NMC responds to latest article in The Independent

We want to use this opportunity to explain how some of the processes highlighted in the article operate, the challenges we know we must address and the improvements we’re making or plan to make. We hope this will provide reassurance for members of the public, professionals on our register and our partners that we are working hard to ensure we do protect the public and promote high standards for nursing and midwifery professionals. 

Responding to concerns 

We’re acutely conscious of the impact on everyone involved when we take too long to reach a decision about a fitness to practise referral of a professional on our register.  We’ve shared information transparently about the timeliness of our decision-making and our caseload at every stage of the process through our regular reports to our governing body, the Council, and our annual reports. We apologise to anyone who has been waiting too long for a decision in their case. In March we’ll present a new fitness to practise improvement plan to our Council, with a significant further investment in the capacity and capabilities we need to make a step change over the months ahead. 

The article references concerns that were first raised last year. We have taken these concerns extremely seriously. External investigations are under way looking at our handling of their concerns being raised, and some fitness to practise cases they highlighted. A third review is looking at our internal culture. The terms of reference for the independent investigations into our fitness to practise casework and handling of the whistleblowing concerns can be found here. The terms of reference for the independent review of our internal culture are here.  

In response to The Independent’s latest article, we hope the following information provides clarity about the issues covered, and the steps we take to protect the public. 

Investigations 

We receive more than 5,000 referrals to our fitness to practise process each year, and we handle these under a multi-stage regulatory process that is guided by legislation. At the end of December, we held 2,582 cases at the initial screening stage, 1,797 at the investigations stage, 313 with case examiners for a decision about whether there is a case to answer, and 1,019 at the final adjudication stage. That’s 5,711 cases in total. 

All referrals are initially screened in line with our published guidance. Where we need to take urgent action to restrict a professional’s practice while we investigate, we apply for interim orders (in 2022–2023 we imposed 688 interim orders). This may mean that professionals cannot work as a nurse, midwife or nursing associate, or if they do, they work within strict conditions of practice to enable them to work safely. 

All cases which are progressed from screening undergo a full investigation at the next stage of the process. At this stage, we gather enough information and evidence to enable a pair of ‘case examiners’ to decide whether there is a case to answer, or no case to answer (or, sometimes, to issue a warning, undertakings or advice, which resolves the case at that point). 

If case examiners feel an investigation put before them is not adequate to make a decision, then they will send it back for further investigation at that stage. This affects a very small proportion of investigations – as highlighted by The Independent as of January there were 32 cases in total awaiting further investigation. This needs to be set in the context of the number of decisions that case examiners make each year (2022–2023: 1,210; 2021–2022: 1,582). 

This means that case examiners always have a full investigation to review so any decision to progress a case to a hearing is safe and appropriate.  

When a case is progressed to adjudication, our case preparation and presentation team may want to gather further information and evidence about a case, over and above what was required for the case examiners' decision. There are a number of reasons for this:

• We have received new information that we need to investigate fully.
• We need further information that clarifies or expands on earlier evidence we obtained.
• A witness who wasn’t previously available is now able to give us a witness statement about the events.

This is done to ensure the strongest presentation of the case at a hearing.

The following comment was provided to The Independent but not published: 

"Every team across fitness to practise is working hard to protect the public. Case examiners review completed investigations to decide whether there is a case to answer. In a small number of cases, they will ask for further investigation and won't make their decision until they have it. 

"Where case examiners do find a case to answer, it will move to our case preparation team. They may carry out additional work to ensure the best presentation of the case at the hearing. 

"We report all our caseload figures for each stage of the process at our public Council meetings. Those papers are available on our website." 

Legal review as part of preparation for a hearing or meeting 

Currently, there are just over 1,000 cases at the adjudication stage of our fitness to practise process, meaning they have had a ‘case to answer’ finding by our case examiners following an investigation. 

Of those, 451 were awaiting their allocation for a legal review in January. The legal review at this stage includes tasks such as drafting the charges and lining up the order of witnesses for a hearing. All these cases will have had legal reviews at previous stages of the process. 

Of the 451 cases awaiting a legal review at this stage, 83 were subject to interim orders. The article suggests that all 83 professionals could be practising, however they will include professionals who are under interim suspension orders and therefore not practising. The remainder will be under interim conditions of practice orders, which are strict conditions that the NMC and an interim panel have deemed appropriate to protect the public in advance of a final hearing or meeting being held. 

We have been working to improve efficiency at each stage of our casework, and over the past year we have significantly increased the number of adjudication decisions we are making each month, from 41 in January 2023 to a high of 87 in October 2023, and 61 in January 2024.

Transparency of our caseload 

We’ve been open and transparent about our caseload at each stage of the fitness to practise process and in total. The cases described in the article as ‘hidden’ are not hidden, they are included in the adjudication stage caseload figure and the total caseload figure, which are reported to Council every two months and published on our website. This report has been a standing item at Council since 2021. 

Colleagues supporting fitness to practise teams 

Fewer than 20 colleagues from across the NMC have provided very effective and welcome support to our fitness to practise teams over recent months. 

Some of these are colleagues who previously worked in fitness to practise and have reprised those roles or responsibilities. Others have volunteered or agreed to perform tasks in fitness to practise for the first time. Each of those individuals has had appropriate training and access to managerial support. 

In addition, the employer link service, which is trained to provide advice on the referral of fitness to practise cases, was also involved in supporting the screening team in their initial assessment of a limited number of cases. 

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