The Nursing and Midwifery Council (NMC) is grappling with serious issues including bullying, harassment and racism, according to an independent culture review published in July 2024, as the regulator also faces a separate admission that it failed to properly assess the health and character of registrants for more than a decade.
Culture Review Findings
The independent review, commissioned by the NMC and conducted by Nazir Afzal OBE and Rise Associates, described a “dangerously toxic culture” within the organisation. It highlighted significant safeguarding concerns and found that staff had experienced racism, discrimination and bullying, with some suffering emotional distress, burnout, hair loss and sleep deprivation as a result. Over 1,000 current and former NMC colleagues, along with more than 200 panel members who sit on fitness to practise hearings, shared their experiences for the review. The report noted a failure of senior leadership to address these challenges, stating that “culture is shaped by what leaders tolerate” and that unacceptable behaviours should have been called out and tackled sooner. The NMC has accepted the report’s recommendations and apologised, promising a culture change programme.
Systemic Failures in Health and Character Checks
Alongside the cultural problems, the NMC has admitted to a critical operational failure: it did not consistently assess health and character concerns of individuals on its register for the past 12 years. The regulator stated that this meant professionals with criminal convictions for serious offences or unmanaged health conditions may have remained on the register inappropriately. Alarm bells were first raised in February when a staff member alerted the NMC’s new leadership to concerns that the regulator was failing to follow its full process for investigating declared health and character issues. A rapid review then discovered that this process had not been consistently followed for 12 years. The NMC has said that up to 15 nurses or midwives who should have been removed from the register were allowed to continue practising because of this failing. Those individuals now face removal following a review, with final decisions to be made by an independent panel. The regulator has been reviewing over 18,000 applications made between 2014 and 2026, and is contacting 421 nurses and midwives for more information. The NMC apologised, describing the failing as “completely and utterly unacceptable”.
The Royal College of Nursing condemned the failings, calling them an “astounding failure of its primary purpose to safeguard the public”. Unions said the latest failure “should never have been allowed to happen” and that the NMC had “undermined” patient confidence. The Patients Association warned that failing to investigate backgrounds undermines patient trust in the safety of healthcare staff.
Backlogs and Regulatory Performance
The NMC has faced a challenging period for a number of years, with the Independent Culture Review highlighting “dysfunctionality at virtually every level of the organisation”. This has contributed to significant backlogs in fitness to practise (FtP) cases. As of July 2024, the NMC was dealing with almost 6,000 FtP cases, with some nurses having been in the process for nearly 10 years. UNISON called for the NMC to eliminate backlogs at the screening and investigation stages by 2025 and 2026 respectively, and to develop a plan for cases awaiting adjudication. The Professional Standards Authority (PSA) reported in June 2025 that the NMC failed to meet key standards in 2023-24, including those on safeguarding and fitness to practise, meeting only 11 out of 18 assessed standards. Concerns have been raised about the handling of FtP cases, with criticisms including mishandled cases, inconsistent decision-making, and a culture that prioritises bureaucracy over compassion and transparency. The review also highlighted that six people died by suicide or suspected suicide while under, or having concluded, a fitness to practise investigation by the NMC since April 2023. UNISON expressed sympathy for the families of those who died by suicide while being investigated, noting the extreme stress of NMC proceedings.
NMC Response and Reforms
The NMC has apologised for its failings and committed to a culture change programme based on the Independent Culture Review’s recommendations. A three-year transformation programme is underway under new leadership. The regulator has strengthened guidance on concerns about sexual misconduct and other forms of abuse outside professional practice. Plans include expanding resources for its safeguarding team and establishing a safeguarding hub. The NMC is implementing a £30 million plan to ensure FtP decisions are reached more quickly and considerately. In July 2025, the NMC Council approved a new “Raising Concerns Policy (including Whistleblowing)”, broadening the scope from just “whistleblowing” to “raising concerns” to reduce barriers to speaking up. The NMC first reviewed its whistleblowing policy after disclosures by a whistleblower to The Independent newspaper in 2023, which reported that nurses accused of abuse were allowed to continue working because whistleblowers were being ignored. The NMC has a legal duty to publish an annual whistleblowing report under the Public Interest Disclosure Act 1998, which provides legal protections for workers who raise genuine concerns about wrongdoing in the public interest. Paul Rees is the NMC Chief Executive and Registrar.