1. Aligning professional and systems regulation: Can the whole be greater than the sum of its parts? Jon Billings Director of Strategy, Nursing and Midwifery Council, UK Dubai Health Regulation Conference, 22-23 October 2014

2. Overview Nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland (one of 9 professional regulators) Remit and powers set out in the Nursing and Midwifery Order 2001 Subject to oversight by the Professional Standards Authority (PSA) Accountable to the public and to Parliament, through the Privy Council 680,000 nurses and midwives on register

3. The NMC’s regulatory functions Holding the register of nurses and midwives who practise in the UK Setting standards of education and quality assuring programme provision Ensuring nurses and midwives continue to be fit to practise once on the register by setting conduct and performance standards Taking action to prevent harm to the public where nurses and midwives fall short of required standards

4. Today’s discussion Models of establishment and professional regulation Drivers and challenges for integration International use of standards in each sector Possible approach to better coherence between establishment and professional regulation

5. Models of regulation Professionals State/province run – e.g. Dubai Professional run – e.g. Germany Independent (from govt. and profession) – e.g. UK, Netherlands Institutions, establishments, ‘systems’ Statutory inspection or supervision - e.g. UK, Ireland, Netherlands Statutory accreditation Voluntary accreditation

6. Separate v integrated regulation Integrated Netherlands Denmark France Dubai Health Authority Separate UK Ireland US Australia

7. High profile failings have shaped UK regulatory policy Bristol Royal Infirmary – late 1990s - 33% of children having cardiac surgery had sub-optimal care - caring, well motivated people lacked insight; failed to communicate and work together in the interests of patients - lack of leadership and teamwork Shipman enquiries - mid 2000s - well regarded doctor; popular with patients – killing hundreds - questions the impact of medical regulation and clinical governance - highlighted need for intelligent use of performance indicators Mid Staffordshire NHS Hospital – late 2000s to early 2010s - failure to deliver acceptable care to patients - too focused on finances rather than on experiences of patients - need for better coordination between regulatory bodies

8. Challenges to a joined-up approach Regulators developed at different times, from different origins and with different statutory bases In Europe regulation split between different or overlapping government departments at national or regional/provincial/local level UK has many professional regulators and different systems regulator in each of its 4 jurisdictions Scale and specialisation in larger jurisdictions Standards for organisations and individuals not aligned

9. What do we learn from experience? Serious failures rarely due to either systems or individuals alone poor performing individuals can lead to poor performing organisations poor performing organisations will inhibit well performing professionals leadership, management, openness and accountability essential for good clinical services – organisation competence and behaviour Conduct, skills, training and development are paramount – professional competence and behaviour

10. Safety and quality: a shared agenda Professions focus Establishment focus Leadership Governance System and professional standards Effectiveness Recruitment and credentials Training and development Audit and monitoring Responding to concerns Use of information and data Feedback from staff and patients

11. Establishment v professional standards, UK Care Quality Commission, England Safe Effective Caring Responsive to needs Well led General Medical Council Knowledge, skills and performance Safety and quality Communication, partnership and teamwork Maintaining trust

12. Establishment v professional standards, Ireland Health Information and Quality Authority Person-centred Effective Safe Better health and well-being Leadership Workforce Resources Information Nursing and Midwifery Board Respect for dignity Responsibility and accountability Quality of practice Collaboration with others

13. Establishment v professional standards, US JCI hospital standards Safety Access & continuity Rights Patient assessment Anesthesia & surgery Medication Patient education Quality improvement Infection control Governance Staff qualifications American Medical Board Clinical practice improvement advice Safety Legal issues Ethics Medical science

14. Person-centred Safe Effective Trustworthy Towards core principles Care Compassion Dignity Care Compassion Dignity Safety behaviour Human factors Team orientation Reporting Safety behaviour Human factors Team orientation Reporting Evidence-based practice Technical skills Experimentation Evidence-based practice Technical skills Experimentation Honesty Probity Professionalism Honesty Probity Professionalism Personalisation Involvement Listening Rights Personalisation Involvement Listening Rights Safety systems Safety culture Monitoring Safety systems Safety culture Monitoring Clin. guidelines Learning Innovation Quality control Clin. guidelines Learning Innovation Quality control Transparency Leadership Governance Transparency Leadership Governance Establishments Individual professionals

15. Conclusions Service quality (and service failure) rarely result from either organisation or individual performance alone. Care quality ‘happens’ between a professional and their patient so individual competence and professionalism are vital But organisation structures, systems, resources and culture are crucial in setting the environment for care Integrated establishment and professional regulation may be optimal, but scale and specialisation are an issue in some jurisdictions Setting establishment and professional standards based on shared core principles may help in bridging the establishment/professional divide

16. Thank you Jon Billings jon.billings@nmc-uk.org @nmcnews @billingsjon