Ajala v Nursing and Midwifery Council

On a statutory appeal against a professional disciplinary sanction, the court reviews the tribunal’s decision with appropriate respect for its specialist expertise. An appellant challenging sanction must show that it was excessive and disproportionate or outside the range of reasonable decisions. Dishonesty by a nurse may damage public confidence in the profession even where no patient suffers harm or faces clinical risk. A sanction is protective and regulatory rather than principally punitive, although a punitive element is inherent in suspension or erasure. The tribunal must consider the available sanctions and weigh the registrant’s interests against the wider public interest, including maintaining confidence in the profession. Its reasons should be read fairly and as a whole, rather than subjected to minute forensic analysis.

This was a statutory appeal under article 38 of the Nursing and Midwifery Order 2001 (SI 253) against a Conduct and Competence Committee decision. The Committee found that the appellant’s fitness to practise was impaired following convictions for dishonesty offences and failing to provide a specimen of breath. It imposed a six-month suspension order.

The appellant argued that there had been no patient harm or risk, that the sanction was punitive and disproportionate, that public confidence did not require suspension, and that a caution or another lesser sanction was appropriate. The central issue was whether the suspension was wrong, excessive and disproportionate, or outside the range of reasonable decisions.

1. Appeal dismissed. The court’s powers under article 38 included dismissing the appeal, quashing or substituting the decision, or remitting the case with directions.
2. Under CPR 52.11, the appeal was ordinarily a review. The court was required to give appropriate weight to the specialist tribunal’s expertise, its assessment of evidence, and evaluative judgments akin to jury questions. On sanction, the appellant had to establish that the order was excessive and disproportionate or outside the range of reasonable decisions.
3. The absence of patient harm or clinical risk did not answer the public-interest issue. Dishonesty by a nurse undermined trust and integrity and could damage the reputation of the profession. Public harm was not confined to financial loss or direct patient injury.
4. The purpose of professional sanctions was not punishment, but a punitive element was inevitable in suspension or erasure. The relatively short delay in this case did not make the sanction punitive or materially relevant.
5. The Committee had considered the available options, applied proportionality, and balanced mitigation against the protection of the public and confidence in the nursing profession. It was entitled to conclude that dishonesty convictions of this seriousness made a caution or conditions of practice insufficient, while erasure was not inevitable.
6. The Committee’s reasons had to be read fairly and as a whole. They did not require minute forensic examination, and the court found no material error in the treatment of coercion, mitigation, or the alternative sanctions. The appeal was dismissed and the appellant was ordered to pay the respondent’s costs, to be assessed if not agreed.

The judgment does not state a further appellate history. The appeal was from the Conduct and Competence Committee of the Nursing and Midwifery Council’s decision dated 24 August 2011.