There are several healthcare regulators in the UK, with the Nursing and Midwifery Council (NMC) being one of 10. The NMC regulates over 800000 nurses and midwives. To fulfil its role, the NMC must ensure that nurses, midwives and nursing associates provide care that meets the highest standards, thereby protecting the health and wellbeing of the public. However, it could be suggested that, for some time, the NMC has not been effective in fulfilling its statutory duties.
The NMC has faced various criticisms over the years, often related to its regulatory processes, handling of complaints and the impact on professionals. In response, the NMC has made numerous attempts to improve its processes, increase transparency and engage more effectively with stakeholders. Despite these efforts, significant challenges remain.
An independent review led by Nazir Afzal and Rise Associates (Rise Associates, 2024) found that individuals working within the NMC have experienced racism, discrimination, bullying and safeguarding failures. The review reveals that the NMC is endangering the public due to its toxic culture and failure to address widespread racism within its ranks. Reports of being ignored, gaslighted and intimidated by NMC staff are deeply concerning and not what we should expect from a professional regulator.
This review comes after the recent resignation of the NMC's chief executive and registrar, followed by the brief tenure (a matter of days) and subsequent resignation of an acting chief executive and registrar.
The review highlights numerous NMC failures, including inadequate enforcement of regulations, delays in responding to critical incidents and a lack of transparency. The review calls for immediate action to address these shortcomings. There is an urgent need for a comprehensive overhaul to restore trust and ensure better compliance with regulatory standards.
The review makes 36 recommendations; the NMC has agreed to act on all of them.
The report also reveals that since April 2023, six individuals have died by suicide or suspected suicide while undergoing or shortly after concluding fitness to practise investigations by the NMC. These tragic incidents raise serious concerns about the mental health and wellbeing support provided to practitioners during these investigations. Critics argue that the stress and pressure associated with the fitness to practise process may be contributing factors. Consequently, there are increasing calls for the NMC to review and reform its investigation procedures, implement better mental health support systems and adopt a more compassionate approach to dealing with practitioners under scrutiny. The report highlights the urgent need for systemic changes to prevent further loss of life and safeguard the wellbeing of health professionals.
The Professional Standards Authority (PSA) has responded to the publication of the review (PSA, 2024). The PSA's role is to help protect the public by improving the regulation and registration of healthcare workers. It is responsible for reviewing the work of health and care regulators, accrediting organisations that register practitioners in unregulated occupations, providing policy advice to ministers and others and encouraging research to improve regulation.
The publication of this report places significant responsibility on the PSA. It must take a much more proactive approach, rigorously overseeing how the NMC responds to and implements the recommendations. It needs to ensure that the NMC not only addresses the identified failures but also takes tangible steps towards systemic improvements. The PSA must rise to the occasion, demonstrating robust leadership and accountability to restore confidence in the regulatory framework. This involves regular monitoring, transparent reporting on progress and engaging with stakeholders to guarantee that the necessary reforms are effectively carried out. The stakes are high for all practitioners and patients and the PSA's proactive and decisive action is crucial to prevent further tragedies and uphold the integrity and trust in the healthcare regulatory system.