There is shocking bullying, racism and incompetence in the organisation responsible for ensuring NHS nurses and midwives in the UK are safe to have around patients, a damning report says.
The independent review warns of a dangerously toxic culture within the Nursing and Midwifery Council (NMC), which oversees and regulates hundreds of thousands of nurses and midwives.
Good nurses find themselves investigated for years over minor issues, while some bad ones escape sanction, it says.
Meanwhile, some NMC staff feel stressed, frustrated and unsupported.
The NMC said it was "profoundly sorry" and fully accepted the recommendations for urgent change.
It had commissioned former chief prosecutor Nazir Afzal and Rise Associates to independently look at its culture, after a whistleblower alleged it was failing to tackle serious sexual, physical and racial abuse.
Everything the whistleblower documented was corroborated and many of the more than 1,000 current and former NMC colleagues the review heard from - along with over 200 panel members who sit on fitness-to-practise hearings - had had similar experiences in recent years.
Bad management
The review found dysfunction across "virtually every level" of the NMC.
It heard of staff on antidepressants, with their hair falling out and unable to sleep because of bullying and bad management.
Many were content - but far too many were struggling, its report says.
"They were angry, frustrated and exhausted," it says.
"We saw staff break down in tears as they recounted their frustrations over safeguarding decisions that put the public at risk."
'Profoundly distressing'
The organisation has a massive backlog, with nearly 6,000 fitness-to-practise cases yet to review, meaning some nurses, patients and families wait years for a decision.
And in the past year, six nurses have killed themselves while under investigation by the NMC.
The review also highlights cases that were "dropped" because alleged incidents occurred outside of the workplace, with one NMC lawyer telling the review team: "Racism cases are dropped in screening because it's outside of the workplace and the view is, and I'm obviously paraphrasing, that 'people are free to be racist in their own time' because they are not involving patients."
Sir David Warren, who chairs 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 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.
"I am extremely sorry to hear the testimony of NMC colleagues who have shared their distressing experiences of racism, discrimination or bullying.
"On behalf of the council, I give my absolute assurance that addressing this will be front and centre of change at the NMC."
A Department of Health and Social Care spokesperson said: "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."
