Nurse campaign groups have called for the Nursing and Midwifery Council (NMC) to take reforms seriously, warning against “performative change”, following a damning review by the super-regulator.
The Professional Standards Authority (PSA) today published its latest annual review of the nursing regulator, which uncovered “serious issues” in the performance of the NMC between 2023 and 2024.
The PSA found that the NMC had only met 11 of the 18 regulatory standards, warning that this was only the second time that a regulator had failed this many standards in a single year.
Among the failures identified in the report were:
“Serious issues” across a number of the NMC’s regulatory functions during the period;
The regulator not being clear about its purpose;
Limited evidence of work undertaken to embed equality, diversity and inclusion (EDI) at the organisation;
Significant concerns about the NMC’s processes for assuring the quality of nurse education and training;
A rise in the number of incorrect fraudulent or incorrect entries to the register;
Fitness to practise (FtP) timeliness remaining “concerning” and cases taking too long to process;
Not prioritising FtP cases in which patients were most at risk;
Safeguarding still being one of the greatest risks at the organisation.
The PSA report has been published late because it was awaiting the outcomes of a number of external reviews, including an independent culture review that found a “hotbed of bullying, racism and toxic behaviour” within the regulator.
Two outstanding independent reviews into the NMC’s handling of whistleblowing concerns and of certain FtP cases highlighted as part of the whistleblowing disclosures, being led by Ijeoma Omambala KC, are still yet to be published.
Responding to the report, the NMC’s interim chief executive and registrar, Paul Rees, said it reflected “a dark period in the NMC’s history” but that the organisation had started to deliver “radical change which is turning the NMC around”.
The retrospective report covered the period from 1 July 2023 to 31 December 2024.
Since then, the NMC has made significant strides to overhaul the organisation, including reshuffling its executive board and pledging to bring “root-and-branch change” to the regulator through a culture transformation plan.
The NMC has also started to see progress in improving the time in which FtP cases are dealt with, through a revised FtP plan backed by a £30m cash injection.
However, campaigning groups representing nurses who have been impacted by NMC failures want to see further changes and have warned against any actions that may be deemed “performative”.
Cathryn Watters
Cathryn Watters, founder of NMC Watch, which provides support to registrants going through the FtP process, told Nursing Times that there was now “robust evidence” of everything its members “have been saying for a number of years”.
She said: “To have a regulator that is failing so catastrophically is deeply concerning and shows that it is absolutely not fit for purpose anymore.”
Ms Watters welcomed the arrival of Mr Rees, as well as Ron Barclay-Smith, NMC Council chair, and Donna O’Boyle, acting director of professional practice, but feared the culture was “too deeply set and beyond remediation”.
As such, she called for ministerial intervention and suggested that the organisation should be “disbanded and rebuilt”.
The PSA today wrote to the secretary of state for health and social care, Wes Streeting, and the chair of the Health and Social Care Committee, Layla Moran, to make them aware of the concerns in the report.
In the letters, the super-regulator asked to meet with government officials “to discuss the NMC’s performance and how it can be supported to improve”.
A Department of Health and Social Care spokesperson said: “Patient safety is our top priority and we expect the NMC to fully address the PSA’s concerns to protect patients and staff.
“We will continue to work closely with both organisations as the NMC implements its action plan of reforms.”
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 independent culture review was first published.
Its founder, Neomi Bennett, told Nursing Times that the PSA review was “not a revelation” to the group, but rather “confirmation” of what its members had experienced over many years.
She said: “For far too long, Black nurses have spoken of fear, mistrust and injustice at the hands of the very regulator meant to protect them.”
Neomi Bennett
Like Ms Watters, Ms Bennett warned that the regulator must not implement “performative change” but must instead press ahead with repairing the damage it had caused to registrants.
She called for a full review of racially-motivated FtP referrals, after the PSA found that the NMC “does not currently collect EDI data on those raising FtP concerns”.
Ms Bennett also called for “public accountability for historic injustices” and redress for all registrants whose careers had been “destroyed” by NMC processes.
Meanwhile, 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.
Roger Kline
Ms Brodrick resigned before taking up the interim post after it transpired that she was linked to a high-profile NHS race discrimination case.
Mr Kline told Nursing Times that one year after the independent culture review, he had been “repeatedly told” by staff at the regulator that “a culture of denial and a focus on performative action is common, especially on racism”.
“My impression is there is continuing avoidance, denial and performative actions on culture which I suspect the long-delayed Ijeoma Omambala KC inquiries will confirm,” he added.
Responding to the critics, Mr Rees told Nursing Times that the PSA report was a “retrospective review” covering “a dark period in the NMC’s history”.
He said: “Since the turn of the year we have started to deliver radical change which is turning the NMC around, making it a better place to work and a more effective regulator.”
Mr Rees noted the NMC’s new leadership, with himself as the interim chief executive and registrar and a new chair of council.
He added that the FtP plan was “delivering record numbers of decisions at screening” and there were an increasing number of cases being resolved within the NMC’s 15-month target.
The rolling monthly average timeliness figured had improved from 60.8% in July 2023 to 69.8% today.
Paul Rees
“We have also established a safeguarding hub, which is triaging all new referrals to spot cases where there are safeguarding risks and provide wellbeing support to registrants where needed,” Mr Rees explained.
He added: “We are well underway with the roll out of our comprehensive, three-year culture transformation plan.
“As part of this, we have signed the Unison anti-racism charter, relaunched our flagship staff mentoring programme, and started to deliver coaching to all managers. We have also consulted with staff on new NMC values.”
Mr Rees said next steps would be setting equality, diversity and inclusion targets “to eliminate bias from our regulatory processes, informed by NMC-commissioned research”.
He also said the organisation would be taking “radical steps to reduce our ethnicity pay gap”.
