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Nursing & Midwifery Council

Volume 473: debated on Tuesday 11 March 2008

It is a pleasure to secure my first Adjournment debate under your chairmanship, Mr. Bercow. Your reputation for fairness, modesty and humility precedes you, and I know that you will exhibit the same during the debate.

Matched only by myself.

The Nursing & Midwifery Council is a public body that is also registered as a charity. It regulates almost 700,000 nurses and midwives. In line with its principle of self-regulation, it is funded by those whom it regulates. Nurses and midwives currently pay a mandatory annual fee of £76. That has increased by 77 per cent. since 2007. I will return to that point.

Members of the NMC’s council are responsible for its governance and are charity trustees. They have a general duty of care to ensure that the organisation is properly run, that what it does accords with its purpose and that action is not taken beyond its constitution. There is a particular duty to ensure that its moneys are used only for legitimate purposes. As trustees of a charity, they must ensure that there is no misuse of funds, for example, through supporting activities that are outside the body’s defined activities or by incurring excessive costs that are not commensurate with the scale and needs of the fulfilment of its objectives.

As a self-governing regulator, whose purposes are public protection and the public interest, the NMC should be run with integrity, competence and transparency. Unfortunately, that appears not to be the case. It appears to be a fundamentally dysfunctional organisation where the priority of those in control is to maintain the status quo at the expense of proper transparency and good governance. Its funds are being misspent and staff time is being misused. Poor financial management has resulted in nurses and midwives, who are already under financial pressure, being faced with nearly a doubling of their annual fees, which they must pay each year to be licensed to practise. Trustees are systematically prevented from doing what they are supposed to do. There appears to be an ingrained culture of bullying and racism as a means of preventing good governance in general, and in particular, any proper examination of what is going on. I will deal with those very serious allegations in detail.

Sadly, since this matter has come into the public domain, there has been an attempt by the NMC to portray me as a man running a personal vendetta. That is not the case. I trained as a nurse and represented nurses as a lay and full-time officer for more years than I care to remember. I believe that I can recognise a serious issue when it is brought to my attention. The lack of governance at the NMC is a very serious issue that we, as parliamentarians, cannot ignore.

I have six statements from former members of the council and its staff and one from a trade union representative who represented a staff member at the NMC. Those individuals live throughout the United Kingdom and I understand that other hon. Members have been approached by constituents with similar issues.

I, too, have been approached with very serious allegations about probity and conduct. Whistleblowers are in an awfully difficult position. The person who approached me asked who regulates the regulator, because they have nobody to complain to.

The hon. Gentleman raises a very interesting point, which I will hopefully return to at the end of my contribution.

Allow me to quote the statement from the trade union representative who represented a member of staff at the NMC:

“My enquiry suggests that the organisation is dysfunctional and out of control. It is not just the staff but council members are also being harassed and bullied, contrary to the Nolan principles.”

I congratulate my hon. Friend on taking up this issue. Does he agree that it is completely and utterly unacceptable that any member of a regulatory council is afraid to speak out and be identified, let alone a representative who is one of the most experienced and respected members of the profession in this country?

I am grateful to my hon. Friend for that intervention and I will deal with his point at the end of my contribution.

The trade union representative went on to say:

“My member has also, as I have seen, experienced a lack of due process and investigations and equally annoying a failure of natural justice. This has been compounded by a perverse use of individuals under a grievance investigation to carry out investigations into staff who are the grievance source.”

That is absolutely unprecedented.

A former member wrote to me, saying:

“We are hoping to make a contribution to a body run with integrity and competence while we would have confidence in its leadership. Sadly this is not the case. The NMC is a fundamentally dysfunctional organisation where the priority is on maintaining the status quo at the expense of proper transparency and integrity, where funds are being misspent and where trustees are being systematically prevented from doing what they are supposed to do.”

Like other hon. Members who have contributed, I have a constituent who is a council board member, and they have expressed similar concerns about the organisation. Does my hon. Friend agree that the fact that there is no agreed procedure for handling complaints at the NMC is a very serious matter that should be rectified immediately?

My hon. Friend is exactly right. It is an issue that I hope to touch on in my contribution.

Another council member wrote:

“I am aware that there are other past council members as well as current ones who feel as I do about the organisation. They would be prepared to share these concerns with you but the current members especially are extremely concerned that their names are not divulged to the NMC because of a fear of incrimination, bullying and harassment. It is essential therefore that you provide a guarantee of confidentiality at the outset.”

Another former member contacted me and stated:

“I also have lingering concerns from the old council about the way a particular member of staff had been eased out of the NMC. I have signed a confidentiality agreement about that matter and so am not at liberty to say any more than this. That was the context to my own resignation.”

Another former council member wrote:

“My concerns about the NMC are a culture of institutional bullying dominated by a few individuals; a failure to respect all views even if they are in the minority; over use of outside legal advice, some of it conflicting, and; inappropriate use of registration fees.”

A former staff member wrote:

“I was very happy when I joined the organisation, loved the job and the working environment. Things changed when”

the new chief executive

“arrived and I was very soon out of favour. I was very happy with the idea of change but the changes made to the culture of the organisation resulted in a very unpleasant, punitive and negative working environment lacking transparency. Sarah held what she termed ‘soft chair conversations’ with staff who were not in favour. This involved me being given at one point what she termed a bollocking.”

The national committee of the Community Practitioners and Health Visitors Association passed a vote of no confidence in the ability of the NMC to protect the public. All those people cannot be wrong, and hon. Members throughout the United Kingdom have expressed similar concerns from their constituents. Those individuals are strong people and leaders in their chosen career field, yet every one of them, whether a past or present member, is frightened to have their name mentioned, even in this privileged place. I can think of no better proof that a culture of bullying prevails in the NMC.

The culture at the NMC is reflected by the fact that some 20 complaints and counter-complaints have been filed in the past year against eight current and two previous members of the council, and I understand that there are more complaints in the pipeline. Given that there are only 23 council members, that is completely disproportionate. The NMC’s expenditure on outside legal advice is also excessive. Legal fees are paid not to address the organisation’s proper purposes, but to deal with, and often to create and pursue, such spurious complaints. In 2007, legal expenditure on governance issues and the costs of investigating complaints in relation to council members seeking transparency and satisfactory explanations were well over £120,000.

The expenditure continues, and it is now significantly higher. The money is nurses’ and midwives’ money, paid in the name of public protection, and its misuse raises serious issues for public protection. Costs as high as £250,000 to £300,000 equate to the annual registration fees of 3,200 to nearly 4,000 nurses. The NMC’s reaction the first time that I raised the matter in the House was to seek legal advice. It is a bizarre organisation.

The concern is not only that money is being spent on complaints, bullying and so on but that staff and council members’ time is dominated by those matters rather than by the organisation’s proper purposes. Staff whose faces do not fit are subject to disciplinary action, paid off and required to sign confidentiality agreements. I have been told of two recent such payments of £100,000. The absence of transparency, responsiveness and integrity in the organisation means that it is not possible to hold the chief executive to account and that the governing body is not given the information that it needs for effective decision making.

I understand that the NMC’s approach to governance is also very worrying. It is not unusual for the decisions of the council and its committees to be ignored or circumvented, and standing orders are routinely put to one side to suit the position of the chief executive and prevent the council’s consideration of legitimate business. In a formal note, the chair of the council’s audit committee suggested that certain council members should be barred from participating in a council debate on the basis of their past voting patterns. I find that unbelievable. When two respected lay members of the council resigned last year, the Appointments Commission was told about it and invited to intervene, but did absolutely nothing. It went ahead with replacing the two people who had resigned, despite their suggestion that it should not do so until the reasons for their resignation had been properly investigated.

We have moved on, rightly, from a situation in which professions are allowed to regulate in their own self-interest. If self-regulation is to be sustainable, it must involve accountability and the highest possible standards of ethical behaviour and competence. An important point has been made by hon. Members about the position of non-executive trustees in bodies such as the NMC. Trustees are protected against discrimination only. Because they are not employees, no other legislative protection or redress is available to them, and they can be very exposed. Unlike employees, trustees and public office holders who blow the whistle have no legal protection.

The NMC was set up to protect patients, raise standards in the profession and act in the public interest. Unfortunately, it is acting only for a small group of staff. Our first priority must be to rebuild the NMC on a sound footing, but it is equally important to look to the future. The House, the nursing and midwifery professions, other professions and the public need assurances that lessons will be learned from the NMC debacle. I say in a comradely way to the Minister that, after parliamentarians from throughout the United Kingdom have expressed concern about the workings of an organisation that regulates 700,000 nurses, it is not good enough to say that the matter has nothing to do with Parliament, and I hope that he will not go down that road.

I congratulate my hon. Friend the Member for Livingston (Mr. Devine) on raising this important and worrying issue for discussion. I know that he has much personal experience in such matters from his early years as a psychiatric nurse and his later trade union career with the Confederation of Health Service Employees and then Unison. I take this opportunity to reassure him and the other hon. Members present that the Government take the matters that he has brought before us extremely seriously. The governance of the Nursing & Midwifery Council is of great importance, as is the governance of all health professional regulators.

The majority of concerns raised by my hon. Friend relate to the internal proceedings and management of the NMC, which has been charged with operating in an atmosphere of bullying, harassment and institutionalised racism. The NMC is, as he acknowledges, an independent professional regulatory body, and the Government therefore have no power to intervene directly in its internal operations. However, the situation has been causing serious concern for some time, and I know that he does not make such charges lightly. Although I am sure that he will accept that it would not be right, even if it were possible, for me to judge or pre-judge goings-on at the NMC, as well as that some would challenge the allegations that he has made today, the Government will do what we can to help the organisation to get out of the problems that it faces and rebuild its members’ confidence.

My hon. Friend will be aware that the NMC itself has instigated an inquiry into the criticisms that he outlined. As I understand it, that will include asking an independent, external party to investigate the charge of institutional racism. I understand that the NMC has invited him to meet its members, visit the organisation and discuss his concerns. However, given the seriousness of the breakdown of relationships within the NMC and the level of concern expressed by hon. Members, an internal inquiry is not likely to satisfy the NMC’s critics. That is why I will write today to the Council for Healthcare Regulatory Excellence and the Charity Commission to encourage them to play a role in resolving the long-standing problems at the NMC.

The Council for Healthcare Regulatory Excellence is the independent umbrella body that oversees the operation of the various health professions’ regulatory bodies. It is already undertaking its annual performance reviews of all the regulators, the results of which are due to be published in the summer, but because of the seriousness of the situation at the NMC, I will ask the CHRE if it is possible to expedite its review of that organisation, including addressing the crucial question whether the organisation is fulfilling its statutory functions. I understand that a number of people involved in the NMC’s internal rows have asked the Charity Commission to intervene. I welcome that move, and have written today to the Charity Commission to say so.

It important to me as well as to thousands of nurses and midwives that the workings of the NMC and all regulators should be open and transparent. That is crucial to maintaining patient and public confidence. If neither the NMC’s internal processes nor the measures that I have just outlined are sufficient to resolve the problems at the council, the Government would not rule out formally asking the Privy Council to investigate. However, I am sure that my hon. Friend appreciates that that would be a nuclear option.

In the longer term, the Government are taking a number of other measures. My hon. Friend will be aware of the passage through Parliament of the Health and Social Care Bill; indeed, it was on Report that he raised with me his concerns about the NMC. The Bill is part of a programme of legislation on matters relating to professional regulation that the Government introduced after the publication of our White Paper “Trust, Assurance and Safety” in February last year.

The Bill introduces a number of reforms regarding the governance of regulatory bodies and the Council for Healthcare Regulatory Excellence. As part of the new governance arrangements that we will shortly put before Parliament in a section 60 order, under the Health Act 1999, greater transparency will be introduced to the process of disciplining members. Each council will have a constitution order, made by the Privy Council, that will set out the grounds for removing council members from office. Under the proposals, which the Department of Health is in the process of sharing informally with the regulators, council members and employees will be given a statutory right to notify the Privy Council if they consider that a council member should be removed from office. Responsibility for considering the matter will then be delegated by the Privy Council to the independent Appointments Commission.

Together, the Bill and the section 60 order will meet the commitment that we made in the White Paper to reform completely the governance of regulatory bodies by introducing smaller, more board-like councils which are fully appointed by the independent appointments commissioner, and which operate in a more strategic manner. Those changes will allow councils to set the strategic direction of the regulator and to hold the executive properly to account for the day-to-day running of the organisation. That should help to avoid some of the long-standing problems on the board of the NMC.

The Bill amends the governance of the Council for Healthcare Regulatory Excellence, giving it a new primary objective and enhancing its powers to look at regulators’ functions and processes. The Government are also taking new powers to direct the CHRE to investigate particular concerns or issues that arise. Those powers would have been useful in preventing the breakdown of the NMC’s functionality. The changes will ensure that the CHRE acts as a strong, independent voice for patients and the public. Its board members will no longer consist of the presidents of the regulatory bodies, but of independent people approved by the Appointments Commission.

As a result of the concerns raised today, I shall ask the CHRE to advise on what further steps could be taken, under secondary legislation relating to the regulators, to enhance confidence in this area. I thank my hon. Friend again for raising his concerns, and I hope he accepts that within the limits of our powers of intervention, the Government are doing what we can to help the NMC to address serious, long-standing problems. The changes that we are making through the Bill should help to ensure that such problems cannot arise in future.

I am grateful to the Minister of State for his contribution.

As both the right hon. Member whose debate it is and the Minister who is to respond are present, we can proceed to the next debate.