut down admin, bureaucracy + pen pushing staff.

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  • All the more reason for the NMC to be funded by public money.

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  • andy | 11-Jun-2012 12:55 pm

    good idea. how about one single regulating organisation with different departments for each profession and one for regulating the employers and the organisation and management of the NHS as a whole. This would seem more logical, less cumbersome, more streamlined, more integrated and targeted towards the common goal of quality patient care of the highest quality and more cost effective and funded by the public with the professionals just paying a fee to join the register and if necessary reasonalble annual fees to maintain their names on it.

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  • I can recall in the NHS "service managers" who come from other disciplines such as occupational therapy, social workers, heading units. None of them had a clue, and one such case arose when shower cords were removed and awful fitted things installed with a push switch which stopped every five mins (extremely annoying) Now as a nurse I know the importance of a hand held shower, Eg, promoting circulation, washing under large skin flaps etc. What I am getting at is...what the hell has happened ?
    Matrons and senior nurses ran hospitals once upon a time. Of course any top position within the NMC should be headed by a trained nurse, and a trained nurse with several qualifications, RMN, RGN etc. Only a nurse can understand a nurse. The NMC is becoming very scary indeed. We are so concious of being "Investigated" for some petty things like forgetting to sign an RX sheet that we spend more valuable time on administration work instead od participating in client care..lets face it as lond as all the paperwork is complete the NMC is happy...lip service to nursing care.

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  • Fitness to practice regulator-get judge Judy in to get rid of all those awful creatures awaiting their hearings. Impose a fine with striking off order and reduce the registration fee for nurses who do a good job. Not rocket science!! Job for me when i retire!!!!

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  • tinkerbell

    Good old Judge Judy. Straight talking, no nonsense. As she would say 'beauty fades, dumb is forever'.

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  • Self Regulation does not work. Too many vested interests - look at the Press Commission!! Does the public want further expense such as the Leveson inquiry?

    As a registered nurse of considerable years and experience I just want nursing to be regulated properly.
    No vested interest, no conflicts, total accountability.

    Get rid of the Royal out of RCN - they are a union after all and do nothing to improve practice - in fact practice has been unsupported and got worse by the poor leadership from the RCN.

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  • I so agree with Mike Stone, I cannot see the GMC agreeing to a non-medic! And haven't the biggest complaints about the NHS come from people saying we shouldn't have put an M&S manager in place. Why would we want a non-nurse to be responsible for ensuring nursing is a valuable, quality profession? Although I wish that either the NMC or the RCN had more clout around ensuring the education of nurses post qualification.

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  • So hospital are managed by accountants, nurses are to be regulated by goodness know who without experience of the professional body they represent AND we are told 60% increased fees is necessary? Why on earth do we need to be registered as nursing professionals any more, if we are represented by non nursing body of people? Please enlighten us because along with everything with the word nurse the profession appears to being eroded.

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  • "And haven't the biggest complaints about the NHS come from people saying we shouldn't have put an M&S manager in place."

    don't know about him/her but if Mag Thatch and her health minister hadn't sought advice from the Sainsbury's grocer, Jo Griffiths on how to run the NHS, General (industrial-style) Management, which attempts (and sadly fails) to process and manage human beings like commodities would never have been introduce and the NHS would have continued to run far more effectively as far as quality of care goes under the direction of doctors and nurses and other hc professionals who are the only ones who truly understand and are professionally trained to meet the needs of their patients.

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  • I do not wish to have a rag and bone man regulate my profession, and have to pay dearly for the privilege! The NMC will have to come up with some better ideas.

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  • Florence

    I agree with Mike Stone and Candy Cooley ! Yes go on ahead just so long as The GMC agrees to regulation by a non- medic !
    Obviously we require a Nurse who has at least dual registration . With extensive clinical and senior management experience.Obviously educated to at least degree level. And a Nurse with a law degree too would be an absolute bonus.
    It is only common sense that we are regulated by a Nurse.

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  • We would need a very detailed job description to see all that is entailed before passing any judgement but at first glance it seems that it a post that should be filled by a registered nurse with considerable experience in the field as well as adequate training management.

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  • Practising nurses and midwives should be banned in future from the top job at the Nursing and Midwifery Council, jolly good, I'm a plumber, so let me do it.

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  • Anonymous | 12-Jun-2012 8:21 am

    as a plumber you must have excellent organisational skills. You're on!

    Are you sure you are not a GU nurse or surgeon! in which case you would not qualify for the job!

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  • michael stone

    andy | 11-Jun-2012 12:55 pm

    'Maybe its time for all regulators to be funded by the state as it is there for the protection of the public and we are all members of the public.
    The NMC should not be called a professional body anymore, it should just be a regulatory body'

    The fact that the NMC is primarily to protect the public from incompetent or malicious nurses, is the basis of the argument for not having a nurse 'at its top'. The fact that assessments must properly take into account the practicalities of nursing, is the argument in favour of having a nurse 'at the top'.

    Actually, I think a dual 'top' with a nurse and a layman, in a joint job title, probably fits best. It is the right balance, which needs to be achieved.

    And, is the NMC 'a professional body' for nursing ? Isn't it just the regulator ?

    To my mind, it is the union aspect of the RCN where that problem lays – the RCN is, it seems to me, both 'the learned body for nursing' and also a union: doctors have the BMA as a union, and all manner of Royal Colleges as 'learned bodies'. But there is the 'Royal' in the RCN, but not in the BMA – so surely to be equivalent, you would split the RCN into RCN and also a separate BNA ?

    Candy Cooley | 11-Jun-2012 4:21 pm
    morag cunningham | 11-Jun-2012 10:40 pm

    Re what I write above, I am not entirely sure if you do agree with me.

    My point, from my original post, is that if nursing is a profession, and nurses are 'self-regulating' in the same way that doctors are, it is insulting and offensive to nurses to treat nursing differently from medicine. Obviously when assessing 'bad practice' you need nursing expertise to set the 'acceptable standard', but you should not have 'professional defensiveness' within the NMC protecting bad nurses (or bad doctors re the GMC): it is the role of whoever is acting as 'defence council' to provide that defence.

    And drifting, I think Police self-regulation is an area in need of correction much more than the self-regulation of the clinical professions !

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  • Is the concern that there may be corruption e.g., with police investigating police and nurses investigating nurses and removal of any objectivity.

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  • Are they suggesting that a nurse doesn't have the integrity to hold this position. I'd have thought you need a nurse to understand what nursing involves and have the knowledge and maturity to consider there may well be mitigating factors surrounding each case - maybe that's what they are scared of.

    Surely if they are considering financial penalties then there is no reason for their proposed huge increase in fees. I like to think that 'failure to comply' also means fining those who make false, exaggerated or spiteful referrals and also those managers who haven't bothered to deal with issues at local level.

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  • bob cat

    I agree with Mike, I would also argue the same for politicians!
    The real question, or one of them, is why does CHRE argue this point, what do they have to gain?? My instinct is that 'doing the right thing' is getting in the way of 'getting things done'.
    However, conflating competition speak phrases like 'conflict of interest' with professional accountability issues demonstrates either the lack of understanding that we are articulating, OR a better understanding with a deliberate and strategic application. Both scary!

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  • Does anyone know if Gp's hold the top job at the GMC ? Be a useful refernce point

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  • bob cat


    Professor Sir Peter Rubin, current chair of GMC ,doctor of medicine and still practising medicine.

    http://www.gmc-uk.org/about/council/9905.asp

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  • Good idea, a better suggestion and certainly more appropriate would be to have the House of Commons and our 'Honourable Members' overseen by animal trainers.

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  • Righto, lets remove all "specialism" and put Joe Soap in charge of the NMC ,he/she can't do a worse job than the Nurses at the top are doing right now. But then lets not call ourselves nurses either, because the real meaning of the title has so many diverse meanings in the mind of the public and meaning which I for one would never take on as the meaning of my profession.

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  • "Nurses should be banned from top NMC job, says super regulator"

    is this a typo? surely it should read "Nurses should NOT be banned..."?

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  • Anonymous | 14-Jun-2012 11:15 am

    sorry I should have read the article before making my comment, which I did way back on 11 June but have forgotten what it was all about.

    then I said to myself, what is the point! Now I am fed up, and I give and thank goodness I can retire.

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  • posted before I was finished.

    Stupid - I mean the website, not me! (well, to be really honest, I give it the benefit of the doubt in this case).

    correction to last para.

    then I said to myself, what is the point! Now I am fed up, and I give up and thank goodness I can retire. I still have a passion for nursing and can watch from the sidelines but can severe myself from the clutches of the NMC before they hike their fees, incur further managerial problems and inefficiencies and before I have any trouble from them which could mar the end of a successful career.

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  • Anonymous

    Nobody is arguing, I think, that you must not have nursing expertise within the NMC.

    The point is that if the NMC is to rule on good or bad behaviour, it has to be seen to be neutral: if there were only nurses considering the behaviour of other nurses, accusations of potentially 'protecting our own' could arise. If you only have laymen, they don't understand the job of nursing.

    You need both - and I think, from memory, that when the GMC sets up a panel to decide if a doctor is fit or not, the panel has a majority of lay members on it (But I am not 100% sure that I can trust my memory on that).

    Politicians are not keen on being regulated by anybody. I have always wanted a Pinocchio nose device, to be fitted to all politicians as standard: when they tell a porky pie, their nose grows so the rest of us can see for sure what is going on. It would change the way they behave, and it would let us all see if the reasons they give for policies, are their true motivations !

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  • bob cat

    Interestingly both NMC and GMC hearings work on a similar basis, I had a look after the comment above. Both have lay members as part of the panel, as well as professional nurses or doctors. So why would CHRE be calling to ban nurses being in the top job at the NMC and not the GMC? Where's the money?

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  • bob cat

    FAO NT: Where does it say that the CHRE is stating that a registrant should be prohibited from holding the position of registrar because I can't see any reference to that in the interim report. Would you provide your reference for us please?
    Thanks

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  • Toby Ornottoby

    Does the military have non-military people to run its disciplinary processes? Should NMC disciplinary hearings (a court martial) be organised by a lay person?


    Me thinks not. To quote the Americans, because they actually have a written Constitution.... The panel of a court martial...

    https://en.wikipedia.org/wiki/Courts-martial_in_the_United_States#Constitutional_foundation_for_courts-martial

    "A court-martial has always been an ad hoc tribunal created and appointed by the order of a commanding officer, as the convening authority, the tribunal is established the express purpose of considering a set of charges that the commander has referred to the court.

    The convening Authority considers the statutory prescription offered by the United States Congress, those "BEST QUALIFIED," in selecting the "panel" or jury for the court-martial. In turn, the members of the court-martial, who are generally under the command of the convening authority, take an oath to "faithfully and impartially try, according to the evidence, their conscience, and the laws applicable to trial by court-martial, the case of the accused." By their oath, the panel members expressly agree to leave behind any influence from the commander who appointed them. The current practice in the United States Armed Forces is to appoint a number of officers to a standing panel of members. In cases where the accused is an enlisted member, the accused may request that enlisted service members be appointed to the panel.

    The appointed or retained defense attorney may challenge both the military judge and members of the panel for cause. However, the military judge determines the relevance and validity of any challenge. The prosecution and defense initially possess one peremptory challenge to members of the court-martial. The accused may also challenge a member of the panel for cause "at any other time during trial when it becomes apparent that a ground for challenge exists." The UCMJ prohibits a convening authority from unlawfully influencing the court. A defense attorney may bring a motion to challenge the validity of the court-martial where it appears that a convening authority has unlawfully influenced court-martial members."

    Very long-winded I admit but it does point out that professionals should judge professionals because only they can actually understand the intricacies of a particular case.

    While I acknowledge that the vast majority of senior nurses I know couldn't organise a "grand urination celebration in a distillery" I would at least be able to talk peer-to-peer with them instead of teaching them the basic of nursing and/or spelling.

    Much fun is currently being enjoyed by watching the Leveson Inquiry. Who is the panel made up of? Yup MPs judging MPs... Of course it's the lunatics supervising the lunatics... BUT AT LEAST IT IS DONE IN FULL VIEW OF THE PUBLIC!

    Imagine the mirth with these headlines....

    George Collins (former manager of BetterBuys) Head of the Metropolitan Police said today that from now on every Wednesday will now be a statutory police holiday.

    C of E Archbishop George Stropolis (former CEO of the Bank of Greece) today abolished singing in churches due to the risk of airborne infections.

    His Holiness Pope Dave Betts (former housewife) decreed that, according to equal opprtunities legislation, men can now become Nuns.

    Queen Elizabeth II has abdicated and appointed Tinkerbell as her direct successor.

    Actually... I'd be happy the last one!

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  • Tiger Girl

    Toby Ornottoby | 15-Jun-2012 8:11 am


    If the court martial is internal - just soldiers involved, disobeying orders, etc - then clearly it is a purely military affair (human rights of individual soldiers apart).

    But nurses and doctors are involved with patients, and patients are usually not nurses and doctors: a bit like would you use a court martial, if a rogue soldier had started to machine-gun people in Trafalgar Square ?

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  • Toby Ornottoby

    Tigga - Court Martials are used for all breaches of professionalism in the armed forces - including interactions with the public they serve. Most professional organisations have "Departments Of Internal Affairs" and most of them are staffed by members selected from within their own ranks.

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  • bob cat

    We're not the armed forces though. Different model. There could be a case for including lay members in court martials as well.

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  • bob cat

    Any progress on that reference NT?

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  • Toby Ornottoby

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  • In response to Bob, the CHRE link is -http://www.chre.org.uk/_img/pics/library/120531_CHRE_response_to_Law_Commission_consultation.pdf.
    The Law Commission has consulted on proposed ways to increase consistency and efficiency across regulation. The link is to CHRE's response to that consultation. On page 16, you'll find the relevant part (to this article) of CHRE's response. It's a general comment, not aimed at the NMC in particular but to all the health care regulators.

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  • Juggling Dog

    the positive imbalance of "learned-judges" (Registered Nurses) against "lay" (Daily Mail readers) members.

    Toby Ornottoby | 18-Jun-2012 2:37 pm

    Let's not get carried away here - I am entirely in favour of lay representation, but I draw the line at Daily Mail readers !

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  • I am becoming increasingly concerned about the role of CHRE and not surprised by this latest pronouncement on the NMC. A Nurse/Midwife needs to be in charge of their Regulatory Body otherwise why are nurses/midwives required to fund it.I am aware of the ongoing difficulties at the NMC as it tries to manage a hugh workload but perhaps the money it has to pay to CHRE to fund its existance could be better utilised by the NMC to deal with its Fitness to Practice backlog.Perhaps it is time all the Health Regulatory Bodies petitioned the Government to abolish CHRE.

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  • bob cat

    19-Jun-2012 11.55: thanks for that, interesting reading what the CHRE is proposing and the response of the Law Commission. The LC doesn't dictate a view though, only suggest a way forward in the specific context of the CHRE having an ability to appoint a registrar rather than ?elect from the members maybe?
    Given the shambles demonstrated by the current NMC a reorganisation is needed but not in the absence of registrant context and knowledge I would say.

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  • At last - complete sense! Of course the top job at the NMC must be somebody completely impartial to the profession.

    IF the NMC wants to be a 'true' regulator it should in fact be government funded, rather than funded by Nurses and Midwives. Until this occurs the NMC will only ever be regarded as a 'protector' of Nurses and Midwives rather than the 'public'.

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