Toxic culture at NMC is endangering nurses’ lives
Posted 09 July 2024 - 00:01
Nurse suicides, racism, fitness to practise backlog and safeguarding concerns must prompt nurse regulator to produce urgent plan to transform how it operates, lawyer-led review finds
A toxic and dysfunctional culture at the nursing regulator is endangering lives, with six registrants having reportedly died by suicide in the past year while under investigation, a review found.
A senior lawyer was commissioned by the Nursing and Midwifery Council (NMC) to conduct an independent review of its culture. Speaking ahead of the publication of his review report, former chief Crown prosecutor for north west England Nazir Afzal said the regulator is now in ‘the last-chance saloon’. He revealed his review team had uncovered bullying, racism and burnout in the organisation, pointing to an urgent need for a turnaround plan.
NMC’s culture of fear and cronyism, along with casual racism
The NMC commissioned Mr Afzal’s report, published today (Tuesday 9 July), following allegations by a whistleblower that a deep-seated toxic culture was leading to skewed and failed fitness to practise (FtP) investigations.
The official accused the regulator of failing to tackle serious sexual, physical and racial abuse because of a culture of fear and cronyism. Other staff alleged casual racism displayed by recruitment interview panels, day-to-day ‘micro-aggressions’ and remarks that displayed ignorance.
‘Poor judgement, toxic behaviours and paralysis in the NMC is affecting decision-making… Good nurses find themselves being investigated for years over minor issues and bad nurses are escaping sanction’
Nazir Afzal, independent reviewer
The report said the review had corroborated all the whistleblower’s claims and described it as remarkable more people had not come forward.
Mr Afzal said: ‘The culture is dysfunctional and it’s taking a heavy toll on staff, but it is also impacting on their work. We have found a workforce that’s really struggling and an environment where poor judgement, toxic behaviours and paralysis is affecting decision-making,’
‘Good nurses are finding themselves being investigated for years over minor issues and bad nurses are escaping sanction because of a system that’s not functioning as well as it should.’
Safeguarding failures and wilful blindness
The report found potentially serious failures in the FtP screening stage, where allegations – even including the accessing of category A child pornography, or sexual crimes against the public or patients – were thrown out because they related to situations outside work. In one case, a nurse had been accused of sexually assaulting patients and raping a colleague after spiking their drinks. However, the case was closed by the screening team on the basis that ‘the rape was done outside work after a social event’.
‘I 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’
Sir David Warren, chair of NMC’s ruling council
The nurse had also been accused of asking patients to go on dates and of requesting their phone numbers. It took seven years after the NMC first received complaints for the nurse finally to be struck off, in 2024.
Nurses facing minor allegations were waiting up to ten years for cases to be resolved. The report said it found failings stemmed from a culture of fear to speak up, where apathy reigns.
‘We found some really worrying examples of safeguarding failures and a culture of burnout, bullying, racism and wilful blindness that urgently needs to be addressed,’ added Mr Afzal.
The NMC recently pledged to invest £30 million to address its 6,000-case backlog. But one senior nursing figure told the investigation the process had become too ‘legal, combative and procedural' and that without reform, the NMC would struggle to reduce its backlog.
Afzal review recommendations to NMC
Nazir Afzal’s review engaged with 85% of current NMC staff, and used surveys, focus groups and hundreds of interview hours. It spoke to former staff, unions, chief nurses and midwives, staff networks and other stakeholders.
The review suggested a new structure of professional regulation should be considered, and issued the NMC with 36 recommendations, including to:
- Conduct an urgent review into safeguarding responsibilities
- Set a two-month deadline for case-screening
- Use specialist teams to manage complex cases
- Clearly define the fitness to practise process when a criminal case is underway
- Improve black and minority representation at manager level
NMC response to review of its culture
The NMC said the review report was a turning point, and it accepts all the recommendations.
Chair of the NMC’s ruling council, Sir David Warren said: ‘This is a profoundly distressing report. First and foremost, I express my condolences to the family and friends of anyone who has died by suicide while under FtP investigation. Our safeguarding lead is urgently revisiting those cases and examining the impact of our processes on all those involved.
- RELATED: FtP backlog: is NMC doing enough?
‘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 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 FtP decisions. Nazir Afzal’s recommendations, together with our existing improvement plan, will make the step change in experience they expect and deserve.’
The Department of Health and Social Care said it expected the NMC council to respond to the review's recommendations with 'swift and robust action'.
There should be no delay in addressing key issues
RCN acting general secretary Nicola Ranger said: ‘Today’s report makes for distressing reading and shows the NMC is failing in a number of its core duties. Most nursing staff will never appear before the NMC but those who do deserve a transparent and fair process that is free from racism and all forms of bias – and timely, recognising the impact on individuals.
‘Deep-rooted issues take time to resolve but there can be no further delay in addressing the backlog of cases and making improvements to fitness to practise screening, investigation and adjudication. The RCN will represent many registrants’ views to secure the necessary reforms and improvements.’
Support for you if you’re a nurse worried about suicidal thoughts
If you are struggling with mental health issues or suicidal thoughts, help is out there:
- Laura Hyde Foundation
- The Samaritans, or call 116 123
- National Suicide Prevention Helpline UK, or call 0800 689 5652
- RCN counselling service
Futher information
NMC (2024) Independent Culture Review
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