Independent review denounces ‘widespread’ toxic culture at nursing regulator charity 

09 Jul 2024 News

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Nursing and Midwifery Council

An independent review has reported a “widespread” toxic culture at the Nursing and Midwifery Council (NMC).

In January, NMC commissioned former chief crown prosecutor Nazir Afzal and specialist consultancy Rise Associates to review its internal culture in the last five years following several disclosures by a whistleblower last year.

Afzal and Rise Associates’ review, published today, found long-standing issues at the charity including bullying, racism, incompetence and a dysfunctional and toxic culture. 

NMC apologised and pledged to “deliver a culture change programme” rooted in the review’s 36 recommendations.

This comes after a recently appointed interim chief executive of NMC, which the Charity Commission is currently investigating due to concerns over its governance, resigned before starting the role.

‘Bullying, racism, incompetence and dysfunctional workplace culture’

The review says that NMC has been dogged by “claims of bullying, racism, incompetence and a dysfunctional workplace culture that fails patients and families” for over a decade.

Staff recounted experiences of racism in the workplace, people being afraid to speak up and nurses accused of sexual, physical and racial abuse being allowed to keep working on wards.

The review shows that an early indication of some of the cultural problems encountered was found in an online survey emailed to all NMC staff and completed by 1,044 employees. 

Over 30% of respondents felt “emotionally drained from their work often or all of the time and over 40% “had witnessed or experienced micro-aggressions” over the last 12 months. 

There is “a dysfunctionality” causing emotional distress to staff and preventing the organisation from properly functioning at every level of the charity, the review says.

“In the course of our review, we heard of many poor behaviours including racism, bullying and discrimination. 

“But while these combined to create a toxic culture in certain parts of the organisation, it begged the question: how have these deep-seated issues ultimately impacted on NMC’s mission to protect the public?”

The review also finds that the number of sickness days at NMC due to stress, anxiety and depression almost doubled between 2018 and 2023 from 1,220 to 2,389. 

NMC is beset with systemic issues

Interviews with NMC’s executive and senior leadership show that the team is “not functioning properly” while there is a “major split between long-standing leaders and newer members who couldn’t understand why problems repeat, why there has been a lack of urgency on the case backlog and why progress to make change is slow”.

The review adds: “NMC is beset with systemic issues which have not been addressed with a sustainable approach. The lack of visible diversity in the top leadership team is in stark contrast to the junior bands and the nursing and midwifery profession as a whole.

“Worse, there is little evidence that efforts are being made to improve things. ‘Things are done for show’ was a common refrain from staff, but ‘nothing changes’ is the disheartening conclusion.

It concludes that a combination of Covid-19, pressures of a growing backlog of fitness to practise cases – which is close to 6,000 – and a senior leadership team that has failed to meet the existing challenges “has created a perfect storm that’s doing great damage to NMC”. 

‘NMC is in the last chance saloon’

Afzal said: “We found that the whistleblower was right to speak up. 

“In fact there could have been a hundred more whistleblowers, as many people we spoke to had very serious concerns. But they had no confidence that speaking out would lead to any change.

“We know there are a lot of good people working at NMC, and this report will be difficult reading for them. 

“But they know NMC is in the last chance saloon and the chair has assured us that their priority is delivering urgent transformation to rebuild confidence, protect the public and ensure that all nurses and midwives are treated fairly.”

NMC: ‘We accept the review’s recommendations’

In light of the review’s findings, NMC apologised and accepted its recommendations.

On racism, discrimination and bullying, it said that these “should never have had any place” at the charity.

“Where it’s been raised in the past, the organisation hasn’t taken enough action to address it and hold people to account. The report’s recommendations will help to address this and move NMC towards achieving racial equity for its people.

“This is a turning point for NMC. The organisation has already started to address some of the regulatory issues raised in the report.”

NMC chair David Warren said it is “a profoundly distressing report to read”.

He said: “I’m extremely sorry to hear the testimony of NMC colleagues who have shared their distressing experiences of racism, discrimination or bullying. On behalf of the Council, I give my absolute assurance that addressing this will be front and centre of change at NMC.

“I also apologise to those nurses, midwives, nursing associates, employers and members of the public for whom we have taken far too long to reach fitness to practise decisions. Afzal’s recommendations, together with our existing improvement plan, will make the step change in experience they expect and deserve.

“NMC commissioned Afzal and Rise Associates to do this review because we knew they would not hold back. We now have clear recommendations to take the organisation forward. I’m grateful to all our colleagues who have spoken up about these issues. I know that what matters to them now is action, not words.”

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