Having spent years supporting registrants through the Nursing and Midwifery Council’s (NMC) Fitness to Practice process, I’ve seen its impact up close – and I’m here to tell you, the system is broken.
written by Simon Holborn – Head of Advocacy at NMCWatch.
I see the issues relating to too little too late for serious cases but just as important is the great damage being done to the 6000-plus registrants referred each year. We need to do this better, quicker and with more purpose. I feel I need to speak to the many unfortunate Registrants whom I have assisted through a process which is not fit for purpose and damages them no matter the outcome. We are not supporting our frontline nurses and midwives and they deserve better.
The FtP process is supposed to protect public safety while ensuring fairness for professionals under investigation. Instead, it drags on for years, leaving people’s careers and mental health in tatters. Many registrants are accused of relatively minor issues but are still left feeling tarnished just because they’re being investigated and because of the way such allegations are investigated.
The problem with delays – the elephant in the room – is the time it takes to resolve these cases. Seven years to act on serious misconduct? That’s what the Afzal Review found in one example. Now imagine you’re a nurse or midwife accused of something relatively minor which you have accepted or partially accepted and learned and you simply want to say sorry and genuinely move on. You’re stuck in limbo for years, unable to plan your life.
Even when cases are resolved in the registrant’s favour, the damage is often already done. Reputations are hard to rebuild, and the stress can take a toll on even the most resilient individuals.
It’s not just the wait.
The process itself is a mess. It’s legalistic, adversarial, confusing, opaque, and leaves registrants feeling isolated. I’ve worked with professionals who had no idea what was coming next or how long they’d be under scrutiny. That uncertainty makes an already stressful situation unbearable.
And let’s be real – just being under investigation creates a stigma. Even if you’re cleared, people will wonder, “What did they do to get investigated in the first place?”.
What needs to change
The NMC has taken some steps to improve, but there’s still a long way to go. From where I stand, here’s what we need:
- End the Adversarial process – no matter what is said the process is legalistic, it is blame-orientated and adversarial.
- Be inclusive, open and genuinely none judgmental. Devise a fair set of rules and regulations.
- Set Deadlines That Stick: these endless investigations need to end. Give cases a clear timeline and follow it.
- Be Clearer: Registrants should always know what’s happening, why, and when. No more guessing games.
- Offer Genuine Support: It’s time to acknowledge the emotional toll this process takes. Access to mental health and professional support isn’t a luxury – it’s a necessity.
- Bring in Oversight: someone needs to keep the system in check. An independent body could ensure fairness and efficiency.