Nursing leaders have called for the government to launch an independent investigation into the Nursing and Midwifery Council (NMC), following the release of a damning report by former chief crown prosecutor Nazir Afzal, and Rise Associates. Nursing leaders are concerned that despite promises from the NMC, little will change and public confidence will not be restored.

The NMC regulates more than 808,000 nurses and midwifery staff in the UK. The Independent Culture Review, published 9 July, found a toxic culture at the NMC with serious bullying and racism.

A particular focus was the fitness to practise cases (FtP), of which there is now a backlog of almost 6,000, and the detrimental effect on staff of these not being dealt with in a timely and appropriate manner. Often good nurses have been investigated for several years over minor issues, causing extreme amounts of stress. The report noted that six nurses had died by suicide or suspected suicide since April 2023 while under investigation by the NMC.

In other situations nurses who had strong cases against them were continuing to practice because the FtP process was taking too long, potentially putting others in danger.

Racism and discrimination in the NMC was found to have resulted in people leaving. Interviews of staff showed that their experiences “stood in stark contrast” to the NMC’s commitment to treat everyone fairly and with kindness.

The report contained 36 recommendations for the NMC, which include eliminating the FtP screening backlog by 2025, a specialist team for complex and serious cases and publishing an anti-racist action plan. The NMC has said it will implement all recommendations.

The review was commissioned by the NMC itself triggered by claims made by a whistleblower reported in The Independent that a “culture of fear” exists within the regulator.

This is just the latest in reports into the culture at the NMC, where claims of bullying, racism, incompetence and a dysfunctional workplace failing patients and professionals, have been under scrutiny for well over a decade. 

In 2008 a report by the department of Health investigated allegations of racism, bullying and serious concerns on FtP. In 2012, there was a strategic review for the Council for Healthcare Regulatory Excellence, which found weakness in governance, leadership, decision making and operational management. The NMC was also criticised in the Francis Report, into the failings in care at Mid Staffordshire NHS Foundation Trust. 

The Chief nursing officers (CNO) from England, Wales and Northern Ireland, reacting to the review on social media site X, all said that they had been raising concerns with the NMC for “some time”.

It is therefore not surprising that The Queen’s Nursing Institute (QNI) has not been assured by the response from the NMC and has written to the new health and social care secretary, Wes Streeting, requesting the government begin an independent review of the regulator and the performance of its regulatory functions.

The letter states that the “Nursing and Midwifery Council has been dysfunctional for decades with significant issues around culture, the management of fitness to practise cases and the exercise of its regulatory functions.” 

And a review was “essential to restore public confidence and the confidence of the profession”.

The QNI is concerned that despite the NMC’s response to the published review, the NMC “will do little to address the issues highlighted by the whistleblowers.”

Noting that the NMC “has already spent a considerable sum of money employing a reputation management company to help them manage the fallout from their own review of their culture. This suggests that they are more concerned about how the organisation is perceived than how it operates.” 

The NMC has agreed a contract with River Effra, the PR company that worked for the Police Federation during the Stephen Lawrence Inquiry and the Charity Commission’s inquiry into Oxfam.

Just before the Culture Review’s publication, the NMC’s new interim CEO and registrar Dawn Broderick resigned after just four days in the job,  following concerns of her involvement in an NHS race discrimination case. The Independent reported that staff had come forward to them concerned that the appointment indicated that the board would not take racism seriously. The NMC had originally defended the appointment of Ms Broderick to replace the previous CEO Andrea Sutcliffe, who stepped down due to ill health.

Ms Brodrick was previously chief people officer at King’s College Hospital NHS Foundation Trust when it was found to have discriminated against a Black employee.

The Royal College of Nursing (RCN) acting general secretary and chief executive, Nicola Ranger, said the Culture Review “makes for distressing reading and shows the NMC is failing in a number of its core duties.”

“The majority of nursing staff will never appear before the NMC but those who do deserve a process which is transparent and fair; free from racism and all forms of bias; and timely, recognising the impact on individuals.”

The published Culture Review is the first review to report; two further reviews into the NMC’s handling of FtP cases and treatment of whistleblowers led by Ijeoma Omambala KC are due to publish later this year. 

The NMC is not the only nursing organisation to be facing criticism of its culture; the RCN has been heavily criticised in recent years for a dysfunctional culture that upholds racism and bullying, as detailed in the Carr Review in 2022, and has now launched a strategy to become a more diverse, inclusive, and reflective organisation that truly understands and represents its members, noted Nicola Ranger. 

This week has also seen a letter demanding that, Wes Streeting, steers the NHS into tackling racism set up by the human rights charity Brap. In June 2024, a Nursing Times investigation found that the problem of racism is getting worse, despite awareness of racism increasing. With the Nursing Times being told that racism is not being taken seriously in the NHS and that it has become so “normalised” that many Black nurses did not report it. 

The Brap letter said Mr Streeting had the “opportunity” to create a “more equitable and inclusive” NHS.

The letter was co-signed by Michelle Cox, Queen’s nurse and race equality consultant, along with Brap chief executive Joy Warmington and Middlesex University research fellow Roger Kline.

Ms Cox won an employment tribunal case against her NHS employer recently, after she experienced racism at the hands of senior leaders.

Her employment tribunal, supported by the RCN, ruled, on the balance of probabilities, that race did, in fact, play a large part in Ms Cox’s treatment.


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