Response to the Independent Culture Review of the NMC

To Wes Streeting MP, Secretary of State for Health & Social Care

Response to the Independent Culture Review of the Nursing & Midwifery Council carried out by Rise Associates

(Review Chair Nazir Afzal OBE) July 2024

The Association of Radical Midwives welcomes this report and endorses its findings which accord with its own observations and experiences over many years.

Our Midwives Haven support network has supported many midwives undergoing the NMC’s Fitness to Practise processes since 2017, after we became concerned at the FtP culture operating at the NMC. We have seen the FtP process at close hand and had dealings with with NMC staff for over 7 years, and have become very troubled by what we have learned from that.

The NMC’s lawyer-driven, adversarial, punitive, destructive, and ridiculously drawn out approach to professional discipline and regulation is not in the public interest. It works against a restorative, retentive, and learning approach to clinical errors or poor practice. Many thousands of registrants are caught up in the NMC FtP process and this not only affects them but also their colleagues, families and friends. Fear has pervaded the workplace as admitted by the previous CEO Andrea Sutcliffe, to the House of Commons Health Committee a couple of years ago. Thousands of registrants have left the profession as a result of their experiences or those of colleagues, and many of these were eventually found to have no case to answer or allegations dismissed. Others have taken their own lives (six in the last year), something the NMC did not even keep statistics on until Midwives Haven insisted they audit this.

The NMC, in particular, has carried out what can only be termed a persecution of independent (self-employed) midwives. These midwives are subjected to multiple investigations by the NMC as a result of their advocacy for and support of women seeking an alternative to standard NHS care. The charges made against them often result from the NMC’s complete lack of understanding of women’s reproductive rights and autonomy. We believe there should be an immediate investigation of these cases, and that all independent midwifery cases should be taken away from the NMC’s jurisdiction forthwith and for the immediate future. The NMC is directly having a detrimental effect on choice for women in this country.

We are also concerned at the make-up of FtP panels and their training. We have seen and formally complained about the bullying of registrants by panel chairs, only for this to be ignored by the NMC. FtP case conduct breaches the Nolan Principles so frequently as to be routine, such as in the suppression of documents that aid the registrant’s defence. Case preparation, organisation and running is too often simply a disgrace with chaotic bundles, poor IT, and unnecessary delays due to poor organisation. Panellists are appointed, appraised and paid by the NMC and many panellists do not understand that they are independent of the NMC. The clinical knowledge and experience of registrant panel members is too often outdated or irrelevant to the case. The registrant’s sworn testimony and evidence is too often simply disbelieved in favour of that of a manager, even when there is a long history of bullying of the registrant by that same manager or of whistle-blowing by the registrant.

The NMC is effectively an institutional bully of the professions it regulates. The toxicity of its culture is permeating midwifery and nursing as NHS managers take their lead from its destructive approach. Far from maintaining public safety, as the NMC repeated parrots as its role, the NMC is a contributor to the implosion of the maternity services over recent years and the unsafe environments in which women in the UK are giving birth to their children. The report of the group #Saynotobullyinginmidwifery (https://www.amazon.co.uk/Saynotobullyinginmidwifery-behaviours-consequences-experiences-bullying/dp/1399969005) contains many stories of how the toxic culture of the maternity services are inter-twined with the toxic culture of the NMC.

The Independent Culture Review focussed, as was its remit, on racism within the NMC. We believe racism permeates the NMC’s FtP processes. Black and ethnic minority/overseas midwives are disproportionately referred to the NMC, and these referrals are predicated on the many and various manifestations of racism and prejudice in the workplace. Successive NMC FtP annual reports have identified the disproportionate referral rate of BAME midwives and nurses with ineffective promises of action. We have seen overt racism in FtP cases and our black colleagues, in particular, hounded out of our profession without the racist threads running through their cases being recognised or challenged. Black nursing and midwifery groups such as the Society of African and Caribbean Midwives in the UK have repeatedly raised concerns about these problems.

We believe that the NMC is incapable of reform or of being reformed, so long-standing and embedded are the issues presented by Nazir Afzal and his team. We urge the new government to abolish the NMC and to replace it with smaller, smarter midwifery and nursing regulatory bodies with much more oversight and leadership from professional and expert lay people, able to build a professional regulatory structure that is compassionate, retentive, learning and efficient, able to look at structural issues as well as those relating to the individual registrant.

The NMC does NOT have the confidence of midwives in the UK. Please, Secretary of State, take action.

Association of Radical Midwives
16.7.24

Independent Culture Review of the Nursing & Midwifery Council carried out by Rise Associates