Blog: Better, safer regulation for the public

Published on 13 May 2021

Our Executive Director of Strategy and Insight, Matthew McClelland, explains why the Government's proposed changes to our legislative framework will allow us to do more to make care safer across the UK.

Earlier this year, the Government started consulting on important changes to the legislative framework of nine healthcare regulators, including the NMC.

As the regulator of nearly 725,000 nurses, midwives and nursing associates, we play a vital role in upholding the highest standards in nursing and midwifery practice and keeping the public safe. The legal framework that guides our work has a significant impact on the way we are able to achieve this. Removing legal barriers that limit improvements in the way we regulate will enable us to deliver safer regulation for the public and better support our registrants.

The time has certainly come to make positive changes to our legislation – it was written over 20 years ago. Over that time everyone’s expectations of care and how it is delivered have changed hugely, but our legislation hasn’t kept pace. The pandemic has shown that with greater flexibility we can act quickly to deliver for the public. But we need more modern, flexible legislation to do so. We believe the Government’s consultation provides us with a once in a generation chance to create this change.

Regulating a changing workforce

Over the last three years, we have done a huge amount with the public, professions, and our key partners to modernise our standards for nurses and midwives, and we began regulating nursing associates in England. We’re currently consulting on post registration standards for community and public health nursing. The vision at the heart of all our standards is safe, effective and kind nursing and midwifery practice that improves everyone’s health and wellbeing.

However, health and social care are continually changing and the demands on professionals are evolving as well, while we are still regulating within parameters that were set in legislation 20 years ago. That risks regulation lagging behind the curve of how the workforce is changing.

Reform will enable us to make sure that we regulate at the leading edge of practice into the future, collaborating with our partners and other regulators to make sure that regulation reflects the multidisciplinary environments in which care is delivered and the advanced skills and specialisation which complex, patient-centred care requires.

Registering the right people at the right time

Workforce supply is clearly a very pressing issue for everyone involved in the health and social care system. Over the last few years, the professions we regulate - especially nursing - have become increasingly global. We have a role to play to support the workforce by making sure we are registering people with the right knowledge, skills, and experience to meet our standards - and to do that as quickly and efficiently as we can.

We have done a great deal to make sure that our approach is as efficient and effective as it can be at the moment. But we are constrained by provisions in our legislation that prescribe unnecessary waiting times and obsolete requirements. Regulatory change will enable us to bust these bureaucratic barriers – and crucially, it will mean that we will be able to change our own processes in the future without the need for new legislation.

Fostering a fair, safe culture

Safety is, of course, at the heart of our standards. But we have a responsibility to make sure that we use all our regulatory tools to foster a fair, safe culture in health and social care. Our fitness to practise process should keep people safe: it should prevent things from going repeatedly wrong, and should treat people with the dignity and respect they deserve. We believe that the best way to do this is to give professionals the chance to address concerns, encouraging them to be honest and reflective and building a culture of openness.

Our current legislation sets prescriptive requirements about how we manage cases. It dictates an adversarial model which, at the moment, creates fear of blame and punishment rather than fostering the openness and learning from mistakes which are central to safety culture.

The Government’s proposals look to change this and deliver a less adversarial approach to fitness to practise. They are proposing the introduction of an ‘accepted outcomes’ route to make sure that cases can be resolved quickly where the regulator and the professional agree on what the problems with the individual’s practice are and what steps are needed to protect the public. We support this approach and believe it will benefit all parties involved in fitness to practise proceedings, delivering protection for the public more quickly, reducing the stress on registrants and increasing the likelihood of reflection and learning from cases.

We also support the Government’s proposal to give new powers to the public to request a review of fitness to practise referrals. We believe these reviews will introduce new oversight of many of our decisions, again helping us make our systems fairer and improving public protection. If the Government’s proposals are accepted, we will work with the public to co-produce a fully transparent, accountable approach to reviews which earn the trust and confidence of the public.

Taken together, the Government’s proposals will enable us to deliver more quickly, fairly and effectively for the public, allowing us to do more to make care safer.  

The Government consultation closes on 16 June 2021, and we will publish our full response shortly before then. In the meantime, we will continue to talk to the Government and our partners about the positive changes we want to see that enable us to support nurses, midwives and nursing associates to deliver excellent care to the public across the UK.

Update - 16 June 2021: We've published our response to the Department of Health and Social Care’s consultation, ‘Regulating healthcare professionals, protecting the public’. 

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