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Any hopes that the Nursing and Midwifery Council (NMC) had of being left to put its house quietly in order after the Council for Healthcare Regulatory Excellence's (CHRE's) damning verdict were dashed late last month.

The echoes of the CHRE's findings of a 'serious weaknesses in governance and culture' were scarcely fading when a new development revived interest.

NMC vice president Moi Ali, a public relations consultant, resigned and made sure her resignation as office holder and council member was as high profile as possible, claiming 'veiled threats' from the DoH to get her out.

'I may have held the title of vice president,' Ms Ali said in her press-released resignation statement, 'but the leadership made every effort to prevent me from exercising that role. I was marginalised, sidelined and excluded.'

Speaking out against the NMC
Now, she tells Independent Nurse, she is 'unshackled and have my voice back'.

Ms Ali's departure followed announcements that president Nancy Kirkland and chief executive Sarah Thewlis are leaving. Ms Kirkland will stand down on 12 August, but will stay on council.

The NMC first heard of Ms Ali's resignation through the media.

It was Ms Ali's Livingston Labour MP Jim Devine who aired allegations in the Commons of bullying and racism at the nurse regulator in March, which triggered the CHRE probe.

Ms Ali's next date with the NMC is likely to be in September, when the hearing of her claim of racial discrimination against the regulator is expected to open.

'The full details of my treatment will be recounted in public at the tribunal,' she says.

While the CHRE says that it 'neither heard nor saw evidence of racism' at the NMC, it did gather evidence of bullying. It heard complaints that council members used 'inappropriate and aggressive language' and showed 'emotional or aggressive behaviour in meetings'. Its readiness to involve lawyers in 'all and any complaint' was intimidating, the CHRE said.

Another allegation Ms Ali made in her resignation statement was that the council spent over £300,000 investigating its own members rather than protecting the public. It was she who alerted the government in 2007 when the NMC failed to strike off nurses caught looking at child pornography on the internet.

She also says that she 'raised governance and performance' concerns within the NMC, the DoH, the CHRE and with trade unions.

The NMC said Ms Ali's claim about legal fees is 'one of a number of issues that is yet to be disclosed'.

'As a public organisation we reserve the right to seek legal advice,' the NMC said at the time.

At the same time as the dirty linen is being aired this autumn, a caretaker NMC president and council until now riven by internal strife will be grappling with the exacting demands of the CHRE.

The regulatory body has been given a year to get effective governance in place, to speed up its complaints resolution by moving into the electronic age and to brush up its image so that patients and the public are clear that their protection is its raison d'etre.

Health minister Ben Bradshaw fully accepted the CHRE's findings.

'We are particularly concerned by the suggestion that the NMC has failed to carry out its statutory duties to the standard that the public has the right to expect of a regulator,' the DoH says.

The CHRE will be keeping a close watch on the NMC and the DoH has asked the Privy Council to look into its running. The Privy Council, a cross-party body made up mostly of cabinet ministers, senior politicians and top judges, has powers of direction over the nurse regulator.

The DoH is said to be forwarding concerns over the delays in the NMC's handling of its fitness-to-practise cases to the Privy Council.

But the NMC says it has already made improvements. The CHRE reported that fitness-to-practise cases were completed within an average of 29 months in 2007, compared with 35 in 2006.

Last year fitness-to-practise panellists heard 612 cases, a 119 per cent increase on the 2006/7 total of 279. The NMC has also set a target of starting work on complaints within six months of their being made.

Electronic case management is under way, the NMC says, though there is no time scale yet for its introduction. It hopes to have fit-for-purpose assessment of panellists in place by the end of the year.

Overseeing the reforms
The job of overseeing 'urgent reforms' will be tough for the caretaker council, which will be in post until the end of the year under an interim presidency.

Made up of a nurse, midwife and public health nurse from each country in the UK plus 11 lay members, the NMC's council has historically been beset by factional infighting.

The DoH is setting great store by the new slimline, all-appointed NMC, whose introduction has been brought forward by four months and is now due in post by January 2009. The 14-member body will have no professional majority.

'In future council members will not be representing specific professional interest groups,' the DoH says.

Ms Ali will not be standing for the new council. But others from today's council may well put themselves forward. The only people debarred will be those who have already served two consecutive terms on the NMC since 2002.

Small wonder that the DoH says the NMC should seek outside help to sort itself out.

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