The current Nursing and Midwifery Council (NMC) (2008)Code was published close to 7 years ago. This not only predated the reforms following the ‘liberation of the NHS' (Department of Health, 2010), which many referred to as the biggest shakeup in NHS history, but also came before important inquiries into patient safety, such as the Francis (2013) report and the Berwick (2013) review, among others.
Jackie Smith, Chief Executive and Registrar of the NMC says that the revised Code, which will come into effect on 31 March 2015, is a response to these inquiries, as well as the dramatic changes to health care and public expectation, and, of course, is a forerunner to the new model of revalidation being launched at the end of 2015. ‘This Code is taking into account the change to the landscape in health care, dealing with particular issues around fundamentals of care, making sure patients get fed and watered, for example, and focusing on the need to be open and honest when things go wrong—so the duty of candour,’ said Jackie in an interview with the British Journal of Midwifery the day after the publication of the new Code.
Clinical supervision
In conjunction with changes to the Code, Jackie also discussed the recent controversial news that the NMC will no longer be involved with supervision (NMC, 2015b). ‘We recognise that people feel really strongly about it, they're passionate about its value, but that is not something that should sit with a professional regulator because we don't have any control over it,’ said Jackie. ‘That's a matter for the four countries in the United Kingdom.’
Carmel Lloyd, Head of Education and Learning at the Royal College of Midwives (RCM) says that while the Royal College recognises some of the difficulties that lie with some aspects of supervision such as the investigatory process, they are concerned and disappointed with the decision. ‘To go into the NHS at the moment, they're trying to look for financial reductions everywhere so there's no incentive for them to maintain supervision,’ said Carmel. ‘From our perspective, it means that the support mechanisms that women and midwives had—and we do relate it to ensuring health and safety for women and babies—will be lost. We have significant concerns around that.’ However, Jackie Smith says the NMC is committed to ensuring supervision is picked up by the four Chief Nursing Officers.
Changes to the Code
In terms of the changes made to the Code, there have been several revisions. The new Code is based around the four themes of prioritising people, practising effectively, preserving safety and promoting professionalism and trust.
While much of the content of the Code remains the same, certain sections which were very short but were identified as needing additional attention have now been extended. In addition to the fundamentals of care and the duty of candour, how individuals should deal with social media, record keeping and team working have also been revised, said Jackie Smith.
Responding to the increased focus on the duty of candour, Carmel Lloyd notes that litigation in obstetrics will pose challenges when it comes to acknowledging when mistakes are being made and apologising, and she emphasises the need for good support frameworks within Trusts to enable midwives and other staff to engage with this principle safely.
The section on seeking feedback from colleagues and then reflecting on that feedback to improve performance and practice has also been expanded. Lloyd suggested that, while it is not expressly stated in the Code, this particular point will be key to the revalidation process. Other areas that have been expanded on include cooperation with investigations and audits and the specific requirements around leadership.
Conclusion
While the new Code covers social media to a greater extent in response to its increasing popularity, the NMC has moved away from the electronic practices of the last few years for the purpose of sending hard copies of the Code to its members. Each midwife and nurse on the register is currently being sent his or her own personal copy of the revised Code as a way for each of them to engage with it more effectively before it comes into effect at the end of the month. The RCM feels confident that midwives have already been very good at engaging with the Code so all that is really needed is for them to tease out the areas which have been revised so they can pay particular attention to them. How the new revalidation process plays out and what actions are taken to address the uncertainty around clinical supervision are what importantly remain to be seen.