In her first interview with Nursing Times since taking on the role in January, Andrea Sutcliffe also said she wanted to gauge the appetite for regulation of healthcare assistants and advanced nurse practitioners, as part of work on a new five-year plan for the NMC.
The former chief inspector of adult social care at the Care Quality Commission brings a wealth of leadership experience to the challenging job of NMC chief executive and registrar and her appointment has been widely welcomed.
She told Nursing Times she wanted to ensure the professional nursing regulator was fulfilling its role “as effectively as possible” while also exploring what more it could do.
The NMC is currently overhauling its fitness to practise regime and Ms Sutcliffe said she wanted the process to become more compassionate – admitting existing procedures could “feel very cold”.
“Given that the ultimate sanction that we can make – which is to strike somebody off – is very, very significant and absolutely impacts on somebody’s livelihood, we have to make sure that we do that in a rigorous and appropriate way,” she told Nursing Times.
“It is a very legalistic process but that doesn’t mean to say we can’t do it with a degree of humanity for the individual under scrutiny and the family or the person who has been affected by poor care,” she said. “I think we still have more to do on that. The processes and procedures that we go through, it can feel very cold and nobody intends to do that.”
“Nurses haven’t necessarily seen the NMC as supporting their professionalism – we can do more around that”
She added that both families and professionals needed to be treated with “dignity and respect”.
As part of its new approach to fitness to practise, the NMC is set to take greater account of the context in which mistakes happen and to strive keep nurses and midwives on the register when they show remediation.
Ms Sutcliffe said: “We may well say [in future], yes something went wrong, the individual wasn’t being reckless, wasn’t deliberately trying to harm people, has got insight into what happened, has reflected upon it and has addressed their own shortcomings; and actually, they are still fit to practise.”
Meanwhile, where problems were seen to be systematic or related to leadership, rather than individual poor practice, Ms Sutcliffe said the NMC would in future consider referring the case to other appropriate regulators like the CQC.
In addition, she said the NMC could play a greater part in tackling workforce challenges by bolstering the “professional pride” of nurses – admitting this was an area in which it had previously fallen short.
“When I talk to [nurses] across the country…that pride just drips out of people’s finger tips,” she said. “They love being a nurse, they love the difference that they can make. But I don’t think they have necessarily seen the regulator as supporting that professionalism and enabling them to be proud of what they do, and I think that we can do more around that. We really can enhance that professional pride.”
This idea was “absolutely in tune” with what England’s new chief nursing officer, Dr Ruth May, was trying to achieve, she said, adding: “It’s one of the contributions that we can make in terms of supporting the recruitment and retention of nurses.”
Ms Sutcliffe also said she wanted the NMC to use and share the information it held about registrations or fitness to practise in a more constructive way to help the system respond to emerging issues.
Significantly, she has already been tasked with creating a new five-year strategy for the NMC that is due to be launched in 2020. She said she wanted to produce the blueprint in a “very inclusive way”, taking in views from professionals, partners, the public and NMC staff.
“Let’s have an honest, open dialogue about what it is people think the regulator should be doing”
Asked by Nursing Times for her views on whether healthcare assistants and advanced nurse practitioners should in future face mandatory regulation, Ms Sutcliffe said she wanted to explore this question as part of the strategy consultation process.
She described the debate over advanced nurse regulation as a “very live issue” and said many in the field that she had spoken to were “very keen” for it to happen. Although she also noted that she was aware that others in the nursing world did not think it was “necessary or appropriate”.
She stressed that the ultimate decision about which professions were regulated sat with the government, but stated: “Let’s have the conversation, let’s an honest and open dialogue about what it is that people think that the regulator should be doing.”
As part of the NMC’s current revalidation process, nurses are required to undertaken 35 hours of continuing professional development (CPD) every three years. In the wake of brutal cuts to training budgets in recent years, Ms Sutcliffe said she believed the organisation had a “critical” role to play in ensuring the importance of CPD was recognised.
She spoke passionately on the subject to Nursing Times, stressing how access to good CPD was essential for improving nurse retention – an opinion that has been shared broadly by national leaders in recent months. Reinvesting in CPD was “both the right to do but also is economically the sensible thing to do”, said Ms Sutcliffe.
“If we want to boil it down to the economics – every nurse we lose costs,” she said. “Because they have been trained, and they’ve had all of that support from the health service, or indeed in social care, and so we lose that.
“We have lost that expertise, the memory that they have got of all the things they have done, and the difference they can make,” she said. “We also lose, because we have to recruit new people,” she said, highlighting the financial cost of recruitment in terms of advertising and interviewing, and also the time required.
Her words reflect commitments from health service leaders. In January, the new NHS Long Term Plan stated that investment in CPD would increase each year over the next five years and, speaking at last month’s chief nursing officer’s summit, NHS England chief executive Simon Stevens gave his “personal guarantee” to get CPD budgets restored – a pledge that was subsequently supported by health secretary Matt Hancock.
Meanwhile, Labour health spokesman Justin Madders recently told Nursing Times he feared the annual £120 nurse registration fee could rise due to Brexit, because UK regulators would be required to do work currently done on a Europe-wide basis.
While admitting fee increases could never be ruled out, Ms Sutcliffe said they would only be a last resort and that the NMC would first try and absorb the cost of any extra work by becoming more efficient in other areas.
“I am very conscious that £120 a year for an individual nurse is a significant amount of money – we need to use that money wisely and we need to do everything that we possibly can do to ensure that we are not increasing that inappropriately,” said Ms Sutcliffe.
The NMC is also in the middle of revamping its international nurse registration processes, which has already resulted in a lowering of the score required to pass the writing element of the English language exam. Asked if similar relaxations to the reading, speaking and listening scores could be expected to follow, Ms Sutcliffe said: “We will always keep it under review but that’s not on the immediate horizon.”
The long-term plan has said a “step change” in international nurse recruitment is needed in the short-term, with “several thousand” overseas recruits required annually over the next five years to meet demand. This warning was reinforced by a major report on nurse staffing shortages published in March by three leading independent health think tanks.
Ahead of any international influx, Ms Sutcliffe noted that the NMC was working to “streamline” its processes, for example, by moving to a digital platform for overseas applicants to send over their documentation electronically. “We have a very significant paper chase at the moment, and we need to do that better, so we are looking at some very practical ways that we can speed that process up,” she said.
In addition, Ms Sutcliffe said the NMC would be offering to allocate trusts a case manager ahead of any major international recruitment drives to “guide” them through the process and “smooth some of the rough edges that there might be, so that we can be as responsive as we possibly can be”.
In November last year, Nursing Times revealed the NMC was battling the government to get access to evidence gathered by the inquiry into the Gosport care scandal that could help it identify any registrants involved in wrongdoing. Ms Sutcliffe said she was now “much more encouraged” by the situation and was “confident” the NMC would get hold of the information it needed.
The NMC has often faced criticism during its 17-year history and several of Ms Sutcliffe’s predecessors have left under a cloud. Reflecting on her NMC appointment, she said it was an “absolute privilege” but that she recognised the job was not going to be easy.
She said: “I will have tough times, I will have to make difficult decisions, and there will be occasions when I want to sit in the corner and cry. But actually, there are going to be many occasions where we will be able to say as a fair, transparent, humane regulator, we truly have helped nurses and midwives and nursing associates to do the best job possible and that makes a difference for everybody.”