Black nurses and midwives are more likely to be referred to the Nursing and Midwifery Council than their white counterparts, independent research carried out for the regulator has found.
A study by academics at the University of Greenwich looking at the treatment of black and minority ethnic registrants during fitness to practise procedures also found that where the referral had come from was “extremely consequential” for the result of the case.
“There is some evidence of discrimination in terms of the disproportionate number of referrals by employers”
University of Greenwich report on BME FtP
Researchers found employers were the largest source of referrals for all registrants – as opposed to the public, which is the other most popular source – and that these were more likely to go on to the later stages of FtP.
When it came to BME nurses and midwives, more were referred by their employer than would be expected, which therefore meant more were then likely to go on to further stages.
However, the researchers pointed out the data only showed the ethnicity of around 60% of all registrants involved in FtP cases, because many do not disclose this information.
“At adjudication, BME nurses and midwives are the least likely to receive a penalty that prohibits them from working”
University of Greenwich report on BME FtP
In terms of progression through the FtP stages, there was a link to ethnicity, said the report – titled The Progress and Outcomes of Black and Minority Ethnic (BME) Nurses and Midwives through the Nursing and Midwifery Council’s Fitness to Practise Process.
“Cases brought against nurses and midwives of white, other or unknown ethnicities are more likely to be closed at screening than are cases brought against Asian or black nurses and midwives, whose cases are more likely to be closed at the investigation stage,” it said.
But at the adjudication stage of FtP – the final part of the process after screening and an investigation – BME nurses and midwives were the least likely to receive the most serious penalties of being suspended or struck off.
Although again, researchers pointed out that a large amount of the data did not include registrants’ ethnicity which could affect the results.
Overall, the academics found that while the FtP process does not discriminate against BME registrants, there is “some evidence of discrimination in terms of the disproportionate number of referrals by employers”.
“The evidence suggests that there is discrimination in the NHS and this needs to be tackled and stopped”
Meanwhile, men in general were referred to the NMC at approximately twice the rate than would be expected, given the number of male nurses and midwives registered with the regulator, said the report.
In addition, a “significant relationship” between ethnicity and gender was found, with more BME male nurses and midwives being referred to the NMC than would be expected.
“Male nurses and midwives may experience a double disadvantage in that they are a minority in society by virtue of their ethnicity and a minority in the profession by virtue of their gender,” said the report.
Researchers also looked at whether the country where someone trained affected their chances of being referred.
They found nurses and midwives who trained in Africa were more likely to be referred (4.4% of all referrals) than expected, considering their numbers (1.9% of all registrants.)
“There is a pressing need for all the organisations involved - the NMC, employers, the RCM and others - to work together”
In addition, having trained outside the UK was associated with cases going to investigation, and having trained in Africa or Asia increased the risk of the case going to adjudication, added the report.
“There is evidence that ethnicity plays a role in referrals to the NMC and it is important to note that the NMC has no control over referrals. The regulator must deal with all referrals that are made to it,” said the report in its conclusion.
“Our analysis does show that cases against BME nurses and midwives are more likely to progress through the FtP process, but this difference is not statistically significant once the source of the referral is taken into account.
“Employers refer BME nurses and midwives and referrals to the NMC that come from employers are more likely to progress to the final stage,” it said.
“However, at adjudication, BME nurses and midwives are the least likely to receive a penalty that prohibits them from working,” it added.
“This suggests that the FtP process does not discriminate against BME nurses and midwives, but that there is some evidence of discrimination in terms of the disproportionate number of referrals by employers,” concluded the report.
“Urgent, decisive and intelligent action is needed on the part of employers”
The Royal College of Midwives described the research as “valuable” and that it confirmed what the RCM had suspected.
But it said the NMC was missing an opportunity to ensure BME registrants were treated fairly, in particular due to inappropriate referrals by employers.
“There is a pressing need for all the organisations involved – the NMC, employers, the RCM and others – to work together to stop this happening,” said RCM director for services Suzanne Tyler.
“The evidence suggests that there is discrimination in the NHS and this needs to be tackled and stopped,” she said. “The NHS needs to make sure that staff are treated fairly and equitably.
“Until that happens, I fear that we will still be seeing our BME colleagues treated unfairly by their employers and by the system and this is not good enough,” she added.
Chris Cox, the Royal College of Nursing’s director of membership relations, said: “We’re deeply concerned by further evidence which shows the devastating impact of racism in the workplace.
NHS staff face ‘tinderbox’ of frustration and aggression
“It’s clear that BME nurses and midwives experience severe and persistent disadvantage in the workplace at a point where the shortage of qualified health professionals becomes more acute,” he said. “Urgent, decisive and intelligent action is needed on the part of employers to robustly tackle any form of racism, bias and unfairness in their systems and processes.”
He added: “We will continue to work with the NMC and other agencies to find ways to tackle and eliminate racism across all forms of healthcare and healthcare regulatory processes. We also intend to work with system leaders to tackle these issues in partnership and ultimately build strong leadership for making equality and inclusion a reality for all staff.”
- BME nurses more likely to feel discriminated against
- ‘Spectre of discrimination’ against BME midwives