Mark Hulme (Registrant member) David Bleiman (Lay member)

Transcription

1 Conduct and Competence Committee Substantive Hearing Monday 3 April 2017 Friday 7 April 2017 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of Registrant Nurse: Cheryl Fiona Henwood NMC PIN: 86C0685E Part(s) of the register: RN1, Registered Nurse (sub part 1) Adult (25 March 1994) RN2, Registered Nurse (sub part 2) Adult (10 April 1990) V300: Nurse Independent/supplementary Prescriber (2 August 2010) Area of Registered Address: England Type of Case: Misconduct Panel Members: Monica French (Chair Lay member) Mark Hulme (Registrant member) David Bleiman (Lay member) Legal Assessor: Susan Monaghan Panel Secretary: Hassan Reese Cheryl Fiona Henwood: Present and represented by Ms Shah, Counsel instructed by Royal College of Nursing Nursing and Midwifery Council: Represented by Tom Hoskins, Counsel, instructed by NMC Regulatory Legal Team. Facts proved by admission: Charge 1 Facts not proved: Charge 2 Fitness to practise: Impaired Sanction: Striking-Off Order Interim Order: Interim Suspension Order 18 months 1

2 Details of charge: That you, a registered nurse, 1. Between 11 March 2011 and 9 November 2011 failed to inform Wirral Community NHS Trust that you were subject to an HM Revenue and Customs investigation. 2. Your actions as alleged in charge 1 were dishonest in that you sought to conceal the investigation from the Trust. AND in light of this your fitness to practise is impaired by reason of your misconduct 2

3 Decision and Reasons on application under Rule 19: Ms Shah, on your behalf made a request that part of your hearing be held in private. [PRIVATE] Mr Hoskins, did not object to this application. The legal assessor reminded the panel that while Rule 19 (1) of the Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended 2012) (The Rules) provides, as a starting point, that hearings shall be conducted in public, Rule 19 (3) states that the panel may hold hearings partly or wholly in private if it is satisfied that this is justified by the interests of any party or by the public interest. The panel [PRIVATE] determined to hold those parts of the hearing in private. Determination on the application to allow evidence of Mr 3 to be given via telephone link Ms Shah informed the panel, that due to only being contacted on the first day of the hearing, Mr 3 was not in a position to attend the hearing in person. The panel heard submissions from Ms Shah to allow the evidence of Mr 3 to be given via telephone link. Mr Hoskins did not oppose this application. The panel heard and accepted the legal assessor s advice on the issues it should take into consideration in respect of this application. The panel considered that Mr 3 s evidence would be clearly relevant as he was a key witness to the events. The panel considered that it was fair and appropriate to permit this evidence to be adduced via telephone link. Admissions: 3

4 At the outset of the hearing, you admitted charge 1. The panel therefore found the facts in relation to charge 1 proved by way of your admission. Background The NMC received a referral from Wirral Community NHS Trust ( the Trust ). You were employed by the Trust at the material time. It is alleged that you did not disclose to the Trust between 11 March 2011 and 9 November 2011,that you were subject to a criminal investigation by Her Majesty s Revenue and Customs (HMRC). Prior to 11 March 2011, the previous investigation into you by the Trust and NHS fraud included an investigation into your mileage claims and your employment outside the Trust, in particular about an alleged property management business with your husband. These investigations did not conclude with any adverse findings against you. The allegation from the Trust concerns your arrest and interview under caution on 11 March 2011 for allegedly falsely claiming benefits, then failing to advise the Trust of this investigation. This was in relation to a claim for Tax Credits. It is alleged that following the arrest and search of your property in March 2011, you did not disclose this investigation to the Trust until November It is further alleged that you were dishonest in seeking to conceal the investigation from the Trust. Submissions Mr Hoskins submitted that you had a duty to disclose the investigation to the Trust. He submitted that in relation to dishonesty, there has been a shifting of sands in your story, and gave examples of inconsistencies in the accounts you have given. He 4

5 submitted that you deliberately sought to conceal the investigation from the Trust and in so doing you acted dishonestly. Ms Shah on your behalf submitted that you had acted on the legal advice from Mr 3, an accredited police station representative. She submitted that he advised you that you did not need to inform your employers at that stage as they already knew. She referred to the evidence of Mr 3 and she also referred the panel to your contract of employment which states that you only need to inform the Trust if you have been charged with a criminal offence. Ms Shah submitted that when giving answers throughout the investigation, you often became confused and that you were not clear. She submitted that this did not demonstrate that you were a dishonest person. She invited the panel to conclude that you were not acting dishonestly. Decision on the findings on facts and reasons In reaching its decisions on the remaining charge, the panel considered all the evidence adduced in this case together with the submissions made by Mr Hoskins, on behalf of the NMC and those made by Ms Shah on your behalf. The panel heard and accepted the advice of the legal assessor. The panel was aware that the burden of proof rests on the NMC, and that the standard of proof is the civil standard, namely the balance of probabilities. This means that the facts will be proved if the panel was satisfied that it was more likely than not that the incidents occurred as alleged. The panel heard evidence from the following witnesses: 5

6 Ms 1; employed as the Head of Wirral Fraud and Probity Service for NHS Wirral at the time of the events. Mr 2; employed by the Trust as the Divisional Manager of Children and Wellbeing. He was the Chair at your Trust disciplinary meeting on 31 May Mr 3; employed as a accredited police station representative, who represented you upon your arrest on 11 March The panel also heard from you. Further, the written statement of Ms 4, who was Head of Nursing at the Trust at the time of the events, was before the panel as agreed evidence. The panel began by considering the credibility of the witnesses it heard. The panel found Ms 1 to be a credible witness who was straightforward, honest and reliable. The panel noted that she was professional and answered only to questions which she knew she could answer. The panel also found Mr 2 to be a credible and professional witness. The panel felt that his evidence was limited to his role as Chair of the disciplinary meeting. He confirmed the broad accuracy of the transcript of that hearing. He was a careful witness and if he did not recall information, he said so. Mr 3 gave his evidence by telephone. The panel found him to be a credible and reliable witness. The panel felt that when he did not remember any information, he would say so. The panel noted that he was able to confirm the evidence which he had provided at your Trust disciplinary hearing in May The panel found you to be a credible witness. The panel felt that you were candid when giving evidence. It noted that sometimes you had difficulty on one or two occasions in understanding questions and therefore gave muddled answers. The panel considered you to be honest when giving answers to the questions posed and took into account that the events took place a long time ago. The panel was of the view that you were 6

7 frank when you could not remember information. It felt that you were consistent, and did not try to mislead or conceal in anyway. You told the panel that you accepted Charge 1, and that in accordance with the Trust s Standards of Conduct and Disciplinary Policy in place at the time, you were obliged to make that disclosure to the Trust. You said that you did not make the disclosure as you were following legal advice given to you by Mr 3 on 11 March You referred to your employment contract dated 24 February 2004, which you received in April You said that you were working with the Trust prior to this contract, and had transferred roles. You said that you read the contract, and that you understood the contract to mean that you had to inform your employer only if you were charged. You told the panel that you recall reading about the issue of disclosure of criminal investigations but that you could not remember exactly when, but that this would have been after 11 March You said that you remembered asking Mr 3 if you had to tell your employer about the investigation. You said that you were told that you did not need to tell them as they already knew, and that you also believed this. You told the panel that on 11 March 2011, you were interviewed by the HMRC. You said that you felt that the HMRC and your employers had been sharing information prior to the interview due to the questions that were being asked. You told the panel, that you did not seek to conceal the investigation. You said that you had failed to inform the Trust but that this was not dishonest as you genuinely believed that the Trust already knew. With hindsight, you would now do things differently and would tell your employers everything. [PRIVATE] You said that you were not thinking straight, and became muddled and confused. You also said that you were off from work for 12 months, between November 2009 and November

8 [PRIVATE] You said that issues of driving expenses and whether you had been working for your husband s property management business during work hours were considered during the Trust s investigation. You said that the investigation did not involve tax credits. You said you were made aware that the Trust had finished their investigation by the end of The panel has heard and accepted the advice of the legal assessor who advised the panel how to approach the issue of dishonesty. In light of the admissions of the charge 1, the panel then went on to consider the remaining charge. Charge 2 Your actions as alleged in charge 1 were dishonest in that you sought to conceal the investigation from the Trust. This charge is found NOT proved The panel noted that you accept that you failed to inform the Trust that you were subject to an HMRC investigation. The panel accepted your evidence that you relied on the legal advice given to you by Mr 3, stating that you did not need to disclose the investigation to your employer as they already knew. The panel also had regard to your contract of employment in particular 23.1 which states Any charges brought against you for a criminal offence, whether connected with your employment or not must be reported to your manager. The panel went on to consider whether your actions would be regarded as dishonest according to the standards of reasonable and honest people. It concluded that it would not. 8

9 The panel noted that your evidence included some inconsistencies but did not attribute this to an attempt by you to mislead. It accepted your evidence that you relied on the advice given to you by Mr 3 and it also took into account that your contract of employment specifically refers to the fact that you only need to notify the Trust if you are charged with a criminal offence. The panel also noted that you had telephoned the NMC shortly after your arrest and you were advised that you only needed to inform your employer and the NMC if you were subsequently charged. The panel also accepted your evidence that you believed that the Trust investigation was ongoing and that you did not need to inform them as they already knew. The panel accepted Ms 1 s evidence that on the day of your arrest, she had informed the Trust s head of HR of the HMRC investigation into you. The panel considers it inherently implausible that you would try to conceal from your employers something which in fact they did know about, which your legal advisor told you they knew about and which you yourself believed that they knew about. The panel therefore concluded that your actions were not dishonest and accordingly, it finds charge 2 not proved. Submissions on misconduct Having announced its findings on the facts, before the panel moved on to consider whether your fitness to practise is currently impaired by reason of your misconduct, a joint application was made by Mr Hoskins and Ms Shah, on your behalf. The application was made to have the issue of misconduct solely considered at this time, without impairment. It was submitted that the panel had a discretion in relation to the order of proceedings before it. Both Counsel submitted that if the panel were agreeable to this application, matters would be simplified. The panel accepted the advice of the legal assessor. 9

10 The panel had regard to rule 24 (1) which permits a committee to exercise discretion in the order of proceedings. Given that both parties explained that by dealing with the issue of misconduct separately would simplify matters, the panel considered that this course of action was appropriate. The panel therefore agreed to determine the issue of misconduct at this stage. Misconduct Mr Hoskins did not invite the panel to make a finding of misconduct. Ms Shah, on your behalf submitted that in light of the finding of fact and the reasons behind the panel s findings, the failure to disclose in this matter does not amount to misconduct. She submitted that there was no attempt to deliberately conceal the investigation from the Trust, and that the panel had agreed this. She submitted that the panel also had evidence to show that you relied on legal advice and therefore did not tell the Trust as you thought they already knew. Ms Shah submitted that although there was an omission, it had no effect on the Trust s state of knowledge and there was no risk to patients. She submitted that there had been no breach of the NMC s code of conduct. Decision on misconduct: When determining whether the fact found proved amount to misconduct the panel had regard to the terms of The code: Standards of conduct, performance and ethics for nurses and midwives 2008 (the Code). The panel, in reaching its decision, had regard to the public interest and accepted that there was no burden or standard of proof at this stage and exercised its own independent professional judgement. 10

11 The panel was of the view that you did not deliberately attempt to conceal the investigation from the Trust. You accepted that you did not follow the Trust policy by not informing them that you were subject to an HMRC investigation. However the panel has already accepted that the Trust were aware of the investigation and therefore your failure was not significant. The panel determined that there is no suggestion on behalf of the NMC that your actions amounted to misconduct. The panel therefore determined that your actions did not fall significantly short of the standards expected of a registered nurse, and that your actions did not amount to a breach of the Code. It therefore follows that your actions did not amount to misconduct. Conviction The panel then went on to consider the fact of your conviction. The conviction reads as follows: That you, a registered nurse 3. On 23 July 2013, were convicted at the Crown Court Sitting at Liverpool of twelve counts of being knowingly concerned in fraudulent activity with a view to obtaining tax credit contrary to section 35 (1) of the Tax Credits Act 2002 and were subsequently sentenced to 12 months imprisonment. AND in light of this your fitness to practise is impaired by reason of your conviction. Background On 23 July 2013, after a jury trial, you were convicted of 12 counts of being knowingly concerned in fraudulent activity. This fraudulent activity occurred over a period of approximately seven years and as a consequence of that fraudulent activity you were overpaid 92,075.18p by way of tax credits. The fraudulent activity was two-fold in that you were claiming benefits as a single parent when in fact you were married and living 11

12 with your husband. You were claiming benefits at a higher rate than they were entitled to for one of your children. You were sentenced to a period of 12 months imprisonment. Decision on the findings on facts and reasons You informed the panel that you admitted charge 3. The panel therefore found the facts in relation to charge 3 proved by way of your admission. Determination on the application to allow evidence of 4 of your witnesses to be given via telephone link Ms Shah informed the panel, that due to a variety of genuine reasons, 4 witnesses were not in a position to attend the hearing. The panel heard submissions from Ms Shah to allow the evidence of 4 witnesses to be given via telephone link. Mr Hoskins did not oppose this application. The panel heard and accepted the legal assessor s advice on the issues it should take into consideration in respect of this application. The panel considered that this evidence would potentially be relevant at this stage of the hearing. The panel considered that it was fair and appropriate to permit this evidence to be adduced via telephone link Submission on impairment The panel considered whether your fitness to practise is currently impaired by reason of your conviction. The NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. 12

13 Mr Hoskins invited the panel to take the view that your conviction amounted to a breach of The Code: Standards of conduct, performance and ethics for nurses and midwives 2008 ( the Code ). He addressed the panel on the need to consider the public interest. This included the need to declare and maintain proper standards and maintain public confidence in the profession and in the NMC as a regulatory body. Mr Hoskins referred the panel to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). He submitted that your actions, for which you were convicted, undermined public confidence in the nursing profession. Ms Shah, on your behalf submitted that you admitted the charge. She submitted that although this matter is serious, you have been practising as a nurse for some time since you have served your prison sentence. Ms Shah submitted that there is evidence which therefore addresses the risk of repetition. She referred to the evidence of Ms 5 who said that she felt safe with you in the care home. Ms Shah referred to Ms 5 who spoke of your dedication and commitment to nursing and that your care is described as exceptional. She therefore submitted that the risk of repetition is low. Ms Shah submitted that you accept that your fitness to practise is currently impaired on the grounds of public interest as opposed to there being a continued risk of repetition. The panel has accepted the advice of the legal assessor. The legal assessor referred th panel to a number of authorities, including: Cheatle v GMC [2009] EWHC645, Meadow v GMC [2007] 1QB462 and Yeong v GMC [2009] EWHC1923. Decision and reasons on impairment The panel moved on to consider whether, as a result of your conviction, your fitness to practise is currently impaired. The NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. 13

14 You gave evidence on oath. The panel also heard from 4 witnesses, who gave evidence by telephone on your behalf. The panel considered a large number of documents submitted on your behalf. In reaching its decision on impairment the panel had regard to the need to safeguard the public interest, which includes the maintenance of public confidence in the profession, and the upholding of proper standards of conduct and behaviour. Nurses occupy a position of privilege and trust in society and are expected at all times to be professional. Patients and their families must be able to trust nurses with their care and the care of their loved ones. They must make sure that their conduct at all times justifies both their patients and the wider public s trust in the profession. The panel accepted that there was no burden of proof to be discharged at this stage and it exercised its own independent judgment. The panel considered the wider public interest. It took account of the judgment of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). Mrs Justice Cox also endorsed the impairment test set out by Dame Janet Smith in her fifth Shipman report as follows: Do our findings of fact in respect of the [registrant s] conviction[s] show that his/her fitness to practise is impaired in the sense that s/he: a.. b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. 14

15 The panel determined limbs b, c and d of this test are engaged. Further, the panel noted The Code: Standards of conduct, performance and ethics for nurses and midwives 2008 ( the Code ) and considered that you breached the following sections: From the preamble: be open and honest, act with integrity and uphold the reputation of your profession. You must always act lawfully, whether those laws relate to your professional practice or personal life. From the numbered standards: 49 You must adhere to the laws of the country in which you are practising. 61 You must uphold the reputation of your profession at all times. The panel considered whether your actions, as evidenced by your criminal conviction, put patients at unwarranted risk of harm. The panel noted that there were no clinical issues in this matter and that no patients suffered any harm. The panel was satisfied that your actions did not place patients at unwarranted risk of serious harm. The panel considered that in committing and being convicted of the criminal offence of fraud, you had shown a disregard for the laws of the country. Taking this into account the panel therefore determined that, you have in the past breached fundamental tenets of the profession and inevitably brought the profession into disrepute by acting dishonestly. 15

16 In considering whether you would be liable, in the future, to act so as to place patients at unwarranted risk of harm, to bring the profession into disrepute, and/or to breach one of the fundamental tenets of the profession, the panel also had careful regard to the issues of insight and remediation. The panel were satisfied that you have shown insight into your actions and acknowledged the gravity of them. It took into account that you did not seek to blame anyone for your actions and that you have made no excuses to minimise your behaviour. It noted the telephone and written evidence provided on your behalf, which shows that you have been frank about your conviction. You accepted that your actions undermined the reputation of the profession. Regarding remediation, the panel considered that dishonesty is difficult to remedy. It noted that following your release from prison, you have managed to secure employment in a nursing home, where you have worked for 2 years, without any further concerns raised. The panel also noted that it has been over 6 years since the fraudulent activity happened. The panel took into account the evidence of Ms 5 that you have been trusted to handle money and valuables of residents in your current workplace without any concerns. The panel was of the view therefore that the risk of repetition has diminished somewhat with the passage of time and that you have demonstrated some trustworthiness. The panel took account of all of the evidence presented both oral and documentary and noted that you have reflected upon your actions and the impact this has caused to you, your colleagues, the profession, the public and to the NMC as its regulator. The panel took the view that your remorse for your actions was genuine. The panel considered that your conviction involved serious dishonesty. It went on to consider whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not 16

17 made in the circumstances of this case. The panel was of the view that public confidence in the profession would be seriously undermined if a finding of impairment was not made in a case where a nurse had been convicted of fraud of such magnitude. You were convicted of 12 separate counts of fraud totalling an amount of over 92,000 committed over a period of 7 years. The panel determined that your fitness to practise is impaired by reason of your conviction. It considered that your conviction undermined public confidence in the nursing profession and failed to uphold proper standards of conduct and behaviour. Such a finding of current impairment is required to reaffirm clear standards of professional conduct so as to maintain public confidence in the profession. In conclusion, the panel has determined that your fitness to practise is currently impaired. Decision on sanction The panel went on to consider what sanction, if any, it should impose. In reaching its decision, the panel has considered all the evidence before it and the submissions made by Mr Hoskins, on behalf of the NMC and Ms Shah, on your behalf. Mr Hoskins reminded the panel of the Indicative Sanctions Guidance (ISG) and submitted that it was a matter for the panel to decide what if any sanction to impose. Ms Shah invited the panel to impose a caution order for a period of 5 years. She submitted that the impairment found in this case was at the lower end of the spectrum. She also went through the other sanction options for the panel if it was not minded to agree that a caution order was the appropriate sanction. Finally, she submitted that a striking-off was not the only order that could be imposed in this case. Ms Shah referred the panel to the fact that you had expressed remorse and had worked as a nurse for 2 years without any further incidents. 17

18 The panel has heard and accepted the advice of the legal assessor. The panel was referred to the case of Bolton v The Law Society and the case of Atkinson v GMC [2009] EWHC Under Article 29 of the Nursing and Midwifery Council Order 2001, the panel can take no action or impose any of the following actions in ascending order: make a caution order for one to five years; make a conditions of practice order for no more than three years; make a suspension order for a maximum of one year; or make a striking off order. The panel has borne in mind that the purpose of a sanction is not to be punitive, though it may have that effect. The panel has sought to apply the principles of fairness and proportionality, weighing the interests of patients and the public with your own interests and taking into account any mitigating and aggravating features in the case. The panel has also taken account of the NMC s Indicative Sanctions Guidance of May 2012 (updated January 2016) (ISG) and exercised its own judgment considering the particular facts of this case. The panel has considered the mitigating and aggravating factors in this case. The panel considered that the aggravating factors were as follows: You were dishonest for a prolonged period (7 years). The dishonesty was not a single isolated incident. You committed 12 separate counts of fraud which was in excess of 92,000, leading to a custodial sentence. You were effectively stealing from taxpayers, limiting the public purse as a result. The panel considered that the mitigating factors were as follows: You have shown insight into your dishonesty. You have acknowledged the gravity of your dishonesty. You repaid the monies owed to the public purse prior to sentence. 18

19 You were experiencing stressful personal circumstances at the relevant time It has been six years since you committed the offences, with no reported recurrence. You have been working as a nurse since the dishonesty and have been trusted to handle money and valuables. The panel has borne in mind that the public interest includes the protection of patients, the maintenance of public confidence in the profession and in the NMC as regulator, and the declaring and upholding of proper standards of conduct and behaviour. The panel first considered taking no action. The panel considered the guidance outlined in the ISG. It decided that taking no action would not be appropriate given that it found that you had breached fundamental tenets of the nursing profession. The panel considered that this matter was far too serious to take no action. To take no action would be wholly inappropriate in that it would not uphold confidence in the profession or the NMC as a regulator. Next, in considering whether a caution order would be appropriate in the circumstances, the panel took into account the ISG, which states that a caution order may be appropriate where the case is at the lower end of the spectrum of impaired fitness to practise and the panel wishes to mark that the behaviour was unacceptable and must not happen again. The panel rejects Ms Shah s submission that your impairment was at the lower end of the spectrum. The panel considered that a caution order would be inappropriate in view of the seriousness of the case and the aggravating factors. The panel was of the view that a caution would not suffice to maintain confidence in the profession. It decided that it also would be neither proportionate nor in the public interest to impose a caution order. The panel next considered whether placing conditions of practice on your registration would be a sufficient and appropriate response. The panel bore in mind that any conditions imposed must be proportionate, measurable and workable and must provide 19

20 sufficient public protection. The panel bore in mind that the principal concerns related to fraud and dishonest behaviour. The concerns in this case do not relate to clinical practice. As such, the panel concluded that it was not possible to formulate conditions which would address the concerns raised in your case. In addition, given the fact that the case involved dishonesty, the panel considered that conditions of practice would be insufficient to mark the seriousness of this case in order to satisfy the public interest considerations. The panel then went on to consider whether a suspension order would be an appropriate sanction. Paragraph 67 indicates that a suspension order would be appropriate where (but not limited to): 68 the misconduct is not fundamentally incompatible with continuing to be a registered nurse or midwife in that the public interest can be satisfied by a less severe outcome than permanent removal from the register. This is more likely to be the case when some or all of the following factors are apparent (this list is not exhaustive): 68.1 A single instance of misconduct but where a lesser sanction is not sufficient No evidence of harmful deep-seated personality or attitudinal problems No evidence of repetition of behaviour since the incident The panel is satisfied that the nurse or midwife has insight and does not pose a significant risk of repeating behaviour. The panel considered whether a suspension order would be an appropriate and proportionate sanction. The panel noted that this was not a single isolated incident but took place over a protracted period of 7 years when you fraudulently obtained tax credits that you were not entitled to. The panel accepts that you are a competent and caring clinician. It also accepts that you have worked for the last two years as a nurse without any issues arising. However 20

21 this is a serious matter. Members of the public would not expect a nurse who enjoys a privileged standing in society to defraud the public purse in excess of 92,000. Such behaviour demonstrates a significant departure for many years from the standards expected of a registered nurse. The panel therefore concluded that a suspension order would not be a sufficient, appropriate or proportionate sanction to satisfy the public interest in declaring and upholding of proper standards of conduct and behaviour and further it would not maintain public confidence in the profession or the regulatory process. Having determined that a suspension order is not an appropriate or proportionate sanction, the panel is accordingly satisfied that the only appropriate and proportionate sanction that would satisfy the public interest is a striking-off order. Having regard to the matters identified, and in particular, the fraudulent activity which took place and subsequent custodial sentence, the panel concluded that you have brought the profession into disrepute by adversely affecting the public s view of how registered nurses conduct themselves. It noted that the aggravating factors in this case were so serious, that anything less than a striking-off order would be insufficient to protect the public interest. The panel has concluded that nothing short of a striking-off order would be sufficient. Such a sanction is necessary to mark the serious nature of your dishonesty and to send a clear message to the public and the profession about the standards of conduct and behaviour expected of a registered nurse. Before coming to this conclusion, the panel had regard to the mitigating factors it has already set out. However, it considered that the aggravating factors in this case outweighed the mitigating circumstances. By fraudulently defrauding the public purse for a period of seven years, the reputation of the profession has been adversely affected. Members of the public would be appalled to find that a registered nurse, a professional in a position of trust in society would behave in such a way. The panel weighed in the balance upon you the severe impact, financially, professionally and personally, if you are unable to practise your profession. The panel concluded that notwithstanding your own personal interest, that a striking-off order is required to protect the reputation of the profession. 21

22 The panel therefore directs that your name be removed from the NMC register. You may not apply for restoration until five years after the date that this order takes effect. Unless subject to an appeal, the striking-off order will take effect 28 days from the date this decision is deemed to have been served upon you. Decision and reasons on interim order: The panel has considered in accordance with Article 31(2) of The Nursing and Midwifery Order 2001 whether an interim order should be imposed. The panel has heard the submissions of Mr Hoskins, on behalf of the NMC, who sought an interim suspension order for a period of 18 months on the grounds of the public interest to cover the 28 day appeal period and to allow for any possible appeal to be made and determined. No submissions were made by Ms Shah. The panel heard and accepted the advice of the legal assessor. The panel has taken account of the guidance issued to panels by the NMC when considering interim orders and the appropriate test as set out at Article 31(2) of The Nursing and Midwifery Order The panel is satisfied that an interim suspension order is necessary on the grounds of the public interest. In reaching its decision, the panel has had regard to the seriousness of its findings and the detailed reasons outlined in its decision to impose a striking-off order. To do otherwise would be inconsistent with its decision to impose a striking-off order. The period of the interim suspension order is for 18 months to allow for the possibility of an appeal to be made and determined. If at the end of the 28 day appeal period, you have not lodged an appeal, the interim suspension order will lapse and will be replaced by the striking-off order. However, if 22

23 you do lodge an appeal, the interim suspension order will continue to run for the period imposed or until the appeal is determined. This decision will be confirmed to you in writing. That concludes this determination. 23