Annual accountability hearing with the Nursing and Midwifery Council - Health Committee Contents

4 Proactive regulation

48. The fitness to practise activities of the NMC are by the far its most labour and resource intensive. In the Command Paper on professional regulation the Department of Health stated that:

[…] fitness to practise amounted to £19.7 million out of a total expenditure of £36.7 million. This amounted to around 54% of the NMC's entire expenditure over the year.[56]

49. The size and scope of the nursing and midwifery professions present the NMC with the unique challenge amongst professional regulators of regulating two key professions in a way that is both effective and affordable.

50. In light of this challenge, and scandals such as that at Mid Staffordshire NHS Foundation Trust, the NMC has been examining ways in which it can be more proactive in its protection of the public, as opposed to waiting for fitness to practise allegations to be made. The NMC has opened 153 fitness to practise cases about nurses and midwives in this manner, and recently suspended two nurses from the register that were working at the Winterbourne View care home in Hambrook.[57] We welcome the NMC's initiative in opening proactive investigations into registrants without a formal referral from an employer, a member of the public or another professional.

51. The NMC has conducted at least two extra-ordinary reviews of pre-registration nurse education in NHS Trusts: North West London Hospitals NHS Trust in 2005,[58] and Basildon and Thurrock University Hospitals NHS Foundation Trust in 2009.[59] This latter review was in response to concerns raised by the CQC and Monitor about the leadership, quality of care and governance arrangements in the organisation.[60]

52. In 2009 the NMC commissioned Dame Elizabeth Fradd to consider how the NMC could proactively safeguard patients either within its existing powers or through extending them.[61] Based on this report, the NMC has concluded that:

Whilst NMC has overarching duties to establish and maintain standards of education, training, conduct and performance of nurses and midwives, there is no clear power which permits the NMC to intervene to investigate healthcare organisations. Lawyers advise that in order to limit the risk NMC should agree the nature and scope of proposed interventions with other regulators.[62]

53. In response to Dame Elizabeth's report, the NMC will be establishing a Critical Standards Intervention unit that aims to "identify, assess and act upon systemic failures".[63] The unit will require a significant change in how the NMC operates in order for it to become more proactive and for sections of it to work together:

There has been little history of doing this in the past. Pockets of information are currently kept in silos i.e. in the sections that receive the information, which significantly, may not necessarily be the section that can make best use of it.[64]

54. The NMC acknowledges the cultural shift that will be required to deliver on proactive regulation.[65] The Critical Standards Intervention project has been reviewing options for further proactive actions that the NMC could take. It recently reported that the NMC should use and "stretch" its existing powers to investigate standards of training in healthcare providers. The NMC told us:

[…]we do have powers to appoint visitors to look at the quality of the education environment within a healthcare organisation, refer concerns to our investigating committee for fitness to practise action and review arrangements to protect the public from practitioners whose fitness to practise is in doubt.

The NMC will also develop memoranda of understanding with the CQC and other organisations to enable information sharing.[66]

55. The NMC's plans for investigation of and intervention in a healthcare organisation where concerns are being raised is a creative and interesting approach to regulating what is a large group of professionals working across a variety of settings. It offers the NMC another tool to strengthen public protection.

56. We do feel however that whilst the power to look at the quality of educational environments gives the NMC "a foot in the door", clear power must be established in law for further expansion of this role, and we encourage the Government and the NMC to work together to develop this approach. The Committee would particularly like to see the NMC responding to trends in outcome and complaints data from NHS and social care providers.

56   Department of Health, Enabling excellence, autonomy and accountability for healthcare workers, Cm 8008, 16 February 2011 Back

58  57   "Nurse policing is to be 'more proactive'", the Health Service Journal, 16 December 2009  Back


59   The Nursing and Midwifery Council, Report on the extraordinary review of nursing (adult) education and the maternity services at Basildon and Thurrock University Hospitals NHS Foundation Trust, December 2009 Back

60   Ibid. Back

61   The Nursing and Midwifery Council, Critical standards intervention project final report, September 2010 Back

62   Ibid. p4 Back

63   Ev 18 Back

64   The Nursing and Midwifery Council, Critical standards intervention project final report, September 2010 Back

65   "NMC opens up 153 new cases following media reports of poor care", NMC website, 26 June 2011, Back

66   The Nursing and Midwifery Council, Critical standards intervention project final report, September 2010 Back

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Prepared 26 July 2011