Professional Standards Authority for Health and Social Care v Nursing and Midwifery Council & Anor

On a statutory appeal concerning professional disciplinary findings and sanction, the High Court may draw inferences from established primary facts where it is suitably placed to do so. Reasons must enable the parties and the appellate court to understand what was decided and why; a tribunal cannot rely on an unanticipated distinction in evidence without giving the witness a fair opportunity to address it.

Sanction is an evaluative decision, but appellate intervention is justified for an error of principle or a conclusion outside the range reasonably open to the disciplinary tribunal. A repeated pattern of uncaring conduct towards vulnerable residents, combined with attitudinal concerns and insufficient insight, may make suspension inappropriate and striking off necessary to protect the public and maintain confidence in the profession.

The Professional Standards Authority appealed decisions of the Nursing and Midwifery Council’s Fitness to Practise Committee concerning a registered nurse. The Panel found multiple allegations proved, including failures affecting vulnerable care-home residents, dishonesty in medication records, and misconduct, but dismissed an allegation that conduct towards Resident A was intended to humiliate and did not find proved an allegation that the Registrant grabbed Resident B’s face. It imposed a 12-month suspension order.

The appeal challenged the factual findings, the adequacy and fairness of the Panel’s reasoning, and the sanction. The central issues were whether the Panel had drawn the permissible inferences from its findings, whether it had acted fairly in assessing disputed evidence, and whether suspension was within the range of sanctions reasonably open to it.

1. Charge 11. The Panel’s reasons did not make clear what it had decided about the Registrant’s intention during the incident involving Resident A or why. That inadequacy allowed the appeal to succeed. On the unchallenged primary facts, including the Registrant’s own evidence and the Panel’s findings that her conduct humiliated Resident A and that her safety-based explanation was untenable, the only inference was that humiliation was intended. The Court substituted a finding that Charge 11 was proved.
2. Charge 13d. The Panel acted unfairly by treating “grabbing” a resident’s face and “squashing” the cheeks as materially inconsistent descriptions without exploring the alleged distinction with the witness. It also relied on a material misstatement that the witness had described the conduct as violent. The written accounts were properly read as consistent, with the reference to squashing providing further detail. The appeal was allowed, but the Court declined to make its own primary factual finding and initially invited submissions on remittal. Following the parties’ later agreement that remittal was unnecessary in light of the sanction decision, Charge 13d was not remitted.
3. Sanction. The Panel’s sanction decision was outside the range reasonably open to it. It had found repeated misconduct over several years, a pattern of uncaring behaviour, attitudinal concerns not amenable to training, and insufficient insight. Those findings were inconsistent with the suspension guidance checklist. The Panel also failed to address its significant departure from the guidance and failed properly to consider the striking-off guidance, including whether the conduct raised fundamental questions about professionalism and its effect on public confidence.
4. General testimonials about current conduct could not establish insight into the motivations and triggers underlying past misconduct or reduce the risk of repetition. The appropriate sanction was striking off. The Court substituted that sanction for the suspension order and allowed the appeal on all grounds.

1. High Court (Administrative Court): appeal from the Fitness to Practise Committee’s substantive decision dated 4 July 2025. The appeal was allowed on all grounds, Charge 11 was substituted as proved, the suspension order was replaced by striking off, and Charge 13d was ultimately not remitted.