A damning inquiry into the culture of the Royal College of Nursing has exposed “division, dysfunction and distrust” riddled throughout its senior leadership and laid bare issues of bullying, misogyny and a lack of diversity within its governing council.
The independent investigation by Bruce Carr QC also revealed that the RCN’s annual congress had an “inappropriate sexual culture”, which is “seen by many as an opportunity to engage in sexual activity” and where the “risk of exploitation is significant”.
The RCN’ general secretary and chief executive, Pat Cullen, has pledged to “overhaul” the organisation following the review and has apologised on behalf of the college for times where “behaviours have fallen short”.
She also pledged that investigations would now follow into incidents described in the report, with those found at fault set to “face internal and regulatory consequences”.
Ms Cullen was appointed as interim general secretary and chief executive in July 2021 and has been acting in the role since April of that year, following the departure of previous incumbent Dame Donna Kinnair.
The review by Mr Carr, a leading expert in the field of industrial relations law, was commissioned by the RCN in September 2021, as part of a “commitment to change” by the college.
It covered allegations of sexual harassment, as well as looking at equality and inclusion, decision-making and accountability, financial management, management of the departure of staff and elected members, and the roles and responsibilities of elected members.
The review drew on written submissions and interviews with members and staff, both current and past, and covers the period of “around 2018 to the present day”.
It focused primarily on the leadership culture “at the level at which decisions are made that affect membership”.
The external review into the RCN’s culture and decision-making was separate to an earlier governance review carried out by professional services organisation KPMG.
The report of the Carr review said it recognised that “most of the problems that the college face are identifiable” within the RCN’s leadership structures, namely its ruling council and executive.
The start of the review followed a number of high-profile resignations from the RCN, problems related to the college’s presidential election in 2020 and sexual harassment allegations in 2021.
Writing in the report, Mr Carr said: “The RCN has been described as being ‘in a state of crisis as it goes blindly from one catastrophe to another without any respite in sight’. On the basis of what I have seen, it is difficult to argue with that assessment.”
Meanwhile, the publication of its findings come at an awkward moment for the college, as it ballots its members across the UK on strike action following the government’s latest pay awards for 2022-23.
Equality and Inclusion
Overarchingly, Mr Carr stated that the way that the RCN Council was run “is not fit for purpose”.
It was seen by many as a “bullying and misogynistic environment in which women and those from the [Black, Asian and minority ethnic] BAME community are not welcome”.
The review draws attention to the fact that 60% of the RCN Council are male – despite its membership being almost 90% female.
In addition, the council was “not reflective of the fact that around 45% of RCN members are from the BAME community”, said the report.
“Many of those who serve on council are seen as being ‘the same old faces’ who have operated in the upper echelons of the college for many years,” the review said.
“This, together with the lack of women or ethnic minority members, permits of a culture in which the college is seen to be run by middle-aged, white men,” it said.
The review noted that, over the last three years, there have been five resignations from RCN Council, four of which were women and three from a BAME background.
Mr Carr said the council was seen by many as “a misogynistic environment in which loud and abrasive male voices dominate the environment to the detriment of women”.
“It’s current composition and way of doing business is not fit for purpose,” the review report warned.
One staff member informing the review said there was “no doubt in my mind that there were misogynistic tendencies and traits amongst our council”.
“There are male council members that treat women differently, without a shadow of a doubt,” the staff member added.
Another staff member said some male council members “used bullying tactics” and that women would be “belittled”.
Allegations of sexual harassment
In August 2021, the RCN announced its annual conference would move to an online-only event because of “serious allegations of sexual harassment”.
As part of his review, Mr Carr said he set out to examine whether there was a culture within the RCN in which sexual harassment “was allowed to go unchecked and whether as a result of any such culture, individuals did not feel that congress was a safe space for them to attend”.
In his report, he said: “On the evidence that has been provided to me, it is clear that congress is seen by many as an opportunity to engage in sexual activity which will carry with it a substantial risk that a line will be crossed so as to become exploitative.
“Whilst most such activity appears to be consensual, the risk is that where individuals attend congress in the expectation of some form of sexual encounter, there is the potential for the boundaries of what is truly consensual and what is not, can become blurred.”
In addition, he said there was a “power imbalance” between those involved, and “all the more so where large amounts of alcohol are consumed”.
To further illustrate the point about behaviour at the annual conference, the report added that there was a culture in which ‘congress wife/husband’ was a “term in common usage”.
“This not only creates the risk that flows from others then expecting to have the opportunity engage in similar behaviour – and as a consequence puts others at risk of exploitation – but it also makes other congress attendees feel complicit in such behaviour,” said the review.
“It also appears to be something that makes others feel that they are at risk of being approached so much so that they take steps to reduce that risk,” it said.
Examples included in the review described circumstances where senior elected officials made “advances” to students by sending them messages and asking them to come to their rooms for a drink.
One council member informing the review said: “Two council members – when they got onto council, they were very ‘giddy’ at the attention they got from student nurses. And it wasn’t unusual to see them, or student nurses, leaving their accommodation at silly hour in the morning.”
Another council member said: “I’ve heard talk of sexual, not so much sexual harassment, but people taking advantage.”
Decision-making and accountability; financial management
Mr Carr drew attention to a £35m strike fund set up by the RCN Council during an emergency meeting in March 2021. It came in response to the government’s recommendation of a 1% pay award.
Mr Carr said the way in which the decision to create this fund was taken “does not appear to evidence any proper consideration of the feasibility or mechanics of setting up such a fund or how it would operate in practice”.
One staff member at the college said there was no approval from the executive team on that decision. “No mechanism was ever set up to access that money, at any point in time,” the staff member added.
Other key issues found
Mr Carr lists several “key problems” based on the evidence he gathered.
For example, he said there was a “focus on crisis management which is exacerbated by the absence of a clear understanding of what the college should be doing as an organisation and how that should be put into practice”.
“It does not appear to have an overarching plan or strategy,” the review said. It added: “It is an organisation which at its top, is riddled with division, dysfunction and distrust.”
In particular, the review highlighted divisions between members of the RCN’s elected council and its appointed executive officers, and also between the organisation’s differing roles as a union and professional body.
“Whilst the distrust is most prominent in relation to the RCN’s council and its executive, it extends to relationships within council and within the membership as well as between its professional and trade union arms.”
There was also a “culture of suspicion” within RCN Council that it does not believe the RCN executive team is “acting in the best interests of members and in which it sees itself as being forced by the executive into taking decisions that the executive wants it to take, rather than making its own decisions”.
This meant the council had moved from being an oversight body into an “executive function”, said the report, and led to RCN staff being subjected to “high levels of scrutiny and criticism”.
College staff “often feel bullied, disrespected and undermined”, which was evidenced by a “remarkably high turnover”, especially in senior positions, the report added.
Mr Carr said his work served to reinforce recommendations made by KPMG in a separate review of RCN governance, the findings of which were published earlier this year.
The KPMG report called for “significant change” and included 25 recommendations across four themes: strategy, member leadership and RCN Council, governance structures, and supporting mechanisms.
Additional recommendations made by Mr Carr, however, included the need to rebuild trust between the RCN’s council and executive.
The review recognised that there had been “improvement in the last year or so”, but said there was still a “substantial trust gap”.
In addition, it said new harassment policies and procedures should be developed for both members and staff.
“These should extend not just to sexual harassment but harassment by reference to other protected characteristics such as sexuality or disability,” the report added.
More support should also be provided for attendees at RCN Congress.
“Given not least the concerns that have been raised with me about inappropriate sexual activity at congress, the college should take steps to establish a formal structure to support vulnerable attendees, in particular, those with protected characteristics but also other groups – for example, students – who may be susceptible to sexual exploitation,” said the review.
In a response from the RCN, issued earlier today, chief executive and general secretary Pat Cullen confirmed that “immediate investigations” into the incidents highlighted in the review were being launched.
Depending on the outcome, individuals involved would face “appropriate internal and regulatory action”, she said.
“The college owes Bruce Carr QC a debt of gratitude for the time he has taken to produce a report of such detail, breadth and quality,” said Ms Cullen.
“Where behaviours have fallen short in the past, I apologise today on behalf of the entire RCN,” she said.
“I will hold this report close as I redouble efforts to overhaul this college and give members the strong, professional and genuinely representative organisation they deserve.”
“Since I put the college on that journey last year, we have reached record size and led our members into the historic NHS strike ballot.
“Our collective voice is louder and our professional image much improved,” said Ms Cullen.
“New safeguarding measures and protocols have been introduced and we are modernising our governance and rethinking our approach to equality and inclusivity.”
Ms Cullen said she did not want to see the RCN “dragged through the mud, but my commitment to leave no stone unturned is even greater”. “No individual is beyond reproach,” she said.
“Whatever role they held previously or even today, those implicated in the report, and following appropriate investigation, will face internal and regulatory consequences.”
She added: “This review does not attach names to the incidents described but I am determined that the forthcoming investigations give complainants and victims the justice they deserve and serve as definitive proof of our commitment to change.
“Everybody who shared difficult personal experiences, of any kind, has my personal appreciation and support again today.”
The RCN said it had accepted the recommendations of both Mr Carr and KPMG.
A member event to hear more about Mr Carr’s report is being held tomorrow evening and a formal general meeting will be convened in person on 29 November.