The PSA publishes its review of the Nursing and Midwifery Council’s performance for 2024/25

We have today published our annual performance review of the Nursing and Midwifery Council (NMC) for the period 1 January - 31 December 2025.

We conducted a periodic review of the NMC’s performance against the Standards of Good Regulation (the Standards). Usually our periodic reviews are conducted every three years (with shorter monitoring reviews in the two years between them). However given the concerns identified in the July 2024 Independent Culture Review by Nazir Afzal OBE and Rise Associates, and the outcome of last year’s periodic review (the NMC met 11 of the 18 Standards), we undertook a further periodic review for 2024/25. This included an audit of cases closed at the screening stage of the NMC’s fitness to practise process. 

For this period, the NMC has met nine out of the 18 Standards. Our report explains how we made our decisions. 

We understand that 2025 was a challenging year for the NMC as it worked to tackle its well-documented operational challenges. The PSA recognises that significant steps have been taken by the NMC to understand the issues within the organisation and improve its performance including the appointment of a new Chief Executive and Registrar, and a new Chair during the reporting period. While we are encouraged by the new leadership’s intentions and commitment to change, in the period under review we have not seen evidence of substantial and sustained improvement. 

While recognising the steps being taken to deliver improvement, progress has been mixed and there are some areas where the NMC has taken very limited action to address issues identified in our last review. 

In our report we have made a number of recommendations for the NMC, to indicate some of the areas where we expect the organisation to urgently focus on improving its performance. The recommendations are not exhaustive but highlight certain areas of underperformance that we have identified this year, issues that the NMC is aware of but has not yet addressed, or where we think changes could be made reasonably quickly to improve the NMC’s performance. 

Findings
In this reporting period the NMC has not met the following Standards: 

• Standard 2 (clear about purpose): While we note that the NMC has put in place a number of plans aimed at improving the way it operates during this review period, we have not yet seen clear evidence of progress in how it ensures that its policies are applied appropriately across all its functions and that relevant learning from one area is applied to others.
   
• Standard 3 (Equality, Diversity and Inclusion (EDI)): We note that the NMC has made progress in this area. It has established appropriate governance, structures and processes to embed EDI across its regulatory activities and continues to engage with a diverse range of stakeholders to advance EDI issues. However, we have seen limited evidence of the impact of the changes the NMC has made with respect to EDI in this reporting period, and we have seen evidence of disparities in the NMC’s fitness to practise outcomes.
   
• Standard 4 (reports on itself and addresses concerns): The NMC has failed to address some of the issues identified in our last performance review, most notably in respect of education quality assurance. We have also identified issues with respect to the NMC’s transparency of reporting during this review period, which we consider is lacking when compared to other regulators, and falls short of the standard expected. 
   
• Standard 9 (quality-assures education providers): The NMC’s education quality assurance function remains an area of high risk. We highlighted this in our performance review for 2023/24, and we are concerned that the NMC has taken very limited action to address this in 2025. 
   
• Standards 10 and 11 (maintains an accurate register, registration process operates fairly and effectively): The NMC notified us that it identified that its registrations team had not been following its process to refer high-risk or borderline decisions involving health and/or criminal conviction declarations to an Assistant Registrar for a decision. This had been ongoing for a number of years and affected a significant number of cases. This failure to follow its own processes serves to undermine the integrity of the NMC’s register and the proportionality of its process for registration. 
   
• Standards 15, 16 and 18 (fitness to practise): The NMC has made significant improvements to timeliness of decision-making at the screening stage of its fitness to practise processes, however this has not been replicated at the investigations and adjudications stages. Cases are still taking too long to process, and we could only take limited assurance from our audit about the quality of the NMC’s decision-making at the screening stage. We have seen the NMC take steps to better support registrants in the fitness to practise process, most notably by establishing a Public Support and Engagement team and by trialling new approaches to contacting registrants. However, we continued to have significant concerns about how the NMC kept parties updated. This is of particular concern given the length of time these processes take to conclude. 
  
  In line with our Escalation Policy, we have written to provide an update on the NMC’s performance to the Secretary of State for Health and Social Care and the Chairs of the Health and Social Care Committees in the four UK parliaments. We have outlined the key areas that we are concerned about and the recommendations we have made.

Assessing and monitoring
The judgements we make against each Standard incorporate a range of evidence to form an overall picture of performance. Meeting a Standard means that we are satisfied that a regulator is performing well in that area. It does not mean there is no room for improvement. 

Our oversight does not stop when we publish our report. It is an ongoing, continuous process and, where we have identified areas for improvement, we pay particular attention to these in our performance reviews.

Next review
Our next review of the NMC is already underway and covers the period 1 January - 31 December 2026. As part of the review, we will consider the further scrutiny we think is necessary as we continue to closely monitor the NMC’s performance. Our report on this period is due to be published in March 2027. 
 

ENDS

Professional Standards Authority for Health and Social Care

Contact: media@professionalstandards.org.uk
 

Notes to the editor

1. The Professional Standards Authority for Health and Social Care (PSA) is the UK’s oversight body for the regulation of people working in health and social care. Our statutory remit, independence and expertise underpin our commitment to the safety of patients and service-users, and to the protection of the public. There are 10 organisations that regulate health professionals in the UK and social workers in England by law. We audit their performance and review their decisions on practitioners’ fitness to practise. We also accredit and set standards for organisations holding registers of health and care practitioners not regulated by law. We collaborate with all of these organisations to improve standards. We share good practice, knowledge and our right-touch regulation expertise. 
2. We also conduct and promote research on regulation. We monitor policy developments in the UK and internationally, providing guidance to governments and stakeholders. Through our UK and international consultancy, we share our expertise and broaden our regulatory insights.
3. Our values are – integrity, transparency, respect, fairness and teamwork – and we strive to ensure that they are at the core of our work. 
4. More information about our work and the approach we take is available at www.professionalstandards.org.uk