The Nursing and Midwifery Council (NMC) has apologised and promised action after an independent review of its culture highlighted safeguarding concerns, and found that people working in the organisation have experienced racism, discrimination and bullying.
The NMC responded by stating that it takes the findings "extremely seriously" and will deliver a culture change programme rooted in the review’s recommendations.
The NMC commissioned Nazir Afzal OBE and Rise Associates to carry out the review after concerns were raised about the organisation’s culture, including racism and fear of speaking up. Over 1,000 current and former NMC colleagues, plus more than 200 panel members who sit on fitness to practise hearings, shared their lived experiences as part of the review. The NMC accepts the report’s recommendations.
The NMC’s casework brings it into contact with members of the public, employers and professionals on the register, and the regulator has a responsibility to recognise if anyone has vulnerabilities it needs to consider. As highlighted in the report, since April 2023, six people have died by suicide or suspected suicide while under, or having concluded, fitness to practise investigation. The NMC said that it offers its sincere condolences to their relatives.
Sam Foster, Executive Nurse Director of Professional Practice and the NMC’s executive safeguarding lead, has led an expansion of resources for the safeguarding team over recent months. Sam is increasing knowledge and training, alongside strengthening the regulator’s operating procedures. This builds on work started several months ago to better understand how the NMC can improve its processes to reduce the impact and risk of harm to people – this work will be completed by September. The organisation is also establishing a safeguarding hub, which will provide advice to staff working in fitness to practise.
The report finds a link between the NMC’s regulatory performance and its culture. In particular, the ongoing challenges with the high fitness to practise caseload have put some of the NMC’s people under immense pressure. As well as following through on the report’s recommendations, the NMC will continue to deliver its £30m, 18-month plan to make a step change in fitness to practise. This plan was announced in March, with a clear goal to reach decisions in a more timely and considerate way.
The report finds there are at least two cultures at the NMC – colleagues might pass each other in a corridor with experiences that are worlds apart: one may be on an upward career trajectory, highly motivated and satisfied with their work. The other may be subject to bullying and harassment.
Racism, discrimination and bullying should never have had any place at the NMC. Where it has been raised in the past, the organisation hasn’t taken enough action to address it and hold people to account. The report’s recommendations will help to address this and move the NMC towards achieving racial equity for its people.
The organisation says that it has already started to address some of the regulatory issues raised in the report. For example, in February, the regulator strengthened its guidance on concerns about sexual misconduct and other forms of abuse outside professional practice – making it absolutely clear that whether they occur within or outside a work setting, the regulator takes these concerns extremely seriously.
Sir David Warren, Chair of the Council, said: “This is a profoundly distressing report to read. First and foremost, I express my condolences to the family and friends of anybody who has died by suicide while under fitness to practise investigation. Our safeguarding lead is urgently revisiting those cases and examining the impact of our processes on all those who are involved in them.
“I am extremely sorry to hear the testimony of NMC colleagues who have shared their distressing experiences of racism, discrimination or bullying. On behalf of the Council I give my absolute assurance that addressing this will be front and centre of change at the NMC.
“I also apologise to those nurses, midwives, nursing associates, employers and members of the public for whom we have taken far too long to reach fitness to practise decisions. Nazir Afzal’s recommendations, together with our existing improvement plan, will make the step change in experience they expect and deserve.
“The NMC commissioned Nazir Afzal and Rise Associates to do this review because we knew they would not hold back. We now have clear recommendations to take the organisation forward. I’m grateful to all our colleagues who have spoken up about these issues. I know that what matters to them now is action, not words.”
Responding to the report, RCN Acting General Secretary and Chief Executive Nicola Ranger said: “The Nursing and Midwifery Council plays a crucial role in health and care and it must be fit to uphold standards and safeguard the public. This report makes for distressing reading and shows the NMC is failing in a number of its core duties.
“The recognition of the failings in this report is a start. But the trust of nursing professionals and patients will only be re-established through immediate and ongoing action. We are committed to ensuring that, in future, the NMC represents the modern reality and interests of nursing, midwifery and patients.
“Deep-rooted issues take time to resolve but there can be no further delay in addressing the backlog of cases and making genuine improvements to fitness to practise screening, investigation and adjudication. As ever, the RCN will represent the views of many registrants to secure the necessary reforms and improvements.
“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 second review, by Ijeoma Omambala KC, must take note of these findings but follow in good time and make more substantive recommendations – the case for change is urgent.
“The RCN is on its own journey and has recently launched a strategy to become a more diverse, inclusive, and reflective organisation that truly understands and represents its members. Through this process, we have seen that many nursing staff experience racism and bullying every day from colleagues and patients - this is never acceptable and the NMC must be fit to play a stronger part in bringing it to an end.”
