Recommendation F231: Coordination with internal procedures
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
It is essential that, so far as practicable, Nursing and Midwifery Council procedures do not obstruct the progress of internal disciplinary action in providers. In most cases it should be possible, through cooperation, to allow both to proceed in parallel. This may require a review of employment disciplinary procedures, to make it clear that the employer is entitled to proceed even if there are pending Nursing and Midwifery Council proceedings.
In brief (written by this site)
The Department of Health and Social Care and NHS England reported in February 2026 that the Nursing and Midwifery Council had introduced a Fitness to Practise Strategy in 2018 promoting a local-first approach, under which "employers should act first to deal with concerns" unless immediate regulatory action is needed, supported by detailed employer guidance (DHSC and NHS England, Feb 2026). Previously, the Thirlwall Inquiry legal team noted in May 2024 that the government had accepted the recommendation and that the council had planned to review its guidance on fitness to practise processes (The Thirlwall Inquiry legal team, May 2024).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
Government response
Accepted.
The Nursing and Midwifery Council have made clear their view that their procedures should not obstruct internal disciplinary action, and that it would not expect the making of an interim order by the Nursing and Midwifery Council to prevent the completion of disciplinary action. The Nursing and Midwifery Council will review the guidance it provides to employers and the public to ensure that this issue is addressed clearly.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England say in progress (27 February 2026)
The NMC introduced a new Fitness to Practise Strategy in 2018. This is based on 12 key strategic principles which reiterate and promote a local first approach: “employers should act first to deal with concerns about a nurse, midwife or nursing associate’s practice, unless the risk to people receiving care or the public is so serious that we need to take immediate action” (Principle 4). This principle reiterates that the NMC only needs to become involved early on if the registrant poses a risk of harm that an employer cannot effectively manage. The NMC has also published detailed guidance for employers on managing concerns, which explains which concerns should be raised with it and seeks to encourage employers to take steps to manage the referral locally where appropriate. It has a specific section dedicated to managing concerns locally. Its Employer Link Service (ELS) team also support this aim – please see response to recommendation 232. Safety culture is one of the two key foundations of the NHS patient safety strategy. PSIRF is a contractual requirement under the NHS Standard Contract and appropriate concerns about safety should be reported.
By law, all employers must have a grievance policy and share that in writing
For nurses, the RCN provide guidance on the grievance process.
Revalidation and appraisal requirements for nurses are set by the NMC.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented – Ongoing.”. Table row: section 18.2 No. 231, PDF page 545-546.
Department of Health and Social Care says in progress (11 February 2015)
The Nursing and Midwifery Council maintains the position that any interim order imposed by the Nursing and Midwifery Council should not impact further disciplinary action by the employer with regards to an individual nurse or midwife. The Nursing and Midwifery Council continue to work with employers to ensure they are aware of any action being undertaken by the Nursing and Midwifery Council and that they are aware of their role in the process.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
Site note: The Inquiry addressed this recommendation to the Nursing and Midwifery Council, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on it.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government.
In the January 2014 Hard Truths report, the Government said that the Nursing and Midwifery Council’s view was that its fitness to practise procedures did not obstruct the progress of internal disciplinary action by providers, and that in most cases it would expect the provider or employer to complete its own internal investigation before making a referral. The Nursing and Midwifery Council said it would review the guidance it provided to employers and the public on fitness to practise processes.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 231, PDF page 504-505.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding