NMC bosses quizzed on response to culture review
The Nursing and Midwifery Council (NMC)’s most senior leaders have been pressed for more detail and clarity on their response to a major review into the regulator, which found a culture of bullying, racism and major issues with its fitness to practise procedures.
This review, undertaken by Rise Associates and former chief crown prosecutor Nazir Afzal, was published in July and contained heavy criticisms of the NMC’s internal culture.
“It’s very clear that trust and confidence is low, and there’s a very clear and understandable desire for rapid progress”
Matthew McClelland
It described the NMC as a “hotbed” of bullying and toxicity, and laid bare the impact of the large fitness to practise backlog on registrants – some of whom had died by suicide while awaiting a conclusion to their referral.
Rise Associates’ review listed 36 recommendations for the NMC, including a demand to speed up the fitness to practise screening process and create a positive working culture which promotes equality, diversity and inclusion.
Today, the first in-person public meeting of the NMC Council was held at its headquarters in central London.
There, members of the NMC’s executive team delivered updates on progress in responding to Rise Associates’ 36 recommendations and were questioned by council members as well as members of the public.
Opening the meeting, NMC executive director of strategy and insight Matthew McClelland – speaking on behalf of interim chief executive Helen Herniman who was delayed by travel problems – acknowledged that the review’s findings had left trust in the regulator shattered.
“[The review] found very serious problems with our culture and aspects of our regulatory operations,” he said.
“Since then, we’ve been working at pace to plan how we address those recommendations and, indeed, how we go beyond them to make enduring change in the organisation.
Matthew McClelland
“It’s very clear that trust and confidence is low, and there’s a very clear and understandable desire for rapid progress.”
He further said that the report also highlighted how changes the NMC had made after previous reports into its internal culture had not cut it.
Mr McClelland said the latest plan for change was a long term one, to be performed over the coming years – not months.
“In essence, that’s how we’re tackling this,” he added.
“We will be focusing on long-range sustainable changes that we need… while at the same time working at pace to tackle unacceptable behaviours and to bring in additional support.”
The culture and regulatory performance of the regulator are “intertwined”, Mr McClelland said, adding that the plan for change would follow an “iterative process” and would adapt based on feedback from stakeholders.
Executive leaders of the NMC outlined some of the specific changes which had been, or were about to be, made in light of the recommendations.
Many of these line up with a summary of its “multi-year” plan the regulator issued yesterday, as reported by Nursing Times.
Interim executive director for resources and technology services Tom Moore, for example, spoke about the roll out of a new NMC fitness to practise case management system and how this could help speed up processes and improve safeguarding.
Anne Trotter, assistant director for education and standards, said there was “still work to do” on safeguarding, but that there had been “positive progress” so far.
The NMC confirmed following the meeting that work on the plan will continue and that there was “general support” for the way it was being carried forward.
However, council members and public observers to the meeting did critique the draft plan for a lack of detail or clarity in some aspects.
Lay member and vice chair of council Anna Walker questioned why a “diagnostic” of the NMC’s culture, which under the current timeline would be finished in the first quarter of 2025-26, could not be done quicker.
Ms Walker asked: “Can we have it earlier than that? I think we’re ready for it.”
Registrant members Dr Margaret McGuire and Claire Johnston further questioned if the language used in the report was accessible enough for the general public, in keeping with recommendations from Rise Associates about transparency and engagement with external stakeholders, which includes the public.
Similar questions arose from the audience.
A member of the public, present at the meeting, also asked about a “lack of clarity” on some of the points in the plan, questioning how much engagement there had been with “coalface” staff and unions ahead of its drafting.
Another described some of the language used in the plan as “ambiguous and nebulous”. This audience member said people may see this “as a smokescreen”.
Sir David Warren, chair of the NMC Council, in response, agreed and said he “applauds” the desire for NMC communications to be written in “plain English”.
David Warren
Others wished to reiterate their disappointment about the findings of the culture review, and pressed the NMC’s executive directors on their immediate actions in the wake of its publication.
One audience member, a former midwife, asked whether families of those who died by suicide on the register had received direct, in person if necessary, apologies and acknowledgements of impact by the regulator.
In response, acting chief executive and registrar Helen Herniman confirmed that “where appropriate”, families of those who had died by suicide while on the fitness to practise waiting list had been contacted directly.
