Can you explain the role of the NMC?

Jonathan Asbridge:The Nursing and Midwifery Council is the GMC for nursing. The whole purpose of the Council is to protect the public and we do this in three different ways. We hold a register of all nurses, midwives and health visitors in this country. The register is a very important function of the Council in that nobody can practise as a nurse, midwife or health visitor without being on the Council's register. In order to go onto the register, an individual has to demonstrate all the competencies of professional practice. They also have to prove they are of good character. In the future they will also have to prove they are of good health every time they re-register. Currently an individual has to re-register every three years.

The Council also has the function of defining standards and conduct. This is enshrined in something called the Code of Professional Conduct. Anybody who wilfully disregards the Code is investigated by the Council and if their conduct is putting the public at risk, then we will remove them from the register and so they will no longer be able to practise. We have similar powers for those unfit to practise on the grounds of ill health.

So in a nutshell, our job is to set standards for putting people on the register, setting standards for conduct which allow people to remain on the register and taking action to remove people from the register either if they behave badly or are unfit to practise.

So do you work closely with the Royal College of Nursing?

Jonathan Asbridge:The RCN and all the staff side organisations have a responsibility and actually do promulgate along with us the standards of the Council. And also the unions themselves represent their members if they should be brought before one of our committees. So, yes we do work closely with them and consult these organisations on all major policy matters. We are very open in the way we involve others in our work.

The NMC is a recently formed organisation. What was the system like before?

Jonathan Asbridge:The Nursing and Midwifery Council was formed as a result of a change in legislation which came about in April this year. The formation was just part of an overall overhaul of regulation. What the NMC was formed to do was to streamline regulation. The NMC took over from five bodies that existed previously. There was a body for each of the four countries in the United Kingdom which had responsibility for monitoring standards of education. They also had to provide advice and guidance for midwifery supervision.

The new legislation has brought all of these functions together. So we have the responsibility not only for setting the standards of education programmes, we also have the responsibility for quality assuring all of the courses. No university can run a pre-registration nursing, midwifery or health visiting course without being approved by us.

We also have the responsibility for dealing with midwifery supervision.

This Council consists of 35 people, of whom 23 can vote. The most significant difference is the mix. The UKCC and the National Boards had between them over 100 people sitting. Of those 95 per cent would have been nurses, midwives and health visitors. The government was determined to improve the input of lay people into regulatory bodies so our Council has 12 voting nurses, midwives and health visitors and there are 11 lay people, so it is nearly 50-50.

How will the new over-arching regulator - the Council for the Regulation of Health Care Professionals - affect the NMC when it comes into effect next April?

Jonathan Asbridge:The thing that I think is absolutely right in the legislation is that what government's don't want to see is a variation in the standards of regulation. Within health, one of the things the Kennedy report demonstrated was the different practices of the regulators in terms of the standards they lay down for the operation of that self regulation.

So the Council for the Regulation of Health Care Professionals (CRHCP) has been set up to ensure there is consistency amongst regulators for standards of professional conduct and so on. This will be very helpful. It will be made up of a majority of lay people and will report directly to Parliament. It will oversee all the other regulators. Although they will have a direct line to the Privy Council, in effect it will mean that we will be required to submit an annual report to the overarching body. The government will be in a position to ask the Council to review any cases or issues which may arise.

Do you think you get enough government funding?

Jonathan Asbridge:Well the whole principle of professional self regulation is not to take money from government. The principle is that the profession itself, in order to be a profession, pays for the mechanisms which protect the public. If you go back to the first professional bodies, nursing became regulated in 1919 and midwifery became regulated in 1902. The whole purpose was to protect the public from charlatans.

So professional self regulation is very important because at the end of the day the profession and the public needs to set standards for practice and we cannot allow ourselves to be interfered with by the government of the day.

What is your response to the popularity of Caesareans among celebrities. Is there a health risk?

Jonathan Asbridge:This is not an issue for the regulator. I think that, at the end of the day, people choosing to opt for elective caesareans is up to individuals based on the information they are given. What any regulator would be interested in is to ensure that any decision taken by patients or clients or practitioners would be based on a solid standard of informed consent. What the regulator would be interested in is erroneous information given to the clients rather than whether or not it is clinically appropriate.

You have three years before handing over the first elected NMC Council. What legacy do you want to pass on?

Jonathan Asbridge:We have an absolute imperative to deliver the legislation, so what we would want to hand over is the completed legislation and that means a new register for nurses, midwives and health visitors, it means new fitness for practice rules, it means ensuring that midwifery supervision is bedded in and it means we should have a very robust system of quality assurance.

I would like to hand over a healthy financial situation. We also want to hand over efficient registration systems and also no large backlogs in professional conduct.

What are your main projects for the next 12 months?

Jonathan Asbridge:We want to have a new streamlined registration system and we also want to ensure we have an efficient system for those wanting to access advice from the Council. We also want to make it easier for individuals to contact us when wanting to alert us to any changes in their registration. One of the projects we're undertaking is making sure that underpinning the register are effective information systems.

We are currently out to consultation on the new register. We currently have 15 parts to the register. We want to reduce this to three so there is a logistical issue to address.

We are also working on developing new fitness for practice rules. We've got the competencies which need to be met before getting onto the register, but we also need to define the new and operationalised standards. We have to look at misconduct and, for the first time, lack of competence. This is going to be quite a difficult task. We have to make sure that we are very clear in what we expect to have referred to us, as there is a real danger of volume overload.

How common is it for nurses to be found incompetent?

Jonathan Asbridge:We're likely to remove around 200 people this year for misconduct - which is up quite significantly since the NMC came in. Up to now we've been hearing three cases a day, five days a week in order to clear the backlog. But if you think about it there are 644,000 nurses working in the UK. It shows that professional self regulation works because it means that nurses and midwives themselves are applying the standards. The competence issue is more difficult as it can be argues that everyone lacks competence at some time or other; we are all human and nurses, midwives and health visitors work under tremendous pressure. We have to define very tightly what the legislation blandly terms "lack of competence" and ensure that employers are signed up to our definition.

Are there any European policies which are you concerned about?

Jonathan Asbridge:There is a new draft directive on freedom of movement being tracked through the European Parliament at the moment. It is a proposal that would mean that anyone who is on a professional register for any profession, should be allowed to work without registration in another country for up to 16 weeks. It's a frightening prospect when you think about it.

The health regulators have got together to protest about this because there are differences in standards in the regulation of nurses and midwives in Europe. We can register someone from the EU very quickly here. The danger of allowing to someone to work without registration for 16 weeks si that there is no remedy when something goes wrong. An individual could be removed from a register for misconduct in one country and then go and work in another country for up to 16 weeks. In some countries the enactment of a striking off order pay not come into effect immediately, so someone could be in the process of being struck off when they change countries. There is a huge risk to public safety for no good reason.

It takes 16 seconds to damage a patient - let alone 16 weeks. So all the health professions are protesting against this legislation and believe that, in the interest of public protection, the health professions should be seen as a special case. We've been lobbying in Brussels and Westminster on this and will continue to do so.