The Nursing and Midwifery Council's failings in achieving its core aims stem from an insufficient skill mix and capacity in its leadership, the final report of its strategic review by the Council for Healthcare Regulatory Excellence advises.

Commenting on the report the Council's interim chief executive, Jackie Smith, advised that the regulator would use the report as a "catalyst for change at every level" of the organisation.

In an interim report published in April, the CHRE advised that the NMC, responsible for 670,000 nurses and midwives, was not focused on its core aims and was in fact confused by what these aims were.

At that time it identified weaknesses in leadership, decision-making and operational management. The specifics of these weaknesses were further identified in CHRE's final report, published yesterday, which adds that the regulator also suffered from "poor financial stewardship" and "a passive, hierarchical culture of 'resigned resilience'".

CHRE was commissioned by the Department of Health to undertake a review of the NMC in January this year. The review is part of the government's wider overhaul of regulatory bodies in the National Health Service which aims to increase their independence and autonomy.

Staff endured 'years of criticism'

The NMC's "troubled history" has come to the fore under the review which said that "a succession of chief executives, chairs and council members have failed to create the modern, effective and efficient regulator that the public, nurses and midwives need and deserve".

The 400 staff at the Council "have endured years of criticism and frustration. They have either left rapidly or adopted a resigned acceptance of poor standards and developed a belief that they cannot influence improvement," the report states.

The regulator is currently working under an interim chief executive and chair, Jackie Smith and Professor Judith Ellis, respectively. The CHRE's report says that the appointment of a strong management team will be key to the future success of the Council, whose core aims are to uphold confidence in the practice of nurses and midvives and to protect the public.

"Its new leaders will need to develop a constructive, empowering culture and rebuild the confidence of the NMC’s staff as well as its stakeholders," it said.

While candidly critical of the running of the NMC, CHRE remains positive that the Council can turn itself around:

"As we explain in our two reports, the problems here are at every level, in every system. Amongst its staff however, there is a strong passion for public protection, a potential to get it right and some fertile ground for a clear-sighted council, chair and a chief executive skilled in turning the organisation around and establishing competent management systems," the report advised.

NMC apologises for its failings

The NMC said the report and the Council's annual performance review, also undertaken by the CHRE and released on 28 June, "make difficult reading" for the Council, and apologised for its inadequacies. Smith, who was the former fitness to practise director before being appointed interim chief executive, said:

"[The reports] highlight substantial failings in the delivery of our regulatory functions and in the management of our organisation. We recognise the failings that CHRE have set out in their reports, and we are sorry. It is clear that the NMC has not delivered effective and efficient regulation, and we are committed to putting that right.

"We will use these reports as a catalyst for change at every level of our organisation. The reports rightly challenge us to effectively deliver our regulatory functions, to build appropriate relationships with external stakeholders, and to implement changes in our management and culture that will address our operational weaknesses," she asserted.

Early improvements

CHRE's report recognises that improvements are already underway at the Council, advising that it has begun to refocus its work and restructure to support its work.

April's report had advised that the Council "does not understand its primary purpose" and that it has been "too ambitious", investing too much of its resources in areas outside of its core remit, such as in developing an index of nursing students. The Council has now begun to scale back its work in standards and policy to concentrate on its core aims.

Smith advised that wheels of change were put in motion after the interim report:  “In response, we established a change management programme to implement the recommendations they made at that time. We would like to thank CHRE for their acknowledgement of the progress we have made since then, but we recognise we have more to do.

"The Council and executive of the NMC will now want to study the findings and recommendations of these reports in detail, and put in place further plans to address the weaknesses that CHRE have highlighted."

The Council published its Corporate Plan for 2012 - 2015 on 10 May, which outlined its intentions to turn around the regulator, and develop "a culture of excellence".