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An explosive review of the nursing watchdog has found a toxic and dysfunctional culture at “every level” and an organisation that turned a blind eye to serious sexual, physical and racist abuse.
Shocking failures within the Nursing and Midwifery Council (NMC) include a seven-year delay in striking off a nurse who was accused of raping a colleague and sexually assaulting a patient.
In another finding, the NMC – which regulates more than 800,000 staff – took no action despite knowing that a nurse or midwife had been accused of accessing category A images of child sexual abuse. The NMC said it could not find a record of the case.
The review, carried out by Nazir Afzal KC, was commissioned after a series of reports by The Independent revealed allegations from an inside whistleblower.
Former public prosecutor Mr Afzal said he was close to tears upon hearing the testimonies of hundreds of staff interviewed for his report.
He applauded this publication for shining a spotlight on the issue, saying: “Thank you to The Independent because you gave a voice to the whistleblower. Everything that the whistleblower has said has been confirmed by our findings.”
The former chief executive of the NMC, Andrea Sutcliffe, apologised to all those affected and described their experiences as “not acceptable”.
Following a five-month-long investigation, the report accused the NMC’s leadership of failing to take concerns seriously or to tackle problems it had been aware of for the past 15 years.
Other shocking findings include:
- Multiple failures by the NMC to act on allegations of sexual and physical abuse against children, staff, and patients
- Delays in acting against nurses accused of perpetrating mental and physical abuse
- Racism cases against workers being dropped because of an apparent attitude that “people are free to be racist in their own time”
- In cases the NMC did look at, nurses and midwives being left in limbo for up to 10 years amid a backlog of 6,000 complaints
- Six nurses taking their own lives in the last year after facing investigations that were delayed by up to five years
In one case, reported in 2018, the NMC allowed a nurse found to have referred to colleagues as “lazy ... spear-chuckers” to continue practising.
The report makes 36 recommendations, including greater investment in staff, a fast-track process to screen complaints, a new safeguarding hub, and an increase in Black and minority ethnic managers.
The whistleblower who first came forward with the allegations told The Independent: “After many years of enduring gaslighting and workplace mobbing at the NMC, it is bittersweet reading Nazir’s conclusion that my reported claims of racism, people being afraid to speak up, and nurses accused of serious sexual, physical and racial abuse being allowed to keep working on wards were all repeated to him on multiple occasions, and that everything I documented was corroborated.”
They said they would like to thank Mr Afzal and The Independent for giving them a voice and helping to bring to light “the serious public safety implications stemming from the toxic culture at the NMC”.
Mr Afzal said: “We have found a workforce that’s really struggling, and an environment where poor judgement, toxic behaviours and paralysis are affecting decision-making.
“The 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.”
Have you been affected by this issue? Email rebecca.thomas@independent.co.uk
‘This is not for us’
He added: “There are good nurses and midwives who are stuck in an investigation that goes on for years, and whose lives are devastated, and at the end nothing ever comes of it. But there are also bad nurses who are allowed to remain working because the system is full of delays.”
A key problem found by the reviewers, uncovered by this publication in January 2023, was that the NMC’s policies allowed staff to get away with abuse or racism if it was committed outside of the workplace.
A staff member quoted in the report said: “The reasoning was ‘This is not for us’, they can do what they want outside of work. It made me sick.”
In the case involving a nurse accused of sexually assaulting patients and raping a colleague after spiking their drink, the NMC’s decision not to act was made on the basis that the alleged attacks were not committed at work. This nurse was reported seven years ago, via multiple referrals, but was only struck off in 2024.
When senior leaders were asked by a staff member why they had closed a complaint against nurses and midwives accused of accessing indecent images of children, they are reported to have argued: “This is our guidance.”
‘Dysfunction at every level’
The review found that previous reports on the NMC had identified a long history of “toxic culture” dating back to at least 2005, but the concern now is that the issues are widespread.
Mr Afzal warned that the NMC is beset by systemic issues, with staff reporting that bullying and bad management had left them needing antidepressants and caused their hair to fall out.
Senior leadership at the NMC is problematic, he added: “At virtually every level of the organisation, across all directorates, we witnessed a dysfunctionality that was causing emotional distress to staff.”
Executive leaders were also criticised for treating the original whistleblower as a “source of irritation”, with the report warning that this reflected a “wilful deafness to criticism”.
Humiliation of Black staff
Examples of racism are cited throughout the report, with staff found to have been bullied and humiliated. In one shocking revelation, some Black and minority ethnic staff were told that they had been put on a list of people who could not be promoted.
The report found further instances of humiliation of minority ethnic staff through bullying, and stories of “sadistic managers who seemed to take pleasure in reducing staff to tears”.
One worker said: “White men have humiliated me. I am a Black woman ... I have never had to complain to other professionals that the way in which they treated me was humiliating and belittling. Within two years at the NMC, I have had to do it twice.”
The NMC accepted all the recommendations and pledged to put £30m of its funds into improving the situation for staff.
Sir David Warren, chair of the NMC, 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 a fitness-to-practise investigation. Our safeguarding lead is urgently revisiting those cases and examining the impact of our processes on all those who are involved in them.”
Ms Sutcliffe, who stepped down on health grounds last week after five years as NMC chief executive, said: “Clearly some colleagues have had experiences at the NMC that are not acceptable and should not be tolerated. I’m devastated this has happened on my watch and I apologise to everyone affected, our colleagues, professionals on our register and the public.”
She said the NMC needed a “step change” in its culture.
The Department of Health and Social Care did not comment on whether it would take action over the damning findings, despite promises by the health secretary Wes Streeting to protect NHS whistleblowers.
It added: “Bullying and racism are unacceptable. It is vital that whistleblowers are free to speak up, knowing that they will be supported and their concerns will be listened to and acted upon.
“This review makes clear recommendations for the NMC, and we expect its council to respond with swift and robust action.”
If you are experiencing feelings of distress, or are struggling to cope, you can speak to the Samaritans, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch.
Rape Crisis offers support for those affected by rape and sexual abuse. You can call them on 0808 802 9999 in England and Wales, 0808 801 0302 in Scotland, and 0800 0246 991 in Northern Ireland, or visit their website at www.rapecrisis.org.uk.
If you are a child and you need help because something has happened to you, you can call the NSPCC free of charge on 0800 1111. You can also call the NSPCC if you are an adult and you are worried about a child, on 0808 800 5000. The National Association for People Abused in Childhood (Napac) offers support for adults on 0808 801 0331
This story was updated on 9 July to clarify that the review found that a nurse or midwife had been accused of accessing category A child abuse images, rather than multiple staff.
