The Nursing and Midwifery Council (NMC) exists to protect the public by regulating the nursing and midwifery professions. It holds enormous power over the careers and reputations of registrants; those same nurses and midwives who are the backbone of the UK’s healthcare system. Yet, the NMC’s ongoing failings increasingly suggest that the organisation has lost sight of the people it regulates and, in doing so, risks eroding trust in its very function as a fair and just regulator.
Systemic and Cultural Failings
In recent years, numerous investigations and testimonies have exposed serious shortcomings within the NMC. These include mishandled fitness to practise (FtP) cases, inconsistent decision-making, and a culture that prioritises bureaucracy over compassion and transparency. Reports from both internal reviews and external observers point to an organisation struggling to live up to its stated values of fairness, inclusivity, and accountability.
For registrants caught up in NMC proceedings, the experience can be devastating. The process often feels adversarial and isolating, with little regard for the human impact. There are increasing concerns that the NMC’s culture of defensive regulation, focused more on process than on people, has led to a regulatory environment that causes harm rather than prevents it.
Failure to Support Registrants in Engaging with the Process
Perhaps one of the most serious and enduring criticisms of the NMC is its failure to support registrants adequately in engaging with the regulatory process. Many nurses and midwives facing FtP investigations report feeling confused, unsupported, and even intimidated. The language used in NMC correspondences is often highly legalistic, and there is limited practical guidance to help registrants understand what is required of them or how to respond effectively.
Unlike some other professional regulators, the NMC offers no formal system of case support or independent advocacy for registrants. Those unable to afford legal representation are often left to navigate a complex process alone, while managing the emotional and professional toll of being under investigation. The lack of accessible information, empathy, and communication from the NMC exacerbates feelings of distress and mistrust.
This failure is particularly troubling given that the majority of NMC cases do not result in sanctions. Many nurses and midwives are ultimately cleared of wrongdoing, but the process itself can be so damaging that their careers, confidence, and mental health are left in tatters.
The NMC has introduced its own Safeguarding Hub that claims to review all new cases for safeguarding and wellbeing concerns and has reviewed thousands of cases as a result. However, once again, their data does not show efficacy and we are yet to see any thorough and impactful information come from those referrals to show impact and safety measures. We also see that registrants whose cases have sat with the NMC for a number of months or years seem to receive nothing more than a number for Careline and advice to get legal support. To suggest a nurse or midwife, potentially out of work, can afford expensive legal representation is unrealistic and offensive.
When cases come to hearing on health grounds, which the NMC pursue in the belief of it affecting a registrant’s fitness to practice, it is callous for them not to assess wellbeing to ensure that a registrant does not fall into the annual statistics of those who take their own life during FtP. The ongoing lack of data around registrants who self-harm during FtP and have worsening mental health affecting their ability to work and function is glaringly obvious for all to see. If the NMC wants to be taken seriously about safeguarding the mental health of those professionals they are, quite frankly, not doing enough.
Frozen fees and redundancies
The future of our healthcare regulation is at risk. In October 2025, the NMC announced plans to cut 145 posts, nearly 10% of its workforce, in a bid to save £9.7 million annually. This comes after a decade of frozen registration fees, a 28% drop in real-terms income, and a staggering £24 million deficit this year alone.
But these cuts don’t explain the true facility of the regulator and the poor financial governance that at best is being ignored and at worst perpetuated by those that benefit. Below are just a few examples of how the spending is out of control.
Effective use of fees?
- ljeoma Omambala investigation, £100,000 = 834 annual registrant fees (report recommissioned before publication)
- Rise Associates report, £96,000 = 800 reg fees
- “External legal and HR services, £178.032 = 1,483 fees
- Price Waterhouse Cooper “assistant contract”, £9million = 75,000 fees
- Capsticks and Weightmans, £14.9million = 124,166 fees
- B3sixty, £30,063 = 250 fees
- Bates Wells, £64,161.50 (to date) = 560 fees
This, apparently, is “justified spending”, and yet those registrants have had no say over this. In addition to this the NMC have announced yet another external consultancy firm will be taking over the consultation work on fee rises, amongst other issues. “Thinks” will be responsible for all the engagement, consultation and implementation work for the measly sum of £82k and counting. Once again, the powers that be are saying that this is justified work, but we are sure that those members of staff at the NMC desperately trying to do their jobs effectively would argue otherwise.
The NMC currently has a backlog of over 6,000 fitness to practise cases, how will they ensure that this situation will not continue to get worse – oh yes, use external law firms such as Capsticks to assist, clear, and manage!
A Call for Sense
If the NMC is truly committed to protecting the public, it must first ensure that its processes are fair, transparent, and humane. Regulation should not be punitive; it should be restorative, focused on learning and improvement. Supporting registrants through the process by providing clear information, emotional support, and access to advocacy, is not only a matter of fairness but also essential for maintaining confidence in the regulatory system.
The NMC has acknowledged many of its failings and promised reform. However, promises of change have become a familiar refrain. What is needed now is meaningful action rooted in listening to registrants, rebuilding trust, and embedding compassion into every level of its work.
It is clear that the NMC has no respect for the fees that enable their financial overspending, and that the council is impotent to stop this or put any measures in place to ensure that these contracts give “value for money”. We continue to ask, why do the registrants who fund the NMC have no say over the spending, and are unable to do anything but pay their fees to be able to work?
We have lost faith, and if the NMC was honest and open they would admit that they need major help. If showing insight is a fundamental requirement of Fitness to Practice, why does the NMC show so little when it comes to their own organisation? Their lack of respect for those they regulate is constantly demonstrated through poor case management, lack of preparation of cases at hearing, and general chaos. All this, despite the expense of the consultancies who should be doing a lot better. Regulation is not about numbers of cases cleared but about safe assessments and keeping a register of professionals fit to care for our patients. The current state of our regulator can not ensure either to any degree and is potentially putting the profession, and our patients, at risk.
