Nurses: Review a turning point, says RCN
Lawyers at the Nursing and Midwifery Council (NMC) found it “very hard to challenge” the orthodox approach to cases of serious misconduct outside of work, which formed part of a damning report on the regulator published yesterday.
The review highlighted concerns over how it handled safeguarding complaints about nurses, and found that people working in the organisation have experienced racism, discrimination and bullying.
Commissioned by the NMC, it was led by solicitor and former chief crown prosecutor Nazir Afzal and followed claims by a whistleblower of “a toxic culture” at the regulator, racism and failure to act over nurses accused of criminal offences.
Mr Afzal and researchers from consultants Rise Associates concluded that “everything the whistleblower documented was corroborated and we spoke to many others that had similar experiences”.
The NMC has accepted the review’s 36 recommendations, including more investment in people, a faster screening process to tackle complaints, a new safeguarding hub, and increased black and ethnic minority managers.
The review said that “a number of NMC lawyers” shared the views of other staff that safeguarding processes were “seriously flawed”, citing the case of a nurse found to be in possession of category A child pornography, which was considered to be “part of their private life so no action is taken”.
At the same time, these lawyers “acknowledged that they were in a minority and that it was very hard to challenge the safeguarding orthodoxy”.
One lawyer said they had seen “mishandling of fitness to practise cases relating to racism and sexual assault” where the public had not been protected.
“Racism cases are dropped in screening because it’s outside of the workplace and the view is, and I’m obviously paraphrasing, that ‘people are free to be racist in their own time’ because they are not involving patients.”
Another example cited by a lawyer was a sexual assault allegation “closed on the basis that the nurse drugged and raped someone outside of work”.
Researchers commented: “There was clearly a divide among lawyers around safeguarding. One member of staff, for example, told us that they were appalled at decisions made by the screening team to close down cases where nurses posed a danger to the public.
“In one case, a nurse had been accused of sexually assaulting patients and raping a colleague after spiking their drinks.
“This was closed down in the screening team on the basis that the rape was done outside of work after a social event and the sexual assault on a patient was carried out outside of a hospital as the nurse had instigated a meeting.
“The nurse had also been accused of asking patients to go on dates and requesting their phone number. Seven years after the NMC first received complaints, the nurse was finally struck off in 2024.”
Researchers said they heard of similar cases involving racism and drink driving, “with lawyers expressing deep frustration at the lack of action taken”.
One told researchers: “Some people don’t perceive racism to be a problem. But I wouldn’t want my mum treated by a racist nurse.”
But a senior nurse blamed the NMC’s “arrogant” legal team for safeguarding failures.
“I’ve been very proud of the NMC but in response to recent safeguarding cases I have been shocked to my bones about their processes.
“The legal team is arrogant and really does not give credibility to the level of skills and experience that we all cover.
“They need to look at the skills and knowledge of people in their fitness to practise team. There is a problem in the NMC around how they escalate concerns.”
Other members of staff spoke of “safeguarding generally being devalued” across the NMC.
“Unless you’re from a legal background you know your expertise isn’t valued in the same way that it is, if you’re from a clinical or a safeguarding or any other expert background.”
Researchers recommended that the regulator “clarify the relationships between legal teams across the NMC and the role of legal expertise in multi-professional teams”.
The experience of racism within the NMC was also highlighted, with “a number of white employees” sharing concerns around the discriminatory culture that existed in their directorates.
“There was a lot of racism in my team,” one ex-employee was quoted as saying. “I always heard people complaining that there were too many of them, referring to Asian lawyers.”
The review said it also heard “many difficult accounts from people who said they had worked incredibly hard and not been able to become a lawyer or progress their career – and had been sold false hopes about opportunities in the NMC in the process”.
Describing the review as a “turning point”, the NMC apologised and promised to deliver a “culture change programme” rooted in the recommendations.
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