Hundreds of frontline NHS staff are treating patients despite being under investigation for their part in an alleged “industrial-scale” qualifications fraud. More than 700 nurses are caught up in a potential scandal, which a former head of the Royal College of Nursing said could put NHS patients at risk. The scam allegedly involves proxies impersonating nurses and taking a key test in Nigeria, which must be passed for them to become registered and allowed to work in the UK. “It’s very, very worrying if … there’s an organisation that’s involving themselves in fraudulent activity, enabling nurses to bypass these tests, or if they are using surrogates to do exams for them because the implication is that we end up in the UK with nurses who aren’t competent,” said Peter Carter, the ex-chief executive of the RCN and ex-chair of three NHS trusts, calling it an “industrial-scale fraud”. He praised the Nursing and Midwifery Council (NMC) for taking action against those involved “to protect the quality of care and patient safety and the reputation of nurses”. Nurses coming to work in the UK must be properly qualified, given nurses’ role in administering drugs and intravenous infusions and responding to emergencies such as a cardiac arrest, Carter added. Forty-eight of the nurses are already working as nurses in the NHS because the NMC is unable to rescind their admission to its register, which anyone wanting to work as a nurse or midwife in Britain has to be, on unless directed to do so by an independent panel at a hearing. In the meantime, it has told them to retake the test to prove their skills are good enough to meet its standards but cannot suspend them. The 48 are due to face individual hearings, starting in March, at which they will be asked to explain how they apparently took and passed the computer-based test (CBT) of numeracy and clinical knowledge taken at the Yunnik test centre in the city of Ibadan. At the hearings, a panel may direct the NMC to remove individuals from the register. The times recorded raised suspicions because they were among the fastest the nursing regulator had ever seen. But the NMC is taking more direct action with a 669-strong second batch of Nigerian health staff – again mostly nurses, but also including fewer than five midwives – whose test results it has found were also obtained through fraud. Most of them have also already come to the UK, sources say. However, they are in a different position to the 48 because they are thought to be mainly working as healthcare assistants in the NHS and care homes. That is because the NMC has not approved their applications to join its register while it continues to investigate widespread impersonation at the Yunnik test centre. About 80 nurses from the 669 applicants have obtained a new CBT test and applied to join the NMC register, so they can start working in that role. However, the nursing regulator has banned almost all of them because it had “serious concerns” about their honesty and trustworthiness. “This is because even with a new CBT there remains character concerns given what happened at Yunnik and what the data appeared to show about these individuals,” the NMC said. Andrea Sutcliffe, the NMC’s chief executive and registrar, said it had taken necessarily robust action after Pearson VUE, which had a contract with the Yunnik test centre, alerted it last year to what she called “widespread fraudulent activity” in which a “proxy tester” posed as a nurse. “This is the first time we’ve found evidence of widespread fraud at a test centre,” she said. It is the biggest-ever such fraud the NMC has come across, she added. The deception at Yunnik has led to the NMC declaring the CBT test results apparently obtained by 1,955 Nigerian-trained health professionals to be invalid. All of them, even including the 1,238 about whom the regulator says it cannot prove fraud was involved, have been given three chances to resit the CBT test, or face expulsion or exclusion from the register. “We have concerns that 48 people already on the register obtained their test result fraudulently. We’ll hold hearings where an independent panel will decide whether those individuals gained fraudulent entry to our register. If so, they’re likely to be removed from the register,” said Sutcliffe. “There are 669 applicants to the register about whom we have the same fraud concerns. We’re reviewing each application carefully in line with our guidance on health and character. We’ve refused entry to the register for the vast majority of the 80 applications we’ve considered so far, and those individuals can appeal.” The future of the 717 nurses remains unclear. The GMB union fears that those refused on to the NMC register will be sent back to Nigeria. It said nurses had been “exploited” in Nigeria, urged the NMC to let all those with suspect test results to be allowed to retake the test in the UK and said the health service needed their skills to help address the UK-wide shortage of nurses. The GMB said two Nigerian women who are members had had their applications for NMC registration refused, despite insisting that their test results from Yunnik were legitimate. Both had then been dismissed by the private care home where they were working, until their status was established, and they now fear they will be deported to Nigeria with their families. “Those in charge at this centre have exploited the hope of workers wanting to nurse in the UK and left our members in a desperate situation. “The profession’s high standards of integrity must be enforced but these aspiring nurses were badly advised, firstly to enrol at this centre and then give questionable accounts of what happened there,” said Louise Gilmour, the GMB’s Scotland secretary. “They should be given another chance and allowed to work if they pass the necessary tests in the UK. “These are workers, mostly women, willing to uproot their lives and settle here to work in a health and social care service that is suffering a crisis in staff recruitment and retention.” The NMC has stopped using 40 of the 800 test centres worldwide it used before the Yunnik fraud came to light, including Yunnik itself. A Department of Health and Social Care spokesperson said: “We are aware of the Nursing and Midwifery Council’s (NMC) fraud investigations into nurses who passed their computer-based test in one centre in Nigeria. “We are advised that the NMC is taking all necessary steps to ensure the integrity of its register and that patient safety is protected.” This article was amended on 14 February 2024 to include details on how the Nursing and Midwifery Council could remove any nurses from its register. Also, an earlier version said that Pearson VUE operated the test centre in Yunnik; in fact it was a third-party test centre contracted to Pearson VUE. It was further amended to reinstate a reference to “industrial-scale fraud” which had been removed during the editing process.