NMC performance of ‘considerable concern’, finds super-regulator

The government has been warned of several ‘weaknesses’ within the regulatory functions of the Nursing and Midwifery Council (NMC), in a damning review which found the regulator only met half of its expected standards.

A review of the NMC’s performance in 2025 has left the Professional Standards Authority (PSA) with ‘considerable concern’ and shows the nursing regulator has ‘a lot more work’ to do to bring about improvements required.

Concerns have been once again raised around the NMC’s fitness to practise (FtP) processes and timeliness, while its education quality assurance function was described as carrying ‘significant risks’ and ‘shown to be ineffective’.

In addition, while recognising some efforts to improve equality, diversion and inclusion (EDI), the PSA said it had seen ‘limited evidence of the impact of the changes the NMC has made with respect to EDI in this reporting period’.

The super-regulator did acknowledge several changes within the NMC’s leadership team, including the appointment of Paul Ress as chief executive and registrar, and said it was ‘encouraged by the new leadership’s intentions and commitment to change’.

However, it said it had ‘not yet seen significant evidence of overall improvement and this is reflected in our findings for 2025’.

Ultimately, it found the NMC had only met nine of the 18 standards set by the PSA – down from 11 the year before.

Education quality assurance an ‘area of high risk’

The PSA identified serious concerns around the way the NMC checks the quality of nurse education programmes.

It sets out examples in Southampton in 2025 and in Brighton the year before where students carried out significantly less hours than required while in training.

‘The NMC’s education quality assurance function remains an area of high risk,’ the review said.

‘We highlighted this in our performance review for 2023/24, and we are concerned that the NMC has taken very limited action to address this.’

It said it was particularly concerned that the NMC was ‘overly reliant on unsubstantiated self-reporting from education providers’, which it said carried ‘inherent risks’.

NMC fails to meet FtP timeliness standard again

The last time the NMC met the super-regulator’s standard for FtP timeliness (standard 15) was in 2018/19.

While the PSA said the NMC had made ‘significant improvements to timeliness of decision-making at the screening stage’ it felt this had ‘not been replicated at the investigations and adjudications stages of the process’.

It also warned that its own audit of cases ‘identified delays and concerns around case progression, which was corroborated by the dataset provided by the NMC as well as stakeholder feedback’.

‘The NMC did not meet Standard 15 because it continues to take too long to deal with fitness to practise cases,’ the review said.

Other concerns were raised around FtP, including around case progression and keeping parties updated.

An audit carried out by the PSA also suggested that of 42 cases, six FtP cases were ‘closed prematurely’.

‘Accordingly, we could only take limited assurance about the quality of the NMC’s decision-making at the screening stage,’ it said.

In addition, it flagged concerns around ‘poor record-keeping in respect of safeguarding
considerations and decisions throughout our audit’ and ‘only took limited assurance that the NMC was appropriately identifying and managing’ risks within FtP cases.

‘Limited evidence on impact of EDI changes’

The NMC has been working to improve EDI within its regulatory functions and the wider nursing and midwifery professions, including through new targets, initiatives and reporting measures.

The PSA also pointed to the NMC’s ongoing reviews into the Code, revalidation and practice learning which have a focus on strengthening EDI requirements for students and registrants.

‘However, we have seen limited evidence of the impact of the changes the NMC has made with respect to EDI in this reporting period,’ the review said.

‘We have also seen limited evidence that the NMC is encouraging registrants to improve their EDI knowledge through the revalidation process, and we continue to have significant concerns about the NMC’s approach to monitoring education providers’ compliance with its standards.’

The review also highlighted how the NMC has failed to ‘consistently’ assess health and character concerns of those on its register – such as those with a criminal record for a serious offence or with an unmanaged health condition – for more than a decade, as admitted by the regulator earlier this week.

Recommendations from the PSA

The PSA has written to the health and social care secretary outlining its concerns and a list of recommendations made to the NMC.

The NMC’s performance during the review period ‘has caused us considerable concern’, it said, adding: ‘We have identified weaknesses in multiple regulatory functions during this period which have led us to conclude that the NMC has not met nine of our 18 Standards this year – two more than in the last review period.’

Among its recommendations, the PSA said the NMC must prioritise its education quality assurance improvement plan to ‘develop and introduce a process that provides effective, robust assurance of the quality of education and training that supports public protection’.

In addition, the NMC was told to focus on risks ‘throughout the life’ of a FtP case and to review its processes to ‘improve its ability to support and keep parties updated’ on cases.

Recommendations in full:

Standard 4: We recommend that the NMC reviews its public Council reporting in order to improve transparency, particularly in the areas of strategic risk management and fitness to practise timeliness.

Standard 9: We recommend that the NMC prioritises its Education Quality Assurance improvement plan to develop and introduce a process that provides effective, robust assurance of the quality of education and training that supports public protection. The current process, including a reliance on uncorroborated self-declarations, carries significant risks and has been shown to be ineffective.

Standard 16: We recommend that the NMC should accurately capture when and why a full safeguarding assessment is carried out in a fitness to practise case, and what the findings and resulting actions are.

Standard 17: We recommend that the NMC keeps risk under review throughout the life of a fitness to practise case.

Standard 18: We recommend that the NMC reviews its processes to improve its ability to support and keep parties updated on fitness to practise cases. This is particularly important given the challenges the NMC has in terms of timeliness and case progression and the stress placed upon all those involved in the process.

The NMC said it was committed to implementing the recommendations in the report and outlined progress made since the reporting period (see box below).

‘The NMC will accelerate our efforts further’

NMC chief executive and registrar Mr Rees said: ‘It’s encouraging that the PSA’s review of the NMC’s performance in 2025 recognises the new leadership’s commitment to change, and the progress we’ve made to start improving operational performance.

‘But the report also reflects the legacy issues uncovered under new management, which add to the scale of the turnaround we’re working to deliver.’

He added: ‘Only once we’ve transformed our culture, regulatory performance and uncovered and fixed all these legacy issues will we be in a position to meet all the PSA’s important Standards of Good Regulation – we’re committed to working closely with the PSA to provide the assurance it needs that change at the NMC is lasting and meaningful.

‘Transformation takes time, and we still have two years of our three-year turnaround plan to go.

‘We’ll now accelerate our efforts further, including carrying out “health checks” across all the NMC’s regulatory areas – followed up by the roll out of a central quality management system – to make sure they’re operating as expected.

‘We’ll also deliver further transformative improvements in all strategic priority areas identified in the report, from EDI to education quality assurance – as we continue building a new NMC that aims to be the strong and independent regulator needed to protect the public, maintain confidence in the nursing and midwifery professions and uphold the standards of the professions.’

Since 1 January 2026, the NMC said it has:

Increased the rolling average of FtP cases being resolved end-to-end within 15 months to around 74% – the highest since late 2020
Set up a new directorate – Transformation and Technology Services – to make sure that all the NMC’s regulatory functions are operating as expected, by carrying out ‘health checks’ to ensure all areas are following the correct processes and policies as well as quality assuring their work
Set out concrete measures to meet its ambitious regulatory fairness targets – aiming to eliminate disparities in the FtP process by 2030, including disproportionate referrals made by employers
Progressed a comprehensive review of the Code, with a focus on stronger behavioural standards on equity, diversity and inclusion (EDI), with the new iteration due to be published in autumn 2027
Co-designed anti-racism principles for midwifery and nursing education and practice, to help tackle the Black maternal health crisis and wider health inequalities suffered by racially minoritised people
Developed a robust improvement plan to deliver a modernised education quality assurance process for nursing and midwifery programmes, which it has now started to roll out – with further details to be announced shortly
Reviewed a further 945 FtP referrals through a safeguarding lens up to the end of March, and of these, discussed 367 within the dedicated Safeguarding Hub – enabling steps to be taken to protect vulnerable people from risk of harm.

Responding to the review, Royal College of Nursing (RCN) chief nursing officer Professor Lynn Woolsey, said: ‘Today’s report from the Professional Standards Authority (PSA) provides a damning indictment of the NMC, finding that it meets just half of the standards expected of a regulator.

‘The official verdict is that performance is getting worse and that is of serious public and professional concern.

‘That it comes just a day after the NMC admitted it failed for 12 years to properly risk assess those with criminal convictions and health concerns shows just how far it has to go to simply deliver on its core functions as a minimum.’