INDMA Forum 31 October 2024

Agenda items covered

1. Welcome from the Chair

• Sam Foster (SF), Executive Nurse Director of Professional Practice, NMC, and Chair of the IDNMA Forum opened the meeting.
• SF led a round of introductions and ran through the agenda.

2. Culture review update

• Karen Lanlehin (KL), Head of Culture Transformation, provided an update on the work the NMC has been doing since the Forum last met in August to implement the recommendations of the independent culture review.
• The NMC has accepted all the recommendations made by the review. We are now in the process of implementing immediate actions and planning for long-term changes. We understand the impact that culture has on public safety and the significance of this.
• We have set up a safeguarding hub as part of the fitness to practise (FtP) process. When concerns are raised about a registrant, this allows it to be looked at through a safeguarding lens.
• Kuljit Dhillon, who has recently been appointed as the Executive Director of Strategy and Insight, will also be the Executive Director lead on the culture review.
• We have appointed Anthony Omo on a three-month secondment from the General Medical Council to advice the team on improvements we are making in our regulatory work. Following the independent culture report, we have committed to identifying external expertise to provide insight, support and advice on our FtP plan.

Discussion on this item included:

• Cultural support cannot be viewed as a competence; instead, we should be looking for cultural humility. Cultural humility includes self-awareness, openness, and person-centred care and support.
• It would be good to get more clarity on what cultural outcome the NMC is hoping to achieve (Action 1).
• Cultural differences and behaviours need to be accommodated by those already working in the UK.
• The NMC is planning for a day in December to discuss FtP with registrants in the process to hear more on their experiences of it.
• How does the NMC consider the concerns they receive about professionals? How are written concerns and evidence examined from employers, and is the same approach taken with all employers? (Action 2)
• Clear guidance needed on what meets the threshold for a referral to the NMC, to allow for consistency (Action 2).

3. Greenwich University research

• Caroline Kenny (CK), Head of Research and Evidence, spoke to the Forum about the research we commissioned the University of Greenwich to do into our Fitness to Practise process.
• In 2017, we commissioned the University of Greenwich to examine disproportionality in fitness to practise progress and outcomes. Their research found that while Black and minority ethnic professionals are more likely to progress and receive a more serious outcome, this is driven by the fact that they are referred (more often) by their employer.
• In 2020, we re-ran this analysis in our Ambitious for Change research. We found that disparities for Black and minority ethnic professionals still exist and seem to be driven by diversity characteristics not who refers them. We also found differences for other groups of professionals in terms of case progression and outcomes at adjudication stage.
• We committed to commissioning an independent review into our fitness to practise decision-making to help us understand why these differences exist. We’ve since commissioned the University of Greenwich to undertake this work.
• The Ambitious for Change analysis is ongoing, but the findings are expected in early 2025. We will share the findings with the IDNMA Forum and consult with the group on our proposed next steps.

Discussion on this item included:

• Disappointment that it has taken this long to carry out research on why these disproportionate referrals exist, but pleased it’s finally happening.
• It would be valuable to have a representative from the Employer Link Service (ELS) attend a future meeting to hear more on what they’re currently doing to address disparities in our decision-making processes (Action 1).
• There is a rise in islamophobia and antisemitism due to the ongoing conflict in the Middle East – look into this going forward when considering biases in referrals (Action 2).
• Can the NMC consider providing feedback when there is no case to answer, especially when referrals seem to clearly be driven by biases (Action 3).
• Would like to know which representative bodies are part of the Professional Standards Authority (PSA) Oversight Group (Action 4).
• When we use the term ‘Black nurses’ it diminishes ethnicity and identity. Would like to know how ‘Black professionals’ are being defined in this research – does it mean Black African/Caribbean? Does the research cover their different experiences? It would be good to review the language the NMC uses, to encourage us to keep moving and take positive position. It would be valuable to have Mac Alonge (EDI Advisor to the NMC Executive Board) toa attend a future meeting and speak on this (Action 5).

4. Safeguarding in the FtP process

• Nicola Burns-Muir (NB-M), Specialist Advisor in the Employer Link Service, provided an update on a recent piece of work that has been carried out to set up a safeguarding hub as part of the fitness to practise process.
• Our regulatory work brings us into contact with many people in difficult or vulnerable circumstances, and we need to elevate the focus on safeguarding within our casework.
• We have now established a safeguarding hub, which means that since September, every referral received in screening has been looked at through a safeguarding lens.
• All our wider fitness to practise teams will be using this by the end of the calendar year.

Discussion on this item included:

• It is useful to understand the difference between wellbeing and safeguarding at the NMC and differentiating different needs.
• SF shared details on the new public referral form that will be needed in order to make a referral to the NMC. It will require more detail than before, and a minimum data set will be needed. Currently, 70% of public referrals are closed at screening – the introduction of a detailed form will help with evidence and make it clearer on which referrals are serious, which are not, and which might be based on biases or discrimination.

5. International Registration: The process of receiving a PIN following the NMC Test of Competence

• Kathleen Dalal-Molloy (KD-M), Senior International Registration Manager, provided an overview of the International Registration team’s work, their processes, and how they handle overseas registration applications.
• The International Registration team works closely with the Test of Competence team, who are responsible for looking after the CBT and OSCE tests that international applicants take as part of their applications to ensure a smooth and efficient customer journey.
• Between 1 April 2022 and 31 March 2023 the team supported international 25,006 applicants join the register for the first time.
  Registration requirements include identity verification, qualifications, health declarations, an approved English language test and supporting statements on character.
• The team aims to assess 95% of applications within 30 calendar days of receiving a complete application.
  
  KD-M explained some of the top reasons for repeat assessments, which include (but not limited to):
  
• A SIFE (supporting information from employer) form not being completed properly
• The applicant not providing evidence that their training was conducted in English.
• The applicant has not provided consent for their OET result to be verified.
• The applicant’s support character verification or police clearance certificate is out of date.
• If a representative of a IDNMA organisation is supporting an overseas trained nurse in the registration process, they can nominate the IDNMA member to be the authorised third party who checks their application status.

Discussion on this item included:

• There seems to be a variation in people’s experiences and what documentations they are asked to provide for registration – standardisation would help the process (Action 6).
• Education curriculums can vary tremendously, as can the different systems of preceptorship. How does the NMC work with organisations to check the standards? Are there organisations that support the NMC with this? (Action 6).
  o In a future meeting it would be helpful to hear what good relationship management looks like between international stakeholders, ELS and the NMC (Action 7).

6. Fitness to Practise panel member recruitment update

Kelly O’Brian (KO’B), Panel Support Team Manager, provided an update:

• In July 2024, we announced we were recruiting for panel members and chairs to assist with fitness to practise cases. The application window was live for a month, and we received 1,729 applications. 919 of these were from professionals on our register, and 810 were from laypersons.
• The diversity of the applications has been strong – 35% of applicants are from a Black, Asian and minority ethnic background (up from 16.5% of applicants received last year). This is much improved representation, as 30% of professionals on our register (as of March 2024) are from a Black, Asian and ethnic minority background.
• We are working towards appointing 140 panel members who will start their roles by the start of February 2025. 55 of these appointments will be for panel chairs, 60 will be registrants, and 80 will be lay.
• We are currently at the interview stage (the final stage) of the application process. Over a 9 week period we are doing 450 interviews. Interviews are with a panel of three, one internal NMC assessor, one external NMC appointed assessor (a previous Panel Member or Appointments Board member), and an Inclusive Boards assessor.
• The number of candidates we are interviewing is high because we are hoping to create a reserve list who meet the minimum criteria but will not be appointed in late Jan 2025. They may be called upon in the next couple of years and will be put forward to our Board and Council for appointment as they are needed.
• K’OB thanked the IDNMA members on the call for sharing the panel member opportunity with their colleagues.

Discussion on this item included:

• It’s great to see the awareness work that has been done in attracting a diverse pool of candidate, and hope that the percentages of applicants from BME backgrounds represent those that are appointed.
• It would be valuable for KO’B to come back to the group to update on the diversity of the appointments made (Action 8).
• Forum members encouraged and supported people to apply for panel recruitment. Aware that some senior registrants were not even considered for an interview. What criteria is being used in selecting people to be shortlisted? It would be helpful if Kelly came back to the group to explain in more detail what criteria is used in selecting candidates for interview, how more support can be given to those who apply, and to provide assurance on how we are confidently assessing those from BME backgrounds. Looking at a small sample would be useful (Action 8).
• K’OB explained that psychometric testing, which has been used in previously recruitment rounds, has been removed this time around.

7. AOB, Reflections and closing remarks

Signposting IDNMAs for FtP Support

• Orla Mackinnon asked IDNMA colleagues whether they’d be happy to have their associations included in a list of organisations on the NMC website who are willing to offer support to registrants involved in a fitness to practise process.
• Including organisations on the website would offer an additional way for registrants who may not have union representation or feel that they are unable to rely on advocacy from their employer, to seek support from a network of peers that they feel comfortable with.
• Forum members were supportive of this, and OM said as a next step she would email colleagues to get written consent (Action 9).

Updates to Midwifery Panel

• Tracey MacCormack updated the group on changes to the Midwifery Panel. We are reviewing who chairs this meeting and are changing the name to the Midwifery Strategic Advisory Group. We are also considering reviewing membership to make it more streamlined and amplifying the service user voice.
• A roundtable discussion on ELS work would be useful to have, ideally before next Spring (Action 10).
• IDNMA Forum meets twice a year for our longer, main meetings – we should think about if this frequency is working (Action 11).

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