Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence.
For the Nursing and Midwifery Council, 2018 was an annus horribilis. Its long-standing chief executive resigned shortly before the Professional Standards Authority published a damning report, which found the NMC had put the public at risk from poor care. The report also discovered the regulator ignored numerous concerns raised by the police about the conduct of midwives at Morecambe Bay, did not take families seriously and was not transparent in its processes.
Andrea Sutcliffe – previously chief inspector of adult social care at the Care Quality Commission – was brought in and has made it clear the regulator had a lot to do. Speaking at the launch of the consultation for its five-year strategy in London last week, she said the regulator was “rightly criticised for the way we treated people when they came to us with concerns about poor care”.
Ms Sutcliffe – now more than six months into the role – called the consultation launch a “milestone moment” for the NMC and stressed the organisation “cannot be an island”.
“We don’t have all the answers and we need to work with other people,” she remarked. “We need to ask, we need to listen and use the wisdom of others to shape our plans. Leaders need to have humility.”
With 698,000 nurses, midwives and now nursing associates regulated by the NMC, Ms Sutcliffe stressed getting its new five-year strategy right matters for its members – and matters for patients.
“How do we make sure we treat people with dignity and respect?” she asked, and drove home that the NMC must operate with kindness.
An audience member honed in on this last point – how exactly will the NMC reflect the refreshed ambition to be kind?
Panel member Katerina Kolyva, executive director of the Council of Deans of Health, said it is possible for a regulator to be kind and clear at the same time.
“The regulator doesn’t need to be the police to be effective. [It can have] a positive narrative while meeting standards,” she said.
The NMC is consulting on five main themes, which include building its relationship with the public, collaborating with others and strengthening its relationship with its professions. “Public confidence in us a regulator is affected by how we treat people who raise concerns with us,” it said in the document.
Regulators need to rebuild trust
The ambition for better collaboration is an interesting one. A point raised in the discussion was whether there should be a single code of practice between the different healthcare regulators, with different competencies according to the occupation. According to Unison’s head of professional services Gail Adams, the difference in staff experience is partly what makes them fearful of the regulator.
Ms Sutcliffe said, although a single code of practice won’t be happening any time soon, common standards and working better together was something the regulators are trying to do. “We are looking at how can we use information about culture to share back out into the system what people could do at a local level to respond to concerns we see coming through,” she added.
Perhaps the other regulators could learn from the NMC’s reflections and its ambitions to extinguish the fear often felt towards it from its registrants.
From conversations with doctors – both junior and senior – it is clear many remain afraid of the General Medical Council, and this climate of fear has worsened post Bawa-Garba. Kindness is not a word many would associate with the medical regulator, despite assertions from its chief executive it wants to be seen as “less of an ivory tower”.
An independent report, commissioned by the GMC and carrried out by former cardiac surgeon Leslie Hamilton, found there has been a “fundamental loss of confidence” in the regulator. It said the GMC should acknowledge its relationship with the medical profession has been severely damaged and it must learn from this.
Could the same apply to Ms Sutcliffe’s former employer, the CQC? Research by NHS Providers discovered trusts reported the regulatory burden their organisation experienced was excessively high and responses from its members also described the health and care regulator as “heavy handed”.
The NMC is clear – a balance must be struck between being a rigorous regulator and not instilling a climate of fear. Perhaps if the various regulators work together, they can find the sweet spot and rebuild trust across the NHS workforce.