Landmark new NMC anti-racism principles to urgently help tackle bias

The development of the principles was driven by the Black maternal health crisis, which leads to Black, Asian and minority ethnic women and their children being more likely to die, or suffer harm during pregnancy, childbirth or after birth. The document also addresses the bias and discrimination faced by racially minoritised people in nursing and midwifery.

The NMC recognises that racist and inequitable care can occur across both the midwifery and nursing sectors. The regulator’s new principles set out some of the ways educators, organisations, registrants and employers can address the growing concerns around inequities in care and racism across health and social care practice, education, and regulation.

Why this matters

The NMC recognises that racism is embedded in structures, policies, processes, power, and culture, not only in individual behaviour – and that anti-racism is fundamental to patient safety and public protection.

Overall, inequities are directly linked to worse clinical outcomes, including higher mortality, greater disease burden, delays in care, and reduced patient safety. For example:

• Black women are 2.3 times as likely to die from pregnancy-related causes during childbirth or within six months postpartum as White women. Asian women are 1.3 times as likely
• Black babies are more than twice as likely to be stillborn as White babies; Asian babies around one and a half times as likely
• Racist stereotypes – such as the false belief that Black women "don't feel pain" or have a "higher pain threshold," or that sickle cell patients seeking pain relief are "drug-seeking" – continue to shape clinical decisions and cause avoidable harm
• People from racially minoritised groups with learning disabilities face a 190% increased risk of premature death compared to their white counterparts
• A higher prevalence of racially minoritised service users being sectioned under the Mental Health Act.

Racism and other forms of discrimination not only affect people receiving care, but also many midwifery and nursing professionals who provide it.
Spotlight, the NMC’s annual insight report, shows that 40% of nursing and midwifery professionals who responded to a survey said they had experienced discrimination in the previous year, most often on grounds of ethnicity or age.

What the NMC principles cover

The new anti-racism principles are designed to strengthen cultural safety, curiosity and respect in practice and education – and to explicitly advance meaningful, sustained anti-racist, bias aware practice. They are organised around four areas.

1. Culture, equity and inclusion

This pillar establishes anti-racism as fundamental to patient safety and public protection – not an optional add-on or a values exercise. It calls on individuals and organisations to take steps including recognising anti-racism as a legal requirement, and embedding anti-racist practice, bias awareness, cultural safety, curiosity and respect across all areas of education and practice.

2. Learning, education and workforce development

This pillar focuses on what future and current professionals are taught, how they are assessed, and the environments in which they learn. It includes expectations to equip midwifery and nursing educators, practice supervisors, and assessors to deliver inclusive, evidence-based teaching and fair, unbiased assessment including the ability to recognise and respond to intersectional bias.

3. Community and person-centred practice

This pillar puts service users, families and communities at the centre of how care is designed and delivered. It encourages everyone in and around midwifery and nursing education and practice to proactively challenge racist stereotypes – and to be aware of intersectional factors that exacerbate inequitable outcomes, including deprivation, domestic abuse, and being LGBTQ+.

4. Assurance, accountability and sector improvement

This pillar makes anti-racism measurable and reportable – embedding anti-racism within governance, decision-making, and performance frameworks across organisations. It sets the expectation that accountability for equitable, anti-racist practice applies to individuals, providers and AEIs – requiring documentation, and active responses to discrimination, support and reflective learning.

An ongoing commitment

The anti-racism principles are intended to drive real change – ahead of the introduction of an updated NMC Code in 2027, which will expressly set the expectations of all nursing and midwifery professionals to recognise, challenge and disrupt racism.

In the meantime, the principles will help to strengthen anti-racism, bias awareness, cultural safety, curiosity and respect, and equitable care in midwifery and nursing education and practice.

They will be judged by whether the actions taken improve safety, belonging, fairness, equity, accountability, and trust for service users, students, and the midwifery and nursing workforce.

The principles in full have been published in a dedicated hub on the NMC website.

Paul Rees MBE, Chief Executive and Registrar, said:

“Tackling racism is vital for us, as we build the new NMC.

“We know that Black, Asian and ethnic minority patients can experience poorer health outcomes than others, sometimes driven by negative racist stereotypes such as: ‘Black women don’t feel pain.’

“We know that Black, Asian and ethnic minority registrants are on the receiving end of bias in their work – referred disproportionately into fitness to practise, and increasingly facing 1970s and 1980s style racism from patients on the frontline.

“We know that the NMC has, in the past, been found to have its own problems with bias – with this being highlighted in the Independent Culture Review, in July 2024, which talked about bullying, harassment and racism.

“As a result of all of these factors, it’s incumbent upon us to confront the racist stereotypes and everyday biases that can lead to unfair treatment at every turn.

“Our new anti-racism principles are a progressive step towards tackling health inequalities – helping to ensure all nursing and midwifery students learn about anti-racism, bias awareness, and cultural curiosity, safety and respect.

“From the autumn of 2027, we’ll go even further with a revised Code that will enshrine anti-racist, culturally safe practice through strengthened behavioural standards.”

Dr Nandi Simpson, Director, Implementation, NHS Race and Health Observatory, said:

“We welcome the principles to support anti-racism in midwifery and nursing education and practice published by the NMC today.

“Poor and unequal outcomes for people from Black, Asian and ethnic minority backgrounds continue to reinforce the role of racism as a determinant of health.

“We look forward to seeing how these principles, which reflect the nine shared anti-racism principles of the UK national regulators, are implemented through standards in the updated Code; we commend the NMC for their leadership and look forward to working with them to help move from statements of intent to action and accountability.”

Ed Hughes, CEO of the Council of Deans of Health said:

“The Council of Deans of Health welcomes the new principles to support anti-racism for midwifery and nursing education and practice published by the NMC.

“Our member universities and colleges have a shared commitment to inclusion, belonging and equitable student outcomes and will already be taking forward much of what the principles set out through curriculum development, inclusive learning environments and in work to address attainment gaps.

“However, we know there are areas where this must improve and the principles and tools which accompany them provide useful guidance and clarity for their work with scope to improve further.

“Racism continues to present challenges for students, staff and patients – we agree that combatting this should be a core practice, taken forward through a whole system approach. We are glad to see this reflected in the principles. We would encourage close cooperation with other professional and higher education regulators to maximise the impact of this work and ensure effective join-up across the health education system.

“The Council of Deans of Health will work with our members to support the implementation out of these principles as we take a further step forward in combatting racism in healthcare education.”

Angela Velinor, Deputy Regional Chief Midwife – South East, who acted as a critical reader during the design of the principles, said:

“It has been a privilege to contribute to the development of the principles to support anti-racism in midwifery and nursing education and practice.

“These principles represent an important step forward in strengthening our collective commitment to tackling inequalities in care and racism, and improving outcomes and experiences for women, babies, families and our workforce.

“They set a clear expectation for cultures of equity, inclusion and accountability across education and practice. We all have an active role to play in embedding these principles into everyday practice and driving real, meaningful and sustained change together.”

Jonah Atos, International Nurse Coordinator Northern Ireland and an internationally educated registered nurse, who acted as a critical reader during the design of the principles, said:

“Drawing from my experience as an Internationally Educated Nurse, educator, and leader supporting workforce integration, I have seen first-hand how inequities in recognition, progression, and support impact both staff wellbeing and patient care.

“Cultural safety and anti-racism must be embedded not only in values, but in systems, structures, and opportunities. The launch of the NMC’s anti-racism principles for midwifery and nursing education and practice is an important step towards recognising the value, skills, and experiences that Internationally Educated Nurses and Midwives bring to the workforce.”

Jodie Deards, Health Equity Leader and a registered nurse, who acted as a critical reader during the design of the principles, said:

“These principles are needed because everyone deserves to feel safe, heard, respected and treated fairly when receiving care, learning, or working in health services. They are about helping to ensure that no one experiences harm or disadvantage because of racism, bias or discrimination.”

Further background

The NMC’s new anti-racism principles apply across all sectors where midwifery, nursing and in England only, nursing associate practitioners learn and work, including education institutions, independent and private providers, social care, and the agency workforce as well as the NHS. The expectations, accountability and support are consistent for all registrants regardless of setting.

The regulator has set out a timeline for adoption of the principles across midwifery and nursing education and practice.

• By end of September 2026 – Healthcare providers will be encouraged to complete a gap analysis as an initial self-assessment benchmark, with a repeat assessment in 2027 in order to evidence progress
• From the start of the 2026/27 academic year – Universities will be urged to use the gap analysis to start aligning course content with the principles, reporting progress through annual self-reporting cycles in 2027.
• October 2027 – Publication of the revised Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates, with mandated behaviours to ensure anti-racist, bias-aware, culturally safe practice.

Other recent news…