The Nursing and Midwifery Council (NMC) is a vital safeguard for care quality and patient safety, but “over a number of years the NMC has failed to understand its function and properly prioritise patient safety” according to MPs on the Health Committee.
Launching a report from the second accountability hearing held with the regulator for nurses and midwives, Committee Chair Stephen Dorrell MP said,
"The NMC’s job is to protect patient safety by registering Nurses and Midwives and by enforcing acceptable standards of practice. The simple fact is that in recent years it has fallen down on that task.
We welcome the fact that the new management team in the NMC is committed to address its failings, and that the latest evidence shows that its performance is improving.
However there continues to be a serious gap between current performance and acceptable standards. The NMC has proposed that fitness to practise cases should be decided on average within 18 months of a complaint being received; the Committee proposes that the average time taken to decide a fitness practise case should be reduced to 9 months, and the maximum time should be set at 12 months.
In the words of the new Chair of the NMC, its “‘fitness to practise’ functions are the engine room of the organisation”, but the regulator still faces a huge backlog of cases, some of which should have been resolved years ago.
Measures to work through this have been put in place by the NMC’s new management team and we are optimistic that these changes will eventually bear fruit. Nevertheless, we believe the NMC must set to this task with greater urgency.
In addition to excessive timescales, the NMC also has had a poor track record of fitness to practise decisions being challenged and overturned. The quality of NMC decisions is just as important as the timescale and we were concerned to hear that the CHRE needed to make almost routine use of its power to refer NMC decisions to the High Court.
We were pleased to hear, however, that there have been no such referrals since September 2010, and urge the NMC to maintain this improvement."
The Health Committee notes that chronic under-investment has characterised the NMC’s past approach to fitness to practise cases. Stephen Dorrell says,
"It is unacceptable that the NMC underestimated the budget for its fitness to practise directorate by 30%. The Committee will be seeking reassurance at the next accountability hearing that this management failure has been addressed.
We accept the NMC requires greater resources in order to do its basic job and we welcome the Government’s intervention to limit the effect of the fee increase on registrants. However, nurses and midwives still face a 32% fee increase at a time of public sector pay restraint.
In the light of these pressures the Committee does not believe a further fee increase can be justified and we recommend that the NMC should consider introducing a phased payment system for registrants."
Language and communication
The Committee notes that the language and communication skills of Nurses and Midwives remains a concern.
"Some progress has been made within the EU, and we welcome the Government’s willingness to take administrative action in the UK to address this issue. This remains an issue of real concern for its impact on patient safety."
MPs also question why the NMC has made such slow progress on a system of revalidation.
"We continue to believe that the NMC should operate a proportionate but effective revalidation process and we are concerned that so little progress has been made on this subject since the 2011 accountability hearing. We hope that when we meet the NMC later this year they will have a more fully developed proposal to extend the assurance of revalidation to cover all registered nurses and midwives.
Lastly, the Committee notes that many of the NMC’s problems (connected with fitness to practise, the projected cost of future workload and how to target high risk groups for revalidation) stem from inadequate IT infrastructure where two key systems cannot communicate directly and deliver incomplete or inaccurate information.
If the NMC’s IT systems are inadequate, then the NMC cannot fulfil its regulatory role. The NMC must take urgent action now to resolve this problem and will be expected to provide concrete evidence of properly functioning IT at its next annual accountability hearing."