The Nursing and Midwifery Council (NMC) is a vital safeguard for care quality and patient safety, but "over a number of years the NMC has failed to understand its function and properly prioritise patient safety". The new management team in the NMC is committed to address its failings. However there continues to be a serious gap between current performance and acceptable standards. The NMC has proposed that fitness to practise cases should be decided on average within 18 months of a complaint being received; the Committee proposes that this should be reduced to 9 months, with a maximum of 12 months. The NMC also has had a poor track record of fitness to practise decisions being challenged and overturned. The CHRE has needed to almost routinely refer NMC decisions to the High Court. It is also unacceptable that the NMC underestimated the budget for its fitness to practise directorate by 30%. The Government's intervention to limit the effect of the fee increase on registrants is welcomed. However, nurses and midwives still face a 32% fee increase at a time of public sector pay restraint. A further fee increase can not be justified and the NMC should consider introducing a phased payment system for registrants. The language and communication skills of nurses and midwives remain a concern. MPs also question why the NMC has made such slow progress on a system of revalidation. Lastly, many of the NMC's problems stem from inadequate IT infrastructure where two key systems cannot communicate directly and deliver incomplete or inaccurate information

In this report the Health Committee welcomes improvements in the performance of the Nursing and Midwifery Council (NMC) over the last year, but expresses continuing concern that the progress made so far remains fragile. The Committee emphasises that it is important to ensure that the new challenges facing the NMC do not become a distraction from the continuing requirement to improve its performance of its core functions. The report is the first example of a Health Committee review of a professional regulator which builds on the work of the Professional Standards Authority (PSA). The length of time the NMC takes to conclude its fitness to practise cases has been an enduring concern for the Committee. From 2015, the NMC proposes to toughen the target period for resolving fitness to practise cases to 15 months (eventually to 12 months). The NMC has announced plans to introduce a system of revalidation by the end of 2015 which is welcomed. The Francis Report into the failings at Mid Staffs examined the role of regulators, including the NMC, in detail. The report stresses the importance of ensuring firstly that registrants understand their professional obligation to raise concerns when they see evidence of poor patient care, and secondly that patients and public are made more aware of the role of the NMC as the regulator of professional and clinical standards. The NMC should take urgent steps to raise the profile of the NMC both among its registrants and among patients and public.

GMC's fitness to practise successfully produces outcomes that protect patients from sub-standard doctors but failures to communicate the reasons for decisions and poor investigative practices have undermined a small number on investigations. The GMC should review its fitness to practice procedures to prevent such mistake. The Committee also found that while it is still too early to judge whether revalidation has been effective there is a worrying approach to the oversight of revalidation. Each designated body has a responsible officer for revalidating their medical staff, but the degree to which the responsible officer will be held to account is unclear. It is imperative that the GMC clarifies the personal responsibility and accountability of responsible officers. There is also concern over the number of responsible officers available to oversee the revalidation of doctors working in primary care. GPs are revalidated not by their own employers but by one of the 27 NHS England local area teams that oversees Clinical Commissioning Groups in England. Just 27 responsible officers will be tasked with overseeing revalidation for approximately 45,0000 GPs in England. The Government's intention had been to give the GMC the power to allow it to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) in 2014 by using a mechanism in secondary legislation called a section 60 order. The Government now plans to introduce the reform in primary legislation as part of a proposed Law Commission Bill thus meeting with even further delay

This is the second annual accountability hearing with Monitor from the Health Committee. The parallel roles of Monitor and CQC were criticised in the Francis report on the Mid Staffordshire Foundation Trust (HC 898, session 2012-13, ISBN 9780102981469) because they created significant opportunities for confusion. The Health Committee concurs and stresses that it needs to be addressed urgently to avoid the twin dangers of gaps in regulation and duplication of regulation. This report concludes that the proposal to use a combination of transitional powers and licensing provisions (designed to apply to all providers of NHS care) to provide the framework for the long-term regulation of Foundation Trusts is profoundly unsatisfactory. The role of Monitor in relation to competition in the NHS remains unclear, and the respective roles of Monitor and the Competition Commission in the market for health and care services need urgent clarification. Monitor's positive approach towards the commissioning of integrated care pathways is welcome. Monitor should use its role in setting the tariff paid for certain NHS services (alongside the NHS Commissioning Board) to encourage system redesign and the integration of service provision, as well as to discourage "cherry-picking" of the most economically attractive patients. The establishment of a provider failure regime is welcome, but a number of important elements in that regime are not yet fully developed and further progress is needed over the coming months.

This year's inquiry into the work of Monitor concludes that the model of care provided by the health and care system is not changing quickly enough with the result that pressures continue to build, threatening the financial stability of individual providers, and therefore the quality of care provided The pressures are likely to be particularly marked in the acute sector as plans are prepared and implemented to achieve the resource transfer required by the introduction of the Better Care Fund from April 2015. Continuing this theme, the Committee argues that as the NHS financial situation tightens, the challenge for Monitor in supporting trusts in financial difficulty is likely to increase. The MPs emphasise the importance of addressing pressures within individual providers in the context of the local health economy. The requirement for major change in the care model can only be delivered if individual providers, and Monitor as their regulator, look beyond preserving existing structures and address the need to develop different structures to meet changing needs. The Committee also expresses concern that Monitor has not done enough to reform the system of tariff payments for providers, arguing that the current tariff arrangements often create perverse incentives for providers and inhibit necessary service change. It recommends that Monitor and NHS England should initiate a formal joint process for a prioritised review of the NHS tariff arrangements with the objective of identifying and eliminating perverse incentives and introducing new tariff structures which incentivise necessary service change

This year's accountability hearings focused on three areas of particular interest: the arrangements for revalidation of doctors, which are to commence on 3 December 2012, and associated matters such as patient involvement and examination of the language competence of doctors; the professional leadership activity undertaken by the GMC in the last year; and the regulation activity undertaken by the GMC, including the establishment of the Medical Practitioner Tribunal Service. The Council is performing effectively in its two roles of defining and applying standards for the medical profession and providing a focus of professional leadership. The outcome of the Law Commission's consultation on professional regulation in the health and care sector, which proposed a formal role for the Health Committee in the accountability structures, is still awaited. Specific concerns included that whilst there has been some progress on the amendment of domestic legislation which restricts the language testing of doctors this is no substitute for the revision of the European legislation which presently prohibits language testing of doctors on a national basis. There have also been continued upward trends in complaints against doctors received by the GMC, and the Committee expects to examine in 2013 the outcomes of further research the GMC has commissioned into these trends. The Committee feels that the present 15-month target for the GMC to complete 90% of its fitness to practise cases should be lowered to 12 months. The Committee also welcomes proposed legislation to enable the GMC's investigatory arm to appeal against decisions made by the MPTS where the outcome of a hearing is disputed

A draft Law Commission Bill on the regulation of health and social care professions sets out the framework for a negative register, but it was not included in the Queens' Speech either as a draft or a substantive Bill. The Government needs to set out what changes to the powers of regulators it is planning to make through secondary legislation instead. Following up themes in the Francis report, regulators need to be visible and accessible to registrants, and also to patients and members of the public who wish to raise concerns about patient safety. Since 2003, the HCPC has recommended that statutory regulation be extended to a further eleven professions from the current sixteen. Of these, the only groups to receive statutory regulation to date are operating department practitioners and practitioner psychologists [the other groups are Clinical Perfusion Scientists, Clinical Physiologists, Dance Movement Therapists, Clinical Technologists, Medical Illustrators, Maxillofacial Prosthetists & Technologists, Sports Therapists, Sonographers and Genetic Counsellors]. The HCPC should list any professional groups for which they feel there is a compelling patient safety case for statutory regulation so that this can be pursued with the Department of Health as a matter of urgency. There is also concern at the length of time it can take for professional groups to gain statutory regulation. Given that new groups can be added to the HCPC's register by means of secondary legislation, there should be no undue delay in extending statutory regulation to professional groups where there is a compelling patient safety case for doing so