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
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, www.nmc-uk.org Back
66
The Nursing and Midwifery Council, Critical standards intervention
project final report, September 2010 http://www.nmc-uk.org Back
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