Evidence of discrimination against BME nurses revealed

Black and Asian nurses and midwives are being disproportionately referred to the Nursing and Midwifery Council (NMC) by their employers, according to a new report.

Black and Asian staff are being disproportionately referred to the Nursing and Midwifery Council (NMC) by their employers, according to a new report.

BME people are more likely to be referred to the NMC. Picture: Charles Milligan

University of Greenwich researchers responded to an advert by the profession's regulator that offered funding for an investigation into its fitness-to-practise (FtP) processes amid concerns about the treatment of NHS staff with black and minority ethnic (BME) backgrounds.

They found a strong link between ethnicity and the risk of being referred to the NMC, as well as evidence showing that black and Asian nurses and midwives are far more likely to advance further along the FtP process than white staff.

Lead researcher and former charge nurse at Royal Edinburgh Hospital Elizabeth West says an article in Nursing Standard three years ago alerted her to the problem.

‘I distinctly remember Jennifer Sprinks’s article in 2014 in which she found that, despite making up only 19% of the nursing workforce in England, BME staff account for more than 25% of the disciplinary cases heard in 2013.

‘When we heard the NMC was looking for an organisation to investigate its FtP data specifically in relation to BME staff, we jumped at the chance because this has never been done before.

‘There has always been qualitative data detailing the experience of individuals, but here for the first time the NMC was giving us complete access to its caseload.’


Before analysing the data, the researchers used a number of mathematical equations to predict what they would find. They compared the number of BME staff working in the NHS in the UK with the 5,851 cases heard by the NMC in 2014.

Based on these figures, they expected to find the ethnicity of registrants referred to the NMC by their employers to be: 95 Asian, 228 black and 988 white. Instead the data show: 113 Asian, 262 black and 865 white.

4 October

The date when Elizabeth West is due to present her report to the four UK chief nursing officers

They went on to discover that cases brought against staff of ‘white’ or ‘other’ ethnicities are more likely to be closed at the screening stage than those brought against people of ‘Asian’ or ‘black’ ethnicities, which are more likely to be closed at the investigation stage.

Professor West adds: ‘BME staff go further along the FtP process when referred by employers and this made us wonder what is happening in the work setting to cause that. While we don’t have the answer, this investigation has crystallised our thinking and shown us where future research needs to be carried out.

‘I want to explore the hypothesis that the risk of a BME member of staff being referred by their employer is directly linked to the kind of work they are doing.

‘It is in care homes and social care settings where you traditionally find a greater concentration of BME workers, who also tend to be stuck in the lower levels of the career hierarchy due to factors such as lack of staff and fewer promotion opportunities.’

Professor West presented her findings on 7 April at the RCN international nursing research conference, in Oxford. She has also presented them to an NMC stakeholder panel that included representatives from the RCN, Royal College of Midwives and NHS Employers, as well as two other academics with experience dealing with BME discrimination in the NHS.

One of them, Uduak Archibong, is director of the Centre of Inclusion and Diversity at the University of Bradford, where in 2010 she carried out research on allegations of discrimination against BME nurses. This found that BME nurses and midwives are twice as likely to enter disciplinary procedures as white colleagues.

1 in 5

of nurses and midwives are from BME backgrounds

Source: NHS England 

Professor Archibong says: ‘We worked with nine health professional regulation organisations, including the NMC, and concluded they had become the dumping ground for employers to get rid of BME-related problems they didn’t want to deal with themselves.’

This month, Professor Archibong will publish a report commissioned by NHS England, which has asked her to re-examine her research. This was done by holding a series of round-table discussions with BME representatives, regulatory bodies and professionals working in human resources.

She says: ‘My conclusion is that here we are, seven years on, and nothing has changed.

‘If the employers do not have a “tidy” system in place for performance managing BME staff then regulators like the NMC will continue to be a dumping ground.


‘The Greenwich report just confirms our fears and also shows that, as long as regulators continue to trust referrals from employers above all others, BME staff are going to continue to be at a disadvantage. The FtP process can take years in some cases to complete and leaves the individual feeling anxious and afraid for their jobs.

‘It is frankly shocking the level of inhumanity we see in the NHS with regard to how staff are treated because of this systemic failure.’

Asked what should happen next, Professor Archibong says: ‘There is no point spending another six months and a huge chunk of NHS budget to gather further information on what we already have ample proof of.

‘Someone, somewhere, has got to be prepared to accept there is discrimination against BME staff in the NHS and take positive action to tackle it.’

The other academic who attended Professor West’s presentation was joint director of the NHS England Workforce Race Equality Standard implementation team and Middlesex University research fellow Roger Kline.

Describing the report as ‘good but long overdue’, he says: ‘There is, however, a serious risk it will gather dust unless the issue of disproportionate referrals by employers is addressed.

‘All senior nurses should read those findings carefully and reflect on what they mean, not least for BME staff who may have suffered career-ending referral for no good reason.’

The NMC has statutory duties under section 149 of the Equality Act 2010, which requires it to have due regard to eliminate unlawful discrimination, harassment and victimisation.

Its equality and diversity report for 2015-2016, paragraph 23, states: ‘We will be receiving and taking stock of our research into BME registrants referred to FtP, and the findings are likely to prompt actions from the NMC and potentially, for others.'

An NMC spokesperson adds: ‘There is an appetite to understand more about this research and to work together to drive forward positive changes.’

Recommendations in Elizabeth West and Uduak Archibong’s reports

  • Training for staff, managers and university students in areas such as unconscious bias.
  • More comprehensive induction programmes for new staff from black and minority ethnic (BME) backgrounds, especially internationally recruited nurses.
  • Changes in workplace culture to address discrimination; this can be effective only if led by management.
  • Training to help staff understand the difference between performance management and disciplinary issues; managers may be unsure of how to support BME staff or what processes to follow if an employee raises a complaint against a BME colleague.

Further information




This article is for subscribers only