Too many BME nurses – and men – being referred to the NMC, report reveals

Disproportionate numbers of nurses from black and minority ethnic (BME) backgrounds are referred to fitness to practise proceedings, according to new data from the Nursing and Midwifery Council.

Disproportionate numbers of nurses from black and minority ethnic (BME) backgrounds are referred to fitness to practise (FtP) proceedings, according to new data from the Nursing and Midwifery Council (NMC)

The NMC has a legal duty to eliminate discrimination based on race, gender,
age and disability.    Picture: Charles Milligan 

Of the 4,512 new referrals made to the regulator last year, 740 cases, or 16%, concerned nurses who were black or mixed race. Nurses from these ethnic backgrounds account for just 7% of registrants.

In contrast, nurses from white and Asian backgrounds were under-represented. Just under half of new cases lodged with the NMC concerned nurses who were white, despite 59% of people on the register being recorded as white. A total 2% of referrals were Asian nurses. Nurses with an Asian background represent 6% of the register.

The figures were revealed in the NMC’s 2015-16 equality and diversity report, published in November. 


Number of referrals to NMC in 2015-16 

The report also uncovered the fact that men and nurses over the age of 40 are significantly over-represented in FtP figures.

Research under way

In the same report in 2014-15, there were 4,302 new referrals. Of this, 9% (393) were from a black or mixed race background, 36% (1,549) were white, 3% (145) were Asian, 1% (27) other and 51% unknown.

In the 2015-16 report, ethnicity is unknown in 35% of new referrals.

The NMC has a legal duty to eliminate discrimination based on race, gender, age and disability. In the latest report, the regulator conceded that there are ‘differential outcomes for different groups’, but did not delve deeper into the figures.

Research on the issue has been commissioned by the NMC and is due to be published in the new year.

Too many referrals 

In the report, NMC chief executive and registrar Jackie Smith said good progress was being made. ‘One of the key expectations of a regulator is that we are fair,’ she said. ‘One of the developments I am most pleased about is that we are capturing and using enhanced equality and diversity data through our new NMC Online system. As ever, we have made strong progress in some areas, and there is more to do in others.’


Percentage of referrals relating to black or mixed race nurses 

But this latest data suggest there could be some way to go to achieve an equal and fair FtP system, and follow comments from the RCN in August regarding a ‘negative and toxic climate’ surrounding race equality in the NHS.

These comments came in response to a call for evidence by Baroness McGregor-Smith, who is leading a review on the issues faced by BME staff when trying to progress at work.

RCN head of equality and diversity Wendy Irwin says that too many BME nurses end up in front of an NMC hearing. 

‘Cannot rule out racism’

‘We cannot rule out the impact of racism,’ she says. ‘BME nurses are represented at FtP at twice the rate they are in the workforce. Organisations need to review their decisions they make to refer BME nurses to FtP, and see if there are some local interventions they can implement that will have the same level of patient safety without having to refer.’

Director of workforce race equality standard (WRES) at NHS England Roger Kline, says that many more BME nurses are referred to the NMC because more end up in local disciplinary proceedings than white nurses.

In 2010, research conducted by the University of Bradford’s centre for inclusion and diversity found that BME NHS staff are twice as likely to be referred to their employer’s disciplinary proceedings as their white counterparts.

Mr Kline says that these findings have been backed up by national information collected as part of the WRES, and the data will be published in February.

‘Punitive’ process

Research suggests there is a tendency to formalise processes with BME staff more than with white colleagues. Some overseas staff are also poorly prepared for their new work environment by inadequate inductions, according to Mr Kline.


Percentage of black or mixed race nurses on the register 

‘It is not because disciplinary processes are different, or because BME staff are much more likely to do things that would lead to them being disciplined, but because managers are much less likely to have informal conversations with black staff as they would when white staff make a mistake, and instead of doing things in a supportive way, they are done in a punitive way,’ he says.

This problem could be addressed by having all cases referred for disciplinary proceedings at a trust checked by either a senior nurse or someone from HR, claims Mr Kline. ‘What changes it is when there is some sense of accountability. If managers have to justify to someone why they started a case that will force them to think about whether they should do it differently.’

Mr Kline called on the NMC to address why so many BME nurses were being referred. ‘The NMC has been reluctant to acknowledge that the real problem is the disproportionate referrals of BME staff, and have been slow to put in place proper ethnicity monitoring and reluctant to talk to employers about why this is happening,’ he says.

An NMC spokesperson told Nursing Standard: ‘The NMC has commissioned research in to this area, which will be published in the new year.

‘We are working closely with a variety of stakeholders, including employers, professional associations and trade unions to identify any areas of action.’

Men in FtP proceedings

  • Men remain significantly over-represented in FtP proceedings compared to women, the new figures from the NMC reveal.
  • Almost one quarter of referrals to the NMC relate to men, despite them only making up 11% of the register.
  • One third of the registrants struck off are men, the figures reveal. One suggested explanation is that more men work in mental health settings, an area disproportionately represented in FtP proceedings.

RCN employment relations adviser Nicola Lee says more detail and research is needed to understand the complex reasons why so many men are being referred.

‘Male nurses tend to work in mental health settings and nursing homes, particularly those who are internationally recruited, and we know that there are more referrals from these settings,’ she says. ‘Black men are disproportionately referred and they tend to be in the frontline areas, whereas white men aren’t because they tend to be in management.’

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