The periodic review of the Nursing and Midwifery Council undertaken by the Professional Standards Authority [PSA] May 2026
Introduction
The PSA is the health regulators’ regulator: it sets the standards for and periodically audits and reviews the performance of the 9 health regulators such as the BDA, GMC and the NMC. Because of the PSA’s concerns in its 2024 inspection and earlier inspections of the NMC, it carried out another review early this year and published its findings (link above) on 28th May 2026. The PSA found that the NMC was performing worse than ever and that it has been slow to implement the recommendations from previous reports and reviews.
The NMC’s poor performance in 2025
The PSA’s review of 2025 assessed the NMC’s performance against its 18 Standards of Good Regulation and failed it on nine of those standards. In 2023 the NMC failed on one standard and in 2024 it failed seven. If midwives and nurses had a choice of regulator, the NMC would go out of business.
The NMC failed:
- Standard 2: Clarity of purpose. The PSA noted examples of lack of communication between different directorates and departments.
- Standard 3: Equality, Diversity and Inclusion (because of limited impact of changes and evidence of disparities in Fitness to Practise [FtP] outcomes). The PSA records, “biases in the NMC’s fitness to practise processes. Alongside this, there are known disparities in the NMC’s fitness to practice processes” (pp 9-11). Those biases are with regard to both black and male registrants. The PSA also discovered that panel members had not been given any anti-racism training since 2023, which is remarkable given the 2024 Independent Culture Report.
- Standard 4: reports on itself and addresses concerns (the PSA are especially concerned about educational quality assurance). The PSA found that “the NMC is overly reliant on unsubstantiated self-reporting from education providers”, and noted a lack of transparency of public reporting, especially around FtP timeliness and strategic risk management. The various statements issued by the NMC claiming that FtP is being dealt with in a timely manner were found to be misleading and lack transparency. Perhaps the NMC has no “Duty of Candour”?
- Standard 9: quality-assures education providers (the PSA identified this as an area of high risk with many issues outstanding from earlier reviews). The PSA called on the NMC to introduce a process that “provides effective robust assurance of the quality of education and training that supports public protection”. It criticised the fact that Approved Education Institutions are not required to give any evidence that they are complying with NMC standards, and that there is very little or no active monitoring of education programmes.
- Standards 10 and 11: maintains an accurate register and registration process operates fairly and effectively (the PSA found that the NMC failed to follow its own policies regatding health and criminal conviction declarations).
- Standards 15, 16, 18: Fitness to Practise (whilst screening decisions are more timely, investigation and hearing stages take too long and the NMC does not keep parties adequately updated). The NMC has to improve safeguarding risk assessments and actions across and throughout the FtP process, and improve the support and updating of all parties in FtP cases with regard to “the stress placed upon all those involved in the process”. The PSA has asked the NMC to remove the concept of “a deep-seated attitudinal issue” from its FtP guidance; this can be an allegation in cases involving independent midwives in our experience.
The PSA Review mentions favourably both the NMC’s Maternity Action Plan and the joint NMC/GMC Good Practice Resources for maternity care, especially for women “outside of guidance” a.k.a exercising choice. The paragraphs on these are on p.19 of the review.
Fitness to Practise
The PSA reports that there is an increase in referrals across all regulators and that 7048 registrants were referred to the NMC in 2025. Whilst the median time for screening referrals (the first stage of the process) has fallen from 13 to 5 weeks, more cases are being sent on for case examination/investigation (the second stage), whilst others are being inapproriately closed at screening (drink driving cases being cited).
Case examination (stage 2) is now taking a median of 21 months. The interval from a case examination/investigation to a decision is now 3 years (i.e. a total of 5 years from referral). There are currently approximately 900 registrants awaiting a FtP hearing. At the end of 2025, 6,369 midwives and nurses were in the FtP process.
The PSA criticised NMC panel members for often failing to give sufficient reasons for their findings and sanctions, something we have complained about for many years. It also found that there is a lot of delay in case progression and often poor communication with parties during adjourned and part-heard cases, which is something we think is increasing (i.e.once started, cases are taking longer to conplete).
The next report of the PSA on the NMC is due out in March 2027.
The RCM and the NMC
A few years ago, ARM made a number of attempts to get the RCM to join in with the widespread criticisms of the NMC but the RCM would not engage. A revolving door of personnel between the two organisations and close personal relationships may have influenced this supine position. For one thing, no RCM personnel ever attend or closely follow FtP hearings (left to the lawyers provided by Thompson’s) so have no first-hand knowledge of the shambles of the FtP processess in action.
Given the nature of this PSA review’s findings, the RCM really had to respond and issued a press release on 28th May 2026 – https://rcm.org.uk/media-releases/2026/05/nmc-failing-midwives-the-nhs-and-the-public-according-to-latest-report/
This RCM statement is, as usual, a very weak response, hoping the NMC will do better, try harder and expresses disappointment. It doesn’t call on the Secretary of State to take a “Fresh Eyes” look at the NMC nor does it call for its abolition and replacement with a new body with a new approach and culture. The RCM is continuing to fiddle while Rome burns around it.
Conclusion
From 9 years of close experience of the NMC, especially its FtP Directorate, I believe nothing else will do other than abolition – the whole approach to professional discipline needs to be RADICALLY rethought to be quick, just, fair, more local, and restorative. The present NMC regime, despite the many and various changes every year or two, is simply incapable of changing course, culture or modus operandi. Educational standards need a better guardian, and universities held to account BEFORE courses are found to be seriously wanting. And the PSA needs to keep probing, and take even closer looks.
Deborah Hughes, Retired Midwife
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