Ibrahim, R (on the application of) v The Nursing and Midwifery Council

A professional disciplinary panel must engage with the registrant’s central case, including any factual context relied upon to justify the conduct. It must make findings on the overall circumstances and explain why the justification is accepted or rejected. Reasons need not address every point, but they must enable the parties to understand why the decision was reached.

In assessing impairment, a panel must distinguish insight from admission of misconduct. It must take account of relevant evidence concerning remorse, future conduct, development and subsequent practice. Where material omissions undermine findings of fact, misconduct, impairment and sanction, the appellate court may quash the decision and decline remittal where a rehearing would be disproportionate.

The appellant, a registered mental health nurse, appealed under Articles 29(9) and 38 of the Nursing and Midwifery Order 2001 against a Conduct and Competence Committee decision imposing a 12-month conditions of practice order.

The Committee found that he had prevented a patient from leaving her room, caused distress and raised his voice to colleagues. It found misconduct, impairment and imposed conditions. The appellant argued that the Committee had failed to engage with the difficult circumstances in which he acted, including the patient’s risks, the reduction from two-to-one to one-to-one care and the absence of an adequate care plan. He also challenged the Committee’s assessment of insight.

The central issues were whether the Committee had given adequate reasons and whether the appeal should be remitted.

1. Appeal allowed. The Committee’s factual findings, findings of misconduct and impairment, sanction and resulting orders were quashed. The case was not remitted.
2. The context relied upon by the registrant was legally material. The patient presented substantial and rapidly developing risks. The Deprivation of Liberty Safeguards assessment under Part 8 of Schedule A1 to the Mental Capacity Act 2005 had authorised deprivation of liberty using two-to-one care. The registrant was nevertheless left alone with the patient and had no adequate care plan. Those circumstances could explain or justify the conduct alleged.
3. A panel must address the substance of a registrant’s justification case at the factual or misconduct stage. It must determine the overall circumstances, including the patient’s behaviour, risks to the patient and others, staffing arrangements and the significance of any departure from the authorised care arrangements. The list of relevant issues is illustrative, not exhaustive. The Committee’s failure to address these matters made it impossible to understand why the justification was rejected.
4. At the impairment stage, insight concerns the risk of repetition. Admission of misconduct is not a precondition to insight, and lack of insight cannot automatically be equated with current impairment. The Committee wrongly stated that the appellant had not recognised the effect on colleagues, had provided no information about future conduct, and had shown no remorse, despite express evidence addressing each matter. It also failed to explain the significance of five years without another complaint.
5. Although appropriate deference is owed to the professional judgment of a specialist panel, the court was sufficiently well placed to determine the consequences of the Committee’s documentary omissions. A rehearing would be disproportionate. The interim order had lapsed, the proceedings had already served their public-interest purpose, there was no evidence of later regulatory concern, and any fresh sanction was highly likely to be unnecessary.
6. The respondent was ordered to pay the appellant’s costs, assessed at £8,809.

• High Court (Administrative Court): appeal under Articles 29(9) and 38 of the Nursing and Midwifery Order 2001 allowed. The Committee’s findings and orders were quashed and the matter was not remitted.