Regulate

Yesterday, I wrote about the NMC…

… I now realise I should have first, gone to B&Q for some scaffold poles to shore-up my inbox!

Wow! If the NMC was a company it would be Thames Water, or a firm of heavy handed debt collectors chasing a parking fine…

They’re the Millwall Football Club of the NHS… ‘Nobody likes us and we don’t care.’

… and to add to the odium…

… the Nursing Standard reports, using FOI; 40 nursing staff have been waiting more than eight years for an NMC hearing.

Eight years!

Children grow up. 

Parents die. 

Relationships break. 

Careers stall…

…the allegation remains, the answers don’t.

Yes, an investigation must establish the facts. 

Yes; it must protect patients. 

Yes; it must be fair to the professional. 

No… none of those duties comes with permission to leave people silently struggling with the punishment of Sisyphus 

Some cases must await criminal or other external proceedings. That requires explanation and regular review.

It cannot explain away the regulator’s wider failures.

The independent Professional Standards Authority recorded a median of 145 weeks from referral to hearing in October–December 2025. Nearly three years. These are people’s lives, measured in a regulator’s reporting periods. 

Frankly, the PSA is next to useless.

It can only point to failures, publish evidence and alert ministers.

A toothless watch-dog dressed up in a party frock, playing pass the parcel.

It cannot compel the NMC to put its house in order.

Consider the charge sheet…

• Delay: the PSA recorded 881 cases awaiting hearings and found that improvements at screening had not been replicated in investigations and adjudication.
• A growing caseload: the NMC’s own papers show 7,284 open cases in June 2026, up from 6,725 in March.
• Failed standards: the PSA found that the NMC met just nine of its 18 Standards of Good Regulation in its review of 2025.
• Selective reporting: the watchdog warned that the NMC’s presentation of fitness-to-practise performance had the potential to be viewed as misleading.
• Obstructed scrutiny: the PSA repeatedly requested the PwC diagnostic work on fitness to practise. The NMC withheld it, citing commercial sensitivity. The watchdog said it could have been shared confidentially. The NMC acknowledged inadequate handling.
• Financial failure: expenditure of £132.4 million against income of £107 million in 2025–26; a £25.4 million deficit before investment gains and pension adjustments…

… if they were a business, they’d be skint.

The response for nurses? A bigger bill.

The annual registration fee increased from £120 to £143 in October. Up 19.2%. The first increase in eleven years, certainly, but…

 … an explanation of costs is not evidence of value.

Pay promptly, or your registration lapses, says the NMC. They’re quick to impose a deadline when the deadline belongs to somebody else.

Its governing Council contains experienced nurses, regulators, lawyers and financial specialists. They each have the qualifications to recognise organisational failure. 

Whether this is groupthink or simply ineffective oversight, the Council has normalised failure. 

Chief executive Paul Rees joined in January 2025. He inherited longstanding problems…

… it is he who now owns the responsibility for delivering the promised turnaround.

There are plans and dated milestones. Yet July’s risk papers still carried a safeguarding-plan delivery date marked ‘TBC’.

How much longer does public protection remain work in progress? However you dress it up, my conclusion; it’s a failing organisation.

For an innocent nurse, delay can become punishment before judgment. For patients and families, it prolongs uncertainty. Employers must manage staffing and risk while a second process grinds on.

Independent scrutiny of employers matters. They can get things wrong, but…

… independence without timely decisions is a failing service.

Decades of regulatory machinery, and the NMC still can’t do the basics.

Nurses are paying more. The NMC has not demonstrated the corresponding improvement in protection the public deserves.

Nurses are paying the NMC Council around £346,000 a year in allowances, expenses and associated taxes. What accountability are nurses and the public getting for that?

By November 2025, the NMC had recorded 17 deaths by suicide during its FTP proceedings since 2018…

… how many more nurses have to die waiting and how much longer do we wait for faster decisions and effective safeguarding.

The ineluctable conclusion… the Council should resign. They look out of their depth. Dump the whole sorry lot of them.

Government should oversee an orderly transition to new leadership and bring forward legislation (It could be tagged onto the Health Bill now in Parliament) to replace this failing model with faster, proportionate regulation;

• clear deadlines, 
• transparent costs, 
• independent decisions and
• proper appeals.

New legislation should protect the title nurse (one of the founding objectives of the NMC in 1919, still not delivered) and require public reporting on the oldest cases, with named responsibility for resolving them.

To make it happen… all nursing unions should get behind a ‘fee-strike‘…every nurse to stop paying their registration fees. 

With no registration nurses can’t work.

With no nurses the NHS can’t work.

It would bring and elegant chaos…

… I guarantee, Two-Clocks-Cooper would sort it out in an hour.

The NMC judges whether nurses are fit to practise.

It’s time for nurses to judge whether the NMC is fit to regulate.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.