The Nursing and Midwifery Council (NMC), the UK's regulator responsible for nearly 800,000 nurses, midwives, and nursing associates, has come under intense scrutiny following a series of failings revealed by independent investigations and media exposés. In a landmark national interview, Paul Rees, the newly appointed chief of the crisis-hit NMC, conceded that the organisation had "completely got things wrong" in its handling of serious misconduct cases, notably those involving sexual assault and patient safety. Rees issued a public apology for past mistakes, including the controversial decision not to investigate off-duty sexual misconduct and the failure to suspend psychiatric nurse John Iwuh promptly, who was later jailed for 16 years for rape and voyeurism.
One of the most glaring examples of the regulator’s mishandling centred on Lucy Letby, the neonatal nurse convicted and sentenced to 14 whole-life orders for murdering seven babies and attempting to murder six others at the Countess of Chester Hospital between 2015 and 2016. The NMC admitted it had a loophole in its guidance at the time, which prevented the immediate suspension of Letby after her initial arrest. It was only a year later, after formal charges were brought, that the NMC took action to suspend her, a delay that has been widely criticised. Following revelations by The Independent, the NMC changed its guidance to clarify that investigators can now issue temporary suspension orders as soon as an arrest is made in exceptional cases involving serious criminal wrongdoing.
Despite her conviction, Letby did not oppose the application to be struck off the nursing register but maintained her innocence. The NMC panel formally found her "unfit to practise" nursing and confirmed she remains suspended from the register as regulatory processes continue. This case is emblematic of broader systemic issues within the NMC, where an independent inquiry led by Nazir Afzal KC, known as the Rise review, identified a "dysfunctional" and "toxic" culture within the organisation. The review exposed evidence of racism, sexism, and resistance to feedback at the leadership level, which ironically contributed to failures in safeguarding public safety.
Paul Rees indicated that the NMC has undergone significant leadership changes since the public backlash, with six senior leaders, including former chief executive Andrea Sutcliffe and former chair Sir David Warren, having left the organisation. These changes reflect a strong desire to reshape the regulator’s culture and operations, although Rees warned it could take years to fully turn around the organisation. He highlighted ongoing improvements, such as a reduction in case processing times from 60.8% to 71% of cases resolved within 15 months as of recent data, although hundreds of referrals from 2021 or earlier remain open.
Alongside Letby's case, the NMC is also investigating claims against Alison Kelly, Letby's former nursing director at the Countess of Chester Hospital, who has been suspended from her current role following accusations of ignoring concerns about Letby. The NMC has referred Kelly to the fitness to practise process, which had been previously paused pending the outcome of the criminal trial.
Notably, the NMC has experienced considerable internal turmoil, with whistleblowers raising serious safeguarding concerns. Some staff who spoke out have left the organisation, and at least one senior leader who made allegations has departed amid ongoing disputes. A recent report by two barristers suggested no detriment had been suffered by the whistleblower who initially raised concerns, although the whistleblower has contested this, alleging the NMC maintained a culture aimed at covering up misconduct and protecting reputations, a claim the regulator denies.
The cases of Letby and John Iwuh starkly underline the critical importance of robust and proactive regulation in the healthcare sector, where failures can have devastating consequences for vulnerable patients. As Mr Rees acknowledged, “We should’ve acted faster” in these cases, a recognition that comes amid wider calls for greater openness, accountability, and reform to restore public confidence in the NMC.
📌 Reference Map:
- [1], [2] (The Independent) - Paragraphs 1, 2, 4, 5, 6, 7, 8, 9, 11, 12
- [3], [4], [5] (Evening Standard) - Paragraphs 3, 4
- [6] (Evening Standard) - Paragraph 7
Source: Noah Wire Services