Blog: Looking back on a rewarding decade at the NMC

2020 has been an extraordinary year for all of us involved in health and social care. For me it’s also marked the end of a fascinating and challenging decade at the Nursing and Midwifery Council.

When I joined the NMC in 2010 to kick off a programme of policy and legislation changes which has continued to this day, I never imagined that I would still be here nearly a decade later. 

After 6 years at the General Medical Council I had some idea of the problems in healthcare regulation at that time. But nothing could really have prepared me for the extent of the changes that were needed for the NMC to regain the confidence of the 665,000 nurses and midwives then on its register, and of the public, for whose protection it had been created.

The intervening years have certainly fulfilled their promise of being challenging but they have also been incredibly rewarding. It’s been an immense privilege to work with so many dedicated colleagues both inside and outside the organisation to slowly build the foundations for the ambition set out in our new Strategy.

Improving Fitness to Practise

My NMC journey started in Fitness to Practise, where the approach to handling complaints about nurses and midwives was process-driven and quasi-criminal with little scope for encouraging candour, insight or remediation. My aim was to reduce the bureaucratic and adversarial nature of the process whilst retaining the safeguards needed for those facing investigation. In the absence of any wider regulatory reform, we set about making as many legislative changes as we were allowed. These included a wider range of decision-makers and regulatory outcomes to encourage engagement and reduce the need for unnecessary hearings.   

Since then lots more improvement work has taken place, including the more person-centred approach at the heart of our new FtP strategy. But some cases do still take far too long and more changes are now underway to ensure that everyone involved in our FtP process is given the individual support they need to give them confidence that a fair outcome has been reached.

The Francis Report

The history of healthcare regulation is sadly punctuated by a series of public reports and inquiries. One of my frustrations has been that significant improvements are often only supported by government following such tragedies. Even then, the changes made are usually too narrow in their focus, which means they are always addressing yesterday’s issues not today’s, and longer-term systemic issues frequently remain unresolved.  

In 2013, I co-ordinated the NMC’s response to the Francis report into the failures of care at Mid Staffordshire NHS Foundation Trust. From that horrific starting point came the crucial learning that led to many of the key improvements we were to introduce at the NMC over the coming years including improved witness support, the employer link service, a duty of candour, an updated Code and perhaps most significantly – a new revalidation process.

Working with others

I spent time over the next two years collaborating with other regulators, patient groups and professional bodies across all four countries of the UK to push forward proposals for sweeping legislative changes in a draft Bill developed by the Law Commissions. Despite widespread support for reform, these plans were put on hold when the Coalition Government ended in 2015. It’s good to hear that wider reform is now back on the agenda again and will build on this important groundwork.

I was then delighted to have the opportunity to lead our ‘upstream’ revalidation programme in 2015. We heard the stories of nurses and midwives from settings across the UK and learnt about the real issues they faced. This led to us focussing our efforts on CPD, feedback and reflection - all of which are of such critical importance to the development and retention of good professionals and are too often overlooked. Revalidation remains one of my proudest achievements at the NMC.

Learning from tragedy

Sadly, important regulatory improvements are not always straightforward or without real challenge, none more so than the changes we made to midwifery regulation following the tragic events at Morecambe Bay and the Inquiries which followed. As well as addressing the systemic failures, we faced lessons to learn of our own when it became clear how badly we had let down the affected families ourselves. That learning, and those from other families who have shared their experiences with us, continues to inform our work to this day.

Building for the future

In 2016 I relished a stint holding the fort in our Education and Standards directorate until the arrival of Dr Geraldine Walters, as colleagues there embarked on our ambitious education reform programme. So far they have produced our fantastic Future Nurse, Future Midwife, Prescribing, Return to Practice and Education programme standards and they are now tackling the increasingly critical post-registration and public health agendas.  

My next endeavour was as part of a team charged with the simple task of creating a brand-new profession from scratch. After many hours of head-scratching and negotiation about the legislative powers we needed with colleagues at the Department of Health and Social Care, we were delighted to welcome the first Nursing Associates in England onto our register in 2019.

Throughout my time here, I have enjoyed advising on many complex legislative issues and legal claims and, of course, implemented many EU Directives. Since becoming General Counsel in 2017, I have set up a new in-house legal team to provide legal advice and support on corporate and strategic issues. It has been a joy to lead a talented and diverse team of lawyers and paralegals who combine legal expertise with our NMC values of being kind, fair, collaborative and ambitious.

Covid-19

Just when I thought there wasn’t much I hadn’t seen or tackled, along came Covid-19, the first global pandemic to seriously impact the UK for a hundred years. Suffice to say that my last six months have continued to be a time of challenge, innovation and learning….

So what have I learned?

Looking back over the last decade, a few common lessons emerge:

• we need to earn and maintain the trust and confidence of the people we regulate and the people they care for
• this means listening to and understanding all their experiences, whether good or bad, and acting on that feedback.
•  whilst it is always better to try and achieve a consensual outcome, we have to be ready to take difficult decisions when different views can’t be reconciled
• as leaders, we also need to keep learning ourselves, be open to new ideas and be ready to try new ways of doing things (not just during a pandemic….)
• we need to recognise the huge benefits that diversity of background, thought and experience can bring to the quality of our debate and decision-making
• we also need to celebrate the diversity of our register and challenge the discrimination that we know many of our registrants experience

And finally, in the memorable words of the late Ruth Bader Ginsburg – “Fight for the things that you care about, but do it in a way that will lead others to join you.”  

Looking forwards…

There are plainly many challenges ahead. Long-standing health inequalities and public health issues have been exposed by Covid-19 and must be addressed. Workforce pressures in health and social care services are immense. But at the heart of that workforce are the amazing 716,000 nursing and midwifery professionals now on our register. Our role as their regulator is to continue to use our powers to regulate, support and influence to enable them to provide the safest care possible to the public. 

So, with pride, a touch of sadness and a huge sense of optimism I am ready to say farewell and prepare for my next adventure. I know that I am leaving the NMC in very good hands to take on whatever the next decade and beyond may bring.

Other recent news…