Research finds systemic inequalities are driving disparities in regulation

Published on 01 August 2022

We have published the second phase of our Ambitious for Change research.

In our latest Ambitious for Change report (published today), we’ve outlined the findings from the second phase of our research into why some professionals have different experiences of our processes. See our previous news story for more detail on the first phase of our research.

In this second phase, we wanted to understand why these differences exist and the impact they have on the professionals on our register. We heard from professionals and employers about their experiences of our processes. We also completed deeper analysis of fitness to practise referrals from employers alongside workforce data.

As the independent regulator of more than 758,000 nursing and midwifery professionals in the UK, we have a duty to do everything we can to eliminate discrimination, tackle inequality, celebrate diversity and promote inclusion.

Our findings highlight opportunities for us to improve our regulatory activities and ensure our processes are fair for everyone. They also highlight where inequalities which cut across the health and social care sector and exist in wider society are contributing to the disparities we're seeing.

Key findings

  • When we compared our fitness to practise referral rates with workforce diversity data, we found concerning results. For example, some employers refer more men and Black professionals to fitness to practise compared to the make-up of our register and their own workforce.
  • Most of the professionals we spoke to told us that they felt one or more of their diversity characteristics played a part in their referral from their employer and said an ‘insider/outsider’ culture left them feeling unsupported.
  • We also found that the work setting and the type of work someone does can influence a person’s experience of revalidation or fitness to practise. Those working in care homes, GP practices or providers which employ a lot of bank and agency staff are particularly affected. We know that certain groups, such as Black professionals, are over-represented in these settings. This indicates longstanding, systemic inequalities across health and social care that perpetuate the disparities we’re seeing.
  • There’s more we need to do to gain insight about some groups who we heard less from in this research. For example, disabled people are among the groups who are less likely to revalidate successfully and more likely to be referred. But we didn’t hear about specific challenges disabled professionals face as part of this research, so we need to do more to understand these differences so we can take action to address any unfairness.

 Andrea Sutcliffe, NMC Chief Executive and Registrar, said:

“It’s essential we recognise people’s experiences of discrimination and inequality in health and care, and the devastating impact they have, so we can take practical steps to stop them happening. That’s the reason we started the second phase of this research.

“The findings highlight opportunities for us to improve our regulatory activities, to ensure our processes are fair for everyone. It is also evident that deep-rooted systemic issues of inequality are contributing to disparities that we’re seeing. The report echoes the findings of others, such as the Workforce Race Equality Survey and the General Medical Council.

“This isn’t a question of whether discrimination and inequality exist. They do. The urgent question is: what are the practical steps we can take to stop them from happening?

“Working with employers and our other partners across the sector is crucial. We need to bring to light what professionals have told us. Together we need to develop solutions to target these inequalities, which have no place in the working environment of our professionals or the care that people receive.

“We’re committed to pushing this work forward to create change and urge others to do the same.”


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