This article contains reference to nurse suicide, self-harm and sexual assault, for immediate support please call the Samaritans on 116 123 or visit the Doctors in Distress website.
An independent review of the UK’s nursing regulator has identified a ‘dangerously toxic culture’ in which bullying, racism and burnout are putting nurses and the public at risk.
The damning report published today called for an ‘urgent turnaround plan’ to ‘stop a dysfunctional culture’ at the Nursing and Midwifery Council (NMC).
Led by former public prosecutor Nazir Afzal, with Rise Associates, the review warned of an NMC workforce that is ‘really struggling’ and an environment where ‘poor judgement, toxic behaviours and paralysis is affecting decision-making’.
And it revealed serious concerns around the way in which fitness to practise (FtP) cases are handled, including that action was being taken ‘against good nurses’ while ‘bad nurses get away with it’.
In a shocking finding, the review team uncovered that six nurses had taken their lives in the past year while under investigation by the NMC and that at least one parent blamed the regulator for their daughter’s death.
Alarmingly, the review also found ‘some really worrying examples of safeguarding failures’ and concerns that criminal behaviour by registrants was excused because it was deemed to be a private matter.
Among the most concerning findings were FtP cases that were closed because they happened outside clinical settings, including allegations of category A child pornography, sexual assault of patients and the rape of a colleague.
The NMC has today issued an apology and promised action to ‘deliver a culture change programme’ following a series of recommendations in the report, including more investment in people, a faster screening process to tackle complaints, a new safeguarding hub and increased black and ethnic minority managers so they can better understand the communities they serve.
A third of NMC staff emotionally drained
Over 1,000 current and former NMC colleagues and more than 200 FtP panel members shared their workplace experiences as part of the review. The review engaged with 85% of NMC staff and featured surveys, hundreds of hours of interviews and multiple focus groups.
It found that over 30% of staff felt emotionally drained from their work, more than half of staff said it was either unlikely or very unlikely that they would be able to fulfil their career aspirations at the NMC and approximately 10% of staff were reporting long-term mental health absences.
The report suggested there were ‘at least two cultures’ operating at the NMC, including some staff that ‘are content in their job’ and directorates that possess ‘healthy cultures that support the essential work of the regulator’.
‘But there are also a growing number of staff who are trapped in a dangerously toxic culture and feel deeply frustrated and upset in their jobs,’ the review said.
‘And it’s this latter culture that is starting to overwhelm the good work and do enormous damage.’
Rise Associates and Mr Afzal were commissioned to complete the independent cultural review of the NMC in January 2024, following a series of disclosures by a whistleblower in 2023, who accused the NMC of a ‘deep seated toxic culture’.
Speaking to Nursing in Practice, Mr Afzal said: ‘We found people who are confident that they can raise their concerns, but we also found people who were struggling, people who were angry, people who were frustrated, exhausted and broke down in tears as they talked about their frustrations.
‘We heard about staff suffering from mental illness, they’re on antidepressants, losing sleep, being bullied and with bad management, [and] having experiences of racism.
‘So, we call it a toxic workplace. It’s a bizarre, bizarre workplace. It almost feels like two people could meet in a corridor, one would be successful and know where they’re going and properly supported, another one would be completely broken.’
The review identified one former member of staff who was ‘hospitalised because of stress’.
‘They said their directorate was a hotbed of bullying, racism and toxic behaviour. But the people running it were too powerful and complaints were always ignored,’ it said.
Safety at risk
In the past year there have been multiple ‘Serious Event Reviews’ addressing the ‘potential failure’ of the NMC to ‘appropriately handle’ allegations of physical or sexual abuse against children taking place outside of clinical settings.
‘Some of these cases were closed at screening due to allegations that include accessing category A child pornography,’ the review said.
‘When staff questioned why these cases were not being pursued, senior leaders responded that, “this is our guidance”.’
The review team also saw ‘serious assault cases’ where ‘staff were furious at inexcusable delays protecting predators’.
In one example, the report described how complaints about serious sexual misconduct and alleged rape were made against a nurse in 2017 but that they were not struck off until 2024.
This same nurse had been accused of sexually assaulting patients and raping a colleague after spiking their drinks, but this was initially closed down on the basis that the rape took place ‘outside of work after a social event’ and the sexual assault of a patient occurred ‘outside of a hospital’.
Wellbeing in crisis
While the findings did acknowledge that ‘there are many staff content in their roles’, the report also found ‘far too many that were struggling’.
It added: ‘The tragic incidents of registrant suicide, of self-harm and untreated trauma both within NMC and by those they regulate is a call for immediate action, not a five year plus strategy.’
One respondent warned there was ‘no support’ for colleagues who are exposed to highly troubling material on a daily basis and recalled how they had personally had to review CCTV of ‘vicious patient assaults’ and incident’s involving ‘rape threats’.
‘You’re reliant on colleagues (who aren’t trained) to support you. None of us are oblivious that this job inherently involves dealing with this kind of material, but it can be haunting and no one senior cares,’ they said.
Microaggressions and racism
Over 40% of staff said they had ‘witnessed or experienced’ micro-aggressions in the last 12 months at the NMC, with the report noting ‘multiple accounts of clumsy and ignorant remarks’ being directed towards minority ethnic staff.
Complaints included a lack of diversity among panel members and how this reduced ‘courtesy’ to members and participants.
‘I was told my name was “very difficult and did I have a shortened version?”. I have an Indian name,’ recalled one NMC staff member.
One respondent said ‘nepotism is rife’ within the NMC, with ‘clear favourites’ among senior managers.
‘I have directly experienced racism and detriment in my time with the NMC and it is not a good place to work for people from my background,’ one respondent added.
‘But I stay because I believe I make a difference to the handling of black minority ethnic registrant cases.’
Another said: ‘I think hearings are often chaired by white, middle-aged ex-policemen. I think they genuinely do not understand what discrimination is… they see it as a sort of “weakness” or not “proper” somehow to support vulnerable people and make necessary adjustments. I have had another recent case where the race of the registrant affected panel member attitudes.’
‘Profoundly distressing to read’
Responding to the report Sir David Warren, chair of the NMC 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.’
Sir David gave his ‘absolute assurance’ that tackling racism, discrimination or bullying will be ‘front and centre of change at the NMC’, extending his apologies to the NMC members currently waiting for FtP outcomes and thanking colleagues for speaking out.
Andrea Sutcliffe, who stepped down as NMC chief executive and registrar last week due to ill-health, said: ‘Having received the draft of this important report three weeks after my decision to step down, I know there is powerful testimony from colleagues sharing their stories about racism, discrimination and bullying and their views of the NMC. It’s extremely important for the organisation to truly listen and respond.
‘Clearly some colleagues have had experiences at the NMC that are not acceptable and should not be tolerated. I’m devastated this has happened on my watch and I apologise to everyone affected, our colleagues, professionals on our register and the public.
‘The NMC needs a step change in its culture to ensure everyone feels supported to thrive and all benefit from the better experience some already have.
‘Regulation of nursing and midwifery professionals also needs to be consistently effective and truly person-centred.’
She added that she would be in hospital when the report is published and apologised that her ill health means she will ‘not be able to lead the necessary changes to make that difference’.
‘I hope the recommendations from the report which I commissioned with the chair will enable the Council and leadership team to ensure the NMC is a more effective regulator and a great employer for all where our values of fairness, kindness, ambition and collaboration are thoroughly embedded and lived,’ said Ms Sutcliffe.
This 2024 review follows from an earlier report conducted by the which investigated allegations of racism and bullying at the NMC, and a 2012 strategic review of the NMC for the Council of Healthcare Regulatory Excellence which found weakness in the regulator’s governance, leadership, decision making and operational management.
The new report said: ‘For well over a decade now, the regulator has been dogged by claims of bullying, racism, incompetence and a dysfunctional workplace culture that fails patients and families.
‘The repeated response from the NMC is a promise to learn lessons. Yet, given the frequency of reports and continual criticisms, questions have to be asked as to whether this commitment is genuine.’
