Nursing and Midwifery Council Investigation of systemic concerns

Accepted in part.
The Nursing and Midwifery Council have made it clear that they are determined to work closely with other regulators, including the Care Quality Commission to share information and analyses, and that it should not have to wait until a disaster has occurred to intervene with its fitness to practise procedures. The Government notes that the Nursing and Midwifery Council have stated that they do not wish to be given the role of directly investigating systems issues given that the primary responsibility for such issues rests with the Care Quality Commission, but that they intend to address the underlying issue identified in this recommendation by working closely with the Care Quality Commission and other regulators to ensure that the most serious matters are appropriately addressed in a systematic manner.

Since the publication of this Inquiry, the NMC has made a number of improvements aimed at enhancing its data and information sharing capabilities and strengthening how it works with our partners. This includes the introduction of new Memorandums of Understanding (MoUs) and joint working protocols with system partners, many of which were made in direct response to this review.

In 2014 the NMC revised its MoU with the CQC. This was later updated in 2018 and the NMC is currently reviewing this arrangement now. The NMC has also updated its joint working protocol in 2017 which provides more detailed working arrangements in support of the MoU. The NMC have introduced new MoUs with a range of bodies, including the Care Inspectorate, Healthcare Inspectorate Wales, Healthcare Improvement Scotland, and the Regulation and Quality Improvement Authority. These are regularly reviewed to ensure they are fit for purpose.

The NMC developed an information sharing agreement with DBS in 2018, which was last updated in 2020.

In December 2021 the NMC signed up to the Emerging Concerns Protocol in England. More recently, the NMC and other regulators in Northern Ireland endorsed a new Intelligence Sharing Framework to address emerging concerns and share information.

In 2020 the NMC introduced its Regulatory Intelligence Unit (RIU). This represented a significant improvement to the way that it monitor, triangulate and share intelligence about potential patient safety risks with its partners. This team works closely with all internal directorates and external organisations to locate, assess and action all available data and information and have helped the NMC become a more intelligence led and dynamic regulator. RIU is responsible for undertaking a quarterly analysis of FTP data to gain insight into its FTP work and emerging trends or themes, and for responding to or sharing this with system partners for action. This team was introduced in direct response to recommendations made by this Inquiry.

NHS England continues to work alongside key regulators, CQC, Health and Care Professions Council, General Medical Council and the Nursing & Midwifery Council through the Joint Strategic Oversight Group (JSOG) function to provide a dedicated space for regulators to share intelligence and develop aligned approaches to support organisations.

The Nursing and Midwifery Council and the Care Quality Commission have refreshed their Memorandum of Understanding that sets out how and when to share information, and are developing a protocol to support staff in implementing the commitments in it. The Nursing and Midwifery Council provides the Care Quality Commission with data from its work on settings due for inspection and is working to improve the quality and accessibility of this data. It has agreed a data strategy to support those improvements.

The Nursing and Midwifery Council is undertaking an internal quality assurance exercise on its own practice under its Memoranda of Understanding, the results of which will inform Memoranda being developed with other regulators. It will first report on the activity occurring as a result of partnership agreements and then undertake a more qualitative assessment of the impact of its own practice on safety and quality.

In its materials about how to raise concerns, the Nursing and Midwifery Council helps to signpost the role of system regulators to registrants and members of the public.

This recommendation was accepted in part by the Government.

In its July 2013 response, the Nursing and Midwifery Council stated it did not wish to be given the role of directly investigating systems issues, and that primary responsibility lay with the Care Quality Commission and other regulators. The Nursing and Midwifery Council said it would work more closely with the systems regulators and share their information and analyses on the working of systems in organisation in which nurses and midwives are active.

In the 2015 Culture Change report, the Government said that the Nursing and Midwifery Council had updated its memoranda of understanding with the Care Quality Commission, setting out how and when they would share information.