‘Dysfunctional’ culture at UK nursing regulator poses safety risk, study warns

A “dysfunctional” culture at the nursing regulator is a threat to public safety, a damning report has found, which found the Nursing and Midwifery Council (NMC) took seven years to strike off a nurse accused of rape and sexual abuse.

According to the authors of an independent investigation into the watchdog, staff at the watchdog broke down in tears “as they expressed their frustrations over protection decisions that put the public at risk”.

The review team highlighted a “toxic culture” at the NMC, with one former employee describing his section of the organisation as a “hotbed of bullying, racism and toxic behaviour”.

The report also highlighted suicides among nurses involved in long-term care pathways. suitability to conduct researchwhich highlights that some nurses had been under investigation for almost 10 years.

The authors commented on the NMC’s backlog of 6,000 cases, which meant some nurses had to wait four or five years for their investigations to be completed, even though some cases were “unfounded complaints for which no further action is required”.

A number of cases are detailed in the report, which was written by lawyer Nazir Afzal and Rise Associates.

“In one case, a nurse was accused of sexually assaulting patients and raping a colleague after spiking their drinks,” the report said.

“This was closed on the grounds that the rape had occurred outside of work, following a social event, and that the sexual assault on a patient had occurred outside of hospital, because the nurse had initiated a gathering.

“The nurse was also accused of asking patients to go on dates and asking for their phone numbers. Seven years after the NMC first received complaints, the nurse was finally struck off in 2024.”

According to the NMC, the nurse was placed under an interim order in January 2018, which “restricted their practice until she was struck off”.

A staff member also told the report’s authors: “I am surprised that a registrant could be in possession of category A child pornography and we would find that it is part of their private life, so no action is taken.”

But the NMC said officials “have looked into this case and to date have not found a case with a closure order corresponding to this”.

The investigation highlighted cases that were ‘interpreted’ because alleged incidents occurred outside the workplace. A lawyer for NMC told the investigation team: ‘Racism cases are interpreted during screening because it happened outside the workplace and the idea is, and I’m paraphrasing of course, that ‘people are free to be racist in their own time’ because they don’t involve patients.’

Staff also told the authors that the regulatory system was “not sufficiently calibrated to distinguish between serious and minor problems.”

The independent analysis found that between April 2023 and April 2024, there were six cases of suicide or suspected suicide among nurses while they were undergoing the suitability process for the profession.

“We spoke to several people who claimed that delayed investigations were a contributing factor to six nurses committing suicide in the past year,” the report’s authors wrote. “We also saw correspondence from a mother who directly blamed the NMC for her daughter’s death because of an incompetent and biased investigation.”

The report highlighted a “dysfunctional culture” at the watchdog, including allegations of racism within its ranks.

The authors said there was “dangerous groupthink” at the NMC and highlighted how leadership failed to take safety warnings seriously. They said too many staff were “struggling” and “angry, frustrated and exhausted”.

And they heard staff talking about “antidepressants, dealing with hair loss and not being able to sleep because of bullying and bad management”.

“At virtually every level of the organization … we witnessed dysfunctionality that caused emotional distress to staff and prevented the organization from functioning well,” the authors wrote.

Afzal, who led the review, said: “The culture is dysfunctional and that takes a huge toll on staff, but it also impacts on their work. We found a workforce that is really struggling and an environment where poor judgement, toxic behaviour and paralysis affect decision-making.

“Good nurses are investigated for years for minor problems, while bad nurses escape sanctions because the system does not function as well as it should.”

Responding to the report, the NMC said the review would be a “turning point” for the organisation and promised to deliver a “culture change programme”.

The chairman, David Warren, said: “This is a deeply disturbing report to read. First of all, I offer my condolences to the families and friends of all those who committed suicide while still able to conduct their investigations.

“I also apologise to the nurses, midwives, nursing assistants, employers and members of the public who have taken far too long to make fitness to work decisions.”

Asked specifically about the case in which the nurse was accused of rape, an NMC spokesperson said: “This was a complex and serious series of concerns about the same individual. Some of those concerns were initially closed but were reviewed by one of our assistant registrars, who recommended that they be investigated further.

“The individual was under a preliminary injunction restricting his/her practice until he/she was disbarred at a hearing.”