As a regulator, it’s our responsibility to tackle inequality and promote diversity and inclusion in everything we do. That starts with scrutinising our own processes to make sure they are fair and accessible. It also means holding people to account and working with our partners to tackle inequalities that cut across the health and social care sector.

Ambitious for change

In 2019, we launched Ambitious for change – a programme of research aimed at assessing the impact our regulatory processes have on different groups of nurses, midwives and nursing associates. We looked at people’s experiences of education, overseas registration, revalidation, and fitness to practise.

Phase one

The first phase involved analysis of our data alongside the data of other organisations and wider research, to explore the impact of our regulatory processes on professionals with different diversity characteristics. We looked at people’s outcomes in our processes between April 2016 and March 2019. The findings told us that people sometimes have different outcomes based on who they are.

Read the findings from Ambitious for change

Read a summary of Ambitious for change (Cymraeg)

Watch our Ambitious for change webinar

Phase two

The second phase delved deeper to understand why these differences exist, specifically in the areas of revalidation and fitness to practise. We spoke to professionals and employers to understand the impact of these differences, and we did further analysis of the referrals we received from employers.

Read the findings from Ambitious for change Phase two

Read the Executive Summary (Cymraeg)

The findings from this research highlight opportunities for us to improve our regulatory activities, to ensure our processes are fair for everyone. They also highlight where inequalities which cut across the health and social care sector and exist in wider society are contributing to the disparities we're seeing.

Addressing the findings

Below we’ve outlined some of the key steps we’re taking to address these disparities. These will be taken forward as part of our EDI plan.

We’re focusing on making changes in areas where our evidence is clear about disparities, including targeted work with specific employers and education institutions, as well as understanding and growing our data and evidence.


  • The data shows that men, students of mixed ethnicity and disabled people had higher drop-out rates from NMC-approved nursing and midwifery courses. Meanwhile, Black and Asian applicants had lower acceptance rates.
  • To help to address this, we’ll strengthen our support to Approved Education Institutions (AEIs) to embed EDI in their curriculum practices. We’ll also implement a data-driven approach to Quality Assurance, including analysing student data by protected characteristics – this will help us to challenge AEIs on student outcomes. Through Regulatory Reform, we’ll secure additional powers to act where we identify concerns.

Overseas Registration

  • We know that between April 2016 and March 2019, applicants who are Black, disabled, bisexual, or aged over 41 had a lower chance of registering.
  • However, in October 2019, we overhauled our process, improving the way that we handle applications. Therefore, our priority is to analyse the data of applicants since we made those changes to identify if the same groups are affected so that we can use the findings to decide further action.


  • Our data indicates that professionals who are disabled, men, aged over 60, White and those living outside the UK/EU/EEA have lower chances of revalidating successfully.
  • We know that disabled professionals have worse outcomes in many of our processes, including revalidation. Although we heard from disabled professionals in the second phase of our research, we didn’t hear about the specific challenges they face in our processes. To help us understand the reasons for these differences our priority is to carry out targeted research with disabled professionals and ensure learning from it feeds into our next review of revalidation.

Fitness to practise – referrals

  • When it comes to fitness to practise, our priority is to address the disparities we see in referrals by working with employers
  • In February 2021, we introduced Managing Concerns, a resource to support employers to effectively manage concerns, including considering bias or discrimination before they make a referral. And we’ve begun targeted work to support internationally educated professionals into UK practice.
  • We plan to refresh the data we have on employer referrals to equip our teams to have targeted discussions with employers to ensure there is no bias or unfairness in their decision making. This will help us to identify barriers and challenges, as well as best practice to share.

Fitness to practise – progression and adjudication of cases

  • Our findings show that professionals who are men, Black, disabled, or whose sexual orientation we don’t know, are more likely to progress through the stages of the fitness to practise process. Meanwhile disabled professionals and men are more likely to have an adjudication decision preventing them from practising.
  • Our fitness to practise improvement programme is our corporate priority. We’re considering equality, diversity and inclusion in changes we make and we’re also commissioning an independent review of our cases to see whether bias is playing any role in the disparities in our fitness to practise decision-making process. We’ll use the findings to determine further action. And we’ll complete a stocktake of our training and guidance for decision makers.

Through these actions we aim to make our processes kinder and more equal. However, systemic problems need system-wide solutions so where disparities are driven by wider unfairness and inequality, we’ll work with partners across health and social care, sharing insight and intelligence.

In doing so, we hope we can collectively create an environment where every nurse, midwife and nursing associate is respected and valued, and supported to deliver safe, kind and effective care to the public.