Culture is about the little things as much as the big - the way we communicate with those we interact with determines whether they in turn engage with us and whether this is positive or negative.  The Nursing and Midwifery Council has regularly told us of the importance of nurses and midwives engaging with them during the Fitness to Practice process. They stress the importance of this in order to assist them in assessing their cases and reach the best outcomes. However when a nurse or midwife's only experience of the NMC is lengthy and confusing letters, repetitive letters and lack of continuity it is difficult for that trust to be gained and automatically puts the nurse or midwife on the defensive. More needs to be done to break down those barriers and rebuild trust and ask difficult questions when this doesn't happen. Reading the NMC website of hearings so many nurses and midwives do not attend and /or are not legally represented - perhaps an honest examination of why this is may give some good insight into the true issues?