Okafor v Nursing and Midwifery Council

The High Court dismissed the appeal under Article 38 of the Nursing and Midwifery Order 2001 against a Conduct and Competence Committee decision that the appellant's fitness to practise was impaired and that she should be struck off pursuant to Article 29(5)(a). The panel’s findings that Charges 1 and 2 (misconduct) and Charge 3 (lack of competence, in part) were proved were upheld, including two findings of dishonesty. The judge applied the established appellate approach to fitness-to-practise appeals (citing Cheatle and Bhatt), rejected the appellant's procedural and substantive challenges, and concluded the striking‑off sanction was proportionate because of the misconduct, dishonesty, lack of insight and a significant risk of repetition.

The court considered and rejected grounds alleging undue delay/Article 6 breach, improper amendment of charges, unfair proceeding in the appellant’s absence on the final day, misapplication of the test for dishonesty, failure to give weight to particular witnesses, improper exclusion or weighting of evidence, disability discrimination, errors on impairment, and that the academic mentor was unqualified. The Okeke decision and Article 29(6) were considered but found not to assist because the striking‑off order was founded on misconduct rather than competence alone.

Background and nature of the claim: The appellant, a midwife, appealed under Article 38 against a Conduct and Competence Committee determination (18 July 2014) that her fitness to practise was impaired and that she should be struck off the Nursing and Midwifery Council register under Article 29(5)(a). The Committee had found proved three broad sets of allegations arising from incidents in 2009–2011: failure to care for Patient A in July 2009, retrospective and dishonest record‑keeping in March 2011, and failures of competence during supervised practice between April 2010 and April 2011.

Procedural posture and hearing: The disciplinary hearing lasted many days across late 2013 and 2014; the appellant attended and gave evidence. The Committee issued detailed written reasons (Decision Letter). The appellant pursued multiple grounds of appeal in the High Court challenging findings of fact, the test applied to dishonesty, alleged procedural unfairness and the proportionality of the striking‑off sanction.

Issues framed by the court: whether procedural defects (delay, change of charges, proceeding in absence) or breaches of Article 6 rendered the hearing unfair; whether the panel misapplied the law on dishonesty; whether the panel erred in weighing witness and documentary evidence; whether there was disability discrimination; whether the impairment finding and sanction were wrong or disproportionate; and what (if any) effect the Okeke decision and Article 29(6) should have.

Court’s reasoning and conclusions: Applying the correct appellate approach to fitness‑to‑practise appeals (Cheatle; Bhatt), the court showed appropriate deference to the specialist tribunal on credibility and professional judgment. There was no demonstrable prejudice from delay and no Article 6 breach. The charges were properly notified and not amended so as to prejudice the appellant. The panel lawfully proceeded in the appellant’s absence on the final day after she indicated agreement. The panel applied the two‑stage Ghosh test for dishonesty (with discussion of later authorities) and was entitled to conclude the false entries in patient records were dishonest by ordinary standards and that the appellant must have known this. The panel gave proper weight to live testimony and appropriately limited the value of character evidence. There was no established discrimination on grounds of health. On impairment the panel properly relied on its findings that the conduct exposed patients to risk, involved dishonesty and showed lack of insight and an ongoing risk of repetition. The panel carefully considered sanctions, applied the NMC Indicative Sanctions Guidance and case law (including Parkinson, Bolton), and reasonably concluded that striking off was proportionate. Okeke and Article 29(6) were considered but did not assist because erasure was imposed for misconduct and dishonesty rather than competence alone.

Appeal dismissed. The High Court found no error in the Conduct and Competence Committee’s findings of fact, dishonesty or impairment; no procedural unfairness or Article 6 breach; and concluded the striking‑off sanction was proportionate given the misconduct, dishonesty, lack of insight and risk of repetition.

Appeal to the High Court under Article 38 of the Nursing and Midwifery Order 2001 from a Conduct and Competence Committee decision of the Nursing and Midwifery Council dated 18 July 2014. High Court judgment recorded at [2015] EWHC 1872 (Admin).