My Lords, I am grateful to my noble friend and the noble Lord, Lord Hunt, for their questions and comments. My noble friend Lady Brinton asked for reassurance about the case examiners. Under the proposals, the two case examiners will independently review the evidence and then agree their decision. This is the same process as used by GMC case examiners, and I am not aware of any particular difficulties that it has encountered in this connection. If the case examiners cannot agree the decision, the case will then be referred to the investigating committee for determination, as I explained.
My noble friend asked about training of the case examiners. Two case examiners, one lay and one registered nurse or midwife, will consider an allegation of impairment of fitness to practise, whereas three investigating committee members are required at present. Co-ordinating meetings of the investigating committee members is time-consuming due to panel members having other commitments or requiring refreshed training. A case examiner will be a skilled role. They will develop expertise that will lead to greater consistency when making decisions because they will be considering a greater number of cases on a regular basis than individual members of a large pool of investigating committee members. This will speed up the fitness-to-practise process and result in reduced costs.
My noble friend asked whether the job specification of case examiners, as employees of the council, must specify that they carry out their roles without fear or favour and be truly free to make comments. Case examiners will be employed by the NMC, whereas investigating committee members, who currently consider allegations of fitness to practise, are chosen from a pool of around 100 individuals who provide their services to the NMC as independent contractors. But, once again, there is no reason to suppose that, as professional people, they will feel inhibited from voicing their full and frank views whenever they feel the need
to do so. Despite their being employees, it is more than any professional’s self-esteem is worth to feel inhibited in that sense. It is a very responsible role. While the individuals will need to be carefully chosen, I have confidence that this arrangement will work.
My noble friend asked about the removal of the requirement for a registered medical practitioner forming part of the panel where health is an issue. We consider it more appropriate for medical advice to be provided by independent expert witnesses and medical reports. Having an independent medical witness will ensure that the panel remains detached from that part of the process and is therefore more able to make an independent decision so making the process more robust and transparent. This would ensure consistency between registration appeals and fitness-to-practise appeals.
The noble Lord, Lord Hunt, expressed concern that case examiners might be target driven, and this was an issue raised in the consultation. We do not believe that this will be the case. Although they will be employed by the NMC, case examiners will be both registrant and lay; that is, a registrant nurse or midwife and a lay person. Their role will be distinct; they will be responsible only for making an assessment of whether a registrant has a case to answer against an allegation that is made to the NMC that their fitness to practise is impaired. They will make their decisions impartially and independently, and based solely on the information provided for the case, including any representations made by the registrant. Any such decision would be made by a pair of case examiners. The NMC will seek to appoint people to these roles who have demonstrated sufficient skills and experience to make robust decisions. The NMC’s case examiner resource will be sufficient to ensure that all decisions will be considered on their merits, without any undue time pressure. Case examiners will not be involved in undertaking the fitness to practise investigation itself, nor in presenting cases at any final hearing.
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I am aware that the decision not to progress a professional regulation Bill in the current Session has come as a disappointment to interested parties and I understand the comments made in that connection by the noble Lord, Lord Hunt. The process of putting together a Bill dealing with all the professional regulators is a complex matter because it touches on many pieces of legislation. However, this decision provides the opportunity to invest time to ensure that this important legislative change is right, and that we get the right framework in place for the benefit of those who will ultimately be affected by it. We continue to work and engage with all the regulators responsible for the healthcare professionals, the Professional Standards Authority and other stakeholders. We are committed to legislate on this important and complex issue when parliamentary time allows. The department is working on a formal response to the Law Commission’s recommendations and will publish it in due course.
The noble Lord asked me about the performance of the NMC and remarked on the progress made to date. I am sure he knows that the NMC has something of a troubled history regarding its performance, which is why Ministers commissioned the predecessor body to
the Professional Standards Authority, the CHRE, to undertake a full strategic review in 2012. On 3 July 2012, the final report of this strategic review was published, which put forward 15 high-level recommendations for improvement in the delivery of the NMC’s regulatory functions, along with the expectation that demonstrable improvements should be seen within two years.
Earlier this year, the NMC commissioned KPMG to undertake an independent review to assess its progress in addressing the recommendations from the 2012 strategic review. The associated report was published on 15 September this year, in which KPMG concluded that the NMC had made a substantial number of improvements, which cumulatively placed it in a much stronger position than in 2012. We have welcomed KPMG’s report on that progress, but we want the NMC to improve much further and faster. These amendments to its existing legislation will undoubtedly help in that endeavour. We welcome the appointment of Dame Janet Finch as NMC chair from 1 January next year and hope that, under her leadership, the NMC will continue to make improvements to become a confident and capable regulator.
On 3 September, my honourable friend the Parliamentary Under-Secretary of State for Health met with Mark Addison, the current NMC chair, and Jackie Smith, the NMC’s chief executive, primarily to discuss the NMC’s failure to meet the standards that were highlighted in the Professional Standards Authority annual report. He explored with the NMC how it is responding to the concerns expressed by the PSA and the action it is taking to ensure compliance. The report shows that the NMC has made progress in becoming a more effective regulator, supported by government grants and decisive NMC leadership, but, as I have said, we believe there is further to go. We will continue to monitor its performance closely and are working to amend existing legislation—this Section 60 order being the first such example—to help in that process.
On revalidation, nurses and midwives have some of the most important jobs in the NHS, caring for patients every day. Making sure that they are up to speed with the latest treatments and practices will help them maintain the high standards that they and their patients expect. That is why we support the NMC in its drive to introduce revalidation. It will improve safety and quality of care and reassure patients that nurses remain fit to carry out their important work.
I am happy to write to both noble Lords to cover the points that I may not have done full justice to. With that, I beg to move.