Trigger Warning: This article discusses suicide, regulatory injustice, and institutional harm. If you are affected by any of the content, please contact Samaritans at 116 123 (UK, free 24/7 helpline).
Disclaimer: This piece offers a strategic perspective on regulatory practice through a human rights and systems lens. It is intended to support reflection and improvement, not to apportion blame. The views expressed are based on public information, experience, and a commitment to justice, equity and human rights.
A total of 16 nurses and midwives are known to have died by suicide since 2018 while under or having concluded a fitness to practise investigation. The figure is confirmed by the Nursing and Midwifery Council (NMC). These nurses and midwives were individuals committed to care who found themselves enmeshed in a system with processes meant to protect the public but arguably failed to protect them.
To date the NMC has not faced legal prosecution for these deaths. Nor have the employers who referred these nurses and midwives—sometimes unnecessarily, sometimes as a shortcut to internal performance management—been held accountable. In a profession grounded in ethics and duty of care, the regulatory system itself appears to operate outside these moral boundaries. This must be interrogated, not only morally but legally.
Absence of legal redress
At the heart of this issue lies a jurisprudential vacuum.
Regulators like the NMC are governed by administrative law. Their actions can be reviewed, appealed, or even overturned, however prosecution is rare, if not unheard of. The legal system distinguishes between poor administration and criminal liability. Only the latter triggers prosecution.
Courts have consistently ruled against imposing a duty of care in tort on regulators to individual registrants (e.g. Yuen Kun Yeu v Attorney-General of Hong Kong, [1988] AC 175). This case, although dated, continues to influence UK legal reasoning: regulators are seen to serve the public, not the professional, and owe no private duty, even where foreseeable harm occurs.
This leaves a problematic gap. If a regulator acts negligently and its processes cause harm, trauma, or death, there is often no route to redress beyond civil litigation or ombudsman complaint. And these remedies rarely result in meaningful accountability.
Employer complicity and moral abdication
Employers, too, escape scrutiny. Despite widely reported concerns about the NMC’s fitness to practise processes, backed by PSA reports, lived experience accounts, and media investigations, there is no legal duty on employers to consider these risks before making referrals. In fact, employers are often legally compelled to refer cases, even when those cases might be better managed in-house.
This legal compulsion effectively overrides ethical consideration. Referrals are often made defensively. Complex human problems including burnout, racism, poor supervision and excessive workload, are externalised and weaponised through referral to a regulator ill-equipped for nuance or care. In some cases, fitness to practice decisions take an inordinate amount of time in an environment with no trauma support for those going through an arduous process. Yet, unless an intent to harm can be proven beyond reasonable doubt, the law remains silent regardless of detrimental impact on the individual.
Regulatory accountability
The NMC has taken steps such as joint statements, action plans and stakeholder engagement to address concerns raised, but these remain internal-driven initiatives. They are not justice for the bereaved. Nor do they satisfy the basic principle of accountability in the public interest.
The Professional Standards Authority (PSA), which oversees the NMC, has no enforcement power beyond issuing critical reports. Public inquiries may raise awareness, but rarely deliver consequence. There is no legal obligation on a regulator to fix systemic failings within a timeframe. There is no requirement for the regulator to provide evidence of how failings are being fixed. There is no statutory requirement to issue reparations to those harmed. There is no trigger for criminal investigation unless fraud or gross misconduct can be shown.
In effect, regulators operate in a legal grey zone where they are answerable to everyone in theory, but to no one in practice.
Reform of the legal framework
This situation is unsustainable and undermines the integrity of regulatory bodies. A public body entrusted with significant power, such as the power to end careers, must be held to a higher legal standard and scrutiny. It is time to:
Create a statutory duty of care from regulators to individual professionals undergoing investigation.
Establish an independent legal route for families to seek redress in cases of death linked to regulatory action.
Mandate employer accountability where referrals are found to be unnecessary, discriminatory, or harmful.
Introduce timelines and binding duties for regulators to act on safeguarding failures, with penalties for non-compliance.
While holding professionals to account for their standard of care and delivery of safe patient care is unquestioned, the accountability must be fair, just, and proportionate. And regulators must be accountable, too, for the process they use and how they safeguard individuals through the process.
If we accept that regulatory harm can lead to death, then we must also accept that justice must apply in both directions.
Directions for legal research
To begin bridging this gap, legal scholars and practitioners should explore several research avenues.
First, the development of statutory amendments to establish a limited duty of care owed by regulators to professionals under investigation. Second, comparative legal analysis with jurisdictions that allow tort claims against regulators or offer more robust ombudsman powers. Third, an exploration of regulatory law through the lens of human rights frameworks—particularly Article 2 (right to life) and Article 8 (right to private and family life) of the European Convention on Human Rights—to assess whether current processes constitute a breach. Fourth, legal innovation around class actions or public interest litigation could be considered to test the boundaries of current law and expand recognition of institutional harm. Ultimately, legal research must serve as a vehicle to challenge impunity, establish precedent, and reassert the value of life and fairness in systems of professional accountability.
If you are struggling with your mental health or have been affected by the issues raised, contact Samaritans at 116 123 (UK) or visit http://www.samaritans.org.
References
GMC & NMC Joint Statement on Tackling Discrimination (2024).
Health and Care Professions Council v GDC [2020] EWCA Civ 210.
Nursing and Midwifery Council (2023) Statement on mental health and fitness to practise.
Nursing Times (2024) “Deaths in FTP: Families demand inquiry”.
Professional Standards Authority (2023). Report to Parliament on the performance of the NMC.
The Guardian (2023) “Regulation, Racism and Risk: Inside the NMC”.
UNISON (2024) Anti-Racism Charter for Regulatory Bodies.
Yuen Kun Yeu v Attorney-General of Hong Kong [1988] AC 175.
King Advisory 
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