INMA Forum 3 April 2024

Agenda items covered

1. Welcome from the Chair

• Sam Foster, Executive Nurse Director of Professional Practice, NMC and Chair of the INMA Forum, opened the meeting by providing some context as to why the NMC had decided to start the Forum.
  • The NMC recognises the need to engage with internationally educated and diaspora professionals because they make up such a significant proportion of the register, and we know that they are not always given the opportunity to thrive in their roles.
  • As well, the 2023 Spotlight report highlighted the disparity of experiences for internationally educated and diaspora professionals compared to other professionals on the register, both in the workplace and when going through NMC processes (ACTION 1).
  • These issues affect internationally educated and diaspora professionals’ ability to provide the best care possible. By creating the Forum, the NMC can work with the groups that represent these professionals to influence change within the sector and throughout the work of the NMC.
    
    
• The purpose of the Forum is to:
  • Ensure that the expertise, evidence, experience, and knowledge of internationally educated and/or diaspora professionals informs and challenges all that we do as we regulate, support and influence.
  • Actively involve internationally educated and/or diaspora professionals in co-producing the NMC’s strategic work as it considers the future of nursing and midwifery regulation in the UK.
  • Enable the NMC to work together with internationally educated and/or diaspora professionals to develop strategic policy and operational decisions, helping us support safe, effective and kind care for the public (ACTION 2).
    
    
• The commitment from the NMC is to listen to attendees of the Forum, learn from their experiences and use their expert knowledge for the betterment of internationally educated and diaspora professionals, and the people they care for.
  • There have been some concerns raised about the NMC’s Fitness to Practise (FtP) processes, as well as our internal culture, resulting in independent investigations into the issues. We are committed to embedding any recommendations from the investigations into our organisational processes.
  • As part of that, we want to work with the Forum so they can influence our work in FtP and ensure we are making changes that will benefit the professionals they represent.

2. Reflections from a member of the INMA Forum advisory group

• Professor Parveen Ali, member of the INMA Forum advisory group and representing the British Pakistani Nurses and Midwives Association, gave her reflections on why the INMA Forum is so important.
  • The NMC has the negative reputation for ‘taking away PINs’ and so there is some reluctance for professionals to work with them. Providing this safe space for discussion is a first step to ensure that internationally educated and diaspora professionals can shape the NMC’s work.
  • It’s important to understand what the remit of the NMC is so any discussion at the Forum is useful and constructive. The NMC doesn’t have the ability to change everything, and so the actions taken forward need to be ideas that are achievable.
  • The INMA Forum can be used as a way to help the NMC understand the cultural differences of internationally educated and diaspora professionals. Whether that is for context in an FtP case, providing training to employers or ensuring that consultations are accessible to professionals with varying backgrounds.

3. Support: What does the NMC do?

• Sam Foster began this item by explaining that the FtP process is highly legalised, which means there are steps and procedures within it that are difficult to change. However, the FtP improvement plan does take into account that there are ways the NMC can ensure their regulatory processes are fairer and kinder and have put them into a plan that will be actioned over the next 18 months – 3 years (ACTION 3). Part of being fairer and kinder is understanding the language and terminology that people use to describe themselves (ACTION 4).
  
  
• Discussion on this item included:
  • What, if any, consequences are there for referrals which result in no case to answer? Given that internationally educated and diaspora professionals are more likely to be referred because of a protected characteristic, is there a piece of work which should focus on the repercussions of an unfair/malicious referral.
    • One of the FtP improvement plan workstreams focuses on reducing inappropriate referrals. The NMC will do this by working with employers and the public to increase awareness of when referrals are appropriate and where people can take complaints that aren’t NMC related (ACTION 5).
  • There is an impact on more than just the registrant, as the whole family suffers the consequences of an FtP referral. It could almost equate to slander when someone is falsely accused of something, and internationally educated and diaspora professionals are particularly vulnerable to issues with their wellbeing.
    • The NMC wants to ensure FtP is a kind and fair process that has the least amount of impact on individuals. That is why the NMC regularly engages with professionals and senior stakeholders to understand what needs to change from their perspectives. Recent engagement with the GMC has been undertaken to talk through their triaging process for FtP and how that could help the NMC’s own procedures. An example is the discussion about whether there should be a responsible officer role for nursing and midwifery referrals (ACTION 6 & 7).
  • There is also value that the attendees from the INMA Forum have cultural intelligence that can be helpful in FtP decision making. An example was given of a GMC registrant using their culture as an excuse for sexual misconduct, suggesting that having a wider diversity of decision makers in FtP would be helpful (ACTION 8).
  • Interest in understanding the relationship between the NMC and the National Guardian’s office, especially the escalation process (ACTION 9).
    
    
• Sam Foster then discussed the NMC’s wider work to dispel the myth that the only role of the NMC is to take away a professional’s PIN.
  • The NMC regulates, so it sets professional standards for all nurses, midwives and nursing associates working in the UK. It also quality assures education programmes so that students have the right skills and knowledge to join the register. To protect the integrity of the register, the NMC also maintains an FtP process to ensure the public receives safe, effective and kind care.
  • The NMC supports its professionals by providing guidance and resources that help with continued professional development (ACTION 10). The NMC also works with employers to help them manage issues locally and reduce the number of FtP referrals, plus the NMC has a range of advice and support services available to professionals going through FtP.
  • The NMC influences the health and social care sector by engaging with senior stakeholders, with the hope to create positive change that will benefit professionals and the public. The NMC also shares insight about the professionals on their register, which can help with workforce planning and understanding the pressures of the health and social care sector.

4. Influence: Ensuring internationally educated and diaspora professionals across all four nations have access to support – what can the NMC do to help?

• Jimmy McGrath, MI Manager in the Data and Analytics team at the NMC, joined the meeting to give an overview of the NMC’s data and how it could be used to help identify professionals for INMAs to reach out to.
  • The NMC holds a lot of data about professionals which is reported on twice yearly through the registration data reports. The NMC gets that data from touchpoints during a professional’s career, such as revalidation or when registrants pay the NMC fee.
  • The NMC holds data about professional’s addresses, which helps to identify how many registrants are based where in the UK. Internationally educated professionals often have an address based in a country outside the UK for a period of time after they join the register – this means that some of the data the NMC holds is inaccurate as there are internationally educated professionals working in the UK that still have an address listed outside the UK (ACTION 11).
  • The NMC is now sharing its data with the census meaning researchers can answer a range of questions around professionals’ employment, education and housing. This will then enable the NMC to share further insights with their partners across health and care which will support workforce planning.
  • The NMC also publishes EDI data for the register and FtP. If any INMAs want specific data about professionals with certain protected characteristics or from specific groups, it’s best to request this through an FOI request so there is an audit trail (ACTION 12). Webpage about this is available here: Freedom of Information (FOI) requests - The Nursing and Midwifery Council (nmc.org.uk)
    
    
• Discussion on this item included:
  • It’s really helpful that the NMC now has more ethnicity options for their data. It means that professionals can identify as the ethnicity that they are, rather than having to choose a catch-all option.
  • It would be interesting if there could be mapping of Trust referrals against the WRES data, to understand if there is any correlation between ethnicity and referrals in specific Trusts. It would also be good to map the NMC’s referral data against the WRES data to understand (ACTION 13).
  • There was a discussion about what the NMC can do to help refugee professionals, as they often face other challenges in being able to join the register (ACTION 14).
  • The NMC’s data is very broad and talks about Indian professionals as a large group, but there are many different groups within India that have different cultures. It would be good if the NMC’s data could be more granular.
  • Is there be a way for INMAs to be signposted to internationally educated and diaspora professionals, especially those who are going through a FtP case (ACTION 15).

5. Regulate: FtP panel recruitment presentation

• Kelly O’Brien, NMC Panel Support Team Manager, and Georgie Hargrove, Senior Stakeholder Engagement Officer at the NMC, joined the INMA Forum to discuss FtP panel recruitment.
  • A group of approximately 420 panel members make decisions about FtP cases in hearings and meetings. They’re independent of the NMC. ​
  • Every panel has three people on it: at least one registered professional, and one lay member. This June, the NMC is running a campaign to recruit at least 50 new registrant panel members. ​
  • The NMC wants to increase diversity so that their registrant panel member pool reflects the diversity of professionals on the register. 27% of people on the register are from Black, Asian and other Minority Ethnic backgrounds, compared to only 14% of the registrant panel member pool (ACTION 16).
  • The NMC wants internationally educated and diaspora professionals to be panel members. These professionals don’t need any specific qualifications or training to apply as they’ll receive all training as part of their induction (ACTION 17).
  • The process will begin in June with applications, and appointments should be made by December/January after all the stages of recruitment are completed.

• Discussion on this item included:
  • Registrants don’t need to have any specific previous experience being a panel member somewhere else, or have been in a senior position, to apply to be a panel member at the NMC.
  • There is lots of support for panel members, including training and a buddy system, to ensure that individuals feel they have the right tools to make decisions fairly.
  • The NMC pays for any travel and accommodation expenses for panel members joining in-person hearings or meetings, but many meetings and hearings are still held online at the moment. Our 18-month fitness to practise plan seeks to increase the number of hearings held in-person.
  • Panel members are expected to give 15 days minimum to the role, but it can work alongside a full-time position.
  • Panel members are given a 4-year term, and there is a possibility for a second 4-year term as well.

6. Reflections and closing remarks

• Sam Foster invited attendees to share their thoughts about the first INMA Forum and reflect on what the future of the forum could look like.
  • Will two meetings a year be enough, especially at this early stage?
    • The NMC have committed to holding at least two INMA Forum meetings a year, but there is flexibility that there could be more than this depending on capacity of the stakeholder team to organise more meetings, or if there are particular subjects that attendees want to focus on.
  • Have a more focused discussion about internationally educated and diaspora midwives, as they face unique challenges compared to nurses (ACTION 18).
  • It would be good to have a more focused discussion about the support that internationally educated and diaspora professionals need when going through FtP, as well as how to ensure employers reduce their inappropriate referrals to the NMC. Is there a way to make sure just culture guidance is taken on board by employers, not just in the NHS, but across the piece, as well as ensure a better triaging process for referrals (ACTION 19 and 20).
  • It was really powerful to hear everyone’s stories and opinions, and for attendees to take three hours out of their time to join the meeting. The NMC wants the INMA Forum to be a critical friend that will allow a learning culture of what’s going well and what needs to be improved.
  • The NMC wants INMAs to shape the INMA Forum; what goes on the agenda, what the focus areas are etc (ACTION 21).

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