An independent review of the NMC has revealed a toxic working environment where employees have experienced racism, discrimination and bullying, and highlighted the long delays for nurses facing Fitness to Practise (FtP) procedures, as well as safeguarding concerns.
The NMC commissioned Nazir Afzal OBE and Rise Associates to carry out a review after concerns were raised about the organisation’s culture, including racism and fear of speaking up. Over 1,000 current and former NMC staff, plus more than 200 panel members who sit on fitness to practise hearings, shared their lived experiences as part of the review.
The NMC has accepted the report’s recommendations and has pledged to ‘deliver a culture change programme rooted in the review’s recommendations. We apologise and promise action.’
The review group heard from over 85% of staff through a staff survey and around 65% of panel members through a separate survey. It also completed over 200 hours of interviews.
Its report said: ‘The NMC is a complex organisation, consisting of six directorates, and while there are many staff content in their roles, we found far too many that were struggling. They were angry, frustrated and exhausted.
‘We saw staff break down in tears as they recounted their frustrations over safeguarding decisions that put the public at risk. We heard staff talk about taking antidepressants, 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 in the workplace.
‘At virtually every level of the organisation, across all directorates, we witnessed a dysfunctionality that was causing emotional distress to staff and preventing the organisation from properly functioning.’
Fitness to practise
Concerns around the NMC neglecting its core purpose were frequently shared, not just from staff, but also from senior nursing and midwifery stakeholders outside the organisation.
Currently, the NMC is trying to get through a huge backlog of FtP cases, which is close to 6,000. Maintaining a register, and investigating concerns to keep the public safe, is the core business of the NMC. And yet because of the heavy backlog, registrants, patients and families are being forced to wait for years until cases are heard. Cases vary from the extremely serious, to baseless complaints where no further action is required. In all cases, it is taking too long for decisions to be taken and the delays are having a serious impact on those who have been referred. In the worst cases, nurses have taken their own lives during the FtP investigation.
One senior nursing figure told the review: ‘There have been six suicides, in the last year, of registrants who are going through the FtP process, and some 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.’
The median time to reach a hearing from receipt of the complaint was 154 weeks in 2022/23.
Other senior nursing and midwifery figures said that the process had become ‘too legal, combative and procedural’ and that unless it was reformed, the NMC would struggle to reduce the backlog no matter how much extra resources were pumped in. They added that this was having a direct impact on patient safety. ‘There will be some nurses who are not performing and there is a danger to the public. Interim suspension orders are very difficult to get when you have a significant concern around an individual. We have problems with people who are demonstrably a danger to the public, and also with those who should not be in the process and pose no danger whatsoever to the public. It’s not working.’
Safeguarding issues
The report also revealed that in the last year there have been multiple Serious Event Reviews relating to the potential failure of the NMC to appropriately handle allegations of physical or sexual abuse against children occurring outside of clinical settings, and ‘multiple examples’ where safeguarding cases have been closed by screening teams on the basis that risks occurred in registrants’ private lives.
The Review’s chair, Mr Afzal, said: ‘This review would not have taken place without the actions of a whistleblower last year who brought to the attention of the media a litany of bad behaviours and concerns that the NMC were failing to protect the public.
‘The resistance we saw to the whistleblower encapsulates a wilful deafness. Those who did complain told us accounts of grievances taking a long time to be heard and going nowhere, complaints being ignored or the complainant being punished or demoted.
The approval of £30 million of funding for the Fitness to Practise plan is an opportunity for the NMC to take a decisive and transformative shift in how it tackles the backlog, and make this a reality. But for the NMC to succeed in its mission, the culture has to change.
‘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 strategy. This requires the NMC’s leadership to depart from a position where bad behaviours are tolerated, where they consult but fail to collaborate and where confidence is replaced by defensiveness.’
Recommendations
Among the 36 recommendations are that the NMC needs to:
- Transform itself into a people focused organisation with significant investment in its people.
- Commit to eliminating the screening backlog by 2025 so that, on average, cases remain at screening for no longer than two months.
- Commit to eliminating the backlog of cases under investigation by 2026.
- Review the contact and case update arrangements for registrants and witnesses to ensure they have a better experience and make improvements
- Introduce an Independent Oversight Board to manage progress on achieving greater transparency, learning in the organisation and on how complaints/ whistleblowers are dealt with.
- Urgently review the NMC’s responsibilities regarding the delivery of safeguarding requirements.
The NMC said: ‘Change starts now with our full acceptance of the recommendations that Nazir Afzal and his team have identified. This acceptance marks a turning point for the NMC.
‘In addition to safeguarding, we've already started to address some of the other regulatory issues identified in the report. In March 2024 our Council agreed a £30m investment in an 18-month plan to make a step change in FtP, with a clear goal to reach decisions in a more timely and considerate way – we will ensure this takes account Nazir’s findings going forwards.
‘In February 2024 we strengthened the guidance we use to make decisions on concerns about sexual misconduct and other forms of abuse outside professional practice – making it absolutely clear that whether they occur within or outside a work setting, we take these concerns extremely seriously.’
Nursing & Midwifery Council. Independent review of the NMC, by Rise Associates, July 2024.
https://www.nmc.org.uk/about-us/independent-reviews/
