Strategic review of the Nursing and Midwifery Council

Background

In January 2012, the Parliamentary Under Secretary of State at the Department of Health commissioned the Professional Standards Authority (then CHRE) to carry out a strategic review of the NMC. This is our final report. We published an interim report in April.

A regulator is charged with two key responsibilities: to protect the public and to uphold public confidence. In the NMC’s case, this means to uphold confidence in the practice of nurses and midwives. The NMC has continued to carry out its public protection duties, although not as well as it should but, as its stakeholders make clear, it is not inspiring confidence in the professions or in professional regulation.

Summary

As we said in our interim report, at the heart of the NMC’s failure to succeed lies confusion over its regulatory purpose, lack of clear, consistent strategic direction, unbalanced working relationships and inadequate business systems.

Our interim report highlighted weaknesses in governance, leadership, decision making and operational management. In our final report, additionally we identify poor financial stewardship, a passive, hierarchical culture of ‘resigned resilience’ and provide further detail on the problems with the NMC's management and business systems.

Much of what went wrong here was the direct responsibility of the NMC’s leaders and a reflection of their skill mix and capacity. However, no organisation operates in isolation and the context in which it conducts its business can affect its success or failure. The NMC has not performed efficiently, it has not had its sights set correctly on its core regulatory functions but it has also reacted to external demands and expectations that are themselves based on a misunderstanding of its proper role and responsibilities. 

The NMC’s response to our review is encouraging. It has cooperated fully, and there has been considerable activity recently under the direction of the interim Chief Executive and Chair. But there is no room for complacency. As we explain in our two reports, the problems here are at every level, in every system. Amongst its staff however, there is a strong passion for public protection, a potential to get it right and some fertile ground for a clear sighted Council, Chair and a Chief Executive skilled in turning an organisation around and establishing competent management systems. We view these new appointments as critical to restoring public confidence in the NMC and so have recommended that due diligence is exercised in the appointment of these roles to ensure that the individuals appointed as Chair and Chief Executive have the personal credibility, leadership behaviours, competencies and communication skills necessary to implement the changes set out in this strategic review.