A “dysfunctional” culture at the UK nursing regulator is threatening public safety, according to a damning report that found the Nursing and Midwifery Council (NMC) took seven years to strike off a nurse who had been accused of rape and sexual assault. Staff at the regulator broke down in tears “as they recounted their frustrations over safeguarding decisions that put the public at risk”, according to the authors of an independent review of the regulator. The review team highlighted a “toxic culture” at the NMC, with one former employee describing their section of the organisation as a “hotbed of bullying, racism and toxic behaviour”. The report also shone a spotlight on suicides by nurses caught up in long drawn-out fitness to practise investigations, highlighting how some nurses had been under investigation for nearly 10 years. The authors commented on the NMC’s backlog of 6,000 cases, which meant some nurses were forced to wait four or five years for their investigation to be completed, even though some cases were “baseless complaints where no further action is required”. Some cases are detailed in the report, which was written by the lawyer Nazir Afzal and Rise Associates. “In one case, a nurse had been accused of sexually assaulting patients and raping a colleague after spiking their drinks,” the report said. “This was closed down on the basis that the rape was done outside of work after a social event and the sexual assault on a patient was carried out outside of a hospital as the nurse had instigated a meeting. “The nurse had also been accused of asking patients to go on dates and requesting their phone number. Seven years after the NMC first received complaints, the nurse was finally struck off in 2024.” The NMC said the nurse had been placed under an interim order in January 2018 that “restricted their practise until they were struck off”. One staff member also told the authors of the report: “I am amazed that a registrant can be in possession of category A child pornography and we determine that’s part of their private life so no action is taken.” The NMC said officials had “looked for this case and has so far found none with a closure decision matching this”. The review highlighted cases that were “dropped” because alleged incidents occurred outside 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.” Staff also told the authors that the regulatory system was “not sufficiently attuned to differentiate between serious and minor issues”. The independent analysis highlighted six suicides or suspected suicides among nurses between April 2023 and April 2024 while were they going through the fitness to practise process. “We spoke to several people who argued that drawn-over investigations were a contributory factor to six nurses taking their lives in the last year,” the report authors wrote. “We also saw correspondence from a mother who directly blamed the NMC for her daughter’s death because of an incompetent and biased investigation.” The report highlighted a “dysfunctional culture” at the regulator, including allegations of racism within its ranks. The authors said there was “dangerous groupthink” at the NMC and highlighted how leadership did not take safeguarding warnings seriously. They said too many staff were “struggling” and were “angry, frustrated and exhausted”. They said they heard staff talk about “antidepressants, managing their hair falling out and not being able to sleep because of bullying and bad management”. “At virtually every level of the organisation … we witnessed a dysfunctionality that was causing emotional distress to staff and preventing the organisation from properly functioning,” the authors wrote. Afzal, who led the review, said: “The culture is dysfunctional and it’s taking a heavy toll on staff, but it is also impacting on their work. We have found a workforce that’s really struggling and an environment where poor judgment, toxic behaviours and paralysis is affecting decision-making. “Good nurses are finding themselves being investigated for years over minor issues and bad nurses are escaping sanction because of a system that’s not functioning as well as it should.” Responding to the report, the NMC said the review would be a “turning point” for the organisation and promised to deliver a “culture change programme”. Its chair, David Warren, 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. “I also apologise to those nurses, midwives, nursing associates, employers and members of the public for whom we have taken far too long to reach fitness to practise decisions.” Asked specifically about the case where the nurse was accused of rape, an NMC spokesperson said: “This was a complex and serious set of concerns about the same individual. Some of those concerns were initially closed but were reviewed by one of our assistant registrars, who recommended that they be investigated further. “The individual was under an interim order which restricted their practise until they were struck off at a hearing.”