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Regulator has ‘dysfunctionality at every level’, finds review

Published on: 9 Jul 2024

The Nursing and Midwifery Council has dysfunctionality “at virtually every level and across all directorates” — and instances of racism, bullying, and discrimination — according to an independent review of its culture.

The report into concerns at the regulator, published today, found a “fundamental disconnect between what the NMC embraces and what it practises”.

The review was commissioned by the NMC in January following concerns raised by a whistleblower, who claimed a “deep-seated toxic culture” was leading to skewed and failed investigations.

It found “angry, exhausted and frustrated” staff, whom the authors saw “break down in tears as they recounted their frustrations over safeguarding decisions that put the public at risk”.

It said: “We heard staff talk about taking antidepressants, managing their hair falling out, and not being able to sleep because of bullying and bad management. And we heard staff angrily recount experiences of racism within the workplace…

“At virtually every level of the organisation, across all directorates, we witnessed dysfunctionality that was causing emotional distress to staff and preventing the organisation from properly functioning.

“This is perhaps best illustrated through comments from a senior leader who referred to a ‘low trust environment characterised by suspicion, fear, blame, resistance and silos.’”

The review gathered evidence from more than 1,000 current and former NMC staff, as well as more than 200 panel members who sit on fitness to practise hearings, over a five-month period.

Delays

The report also highlighted ongoing delays in the NMC resolving fitness-to-practise cases and their impact, including heightening safeguarding risks and the toll on those waiting years for a decision.

In one case, a nurse who was accused of serious sexual misconduct and alleged rape in 2017 was not struck off the register until seven years later, in 2024.

A senior nurse was quoted as saying: “There have been six suicides in the last year of registrants who are going through the fitness-to-practise process, and they have been waiting for four or five years.

“The NMC are leaving people in limbo, and because there are too few clinical voices in the process, they often don’t understand what they are investigating.”

Some staff from ethnic minority backgrounds told of sitting on recruitment panels where colleagues had expressed racist views towards the candidates.

One person is alleged to have said they went through a list of foreign-sounding names and said: “How are we supposed to appoint anyone from this garbage?”

However, the report’s authors stressed there were positive instances and found examples “where empathy was not in short supply”.

One staff member told of how they were supported when their partner died, while some white workers said they were concerned about having witnessed their ethnic minority colleagues being treated unfairly.

‘Dangerous groupthink’

Nazir Afzal, a former chief crown prosecutor for the North West of England, whose team was commissioned to conduct the review, said: “We have found a workforce that is 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 is not functioning as well as it should.”

He added: “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. There is a dangerous groupthink that has gone unchallenged for too long.”

The NMC has apologised to staff who have experienced racism, discrimination or bullying and committed to a change programme after accepting the report’s recommendations.

Andrea Sutcliffe, who stepped down as NMC chief executive and registrar earlier this month as she is undergoing neurosurgery for a tumour, said in a statement she was “devastated this has happened on my watch and I apologise to everyone affected, our colleagues, professionals on our register and the public”.

She added: “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.”

An interim replacement chief executive who was appointed last month was forced to step down just one day into the role, following criticism of her appointment.

Campaigners pointed out that Dawn Brodrick was the chief people officer at King’s College Hospital Foundation Trust during a high-profile discrimination case, which led to a £1m payout.