Nursing and Midwifery Council
The Nursing and Midwifery Council (NMC) is the regulator for nursing and midwifery professions in the UK. The NMC maintains a register of all nurses, midwives and specialist community public health nurses and nursing associates eligible to practise within the UK. It sets and reviews standards for their education, training, conduct and performance. The NMC also investigates allegations of impaired fitness to practise (i.e. where these standards are not met).
Founded
It has been a statutory body since 2002, with a stated aim to protect the health and well-being of the public. The NMC is also a charity registered with the Charity Commission, charity number 1091434 and in Scotland with the Office of the Scottish Charity Regulator, charity number SC038362. All Council members are trustees of the charity.
History[edit]
UKCC[edit]
In 1983, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) was set up following the Nurses, Midwives and Health Visitors Act 1979, replacing the General Nursing Council for England and Wales established by the Nurses Registration Act 1919, the Central Midwives Board in London and seven other bodies.[2][3] The UKCC was expected to maintain a register of UK nurses, midwives and health visitors, provide guidance to registrants, and handle professional misconduct complaints. At the same time, National Boards were created for each of the UK countries. Their main functions were to monitor the quality of nursing and midwifery education courses, and to maintain the training records of students on these courses.
In 1990 the UKCC introduced Project 2000 a higher education scheme in the United Kingdom for nursing qualifications. In 1991 the UKCC agreed on proposals for Post-registration Education and Practice (PREP). PREP took several years to introduce, with the final framework being agreed in 1994,[4] and the scheme itself being introduced in 1995. PREP developed into the current scheme of Revalidation which was implemented in April 2016.[5]
Establishment of NMC[edit]
This structure of the UKCC survived with minor modifications up to April 2002, when the UKCC ceased to exist and its functions were taken over by a new Nursing and Midwifery Council (NMC). This was legislated for in the Parliament of the United Kingdom, through the Nursing and Midwifery Order 2001.[6] The English National Board was also abolished and its quality assurance function was taken on board by the NMC. The other National Boards were also abolished, but new bodies were created in each country to take over their functions.
Council[edit]
The NMC Council has two key roles: setting the strategic direction for the NMC and overseeing the work of senior NMC staff.
The Council ensures that the NMC complies with all relevant legislation, including the Nursing and Midwifery Order 2001 and the Charities Act 1993.
The council is made up of 12 lay and registrant members, including one member from each of the four UK countries. They are appointed by the Privy Council. Registrant members are from a nursing or midwifery background; lay members are selected for their expertise in various fields and strategic experience.
The current Council took office on 1 May 2013.[7]
The NMC's role is to:
Legislation[edit]
Changes to healthcare regulation[edit]
On 2 April 2014, the Law Commission published its draft bill, Regulation of Health and Social Care Professionals. The bill aims "to aim to sweep away the out-dated and inflexible decision-making processes associated with the current legislation."[22] The bill would give healthcare regulators in the UK more autonomy.
The NMC's Chief Executive and Registrar Jackie Smith welcomed the publication of the draft bill, but stated how the NMC needs the bill to become law quickly if it is able to modernise and become an efficient regulator. In its current legislative framework, the NMC spends nearly 80% of its income of fitness to practise hearings.[23]
Affecting regulation of professionals within the EU[edit]
The revised Mutual Recognition of Professional Qualifications (MRPQ) Directive, which came into effect 19 January 2016, will bring in a number of changes that aim to further facilitate the free movement of professionals within the EU, including amendments to language controls.[24] The changes will enable the NMC to ensure, on a case-by-case basis, that a nurse or midwife from the EU has sufficient knowledge and command of English to practise safely and effectively.[25]
Criticism[edit]
Accusations of bullying and racism[edit]
On 11 March 2008 two Members of Parliament, Jim Devine and John Smith, made accusations in the House of Commons of bullying and racism within the NMC. The accusations have been denied by the NMC.[26] The government set up an independent inquiry asking the Council for Healthcare Regulatory Excellence and the Charity Commission to investigate.[27]
The NMC have been accused of nepotism by its members, Nursing Standard, letters-2017. Due to senior members of the NMC also being the instigating officer in cases against nurses, belonging to the same NHS Trust. In one instance a nurse was struck off for a data issue; whereas another nurse witnessed assaulting patients was only suspended for one year. (BFNHST, 2017).
Panorama controversy[edit]
On 16 April 2009, nurse Margaret Haywood was barred from practising as a Nurse in the UK following a ruling by the NMC Conduct and Competence committee panel.[28] This followed Haywood's contribution to a BBC Panorama television programme, exposing significant deficiencies in care at the Royal Sussex County Hospital, an acute teaching hospital in Brighton, England.[29] The public and media response was generally antagonistic towards the NMC, the response being described by the Royal College of Nursing as 'unduly harsh'.[30] On 12 October 2009, the striking off order was dropped, and replaced with a one-year caution.[31]
Regulatory criticism[edit]
In an early July 2012 report, the Council for Healthcare Regulatory Excellence (CHRE), now known as the Professional Standards Authority for Health and Social Care (PSA),[32] critically examined the leadership of the Nursing and Midwifery Council.[33] In late July 2012, a new chair for the NMC, Mark Addison, was appointed by the privy council, an appointment which was subject to criticism by the NMC Council, who described their "grave concern" with regard to what they claimed was a "lack of an open, transparent and equal opportunities process" in regards to the appointment.[34][35] In contrast, the CHRE stated that they were pleased with the appointment of a new chair, and that they would "look forward to working with Mark Addison".[36] On 26 June 2015, the PSA reported in their performance review 2014–2015 report that the NMC had made overall improvements in their performance.[37]
Data loss[edit]
In March 2013 the NMC was fined £150,000 by the Information Commissioner's Office after it admitted that personal data, including "highly sensitive" information about nurses and about vulnerable children, had been placed on DVD without being encrypted, sent by courier and then lost. The ICO said that "it should have been obvious ... that such a contravention would be of a kind likely to cause substantial distress to the data subjects due to the nature of the data involved".[38]
Increase in membership cost[edit]
The cost charged to remain registered on the NMC has increased from £76 per year in 2013, to £100 in 2014. Since 2015 the registration fee is £120.[39] The annual registration fee to the NMC is an allowable expense for UK income tax, however a survey by the NMC discovered that more than 75 per cent of NMC registrants do not claim tax relief on their registration.[40]
Morecambe Bay[edit]
The council was criticised by Bill Kirkup for the way it handled the investigation resulting from events at University Hospitals of Morecambe Bay NHS Foundation Trust relating to misconduct by two midwives involved in the Furness General Hospital scandal. He said their response to his report had "fallen far short of expectations". The Professional Standards Authority said the regulator's investigation was "deficient" because evidence was not presented to the panel by the council, even though it had it in its possession.[41] In 2018 the authority reported that the council had ignored more than 20 concerns raised by Cumbria police in 2012 for two years and that its handling of complaints was “frequently incompetent”. There was poor behaviour by staff towards families, reluctance to take concerns seriously and a lack of openness about mistakes it had made. The chief executive, Jackie Smith, resigned.[42]
English language test[edit]
The process of registering nurses from abroad includes an English language test which has been criticised as too difficult. According to Sir Andrew Foster, “There are thousands of nurses, who came to the UK in the early 2000s and after, who had qualified as nurses in India but can’t get registration here because they have not passed the language test.” Peter Mount, former chair of Manchester University NHS Foundation Trust said the language requirements were to ensure patient safety, although when questioned but NMC have no evidence of fitness to practise cases being brought against overseas nurses related to language weakness. "I am aware of nurses who have taken these language tests over 10 times and have been living and working in care and health settings in [the] UK for over 10 years.--[43] The test is said to be discriminatory because it demands an academic standard of reading and writing that many native English speakers could not meet. This means at least 3,000 qualified nurses from India who are already in the UK are not on the register, and so are paid less for similar work. British applicants generally are only required to have Grade C GCSE.[44] In September 2022, after a consultation exercise, the Council agreed to changes which were intended to slightly relax the testing procedures.[45]
Regulator[edit]
The Professional Standards Authority for Health and Social Care (PSA), is an independent body accountable to the UK Parliament, which promotes the health and wellbeing of the public and oversees the nine UK healthcare regulators, including the Nursing and Midwifery Council.[46]
In 2015 it was suggested that the costs of regulating the Nursing and Midwifery Council would be paid for by the membership of the NMC i.e. nurses and midwives.[47]
In 2015 the PSA published the 2014 audit it had undertaken of the NMC which found that whilst it had improved, it was still failing in areas.[48]