DescriptionHow the system designed to protect patients became a weapon against Black nurses. An investigation by BlackBritish.org.uk — Issue 001, April 2026.

The Referral — BlackBritish.org.uk | Issue 001, April 2026

BlackBritish.org.uk

Research. Evidence. Accountability.

Issue 001

April 2026

Investigation

How the system designed to protect patients became a weapon against Black nurses.

By the BlackBritish.org.uk Research Team

26 April 2026

They came back. She completed the training. She accepted the shift on one condition: that a general nurse with specialist NG experience would be working alongside her. The agency agreed. And then the agency sent her into a situation that would have broken any nurse of any colour in any country on earth. And when it went wrong, as it was always going to go wrong, they referred her to the Nursing and Midwifery Council.

Not the agency. Not the system. Not the governance failures that created the crisis. Her. The Black nurse.

We cannot name her yet. Her case is live, at the screening stage of the NMC's fitness to practise process. But we can tell you what happened, because what happened to her is not an anomaly. It is the pattern. And the numbers prove it.

"Not the agency. Not the system. Not the governance failures that created the crisis. Her. The Black nurse."

Section 01

Let us begin with what is not in dispute, because the NMC itself has published these figures. Between April 2016 and March 2019, the NMC received 13,805 fitness to practise referrals. Of these, 1,084 (eighteen per cent) were against Black men and women. Black professionals make up ten per cent of the NMC register. That is not a gap. That is a chasm.

But it gets worse. The Royal College of Nursing conducted its own review in 2019 and found that Black nurses of African heritage are four times more likely to be referred to the NMC than white nurses. Four times. Not slightly more likely. Not marginally over-represented. Four times.

"On average, two Black nurses are referred to the nursing regulator every single day over concerns about their practice."

— Nursing Standard, 2023

This is not regulation. This is structural violence administered through bureaucratic process.

Section 02

The NMC's own "Ambitious for Change" research programme found something that should have triggered an institutional reckoning: nurses from Black and minority ethnic backgrounds are more likely to be referred to fitness to practise by their employers, while white professionals are more likely to be referred by members of the public. Read that again. The public refers white nurses. Employers refer Black ones.

The NHS Workforce Race Equality Standard confirms this pattern. The 2024 WRES report found that over half of NHS trusts reported BME staff were more than 1.25 times as likely as white staff to enter the formal disciplinary process, a figure that has deteriorated from the previous year.

Relative Likelihood of Entering Formal Disciplinary Process (Selected NHS Trusts)

NHS Trust

BME vs White Likelihood

Source: WRES 2023 Report, via Equality 4 Black Nurses

Twenty-two point four times. How do you explain that without acknowledging that racism is structurally embedded in the system? You cannot. A number like 22.4 is not a misunderstanding. It is an indictment.

Section 03

For Black nurses, there is an additional layer. The recognition that this is not random. The recognition that you are four times more likely to be standing here than your white colleague, and that this knowledge does not protect you. It compounds the injury.

There is a term in psychology for this: moral injury. It is the damage done to a person's conscience and sense of self when they are forced to participate in or witness events that violate their deeply held beliefs about right and wrong. It was first used to describe the experiences of soldiers. It applies with equal force to Black nurses in the NHS.

"Many of the professionals felt they were seen as outsiders, their ethnicity was a reason for their referral, and they were held to different standards."

— NMC "Ambitious for Change" Phase Two Report, 2022

Section 04

We cannot name her, but we can tell you her story. She is a deputy ward manager at a well-known mental health facility. She holds seniority. She carries responsibility. She has a clean professional record. And she is currently facing three allegations from the NMC that, when you examine the evidence, do not withstand scrutiny.

Case Study

The Referral: What Actually Happened

A nursing agency recruited her for a complex community care package involving a non-verbal minor with a rare neurological condition requiring NG feeding. She initially declined the work because she recognised it fell outside her competencies. She then attended training, and accepted the shift only on the assurance that a qualified general nurse with specialist experience would work alongside her.

When the patient developed respiratory distress during the night, it was our nurse who repositioned the patient, suctioned the airway, performed chest and back taps, and monitored the patient until she settled. Alone, because the other nurse had left the room. And when it was over, the agency referred her to the NMC. Not for what she did wrong, but for what the agency failed to provide.

Does she fit the pattern? A Black nurse. An agency placement. A system that failed. A referral that shifts accountability from the organisation to the individual. A case that will almost certainly be closed at screening because the evidence does not support the allegations. But by then, the damage is done.

Section 05

It would be comforting to believe that this is about individual prejudice: a few bad managers, a handful of biased employers. But the data does not support that narrative. When you have a pattern that persists across hundreds of NHS trusts, across multiple regulatory bodies, across a decade of data collection, you are not looking at individual prejudice. You are looking at structural racism.

The NMC has acknowledged this. In June 2025, they set targets to eliminate ethnicity disparities in their processes by 2030. But targets are not justice. A target is what you set when you have decided that injustice can be scheduled for elimination at a convenient future date.

The Lived Reality — NHS Staff Survey Data (2024)

Indicator

Finding

Source: NHS WRES 2024 Data Analysis Report; NHS Staff Survey 2024

Section 06

We are not interested in another report. The reports exist. The data exists. What is missing is not evidence. What is missing is consequence. We call for the following:

Section 07

This is the first issue of the Black British newsletter. We have chosen to lead with this story because it sits at the intersection of everything we care about: justice, community, professional excellence, structural inequality, and the quiet courage of individuals who refuse to be broken by systems that were not designed for them.

The nurse at the centre of our case study cannot be named today. But we will follow her case. We will report the outcome. And we will name the patterns, even when we cannot yet name the people.

Because now, it is written down. And we are not going to stop writing.

The nurse at the centre of this investigation has been anonymised to protect her identity while her NMC fitness to practise case remains at screening stage. This story has been reviewed and approved by her legal representatives prior to publication. No identifying details (name, workplace, or geographic location) have been included. BlackBritish.org.uk has sight of the full case documentation. We publish in the public interest.

BlackBritish.org.uk publishes evidence-led investigative journalism on systemic racism in UK institutions. Every claim in our reporting is sourced to primary data: government reports, regulatory publications, and peer-reviewed research. We do not publish based on allegations alone. We publish when the data and the documentation support the story.

Where individuals are named or their cases described, we seek and respect legal guidance before publication. We are independent, non-partisan, and editorially accountable to our readers.

Source

For support with NMC referrals:

Equality 4 Black Nurses Helpline —

0208 050 2598

Coming in future issues

Issue 002 investigates the racial gap in social housing allocations.

Issue 003 examines exclusion rates in English schools.

Join the relationship debate on BlackBritish.org.uk →

labelMore likely to be referred to the NMC than white nurses

sourceRCN Review, 2019; NMC Data

labelOf all referrals are against Black nurses — who make up only 10% of the register

sourceNMC FtP Data, 2016–2019

labelBlack nurses referred to the NMC every single day

sourceNursing Standard, 2023

labelOf NHS trusts where BME staff are 1.25× more likely to face formal disciplinary

sourceNHS WRES Report, 2024

finding2× white rate

finding24.9%

finding42.2%

finding15.6% vs 28.6%

bodyEvery referral from an employer should be automatically cross-referenced against the referring organisation's WRES data.

bodyWhen an agency refers a nurse to the NMC, the NMC should be required to investigate the agency's own governance with equal rigour.

bodyIf the NMC closes a case because there is no case to answer, the referring organisation should bear the costs of the distress and professional damage inflicted on the nurse.

bodyEvery NHS trust, every agency, every care provider should publish annual data on the ethnicity of staff they refer to the NMC.

bodyA referral is the exercise of power, and like all exercises of power, it can be used as a weapon. The legal framework must recognise this.

textNursing and Midwifery Council. Fitness to Practise Annual Report 2018–19. nmc.org.uk.

hrefhttps://www.nmc.org.uk/globalassets/sitedocuments/annual_reports_and_accounts/ftpannualreports/nmc-fitness-to-practise-report-2019-singles-linked-contents.pdf

textRoyal College of Nursing. Independent Review into Racial Bias in NMC FtP referrals, 2019.

hrefhttps://www.rcn.org.uk/About-us/Equity-diversity-and-inclusion

textNursing Standard. "Two Black nurses referred to NMC every day over concerns about practice." 2023.

hrefhttps://rcni.com/nursing-standard/newsroom/news/disproportionate-number-of-black-african-nurses-face-fitness-to-practise-process-151421

textNHS England. NHS Workforce Race Equality Standard Data Reporting 2024.

hrefhttps://www.england.nhs.uk/publication/nhs-workforce-race-equality-standard-2024-data-analysis-report-for-nhs-trusts

textNMC. "Ambitious for Change: Phase Two Report." 2022.

hrefhttps://www.nmc.org.uk/about-us/equality-diversity-and-inclusion/

textNHS England. NHS Workforce Race Equality Standard Data Reporting 2023.

hrefhttps://www.england.nhs.uk/publication/nhs-workforce-race-equality-standard-2023-data-analysis-report-for-nhs-trusts/

textEquality 4 Black Nurses. "Racism Runs Rampant in NHS Disciplinary Procedures." March 2024.

hrefhttps://www.england.nhs.uk/about/equality/equality-hub/

textNMC. Fitness to Practise Data Dashboard.

hrefhttps://www.nmc.org.uk/about-us/reports-and-accounts/fitness-to-practise-annual-report/

textNHS England. Workforce Race Equality Standard — Resources and Guidance.

hrefhttps://www.england.nhs.uk/about/equality/equality-hub/workforce-equality-data-standards/equality-standard/

textNMC. Regulatory Standards and Guidance.

hrefhttps://www.nmc.org.uk/standards/

4×

18%

, label:

, source:

, ratio:

s NHS Foundation Trust

9.5×

SW London & St George's Mental Health Trust

6.7×

BME staff experiencing discrimination from colleagues

BME staff experiencing harassment/bullying from staff

Black nurses believing in equal career progression opportunities

BME representation at board level vs workforce share

01

Mandatory bias audits on all employer referrals to the NMC.

02

Independent investigation of agency referrals.

03

Compensation for nurses whose cases are closed at screening.

04

Mandatory publication of referral demographics by employer.

05

Legal reform of the fitness to practise process.

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2026-04-26

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The Referral — investigation

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On average, two Black nurses are referred to the nursing regulator every single day over concerns about their practice.

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Ambitious for Change

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Many of the professionals felt they were seen as outsiders, their ethnicity was a reason for their referral, and they were held to different standards.

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