Safeguarding patients: challenging the NMC

The Nursing and Midwifery Council (NMC) exists to protect patients and the public from nurses and midwives who, for whatever reasons, do not uphold the standards and requirements determined by published standards, the Code of Conduct and other guidance. There are, of course, a raft of different regulators for healthcare professionals – all of whom exist for the same basic function and who, in turn, are responsible to the Council for Regulatory Excellence (CHRE), which acts as the independent voice for patients, service users and the public. CHRE has a primary focus of patient safety and the protection of the public, which it undertakes by regular audits of the regulators, publishing annual performance reviews. There is a considerable mood of change within regulation currently, not least in nursing, due to a variety of shameful events at Mid-Staffordshire NHS Foundation Trust, the Health Service Ombudsman’s report into care of the elderly in hospital and the Winterbourne View scandal. As a result of these concerns, the House of Commons Health Committee has recently begun to exercise some authority by investigating the state of healthcare professions regulation. In February 2011, the Secretary of State for Health presented a Command paper to parliament setting out future plans for regulation, Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff.1

Government plans for regulation

The report cites the current complexity of the regulatory framework and believes that the future approach to professional regulation must be ‘proportionate and effective, imposing the least cost and complexity consistent with securing safety and confidence for patients, service users, carers and the wider public’. The proposals they put forward in the paper set out to move power away from the centre and place trust squarely at the door of employers, while sustaining effective national safeguards. It specifies that the focus for reducing risk to patients and service users is often too distant from where the risk occurs and that the risks posed by individual failings are often most effectively and quickly mitigated by timely local action and effective local leadership.2 The paper emphasises the continued UK wide based approach of healthcare regulation in partnership and agreement with the devolved administrations. The report identifies that while the current regulation system is working reasonably well, there is also scope for improvement. Regulation costs more than £200 m per year at present. It is the Coalition’s intention to reduce the complexity and, at the same time, reduce cost within the system. The Law Commission has been tasked with undertaking a simplification review of the existing legislative framework and to draft a bill for consultation. A key driver of the costs within the sector is the investigation of complaints. Fitness to practise investigations reported by the NMC in 2009/2010 were 41% higher than the previous year and accounted for £19.7 m or 54% of its total expenditure over the year. Clearly this is not sustainable, if the trend continues, since most of the income of the regulators comes directly from registrants fees. In seeking to cap costs, the Government will not support expanded functions of healthcare regulators which add to their costs, unless a robust business case can be made. This has direct relevance to the frequent calls made by the NMC, and others in recent years, for the development of mandatory regulation for healthcare support workers.