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Terms set for strategic review of nursing regulator

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Initial recommendations from the strategic review into the Nursing and Midwifery Council are expected in April.

The timetable and terms of reference for the strategic review into the nursing regulator have been published today.

The Council for Healthcare Regulatory Excellence, which is carrying out the exercise, has set out two key questions it will be asking during its four month investigation into the NMC’s continuing failure to satisfactorily improve its performance on handling fitness to practise cases.

These are:

  • Are the leadership, management, organisational structure, and resource allocation, of the NMC correctly aligned to ensure that it can deliver its regulatory functions in the most efficient and effective manner?
  • If not, what changes need to be made to ensure that the NMC (at strategic leadership, management, organisational, and resources allocation levels) is focussed on delivering against its statutory duties, and is able to build capacity to deliver its core functions in a more efficient and effective manner?

The review will be overseen by CHRE chief executive Harry Cayton and managed by Christine Braithwaite, CHRE director of standards and policy.

Initial interviews, scoping and fact finding will be carried out this month followed by observation and follow up interviews in March.

An interim report with the review’s initial recommendations is expected in April, with a final report due in May.

At a press conference announcing the terms of reference, Mr Cayton said the review would be a “vigorous and constructive look forward at how the NMC can meet the challenges of its task and do them well”.

He said: “We are working with NMC to try and help them identify why there have been problems over really quite a number of years and why goodwill and hard work, which I absolutely believe to have been there throughout, have not produced the kinds of changes in delivery of regulation of nurses that the NMC itself would have wished there to have been, or we feel at CHRE that are necessary for the proper protection of the public and the proper regulation of nurses and midwives.”

NMC acting chief executive and registrar Jackie Smith said: “The NMC wholeheartedly welcomes this strategic review.

“We’re grateful to the CHRE for the impartiality and external scrutiny they will bring to the work,” she said. “We’ve been carrying out an internal review of our activities for some time and this has important questions for us about the delivery of our core regulation functions. As an organisation we are firmly committed to effective regulation.”

Ms Smith stepped up to the role from her usual position as director of fitness to practise on 16 December, when the previous incumbent Dickon Weir-Hughes went on sick leave. He subsequently resigned with immediate effect on 12 January. 

As revealed by Nursing Times, NMC director of standards and registration Roger Thompson had previously resigned on 2 December. 

Unison head of nursing Gail Adams told Nursing Times the review had to be “undertaken with complete vigour”, but added she was “confident” Mr Cayton would do a good job.

“We would urge the NMC to give him their fullest collaboration throughout, no matter how difficult things get,” she said, noting the possible “sensitivities” surrounding the recent loss of senior members of staff from the NMC.

Louise Silverton, deputy general secretary of the Royal College of Midwives said:  “We welcome this review and look forward to working with the CHRE and NMC during the review process.

“However, I am disappointed to see that we are in a position where the organisation and running of the NMC is again under review. The NMC is an organisation with a critical and important role for the public, midwives and nurses. I hope that this will be a definitive review of the NMC and that it is an opportunity to get the NMC working effectively and efficiently, so that it can concentrate on its core roles and functions and maintain and improve its services.”

Regarding the regulator’s long standing backlog of fitness to practise cases, Mr Cayton said the NMC and other professional regulators faced an ever increasing volume of complaints to process.

“The volume of complaints, the volume of fitness to practise cases continues to rise. That is not I believe a reflection on the nursing and midwifery professions as such. It is a reflection in the change of attitude of the public and to whether should make a complaint or not,” he said.

“I would like to make it clear that although the volume of referrals to the NMC is very large…. the percentage of nurses about whom there are complaints is really small – smaller than the percentage of doctors or dentists, although the gross number of reports on the nursing and midwifery profession is much higher.”

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