Periodic Review - Nursing and Midwifery Council 2024/25

We have published our performance review report for the Nursing and Midwifery Council. The report covers the period 1 January 2025 to 31 December 2025.

Key statistics

• The NMC regulates the practice of nurses and midwives in the UK and nursing associates in England
• 867,265 nursing and midwifery professionals on the register as of 31 December 2025

Key findings and areas for improvement

Introduction

This report covers the PSA’s assessment of the NMC’s performance during the period 
1 January-31 December 2025. Due to the publication date of this report, approximately five 
months after the end of the review period, we do at times refer to work that has been 
undertaken by the NMC since 31 December 2025. 

We recognise that 2025 was a very challenging year for the NMC as it continues to address 
the significant concerns identified in the Independent Culture Review (ICR) which was 
published in July 2024. 

In this reporting period, in addition to working to try to address its operational challenges, 
the NMC made many senior-level staff changes, including appointing a new interim Chief 
Executive and Registrar in January 2025 – who was appointed to the role permanently in 
July 2025 – and a new Chair in April 2025. We recognise that the NMC has taken a number of significant steps to understand the issues within the organisation and to improve its
operational performance. 

We are encouraged by the new leadership’s intentions and commitment to change. 
However, as this report sets out, we have not yet seen significant evidence of overall
improvement and this is reflected in our findings for 2025 and our conclusion that the NMC 
has only met nine of the 18 Standards in 2025. 

In line with our Escalation Policy, we have written to the Secretary of State for Health and 
Social Care and the Chair of the Health and Social Care Committee to provide an update 
on the NMC’s performance, the key areas that we are concerned about and the 
recommendations we have made.

There is clearly a lot more work for the NMC to do to bring about the improvements 
required in the interests of public protection. Our key findings are set out below. We have 
also made a number of recommendations to help inform the improvements the NMC 
needs to make. 

We will continue to assess the NMC’s performance against our Standards. Our next 
periodic review will cover the period 1 January-31 December 2026 and is due to be 
published before the end of March 2027. 

Equality, Diversity and Inclusion (EDI)

The NMC did not meet Standard 3 because we did not have sufficient assurance that it 
was meeting two of the four outcomes we require to meet this Standard. We note that the 
NMC has made progress in this area in this reporting period. 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. 

The latest phase of the Ambitious for Change research identified biases in the NMC’s 
fitness to practise processes. Alongside this, there are known disparities in the NMC’s 
fitness to practise processes. The NMC has published EDI targets, accompanied by 
supporting initiatives and reporting measures, to address this by 2030. It has also made
progress in its review of the Code, revalidation and practice learning, which will ultimately 
strengthen the EDI requirements for students and registrants. However, we have seen 
limited evidence of the impact of the changes the NMC has made with respect to EDI in this 
reporting period. We have also seen limited evidence that the NMC is encouraging 
registrants to improve their EDI knowledge through the revalidation process, and we 
continue to have significant concerns about the NMC’s approach to monitoring education 
providers’ compliance with its standards. Overall, we found that the NMC did not meet 
Standard 3 in this reporting period. 

Education quality assurance

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. We also remain concerned that the NMC is overly reliant on unsubstantiated self-reporting from education providers, which carries inherent risks. These risks materialised at Southampton Solent University (see Standard 9 in full report for more details) during this review period. Our continued concerns in this area led us to conclude that Standard 9 was not met. 

Registration

In February 2026 the NMC notified us of a significant issue with respect to its registrations 
function. The NMC 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 serves to undermine the NMC’s 
register and the proportionality of its process for registration, which led us to conclude that 
Standards 10 and 11 were not met. 

Fitness to Practise

Timeliness

The NMC did not meet Standard 15 because it continues to take too long to deal with 
fitness to practise cases. The NMC has made significant improvements to timeliness of 
decision-making at the screening stage, however this has not been replicated at the 
investigations and adjudications stages of the process. 

Quality of decision-making

We conducted an audit of cases closed at the screening stage in this review period. This 
differed from previous audits, in that we targeted our audit at higher-risk cases, following 
our findings in last year’s review. Of the 42 cases audited, we identified six cases that were 
closed prematurely. Accordingly, we could only take limited assurance about the quality of 
the NMC’s decision-making at the screening stage. This was a factor in us concluding that 
Standards 15 and 16 were not met. 

Safeguarding

We reviewed how the NMC was identifying and managing safeguarding risks as part of our 
audit. Overall, we only took limited assurance that the NMC was appropriately identifying 
and managing these risks. We also saw poor record-keeping in respect of safeguarding 
considerations and decisions throughout our audit. This led us to conclude that Standard 
16 was not met. 

Recommendations

Within this report, we have made a number of recommendations for the NMC, to provide 
further clarity on some of the areas where we expect the NMC to urgently focus on 
improving its performance. These recommendations are listed below and are included at 
the relevant Standard within the report. 

The recommendations are not exhaustive or intended to cover every area where the NMC 
needs to improve in order to meet our Standards. They are intended to highlight certain 
areas of importance 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. 

Standard 4: We recommend that the NMC reviews its public Council reporting in order to 
improve transparency, particularly in the areas of strategic risk management and fitness to 
practise timeliness.

Standard 9: We recommend that the NMC prioritises its Education Quality Assurance
improvement plan to develop and introduce a process that provides effective, robust 
assurance of the quality of education and training that supports public protection. The 
current process, including a reliance on uncorroborated self-declarations, carries 
significant risks and has been shown to be ineffective.

Standard 16: We recommend that the NMC should accurately capture when and why a full 
safeguarding assessment is carried out in a fitness to practise case, and what the findings 
and resulting actions are.

Standard 17: We recommend that the NMC keeps risk under review throughout the life of a 
fitness to practise case.

Standard 18: We recommend that the NMC reviews its processes to improve its ability to 
support and keep parties updated on fitness to practise cases. This is particularly 
important given the challenges the NMC has in terms of timeliness and case progression 
and the stress placed upon all those involved in the process.