Independent reviews ‘provide reassurance and learning’ for NMC

The nursing regulator has been advised to make several amendments to its fitness to practice (FtP) screening guidance and consider changes to the way in which it approaches cases involving racism.

This comes as part of two independent historical reviews about the NMC’s handlings of 20 FtP cases from 2018-2023 and the regulator’s treatment of the whistleblower who raised concerns about these FtP cases.

The independent reviews, published this week, concluded that the NMC reached the right regulatory outcomes in 19 out of 20 FtP cases raised by the whistleblower. A poor outcome was identified in one case but the individual in that case left the register and so it was found that there was no remaining public protection concern.

In terms of the whistleblower, there was ‘no evidence of whistleblowing detriment’ found, but the review recognised there were matters that ‘could have been dealt with better’.

The NMC said the reviews provided ‘both reassurance and learning’ to inform ongoing improvements at the regulator.

NMC chief executive and registrar Paul Rees said the regulator had ‘radically changed’ its approach to FtP and that he was confident that recent changes had ‘already gone a long way to addressing the issued identified by the reviews’.

Though he added that he was committed to introducing any additional changes that would ‘help further improve our work’.

The ‘problems’ identified with FtP handlings

While the FtP review – completed by barristers Victoria Butler-Cole KC and David Hopkins – found the regulator had reached almost all of the right regulatory outcomes in the cases reviewed, it did outline some problems and therefore offered a list of recommendations.

The report’s authors stressed that ‘the most important message’ from their findings was the need for more clarity on written guidance.

‘Whatever a piece of written guidance says, there needs to be a shared understanding of what it means and how it should be applied throughout the various parts of the NMC’s FtP process,’ the review said.

One concern raised was that the NMC may have applied too narrow a definition when assessing incidents that occur in a nurse or midwife’s private life.

‘In broad terms, the problems concern an overly restrictive approach being taken to what may constitute misconduct, in particular where the behaviour in question occurred in the private, non-working life of registrants,’ the review said.

The NMC was asked to consider amending its screening guidance ‘to ensure it has a clear and unambiguous statement about misconduct covering both private and professional life, and a more comprehensive list of examples that aligns with other pieces of guidance’.

It said it should also ‘consider including in the screening guidance or elsewhere an account of why particular types of behaviour in a registrant’s private life (such as sexual assault, physical violence, domestic abuse, racism and so on) might constitute misconduct and be relevant to FtP’.

Despite concerns around the regulators approach to private life issues, the review found ‘no evidence’ that such an approach led to incorrect outcomes in the cases examined.

In February 2024, the regulator updated its 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 – including concerns about sexual misconduct, domestic abuse and discrimination.

Approach to racism in referrals

The review also covered the NMC’s approach to racism within FtP referrals.

It raised particular concerns about the NMC’s use of the phrase ‘deep-seated attitudinal problem’ when describing racist behaviour and warned that this language risks being interpreted as a threshold test that must be met before a concern can be investigated or pursued.

Instead, all guidance using this term should be revised to eliminate any ambiguity, and staff should be updated accordingly to ensure a shared and accurate understanding of the expectations, the report recommended.

It also asked the NMC to ‘consider amending the guidance on charging racism to make clear that an act includes written and spoken language as well as behaviour, and to ensure that use of racist language is charged if the language in question is objectively racist’.

To support this, the report called for further guidance to be given to staff at the screening and investigation stages of the FtP process, particularly to ensure that the correct evidence is gathered and that charges are drafted with the necessary precision and accuracy in the context of racism allegations.

In addition, the review said the NMC must ensure that all new appointees to FtP panels receive ‘anti-racism training’ before sitting on a panel.

It added that the NMC should establish a formal mechanism that allows panel members to raise concerns about the conduct or approach of fellow panel members, if such issues arise during proceedings.

Whistleblowing report

The FtP review was published alongside a second independent review into the regulator’s treatment of the whistleblower and the handling of their concerns. This review was completed by Lucy McLynn, a partner at Bates Wells law firm.

This concluded that ‘concerns raised were dealt with adequately and in line with policy at the relevant time’, however it suggested there were aspects of how concerns were dealt with which ‘could have been handled better’.

‘Whilst we concluded that there was no evidence of whistleblowing detriment towards the whistleblower, there are similarly matters that could have been dealt with better in terms of how the whistleblower was treated,’ it said.

‘These include in respect of delays, communication, confidentiality and ownership.’

The review listed several recommendations for the regulator, including that all managers receive training on whistleblowing to ‘ensure that they know how to recognise and deal with such concerns, and how whistleblowers should be treated’.

It also suggested that its ‘Raising Concerns’ policy be kept under regular review and be ‘prominently available to all staff’.

The NMC was also asked to establish ‘confidential email addresses or another confidential channel for senior employees with shared mailboxes where confidential information around whistleblowing can be shared’.

A radically changed approach

NMC chief executive and registrar Mr Rees said the regulator had ‘radically changed’ its approach to FtP, including by establishing a Safeguarding Hub which examines cases being referred into FtP for safeguarding concerns in registrants’ private lives, and in their professional roles.

‘These independent historical reviews reflect decision-making taking place in 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,’ he said.

He added that the regulator ‘will carefully consider’ the report recommendations and introduce any changes ‘that will help further improve our work’.

Ron Barclay-Smith, chair of the NMC’s Council, shared the regulators thanks 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,’ he said.

‘Far from the full picture’

Responding to the reviews, the Royal College of Nursing (RCN) chief nursing officer Lynn Woolsey, said: ‘The RCN welcomes the long-awaited publication of both reports and the opportunity it provides the NMC to reflect on its past failures and continue its path to reform.’

She acknowledged that ‘it is positive’ that almost all of the cases reviewed in the report were found to be handled appropriately, but stressed that ‘it is far from a full picture’.

‘Tragically, due to the disproportionate number of referrals, many of those impacted are Black and Minority Ethnic (BME). The focus now must be on dealing with these cases swiftly and fairly,’ she added.

Ms Woolsey cautioned that RCN members will ‘need to see evidence’ that the reforms are working ‘before any judgment is made’.

Delays to publication

Both reviews reports were both recommissioned in June, with the NMC saying there had been several factors that caused delays to the reviews – which were meant to be received in early 2024.

At the time, the NMC explained that due to ‘personal reasons’, Ijeoma Omambala KC – who was commissioned to lead the investigations in 2023 – ‘has not been able to deliver her reports within anticipated timescales’.

Last month, the NMC launched its strategic plan for 2025-2027, outlining five priority areas aimed at strengthening public trust, improving regulatory performance, and embedding an inclusive culture within the organisation.

Spanning the next 18 months, the strategy is especially focused on tackling disparities in FtP outcomes, particularly those based on ethnicity and gender.

In June, the Professional Standards Authority (PSA) said the NMC had failed to meet a wave of organisational standards across areas including safeguarding, FtP and whistleblowing.