Nursing and Midwifery Council

– in Westminster Hall at 4:41 pm on 16th July 2008.

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Photo of Jim Devine Jim Devine Labour, Livingston 4:41 pm, 16th July 2008

Three months ago, I stood here and made some serious allegations about the world's largest health care regulator—the Nursing and Midwifery Council. I claimed that the NMC was a fundamentally dysfunctional organisation, with poor governance, a lack of transparency and a culture of bullying and racism. The NMC strenuously denied those accusations, claiming that it did not recognise the organisation that I had described. The NMC might not have recognised that description, but others certainly did, and they came forward to the inquiry ordered by the Minister in response to the debate.

That inquiry, conducted by the Council for Healthcare Regulatory Excellence, confirmed those serious allegations, yet the NMC continued almost to be in denial. The CHRE's damning report was given to the council on 6 June, nearly six weeks ago, yet it has taken it until today to hold an urgent meeting to discuss the report's findings. However, other things occurred during those six weeks.

Of particular concern to me is what has happened to my constituent, Moi Ali. She was vice-president of the Nursing and Midwifery Council, a role that she took very seriously. She had longstanding concerns about the NMC, and she and others continually raised those matters internally. However, she was rendered powerless; she believed that the president, the chief executive and others had excluded her and subjected her to a prolonged campaign of harassment and bullying.

The things that happened to her are frankly disgraceful. I am therefore pleased to report that, having found a prima facie case of racism, the Equalities and Human Rights Commission is providing Moi Ali with legal support in her case against the NMC. The full details of her treatment will be heard at a tribunal.

Ms Ali came to see me just before Christmas to tell me of her serious concerns. She gave me hard evidence to back up each and every one of her allegations. She told me that she was not alone in being worried about the NMC's ability to protect the public. She showed me a letter that she and seven other members of the NMC—a third of the council—had sent in June last year to Lord Hunt, then Health Minister, pleading for help while there was still time to get the NMC back on course. Sadly, he declined to reply. A civil servant wrote to them stating that the NMC's problems should be resolved from within, despite those council members' well-founded belief that the NMC was incapable of doing so.

Astonishingly, the Department of Health told the NMC about the confidential whistleblowing letter to Lord Hunt. What was the NMC response? Did it ask Moi Ali, who openly admitted signing the letter, for a copy? No. It secretly spent thousands of pounds, money that was intended for public protection, on lawyers in a bid to obtain the letter from the Department. Did it ask Moi Ali about her governance concerns? No. Instead, it mounted a witch hunt to unmask the other signatories, who were understandably too afraid to step forward.

Photo of Jim McGovern Jim McGovern PPS (Mr Pat McFadden, Minister of State), Department for Business, Enterprise & Regulatory Reform

I am grateful to my hon. Friend for giving way. I congratulate him on securing this important debate. If the account that my hon. Friend is so eloquently setting out is accurate—I have no reason to doubt it—I am horrified. Is his constituent a member of a trade union? If so, has she received adequate and appropriate support from the union?

Photo of Jim Devine Jim Devine Labour, Livingston

My constituent is a member of Unite and the National Union of Journalists, and she is being given full support as she pursues her claims.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

I thank my hon. Friend for giving way. I, too, congratulate him on securing this debate. I, too, am shocked at what he has said.

My hon. Friend will, I am sure, be shocked to hear what happened to Jenny Traves of Birchgrove in my constituency in her dealings with the Nursing and Midwifery Council. She heard about a professional misconduct hearing against her independent midwife only through the local press, even though she was the patient involved. She went to the hearing in order to praise the midwife for her care and sensitivity following the stillbirth of a daughter. However, her truthfulness was questioned and her evidence dismissed. Her hospital notes were used at the hearing without her consent. She was asked to leave the hearing when her baby started gurgling, but was not allowed in again, even though the baby was by then asleep. To cap it all, one panel member fell asleep; and the panel had obviously been given no training. Does my hon. Friend not agree that that is a poor way to carry out such proceedings?

Photo of Mike Hancock Mike Hancock Liberal Democrat, Portsmouth South

Order. Before the hon. Gentleman replies, I urge Members to be extremely careful. If that case is the subject of a tribunal hearing, it might be prejudicial to the person's case if too much of it is discussed here. Although the case might not be sub judice, what is said might be prejudicial to the outcome of the tribunal. I would hate it if we had put someone in a disadvantageous position because what had been said here.

Photo of Jim Devine Jim Devine Labour, Livingston

I am grateful, Mr. Hancock, for that advice. I was very aware of the problem when preparing my speech. I have received a document from the Independent Midwives Association, and since I first raised the question in March, I have been inundated with complaints similar to that mentioned by my hon. Friend Julie Morgan.

The NMC spent tens of thousands of pounds on pursuing a formal investigation. The letter to Lord Hunt was sent more than a year ago and the CHRE report clearly vindicates the actions of the signatories, yet the disciplinary investigation continues. Those council members have been subjected to a year of considerable stress merely for doing the right thing in seeking Government help for the organisation.

When the CHRE report was published, Ms Ali and the other whistleblowers breathed a sigh of relief, as their concerns and actions were completely vindicated. However, that sense of relief was short-lived. Civil servants—those who had refused to help—pressured my constituent into resigning. She refused. From her perspective, she was the good guy. She had helped to expose the wrongdoing, having first tried to address it internally. She was the victim of bullying, so why should she resign? The civil servants said that as she was part of the leadership, she had to go. The fact that she had been actively and deliberately excluded from any leadership role was totally ignored.

Photo of David Hamilton David Hamilton Labour, Midlothian

I followed the previous debate, and I am following today's. The House has passed legislation on the protection of whistleblowers. Has my hon. Friend's constituent been able to make use of that? My hon. Friend also mentioned money; how many thousands of pounds will be needed to stifle this discussion?

Photo of Jim Devine Jim Devine Labour, Livingston

I am grateful for my hon. Friend's intervention. I shall deal later with the fact that whistle-blowing has excluded people such as Moi Ali. As for the money, I understand that nearly £400,000 has been spent.

In the House of Commons, the Minister publicly called for the resignation of my constituent, and in the same breath congratulated the president and the chief executive for showing leadership by resigning. My constituent maintains that those people were part of the problem, yet they got pats on the back, whereas she was forced out. The people in charge of the mess have supposedly resigned, yet they continue to lead the organisation. The president will demit office, but not until next month, more than two months after receiving the report. Perversely, she intends to remain an NMC member and is claiming not to have known about the problems despite being on the council for years. Amazingly, the chief executive has given no indication when she will go. The immediate past president, Sandra Arthur, who is widely acknowledged to have played a principal role in this terrible mess, has made no statement about her position and appears to have no intention of resigning from the council.

If we have any doubt about the incompetence of the organisation, we need only look at the contents of a report that has been produced by NHS London about a man called David Britten, a nurse who had sexual relations with 23 different women patients. The NHS London report states:

"We were concerned at the lack of cooperation we received from the Nursing and Midwifery Council during this investigation" and goes on to detail that the organisation actually blocked the investigation. NHS London was not given access to files on the man. He was sacked by the health authority in 2002, yet continued to practise till 2004 and was not removed. This man was a beast and should not have been anywhere near patients, but because of the prevailing problems within the NMC, his behaviour was allowed to continue.

May I give some detail of what was going on? One of the 23 patients was treated as an out-patient from late 2000 until early 2001. The sexual relationship continued during that time. When she went to the clinic, they would engage in heavy petting and oral sex in his office. David Britten continued to telephone her after his suspension. Today, Professor Morris-Thompson, the senior nurse in London, said that the NMC was very unhelpful during the inquiry.

As a trade union official who has worked in the health service I have read many such reports, but I can say that this case is appalling. The Minister will be as embarrassed as I am about the details of it and the NMC's behaviour.

Photo of Jim McGovern Jim McGovern PPS (Mr Pat McFadden, Minister of State), Department for Business, Enterprise & Regulatory Reform

I could not claim to be totally familiar with the case to which my hon. Friend is referring, but I am aware—I do not think he has mentioned this—that the 23 patients who were manipulated into sexual relationships were extremely vulnerable. They were not what we would regard as normal patients, but people in a very vulnerable condition.

Photo of Jim Devine Jim Devine Labour, Livingston

I am grateful to my hon. Friend for that clarification. That is exactly right. The man was in charge of an eating disorder clinic, and my hon. Friend is right that the patients were vulnerable.

Those are exactly the issues that Moi Ali raised both internally and with the Minister last year. Moi Ali is a fairly well-known author; she has her own public relations company and is without any doubt a leader in her field, and she has been a member of other public bodies. As a consequence of resigning, she was forced to resign from NHS Lothian, for which she was an independent board member who sought to serve the interests of the people in my constituency. Why? She was forced to resign because the chairman of the health board did not wish to be associated with anyone who had a leadership role in the NMC, despite the fact that she was denied such a role and was the victim of bullying, not the perpetrator.

Where do we go from here? I am sure that the Minister will talk about the report and the fact that the NMC behaved in such an appalling manner to the inquiry that was set up in 2006. The NMC is there to protect the public from individuals such as David Britten, but instead of co-operating fully, as the report says, the NMC was not helpful.

The chief executive of the NMC must leave immediately, making way for an interim troubleshooter who can restore sound management to the organisation.

Photo of Tom Brake Tom Brake Shadow Minister (Olympics and London), Shadow Minister (Home Affairs), Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Olympics and London)

I am sure that the hon. Gentleman will accept that although it is appropriate for Members of Parliament to defend their constituents, it is incumbent on them to be circumspect under parliamentary privilege about people who are not able to defend themselves in this Chamber.

Photo of Jim Devine Jim Devine Labour, Livingston

I totally agree and accept what the hon. Gentleman says, but I have been told, informally, about problems within the NMC for the last three or four years, even before I was in this place, and nothing was done. I have files about three inches thick with complaints of the type that we have heard. I am sure that the hon. Gentleman has not had a chance to read the report, but when he does, he will recognise my concerns, and that the solutions that I am offering are valid.

The president also needs to go. It is gross hypocrisy for either official to spend one more day in office. The past president should also resign from the council. Those people have no credibility and the report shows that they put public protection anywhere but first. It is a nonsense that individuals who have been found wanting by an independent review are still in charge of the world's biggest regulator—it governs the actions of about a third of the NHS regulated work force, 700,000 nurses, throughout the UK. That is a scandal, and while the situation continues, no one—nurses, midwives and the public—can have any faith in the organisation.

The vice-president should receive public acknowledgment from Government for the positive role that she played to help bring such matters into the public domain. The whistleblowers who tipped the Government off about problems at the NMC should have the ludicrous disciplinary procedures that have been brought against them dropped immediately. They have done nothing wrong, and it is a waste of hard-up nurses' and midwives' registration fees to pursue them when the money should be spent on public protection.

Many mistakes have been made in this saga, and many questions need to be answered. As the problems at the NMC are long-standing, will the Minister explain how previous CHRE annual reviews provided the organisation with a clean bill of health? Did the NMC systematically provide false and misleading information in previous years to receive favourable reviews from the CHRE? In light of the CHRE report and today's report, will the Minister call in the Charity Commission and the Privy Council to investigate the NMC root and branch? Will the Minister confirm that trustees who are whistleblowers will be given the same legislative protection as employees? If not, will the Minister extend the Public Interest Disclosure Act 1998 to cover them, so that it will be unlawful for public-spirited whistleblowers to suffer personal detriment as a result of their actions?

The Minister has some questions to answer and I hope that he does not attempt to distance either the Government or himself from the debacle. Members of Parliament and members of trade unions have been formally and informally advising Ministers of the problem for well over a year. Will the Minister place on record when he was first advised of the matter and what action he took? On 17 June, prior to Health questions, he advised me that the trade unions, including Unison, and the Royal College of Nursing and the Royal College of Midwives were demanding that Moi Ali go. They will feel that they were on the wrong side of the debate when they read today's report. How was contact with those organisations made? How can we ensure, given that there is an all-appointed committee, that we can resolve problems with leadership?

This has been a sorry saga, and hopefully we are coming to the end of it. Nothing short of righting the wrongs will begin to restore public trust and confidence in this most important organisation.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health 4:59 pm, 16th July 2008

I congratulate my hon. Friend Mr. Devine on once again raising this important issue and thank him for doing so.

It is important to make it clear from the outset that the NMC is an independent professional regulatory body, and one that has been in trouble for some time. The locus for ministerial or any other outside interference in such a body is limited. As my hon. Friend will know, having followed the matter closely, one of the main challenges facing the council has been a complete breakdown of relations among its leadership and on the council. Quite rightly, he has concerned himself with the case of one of the individuals concerned, the outgoing vice-president, who is his constituent. However, he will be aware that other members of the NMC's leadership have taken a different view from hers. Indeed, Tom Brake intervened on behalf of his constituent, the outgoing chief executive.

It is not the Government's job to take sides in a dispute such as this, nor should it be. Given the length, depth and rancour of the disagreements that have plagued the NMC's leadership, that would be impossible.

Photo of Tom Brake Tom Brake Shadow Minister (Olympics and London), Shadow Minister (Home Affairs), Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Olympics and London)

I hear what the Minister says about not intervening, but he will be aware of the correspondence that he has signed off to the chief executive, the president and the vice-president, which is a clear and forceful Government intervention in the matter.

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

Yes, and of course I will come to that in a moment.

We have not passed judgment on the performance of any of the individuals concerned, and we will not do so. When my hon. Friend the Member for Livingston and others initially raised their concerns, we urged the NMC to try to address them. However, by the time he secured his previous Adjournment debate on the subject, in March, it was clear to both him and me that the NMC was not capable of resolving its difficulties itself. In light of that, I asked the Council for Healthcare Regulatory Excellence—the regulator of regulators—to expedite its routine annual report on the NMC and to address specifically whether the NMC was performing its statutory functions. We also alerted the Charity Commission to our concerns about the NMC. At the time, my hon. Friend welcomed those courses of action.

The CHRE subsequently spent considerable time and resources looking into the NMC. Its work was led by its highly respected chief executive, Harry Cayton, who has had a long and distinguished career in the public service and representing patients' interests. At the end of that process, the CHRE published its report on 16 June. It was devastating. Without seeking to apportion blame to any particular individual, it stated that the leadership of the NMC had failed to carry out its statutory duties to the standard that the public had a right to expect and that it had lost the confidence of some of its stakeholders. It further stated that there was little evidence that the council had the leadership to extract itself from its current difficulties.

After I had discussed the investigation and the report with the chief executive and chair of the CHRE, the chief nursing officer, Unison, the Royal College of Nursing and the Royal College of Midwifery, it was clear to me that the NMC would not be in a position to recover unless its chief executive, president and vice-president all stepped down. That is the background to the letters I sent to those three people. I made it clear that we did not have the power to remove them or force their resignation, but that we believed that it would be in the best interests of both the NMC and themselves if they stepped down from their positions. I said that if Ministers were questioned on the matter in Parliament, we would have to answer accordingly. We welcome the leadership shown by all three in deciding to step down.

As for the NMC itself, it will now be important for it to demonstrate how it plans to address the recommendations made in the CHRE report. For its part, my Department considers that the NMC should put in place an action plan to implement all the recommendations.

Photo of Jim McGovern Jim McGovern PPS (Mr Pat McFadden, Minister of State), Department for Business, Enterprise & Regulatory Reform

Have the people the Minister complimented on their leadership for agreeing to stand down now gone? If so, when did they go?

Photo of Ben Bradshaw Ben Bradshaw Minister of State (Regional Affairs) (South West), The Minister of State, Department of Health

The vice-president has gone, although there was no requirement on her to leave the council altogether, and the president has indicated that she will depart her position in August. The chief executive has also indicated her intention to resign, but I imagine that as an employee, she will have some contractual arrangements to discuss.

The NMC might wish to consider seeking independent support to help it look afresh at its fitness-to-practise procedures. I note that today, the RCM, RCN, Unison and Unite have jointly offered to help the NMC and urged it to give serious consideration to making an external appointment. They also made a number of other sensible recommendations.

The Government believe that the existing system, whereby professional members are elected to the council, has contributed to the difficulties faced by the NMC. We are changing its governance, and that of all the other health care regulatory bodies, so that in future all members will be appointed. We believe that should help to resolve the council's underlying problems.

As a result of the CHRE report, we are also accelerating the planned reforms to the governance of the NMC. The Nursing and Midwifery (Amendment) Order 2008 has now received Royal Assent, and we are already consulting on a new constitution order for the NMC. We intend that the new council will be appointed through the Appointments Commission against set criteria of skills and competencies, which will ensure that all members of the council are competent board members. We propose to include in the constitution order provisions to allow both council members and employees to notify the Privy Council if they have concerns about a council member and consider that the member should be removed. We are on track to have a new, wholly appointed council in place by 2009.

I turn to the specific points made by my hon. Friend the Member for Livingston. On 24 June, the trade unions made a clear statement. The RCN, Unison and the RCM stated:

"The CHRE report makes it clear that these problems are of long standing and have not been addressed with the speed that they should have been...We commend the actions of the President and Chief Executive in putting the interests of the organisation first and we would urge the vice president to do so also."

My hon. Friend asked me when I first heard of the problems to which he has referred. It was when he intervened during the Report stage of the Health and Social Care Bill on 18 February. After that, we agreed to have a private meeting. He then secured his Adjournment debate, which took over from that private meeting. Ever since then, we have been in close contact, as I have been with other hon. Members.

My hon. Friend asked about the allegation that the CHRE report findings contradict its own performance assessment made in March. Of course, that is a matter for the CHRE, and I understand that it has said that that is not the case. He is welcome to take the matter up with the CHRE, and I understand that he has had a number of conversations with its chief executive in recent weeks. I am sure that the chief executive will be happy to speak to him about the matter.

Many difficult issues have been raised in the debate. However, we believe that it is important that the Government remain focused on what matters most, which is ensuring public and patient safety. That requires a robust system of professional regulation, with adequate checks to monitor the performance of regulatory bodies and detect problems before patient safety is compromised.

My hon. Friend asked about the David Britten case. The CHRE's performance review of the NMC, although it covered a period later than that of the David Britten case, raised significant concerns about the NMC's fitness-to-practise procedures and highlighted delays in investigating cases on occasion. As I have said, it is important for the NMC to put in place plans to address the concerns raised in both the CHRE report and the report on the David Britten case.

There will always be a balance to strike to ensure that the bodies regulating health professionals are independent of Government as well as of the professions that they regulate. The performance review process undertaken by the CHRE is an important component of the regulatory system and helps to ensure that the right checks and balances are in place. This is clearly a difficult time for the NMC, and I am sure that everyone in the Chamber supports the council in addressing the issues raised in the report. I hope that it will soon be in a position to provide reassurance about how it plans to proceed, and that we will then be able to draw a line under what has happened and look to the future and a fresh start for the NMC.

Photo of Mike Hancock Mike Hancock Liberal Democrat, Portsmouth South

I thank Mr. Devine, the Minister and all the Members who have taken part in an interesting but difficult debate. Thank you all for your attendance.

Question put and agreed to.

Adjourned accordingly at nine minutes past Five o'clock.