The third phase has focused on understanding why some professionals face differences in how they progress through our fitness to practise (FtP) processes - the stages they reach and the severity of the outcomes they receive.
We know that male professionals are referred more often for serious concerns such as sexual misconduct and behaviour or violence and they are less likely to demonstrate insight or remediation compared to women. Both of these things affect the seriousness with which we treat cases and make a difference to the outcomes professionals receive. This helps to explain some differences for male professionals but does not give us all of the answers.
The University of Greenwich and Kingston Race and Equalities Council (KREC) examined 288 FtP cases that we had closed between 2019 and 2023 and found disparities that might be attributable to bias in how we handled some cases involving Black professionals compared to white professionals, and male professionals compared to female professionals. No evidence of bias was found in the outcomes of final decisions we made on these cases, or how we handled cases involving disabled professionals or those whose sexual orientation is unknown.
These disparities included us scrutinising evidence more closely in cases involving Black and male professionals and inconsistencies in how we applied interim order conditions of practice. The researchers found that these differences were caused by variation in how we interpret and apply our FtP policies and guidance and made a series of recommendations to improve our approach.
Ambitious for Change Report
Ambitious for Change Executive Summary (English)
Ambitious for Change Executive Summary (Welsh)
Addressing the findings
- Below we’ve outlined some of the key steps we’re taking to address these disparities. These will be taken forward as part of our new EDI strategic objectives which are informed by the Ambitious for Change research programme, including this research from the University of Greenwich.
- We’re focusing on making changes in areas where our evidence is clear about disparities, including targeted work with specific employers and education institutions, as well as understanding and growing our data and evidence.
Education
- The data shows that men, students of mixed ethnicity and disabled people had higher drop-out rates from NMC-approved nursing and midwifery courses. Meanwhile, Black and Asian applicants had lower acceptance rates.
- To help to address this, we’ll strengthen our support to Approved Education Institutions (AEIs) to embed EDI in their curriculum practices. We’ll also implement a data-driven approach to Quality Assurance, including analysing student data by protected characteristics – this will help us to challenge AEIs on student outcomes. Through Regulatory Reform, we’ll secure additional powers to act where we identify concerns.
Overseas Registration
- We know that between April 2016 and March 2019, applicants who are Black, disabled, bisexual, or aged over 41 had a lower chance of registering.
- However, in October 2019, we overhauled our process, improving the way that we handle applications. Therefore, our priority is to analyse the data of applicants since we made those changes to identify if the same groups are affected so that we can use the findings to decide further action.
Revalidation
- Our data indicates that professionals who are disabled, men, aged over 60, White and those living outside the UK/EU/EEA have lower chances of revalidating successfully.
- We know that disabled professionals have worse outcomes in many of our processes, including revalidation. Although we heard from disabled professionals in the second phase of our research, we didn’t hear about the specific challenges they face in our processes. To help us understand the reasons for these differences our priority is to carry out targeted research with disabled professionals and ensure learning from it feeds into our next review of revalidation.
Fitness to practise – referrals
- When it comes to fitness to practise, our priority is to address the disparities we see in referrals by working with employers
- In February 2021, we introduced Managing Concerns, a resource to support employers to effectively manage concerns, including considering bias or discrimination before they make a referral. And we’ve begun targeted work to support internationally educated professionals into UK practice.
- We plan to refresh the data we have on employer referrals to equip our teams to have targeted discussions with employers to ensure there is no bias or unfairness in their decision making. This will help us to identify barriers and challenges, as well as best practice to share.
Fitness to practise – progression and adjudication of cases
- Our findings show that professionals who are men, Black, disabled, or whose sexual orientation we don’t know, are more likely to progress through the stages of the fitness to practise process. Meanwhile disabled professionals and men are more likely to have an adjudication decision preventing them from practising.
- Our fitness to practise improvement programme is our corporate priority. We’re considering equality, diversity and inclusion in changes we make and we’re also commissioning an independent review of our cases to see whether bias is playing any role in the disparities in our fitness to practise decision-making process. We’ll use the findings to determine further action. And we’ll complete a stocktake of our training and guidance for decision makers.
Through these actions we aim to make our processes kinder and more equal. However, systemic problems need system-wide solutions so where disparities are driven by wider unfairness and inequality, we’ll work with partners across health and social care, sharing insight and intelligence.
In doing so, we hope we can collectively create an environment where every nurse, midwife and nursing associate is respected and valued, and supported to deliver safe, kind and effective care to the public.
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