One of the issues I have been reflecting on since joining the Nursing and Midwifery Council (NMC) is the need to seek the views of the public to provide the evidence base for the work that we do. This month, the NMC published its annual ‘insight spotlight’ report. The Spotlight on Nursing and Midwifery report (NMC, 2024) aims to influence positive changes for the benefit of both professionals and the public, and draws on an evidence base from public and professional feedback. This year's Spotlight report is divided into three sections:
I would encourage everyone to read this relatively short report. Each section concludes with a ‘using insights’ section, but I'd like to summarise here some of the key points for me.
Expectations of care
Members of the public shared how several factors need to be present to deliver care that feels of a standard from ‘good’ to ‘excellent’. The report highlights that good care builds on the basic requirements or ‘hygiene factors’, which are often taken for granted - they may only become noticeable by their absence – including elements such as safety, privacy, and fairness. The insight report shared that when thinking about ‘good care’, the public are often thinking about the quality of the conversation with the nurse, midwife or nursing associate, and factors such as effective communication and listening.
‘Excellent care’ is said to be delivered when all the earlier factors are in place and the person can develop a personalised relationship with the nurse, midwife or nursing associate. Continuity of care and emotional wellbeing were also cited as important.
This section also covered an area of focus for the NMC regarding concerns about behaviour outside professional practice. The insights in the report will be used by the NMC to continue to consider how concerns are handled in the future, alongside what people want and expect from their care and those providing it. These insights will also feed directly into the upcoming review of the Code and revalidation process.
Experiences of care
The Spotlight report found lots to celebrate about the positive experiences that people shared – the NMC considers it reassuring that the NMC Code broadly captures behaviours that are valued by the public.
This section recognises the insights about persistent disparities in experiences of care, particularly for those from Black, Asian and minority ethnic groups and disabled people, and those from the previous Spotlight report about newly qualified professionals' apprehension about meeting the needs of a diverse population. Again, this suggests that when we revisit the Code and standards of proficiency, the NMC, employers and education providers should go further in setting expectations about equitable and culturally appropriate experiences for all.
Experiences of raising concerns about care
There were several drivers identified behind steps taken by members of the public to refer nurses to the NMC. The analysis showed that individual motivations range from a desire for accountability and a personal apology to seeking financial compensation. For some, the goal is to effect a change in their care. For others, raising concerns offers an opportunity to release strong emotions and to feel heard.
The NMC reported that from 2019 to 2023, 83% of the concerns raised by members of the public resulted in official decisions not to investigate for various reasons, including that there are often local processes led by employers that are more appropriate to handle these concerns and lead to swifter decisions.
The report shared the NMC response to these insights, with work in several areas well underway to make it easier for members of the public to raise concerns – for example, with a public advice line.
The NMC has a significant programme of improvement work in progress following an independent review of its culture, which includes continued consideration of all NMC processes and how they can be improved.
In addition, an area for the NMC to focus on right away is to enhance its approach to safeguarding to ensure that those referrals received are viewed through a clinical and safeguarding lens. The NMC fitness to practise plan commits £30 million over the next 3 years to deliver sustainable long-term improvements to NMC processes and people's experiences, improving how the NMC works to support safe and swift progression of cases in a person-centred way.