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Problems and failings at Nursing and Midwifery Council

Review of regulatory bodies for nurses and midwives reveals problems ‘at every level’

Photo of midwife + newborn: istock

19 July 2012

A recent independent review of the Nursing and Midwifery Council (NMC), has highlighted myriad problems and failings ‘at every level’ in the organisation. The NMC is responsible for the regulation of nurses and midwives in the UK, setting standards of education, training and performance, and is entrusted with a duty to ‘protect the public and uphold public confidence’. Nurses and midwives are admitted onto its register on the basis that an employer or member of the public can see whether they are authorised to practice, and arguably provide some reassurance as to their capabilities and standard.

The NMC currently holds 670 000 nurses and midwives on its register. This statistic ensures that it is the regulator with the largest bank of workers in the UK. Considering this authoritative position in the field, it is perhaps even more to be expected that there should be the highest and most professional of standards carried out by its nurses and midwives, as any shortcomings would affect a large number as well as a wide variety of people.

However, the strategic review, carried out by the Council for Healthcare Regulatory Excellence (CHRE) at the request of the Parliamentary Under Secretary of State at the Department of Health, revealed that although the NMC was, to some extent fulfilling its role by ‘[protecting] the public’, it was by no means doing this at the best of its abilities.

The main problems with the NMC were clearly outlined in the report. First and foremost was the issue of council’s performance in fitness to practise. In the past, attention has been drawn to this longstanding difficulty, and although some action has been taken, the results have not been ‘as swift or as extensive’ as hoped. The problems have been exacerbated by the sheer volume of cases: the number of cases has risen by just under 50% since 2009. There are considerable backlogs; the report specifies that at the end of 2010, there were 2000 cases in the triage stage, creating a backlog of 1500 awaiting investigation and hearings, which are now referred to as ‘historic’ cases.

This pessimistic terminology perhaps sums up the culture of the NMC that the CHRC identified as ‘resigned resilience’, and now seeks to change. The staff have had to endure years of criticism and frustration, and consequently deal with this either by leaving (indeed, in 2011-2 there was a staff turnover rate of 31%) or by accepting these poor standards and the fact that they can do nothing to change them. The CHRE has stressed the need for a reworking of the organisation’s ethos, suggesting that it is not only the staff to create this sense of resignation, but the leaders as well. It is down to these figures of authority, therefore, to promote a new, more positive set of values within the NMC

A further problem specified by the CHRE is a lack of clarity of purpose, something that can be rectified by concentrating its strategy, business planning and resources on improving effectiveness. It is this that will  start restoring the public’s faith in the organisation, and will be the start of a long process of improving this faulty organisation.

In the NMC’s official response to this report, the Acting Chief Executive, Jackie Smith, admitted that the report made ‘difficult reading for the NMC’ but showed a willingness to accept it as a ‘catalyst for change’ in the organisation. Change is already underway with a new chair and chief executive to be appointed later on this year. Similarly, in response to the original interim report in January, the NMC have been attempting to tackle every issue raised, including establishing a change team and bring in additional expertise, and working to develop their strategies for human resources, engagement, and corporate planning. Changes in response to this second report are imminent, each of the CHRE’s fifteen recommendations are being carefully evaluated and will hopefully transform this crucial but failing organisation into one ‘that the public, nurses and midwives deserve.’

Leigh Day has represented many parents in cases of medical neglect at the hands of NMC nurses and midwives. One such pair is Heather Paterson and Iain Croft, the parents of Riley Croft, who died of asphyxia 35 minutes after his birth at the Royal Free Hospital in London. Leigh Day clinical negligence partner Sally-Jean Nicholes helped them in their fight for justice, and it was ultimately decided at St Pancras Coroner’s Court that neglectful medical staff contributed to his death.

Heather and Iain went one step further in the matter and, advised and supported by Sally-Jean, complained to the NMC about the two midwives under whose care they were placed. The NMC found that both midwives’ fitness to practice were impaired. Eventually, however, the council decided that the first midwife was to be was struck off; the second to be allowed back to work under supervision.
Regardless of these punitive measures, however, the stretch of time between the complaint to the NMC, in 2006, and the hearing, in 2011, illustrates that nurses and midwives can be practising for many years after an incident in which their care is subsequently found to be such that they are unfit to practice. Leigh Day hopes that the changes to be implemented by the NMC because of the CHRE report will lead to greater efficiency and promptness, preventing healthcare professionals from practicing for years after their failings. More welcome, however, would be to prevent these severe inadequacies from occurring in the first place.

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