1 Introduction
1. The nursing and midwifery professions are amongst
the oldest established and the longest regulated professions in
the UK.[2] Regulation of
these professions has taken many different forms and has been
undertaken by several different organisations over the last one
hundred or so years. The current regulator, the Nursing and Midwifery
Council (NMC) has been fully operational since April 2002 and
is the statutory regulator for the 660,000[3]
nurses and midwives in the UK, the Channel Islands and the Isle
of Man.
2. The aims of the NMC are to set standards of education,
training, conduct and performance for nurses and midwives, to
ensure that these standards are maintained and that the health
and wellbeing of the public is safeguarded. It discharges these
functions by maintaining a register of nurses and midwives, setting
standards for education and practice, and giving guidance and
advice to the professions.[4]
3. The legislative basis for regulation of the professions
is set out in the Nursing and Midwifery Order of 2001[5]
and subsequent amendments.[6]
The NMC has requested Department of Health support for further
amendments to the legislation that governs its operation. The
Committee broadly supports this request, as improvement to the
performance of the NMC in some key areas is hampered by its current
legal framework. The Government must prioritise this work if it
wishes to see further improvement in the performance of the NMC.
4. Both the NMC and its predecessor organisation
the United Kingdom Centre Council for Nursing, Midwifery and Health
Visiting (UKCC) have from time to time encountered significant
operational difficulties. In the 1990s the UKCC got into financial
difficulties and had built up significant levels of debt which
were then taken on by the NMC on its establishment.[7]
Since then a financial recovery plan has been put in place. This
entailed efficiency savings, reducing costs and raising the three-yearly
registration fee to £129 from August 2004. In 2007 the three-yearly
fee was raised to £228 (now paid in annual instalments of
£76). The annual report and accounts for the year ending
March 2011 indicate that the NMC's financial recovery plan has
been achieved and that it now has adequate free reserves.[8]
The Committee welcomes the
improved financial performance of the NMC in recent years, but
is concerned about the affordability of the registration fee for
many lower paid registrants. We would urge the NMC to avoid further
fee rises and to consider fee reductions for new entrants to the
register.
5. From time to time since its foundation, various
allegations have been made about the performance of the NMC and
the conduct of its Council. In 2008, the then Minister of State
for Health Services, Ben Bradshaw MP, commissioned the Council
for Healthcare Regulatory Excellence (CHRE), the regulator of
health professions regulators, to undertake a special review into
the conduct of the NMC. The report found that there were:
[…] serious weaknesses in the NMC's governance
and culture, in the conduct of its Council, in its ability to
protect the interests of the public through the operation of fitness
to practise processes and in its ability to retain the confidence
of key stakeholders.[9]
6. The report highlighted a poor level of service
to complainants (sometimes insensitive or misleading information
was being given to them) significant delays in communication with
complainants, poor quality correspondence and long delays in fitness
to practise hearings.[10]
The report also found evidence of inappropriate conduct of the
Council and a lack of confidence in the NMC from its stakeholders.[11]
7. The Government accepted the findings of the report
and subsequently the Council membership has been entirely replaced
and the number of members reduced. There are now seven lay and
seven professional members, all of whom are now appointed, and
the Council has adopted an appraisal system for all its members.[12]
8. The CHRE undertakes an annual review of the NMC
and other regulators. Its 2010-11 report considers the progress
that the NMC has made since the publication of the special review
in 2008 and finds that some "significant improvements"
have been made. The report goes on to say:
However, we remained concerned about the number and
nature of the improvements that the NMC still had to make, particularly
around its customer care and, its management of serious cases
and the timeliness of its case progression.[…] Due to the
importance of these areas that are still in need of considerable
improvement, we agreed with the NMC that we would work alongside
it over the coming months to ensure that improvements continued
to be made.[13]
The CHRE go on to say that:
We can see that it [the NMC] is taking the necessary
steps to address the areas of concern in our progress review […]
We support the NMCs intentions and recognise that the NMC is committed
to improving its performance.[14]
9. The
NMC is now leaving behind its previous organisational and financial
instability, and is improving in many areas of its work. There
remains however a significant amount of work to be done in order
for it to be an effective regulator that has public protection
as its principal concern.
10. Although,
therefore, the Committee recognises that the NMC is developing
a higher level of operational competence, it remains concerned
that the leadership function of the NMC remains underdeveloped,
particularly in the areas of fitness to practise, revalidation,
education and training and proactive regulation. The Committee
hopes that the NMC will embrace more ambitious objectives for
professional leadership, some of which are described in this report.
2 Sixth Report from the Health Committee, Session
1998-99, Adverse Clinical Incidents, HC 549-I, ACI 189 Back
3
Ev 16 Back
4
Nursing and Midwifery Council, Annual report and accounts for
the year ending 31 March 2011, HC 335, July 2011 Back
5
Nursing and Midwifery Order 2001 (2001/235) Back
6
Amended by, for example, the Nursing and Midwifery (Amendment)
Order 2008 (2008/1485) Back
7
Ev 16 Back
8
Nursing and Midwifery Council, Annual report and accounts for
the year ending 31 March 2011, HC 335, July 2011 Back
9
The Council for Healthcare Regulatory Excellence, Special
report to the Minister of State for Health on the Nursing and
Midwifery Council, 11 June 2008 Back
10
Ibid. Back
11
Ibid. Back
12
Nursing and Midwifery Council, Annual report and accounts for
the year 2009-10, February 2010 Back
13
The Council for Healthcare Regulatory Excellence, Performance
review report 2010-11, HC 1084-II, June 2011 Back
14
Ibid. Back
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