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There's something about the NMC that reminds me of a concierge desk, in the mahogany lobby of an ageing hotel.
An impressive frontage. Elaborate procedures. Nothing happens until someone dings-the-bell and waits for an elderly figure to shuffle-in, and reluctantly pass a room-key from a hook to your hand.
Nurse-regulation roots reach back to 1919...
...then, patients needed a dependable way to distinguish trained nurses from people simply presenting themselves as nurses…
... as they continue to do today.
Registration established qualifications and standards, with the possibility of removal for misconduct.
It was a substantial advance in public protection.
Today's NMC opened for business in April 2002. Twenty-four years later, we can all see its approach to public protection belongs in another age.
For example, consider Southport.
The NMC knew in spring 2025, that registrants had improperly accessed survivors’ medical records. Inexplicably, it opted against pursuing action.
HSJ published the story.
The Trust dis-obligingly dinged-the-bell and asked the NMC whether the publicity changed the need for referrals?
Ummm, ahhh… the regulator reconsidered… errrrrr… yes; citing public interest.
It was b£@@&^ obvious from the get-go.
Formal referrals followed. They’re being ruminated, to decide whether full investigations are needed… of course they are.
Everyone deserves a fair hearing. So, what changed?
The patients’ entitlement to privacy existed before the headline. Public protection should not depend on public exposure.
Step back and ask, in today’s world… what could public protection could look like?
A nurse opens the record of someone they have no professional reason to see.
A system flags the unusual access.
Someone checks.
Access is restricted, where justified.
The employer investigates promptly… before another record is opened… before information is shared… before,
A journalist picks up the phone.
Access logs already exist. Our opportunity is to make better use of them.
AI offers the easy prospect of going further; bringing together warning signs that organisations currently examine separately, if they examine them at all.
- Repeated incidents.
- Missing supervision.
- Unfinished training.
- Complaints revealing a pattern.
- Unsafe workloads.
Could we identify where practice is becoming unsafe and intervene before disaster?
Indubitably.
Sometimes the intervention might be an investigation. Often, support, training, supervision or relief for an exhausted team.
Predicting risk should mean preventing failure.
A warning about a nurse may actually be a warning about the conditions in which we expect all of them to work.
In 2002 the NMC could scarcely have envisaged today’s possibilities, yet, today, they still rely on someone dinging-the-bell.
In an AI world, layers of bureaucracy can be operated through the Cloud and a laptop; registration, qualification checks, case tracking, information exchange and early-warning dashboards...
... in rooms above a chip-shop.
However, across its estate, the NMC spends more than £5 million a year on rent and other premises costs.
The laptop could be the front door to secure systems… the mahogany lobby is optional.
The NMC’s average workforce, including agency and contractors, grew from 879 in 2019/20 to 1,275 in 25/26; ~45%.
There’s been improvement in case resolution. Workload increased. Yet...
... the latest independent review found NMC met only nine of 18 regulatory standards.
Bigger is nowhere near better.
Why not national nursing contracts spelling out serious misconduct and its consequences?
Employers investigate. Proven gross misconduct can lead to dismissal and an email to the NMC… to withdraw registration.
Appeals? Through the tribunals everyone else uses… use the NMC's millions to fund them for quicker results.
It could be for the employers, and Trusts to keep national standards. Maintain a digital register.
At the same time, build a smaller independent investigation and adjudication service, for whislteblowers and the public, then…
…invest in prevention.
Lower registration fees, create less uncertainty for nurses.
Nurses received a 3.6% pay award last year. Their NMC fee has now risen by 19.2%.
Comparing the median salaries of nurses with the NMC staff, nurses have 6.4% lower earnings… and the NMC is running a £25.4 million trading deficit.
…. start with the nurse and work backwards.
Are patients safer and nurses are treated fairly?
No.
Should we start with the protection we need and design the organisation around it.
Yes.
The NMC is approaching its silver anniversary. The temptation would be to buy them a new concierge-bell.
I'd suggest… an emergency siren.
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