DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Partially implemented – Ongoing. The NMC has made a number of changes aimed at improving its administration. Changes to Fitness to Practise process were identified as key a priority in our response to the Francis Report. In April 2014 it consulted on a range of amendments tor Fitness to Practise and Registration Rules aimed at improving FtP processes and to allow it to function more effectively. Proposals were approved by its Council in October 2014 and implemented on 9 March 2015. In particular, it introduced a new team of Case Examiners to decide whether there is a case to answer, helping improve the efficiency, quality and consistency of decision making. This process was informed by the GMC's process at the time, which had a well-established Case Examiner role. It also introduced new powers for the NMC Registrar to review Case Examiner or Investigating Committee panel decisions where certain criteria is met. This was a significant improvement as previously it did not have the power to review decisions at their own volition, and instead had to wait for judicial review invoked by a third party. These improvements to processes will be taken further with the implementation of regulatory reform which will provide the NMC with a more modern and flexible legislative framework. Our vision for legislative reform in fitness to practise in particular is to create a less adversarial process. Fitness to practise proceedings are a way for us to establish whether a professional can practise kindly, safely and professionally. Hearings are only necessary when there is a need to take regulatory action. The NMC's ambition is to place a greater focus on resolving concerns at an earlier stage and seeking enhanced information-sharing powers so that it can ensure greater transparency and public confidence. There is much more the NMC can do in the interim to deliver a more effective, person-centred and collaborative fitness to practise approach. In March 2024 its Council agreed a Fitness to Practise Improvement Plan which commits £30 million to fitness to practise over the next three years, with a particular focus on investment and improvement over the next 18 months. It will help to ensure the NMC can make decisions that keep people safe in a more timely and considerate way that will be sustainable into the future. The NMC has better data from process reviews and modelling about the impact of its caseload. The NMC is currently in a period of significant organisational challenge and change. In particular, following whistleblowing concerns being in raised September 2023, the NMC commissioned Nazir Afzal and Rise Associates to undertake a review into organisational culture. This was an independent report and was published on 9 July 2024 ('Independent Culture Review'). The NMC has agreed some immediate steps in response to the report and continues to reflect on the recommendations and is planning what actions need to be taken. The Independent Culture Review highlighted fundamental concerns about the NMCs culture, fitness to practise performance, and approach to safeguarding, and found that people working at the NMC have experienced racism, discrimination and bullying. The NMC has publicly apologised for the failings identified, accepted all the recommendations made in the report, and has committed to addressing the report's findings and delivering a wider culture change programme at pace.

Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.