Super-regulator finds ‘weaknesses’ across NMC’s regulatory functions

The Nursing and Midwifery Council (NMC) has failed to meet a wave of organisational standards across areas including safeguarding, fitness to practise (FtP) and whistleblowing, the super-regulator has found.

The NMC met only 11 out of 18 of the standards assessed in the Professional Standards Authority’s (PSA) 2023/24 performance review, marking only the second time that a regulator has missed this many standards in a single year.

The first time was by the Pharmaceutical Society of Northern Ireland in 2023/24.

‘We have identified weaknesses in multiple regulatory functions during 2023/24 which have led us to conclude that the NMC has not met 7 of our 18 Standards this year,’ the report states.

The review was completed between 1 July to 31 December 2024, it was due to be published last year but was delayed to include the findings of three independent culture reviews into the regulator.

Two of the reviews remain to be published, but the first revealed a widespread and ‘toxic’ culture of bullying, harassment and racism at the NMC.

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The key findings 

Despite the NMC investing £30m into FtP in the last year, the PSA found that cases are still taking too long to process and a significant backlog remains.

The NMC therefore failed to meet the standard on FtP and has not met this since 2018/19. 

The PSA also identified ‘significant concerns’ about the NMC’s ability to monitor and quality assure Approved Education Institutions (AEIs).

An education quality assurance plan is in process, but the NMC had not finalised this by the end of the review period, it said.

Separately, the PSA was not ‘sufficiently assured’ by the NMC’s ability to ensure the integrity of the register and raised ‘significant concerns’ about safeguarding at the regulator.

‘The NMC has taken steps to strengthen its safeguarding capabilities, however safeguarding remains the NMC’s highest-rated strategic risk,’ the PSA found.

The NMC also failed to meet the standard on equality, diversity and inclusion (EDI) which the PSA said was not ‘effectively embedded’ into its work.

Last July, the Nazif Afzal and Rise Associates review into the NMC found ‘some really worrying examples of safeguarding failures’ at the regulator, including concerns about criminal behaviour by registrants which was excused because it took place outside of working hours or was seen as a private matter.

Ron Barclay-Smith, NMC chair of council, said 2023-24 was a ‘particularly difficult year’ for the NMC but assured that the organisation had started to introduce change ‘at pace’.

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‘As chair of Council, I am determined to guide, challenge and support the NMC executive so that the organisation is fit for purpose, and can promote the safe and effective nursing and midwifery care everyone has the right to expect,’ he explained.

The PSA has since written to the secretary of state of health and social care, Wes Streeting, and the vice chair of the House of Commons Health and Social Care Committee, Paulette Hamilton, to make them aware of the concerns raised in the review.

‘Radical changes’ at the NMC 

Interim chief executive and registrar, Paul Rees, said the PSA report ‘reflects a dark period’ at the NMC which had ‘expected to fall short’ on some of the regulation standards set by the PSA.

‘Radical change is underway and we have made significant strides through the delivery of our Culture Transformation and Fitness to Practise plans.

‘In the coming days we will publish ambitious EDI targets, to ensure we achieve equity for our colleagues and everyone involved in our processes,’ he added.

The NMC has introduced a series of changes as part of its culture transformation plan, including signing up to the UNISON Anti-Racism Charter, working to reduce the ethnicity pay gap and establishing a new safeguarding hub.

In March, the NMC launched a three-year programme to build a ‘positive, empowering and inclusive culture’ for staff and registrants. 

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By Autumn 2027, the NMC hopes to have updated its Code and revalidation process, following a review of practice learning that should be completed by Autumn 2026.

Earlier this week NMC annual registration data revealed that the number of professionals on the register had reached a record high, but a ‘significant slowdown’ in international recruitment meant the rate of growth had decelerated.

The leavers survey, which accompanies the annual registration data, revealed that over one in 10 professionals who left the NMC register during the last year said their physical or mental health was the main factor.