Partnership not punishment
By Birte Harlev-Lam, Executive Director Midwife on 26 July 2024
When done well, regulation can be a force for good. It supports staff by providing structure and guidance to practice and it supports services in a similar way around delivery. It also helps build confidence among service users in those delivering care, and where it is being delivered. However, when done poorly, or inconsistently, it can have a seriously undermining effect – on staff, on communities and on confidence.
In recent weeks, there have been damning reports into the two regulators with the most influence on midwifery and maternity services. The Nursing and Midwifery Council (NMC) commissioned an independent report into practices within the Council itself. What it found was shocking – bullying and harassment, toxic workplace cultures, and racism. Understandably, many have questioned whether this sort of environment has leeched into the way the Council’s regulatory work, particularly around fitness to practise (FtP). Meanwhile, an independent review of the Care Quality Commission (CQC) was so damning that the new Health Secretary has questioned whether the regulator is fit for purpose.
The findings of both of these reports, and their implications for us as both registrants and staff, undermine the value of, and the trust we need to have in, regulation. Rectifying this requires focus and determination to do better – and, of course, it requires action.
The RCM has long said that the NMC is under-resourced, with too many of those referred to them waiting in limbo for months, even years, for resolution. This can have devastating effects not only on careers, but on physical and mental health too. As part of their action following this review, the NMC has to put measures in place to provide better support to those under investigation. The RCM already provides both legal and pastoral support to members in this position. It’s in all of our interests for the NMC to be better – and that’s why we have been clear that we stand ready to help make that happen.
The issues raised in the Dash Review of the CQC are stark – but sadly, for those of us working in and around maternity services, not altogether surprising. We have raised with the CQC the inconsistency of inspections, where in one Trust actions are praised while in another Trust similar actions are criticised. Inspectors who have little or no knowledge or experience of maternity services have huge sway over whether that service is good or bad. With such inconsistency of application of the measures, how can Trust Boards, or staff, or the families we care for have faith in those judgments.
The interim Chief Executive recently issued an apology for the implementation of the current inspection regime. We welcomed this honesty at the time – but it has to be translated into action. That the Health Secretary has weighed in so swiftly – and so strongly – suggests that this will indeed be the case. Again, with the wealth of knowledge and examples that you continue to share with us, we are ready to support positive change.
Too often, regulation, particularly by the CQC, feels more like punishment. Every single one of us – whether we’re working clinically, in management, in policy roles or at the RCM – want to provide the best possible care to women and families, and we want them to feel cared for. There are so many examples of good practice in Trusts across the country, but too often they’re overshadowed by the perception of failure. Whatever its future, the CQC needs to work in partnership with the profession, and with all those involved in maternity services, to share this good practice.
Regulation can and should be a force for good. But it has to be done in partnership, not as a form of punishment.