What about the patient?: Jessie Cunnett

What have you done?

I joined NMC as head of public support at the start of 2018. The role was created as a result of the tragic events at Morecambe Bay and the important learning that the NMC had not listened to families, did not sufficiently value their evidence and did not treat them well.  

I arrived at a time when the NMC was grappling with how it needed to think differently, develop a different culture and a different relationship with patients, people who use services, families and the public. At the time, there was no one in the organisation with the skills and knowledge to do that. I joined with an almost blank sheet of paper and a remit to do something very different. It was both exciting and nerve-wracking! 

I was surprised when I started in my role. Fitness to practise was run on a linear pathway, much like a factory model. Deciding if someone was unfit to practice felt like a technical review of a potentially malfunctioning component part. With considerable effort on refining the process, often at the cost of the people the process was set up to serve. Most of the time people in healthcare are trying to do a good job. Even if they are falling short, they are still human beings delivering care to other human beings. If that is not hard-wired into your regulatory approach you run the risk of missing the stuff that matters the most. 

Using the Professional Standards Authority’s lessons learned review report, I helped NMC understand that it was spending too much time on process and was too disconnected from people. I championed the concept of person-centredness as an approach to regulation. The FtP strategy was developed to include a person-centred approach as the number one priority. I was clear that meant we should be concerned with all persons; not only the families affected by FtP but nurses, midwives and nursing associates too.   

Last February we launched a 24-hour emotional support line provided by Victim Support. It is for families and witnesses affected by an ongoing investigation and the service is shared with the General Medical Council. 

We created a team of public support officers. That helps ensure that we have a point of personal contact for every family affected by FtP, who stays with them throughout, and with the opportunity of face-to-face contact. Another change was in how we listened to families during cases. I got to know the mother of a young man who had been abused by a registrant. The family had very little involvement in the case, the mother had no opportunity to give her views and she was not properly looked after. The nurse was allowed to return to practice but the PSA instructed the NMC to re-hear the case. The second time round the family was properly involved and this had a lot to do with a more person-centred approach from our lawyers. 

The mother is now working with the NMC as a member of the public support steering group which I set up. This has been another key change. I felt the need for a group of people to help and guide but also challenge me in moving the NMC towards a more person-centred approach. There are now 25 people on the group. It’s very diverse with members including people who have been directly affected by poor care, as well as charities and advocacy organisations. It’s run on co-production principles and so also includes a member from the Royal College of Nursing and a midwifery advisor and NMC colleagues. The level of debate is excellent and it is great to see people who have been treated so badly by the system nevertheless being able to make such a positive contribution. 

What was your motivation?

I am passionate about amplifying the voice of patients, families and the public. People must have the chance to be heard on the things that matter to them. I founded Patient and Public Solutions, which is a consultancy. I was involved in the turnaround at Mid Staffordshire Trust and in the surrounding areas. This was at a time when trust and confidence had totally broken down. Together with local people we created Engaging Communities Staffordshire, a community interest company that allows the people of Staffordshire to lead and to have their own voice. 

Coming to the NMC made a lot of sense as a next step. Organisations that have got things badly wrong can be braver about making change. It was too big an opportunity to miss!

How were patients and families involved?

Involving people is integral to the whole approach. It starts with understanding the problem from what people are telling us, not what we think it is. The locus of control should not be within. We need to stop making people come to us. Let’s do things on their terms in their time, outside our walls and in their way.

What was the impact?

It’s early days but I think we are making a cultural impact. People in the NMC are starting to understand what being person-centred means to them. We are evaluating people’s experiences and we are starting to see families understanding the processes better and being taken more seriously. For example, people might still be angry about the outcome of an FtP case but nevertheless appreciate that they were heard and given support.

What have you learned?

Fitness to practise is a highly legalistic, mechanical, specialised world. There are real difficulties in how to embrace the world of people and their experiences within that. But it must be done because in the end this is not about making widgets and we can’t ignore people’s experiences. 

It hasn’t cost very much to make the changes we’ve introduced. There are new specialist staff and support services but I wanted to make being person-centred everybody’s day job. So we have put the emphasis on embedding change rather than going for bells and whistles.

What next?

The work so far has been largely located in the FtP part of the organisation because that is where the immediate need and the contact with families was. The NMC has now created a new assistant director of public engagement role, a first for a professional health and care regulator. It’s more senior, covers the whole organisation and builds on the work I have been leading.

What is your message to HSJ readers?

Health and care is a people business. People matter. Their experiences matter. We must never lose sight of that.

The past What about the patient?

Dr Amir Hannan

David Gilbert

Annie Laverty