Independent culture review

Reflection, accountability and action

Why we commissioned a review

An independent review of the NMC's culture has highlighted safeguarding concerns, and found that people working in the organisation have experienced racism, discrimination and bullying. We take this extremely seriously and will deliver a culture change programme rooted in the review’s recommendations. We apologise and promise action.

The NMC commissioned Nazir Afzal OBE and Rise Associates to carry out the review after concerns were raised about the organisation’s culture, including racism and fear of speaking up. Over 1,000 current and former NMC colleagues, plus more than 200 panel members who sit on fitness to practise hearings, shared their lived experiences as part of the review. The NMC accepts the report’s recommendations.

What the review found

Safeguarding people involved in our processes

Our casework brings us into contact with members of the public, employers and professionals on our register, and we have a responsibility to recognise if anyone has any vulnerabilities that we need to consider.

As highlighted in the report, since April 2023, six people have died by suicide or suspected suicide while under, or having concluded, fitness to practise investigation. We offer our sincere condolences to their relatives.

We are expanding resources for our safeguarding team. We are increasing knowledge and training, alongside strengthening our operating procedures. This builds on work to better understand how we can improve our processes to reduce the impact and risk of harm to people.

Culture and regulation are intertwined

The independent report is clear about the link between regulatory performance and our culture. One affects the other and this has created a pressurised environment for our people, which has contributed to poor behaviours and concerning case outcomes in some areas. It has seriously undermined our collective efforts to reach quick, fair and safe decisions across all our casework.

We offer our sincere apologies to anyone involved in a case who has waited too long for a decision, or who hasn’t been treated at all times with fairness and kindness – whether they are professionals on the register, employers or members of the public.

An organisation of multiple cultures

The review has held a mirror up to life at the NMC. At one point, it observes that two people passing each other in a corridor can have very different experiences of working here – some have had experiences of racism, discrimination and bullying, which come across vividly in this report. We apologise sincerely for what those colleagues have been through.

Senior leaders commit to doing better

Among the report’s findings is a failure of senior leadership to rise to the challenges facing the NMC. Culture is shaped by what leaders tolerate. It’s clear some people have behaved in completely unacceptable ways that should have been called out and tackled much sooner. We accept this has contributed to colleagues feeling uncomfortable or even unsafe to speak up, or unconfident that appropriate action will be taken if they do.

Our next steps

Change starts now with our full acceptance of the recommendations that Nazir Afzal and his team have identified. This acceptance marks a turning point for the NMC.

In addition to safeguarding, we've already started to address some of the other regulatory issues identified in the report, including:

  • in March 2024 our Council agreed a £30m investment in an 18-month plan to make a step change in fitness to practise, with a clear goal to reach decisions in a more timely and considerate way – we will ensure this takes account Nazir’s findings going forwards.
  • in February 2024 we strengthened the guidance we use to make decisions on concerns about sexual misconduct and other forms of abuse outside professional practice – making it absolutely clear that whether they occur within or outside a work setting, we take these concerns extremely seriously.
There are further immediate actions we are taking to address the findings
  • We will appoint an equality, diversity and inclusion (EDI) advisor to the Executive Board to support decision making.
  • We will work to increase the diversity of the Executive Board.
  • The Freedom to Speak Up Guardian is now available to colleagues to raise concerns and get independent support from a trained professional.
  • Listening circles facilitated by trained professionals are now available for all colleagues to enable them to openly discuss and decompress about issues raised in the report.
  • We’ve invested in a partner to improve psychological safety in teams, starting in our Professional Regulation directorate which includes fitness to practise, and registration and revalidation.
  • We are extending the offer of decompression support to any colleagues working on sensitive casework. This involves professional counselling from a trained psychologist.
  • We are doubling the amount we spend on learning and development. By October, this investment should enable us to start rolling out improvements in leadership and line management, safeguarding, casework and tackling some of the behaviours in the report such as microaggressions.
  • An external equality, diversity and inclusion (EDI) partner is undertaking a review of our EDI learning and making further recommendations to improve our mandatory training.
  • We are actively working on a new behavioural framework to support recruitment, development, career progression and performance management, for launch in September.

We will work with our people and seek input from our partners to deliver a meaningful, sustainable programme of change. Throughout this period of change, we will remain focused on our core regulatory work, the Code and our Standards, and our education activities.


NMC Independent Culture Review front cover.pngRead the full report

Statement from the Council

Executive team response

Letter from Nazir Afzal to Sir David Warren

Letter from Sir David Warren to Nazir Afzal


This report has been published on 9 July 2024. We updated the document to improve accessibility on 11 July 2024. We will produce a Welsh language version of this report, as well as Easy Read versions of the report in English and Welsh, as soon as possible.


We have a Careline available if you’d like to speak to someone

If you are under investigation through the fitness to practise process and have been impacted by the details in this report, the Fitness to Practise Careline is available on 0800 587 7396 to provide support.

The service is free, independent, confidential and non-judgemental.

This service is available 24 hours a day, 365 days a year.

We have an independent support line for those who have raised concerns with us

If you've raised concerns with us, you can access independent support provided by Victim Support.

This service is available 24 hours a day, 365 days a year.

Phone: 0300 303 3731