NHS blame culture sees nurses referred to regulator without investigations

‘I genuinely do not believe you get safe effective care by making nearly 725,000 people scared of their regulator’

Nursing and Midwifery Council chief executive Andrea Sutcliffe (NMC)

Hospitals and care homes are failing to properly investigate incidents before referring nurses to their regulator, fuelling a blame culture and repeat failures, the head of the nursing watchdog has told The Independent.

In her first national interview, Andrea Sutcliffe, head of the Nursing and Midwifery Council (NMC) said some employers were referring nurses without any investigation at all, while half of initial enquiries to the NMC were rejected or required further work.

She told The Independent this emphasis on blaming the individual meant underlying causes of safety errors were being missed and so they were likely to be repeated. Her ambition is to transform the nursing regulator, which oversees 725,000 nurses and midwives across the UK, into a more forceful watchdog that will flag systemic issues of concern with NHS trusts and care homes.

In a wide-ranging interview, Ms Sutcliffe called on ministers to ensure that planned legislation to reform the way clinicians are regulated be made transparent and maintain the public’s confidence. She also stressed that the impact of coronavirus on nurses mental health meant rushing to restart routine operations in the NHS had to be carefully planned to avoid driving nurses out of the health service.

Ms Sutcliffe, who took over the regulator two years ago amid a storm of criticism over how it was handling concerns and treating families, said she wanted to change its approach to stop nurses being scared to speak up, while emphasising it would always focus on protecting the public from unsafe practise.

Since coronavirus, the NMC has a backlog of more than 6,000 cases, but is lobbying for new powers so it can speed up decisions and avoid courtroom style hearings, except for the most serious cases.

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Last year, it handled around 5,700 cases, of which only 127 resulted in the nurse being struck off the register. The number of complaints from hospitals and other employers are falling but complaints from the public are rising. Proportionally, midwives are more likely to be referred by the public than nurses.

Ms Sutcliffe, a former chief inspector of social care at the CQC, said she was worried about the blame culture in the health and care sectors saying some employers referred nurses unnecessarily.

“The sorts of things we might get is where something may have happened, and actually they’ve not completed their own investigation yet. The immediate response has been to identify an individual and to refer that individual to their regulator, when they’ve not undertaken any investigation locally, to determine whether that’s the right and proper thing to do.

“If your automatic reaction is to say ‘something has happened and who is to blame’, and the first thing you do is refer them to their professional regulator without considering anything else, then you don’t get the learning, you don’t really know what happened.”

The NMC has set up a new employer liaison service which takes enquiries from hospital trusts, care homes and other employers. Ms Sutcliffe said: “In about half of conversations with colleagues from other organisations we say no, that’s not a referral. An awful lot of those referrals that come to us are not issues for us to resolve, they are issues that are much better resolved at a local level.”

Ms Sutcliffe accepted the NMC had played its own part at times in adding to the blame culture, with many nurses fearful of the regulator and its powers to end their careers.

“I genuinely do not believe you get safe effective care by making nearly 725,000 people scared of their regulator, because if they're scared of us, they're going to be defensive, they're not going speak up when they should, they're not going to learn the lessons they need to.”

She said the NMC was aiming to speed up its processes and improve the cases it accepted by pushing back on inappropriate referrals from employers and to reflect back on wider lessons.

“I think that there is something about us trying to be a bit more confident in the voice that we have around, highlighting issues that we see are important for nursing and midwifery.”

But she added the NMC was clear its role was to uphold standards, adding: “I am absolutely clear that where there are serious concerns, and action needs to be taken, then we will take people through that process because it protects everybody – it protects all of the other nurses and midwives on the register and it protects the public.”

The NMC was set up in 2002 but the law underpinning its work is complicated and overdue for reform. Changes to all 12 UK professional regulators has been on the cards for years but the government has suggested it will take steps to change the system as part of a new Health Bill in Parliament later this year.

“We don't have all the powers we would like,” said Ms Sutcliffe, adding: “We would like to be able to make decisions earlier in the process that would enable us to agree how we conclude cases, so we don't have to go all the way through to an adversarial hearing.”

She said at the moment the NMC was forced into a “legalistic approach” that required it to use words like “allegations” and to hold hearings like trials.

She said her favoured approach would be an overarching set of rules that would give the regulator more flexibility in how it chooses to handle complaints.

Within the government’s planned legislation is the power to abolish regulators and to deregulate some professions, but Ms Sutcliffe said she could see no situation where nurses or the NMC would be abolished.

But she wanted more clarity on the safeguards in place on how ministers would exercise the powers.

“One of the key things about professional regulation is that it is seen to be independent. That it commands the confidence of the public, and the professions that are being regulated. We need to be independent of government. And we need to be capable of conducting our day to day affairs without any interference, which is the way that it works at the moment.”

As the NHS emerges from coronavirus, Ms Sutcliffe said the impact on nurses would be factored in to how the regulator judged any complaints but she said the value of nursing had been demonstrated “by the bucketload” in the past year.

But she warned apart from nurses who retire, the biggest reason nurses left the register was because of the pressure of work.

She said this meant restarting elective operations had to be a careful balancing act: “We need to be making sure that we're doing that in a way that is sustainable into the long term. That means we've got to have honest conversations within the system itself, but with the politicians and with the public about what is possible.”