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PSA responds to publication of Independent Culture Review of the NMC

The independent culture review conducted by Nazir Afzal OBE and Rise Associates on the Nursing and Midwifery Council (NMC) has found that people working in the organisation have experienced racism, discrimination and bullying, and evidence of safeguarding failures. This is concerning and these are matters we take very seriously. We are carefully considering the report and its recommendations. We are grateful for the courage of the whistleblower in raising the concerns which led to this review.

The report highlighted that since April 2023, six people have died by suicide or suspected suicide while under, or having concluded, fitness to practise investigations by the NMC. We want to extend our sympathies to the families of those six people.

We appreciate that those affected, the NMC’s registrants and the wider public will be asking questions about how this happened, and what action is now going to be taken. We are pleased to see that the NMC has accepted the all the review’s recommendations and we will be closely monitoring the NMC’s actions to address these. 

In our oversight role of how they deliver their regulatory objectives, we evaluate whether the NMC and the other statutory regulators are meeting our Standards of Good Regulation through our Performance Review assessments. Our Standards currently focus on the key regulatory functions of fitness to practise, education and training, registration, guidance and standards. We also have general standards that cover a range of areas including equality, diversity and inclusion; reporting on performance and addressing organisational concerns; and consultation and engagement with stakeholders to manage risk to the public.

We published our last report on the NMC in September 2023. We found the NMC had a number of areas where improvements were required and did not meet Standard 15. This Standard states: ‘The regulator’s process for examining and investigating cases is fair, proportionate, deals with cases as quickly as is consistent with a fair resolution of the case and ensures that appropriate evidence is available to support decision-makers to reach a fair decision that protects the public at each stage of the process.’. The NMC has not met this Standard since its 2018/19 performance review. In September 2022, we escalated our concerns about the NMC’s performance in this area to the Secretary of State for Health and Social Care and the Health and Social Care Committee; and have continued to update them following each performance review since.

We are currently assessing the NMC’s performance for 2023/24. As part of this, we will consider the findings of the Rise review. We will also consider the findings of Ijeoma Omambala KC’s reviews of fitness to practise cases and the NMC’s handling of whistleblowing concerns, which we expect to be published later this year. We will publish the NMC’s 2023/24 Performance Review report as soon as possible after this time. In the meantime, we will consider the immediate implications of the Rise review with the four health departments of the UK, and closely monitor the NMC’s actions to address the report recommendations. 

We note the Rise review included a recommendation for us to undertake more detailed annual reviews of the NMC’s performance against our Standards, conducting a more in-depth review of randomly selected cases at each stage of the NMC’s processes. We agree that enhanced monitoring will be required of the NMC in the coming months and years to ensure improvements are implemented and sustained. We will provide an update on how we will achieve this shortly, once we have considered the findings of the review in full. We will also be considering the evidence we look at as part of our performance reviews, and our process overall, to see if these can be further improved to help us identify the sorts of issues raised in the Rise review at an earlier stage. 

As part of our regular practice, we are currently reviewing our Standards. This provides an opportunity to also look at whether we should consider internal culture, leadership and governance as part of how we assess how well a regulator is delivering on its statutory responsibilities.


Professional Standards Authority for Health and Social Care


Note to Editors


  1. The PSA oversees 10 statutory bodies that regulate health and social care professionals in the UK.
  2. We assess their performance and report to Parliament. We also conduct audits and investigations and can appeal fitness to practise cases to the courts if we consider that sanctions are insufficient to protect the public and it is in the public interest.
  3. We also set standards for organisations holding voluntary registers for health and social care occupations and accredit those that meet them.
  4. We share good practice and knowledge, conduct research and introduce new ideas to our sector. We monitor policy developments in the UK and internationally and provide advice on issues relating to professional standards in health and social care.
  5. We do this to promote the health, safety and wellbeing of users of health and social care services and the public. We are an independent body, accountable to the UK Parliament.
  6. Our values are – integrity, transparency, respect, fairness and teamwork – and we strive to ensure that they are at the core of our work.
  7. More information about our work and the approach we take is available at