The Commons Health Committee published, today, its reports on the healthcare regulators NMC and GMC.
The Annual accountability hearing with the General Medical Council is available here.
The Annual accountability hearing with the Nursing and Midwifery Council is available here.
Back in 2008, Ben Bradshaw, then Minister of State for Health Services, commissioned a report by the CHRE (C0uncil for Healthcare Regulatory Excellence) – the Regulator of the Regulators. The report highlighted a poor level of service to complainants (sometimes insensitive or misleading information was being given to them) significant delays in communication with complainants, poor quality correspondence and long delays in fitness to practise hearings.
Nothing has changed since 2008, and the CHRE’s 2010/11 annual review still finds concerns ‘about the number and nature of the improvements that the NMC still had to make, particularly around its customer care and, its management of serious cases and the timeliness of its case progression’.
I agree wholeheartedly. I may show bias – but after nearly 4 years of waiting for them all to get their respective acts together, who could blame me.
- ….. the Committee remains very concerned about the existence of low standards of basic nursing care in our acute hospitals and care homes, which appear to be in breach of the code of conduct for nurses and midwives. We are particularly concerned about this in light of the ongoing inquiry into Mid Staffordshire NHS Foundation Trust, the Winterbourne View scandal and the recent Health Service Ombudsman report into care of the elderly in hospital.
- This evidence presents a challenge to the NMC which is responsible for professional standards in the nursing and midwifery professions. Based on its existing guidance on care of the elderly, we propose that the NMC should develop a programme of action to deliver a demonstrable improvement in outcomes for this vulnerable group.
- Furthermore, the NMC needs to send a clear signal to nurses and midwives that they are at as much risk of being investigated by their regulator for failing to report concerns about a fellow registrant as they are from poor practice on their own part.
The CQC is failing older people; the NMC is failing older people. They are both reactive, whereas they both need to be pro-active if they are to protect people in care. Over the last years, I’ve come to understand that systems of all shapes and sizes are sadly lacking. The NMC report in particular confirms to me what I already suspected, in a way, but it distresses me beyond imagination. How have we come to this?
To save you from reading the whole report, here are a few more extracts. (The use of blue is mine.) Make your own mind up about it all.
The report mentions the transition to an all-degree nursing profession by 2013 and the perception that nurses may have “stepped back” from basic nursing care.
- However, the Committee raised the issue that many basic nursing care tasks that used to be undertaken by registered nurses are now undertaken by healthcare assistants. The NMC estimates that there are 300,000 unregistered healthcare support workers and an unknown number of assistant practitioners currently working in the UK. The NMC has “growing concerns” that healthcare assistants (HCAs) are increasingly working on tasks previously undertaken by registered nurses but remain unregulated. This means that there is little control over entry to employment and no final sanction of removal from a register when competence or conduct are not of a sufficiently high standard.
- The NMC commissioned a scoping review of HCA registration which found that there is evidence of HCAs taking up work having been dismissed from other roles for misconduct, and that they are undertaking tasks for which they have not been trained. Based on these findings, the report states that a strong case exists for regulating HCAs.
- They went on to tell us about assistant practitioners who undertake complex procedures such as suturing and giving drugs, but are also unregulated.
- As previously mentioned, the Committee has ongoing concerns about the care and treatment of older people both in hospitals and care homes. Of particular concern to the Committee is the lack of regulation of a range of groups who undertake many basic nursing care tasks.
- The Committee endorses mandatory statutory regulation of healthcare assistants and support workers and we believe that this is the only approach which maximises public protection. The Committee notes that the Government intends to give powers to the relevant regulators to establish voluntary registers for non-regulated professionals and workers, but would urge it to see healthcare assistants, support workers and assistant practitioners as exceptions to this approach who should be subject to mandatory statutory regulation. However, the NMC needs to make significant improvements in the conduct of its existing core functions (such as in how it manages fitness to practise cases) before powers to register these groups are handed to it.
- The current standard for re-registration—completing 450 hours of practice and 35 hours of professional development—is wholly inadequate, as this tells patients and the public nothing about the quality of nursing and midwifery practice undertaken by the registrant. There is also no routine assessment of whether nurses and midwives have even met this minimal standard. The NMC instead relies on honesty within the profession and “whistle-blowing” when registrants are dishonest. For many nurses and midwives this may well be adequate, but for a significant minority, including those most at risk of manifesting low professional standards, it may not be.
- Nurses and midwives from the European Economic Area and Switzerland seeking to practice in the UK cannot routinely be language and competence tested by the NMC. The NMC, along with other professional regulators and the Government is working towards resolution of this with partner organisations across Europe. The Committee takes the view that the current legal framework is at odds with good clinical practice, which is clearly unacceptable.
- The Government, the NMC and the other health professions regulators must now grasp this as a significant risk to patients and dramatically pick up the pace in resolving or mitigating it.
What a way to run a railway!
As for the GMC report, it’s much of a muchness and more of the same.
- Some of the decisions made by fitness to practise panels of the GMC defy logic and go against the core task of the GMC in maintaining the confidence of its stakeholders. Furthermore, they put the public at risk of poor medical practice.
- The GMC holds the dual but potentially conflicting roles of prosecutor and adjudicator in fitness to practise cases.
- The GMC has told us that between 120 to 150 doctors must have known something was going badly wrong at Stafford Hospital yet few raised concerns through the proper channels.
- A clear signal needs to be sent by the GMC to doctors that they are at as much risk of being investigated by their regulator for failing to report concerns about a fellow registrant as they are from poor practice on their own part.
- However, in principle, we believe that it is right that regulatory authorities should not merely react to poor practice but should, where possible, pre-empt it.
- For example, a higher proportion of overseas qualified doctors work in peripatetic locum situations. In moving around within the NHS and not belonging to one organisation, the threshold for referral might be lower because there is no local governance around that doctor when they move on.
After nearly 4 years of ongoing investigations into the circumstances surrounding the death of my own relative in care, I understand more of the pathetic systems of regulation in place. I had no idea then of the way in which so many of our Regulators are failing to regulate.
The one thing I omitted to take on board, when I placed my complaints before the GMC and the NMC, is the fact that you cease to be the concerned complainant once you hand over all of the supporting evidence you can think they might need. You become a witness.
You spend hours, days, weeks putting together your evidence. You spend more weeks, running into months, which then turn into years ‘assisting’ the legal team working on behalf of the Regulator in question. You chase, you correct, you supply further information.
Then the drawbridge is pulled upright. Silence reigns. The weeks pass by, the months pass by, the years pass by. You make polite enquiries as to progress. Obfuscation and downright untruths come your way, all disguised as ‘business’, but all masking inefficiency. That’s where you started – with the inefficency of those charged with the duty of care.
They failed to care, and the Regulators fail to care either.
On it goes – on and on and on.
They hold meetings to ‘facilitate’ the investigation and then the planned ‘hearings’. The Registrants and their legal team are allowed to attend the ‘meetings to facilitate’.
You, the nuisance complainant turned witness, are not allowed to attend. You are not allowed to see one single shred of their evidence submitted, but they are allowed to see everything you submitted.
On it goes – on and on and on. Slowly progressing – or regressing? Towards the hearings. Perhaps. Perhaps not.