The damning report highlights the impact of delays in Fitness to Practice cases, heightened safeguarding risks, and the toll of years waiting for a decision. It found there had been six suicides in the last year of registrants going through the Fitness to Practice process, with some waiting between four or five years for a decision. The review led by former chief public prosecutor, Nazir Afzal, commented on a backlog of 6,000 cases, with nurses, midwives, patients and families being forced to wait years for a decision. Other senior nursing and midwifery figures said that the process had become “too legal, combative and procedural” and that unless the process was reformed, the NMC would “struggle to reduce the backlog”.
The NMC has apologised, accepted all 30 recommendations and committed to a programme of change.
Another regulator under review
The NMC is not the only health and care sector regulator under the spotlight.
In May 2024, the government launched a review of the Care Quality Commission’s (CQC) new Single Assessment Framework (SAF). The SAF, three years in the making, is part of CQC’s new strategy to rely less on set-piece inspections and to instead become a more risked-based and data driven watchdog. So, after years of commenting on the governance of health and social care organisations, the CQC faces a review into its own operational effectiveness.
Recent staff surveys at the CQC have shown concern among staff about leadership and a drop in those who would recommend it as a place to work. Since the government’s review was launched, the CQC’s chief executive, Ian Trenholm, has announced his departure, and Kate Terroni has taken on the CQC’s interim chief executive role. In a subsequent internal memo leaked to the Health Service Journal, Kate Terroni, admitted that “the way we work is not working and we aren't consistently keeping people who use services safe.” On 15 July, CQC published a message from Kate Terroni, in which she apologised and accepted that CQC had got things wrong in the implementation of their new regulatory approach. The message acknowledged that technical issues and challenges had hampered rollout, that changes in how CQC managed relationships had left “many providers feeling unsupported” and that this has led to some providers losing trust in the regulator.
Ms Terroni concludes the message by identifying three urgent and immediate areas of action. Among these are commitments to “increase and improve the support and guidance for providers” and a change in CQC relationship management to enable a “closer and more consistent contact point for providers”.
The concerns appear to reflect what NHS senior leaders and care providers have been saying: that the regulator needs to reform its way of working, with providers requiring consistency in approach and certainty.
Regulation of NHS managers
Sir Robert Francis recommended regulating NHS management in his independent report on the Mid Staffordshire scandal in February 2010. This was resisted in favour of a “Fit and Proper Person Test” regulated by the CQC. However, the case of Lucy Letby where whistleblowers' concerns weren't listened to renewed support for the regulation of non-clinical managers from the BMA and other stakeholders and led the Labour Party to include a pledge to regulate NHS managers in its manifesto.
In a pre-election interview with The Guardian, the new health and social care secretary, Wes Streeting, committed to pushing through the formal regulation of NHS managers, and warned the CQC that its inspectors must get much better at exposing risks to patients’ safety in order to regain the confidence of frontline staff.
Labour’s election victory means regulation of NHS managers is almost sure to happen, but the form and substance of the regulatory regime is still unclear. Care will need to be taken to design a system that works to keep patients safe, and we suggest the starting point should be to see regulators perform their functions fairly and proportionally.
In the meantime, Wes Streeting has announced an independent investigation into the state of the NHS by Professor Lord Darzi with the findings of the rapid review providing the basis of the government’s 10-year plan to reform the NHS. The report is expected in September.
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