When the Independent Culture Review reached publication in July 2024, it described a regulator that judged the conduct of nurses and midwives while tolerating bullying, harassment and racism among its own staff. For an organisation whose authority rests on moral standing as much as statute, that was a grave finding. It landed in a health service already stretched by waiting lists, vacancies and strained industrial relations, and it raised an uncomfortable question for every trust that relies on the register: could the body deciding who may practise be trusted to treat people fairly?

Paul Rees took the interim chief executive role in January 2025 and was confirmed as Chief Executive and Registrar that July. This month he was named among the most influential Black, Asian and minority ethnic leaders in English health and care. The recognition reflects measurable movement rather than reputation alone. Thirty of the review's recommendations have been implemented, with three more due by the end of the year. A three-year Culture Transformation Plan is under way, supported by new organisational values and a behaviour framework for colleagues. The NMC has signed the UNISON Anti-Racism Charter and published anti-racism principles for midwifery and nursing education and practice.

Culture change often stalls at the point where it becomes uncomfortable, and here the record is firmer. Twenty people have left the organisation over two years for bullying, harassment or racism. Many leaders announce values; fewer are willing to act on breaches of them. That willingness is what gives a transformation plan weight with the staff who must live under it.

The relevance to the NHS is practical. The register now carries well over 800,000 professionals, and the health service leans heavily on internationally educated nurses to fill rotas that domestic training cannot yet cover. Those colleagues have the most to lose from a regulator whose processes carry bias, and concerns about disproportionate referral of minority ethnic registrants have long been raised. Mr Rees has set equality targets aimed at removing bias from regulatory processes. If they are met, employers will find fewer cases that collapse under scrutiny, and registrants will meet fewer investigations that should never have begun.

Speed and quality of fitness to practise work matter just as much. A nurse suspended in limbo for months is lost to a ward and anxious at home, while a patient safety concern left unresolved is a risk left open. The NMC's programme of health checks, which tests how closely each regulatory function follows its own procedures and how sound its quality assurance is, addresses this directly. It is unglamorous work. It is also the kind that restores confidence among employers, who need decisions that are timely and defensible.

There are lessons here for NHS leaders beyond the regulator itself. Trusts wrestling with their own workforce race equality data, staff survey results and retention figures can see what sustained reform looks like: a published plan, an external benchmark, named accountability and consequences for poor behaviour. Policymakers pursuing the government's ambitions for a reformed health service should note that workforce strategy depends on institutions staff believe in. Plans for productivity and prevention cannot succeed where the professionals delivering them feel unprotected or unfairly treated.

Mr Rees, the first Black chief executive of a UK healthcare professional regulator, credits his staff and the NMC Council for the progress made, and he is candid that fitness to practise and other regulatory work still need improvement. That candour is a sign of sound leadership. The task now is to hold the pace once public attention moves on, because culture is judged by what persists in year three, not year one.

A regulator that is fair, fast and respected is a quiet asset to a health service in difficulty. Under Mr Rees, the NMC has begun to earn that standing again, and the NHS has good reason to want him to finish the job.

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