The Nursing and Midwifery Council (NMC) has said Nazir Afzal’s independent report into its culture will be a turning point for the organisation after evidence of staff being subjected to racism, discrimination and bullying was revealed.
The report concluded that there are fundamentally two separate cultures within the NMC — one which could see two people pass in the corridor with polar opposite experiences.
The NMC has acknowledged the report’s findings and apologised, vowing to undergo a culture change programme backed by the recommendations made as part of the review.
Part of this change, according to the NMC, is continuing its £30m fitness to practise plan that was announced in March to help reach decisions in a more timely and considerate manner.
The report found that, since April 2013, six people have died by suicide or suspected suicide while under or having concluded a fitness to practise investigation.
The plan is described by the review team as an opportunity to deliver the decisive and transformational shift necessary, but the requisite culture change will not come from policy, processes or technology — it will have to come from the people.
The review captures a culture of blame where leaders consult but do not collaborate and confidence is replaced by defensiveness.
The NMC’s chair, Sir David Warren, described the report as “profoundly distressing” to read. “I am extremely sorry to hear the testimony of NMC colleagues who have shared their distressing experiences of racism, discrimination or bullying,” said Warren.
He continued: “On behalf of the Council I give my absolute assurance that addressing this will be front and centre of change at the 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. Nazir Afzal’s recommendations, together with our existing improvement plan, will make the step change in experience they expect and deserve.”
The review’s 36 recommendations, which have been accepted by the NMC, cover leadership, performance, transparency, recruitment and retention, EDI, and safeguarding to name a few.
As well as pointing to how it strengthened guidance around decision-making for concerns about sexual misconduct and other forms of abuse in February, the NMC has identified a number of immediate steps it is going to take.
These include:
- Appointing an EDI advisor to the executive board
- Increasing the diversity of the executive board
- Doubling the amount spent on learning and development — the NMC says this investment should help it make improvements in leadership, safeguarding, and casework by October.
- Launching a new behavioural framework to support recruitment, development, career progression and performance management in September
- Investing in a partner to improve psychological safety in teams, starting in the professional regulation directorate which includes fitness to practise, and registration and revalidation
Andrea Sutcliffe, who officially stepped down as the NMC’s CEO and registrar on the day of the general election due to ill health, said it is “extremely important” for the NMC to listen and respond to the contents of the report.
“I’m devastated this has happened on my watch and I apologise to everyone affected, our colleagues, professionals on our register and the public,” said Sutcliffe.
“The NMC needs a step change in its culture to ensure everyone feels supported to thrive and all benefit from the better experience some already have. Regulation of nursing and midwifery professionals also needs to be consistently effective and truly person-centred.”
Acting general secretary and CEO at the Royal College of Nursing, Nicola Ranger, said that recognition of the failings set out in the report would signal “a start” to this process. Trust will only be re-established through and immediate and sustained action, however.
Ranger added: “The majority of nursing staff will never appear before the NMC but those who do deserve a process which is transparent and fair; free from racism and all forms of bias; and timely, recognising the impact on individuals.
“The second review, by Ijeoma Omambala KC, must take note of these findings but follow in good time and make more substantive recommendations — the case for change is urgent.”
The Royal College of Midwives’ CEO, Gill Walton, commented: “Sadly, what this damning review has shown is that our regulator, in which midwives must place their trust, does not embody the values it expects from its registrants.
“We have long argued that the NMC is under resourced, and the impact of that is clear to see in this review.”
She added: “The pressure and lack of leadership at various levels has led to a loss of compassion, not only for colleagues but for those going through the fitness to practise process. While I commend the NMC for commissioning this report, it must now learn from it and make the immediate and essential changes to put fairness at its heart.”
Nazir Afzal’s report, in collaboration with Rise Associates, was commissioned at the start of this year after a whistleblower claimed in 2023 that a “deep seated toxic culture” was leading to skewed and failed investigations within the NMC.
The report’s authors say that everything they documented was corroborated by their findings.
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