NURSING regulator on Tuesday (9) apologised after an independent culture review raised alarm over safeguarding issues within the organisation and uncovered instances of racism, discrimination, and bullying experienced by its employees.
The review by former chief prosecutor Nazir Afzal and Rise Associates raised serious concerns about a toxic culture within the Nursing and Midwifery Council (NMC), which oversees thousands of nurses and midwives.
According to the review, good nurses often face lengthy investigations for minor issues, while some under performing ones escape consequences. Many NMC staff feel stressed, frustrated, and unsupported. Dysfunction was found at nearly every level of the regulator, it said.
The review was commissioned after concerns were raised about the organisation’s culture, including racism and fear of speaking up. As part of the review, over 1,000 current and former colleagues of the NMC, along with more than 200 panel members involved in fitness to practise hearings, shared their personal experiences.
It heard distressing accounts of staff needing antidepressants, experiencing hair loss, and struggling to sleep due to bullying and bad management. While some staff were content, a significant number were struggling severely.
"There was anger, frustration, and exhaustion among many," the report said. "Staff broke down in tears recounting frustrations over safeguarding decisions that endangered the public."
The review also highlighted cases where complaints were dismissed because incidents occurred outside of work.
One NMC lawyer said, "Racism cases are dismissed in screening because they happen outside of work and the view is, paraphrasing, that 'people are free to be racist in their own time' since patients aren't involved."
The review outlined several key recommendations to address the organisation's issues. To improve leadership and management, the review suggested transforming the NMC into a people-focused entity with significant investment in staff, implementing 360 feedback for leadership appraisals, and ensuring high completion rates for appraisals that include management and EDI objectives.
It also called for better communication and training on workplace dignity policies, and strengthening measures against bullying and harassment.
In terms of regulation, the NMC is urged to eliminate screening and investigation backlogs by 2025 and 2026, respectively, improve operational data transparency, and manage complex cases with a specialist team. The establishment of an Independent Oversight Board is recommended to enhance transparency and complaint management.
Additionally, the NMC should prioritise to invest in leadership development, and ensure consistent standards across its operations.
For equality, diversity, and inclusion, the NMC should develop an Anti-racist Action Plan, aim for greater diversity in senior positions, and continue public reporting on pay gaps.
The review also stressed the need for improved safeguarding measures, collaboration with other agencies, and clearer processes for managing fitness to practise cases during criminal investigations.
The NMC is also encouraged to adopt a data-driven approach for better regulatory process delivery and increase the diversity of its registrant panel members.
The regulator accepted all these recommendations and said that it has already started to address some of the regulatory issues raised in the report.
Sir David Warren, chair of the council, said, "This is a profoundly distressing report to read. First and foremost, I express my condolences to the family and friends of anybody who has died by suicide while under fitness to practise investigation.
"Nazir Afzal’s recommendations, together with our existing improvement plan, will make the step change in experience they expect and deserve."
He added, "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.”
A spokesperson for the Department of Health and Social Care stressed the importance of ensuring that whistleblowers can voice their concerns freely, with the assurance of support and action. The spokesperson noted that the review provides clear recommendations for the NMC and expressed an expectation for the council to respond promptly and decisively.
A protestor is detained by the police during a demonstration against the proposed site of the new Chinese Embassy, outside Royal Mint Court, in London. REUTERS/Carlos Jasso. 
