Recommendation 22

HM Government Not Addressed

87. We welcome the Committee’s recommendation that the Nursing and Midwifery Council (NMC) and the General Medical Council (GMC) have a role to play in helping to end the blame culture that currently exists in the health sector. DHSC is working with the GMC, NMC and other partners to ensure regulated healthcare professionals feel supported to speak out when mistakes are made. This will help to create environments that enable learning. Steps taken by the GMC and NMC 88. The GMC and the NMC both recognise that more needs to be done to address the blame culture and both have undertaken work to support the development of just cultures. This includes the NMC’s guidance for employers on referrals, a new resource to support employers to resolve concerns locally, and guidance for professionals on speaking up, as well as its animation titled ‘Caring with Confidence’. The GMC’s outreach teams have delivered over 400 sessions on raising and acting on concerns about patient safety. These sessions encourage doctors to actively engage with and participate in patient safety improvements and embrace a just culture. 89. The NMC has also prioritised making improvements to its Fitness to Practise (FtP) procedures. It introduced a more systematic approach towards understanding the context in which incidents occur, rather than focussing on the actions of an individual and apportioning blame. The NMC has also recently improved its guidance and support for those involved in FtP procedures. The NMC has plans to publicise and embed these changes and to understand the impact this has on professionals. 90. In 2019, the NMC published its new Future Midwife Standards3, based on the best global evidence of what is needed to deliver effective and safe care. The NMC is committed to working with partners to embed these important standards across midwifery practice. 91. The GMC recognised that to build trust and confidence as a regulator, it must address any perception of fear that registrants may have. The GMC has reported that the number of cases relating to clinical error brought before Tribunals is very small and their evidence suggests a consistent trend towards fewer cases. The GMC has developed guidance and resources to support both doctors and employers in raising and acting on concerns and to better understand the effect of human factors when things go wrong. 92. In 2018, the GMC commissioned three independent reports4 aimed at supporting a profession under pressure and improving the GMC’s relationship with doctors. The GMC has taken many steps to address the recommendations outlined in the reports and although the scope of this programme is wide, there is commonality across all three reports in respect of emphasising the need to move from a blame to a learning culture. Reform 93. DHSC has consulted on extensive changes to the legislation of all the healthcare professional regulators including the GMC and NMC. Proposed changes will include; providing greater discretion to determine which FtP complaints should be investigated; greater scope for resolving complaints through a process of agreed outcomes without the need for formal FtP Panel/Tribunal hearings; and removing the GMC’s power to appeal decisions of the Medical Practitioners Tribunal. 94. DHSC is working to introduce legislation for these reforms in the course of 2022. These changes will support the GMC and NMC in putting in place FtP procedures which are less adversarial. Next steps 95. A key strategic theme in the GMC’s 2021-25 corporate strategy5 is ‘enabling professionals to provide safe care’. The GMC is scoping how it can take this forward. Examples relevant to recommendation 11 include; collaborating with the NMC on a virtual version of Professional Behaviours and Patient Safety (PBPS) programme, with a plan to pilot with a focus on maternity services; and piloting an updated Responsible Officer referral form as part of its work on Fairer Employer Referrals. 96. The NMC corporate strategy 2020-20256 sets out its commitment to learning the lessons from inquiries into major failings of care. The NMC has committed to a new and more dynamic approach to developing professional standards, to reviewing its Code and to evaluating the initial impact of its new FtP initiatives. To further improve patient safety and system-wider learning, the NMC is piloting work with the GMC and the CQC to share data and support safe cultures; and working together with the HSIB to collaborate on information sharing. 97. The NMC has recently commissioned research to understand how its registrants, the public, employers and its partners understand and engage with it as a regulator. As part of this research, the NMC will explore maternity services, patient safety, and blame culture. The NMC will use this information to develop its communication and engagement approaches.