Professional Standards Authority for Health and Social Care v Nursing and Midwifery Council QBD (Admin), 7 March 2017

The Professional Standards Authority (PSA) appealed against the decision of a committee of the NMC to suspend a nurse, rather than strike her off.

The committee hearing and decision

A committee of the NMC had found that a nurse who worked with adults with learning difficulties and mental health problems had:

  • been deliberately emotionally abusive towards an autistic adult in her care.
  • struck the patient deliberately with a broom handle more than once, and had struck him on the head with her hand. She had done these things knowing they would cause significant distress.
  • the nurse had stopped the behaviour when another member of staff entered but continued after they had left.
  • the nurse had shown no insight or remorse into her behaviour.

When considering the appropriate sanction, the committee had considered the following mitigating factors: the conduct had occurred on a single occasion; there had been no physical harm caused; the nurse had 13 years’ experience. The committee found that it could not conclude that there was any deep-seated problem, and that the nurse could develop insight. It found that, given her experience, striking off would be marginally disproportionate. It imposed a suspension of 12 months.

The appeal

The PSA appealed the decision on sanction on the following grounds: the committee had not considered the public interest, had not considered relevant parts of the indicative sanctions guidance; it was perverse / illogical to say that there was no evidence of a deep-seated problem and that the nurse could develop insight. The PSA claimed that the behaviour found proved was inconsistent with continuing registration.

The court’s finding

For the appeal to succeed, the court had to find that the committee had been wrong, and that the penalty imposed was outside the range of appropriate sanctions. It was not enough for the court to find that the decision was probably wrong; it had to be plainly wrong.

The indicative sanctions guidance stated that strike off would usually be appropriate where a nurse had caused harm to others, had abused her position, had been violent or had shown no insight. These were all factors present in this case. The committee had found that the nurse might repeat the behaviour. There was evidence of a deep-seated attitudinal problem. There had been no remorse and no evidence to suggest that the nurse might develop insight. The panel’s reasons had been inadequate to justify the sanction imposed. The threshold for the court to interfere with sanction had therefore been reached, and the court imposed a striking off order.