The United Kingdom’s Nursing and Midwifery Council (NMC) has been thrust into the spotlight once again, as its new chief, Paul Rees, publicly admitted the regulator’s grave failings in handling the case of convicted child killer Lucy Letby and other misconduct scandals. His candid remarks come amid a period of intense scrutiny for the NMC, which oversees nearly 800,000 nurses, midwives, and nursing associates across the country.
According to The Independent and BBC, Rees, who assumed leadership of the NMC in July 2025, did not mince words regarding the Council’s past actions. “We have to be honest about things that have gone wrong. And things have gone wrong in the past,” he told The Independent. He specifically addressed the NMC’s slow response to the Letby case, admitting, “We should’ve acted faster with Lucy Letby.”
Letby, a former neonatal nurse at the Countess of Chester Hospital, was convicted in August 2023 of murdering seven babies and attempting to murder six others between 2015 and 2016. She was handed 14 whole-life prison sentences at that time and received a 15th whole-life term in July 2024 after being found guilty of attempting to murder another baby. Letby, now 35, is serving her sentences after a highly publicized trial at Manchester Crown Court.
But the NMC’s handling of Letby’s professional status during the investigation has sparked outrage and prompted calls for reform. The Council was first alerted to concerns about Letby in July 2016, when Alison Kelly, then the hospital’s director of nursing, contacted the NMC after consultant paediatricians raised fears that Letby might be deliberately harming babies. Letby was moved to non-clinical duties but was due to return to the neonatal unit before the hospital finally contacted Cheshire Constabulary in May 2017 to investigate the spike in infant deaths.
Despite these grave concerns and Letby’s eventual arrest in July 2018, the NMC did not impose any restrictions on her ability to work. She continued to be employed in the hospital’s risk and patient safety department until her arrest. As BBC reported, a senior NMC lawyer concluded at the time that there were insufficient grounds for an interim order—such as suspension or practice restrictions—without Letby being formally charged. It was not until November 2020, when Letby was charged, that the NMC took decisive action. She was ultimately stripped of her nursing credentials and struck off the professional register in December 2023.
Rees acknowledged the regulatory failure, telling The Independent, “We should have suspended the child killer when she was first arrested.” He further admitted that the NMC’s previous guidance, which excluded misconduct outside the workplace from its remit, was “completely wrong.” He stated, “It should’ve been saying what you do outside of work is just as important as what you do at work.”
The NMC’s shortcomings were not limited to the Letby case. Rees also apologized for the Council’s slow response to suspending psychiatric nurse John Iwuh, who was jailed for rape and voyeurism in July 2025. Iwuh continued working with patients for a year after police first notified the NMC of their investigation in 2022. “We should’ve moved faster to investigate the case; we should’ve moved faster to look for an interim order and, having got the interim suspension order, we should’ve moved faster to communicate with all of the employers,” Rees said, as quoted by The Independent.
The NMC’s failings have been the subject of a series of damning exposés by The Independent, which revealed a “toxic” and “dysfunctional” culture within the organization. An independent review, known as the Rise review and led by Nazir Afzal KC, concluded in June 2024 that the NMC was endangering public safety by failing to properly handle serious allegations of sexual misconduct and other safeguarding concerns. The review also found that the NMC’s leadership had demonstrated a “willful deafness to criticism” and was resistant to feedback, particularly from whistleblowers.
Whistleblower concerns have been a persistent issue within the NMC. Several senior staff members, including chief nurse Sam Foster, left the organization after raising alarms about the regulator’s failure to investigate safeguarding allegations. At least three staff members who raised concerns have departed since the Rise review was commissioned, and one such individual tragically died earlier this year, prompting an inquest.
Rees insists the NMC is now under new management and determined to address its past failures. “I’m determined to fix the challenges and to turn the ship around,” he said. Since summer 2024, six senior leaders have left, including former chief executive Andrea Sutcliffe and former chair Sir David Warren. Rees emphasized the importance of refreshing the top team and pointed to improvements in the speed of handling referrals: as of April 2025, 71% of cases were dealt with within 15 months, up from 60.8% the previous year. Nonetheless, hundreds of cases dating back to 2021 remain open, underscoring the scale of the challenge.
The NMC has also revised its guidance to allow for swifter action in exceptional cases of serious criminal wrongdoing. As Rees explained, “We’ve changed the guidance, so it is clear now where there is an exceptional case of serious criminal wrongdoing, we take action and implement an interim order. It’s incumbent upon us to move fast and bring about these interim orders.” This change, implemented in August 2024, means investigators no longer have to wait until a nurse is formally charged before issuing a temporary suspension.
The NMC’s transformation remains a work in progress. Lady Justice Thirlwall’s final report on the public inquiry into the Letby case and the authorities’ responses is expected in 2026. Rees acknowledged the possibility of further criticism, stating, “We don’t know yet, but it’s a possibility because we should’ve acted faster with Lucy Letby.”
Despite the reforms, skepticism persists. A whistleblower told The Independent, “Since the moment I blew the whistle, every move the NMC has made has been about covering up misconduct and protecting reputations.” The NMC, for its part, has denied these allegations, stating that “no whistleblower had suffered detriment” and pointing to a recent barristers’ report that found, in 19 out of 20 cases reviewed, the NMC ultimately came to the right decision.
Letby’s crimes shocked the nation and exposed deep flaws in the UK’s mechanisms for protecting patients from rogue professionals. The NMC’s public reckoning, led by Rees, signals a new era of transparency and accountability for the regulator. But with the final inquiry report still pending and the wounds from past failures still fresh, the journey toward restoring public trust in nursing oversight is far from over.
