• New NMC chief executive says regulator will raise “systemic” problems
  • “Just” approach sometimes requires striking someone from register
  • Andrea Sutcliffe says NMC has focused on improving after Morecambe Bay scandal

The new chief executive of the Nursing and Midwifery Council has told HSJ she wants the regulator to highlight more of the systemic failings which underpin concerns about individual nurses.

In her first interview, Andrea Sutcliffe told HSJ she accepted the NMC had put patients at risk in its handling of the Morecambe Bay scandal, which led to the resignation of her predecessor, and said it was now focused on improving.

Ms Sutcliffe, who was previously the chief inspector of adult social care at the Care Quality Commission, said she was hoping to develop the NMC’s approach to protecting the public by telling NHS providers about systemic issues it identifies in its investigations of individual nurses.

She warned NHS trusts they needed to ensure nurses and midwives were able to work in environments aimed at delivering person-centred care to avoid risks linked to task-based care, particularly as new roles such as nursing associates enter the workforce.

She said where nurses acted recklessly it was “absolutely their responsibility”, but if NHS trusts had put nurses in “a situation where it is impossible” to avoid this, because of the environment, the NMC should highlight it.

“One of the things I want to explore going forward is what more can we do when these things happen to understand the reasons why they’ve happened and then feed that insight back to the individual employer or to the system as a whole,” she said.

The NMC and other regulators already have protocols in place to share concerns over poor care, but Ms Sutcliffe said: “There is more that we can do. Where we can see that there are systemic issues that it does not appear are being addressed, I think we absolutely have to see our role around public protection and promoting safer better care as using our voice to identify those problems so the right people can take the right action to address them.”

Ms Sutcliffe said the NMC would take a “just” approach to registrants. “It’s about [being] just. And sometimes it will be entirely just that someone is taken off the register because they have behaved recklessly, they have no insight and they are not prepared to change and develop, and you wouldn’t want to be cared for by them. But equally if there are people who have been badly let down by the system, have shown insight, have learnt from what went wrong and really are fit to practise then they should.”

She also said she was concerned how some trusts were using potential referral to the NMC as a threat. “Some employers have used and probably still do use the NMC as a threat,” she said. “There are lots of referrals we receive that don’t go anywhere and there is more we can do to think about why that is.”

Asked about the introduction of new care roles, such as the nursing associate, who will be registered with the NMC, she said she supported their introduction but warned organisations it was incumbent on them to “create an environment within which person-centred care can flourish”.

Nursing research has indicated the introduction of the roles is likely to pose risks, including via care becoming more “task-oriented” – or split up into different functions, increasingly carried out by different individuals.

Ms Sutcliffe added: “There is something absolutely critical about us thinking through how do we do this so it is person-centred around the needs of the individual and in an environment that supports professionals of whatever hue to provide that care in a coordinated and coherent way.”

Ms Sutcliffe accepted the NMC had put patients at risk at the University Hospitals of Morecambe Bay Foundation Trust but said it had since reflected on what had happened and was determined to improve.

She added: “We got things wrong, we did not treat people well and that had an impact on them and their lives and we have to acknowledge that.

“I think the organisation then did take a very hard look at itself. I can see within the organisation people are really keen to do things differently. They acknowledge we haven’t treated people well and they have reflected on that themselves.”

She said she wanted the NMC to be a “human regulator that understands this is all about people and what we do affects people in a variety of different ways and we need to be mindful of that and treat them all with dignity and respect”.

Ms Sutcliffe also revealed plans to invest in the NMC’s infrastructure and processes, reducing manual processing, including to try to reduce risks of human error in the handling of evidence. It will also produce a new strategy with the aim of being clearer about its purpose and role.