A scandal-hit regulator wrongly approved more than 350 “fraudulent” or “underqualified” nurses to work in the UK, amid a “dysfunctional” culture exposed by The Independent.
The Nursing and Midwifery Council (NMC), which regulates more than 800,000 nurses and midwives, is also failing to spot workers who could pose a serious risk to patient safety and to prioritise investigating them.
These are just two of a series of failings uncovered in a review by the Professional Standards Authority (PSA), which regulates the NMC. That was prompted by The Independent’s exposé, which revealed that the organisation’s “toxic” culture had allowed nurses to work unchecked after whistleblower concerns were ignored.
The PSA’s report found that the NMC is failing to meet 7 of 18 national standards, and warned that:
- There are “serious” cultural and operational issues within the NMC
- It is taking too long to deal with fitness-to-practice cases against nurses
- A small number of safeguarding failings could amount to a serious risk to the public
- Hundreds of fraudulent and underqualified nurses were placed on the register in error
- It had significant concerns about the NMC’s ability to manage the quality of education provided by university training courses
- It has consistently failed for years to investigate cases against nurses fairly
Have you been affected by this story? Email [email protected]
Alan Clamp, chief executive of the PSA, said its report showed that “urgent and significant improvements are needed at the NMC”. The watchdog has escalated its concerns to health secretary Wes Streeting and to the vice-chair of the health and social care select committee.
Responding to the report, Crystal Oldman – who is the chief executive of the Queen’s Nursing Institute, which represents community nurses, and is also on a government-appointed board overseeing the NMC – said: “A major step change is needed.”
She warned: “There’s no evidence that there has been a wholesale change. If they’ve not met seven out of the 18 standards, then that is an enormous alarm bell to be ringing.
“Two years since the whistleblower’s concern, and there’s no indication that they’re succeeding on all of these counts, and that is hugely worrying for public protection. That’s their first reason for being there: to protect the public.”
Lynn Woolsey, chief nursing officer at the Royal College of Nursing, said the NMC needs to “start turning the ship around for the good of nursing and healthcare”, adding that “urgent progress is needed” given the serious impact of its failings on some of its members.
The whistleblower who originally exposed the NMC told The Independent that the report showed the watchdog is ‘incapable of making the changes it needs by itself’.
They said: “Today’s report, two years since I blew the whistle and nearly 20 years since these issues first surfaced, support what I have said from the outset – that the NMC is incapable of making the changes it needs by itself.
“How many more people need to come to harm before those in power finally act?”
One key standard the NMC failed to meet is the requirement to ensure that its register of nurses and midwives is accurate. This came after the PSA found that more than 350 people had been added to it in error, allowing them to work as nurses in the UK.
It said: “The total number of people added to the register without meeting the NMC’s requirements is over 350, and could be over 400, depending on the outcomes of the CBT and OET investigations. The NMC’s register is so large that this amounts to a relatively small proportion, but we consider it a large number of individuals to be registered in error.
“Maintaining an accurate register is a key function and duty of a regulator, in the interests of public safety and public confidence. The NMC has added a large number of people to the register who had not met its requirements, and by the end of our review period it had not been able to fully remedy the situation.”
These included “fraudulent” applications from centres in India, Nigeria and Pakistan that test nurses against NMC requirements, such as being able to speak English to the required standard.
The errors also included hundreds of newly qualified nurses who had not completed enough training hours, as revealed last year by The Independent.
The NMC told The Independent that out of those investigated for fraudulent entries, 16 people were removed in relation to one centre in Pakistan and of the 30 registrants at a centre in Nigeria to face investigations, 19 were removed. For those in the India-based centre, 68 nurses were affected, and in all cases, it was found that there wasn’t sufficient evidence to prove fraud.
For nurses who may not have done the required hours, it was decided they met the competencies required for nursing standards.
Another failing was the requirement to identify and prioritise all cases that pose a serious risk to patient safety and to seek interim orders, placing restrictions on staff under investigation, where appropriate.
An internal audit carried out by the NMC, as revealed in January by this paper, found that it was failing to act on its safeguarding duties. While the PSA’s review of 40 cases found no concerns in 90 per cent of them, it criticised the NMC for not seeking further information on criminal cautions and convictions accrued by a worker accused of domestic violence.
The PSA warned: “The NMC itself notes that it had been failing to identify and act on safeguarding concerns, and safeguarding continues to be the NMC’s biggest strategic risk. This clearly raises concerns about the NMC’s performance in this area over the course of the review period.”
Paul Rees, the NMC’s interim chief executive, said the report reflected a “dark period” in the NMC’s history. But he insisted “radical change” was underway.
He said: “I recognise that our performance in 2023-2024 was not good enough, and since joining the NMC in January, I’ve committed to turning the organisation around – ensuring that we build a positive, empowering and inclusive culture for our people, and improve the regulatory experience for the public and nursing and midwifery professionals.
“Radical change is underway, and we have made significant strides through the delivery of our Culture Transformation and Fitness to Practice plans. In the coming days, we will publish ambitious equality and diversity targets to ensure we achieve equity for our colleagues and everyone involved in our processes.”
The latest findings follow the publication last July of the findings of a review headed by barrister Nazir Afzal KC, which found evidence of a toxic and dysfunctional culture at “every level” of the NMC, and that the organisation had turned a blind eye to serious sexual, physical and racist abuse.
Shocking failures identified within Mr Afzal’s report included a seven-year delay in striking off a nurse who was accused of raping a colleague and sexually assaulting a patient.
A further review by Ijeoma Omambala KC, investigating the treatment of the whistleblower who first reported concerns to The Independent and the cases highlighted, was due to be completed last year but has been delayed.
Since The Independent’s reporting, the NMC’s former chief executive and chair have stood down.
