New NMC accelerates change and improvement, five months on from 2024/25 PSA review

The NMC welcomes the recognition from the PSA – its oversight body – of the new leadership’s intentions and commitment to change and improvement.

The PSA acknowledges that 2025 was a very challenging year for the NMC, as it continued to address the significant concerns identified in the Independent Culture Review (ICR), published in July 2024.

The PSA made recommendations in areas where the NMC has made progress over the past year – but still has work to do to assure the PSA of sustained improvement, meaning that the NMC met only nine of the PSA’s 18 Standards of Good Regulation for 2025. The NMC is committed to implementing the recommendations in the report.

During the reporting period, the regulator transitioned to new leadership – Ron Barclay-Smith took up his role as Chair in April 2025, and Paul Rees MBE became the substantive Chief Executive and Registrar (CER) in July, having previously been the interim CER. A virtually new executive team was also appointed during 2025.

The new leadership last year rolled out a three-year transformation plan, designed to ensure that improvements in the regulator’s culture and operational performance progress at pace. This sits alongside the Fitness to Practise (FtP) Plan, which is steadily working towards a faster, fairer process.

As part of the transformation plan, the NMC launched a new set of values – Integrity, Fairness, Respect, Equity and Effectiveness – as well as a new set of behaviours.

Under the new value of Integrity, and the speak up culture being embedded at the NMC, a staff member came forward to raise concerns about an historical failure of the regulator’s registration process.

The regulator uncovered that the organisation had failed to fully assess all health and character declarations made by nursing and midwifery professionals, in their registration and revalidation applications, during a 12-year period. This was an unacceptable failing – one that the new NMC leadership has tackled head on and at pace.
This legacy issue has held back the NMC’s reported progress during the 2024/25 reporting period.

Progress since the reporting period

Since 1 January 2026 the NMC has:

• Increased the rolling average of FtP cases being resolved end-to-end within 15 months to around 74% – the highest since late 2020
• Set up a new directorate – Transformation and Technology Services – to make sure that all the NMC’s regulatory functions are operating as expected, by carrying out ‘health checks’ to ensure all areas are following the correct processes and policies as well as quality assuring their work
• Set out concrete measures to meet its ambitious regulatory fairness targets – aiming to eliminate disparities in the FtP process by 2030, including disproportionate referrals made by employers
• Progressed a comprehensive review of the Code, with a focus on stronger behavioural standards on equity, diversity and inclusion (EDI), with the new iteration due to be published in autumn 2027
• Co-designed anti-racism principles for midwifery and nursing education and practice, to help tackle the Black maternal health crisis and wider health inequalities suffered by racially minoritised people, due to be published on 29 May
• Developed a robust improvement plan to deliver a modernised education quality assurance process for nursing and midwifery programmes, which it has now started to roll out – with further details to be announced shortly
• Reviewed a further 945 FtP referrals through a safeguarding lens up to the end of March, and of these, discussed 367 within the dedicated Safeguarding Hub – enabling steps to be taken to protect vulnerable people from risk of harm.

Standards met

While setting out areas where there is still work to do, the PSA highlighted others where the NMC has performed well – including:

• Maintaining up-to-date standards for education and training, and for registrants, which are kept under review and prioritise patient and service user centred care and safety
• Providing guidance to help registrants apply the standards and ensuring that this guidance is up to date, addresses emerging areas of risk, and prioritises patient and service user-centred care and safety – as part of this, the NMC’s work in partnership with the General Medical Council (GMC), to showcase the value of good teamworking in maternity care, was highlighted as good practice
• Enabling anyone to raise a concern about a registrant, and having proportionate requirements to satisfy itself that registrants continue to be fit to practise
• Identifying and prioritising all cases which suggest a serious risk to the safety of patients or service users and seeking interim orders where appropriate.

The PSA also recognised positive feedback about the nature and extent of the NMC’s engagement with stakeholders – with one saying that the regulator’s engagement with its partners in the health and care system remains a strength.

Paul Rees MBE, Chief Executive and Registrar, said:

“It’s encouraging that the PSA’s review of the NMC’s performance in 2025 recognises the new leadership’s commitment to change, and the progress we’ve made to start improving operational performance.

“But the report also reflects the legacy issues uncovered under new management, which add to the scale of the turnaround we’re working to deliver.

“Those historical issues have held back our progress against the PSA’s Standards of Good Regulation.

“It’s because of our transformation agenda that the historical registration issue around health and character declarations was discovered. We’ll continue to leave no stone unturned as we work to fix this and other legacy issues – we’re determined to turn this organisation around once and for all.

“Only once we’ve transformed our culture, regulatory performance and uncovered and fixed all these legacy issues will we be in a position to meet all the PSA’s important Standards of Good Regulation – we’re committed to working closely with the PSA to provide the assurance it needs that change at the NMC is lasting and meaningful.

“Transformation takes time, and we still have two years of our three-year turnaround plan to go. We’ll now accelerate our efforts further, including carrying out ‘health checks’ across all the NMC’s regulatory areas – followed up by the roll out of a central quality management system – to make sure they’re operating as expected.

“We’ll also deliver further transformative improvements in all strategic priority areas identified in the report, from EDI to education quality assurance – as we continue building a new NMC that aims to be the strong and independent regulator needed to protect the public, maintain confidence in the nursing and midwifery professions and uphold the standards of the professions.”

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