4. The future of regulation
Devon Branch
(MFD) That this meeting of RCN Congress discusses how health care professionals should be regulated in the future
Debate report
Thomas Murray opened this discussion by saying that there are currently four regulatory bodies (the General Medical Council, the General Dental Council, the Nursing and Midwifery Council (NMC), and the Healthcare Professionals Council). If health care professionals are to be regulated, this needs to be executed across all professions, not just nursing. He questioned whether one single regulatory body for health care would be much more fit for purpose.
David Jones from the Greater Bristol branch highlighted that it would be very hard to establish regulation for health care assistants (HCAs) and assistant practitioners, as they have no set job description or training structure.
Jason Warriner of the Public Health Forum stated that he agreed that health care professionals need to be regulated – but disagreed that it should be by one single body.
There was some discussion that the NMC does not currently do a good job, and that an efficient, modern, fit for purpose regulator needs to be established. Richard Holtby works an HCA and is a member of the Health Practitioner Committee, and stated that he and his colleagues support regulation, and he feels that the best way to achieve this is via the NMC.
Thomas Murray closed the discussion by insisting that a single regulatory body for all health care professionals could be highly successful, and may even be more cost effective.
Background
The Nursing and Midwifery Council (NMC) exists to safeguard the health and wellbeing of the public, as set out in the Nursing and Midwifery Order 2001. It is responsible for regulating nurses and midwives in the UK, ensuring public protection by setting standards for education, training, conduct and performance of registered nurses. The NMC is, in turn, regulated by the Professional Standards Authority (PSA) for Health and Social Care and has been scrutinised following findings of mismanagement and failure to deliver core regulatory functions.
Responding effectively to concerns raised by the public or the profession is an essential part of the regulator’s aim of protecting the public. The 2012 accountability hearing of the Health Select Committee stated that, while they were pleased to see the NMC prioritising its core functions, there was a substantial backlog of fitness to practice cases accumulating.
The NMC also sets standards for education to make sure nurses and midwives have the right skills and qualities when they start work, and throughout their careers. Nurses and midwives must continually update their skills and knowledge. Post-registration education and practice (Prep) is a set of NMC standards and guidance which form a legal requirement registrants must meet in order to renew their registration.
Following an audit in 2012, the chief executive of the NMC admitted major problems with the current system of ensuring registrants have met continuing professional development (CPD) and practice standards for re- registration (only four per cent of registrants were checked annually).
The NMC has previously committed to establishing an effective system of revalidation for nurses and midwives by 2015 at the earliest. The RCN believes that revalidation must be a core function of the professional regulator.
We have always encouraged employing organisations to protect time and resources for health care staff to undertake CPD, believing that any system of revalidation will also be dependent on employers investing in proper processes of clinical supervision and appraisals. However, some still do not give sufficient time for this.
The publication of the Francis Report in February 2013, has brought to the fore some key recommendations on professional regulation and also that of health care support workers (HCSWs). In addition to the topics above, it has highlighted that the NMC needs to look at systematic concerns as well as individual ones. It needs to make the public, patients and service users aware of its services, and work more closely with the CQC.
Currently, there is no UK-wide system for the regulation of HCSWs, although there are differing systems in place in Wales, Scotland and Northern Ireland. Codes and standards for health and adult social care support workers in England have been developed by Skills for Health and Skills for Care, but the implementation of these has yet to be carried out.
The RCN has been vocal in trying to ensure appropriate and cost effective regulation, strongly objecting to the NMC fee increase, and has called for mandatory regulation for HCSWs as opposed to the Government- proposed system of voluntary registration.
References and further reading
Council for Healthcare Regulatory Excellence (2012) Strategic review of the Nursing and Midwifery Council: final report London: Council for Healthcare Regulatory Excellence. Available at: www.nmcuk.org/Documents/120629%20CHRE%20Final%20Report%20for%20NMC%20strategic%20review.pdf (accessed 13/03/13) (Web).
The Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. London: Stationery Office (Chair: R Francis). Available at: www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf (accessed 13/03/13) (Web).
Royal College of Nursing (2013) Regulation London: RCN. Available at: www.rcn.org.uk/development/health care_support_workers/professional_issues/regulation (accessed 13/03/13) (Web).
