Independent historical reviews to inform ongoing NMC improvement

Two independent historical reviews published today show that the Nursing and Midwifery Council (NMC) reached the right regulatory outcomes in 19 out of 20 fitness to practise (FtP) cases from 2018-2023 raised by a whistleblower – and that there was no evidence of detriment towards the member of staff who spoke up. The reviews did however recommend improvements to our decision-making guidance and case handling processes.

In summary, the review of our handling of the FtP cases by Victoria Butler-Cole KC and David Hopkins, barrister, found that:

• We reached the right regulatory outcome in 19 of the cases reviewed. There was a poor outcome in one case but the individual in that case left the register, so there was no remaining public protection concern.
• In some cases we took an overly restrictive approach to what may constitute misconduct, particularly where the behaviours in question occurred in registrants’ private lives. This was due to inadequate decision-making guidance on ‘private life’ cases in use at the time.
• There may have been cases – including those involving racist behaviour outside professional practice – that were wrongly not pursued.

Meanwhile, the review of our treatment of the whistleblower, by whistleblowing expert, solicitor, Lucy McLynn, found that:

• We responded appropriately to the whistleblower, in line with our policy in use at the time, and that there was no evidence of detriment being suffered by them.
• The policy in use at the time was fit for purpose and was clear that the NMC took whistleblowing seriously – explaining in detail how concerns would be handled and emphasising that whistleblowers would not be subject to detriment. However, it gave an unrealistic assurance about the extent to which we could maintain a whistleblower’s confidentiality internally.
• While our whistleblowing policy, in place at the time, was fit for purpose – our new Raising Concerns Policy, introduced this summer, strengthens the protections for whistleblowers even further. It clarifies where confidentiality can and cannot be fully maintained, and provides additional clarity on how we will handle concerns.

Both reports recognise that we have improved our decision-making guidance, processes and policies since the period during which the FtP referrals were made and the concerns were raised.

For example, in February 2024, we strengthened our guidance for FtP decision makers on the importance of taking into account concerns arising in registrants’ private lives, as well as in their professional roles. This includes concerns about sexual misconduct, domestic abuse and discrimination.

Our updated guidance makes clear that we treat concerns of this nature extremely seriously, whether they occur within or outside a professional setting.

The report about the FtP cases suggests areas of improvement which ‘could feed into the NMC’s existing programme of improvement to its FtP processes’.

This programme is our Fitness to Practise Plan – launched in April 2024 – which has driven changes such as:

• The introduction, in September 2024, of a Safeguarding Hub – this has identified potential safeguarding risks or wellbeing concerns in 1,262 FtP referrals, enabling us to take appropriate steps to keep people from harm
• Targeted investment – increasing the number of people working in our screening team by more than 50 to approximately 125
• Increasing ethnic diversity among panel members for adjudications – 24% of lay panel members and 23% of registrant panel members are now from Black, Asian and minority ethnic backgrounds, respectively.

Over the past 14 months, we have also established new routes for colleagues to speak up with concerns.

These include the launch, in July 2024, of an Empowered to Speak Up initiative. We have 13 ambassadors across the organisation who offer impartial listening and support. They receive external training via the Guardian Service, and work closely with an external Empowered to Speak Up Guardian.

We also encourage staff to raise concerns with the external Empowered to Speak Up Guardian directly where they wish.

Moving forward, we pledge to carefully consider the recommendations from both reviews and will look to implement those measures that will help to improve our work further.

Ron Barclay-Smith, Chair of the Council, said:

“The Council is unwavering in its commitment to ensuring that the NMC is a strong and independent regulator that delivers effectively on its purpose of public protection, upholding standards and maintaining confidence in the professions.

“Fundamental to this is the need to transform our organisational culture and improve our performance in FtP – we have made significant progress on both fronts this year and these historical reviews provide valuable insight to build on that momentum.

“We are grateful to the whistleblower for raising their concerns. We know it can be hard to come forward and we are reassured by the independent finding that they were treated fairly and without detriment.”

Paul Rees MBE, NMC Chief Executive and Registrar, said:

“These independent historical reviews reflect decision-making taking place in fitness to practise (FtP) cases during a difficult period at the Nursing and Midwifery Council, when in some cases we took the erroneous view that what registrants did in their private lives did not have a bearing on their professional practice. This was wrong and for that we apologise.

“Since that era, we have radically changed our approach. We have set up a Safeguarding Hub, which assesses cases being referred into FtP for safeguarding concerns in registrants’ private lives, as well as in their professional roles. The Hub also strives to find cases where there are wellbeing concerns with registrants in the FtP process.

“The NMC is now under new management. We are confident that changes to our guidance, procedures and policies have already gone a long way to addressing the issues identified by the reviews – but we will carefully consider their recommendations and introduce those measures that will help to further improve our work.”

Notes to editors:

• In February 2024, we announced that we had strengthened our guidance for NMC decision makers on concerns arising outside professional practice, including sexual misconduct, domestic abuse and discrimination. This strengthened guidance makes clear that:
  
  • Sexual misconduct, domestic abuse, and the neglect or abuse of children or vulnerable adults are behaviours that are likely to impair a professional’s fitness to practise.
  • When they occur outside professional practice, these behaviours may both affect public confidence in the nursing and midwifery professions. Professionals who behave in these ways are at risk of being removed from the register.
• In April 2024 we launched our Fitness to Practise (FtP) Plan to improve our regulatory performance.
  
  • In July 2025, the number of FtP referrals at screening fell to 1,983 – the lowest level in five years. This was achieved despite 633 new concerns being referred to the NMC in the same month.
  • In July 2023, the rolling average for completing fitness to practise cases within 15 months stood at 60.8%. By July 2025, this had risen to 71%, which is the highest rolling average since April 2021.
• The Safeguarding Hub, launched in September 2024, has assessed 5,113 FtP referrals. It has identified safeguarding risks or wellbeing concerns in 1,262 of these referrals, which it has taken on for a full review. This found:
  
  • 416 assessed as high risk
  • 591 assessed as medium risk
  • 161 assessed as low risk
  • 94 wellbeing concerns identified, with no additional safeguarding concerns.
• We have taken steps to encourage and enable NMC staff to speak up if they see something they feel isn’t right.
  
  • In July 2024, we launched the Empowered to Speak Up (ETSU) initiative to help remove barriers that prevent some colleagues from speaking up and to build confidence in raising concerns.
  • We have 13 ambassadors across the NMC who are supported to offer impartial listening, protect anonymity, and signpost to relevant policies and support.
  • Ambassadors receive external training via the Guardian Service, alongside internal training on safeguarding, wellbeing, and trauma.
  • Ambassadors work closely with an independent external Empowered to Speak Up Guardian, who brings expertise, support and training, and acts as an impartial point of escalation for any concerns raised.
  • We ensure that our Employee Forum meets with the Executive Board every quarter and can raise staff concerns with senior management.
  • We have a new staff suggestions process, through which staff can suggest improvements, with the Executive Board’s answers regularly being posted on the NMC intranet.
  • We run an increased number of in-person town hall events and online briefings, at which staff can raise concerns.
  • We have introduced a Log and Learn process, through which members of staff can document processes that have gone wrong in order to aid learning within the organisation.
• We originally commissioned Ijeoma Omambala KC to produce both reviews. In July 2025, we announced that, due to personal circumstances, Ms Omambala KC had not been able to deliver the reports within the anticipated timescale. We did not receive reports, findings or any indication of findings from Ms Omambala KC.
• We instructed Victoria Butler-Cole KC and David Hopkins from 39 Essex Chambers to complete the review of fitness to practise cases. Both Ms Butler-Cole and Mr Hopkins have extensive regulatory and public law expertise.
• We instructed whistleblowing expert, solicitor, Lucy McLynn to complete the review of the NMC’s handling of the whistleblowing concerns.

Other recent news…