THE NHS was once Britain’s pride, delivering world-class care through nurses forged in a system of tough exams, strict probation and mentors who demanded excellence. Nurses from the 1980s recall a time when failing basic literacy or maths tests meant finding another job — no exceptions.
Today, it’s a different story. Lower entry standards, watered-down degrees, and a desperate push to fill staffing gaps have chipped away at quality. The result? Preventable patient neglect, soaring disciplinary cases, and nurses entangled in dishonesty, substance misuse, or workplace bullying.
The Nursing and Midwifery Council is waving red flags. Fitness-to-practise cases hit 5,700 in 2023/24, up 14 per cent from the prior year. Striking-off orders for negligence, fraud, or drug issues nearly doubled, with 214 nurses removed in 2023/2024 compared with 109 in 2021/2022. Are we training nurses tough enough for today’s healthcare chaos? Back then, weak candidates didn’t make the cut. Now, government quotas push trusts to rush underprepared applicants through, often under mentors too swamped to teach properly. Ward stories shock: nurses in their 50s botching blood pressure readings, mis-logging vitals, or leaving patients waiting hours for medication. These aren’t one-offs — they’re a pattern.
Overseas recruitment fuels the crisis. Recent data shows 45-50 per cent of new nurses came from abroad in 2022-2024, though dipping to 39 per cent in 2024-25 due to tighter visa rules. Many are stellar, pouring their hearts into the job. But some come from regions — parts of South Asia, Africa or Eastern Europe — where corruption in education and certification runs deep. Reports expose bribed examiners, fake degrees and political meddling in training programmes.
‘The NHS is importing nurses with questionable credentials,’ a BBC investigation warned viewers in 2022, highlighting global certification fraud. Patients suffer errors, neglect, or worse. It’s not about individuals, but the consequences of a system too stretched to police properly.
Cultural differences matter. If someone’s trained where corner-cutting or weak accountability is normal, those habits don’t vanish in the UK. Could this explain the rise in cases tied to dishonesty or neglect? The stats suggest a systemic flaw, not just a few bad actors.
Yet the UK’s got its own mess. Bullying, shoddy hires and rushed training are homegrown. In NHS Scotland, boards face criticism for letting harassment fester, with complaints ignored while managers linger on paid leave.
Take Santosh Chima, NHS Tayside’s former equalities head. As the journalist who broke this story, I built the case for staff using their evidenced emails and correspondence, creating documents showing how the bullying breached NHS policies, plus criminal and civil laws. After pushing for managers to be held accountable and placed on leave, I released the story to the press. A 2022 Herald report noted Chima’s year-long suspension on full pay, quoting her saying: ‘The nature of my suspension and the health board’s handling of it amounts to race discrimination.’
The Scottish Sun in 2023 tied her case to wider issues, reporting ‘bullying, harassment and racism claims’, rocking the board. Front-line staff say whistleblowers flagged toxic leadership but were ignored until media pressure forced action. Managers slipping back without reforms leave staff demoralised and scared to speak up.
This isn’t trivial. ‘The NHS’s toxic work culture is putting patients at risk,’ a 2024 BMA report declared, linking bullying to staff exits and errors. Tayside saw bullying complaints double in a year around 2021-2022, from 18 to 35. Scotland-wide, 210 serious bullying and harassment cases hit in 2022-2023 — more than four a week.
Middle-aged career-switchers entering nursing, often parents of grown children, can bring rigid attitudes that resist retraining. Some studies suggest these applicants arrive with unchecked egos, shaped by years of unchallenged assumptions from parenting or personal life, leading to arrogance — dismissing younger, eager nurses who spot errors or offer help, sometimes with an eye-roll.
Researchers have observed that mature workers may cling to outdated practices or resist feedback, seeing younger input as undermining, fuelling skill gaps and ward tension. Others highlight their empathy, so it’s not universal, but the issue is noticeable enough to harm care. ‘Older nurses bring experience but can struggle with new protocols,’ a 2022 Nursing Times study noted.
Could moral code tests help? Integrity tests, used in some recruitment, ask about behaviours like pilfering office supplies. But who’d admit to that? Overconfident or unethical candidates often give polished answers, making such tests unreliable for catching entrenched arrogance. The NHS’s values-based recruitment probes ethics through scenarios, but it’s not foolproof for complex attitudes shaped by decades of experience. Targeting older applicants risks breaching age discrimination rules, especially since mature nurses face unfair biases despite their value.
Population pressures stretch the NHS thinner, with irregular migration adding strain while legal inflows bolster the workforce. More patients, fewer resources — it’s tempting to lower entry bars or rush half-trained nurses on to wards. But this spikes errors and betrays the NHS’s promise.
The 1980s showed the way: brutal training, patient-first ethos, no mercy for sub-par work. Now, with about 42,000 nursing vacancies and 10,000 more needed by 2025, it’s a free-for-all: lax entry, ignored misconduct, bullies getting second chances. Governments chase numbers, bosses dodge accountability, regulators wait for disasters.
To rebuild, the NHS needs backbone. Raise entry standards. Vet overseas nurses like Australia once did — deep checks, no exceptions. Sack bullies and neglecters for good. Leaders must tackle complaints, no matter how messy. This isn’t about race — it’s maths. Too many patients, too few skilled nurses, too much avoidance. Ignore the ‘bigot’ cries, face the numbers, and Britain can save its NHS. Otherwise, it’s more neglect, more pain, and a system forgetting its purpose: safe, quality care for all.
