Season 2, episode 18

Voices of Care – S2E18 – Andrea Sutcliffe

13 May 2024

Andrea Sutcliffe, CEO at the Nursing and Midwifery Council shares her experiences and expertise in the healthcare landscape.

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Episode chapters

00:00 Intro 

01:08 The Nursing and Midwifery Council  

05:04 Long Term Workforce Plan 

09:58 Nursing and Social Care 

11:41 Inclusion for nurses and patients 

16:55 Leadership in Healthcare 

20:20 2023 and Challenges for the NMC 

23:45 Changing Organisational Culture 

25:39 Future of Nursing Education 

31:42 Outro 

[00:00:00] Hello, I’m Suhail Mirza and welcome to this episode in season two of Voices of Care. I’m joined today by Andrea Sutcliffe, CEO at the Nursing and Midwifery Council. Andrea, thank you very much for taking the time to join us on Voices of Care. It’s an honour to have you here.

[00:00:17] It’s lovely to be here.

[00:00:18] It’s 2024, 2023, five years at the helm as chief executive. Amazing time, tumultuous time. But I wanted to take the opportunity to honour the beginning of the year 2024. The honours list recognised some fabulous nurses for the contributions they’ve made.

[00:00:35] Nurses and midwives and other partners in health and social care. Fantastic to see people being rewarded for the amazing work that they do. And it’s senior leaders like Denise Chaffer, but also people who do just amazing work, Charity Gladstone was one of the ones that I was really pleased to see as well. Great to see those people recognised and supported. And the I love is when their families respond and are so positive about what this means for their loved ones. It’s just great.

[00:01:08] It’s wonderful. Now we’ve got a lot to cover here. But before we go into the detail, looking at the healthcare landscape, I wanted to step back and give you the opportunity to share your coming to the end of 2025 strategy and a year or so to go for the NMC. The role of the regulator, if you can just spell that out. I think everyone seems to think they know, but it’s a very broad role and it’s across the entire UK.

[00:01:34] Absolutely. And you’re so right Suhail, people think that they know and think that we do specific things, but actually don’t see the whole breadth of it. So, we’re here from legislation to protect the public by supporting the nursing and midwifery professionals on our register. But the way that we do that is in three specific functions. So first of all, we regulate. And that’s all about setting the standards for pre-registration education programmes, as well as some post registration education programmes, but also setting the code of conduct, what our expectations are of nursing and midwifery professionals in their work. We use those standards to help us populate the register, making sure that the people who come onto the register have the skills, the competence, the character, behaviour, health, to be able to be professionals on the Nursing and Midwifery Council register and they may be both domestically educated but also nurses and midwives from overseas. We keep the register, we maintain that support people through their revalidation every three years to make sure that they can stay on the register. And we also investigate concerns. Now it impacts on the tiniest percentage of people that are on the register, but it’s something that obviously looms large for people in terms of fitness to practice. But what we want to do is to do that regulatory function in a supportive way. So supporting the professionals on our register to deliver that great care and to be able to have the skills and support to be able to do that. So that’s one aspect of the support. The other is the support for the public who may be bringing concerns to us. And that’s obviously a very difficult time for them, but they may also be involved in our work in all sorts of different ways.

[00:03:26] We’ve got an absolutely brilliant public voice forum who help us shape what we do. And then the third thing that we want to do is we want to use the insight that we’ve got from all of that regulatory work to influence the world of health and social care. So looking at workforce planning by providing information about who’s on our register, what the demographics are like, who’s leaving, why they’re leaving, all of those sorts of things, but also speaking up for some of the issues that impact on the professionals on our register in terms of workplace discrimination and racism, for example. So there’s a huge thing there in terms of what we do. What’s also important is how we do it. And the strategy that you mentioned, we set out four key values, and those were to be fair. And you want your regulator to be fair, don’t you? I mean, making decisions based on the evidence and treating people and celebrating their diversity, tackling inequalities. So being fair, we want to be kind. We want to treat people with dignity and respect, understand their individual perspectives, and respond to that in a person centred way. But we also want to be ambitious. We want to be the best regulator that we can be. And we want, I want the organisation to be the best place that people would want to come and work. And the final one is about working in a collaborative way. Nothing that any one of us can do without working with other people, either within the organisation or with our partners, with the professionals on our register or with the public.

[00:05:04] No. And it’s a tremendous opportunity and of course, an obligation. Now, it’s thriving in many ways, nursing. 800,000, I think you’ve reached in terms of on the register, a huge increase in the previous six months. I wanted to just look at, there’s been a seminal piece of policy, of course, in 2023, which was a long time workforce plan for the NHS, which envisages a huge increase in the number of nurses, nursing associates, transformations in terms of learning and development. Can you just give us a bird’s eye view of its reception by the NMC and the profession at large?

[00:05:38] So I think there’s lots to be positive about in the long term workforce. The fact that we’ve got one is really good. From our perspective, it is only about England and we are a four country regulator, so covering Wales, Scotland, Northern Ireland as well. And each of those countries are doing their own work. And Scotland for example, has got a ministerial led workforce. There’s a task group that is looking at this at the moment as well. So, we need to kind of think about what we’re doing in England and think about how that plays out across the UK. We’re also kind of very supportive of some of the direction of travel in the Long Term Workforce Plan. That real focus on diversifying the routes into nursing and midwifery and supporting people as you quite rightly say, using nursing associates, both the role in its own right and the bridge between health and social care assistance and nursing, but also as a stepping path into nursing. So that’s really, really good to see. The other thing that I think is so important is, yes, we can attract all of the people that we like, but if we don’t look after them and care for them properly when they are working in the NHS or anywhere else, we’re going to lose them. So some of the work on how you support people in their first year of post qualifying, so important, so, so, so important and also the continuing professional development throughout somebody’s career. These are other things that are actually highlighted in the Long Term Workforce Plan as well. Really keen to see that actually kind of taking shape and having an impact.

[00:07:21] Now, it’s a fantastic vista. It is conspicuous on its silence in respect of social care. Now, social care is a sector you know very well as the former chief inspector for adult social care at the CQC. And if I may honour the fact that your services to the adult social care sector were recognised with the CBE back in 2018. So, you know the sector now, there isn’t a workforce plan for that sector, and the sector is under tremendous amount of pressure, which is not the focus for today, but plenty of reports from Skills for Care, CQC that highlight that. Can we just turn the dial on the fact that actually the ubiquity of nursing within social care, I think people don’t really realise how important a cohort of nursing professionals are in social care.

[00:08:08] Oh, incredibly important. And in terms of my assessment of the Long Term Workforce Plan is one of the reasons why it’s not as good as it could be is because it’s not integrated with social care, because in terms of the training, development and support for the future workforce, we need to be focusing on what’s happening in nursing and social care as well. They are tremendously important. They provide such important direct care, but also real opportunities for people in social care to progress in terms of their careers. Many registered managers, for example, have a nursing background and have developed those skills from their nursing, training and education and the career that they’ve had. So it is an important area. It doesn’t get the attention that it deserves. It doesn’t get the support and the value it deserves either. Something that drives me to absolute distraction is people kind of, oh, you don’t want to be involved in that because you’re giving up on nursing if you’re out there. Actually, nursing and social care is the absolute essence of nursing. It’s about how you create a long term relationship with people, how you supporting them holistically in terms of their own care, but also the people around them supporting people at the end of life for example, what a privilege that is for people to make sure that that is done in the right and proper way. So one of the things that we’re actually very keen to see is that there’s a diversity, a greater diversity of clinical placements, for pre-registration nursing students. So they get exposed to social care at that very early stage in their career, and they can see the opportunities.

[00:09:58] And I think the there are some encouraging signs within social care now. Skills for Care have come out, I think, very bravely to say they’re going to begin the research into a workforce plan for social care. We have a chief nurse for social care, and we now have a statutory basis for an integration between health and social care. So perhaps some encouraging signs that the rhetoric and narrative is changing in terms of recognising nursing in social care.

[00:10:27] I hope so. I mean, I think Deborah Sturdy is the Chief Nursing Officer sitting within the Department of Health and Social Care. She’s done an absolutely fantastic job in promoting that. Una Smith, at the Skills for Care, as you again, quite rightly say, you’re really showing that leadership in terms of saying, well if the system isn’t going to do it, we’re going to do it for ourselves. And let’s bring those people together who can help us to create right and proper workforce plan for social care, which will be so important for nursing as well. And the integrated care boards in England, I think, give us a real opportunity there. And what we’ve now got in each of those areas is a social nursing council. And the chairs of those councils are meeting together with Zoe Fry from the Outstanding Society supporting them actually beginning to be a really coherent voice for nursing in social care. What’s important is people need to listen to that voice. They need to listen, need to respond, and need to make sure that some of the things that we are seeing the NHS starting to do for nursing, needs to be happening in social care as well.

[00:11:41] Well, let’s watch this space and I’m sure we’ll come back to discuss that. A couple of key themes I wanted to flesh out. You talked earlier about a significant proportion of people, I think some 164,000, something like that on the register who are educated internationally as a nurse. We’ve seen the Skills for Care reports showing the huge increase in international social care workers coming here into the sector. I want to touch upon just how important inclusion is to the whole retention piece. We’ve had reports, there’s so many, but there’s the NHS staff survey, the level of discrimination that’s faced, the NHS Race and Health Observatory into neonatal experience. It’s a huge issue, but it’s vital in terms of culture that fosters a diverse nursing workforce and celebrates it.

[00:12:32] Absolutely. And I could spend the entire rest of this podcast talking about this Suhail, so forgive me, but there are so many aspects to this. The first is you’re absolutely right. Internationally educated professionals make a significant proportion of the Nursing Midwifery Council register. So 1 in 5 are educated, have been educated overseas. That is an amazing commitment from those people to come to this country very often, leaving family, friends, to make this work over here. So we need to respect that and we need to treat them properly and very sadly, we haven’t always. We’re also seeing that there’s more diversity in people who are training in the UK. And so the overall picture of the register is moving close to 30% are from a black, Asian, or other minority ethnic background. What actually we should probably call the global majority. And again, if we’re not kind of supporting those people, well, not tackling the racism and discrimination that they face, sometimes from colleagues, sometimes from the public, we will lose those people. And the final thing I’d say, because I’m focusing as opposed to everything that I could say. But the final thing I’d say is that this is a safety issue.

[00:13:55] This is a safety issue. If you are from the Philippines or from India or you’re a British born black nurse and you have been the subject of microaggressions which are not micro, they’re aggressions, or banter, or people laughing at you or excluding you. Health and social care is a team sport. You need to be able to rely on those people. If you’re in a difficult situation, if you’ve got a question, you’re going to go to those people who’ve just been absolutely horrible to you. No, you’re not. And that is going to undermine your confidence, undermine your ability and the team’s ability to provide the safe, effective, and kind care that people in health and social care absolutely deserve. So we need not to be kind of shilly shallying about this. We need to be saying this is a safety issue. It is something that we’ve absolutely got to pay attention to and is something that leaders like me who look like me, we’ve got to stand up and be counted around this.

[00:15:03] And I think just to broaden that, just to tarry a moment longer on this issue. And it’s a theme we could talk about forever. It’s also a safety issue you say for the experience of the nursing professionals, but also in a diverse pool of people, patients who are being serviced and supported, the need to understand their background is also a safety as well as a moral issue.

[00:15:25] Absolutely. And you mentioned the NHS Race and Health Observatory report on neonatal experiences. And one of the kind of critical things, you’ve had children yourself, so you may well know this, but the assessment when somebody is born, the Apgar score, asks whether the skin is pink. Well, kind of blindingly obvious that that’s not going to work for everybody. So there are all sorts of things that we need to make sure we are addressing and ensuring that the curricula for nurses and midwives and nursing associates is what we call decolonised, is actually kind of thinking about the diverse populations and communities that we’re serving, responding to that. How do you assess jaundice in a newborn baby if you’re not being taught and encouraged to understand what the signs are with different skin colour? One of the things that we’ve been doing quite a lot of is developing simulation in both continuing professional development, but also in pre-registration education programmes. If every mannequin is white or male, what does that do for people? Some of these things might sound small, but all added together, it makes a difference if we’re actually thinking about the broader picture.

[00:16:55] No, absolutely. And a theme that’s come out from what you’ve just said is that you talked about leaders like yourself. And I want to talk about the importance of leadership itself. It’s often derided as a bit of a soft skill. But it has measurable impact. And there’s been, of course, General Sir Gordon Messenger and Dame Linda Pollard’s look at compassionate leadership, inclusive leadership. I think the NMC has now launched its own campaign linking good leadership to better patient care. So can you expand upon that and how important that will be generally?

[00:17:26] Yes, absolutely. Our code of conduct recognises that the professionals on our register are leaders in their own right. You might be the leader on a particular shift. So you still might be quite a junior member of the team, but actually you’re leading that shift. So there is leadership there. There is obviously leadership at very senior levels in health and social care as well. So one of the things that we have done, and thank you so much for mentioning it, is that we’re developing case studies and resources to really promote the idea of that compassionate, inclusive leadership. And the difference that it makes, the difference that it makes for the team that you’re working with, but also the difference that it makes and the care that can be provided. Because if you’ve got that, if you’ve got leaders who are really concentrating on that, really caring about delivering person centred care, holistic care, supporting their teams to do that, showing that that’s important, that will make a difference. And encouraging leaders to be humans themselves. And we all have an experience of health and social care, bringing our whole selves into this and making sure that we’re understanding how we can help people to deliver the best care possible by demonstrating our own kind of focus around that leadership, around that really important.

[00:18:58] And just to flesh that out just a little good leadership will also play a pivotal role in this whole retention issue, which is at the heart of the workforce plan.

[00:19:06] Well, one of the things that we are told is that people don’t leave bad jobs, they leave bad bosses. And if you are not actually nurturing your team, if you’re not supporting them, if you’re not responding to their needs, if actually you’re not also addressing the concerns that you might have with them, if there’s a performance management, if you’re not doing all of these things in a proper way, then you’re not going to be supporting your team to deliver great care and to stay. And that’s what people need. And we were talking about social care earlier. One of the things that we see in the statistics from Skills for Care is that I think it’s like 1 in 3 nurses leaves their job every year.

[00:19:53] It’s astounding turnover.

[00:19:55] What does that do for continuity of care? What does that do for supporting people to understand the needs of the people that they are caring for? Absolutely nothing. So if you are looking at that level of turnover, you need to be looking at yourself and thinking, what can we do as leaders, as organisations supporting people to want to work there?

[00:20:20] Absolutely. You talked earlier about the values and the strategy of the NMC. 2023 was a tumultuous year for the whole profession, strikes, etc.. I wanted to touch upon your desire and one of the goals stated in the strategy to be empowering and engaging to all stakeholders. Trusted and responsive. The Lucy Letby case. The media coverage around whistleblowing. How does that tie in? Because you’ve been very candid in press interviews regarding this and the desire to make sure that that ambition as a value remains at the forefront in amongst some of these challenges.

[00:21:01] Absolutely. So when we have a fitness to practice case, when some concern is raised about a nurse, midwife or nursing associate, one of the things that we ask for is them to have an understanding and insight into what has happened, and to reflect upon that and to demonstrate the improvement, their strengthened practice. That’s exactly what we need to do as the regulator. And we’ve had a variety of things over this last year. So for the very first time, we withdrew approval for a pre-registration education programme which was in midwifery. We also discovered a fraud in the computer based test element in one particular centre, in our international registration process. We’ve had, as you say, the conviction of one of the nurses on our register. And we’ve had concerns raised about some of our fitness practice casework, but also the culture within the organisation. In all of these areas, we need to take a good, hard look. What have we done? What do we need to do to put it right and then make sure that that happens. And so on that last one, in terms of the concerns that were reported in the press, we have appointed a King’s Counsel, Ijeoma Omambala, to look at the regulatory casework and to look at the way that we handle those whistleblowing concerns, and to give us an independent assessment of all of that, because I think it’s really important that that’s what happens, and that Ijeoma helps us to understand what we can do better.

[00:22:47] The cultural piece is a little bit more, it’s going to be a bit more in depth and take a bit longer. And we’ve absolutely been taking our time to identify the partner that’s going to work with us on this. But what I absolutely want to make sure is that we listen to all of those voices within the organisation, those that tell us that, there were difficult things that are happening and they’d want us to be better, as well as those that are telling us, actually, I don’t recognise this description of the organisation, my experience is very different. What are in terms of their good experiences, can we build on what are the poorer experiences do we need to address? And again, we will be doing that very transparently and demonstrating that. People hate this phrase. Lessons learned. Yes, you’ve got to learn the lessons, but actually you’ve got to learn them to make improvements. You’ve got to learn them to make a difference. And that’s what I’m absolutely committed to making sure that we do.

[00:23:45] And you’ve appointed an internal advisory group for the culture piece, which I think timing wise is interesting because you’ll be beginning or you’ve begun your preparatory work for the 25/30 strategy. Now, looking ahead.

[00:23:56] We have, although we’ve also had to take a bit of a look at ourselves because we have a real issue with our fitness to practice caseload, which as a consequence, partly of the pandemic, but partly of because of other issues, has grown to a very significant number, and we’re not actually addressing those cases in as timely a fashion as we should. And we know what a tremendous impact that has on the professionals who are under scrutiny, but also the employers and the members of the public who may well have been making those referrals. So we’ve absolutely got to focus on addressing that. And so we are reprioritising our work, that is our number one priority. We’ve actually got to really, really put our shoulders to the wheel and make sure that we tackle that. So we are looking at the strategy and thinking maybe we should extend a little bit, taking into consideration actually we had two years worth of a pandemic, which meant that we didn’t do some of the things that we planned to do in the strategy anyway, to maybe change that timing a little bit. But we’re absolutely committed to moving forwards with that. And as you quite rightly say, our internal group, which is drawn from the leaders of our networks and Unison, which is our recognised trade union, but also colleagues across the organisation, is helping to shape what we do and to make sure that they’re putting up the kind of merit of the executive board and sort of saying, what are we doing to sort this out and, and how can we make sure that we’re working collaboratively together to do that in a way that really does make the difference that we need to make for the future?

[00:25:39] Well, turning to the future as our final stop, if I may, going back to the Long Term Workforce Plan and hopefully the plan that will come out for social care. But the workforce plan for the NHS, nursing is very much at the heart of that. The numbers are 170,000 new nurses over the next decade or so. Tripling in terms of the percentage routes, the use of apprenticeships, nursing associates, this will require a revolution in the way nurses are trained, how they’re looked after when they have qualified. I wonder if we could just step back and with your expertise, look at what that looks like, because I think you’ve announced in January 2024, part of a research into how that training practice, learning is going to look like over the next decade or so because there’s huge transformation afoot.

[00:26:30] Potentially there is. But the key thing for us is to make sure that that transformation is evidence based so that we actually don’t just go, oh, Australia managed to get away with training nurses with clinical placements of 800 hours, and in the UK, it’s 2300. We must be able to do it in less hours. Well, we possibly can, but actually, what are the circumstances in the international arena that enable Australia and other countries to do things in a shorter period of time? And so what are the preconditions, if you like, that we need to make sure are in place over here. What is actually the state of pre-registration education placement programmes here already? What can we learn from some of the things that people are doing well, but also some of the areas where we’ve got concerns about those clinical placements and how can we make sure that we’re improving that, supporting people appropriately. So our starting point is to ensure that we’ve got the evidence base about what the situation is here. What could we learn from the international arena so that we can bring that together and potentially make proposals which will take change forward in the future? But we will do that again in a collaborative way. So what we’ve also done is advertise for the independent chair of the advisory group, which will work with Sam Foster, who is our executive director for professional practice, and her team, in terms of looking at what those standards need to be, how we can implement them to make sure that we continue to have the highest possible standards, that we have safe practitioners who are capable, confident and competent at the point that they join the register, because that’s what my mum and dad deserve in terms of the district nurse that’s pitching up today and it’s what everybody’s family member deserves in terms of whatever it is that a nurse midwife, or a nursing associate is doing for them in the future.

[00:28:36] And it’s also very much that whole piece around collaboration. I think you’ve made some resources available to help nurses understand the role of the NMC and their own education piece. You talked earlier, just as a final point, we’ve talked about the training of nurses, but new recruits, who are newly qualified, there is a finding that you’ve shared about inconsistency in terms of how they’re treated, because that’s a really delicate phase in the development of a career. I just want to touch upon that, because that has to be a laser like focus as well.

[00:29:05] Oh, absolutely. And one of the things that we do each year is we ask people why they leave the register and what we found in the survey that we did in 2023 was that people were leaving much earlier than they’d expected to, and that includes people at an early stage of their career as well. And we know from other pieces of work that we and others have done, is that that first year is so important in terms of people being able to consolidate all of that learning and then be able to be confident about the way that they are using that in sometimes very pressurised environments. And if they don’t get the support, we call it preceptorship. If they don’t get that support, if they’re not valued and recognised in that first year as people who need a bit of additional help, then they may not stay with us. And that’s such a loss for them.

[00:30:08] They’ve put all the effort into training.

[00:30:09] Nursing is such a wonderful career. You wouldn’t want to throw it away in the first year. Midwifery is a wonderful career. You wouldn’t want to throw it away. So we need to help them for them, but we need to help them as well in terms of keeping the retention going for the future. So that initial stage is really important. It’s also really important for those colleagues who are coming to us into the UK for the first time, or into new environments, because again, the language that people use is very different. Our idioms are very, very different. And making sure that people understand that and get that support, some of the practical things that people need to have help and support with in terms of being able to make their homes in the local communities, all of that kind of thing really important that employers and the system as a whole, so integrated care boards and others, really think about how is it that we cherish, nurture, support and value, recognise, ensure that nurses, midwives, nursing associates understand their own self-worth because other people are valuing them.

[00:31:21] I think with a general election coming up, you will be having a very busy year. And I think that’s a powerful message. On that note, Andrea Sutcliffe, thank you very much for your characteristic candour and compassion.

[00:31:32] Well, thank you very much. As you can tell, I love talking about it.

[00:31:36] It’s wonderful to hear about it with someone with so much passion for the nursing sector. Thank you so much.

[00:31:40] My pleasure.

[00:31:42] If you enjoyed this episode of Voices of Care, please like, follow or subscribe wherever you receive your podcasts. And if you want to learn more about how we are enabling the healthcare workforce of the future, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I’m Suhail Mirza, thank you very much and I look forward to seeing you on the next podcast.

 

Meet our host, Suhail Mirza

Suhail says: “I have never seen the healthcare system under so much transformation, but our Voices of Care podcast is an opportunity to listen, understand and help shape the future of care for all of us.


Join me, and a lineup of leaders and luminaries from across health and social care, as we debate how we can enable the workforce of the future and truly deliver the care service that Britain deserves.”

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