Exclusive: The new NMC chief on his quest to save the regulator

Critics say trust in the NMC has been shattered, but the new interim chief executive and registrar, Paul Rees, has vowed to turn things around.

“It’s clear that we mean business”

Paul Rees

In his first interview since taking the helm, he spoke with Nursing Times about his vision for restoring faith in the UK nursing regulator.

In 2023, a series of articles published in The Independent claimed there was a “culture of fear” at the NMC.

A subsequent independent review, led by former chief crown prosecutor Nazir Afzal and Rise Associates, confirmed a “hotbed of bullying, racism and toxic behaviour” within the regulator, which was putting the public at risk and endangering registrants.

The fallout of the last two years has been seismic.

Protests have been held outside the NMC’s headquarters, calls for resignations have echoed across social media and multiple executive board members have stepped down.

Can the NMC recover from such turmoil? Mr Rees believes it can and must.

With an “army of people” ready to drive change, he has pledged to lead the NMC into a new era of accountability and integrity through his new culture transformation plan.

Mr Rees has been in post since January and is undertaking a 12-month stint at the NMC while it searches for a permanent post-holder.

He was previously chief executive of the National Pharmacy Association. Before that, he led the Royal College of Psychiatrists and was an executive director of the Royal College of General Practitioners.

In 2022, Mr Rees was awarded a Member of the Order of the British Empire medal for services to mental health and to equality, diversity and inclusion (EDI).

Mr Rees said he felt able to take on the role at the NMC because of his 12 years’ experience working across healthcare organisations, and as a result he was “always up for a challenge”.

“I was really attracted by the idea of helping to make the NMC a better regulator, because it’s really important that nursing and midwifery professionals have the best independent regulator possible,” he said.

Asked if 12 months was enough time to enact meaningful change, Mr Rees noted that he had undertaken culture transformation work at previous organisations over a similar period.

He said: “I think it will take three years to completely turn around the NMC but, I think, after one year, a clear shift can have been achieved.”

Last month, Mr Rees unveiled a three-year culture transformation plan that promised to bring about “root-and-branch” change in the organisation and create a culture that is “positive, empowering and inclusive” for all its staff.

The plan follows a series of listening events Mr Rees held across all NMC sites shortly after his arrival. More than 700 members of staff shared their experiences of working at the regulator, as well as ideas for transforming its internal culture.

“I think the portrayal in the independent culture review was pretty much mirrored by what I heard at those town halls,” Mr Rees explained.

Some said they “loved working at the NMC”, while others said that they had experienced racism and bullying.

Concerns about the regulator being too “bureaucratic, hierarchical and silo based” were also raised.

Mr Rees said the regulator would use the feedback, and the learning from the culture review, to create a culture “where everyone can enjoy working at the NMC, regardless of their background or characteristics”.

His transformation plan is based on six pillars, the first of which pledges to install “strong and effective leadership”.

Mr Rees said the independent review was clear that there was “a problem with leadership at the NMC”.

The NMC has promised to introduce a “culture of coaching” to the organisation, where five experts will regularly coach managers to lead transformational change.

Mr Rees said: “Managers will be equipped to lead in an effective, progressive way and they will be held to account for leading in that way.

“By doing that, we’ll create the right framework for the NMC to be transformed.”

The culture review warned of a hierarchical structure at the regulator, where some members of staff “enjoy a god-like status” and can never be challenged.

It also identified instances in which Black and minority ethnic staff had resigned as a result of bullying and discrimination.

Asked whether those perpetuating the toxic culture had been identified and how they would be dealt with, Mr Rees said it was important for people to be held to account, but added: “Everyone has to be given the opportunity to change and transform the way they do things.”

He explained that, during his tenure at the Royal College of Psychiatrists, the organisation “exited a number of people for bullying and harassing others”, and said he would do the same at the NMC if needed.

Nursing Times raised concerns from critics that individuals with this “god-like status” remained at the NMC, while those advocating for change had resigned. Mr Rees disagreed, noting that the NMC was “leading from the front” by appointing experts in leading culture transformation, including himself.

Nursing Times reported last month that the NMC had been hit with a wave of resignations from its executive board.

Five members left between mid-2024 and January 2025, while two interim directors also stepped down recently.

When pressed on the resignations and how they could inhibit progress, Mr Rees admitted that the staff turnover was “really high” but argued that it was “to be expected in a situation of turbulence”.

“Repairing the immense harm already caused is just as important as preventing it in the future”

Neomi Bennett

The NMC is now looking to fill multiple executive board roles with substantive post-holders. Mr Rees said doing so would allow the organisation “to build a new senior leadership team” of people who would know they would be “held to account for [transforming the culture] from the moment they are recruited”.

He added: “I think it presents an opportunity for the organisation to have a new team that is unified, that works together in line with what we’ve set out in the culture transformation plan and really leads from the front in a values-based way.”

As part of the culture transformation plan, a steering group will lead the work “on a day-to-day basis”.

Co-chaired by Mr Rees and the NMC’s interim director of people and culture, the group will include registrants and representatives from different NMC directorates and staff networks, as well as a union representative.

Mr Rees said: “It’s really important that [the steering group] involves people from across the organisation, at different levels, different tiers and, of course, from different sites.

“We feel that we’ve got an army of people who are going to be helping us drive this forward.”

Meanwhile, EDI is central to the culture transformation plan. The NMC said that, through this pillar, it would become a “genuinely inclusive workplace”.

It said it would implement “anti-racism initiatives”, while all managers and staff will complete EDI training.

Mr Rees said: “I think that it’s really important that an organisation doesn’t just say it’s anti-racist.

“It actually has to carry out measures, or enact measures, that put forward an anti-racist agenda.”

The regulator has further committed to cultivating a culture in which “every team member feels safe to voice their opinions and concerns respectfully”, without fear of repercussions.

This comes after the independent culture review found that the NMC had a “wilful deafness to criticism” and a culture “not open to feedback and opportunities to improve when things go wrong”.

Mr Rees said the NMC was “going to encourage people to speak up through a number of means”, including existing NMC employee networks and the in-house union.

“That creates clear pathways for people who are more junior in the structure to raise ideas with senior leadership, and those pathways weren’t there before,” he said.

The culture transformation plan has also pledged to ensure regulatory practices are “timely, fair and effective”.

As part of this, it said fitness-to-practise processes must be “person-centred and humane”, and as “proportionate” as possible.

Mr Rees said the NMC had been “working really hard to turn fitness to practise around”, noting that it had recently reported its first month-on-month improvement in its fitness-to-practise backlog since 2023.

“Obviously there’s a long road ahead, there’s a lot of work to do, but there are encouraging signs already,” he added.

While the culture transformation plan signals a willingness to change, it will take time to rebuild trust in the NMC.

Mr Rees noted that the plan had received a positive reception from the national chief nursing and midwifery officers, as well as the UK governments.

However, there are many other individuals and organisations who also need to be convinced.

Equality 4 Black Nurses, a peer-led support network for Black nurses who have faced discrimination at work, organised protests outside the NMC headquarters when the culture review was first published.

Responding to the culture plan, founder Neomi Bennett told Nursing Times that “the problems within the NMC run far too deep for incremental reforms to be sufficient”.

She added: “It is our belief that the NMC, in its current form, is unsalvageable.

“The policies and processes designed to protect the public have, instead, produced a punitive environment that disproportionately targets Black nurses, undermining professional growth and wellbeing.”

(From right) Cathryn Watters and Neomi Bennett protesting outside the NMC

It was her view that the entire organisation needed to be dissolved and replaced by a body designed “from the ground up” to be fair, transparent and equitable.

Ms Bennett said: “Repairing the immense harm already caused is just as important as preventing it in the future.

“Our ultimate hope is that nursing and midwifery professionals can serve the public under a regulator that embodies integrity, fairness and the values all nurses strive to uphold in their practice.”

Mr Rees responded to calls for dissolution by acknowledging that it was “fair for people to have concerns about the NMC”.

“As an organisation, we have to be open to that criticism and those challenges,” he added.

Mr Rees also admitted he would only expect people to be convinced once the NMC’s leaders “can demonstrate that we’ve turned the organisation around”.

“We are now starting to turn the supertanker. Obviously that takes some time, but we are now starting to turn it in the right direction,” he said.

Meanwhile, NMCWatch, an organisation that provides support to registrants going through the NMC’s fitness-to-practise process, has also been a vocal critic of the regulator’s performance.

Cathryn Watters, its founder, told Nursing Times about her scepticism surrounding the culture transformation plan, questioning its ability to deliver meaningful change.

“If the same senior leaders remain in place who were intrinsic to poor culture, nothing will change”

Cathryn Watters

While she said the plan was “encouraging,” Ms Watters criticised the lack of external oversight, asking: “If the NMC is responsible for effectively marking its own homework, how can the public and registrants alike be confident anything will change this time?”

She said she also wanted to see clear objectives, timelines and consequences for missed deadlines attached to the plan, and for the government to ensure accountability.

In addition, Ms Watters called on the NMC to “accept that the way they have dealt with things up until now has been substandard”.

“If the same senior leaders remain in place who were intrinsic to poor culture, nothing will change,” she said.

Research fellow Roger Kline, who has authored high-profile reports on race equality and culture issues in the NHS, has previously called out the NMC on its failings.

He was among those to raise concerns about the appointment of Dawn Brodrick, Mr Rees’ predecessor.

Ms Brodrick resigned before taking up the interim post after it transpired that she was linked to a high-profile NHS race discrimination case.

To regain trust, Mr Kline told Nursing Times that the NMC must take steps to show it had learned from past failures.

He said: “There has to be early and significant change, starting with evidence of accountability and learning by those responsible for the mess highlighted by the [independent culture] report.

“To most people, in and out, there is no evidence of that yet.”

Mr Rees expressed hope that, over time, nursing and midwifery professionals “will see that the NMC is changing”.

He stressed that the regulator’s commitment to cultural transformation was an “absolute top priority”.

He added: “The fact that we’ve got this concrete plan, that hasn’t been there before, shows you how serious we are. It’s clear that we mean business.”