“This place is run like a cult,” NMC employee.
The Nursing and Midwifery
Council (NMC) is in trouble again. Their toxic work environment has been
exposed but not for the first time.
The NMC is the
regulator for the nursing profession in Britain, which is a very important
role. They regulate the training/education requirements to become a Registered
Nurse, Midwife or a Nursing Associate. They maintain the professional register that all Registered Nurses, Midwifes and Nursing Associates must be a
member of to work in their role. It is compulsory for anyone in these
professions to be a member of the NMC’s register. They also investigate anyconcerns raised to them about any Registered Nurse, Midwife or a Nursing
Associate, and can prosecute them in a Fitness to Practice hearing. They
are very powerful and have an important responsibility to protect Registered
Nurses, Midwifes and Nursing Associates, but most importantly to protect the
public. There is about 826,000 professionals on their register.
The NMC is a statutory body, formed by an act of parliament, but they are independently funded.
All their funding comes from the fees they charge Registered Nurses, Midwifes
and Nursing Associates to be on their register. It costs £120 a year to be on the NMC register, and all that buys is to be able to work as a Registered
Nurse, Midwife or a Nursing Associate. Their yearly revenue, for 2023 to 2024,
was £108 million. A lot of money.
In September 2023, The
Independent news website ran an exposure of the NMC. A whistleblower blew
the lid on the toxic work environment there and how it was directly impacting
on their work. The whistleblower said staff were working in a “culture of fear”
which was directly impacting on the NMC’s ability to protect the public and the nursing and midwifery profession. This involved:
·
The case of a nurse who
admitted sharing indecent images of children but was only struck off three
years later.
·
A nurse who groped a
patient and was allowed to practice as a nurse, with no restrictions, for eight
months after the case was reported.
·
A nurse convicted of
racially abusing members of the public but who faced no sanctions.
·
A white nurse was
convicted of “racially aggravated intentional harassment” but was not
sanctioned.·
A “culture of fear” in the NMC, were staff are afraid “of making mistakes” and afraid to be
honest when errors occurred.
·
Staff under pressure
with “unachievable” targets to clear
backlogs of Fitness to Practice investigations.
·
Staff were afraid to
raise concerns because they would not be acted on.
·
One member of staff
said: “We’re drowning, we’re struggling,
we’re telling people: we can’t cope with this pressure.”
·
Serious concerns of
racism in the NMC, including bullying of Black staff.
·
Staff claiming sexism
and misogyny within the NMC.
·
Male nurses make up for
80% of striking-off orders, yet they only make up 11% of those on the register.
·
More than 700 cases
have been left open, without any resolution, for three years.
·
They found multiple
cases were nurses were prosecuted, by the police, for domestic violence or
sexual assault but faced minimal restrictions by the NMC.
·
A nurse was convicted
of and imprisoned for actual bodily harm against their spouse but was allowed
to use a “good character statement”
during their hearing and was allowed to practice without restrictions.
·
A nurse was placed on
the register of sex offenders but was only given a four-month suspension by a Fitness
to Practice panel, because they felt it was of the “lower-end” of sexual assaults.
How does this protect
the public and the profession?
When the
September 2023 article came out in the Independent, the NMC responded by
commissioning an independent review of their organisation. It was headed by Nazir Afzal, the Chancellor of Manchester University and the former Chief Crown
Prosecutor for North West England. This review was published in July 2024. It is a damning report, at 133 pages long it was
very in-depth, but it made for a shocking and sickening read. I have been a
critic of the NMC, almost from their founding, but this review showed the NMC
has reached the very low depths of incompetency. It found:
·
12% of staff had
experienced bullying, in the last year, and 17% had witnessed bullying of colleagues.
·
40% of staff had
experienced or witnessed macroaggressions in the last
year.
·
Nepotism is rife.
People only got promoted if they were one of their manager’s favourites.
·
There have been large
fluctuations in staff turn-over. In 2018, 22.8% of staff left, which came down
to 9.3% in 2023.
·
There has been a 96%
increase in sickness between 2018 and 2023, mostly due to stress, anxiety and
depression.
·
The toxic culture at
the NMC is a long standing problem, as exposed by previous reports.
·
There is a blame
culture where people are afraid to speak up.
·
NMC leadership is
defensive and has tolerated bad behaviours.
·
There is a lack of
maturity around risk management.
The descriptions of
bullying were the hardest to read. I am not naïve, I know that bullying of
staff is something that is still tolerated in healthcare, which is not
acceptable on any level. How can we say we are in a caring profession, when we
tolerate bullying? How can a professional regulator tolerate bullying? Bullying
can be the topic in Fitness to Practice hearings, the defendants can be the
perpetrators or the victims of bullying. Yet the NMC tolerates it within their
own staff.
Since April 2023, six nurses have killed themselves while under investigation by the NMC. This
is the most shocking of all, that the NMC failed so completely that six people
killed themselves from the stress of being investigated by this organisation.
What has gone wrong? Why are we tolerating this?
"Good nurses are finding
themselves being investigated for years over minor issues and bad nurses are
escaping sanction because of a system that’s not functioning as well as it
should," Nazir Afzal.
This review makes
eleven recommendations, but will anything come of them? I want to say, “Time will only tell.” But this isn’t the
first time the NMC’s failings and toxic culture has been exposed (18) and yet
again here we are, exposing the same things.
The NMC quickly released their response to this review. It was high on soft promises, especially
promises to make things feel better, but low on measurable interventions. From their statement, I found the following:
·
They are investing £30
million (nearly a third of their yearly income) into a plan to improve the
Fitness to Practice process. Their promise is to reach decisions in a “more timely and considerate way.”
Though Nazir Afzal’s review recommended that screening of these should not take longer than two months.
·
They have “strengthened” their guidance when sexual misconduct and other abuse
is involved in Fitness to Practice hearings.
·
They will appoint an equality, diversity and inclusion (EDI) advisor to the Executive Board.
·
They now have a Freedom
to Speak Up Guardian available to their staff. This role was first introduced
in 2016, following the Mid-Staffordshire NHS Foundation
Trust scandal and Sir Robert Francis's inquiry (13) into it. Is the NMC only
now introducing it?
·
They will introduce “listening circles”, “improve psychological safety in teams”,
and “extending the offer of decompression
support”. But nothing about improving their complaints procedure.
·
They will be “doubling” the amount spent on learning
and development, especially with regard to leadership, safeguarding and macroaggressions. But they do not give any figure as to
what was originally being spent.
·
They will
improve their recruitment and career progression. ·
There was a high turnover of
staff, 24.5% of staff left there in 2015-2016. This is a red flag that an
organisation has a toxic culture.
·
The NMC had £41 million in
reserves but in 2015 they imposed a 20% increase in nurses’ yearly registration
fees.
·
They had 120 data breeches in 2016.
·
Their own Head of Internal Audit
found the NMC’s own
internal control, governance and risk management were failing. “Significant improvements” were needed.
·
The Head of Internal Audit also
found, due to the high turnover in staff, deterioration in Finance, Procurement,
HR and Technology Business Services.
·
The NMC took the longest to resolve
complaints against their registrants. The average was 51 weeks (just under a
year) and their longest was 401 weeks (just over 7 years).
·
They criticised the NMC for its
lack of transparency, especially around how the decisions of their Fitness to Practice
hearings were reached.
·
PSA had the power to refer
Fitness to Practice decisions to the High Court when they found that these decisions
were too lenient. They did that in 62% of the NMC’s Fitness to Practice
decisions in the 2016/2017 period.
From the NMC’s own data, I found that BME, male and
older nurses were disproportionately referred to Fitness to Practice hearings,
in 2017. I found:
·
16% of Fitness to Practice
hearings were against BME nurses, though only 7% of Registered Nurses were BME.
·
25% of Fitness to Practice
hearings were against male nurses, though only 11% of Registered Nurses were
male.
·
76% of Fitness to Practice
hearings were against nurses over 40, though only 69% of Registered Nurses were
over 40.
Even though the NMC had
a legal responsibility to reduce discrimination, apart from collecting this
data, the NMC showed no plans to investigate this nor to tackle this
discrimination.
I wrote this blog back
in 2017, listing all these failings of the NMC, from documents in the public
domain, some the NMC’s own regulator had identified, and the NMC has done
nothing to change since then. Instead the NMC has allowed its failings to just
become worse. Their failings are exposed and the NMC does nothing about them,
they certainly do not seem to be trying to improve the service they deliver.
This seems to have been their attitude since they were created. There is a
scandal and the NMC does nothing about it, certainly nothing to prevent it
happening again.
In 2008, Jim Devine MP accused the NMC of bullying and racism, in the House of Commons. The NMC denied it.
In 2009, Margaret Haywood was struck off for exposing the shocking poor standards of care at an
NHS trust. She was later reinstated on appeal, and after a very vocal
public campaign.
In 2016, Bill Kirkup MP, criticised the NMC for the poor way they handled the failings in thematernity unit, at the University Hospitals of Morecambe Bay NHS Foundation
Trust. He said the NMC had "fallen
far short of expectations". This led to the NMC being stripped oft heir role of supervising midwives and ultimately was one of the factors
that saw their chief executive, Jackie Smith, resign.
Also in 2016, the NMC charged nurse Pauline Cafferkey with misconduct just because she caught Ebola. Fortunately, this
case was dismissed.
In July this year, the
NMC had to appoint a second new CEO, in a week, after the previous one was
exposed to have been involved in a high-profile race discrimination case, in
their previous role. They were only in post 24 hours.
The Department of Health and Social Care said it expects the NMC council
to respond to the Nazir Afzal’s review's recommendations with “swift and robust action”. But has the NMC ever done this before? Why do they expect the NMC to
behave any differently now?
How can we trust an
organisation to keep its house in order when it repeatedly fails and fails and
not only doesn’t learn from these mistakes, but ignores them and then repeats
them? How in any measure, is the NMC fit for propose? They cannot even produce
a plan that addresses all the recommendations of their own independent review.
But the NMC isn’t
funded with public money, instead its funded by the yearly fee to be on its
register, so it isn’t seen as a priority by government, it isn’t seen as
“wasting” public money. And so the NMC is left alone to carry on with its toxic
culture and disgusting failure to protect the public and the nursing
profession.
I want the NMC
dissolved, it executives, broad members and senior management publicly sacked
for their failings, and their remaining staff transferred to a new regulator
who has the active involvement of the nursing profession and rigorous
government oversight. But I fear that this is just a wish of mine that will
come to nothing. What I am almost certain of, is that the NMC will increase
their fees on the back of having to sort out their own mess. Nurses will have
to pay for the NMC’s failings, again.
Drew.