Money For Nothing and Your Chips for Free

Jackie Smith, the chief executive of the Nursing and Midwifery Council (NMC), the nursing regulator, received a pay rise of nearly £20,000 last year on her basic pay. That is an 11% pay rise, but that was only on her basic pay. Her overall pay package rose to £256,027, a £35,743 rise, which includes a £11,921 “performance bonus” (1).

That £35,743 rise is equivalent to the yearly salary for a Band 6 Nurse (1), someone working as a Junior Ward Manager or Deputy Team Leader. In one year she has received a percentage increase in her salary greater than the combined pay rises NHS nurses have received since 2010. Since 2010 NHS nurses’ pay has risen by only 6% (2).

Is she worth this pay rise?

The NMC seems to think so. In their annual report they said, “Executive salaries in the NMC were generally out of alignment with median pay for comparable roles in the wider market, in some cases considerably so.” (1) It may sound familiar because it’s the same argument that was used in 2015 when MPs received an inflation busting 10% pay rise (3). That wasn’t a popular move.

Is she earning her £256,027 salary?

The NMC’s own Annual Report and Accounts 2015–2016 (4) details many of the NMC’s current failings. From it I learnt of the following failings:

• They had a staff turnover of 23.5%, 24.5% the year before. Nearly a quarter of their staff left in a year, and just under a quarter of their staff left the year before. It must be a pretty toxic working environment.
• It has taken until 2016 for nurses to be able to pay their registration fees in quarterly instalments, we still can’t pay in monthly instalments because that still seems beyond the NMC to organise.
• As of March 2016, the NMC had £41million in reserves, yet their annual report makes no mention of using these reserves. In 2015 the NMC imposed a 20% increase in nurses’ fees because they said they needed that money to function, especially to pay for Fitness to Practice hearings (5). So if this was the case why do they have so much in reserves?
• They had 120 data breeches, one more than the year before.
• Their own Head of Internal Audit found that the NMC’s own internal control, governance and risk management were failing. “Significant improvements” are needed.
• The Head of Internal Audit’s report found deterioration in services from having so many temporary senior managers, especially in Finance, Procurement, HR and Technology Business Services.
• There were “specific weaknesses” in the NMC’s finance and procurement controls, there are serious problems in their financial department.
• Their high staff turn has also resulted in “increased costs”, money wasted because the NMC has created such a poor working environment.

This are just the failings that the NMC themselves identified, even though their annual report tried to wrap them up in positive sounding management speak.

The Professional Standards Authority (PSA) is an independent body, accountable to Parliament, which has a duty to oversee the work of the nine statutory bodies that regulate health and care professionals in the UK, including the NMC (6). For the last two years they have produced an annual report comparing all the organisations they regulate and how well each organisation is operating. Their recent report did not paint the NMC in any type of glowing light (7). They found the NMC failing in the following ways:

• The NMC took the longest time, out all nine regulators, from receipt of initial complaint (About a registrant) to their final decision. Their avenge time was 51 weeks, their longest time was 401 weeks (7). The NMC’s own Fitness to Practice report 2016-2017 (8) stated all that Fitness To Practices should be resolved in 15 months, not a fast resolution.
• PSA requires regulators to deal with complaints as quickly as possible, but the NMC failed this standard and the PSA were not convinced that the NMC was improving.
• They were also concerned about the lack of transparency when the NMC reached agreements were the nurse resigned from the register rather than face an investigation or a Fitness to Practice hearing.
• The PSA has the power to refer complaints to the High Court when they feel a regulator has been too lenient in their Fitness to Practice decision, 62% of these actions were following NMC Fitness to Practice decisions. On “several occasions” PSA had to seek legal injunctions to stop the NMC allowing a registrant to resign from the register before the PSA had referred their Fitness to Practice decision to the High Court.

These are incredibly serious failing and all of them revolved around Fitness to Practice hearings, something that the NMC has repeatedly failed at. The previous year the NMC failed to meet five of the PSA’s standards (9). They have improved but it is disgusting that they first got into this position and that it took a PSA’s report to force them to improve. Would they have improved without this public naming and shaming by their own regulator?

What is most shocking, though, is that the NMC is being stripped of its supervision of midwives (10). They will continue to regulate midwives, but they will be stripped of their statutory responsibility to also supervise midwives. This is a huge change to the NMC, they are being stripped of one of their statutory responsibilities. The NMC are trying to spin this as a positive change (11), but this is a result of NMC failings. A damning Kings Fund report (12), commissioned by Parliamentary and Health Service Ombudsman following the failing in maternity care at Morecambe Bay NHS Foundation Trust, found that the NMC was not suitable to carry on supervising midwives. This is all in the light of this week’s news that maternity units in England were forced to close 382 times last year because of shortages of midwives (13).

These are not the only issues the NMC has in its role as regulator, it is failing nurses in so many different way.

It can take the NMC two to three months to be process a newly qualified nurse onto the nursing register and get them their PIN number (14), without which they cannot work as a registered nurse. This makes starting their first job challenging at best.

Disproportionate amounts of BME, male and older nurses are referred to Fitness to Practice hearings. 16% of new complaints to the NMC are about BME nurses, but only 7% of registered nurses are BME (15). 25% of new complaints were against male nurses and men make up only 11% of registered nurses (15). Nurses over 40 make up 76% of new complaints, and yet only 69% of registered nurses are over 40, and four out five nurses struck off by the NMC are over forty (16). The NMC has a legal responsibility to reduce discrimination, yet all they seem to have done is commission research that told them a disproportionately high number of BME nurses receive complaints against them (8), nothing more than that. So far they have announced no plans to tackle this obvious discrimination, nor do they seem very interest in it.

The NMC will regulate the new role of nursing associates (17), but soon as that was announced they showed that they actually understand very little about the role of the Registered Nurse. They released proposals to change Registered Nurse training (18), which was obviously designed to draw a distinctive line between Registered Nurses and Associate Nurses but all it showed was how little they actually know about the role of the Registered Nurses (19). They seemed to think it is solely made up of performing physical tasks.

Recent NMC Fitness to Practice Hearings have produced some very questionable findings. Jane Kendall, the nurse who was convicted of harming a patient because she didn’t perform CPR on that patient after they had died over an hour before. Donna Wood was convinced of falsely recording a temperature when there was no physical evidence that she did. They even tried to prosecute Pauline Cafferkey for contracting Ebola, they failed and were publicly roasted in the media for doing so. Their response to this was to no longer publish the names and allegations of nurses and midwives under investigation (20), removing another level of transparency.

The NMC proposes to split the role of mentor into practice supervisors and practice assessors (20a), were the supervisor would train the student and the assessor would only assess them. It is hard enough to find enough nurses to act as mentors, under this scheme we would have to double the numbers, even before we come to all the problems inherent with splitting the role. Again they showed they do not know what is involved in the role of a Registered Nurse, and they regulate the role.

Nursing is in crisis now and the NMC has provided no leadership on any of the problems facing us. They have been overly silent on the following issues:

• The 40,000 nursing posts that are vacant in the NHS, leaving far too many wards, units and teams seriously under staffed (21).
• In March this year, more nurses and midwives left the NMC register (affectively stopping working as nurses and midwives) than those who joined it (22). A reduction in the number of nurses and midwives.
• There are still no safe staff levels for wards, departments and the community (23). This leaves units seriously understaffed and dramatically increases the workloads of nurses working there, the perfect storm for mistakes to happen.
• Less people are applying to train as nurses. There was a 19% fall in people applying to train this year, and a 28% fall in mature students applying (24). This is when we need more nurses, not less.
• There has been warning sign (25) after warning sign (26) that the NHS is heading towards a crisis. Sir Robert Francis QC said it was only the “superhuman” efforts of NHS staff that prevented the NHS breaking during the last winter (27). It is now the summer, traditionally a less stressful time for healthcare, and the NHS is so flooded with demand that the near-breaking strain has not eased up. The Point of Care Foundation said that NHS staff have become the “shock absorbers” for the overwork and demand heaped onto the NHS (28).

Yet the NMC has remained silent over all this, no advice, no guidance, no leadership. It is as if the NMC is not bothered by any of this. If nurses are under increasing stress and workloads, with falling numbers of actual nurses, this is the perfect situation for mistakes and errors to be made. Surely, as the nursing regulator the NMC would want to cut down on any mistakes? Or are they only interested in running Fitness to Practice hearings?

The NMC’s predecessor, the UKCC held regular elections to its governing council (29). All Registered Nurses were able to vote for who would be members of it. We cannot do this with the NMC because their governing council are appointed, after a selection process, by the Privy Council (4). As nurses, we have no say in the running of our regulator, the NMC, and no way to change their failings.

In 2015, Professor Ian Peate, professor of nursing at the school of health studies in Gibraltar and editor-in-chief of the British Journal of Nursing, wrote a scathing editorial criticising the NMC’s performance (30). He basically called them unfit for purpose, I cannot see how NMC has improved since then. His assessment of them still stands.

Is Jackie Smith worth £256,027 a year?

I cannot see how. Researching this blog left me feeling sick and demoralised reading all the failings of the NMC, and by how little the NMC seems to be doing to correct them. Jackie Smith is at the helm of this organisation and seems unable or unwilling to solve these failings. How can the NMC turn themselves around with Jackie Smith still in charge? The organisation needs a new chief executive, a new leader to solve their problems. But after bestowing an obscenely large pay increase on Jackie Smith, there seems no desire to do this by the NMC’s council.

As for me, there is nothing I can do about this, I have no voice in the NMC, but I still have to pay them my annual fee otherwise I cannot work as a nurse. I have no say in this at all.

Drew Payne