Administrative reform

Accepted.
The Nursing and Midwifery Council has made clear its commitment to implementing the recommendations and achieving the required improvements in the delivery of its regulatory functions set out in the strategic review undertaken by the Professional Standards Authority in 2012, most recently in its 2013-2016 corporate plans.
In relation to the recommendation to appoint a strong leadership team to drive forward turn around work, Mark Addison was appointed Chair of the Nursing and Midwifery Council in September 2012, and Jackie Smith was permanently appointed to the role of Nursing and Midwifery Council Chief Executive in June 2013. In addition, the Nursing and Midwifery Council was re-constituted from 1 May 2013.
The Government has demonstrated its determination to ensure the Nursing and Midwifery Council is an effective regulator that serves its members well. In February 2013, the Government provided a £20m grant to support the Nursing and Midwifery Council to achieve a number of improvements including clearing a backlog of historical fitness-to-practise cases, speeding up fitness to practise proceedings, ensuring free financial reserves are at agreed levels and reducing the effect of an annual fee rise for nurses and midwives. Departmental officials continue to closely scrutinise and monitor the Nursing and Midwifery Council’s progress in making the required improvements within the timescales specified.
In addition, the Government is working on an order under section 60 of the Health Act 1999 to amend the Nursing and Midwifery Order 2001. This is in advance of any measures which may be taken forward following the Law Commission review which is considering the overhaul of the complex legislative framework that governs the Nursing and Midwifery Council and the regulators of other UK health professionals and, in England, social care professionals into a single Act, subject to Parliamentary timetables. Within this section 60 order the Government intends to make a number of amendments including change to achieve greater efficiency in fitness to practise procedures, including a reduction in the overall time that a case takes from start to finish.

The NMC has made a number of changes aimed at improving its administration.

Changes to Fitness to Practise process were identified as key a priority in our response to the Francis Report. In April 2014 it consulted on a range of amendments tor Fitness to Practise and Registration Rules aimed at improving FtP processes and to allow it to function more effectively. Proposals were approved by its Council in October 2014 and implemented on 9 March 2015. In particular, it introduced a new team of Case Examiners to decide whether there is a case to answer, helping improve the efficiency, quality and consistency of decision making. This process was informed by the GMC’s process at the time, which had a well-established Case Examiner role. It also introduced new powers for the NMC Registrar to review Case Examiner or Investigating Committee panel decisions where certain criteria is met. This was a significant improvement as previously it did not have the power to review decisions at their own volition, and instead had to wait for judicial review invoked by a third party.

These improvements to processes will be taken further with the implementation of regulatory reform which will provide the NMC with a more modern and flexible legislative framework. Our vision for legislative reform in fitness to practise in particular is to create a less adversarial process. Fitness to practise proceedings are a way for us to establish whether a professional can practise kindly, safely and professionally. Hearings are only necessary when there is a need to take regulatory action. The NMC’s ambition is to place a greater focus on resolving concerns at an earlier stage and seeking enhanced information-sharing powers so that it can ensure greater transparency and public confidence. There is much more the NMC can do in the interim to deliver a more effective, person-centred and collaborative fitness to practise approach.

In March 2024 its Council agreed a Fitness to Practise Improvement Plan which commits £30 million to fitness to practise over the next three years, with a particular focus on investment and improvement over the next 18 months. It will help to ensure the NMC can make decisions that keep people safe in a more timely and considerate way that will be sustainable into the future. The NMC has better data from process reviews and modelling about the impact of its caseload.

The NMC is currently in a period of significant organisational challenge and change. In particular, following whistleblowing concerns being in raised September 2023, the NMC commissioned Nazir Afzal and Rise Associates to undertake a review into organisational culture. This was an independent report and was published on 9 July 2024 (‘Independent Culture Review’). The NMC has agreed some immediate steps in response to the report and continues to reflect on the recommendations and is planning what actions need to be taken.

The Independent Culture Review highlighted fundamental concerns about the NMCs culture, fitness to practise performance, and approach to safeguarding, and found that people working at the NMC have experienced racism, discrimination and bullying. The NMC has publicly apologised for the failings identified, accepted all the recommendations made in the report, and has committed to addressing the report’s findings and delivering a wider culture change programme at pace.

The Nursing and Midwifery Council commissioned an independent review to assess its progress in addressing recommendations made in the Professional Standards Authority’s Strategic Review of it. The report from this review was published on 15 September 2014. The review concluded that the Nursing and Midwifery Council has made a substantial number of improvements, which cumulatively place it in a much stronger position than in 2012. However, it also highlights areas where the Nursing and Midwifery Council needs to continue to make progress.

The 2012 Strategic Review was clear that high quality leadership was critical to restoring confidence in the Nursing and Midwifery Council’s reputation as an effective regulator. In September 2014, the Nursing and Midwifery Council announced that Professor Dame Janet Finch DBE had been appointed as its next Chair from January 2015.

In summer 2014 the Nursing and Midwifery Council had cleared the backlog of historical fitness-to-practise cases in advance of its December 2014 target, and has increased the number of hearings to more than 22 per day in order to meet the adjudication target by December 2014.

The Nursing and Midwifery (Amendment) Order 2014 came into force on the 11th December 2014. The Order made amendments to the Nursing and Midwifery Council’s governing legislative framework. Associated amendments to the Nursing and Midwifery Council’s rules will come into force in March 2015. The amendments in the Order give the Nursing and Midwifery Council powers to carry out its fitness to practise role and functions more effectively, enabling complaints to be dealt with more quickly and resulting in improved public protection.

This recommendation was accepted by the Government.

In its July 2013 response, the Nursing and Midwifery Council said it was making good progress against the recommendations in the strategic review carried out by the Professional Standards Authority.

In the January 2014 Hard Truths report, the Government referred to amendments made to the legislative framework in relation to fitness to practise procedure, to make them more efficient. The Government also referred to leadership change at the Nursing and Midwifery Council in 2012 and 2013, as well as the provision of a £20m government grant to it in 2013.

The Nursing and Midwifery (Amendment) Order 2014 made amendments to the Nursing and Midwifery Council’s governing legislative framework. Further changes were made in the Nursing and Midwifery (Amendment) Order 2017.

In the February 2015 Culture Change report, the Government said that the Nursing and Midwifery Council had cleared the backlog of historical fitness to practice cases in summer 2014.