Nursing Regulator Delayed Action After Letby Arrest Due to Guidance Loophole, Review Finds

The nursing and midwifery regulator has faced criticism for its delayed action following the arrest of nurse Lucy Letby due to a loophole in its guidance, as revealed by an unpublished review. The Nursing and Midwifery Council (NMC) sought the expertise of a prominent barrister to assess its response to a referral regarding nurse Letby in 2018, after concerns were raised internally about the alleged lack of action.

Despite Letby's arrest in connection with the murders of several babies at the Countess of Chester Hospital, the regulator did not impose a temporary suspension order on her practice rights until a year later in 2020 when she was formally charged. Sources indicate that the barrister's review, conducted for the Thirlwall Inquiry, found that the NMC could have taken earlier action following her arrest. Although the findings are yet to be published, the NMC has revised its guidance in April this year, clarifying that investigators are not required to wait until a nurse is charged to impose a temporary suspension order.

NMC Under Scrutiny

This assessment comes on the heels of a series of reports that uncovered a "toxic" culture within the NMC, including its failures to address a whistleblower's concerns regarding its handling of sexual assault, domestic violence, and racism cases. The inquiry's results, published last month, revealed the watchdog's shortcomings, including a seven-year delay in striking off a nurse accused of raping a colleague and sexually assaulting a patient.

Earlier this month, reports revealed that numerous nurses and doctors were allowed to practice without temporary sanctions between 2018 and 2024, despite facing serious sexual assault allegations. In Letby's case, although bail conditions prevented her from working with children and babies, she technically remained free to practice as a nurse. The NMC stated that Letby was referred after the murders occurred, and the trust had removed her from clinical practice. The regulator published new guidance on temporary suspensions of nurses in March, which was prompted by the barrister's advice. The updated guidance specifies that the NMC does not always need to await a charge before applying for an interim order and may decide to put a case before a panel for interim order consideration prior to charges in appropriate cases.

Responding to the Inquiry

An NMC spokesperson mentioned that the organization, as a core participant in the Thirlwall Inquiry, is providing evidence about its handling of Letby's fitness to practise case. The spokesperson added that once the inquiry concludes, the NMC will provide a statement addressing any recommendations made by the inquiry.

The NMC stated that it announced an internal review group at the end of 2022 and has been engaged in an ongoing process to learn lessons and inform its evidence to the Thirlwall Inquiry. As part of its review, the NMC has made changes to rules around interim orders to ensure greater oversight in exceptional cases. Under the updated guidance, the NMC will consider applying for an interim order when there is cogent evidence of wrongdoing, for instance, when a professional is being investigated for extremely serious criminal offenses. These changes aim to clarify how the NMC addresses extraordinary cases.

Controversies and Challenges

The NMC has set a target of imposing 80 percent of interim orders within 28 days. However, as of June 2023, the watchdog reported that only 60 percent of referrals had an interim order within this timeframe. This statistic raises concerns about the regulator's ability to meet its own targets and the timeliness of its actions in addressing serious allegations against healthcare professionals.

Additionally, investigations by The Independent have uncovered cases of nurses accused of murder who were not subject to an interim order when arrested. For example, Victorino Chua was charged with the murder of three patients at Stepping Hill Hospital in 2014, and the NMC did not initiate an interim order hearing until he was charged in 2014, despite receiving a referral from the NHS hospital where he worked in 2012. Similarly, another nurse, Wilfred Mvikeli Jacob, was arrested for murdering his wife in September 2019, and the NMC did not remove him from the register until September 2021, after his conviction and life imprisonment sentence.

The NMC has faced further scrutiny following reports that it was not acting on sexual assault and domestic violence complaints against nurses and midwives if the incidents occurred outside of the workplace. In response to these findings, the regulator was compelled to revise its guidance on how it handles such cases.

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