This article appears as part of the Inside the NHS newsletter.
The number of nurses and midwives being struck off for misconduct has almost doubled in the past few years, most often for breaches of patient care.
Should we be worried about the profession - or the regulator?
Struck off
In 2023/24, a total of 210 nurses and four midwives were removed from the Nursing and Midwifery Council (NMC) register across the UK following fitness to practise tribunals.
A striking-off order is the most serious sanction that can be levied by the regulator for professional misconduct.
It bans nurses and midwives from working in the UK for at least five years, both in the NHS and private sectors.
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According to figures disclosed last week following a freedom of information request by Medical Negligence Assist - a 'no-win no-fee' claims firm - the number of nurses and midwives struck off last year is up by 96%, from 109 in 2021/22.
Of the 979 separate allegations upheld last year in striking off cases, the most common - roughly 18% - related to failings in patient care.
Among nurses, these included failing to respond appropriately or quickly enough to patients who were deteriorating, as well as wrongdoing relating to the diagnosis or observation of a patient and issues relating to safeguarding, such as meeting hygiene, nutrition, infection control, or hydration requirements.
There were also cases of nurses being struck off for sleeping on duty, bullying, collusion to cover up information, and theft of drugs from the workplace.
In midwifery, one midwife was struck off for "a lack of basic midwifery skills".
The other cases of involved failures in monitoring, assessment, or to "respond appropriately" when a woman or baby were deteriorating.
'Tiny minority'
There are some 808,000 nurses and midwives registered with the NMC in the UK.
Lesley Maslen, its executive director of professional regulation, has previously stressed that the number of potential misconduct cases they investigate each year represents a "tiny minority" of the nursing and midwifery profession and only the "most serious" will be struck off to protect the public.
However, concerns have been raised that high vacancy rates and bed shortages within the NHS is creating fertile territory for more things to go wrong when it comes to patient care - and for nurses to be blamed.
In 2023, a survey by the Royal College of Nursing found that 60% of its members working in emergency departments feared being struck off as a result of treating patients in "inappropriate" conditions.
'Culture of fear'
Over the past year, the NMC itself has come under scrutiny.
In July, an independent review criticised the regulator as a “hotbed of bullying, racism and toxic behaviour”.
Nazir Afzal, a former chief crown prosecutor who headed the review, said the findings were a "last chance saloon" for the NMC to get its house in order.
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The NMC has pledged to clear its backlog of fitness to practise cases by 2025 amid criticism that the delays were resulting in some good nurses being investigated for years over minor issues while bad nurses escape sanctions.
The review found that six nurses died by suicide in the past year while under investigation by the NMC.
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The review was triggered after a leaked internal report revealed that dozens of NMC staff had complained that they were being given "unachievable" targets but were too scared to own up to errors due to a "culture of fear" within the organisation.
Meanwhile, NHS whistleblowers claimed nurses and midwives accused of serious sexual, physical and racial abuse were returning to wards unchecked because a “deep-seated toxic conduct” within the NMC was leading to failed and biased investigations.
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