The Nursing and Midwifery Council (NMC), the regulator responsible for overseeing nurses, midwives, and nursing associates in the UK, has acknowledged significant shortcomings in how it assessed declarations made by healthcare professionals renewing or reinstating their registration. These declarations, which include disclosures about criminal convictions or health conditions that might impair safe practice, were not consistently reviewed in accordance with established procedures over a 12-year period.

The regulator revealed that concerns about practitioners were not always escalated to senior managers known as assistant registrars, who are responsible for making final decisions on the fitness to practise of applicants. As a result, hundreds of applications may have been inadequately scrutinized, raising questions about the robustness of safeguarding processes within the nursing profession. The NMC confirmed that it is conducting a thorough investigation to clarify the extent and details of this historical failure.

A high-profile case exemplifying the consequences of this lapse involves convicted serial killer Lucy Letby. Lancashire police have stated that the NMC did not impose sanctions when they first received referrals concerning her, despite her serious criminal offences. The regulator did not provide further detail on when or how these failures occurred in relation to Letby’s registration.

Paul Rees, the NMC’s chief executive and registrar appointed in 2025, issued a formal apology for the breakdown in the assessment process. He described the failure to apply full scrutiny to health and character declarations as "completely and utterly unacceptable." Rees also pointed to an independent culture review published in mid-2024, which had identified systemic issues within the organization, including bullying, harassment, racism, and operational weaknesses.

Since taking leadership, Rees said the NMC has been focused on comprehensive reform and cultural change. Over the past 20 months, the body has dismissed 18 individuals for behaviors such as bullying and racism as part of an effort to improve workplace culture. He emphasized the regulator’s commitment to transparency and accountability, stating that ongoing reviews and new procedures have brought the historical issues to light and that further corrective actions are underway.

The NMC plans to implement a three-year turnaround strategy aimed at restoring confidence and ensuring that all future assessments are handled rigorously to protect patients and uphold professional standards. The scope of the investigation and any potential regulatory or legal follow-up remain under review.