Exclusive: Departing chief spells out ongoing NMC challenges

With deep regret and sadness, Andrea Sutcliffe revealed in May that she would be resigning as chief executive and registrar of the Nursing and Midwifery Council (NMC) due to ill health.

“Some people’s experience within the organisation is not acceptable, and we’ve got to get that right”

Andrea Sutcliffe

Marking the end of her tenure at the NMC, Ms Sutcliffe spoke to Nursing Times about some of her key achievements while leading the organisation over the last five years, and the challenges that lie ahead for her successor and the important work that must be prioritised in the coming months.

“It just does feel that there is unfinished business, an awful lot of unfinished business, that I really wish I was going to be able to stay and see through,” she said.

Ms Sutcliffe’s departure comes at a tricky time for the regulator, which has come under fire for alleged failures in its regulatory processes and concerns about its internal culture.

However, Ms Sutcliffe has not shied away from this, stressing that her decision to step down came because there was “still a lot to do” around these important issues.

She said: “This job demands 150% commitment and dedication, and I won’t be able to do that for a good period of time.

“It’s not fair to the organisation, [and] to the people who we serve, for me not to be able to do the job properly.”

Ms Sutcliffe is due to have neurosurgery in July after a tumour was unexpectedly discovered while she was having a scan that was ordered after she fell over and broke her shoulder.

While the tumour is thought to be benign, and a full recovery is expected, there will be a lengthy recovery period after her operation, which is why Ms Sutcliffe has chosen to step down.

Meanwhile, in recent months, the NMC’s internal culture has been subject to scrutiny.

A series of articles were published by The Independent last year, which raised serious concerns about the inner workings of the NMC, the way it treats staff and how it handles whistleblowing.

The newspaper reported that there was a “culture of fear” at the NMC that meant staff were afraid to speak out, while also claiming that there were issues of racial discrimination and sexism within the organisation.

In addition, the articles alleged that the regulator was failing in its handling of fitness-to-practise (FtP) cases, including those involving nurses accused of sexual abuse and racial discrimination.

They said that NMC staff had been encouraged to prioritise the speed of clearing the FtP backlog, which reached a monthly record high in February this year, instead of handling the cases sensitively and thoroughly.

The NMC has since commissioned three independent reviews to investigate all the issues highlighted by The Independent.

Ms Sutcliffe said the articles raised “really serious concerns” about the internal workings of the NMC and stressed the necessity of the independent reviews to “thoroughly scrutinise” what has been going wrong.

“We’re trying to do things, but we’re clearly not doing enough and it’s not making the difference it needs to,” explained Ms Sutcliffe.

“Some people’s experience within the organisation is not acceptable, and we’ve got to get that right.”

Ms Sutcliffe said she hoped the reviews would “really thoroughly get underneath the skin” of the NMC, to give the organisation the best opportunity to make internal changes.

“Undoubtedly it will make difficult reading, but we need to make sure that we see that as the opportunity to make the step change that’s needed,” she added.

“I think that in commissioning the reviews, we have opened ourselves up quite appropriately to that level of scrutiny, that level of challenge and, hopefully, that level of support and direction in what we can do to move things forward.”

Ms Sutcliffe also noted that the fact the NMC has an issue with its handling of FtP was “not new”, as the regulator has been repeatedly criticised for failing to clear its backlog of cases.

The NMC ended 2023-24 with an FtP caseload of 5,994, which was higher than the prior year, when it was 5,577.

“We’ve tried to do an awful lot to improve, but we know that people are still waiting far too long for their cases to be resolved, and some people do not have good experiences with us,” said Ms Sutcliffe.

“We need both to be doing the process better and we need to be treating people better.”

Earlier this year, the NMC approved a £30m investment in FtP to tackle the backlog and announced that improving the timeliness and quality of decision making would be the top priority for 2024-26.

Separately, it commissioned another review into its FtP cases, this time to find out why there were different experiences and outcomes for professionals from diverse backgrounds, after a previous review found that these differences exist.

Ms Sutcliffe said she hoped these plans would make a “sustainable change” in the NMC, so that her successor was “not having to have this conversation” in the future.

“[I hope] that actually this time we get it onto that even keel, which means we respond to concerns effectively and we do it in a timely fashion, and we do it in a person-centred way,” she said.

Alongside some of these key challenges facing the organisation, Ms Sutcliffe said there were also a number of things she was proud of, including the work that the NMC undertook during the Covid-19 pandemic.

At the time, the regulator launched a temporary register to allow former nurses and some internationally qualified nurses to work in healthcare services across the UK. It also rolled out emergency standards to enable students to join the workforce.

“[When] establishing the temporary register from scratch, we didn’t have the legislation to do that when it was first announced, but we managed to do that,” Ms Sutcliffe said.

“The joint work that we did with the UK’s chief nursing officers, representative bodies and others at that stage was just really important in terms of trying to respond to [the pandemic].”

Ms Sutcliffe also praised the regulatory advances the NMC has made in recent years, including the updates to pre-registration standards, publication of post-registration standards and changes to English language requirements.

“I’ve got health and social care in my blood and I don’t think I can let it go”

Andrea Sutcliffe

Another key piece of work undertaken by the NMC was the publication last year of its inaugural Spotlight on Nursing and Midwifery Report.

The report made new use of the various data that the NMC holds on its more than 800,000 registrants to uncover issues facing the professions.

Among the findings of the spotlight report were sobering testimonies from internationally educated nurses, who said they did not feel treated the same as their UK-educated colleagues and had been left “traumatised” because of the racist and derogatory comments they had faced at work.

On this, Ms Sutcliffe said it was vital for all nurses and midwives to make sure that their international colleagues were supported and “get the pastoral care they need”.

She called for more cultural competency training for healthcare staff, to ensure colleagues from overseas were “received well by their colleagues”.

“[It is about] making sure that people understand that, actually, it is part of their job to support and help people, and if there was any discrimination that it would not be tolerated,” she said.

If internationally educated nurses feel targeted or isolated at work, it can become a “safety issue”, warned Ms Sutcliffe, adding: “If we don’t look after the people coming across, they’re not going to be able to do their job properly.

“And the only people who that directly impacts are the people they’re caring for. We just need to make sure that people see that’s important.”

It was announced this week that Dawn Brodrick, chief people officer at the Crown Prosecution Service, would become interim chief executive and registrar of the NMC.

Tackling FtP must be “the number one priority” for Ms Brodrick followed by addressing the findings of the independent reviews into the regulator, urged Ms Sutcliffe, who was the chief inspector of adult social care at the Care Quality Commission before joining the NMC.

Andrea Sutcliffe

In addition, Ms Sutcliffe said it was imperative for her successor to press ahead with the work that the NMC has in the pipeline, including its review into nursing and midwifery practice-based learning and its work around regulating advanced practice.

The regulator is also preparing for a review of revalidation and the NMC Code in 2025-26, to mark the 10-year anniversary of both.

She said all these pieces of work were “opportunities” that the next leader of the regulator should seize.

Over the last five years, Ms Sutcliffe and her wider leadership team have overseen some huge changes within the organisation, and have also been met with huge challenges.

For that reason, she said she felt immense sadness about having to step down during such a pivotal time for the regulator.

“I genuinely feel very sad that I am stepping down,” she said.

“[It has] been a challenge but an absolute privilege to lead this organisation, to be the registrar for over 800,000 professionals on our register, and to effectively try and make a difference for the public that use health and social care services that they support.”

While the absolute priority for now is ensuring that she has a smooth recovery, Ms Sutcliffe said she had not ruled out returning to another health and social care role in the future.

“I genuinely don’t know what will be on the other side,” she explained, adding: “If there were opportunities and people still want me, that would be fantastic.

“I’m not sure that I would be doing another big executive job. But I’ve got health and social care in my blood and I don’t think I can let it go.”