A damning report reveals that more than 350 fraudulent or under-qualified applications from centres in India, Nigeria and Pakistan were mistakenly approved by Britain’s nursing watchdog, with a review by the Professional Standards Authority (PSA) saying the Nursing and Midwifery Council also failed to meet seven of 18 national standards.
The scandal-hit council, which regulates more than 800 000 nurses and midwives, wrongly approved hundreds of nurses to work in the UK amid a “dysfunctional” culture previously exposed by The Independent, and is also failing to spot workers who could pose a serious risk to patient safety and to prioritise investigating them – just two of a series of failings uncovered in the review by the PSA, which regulates the NMC.
The Independent exposé had revealed that the organisation’s “toxic” culture had allowed nurses to work unchecked after whistle-blower concerns were ignored.
The PSA’s report also found “serious” cultural and operational issues within the NMC; that it is taking too long to deal with fitness-to-practise cases against nurses; it had significant concerns about the NMC’s ability to manage the quality of education provided by university training courses; and it has consistently failed for years to investigate cases against nurses fairly.
Alan Clamp, chief executive of the PSA, said its report showed that “urgent and significant improvements are needed at the NMC”.
The watchdog has escalated its concerns to Health Secretary Wes Streeting and to the vice-chair of the health and social care select committee.
Responding to the report, Crystal Oldman – chief executive of the Queen’s Nursing Institute, which represents community nurses, and who is also on a government-appointed board overseeing the NMC – said: “A major step change is needed.”
She warned: “If they’ve not met seven out of the 18 standards, then that is an enormous alarm bell to be ringing.
“Two years since the whistle-blower’s concern, and there’s no indication they’re succeeding on all of these counts, which is hugely worrying for public protection.”
Lynn Woolsey, Chief Nursing Officer at the Royal College of Nursing (RCN), said the NMC needs to “start turning the ship around for the good of nursing and healthcare”, adding that “urgent progress is needed” given the serious impact of its failings on some of its members.
One key standard the NMC failed to meet is the requirement to ensure its register of nurses and midwives is accurate. This came after the PSA found that more than 350 people had been added to it in error, allowing them to work as nurses in the UK.
It said: “The total number of people added to the register without meeting the NMC’s requirements is more than 350, and could be 400, depending on the outcomes of the investigations.
“Maintaining an accurate register is a key function and duty of a regulator…. The NMC has added a large number of people … who had not met its requirements, and by the end of our review period it had not been able to fully remedy the situation.”
These included “fraudulent” applications from centres in India, Nigeria and Pakistan that test nurses against NMC requirements, such as being able to speak English to the required standard.
The errors also included hundreds of newly qualified nurses who had not completed enough training hours.
The NMC told The Independent that out of those investigated for fraudulent entries, 16 people were removed in relation to one centre in Pakistan and of the 30 registrants at a centre in Nigeria to face investigations, 19 were removed. For those in the Indian centre, 68 nurses were affected, and in all cases, it was found that there wasn’t sufficient evidence to prove fraud.
Another failing was the requirement to identify and prioritise all cases that pose a serious risk to patient safety and to seek interim orders, placing restrictions on staff under investigation, where appropriate.
An internal audit carried out by the NMC found that it was failing to act on its safeguarding duties. While the PSA’s review of 40 cases found no concerns in 90% of them, it criticised the NMC for not seeking further information on criminal cautions and convictions accrued by a worker accused of domestic violence.
The latest findings follow the publication last July of the findings of a review headed by Barrister Nazir Afzal KC, which found evidence of a toxic and dysfunctional culture at “every level” of the NMC, and that the organisation had turned a blind eye to serious sexual, physical and racist abuse.
Shocking failures identified within Afzal’s report included a seven-year delay in striking off a nurse who was accused of raping a colleague and sexually assaulting a patient.
Overseas recruitment drops
Adding to the nursing sector’s woes, while the number of professionals on the NMC register has reached a record high, a “significant slowdown” in international recruitment means the rate of growth has decelerated, new data reveal.
International recruitment between April 2024 and March 2025 has fallen by almost a third (30.2%) – ending the ending the upward trend seen over the past six years, reports Nursing Practice.
And while the number of UK-educated professionals joining the register has grown by 5.9%, the NMC warned that this was not enough to offset the fall in international recruitment.
The regulator’s annual registration report shows there are now 853 707 NMC registrants – representing 2% of the entire working age population.
Changing registration trends
Between April 2024 and March 2025, the register grew by just 3.3%, down from 4.8% during the same period in the year before, which the NMC attributed largely to a fall in international recruitment.
The data show that just under a third (30.2%) fewer professionals who were educated outside the UK joined the NMC register for the first time in the past year, with 20 671 such professionals joining overall.
The slowdown has been seen across nations, said the NMC, with 47.6% fewer nurses from the Philippines and 36.7% fewer nurses from India joining in the past 12 months.
There was also a 25.5% fall in recruitment from red-list country Nigeria.
The number of internationally educated professionals joining the NMC register had been rising steadily since 2018/19, with an exception during the pandemic in 2020/21.
The NMC said recent changes to British visa rules “may have played a part”, as well as a stronger focus from the government in England to recruit people locally.
The RCN’s Woolsey criticised the government for its “unethical” approach to stopping international recruitment.
It was announced last month that the government plans to ban the recruitment of care workers from overseas.
This came after it had banned direct care workers arriving from overseas from bringing dependents on their Health and Care Worker visa.
“We warned that hostile immigration policies and poor pay were driving international staff away and at a time when we couldn’t afford to lose a single nurse,” Wolsey said.
She added that the “slowing growth of the UK-trained workforce isn’t coming close to offsetting the number of international recruits leaving”.
“With tens of thousands of vacancies in the NHS and social care this will be a worrying time for patients,” she said.
Professionals leaving
In total, 28 789 people also left the NMC register in the year to March 2025, equalling 3.5% of the register compared with 3.4% the previous year.
Some 5 276 international professionals left the register in the last year – a third more than in the previous 12 months.
In the context of a growing register, this means that 2.7% of the international cohort left in 2024/25, compared with 2.4% in the previous year.
Rohit Sagoo, founder of the British Sikh Nurses Association and Queen’s Nurse, said England was becoming a “stop gap” for international nurses looking to move to other countries like Australia.
He added that the financial burden of visa applications also discourages international nurses from moving to the UK.
At the RCN Congress last May, nurses warned of the ‘incredibly miserable’ consequences of the government’s plans to ban the recruitment of care workers from overseas. In December, figures showed a 65% annual drop in visa grants when compared with data from 2023.
See more from MedicalBrief archives:
UK nursing regulator boss resigns after report
Nurse suicides linked to probes by ‘toxic’ UK nursing council
UK nurse sues NHS trust after suffering racist assault and abuse