interviews

NMC: ‘Unbelievably disappointed’ at lack of desperately-needed legislative change

Jackie Smith, chief executive and registrar at the Nursing and Midwifery Council, talks about the urgent need for legislative regulatory reform.

On 2 April 2014, the Law Commission completed its review into the laws governing the regulation of healthcare professionals in the UK. It also submitted a draft Bill to the government – The Regulation of Health & Social Care Professionals etc Bill – which aims to create a single legal framework for all the regulators of health and social care professionals.

Hopes that the Bill would make it into this year’s Queen’s Speech, however, never materialised. The likelihood now is that a decision will be made on whether to take the Bill forward when a new government comes in after the 2015 general election.

One of the nine regulators the Bill will affect if passed is the Nursing and Midwifery Council (NMC). The organisation’s chief executive and registrar, Jackie Smith, told NHE: “We were unbelievably disappointed that the Bill didn’t make it into the Queen’s Speech, and we remain extremely concerned that the outdated nature of our legislation is not being fully appreciated by government in terms of the impact it has on our ability to get through fitness to practice (FtP) cases.”

The NMC is one of the world’s largest healthcare regulators with more than 680,000 nurses and midwives on its register. Its costs are funded by the registration fee, but about 77% of its entire budget is spent on its FtP work.

But it cannot significantly cut the number of FtP hearings without further legislative change to allow it to deal with its cases in a more appropriate and proportionate manner.

The doctors’ regulator the General Medical Council (GMC) has had the power to agree “undertakings” or “give warnings” at the end of the investigation stage for 10 years, significantly reducing the number of final hearings it holds.

While the GMC receives over 10,000 referrals each year, only 2,371 GMC referrals proceeded to a full investigation in 2013-14 and only 241 cases went to a final hearing. In contrast, the NMC received 4,000 referrals, 2,961 of which proceeded to a full investigation, with 1,756 cases going to a final hearing.

“We do not currently have any alternative options for resolving cases at the investigation stage and as a result we are currently holding more than twice as many final hearings as all the other nine UK healthcare professional regulators added together,” said Smith.  The average cost of each hearing is £13,000.

Delayed legislation

Smith told us: “The delay in passing the legislation affects how quickly we can process FtP cases. That is the bottom line.

“On average we’re doing about 70% of our cases from start to finish in 15 months. This is hugely better than we were but it is still a heck of a long time along with the cost. Because we have a clunky Victorian legal framework, the cost of it means that we have to continue holding hearings and that is just not the way to do business. I’m afraid it is not an effective form of public protection.

“There are better ways of doing it and we’re being prevented from using those ways and it is a great shame for the profession and for the public.”

The changes could cut the number of hearings being held by a quarter, the NMC says. It would also like powers to work more closely with other regulators and share certain functions;  have more flexibility in its FtP investigations, with a single FtP panel in place of the current practice committees; and greater powers to resolve non-contentious matters without full panel hearings. It says removing the requirement for the Privy Council to approve fee changes would reduce unnecessary process, time and costs.

Smith added: “We need to do more work in education but to do this we need more funding or at least we need to be able to release some funding. It’s a great shame that we have to spend so much of our resource in one area when there is plenty of other work we could be doing, but we’re limited because we simply don’t have the funds.”

Even if the legislation was passed quickly post-election, it would take two to three years to come into effect.

“Revalidation will have an impact and it will help us identify concerns early on, but the thing that is going to make the big difference is reducing spend in FtP. This can only be done with a change in legislation,” Smith reiterated.

From February, the NMC fee for nurses and midwives rises from £100 to £120. A long-term delay in passing the legislation could mean a further rise, Smith told us, but she is hopeful this won’t happen in the next fee review.

The NMC wants all the main political parties to commit to take the recommended amendments forward urgently in the next Parliament, either via an overarching ‘healthcare regulation Bill’, based on the Law Commission’s work, or by a Section 60 Order and associated rule changes.

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