Olubokola Bridget Ajana v Nursing and Midwifery Council

An appellate court reviewing a professional disciplinary sanction must give appropriate deference to the specialist tribunal and must not conduct a resentencing exercise. Intervention is justified only where the tribunal made an error of principle or reached a decision outside the range reasonably open to it, or where the decision was wrong or unjust because of serious procedural irregularity. A tribunal should identify relevant aggravating and mitigating features and assess their weight, but an imperfect mitigation list is not necessarily material where the reasons read as a whole show that the evidence was considered. Risk of repetition, insight, patient safety and public confidence may be assessed across the tribunal’s decision and need not be repeated in the sanction section.

A panel of the Nursing and Midwifery Council’s Fitness to Practise Committee found that Olubokola Bridget Ajana, a registered midwife, had committed misconduct which impaired her fitness to practise. The misconduct involved repeated hostile and unsafe treatment of vulnerable patients, including shaking a baby. The panel imposed a striking-off order.

Ms Ajana appealed against the sanction under article 38(1) of the Nursing and Midwifery Order 2001. She did not challenge the underlying findings of misconduct or impairment. The central issues were whether the panel had failed to consider mitigation, insight, risk of repetition, proportionality and the NMC’s sanctions guidance, and whether its procedural decisions disclosed apparent bias.

1. The appeal was dismissed. Under article 38(1) of the Nursing and Midwifery Order 2001 and CPR 52.21(3), the court could intervene only if the panel’s decision was wrong or unjust because of a serious procedural irregularity.
2. On sanction, appropriate deference was required because the panel had specialist expertise. Applying General Medical Council v Bawa-Garba [2018] EWCA Civ 1879, the court was not to substitute its own view or conduct a resentencing exercise. Intervention required an error of principle or an evaluation outside the bounds of what a reasonable panel could properly decide.
3. The panel erred by failing to list all material mitigating features and by failing expressly to state the weight assigned to them. That error was not material. Reading the decision as a whole, the panel had considered the relevant evidence, including good-practice evidence, references, training and the appellant’s subsequent work. It had wrongly conflated identifying mitigation with assessing its weight.
4. The panel had properly considered suspension, insight and risk of repetition. It did not equate denial of the allegations with lack of insight. Its finding of an entrenched attitudinal problem was supported by the repeated pattern of misconduct over ten months. Its conclusions on risk and proportionality could be understood from the decision as a whole and did not need to be repeated under the heading dealing with striking-off.
5. The panel followed the staged approach in the NMC sanctions guidance and addressed proportionality, public protection and public confidence. Given the seriousness of the misconduct, including shaking a baby and repeated hostility towards vulnerable patients, the striking-off decision was within the range reasonably open to the panel. It was neither wrong nor unjust because of serious procedural irregularity.

The appellant was ordered to pay the respondent’s appeal costs, summarily assessed at £7,247.

• Nursing and Midwifery Council Fitness to Practise Committee: on 24 September 2024, found misconduct and impairment and imposed a striking-off order.
• High Court (Administrative Court): dismissed the appeal against sanction and ordered payment of the respondent’s costs.