Part(s) of the register: RN1, Registered Nurse (sub part 1) Adult (8 June 2016) Lack of knowledge of English/Misconduct

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1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Hearing February April June 2018 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Giovanni Cardelli 16F0195C Part(s) of the register: RN1, Registered Nurse (sub part 1) Adult (8 June 2016) Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Registrant: Italy Lack of knowledge of English/Misconduct David Newman (Chair, lay member) Stella Tracey Armstrong (Registrant member) Anita Underwood (Registrant member) Nigel Pascoe QC Amira Ahmed Not present and not represented in absence Nursing and Midwifery Council: Represented by Christopher Harper (22-23 February 2018) / Kim Elcoate May (25-26 April 2018, 7 June 2018), NMC Case Presenters Facts proved: 1 Facts not proved: 2 Fitness to practise: Sanction: Interim Order: facilitate Voluntary Removal Impaired N/A - Voluntary Removal Application Granted Current Interim order is to be revoked to Page 1 of 21

2 Details of charge: That you, a registered nurse: 1. Do not have the necessary knowledge of the English language to practise safely and effectively; [Proved] And/or 2. Failed to co-operate with NMC investigation in relation to your knowledge of English in that you did not comply with the NMC s direction to take a language assessment. [Not Proved] And in light of the above, your fitness to practise is impaired by reason of your lack of knowledge of English in respect of Charge 1 and/or your fitness to practise is impaired by reason of your misconduct in respect of Charge 2. Page 2 of 21

3 Decision on Service of Notice of Hearing The panel was informed at the start of this hearing that Mr Cardelli was not in attendance and that written notice of this hearing had been sent to Mr Cardelli s registered address by recorded delivery and by first class post on 18 January Notice of this hearing was delivered to Mr Cardelli s registered address on 31 January The panel took into account that the notice letter provided details of the allegation, the time, dates and venue of the hearing and, amongst other things, information about Mr Cardelli s right to attend, be represented and call evidence, as well as the panel s power to proceed in his absence. Mr Harper submitted the NMC had complied with the requirements of Rules 11 and 34 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended ( the Rules ). The panel accepted the advice of the legal assessor. In the light of all of the information available, the panel was satisfied that Mr Cardelli has been served with notice of this hearing in accordance with the requirements of Rules 11 and 34. It noted that the rules do not require delivery and that it is the responsibility of any registrant to maintain an effective and up-to-date registered address. Decision on proceeding in the absence of the Registrant The panel next considered whether it should proceed in the absence of Mr Cardelli The panel had regard to Rule 21 (2) which states: (2) Where the registrant fails to attend and is not represented at the hearing, the Committee Page 3 of 21

4 (a) (b) (c) shall require the presenter to adduce evidence that all reasonable efforts have been made, in accordance with these Rules, to serve the notice of hearing on the registrant; may, where the Committee is satisfied that the notice of hearing has been duly served, direct that the allegation should be heard and determined notwithstanding the absence of the registrant; or may adjourn the hearing and issue directions. Mr Harper invited the panel to continue in the absence of Mr Cardelli on the basis that he had voluntarily absented himself. He also drew attention to the that Mr Cardelli sent on 19 February in which he explained his lack of knowledge of English and expressly stated I will not be able to understand what happens. Mr Harper submitted that there was no reason to believe that an adjournment would secure Mr Cardelli s attendance on some future occasion. The panel accepted the advice of the legal assessor. The panel noted that its discretionary power to proceed in the absence of a registrant under the provisions of Rule 21 is not absolute and is one that should be exercised with the utmost care and caution. The panel further noted the case of R (on the application of Raheem) v Nursing and Midwifery Council [2010] EWHC 2549 (Admin) and the ruling of Mr Justice Holman that:...reference by committees or tribunals such as this, or indeed judges, to exercising the discretion to proceed in the person's absence "with the utmost caution" is much more than mere lip service to a phrase used by Lord Bingham of Cornhill. If it is the law that in this sort of situation a committee or tribunal should exercise its discretion "with the utmost care and caution", it is extremely important that the committee or tribunal in question demonstrates by its language (even though, of course, it need not use those precise words) that it appreciates Page 4 of 21

5 that the discretion which it is exercising is one that requires to be exercised with that degree of care and caution. The panel noted the correspondence from Mr Cardelli in which he stated in an that he would not be attending the hearing and would not like to participate in any way. The panel has decided to proceed in the absence of Mr Cardelli. In reaching this decision, the panel has considered the submissions of the case presenter, and the advice of the legal assessor. It has had regard to the overall interests of justice and fairness to all parties. It noted that: no application for an adjournment has been made by Mr Cardelli; there is no reason to suppose that adjourning would secure his attendance at some future date; not proceeding may inconvenience the witness and her employer; there is a strong public interest in the expeditious disposal of the case; Mr Cardelli was given the opportunity to participate in the hearing by telephone or Webex, but has not taken that opportunity. There is some disadvantage to Mr Cardelli in proceeding in his absence. He will not be able to challenge the evidence relied upon by the NMC and will not be able to give evidence on his own behalf. However, in the panel s judgment, this can be mitigated. The panel can make allowance for the fact that the NMC s evidence will not be tested by cross examination and, of its own volition, can explore any inconsistencies in the evidence which it identifies. Furthermore, the limited disadvantage is the consequence of Mr Cardelli s decision to absent himself from the hearing, waive his rights to attend and/or be represented and to not provide evidence or make submissions on his own behalf. In these circumstances, the panel has decided that it is fair, appropriate and proportionate to proceed in the absence of Mr Cardelli. The panel will draw no adverse inference from Mr Cardelli s absence in its findings of fact. Page 5 of 21

6 Issues raised by the panel The case was opened by Mr Harper for the NMC, and the panel was given the opportunity to read the witness statements and other documentation which Mr Harper stated that he wished to adduce as evidence. Following the panel reading the relevant documentation, it raised certain issues, without at that stage intending to make any decision or findings. The panel noted that Mr Cardelli s name was placed on the register in June 2016, since when there have been changes to the rules regarding evidence of English Language skills competence at the point of registration. There is now a requirement to have an average score of 7 in the IELTS test before registration. When Mr Cardelli registered as a nurse this requirement did not exist. The panel noted that a complaint had been made by Mr Cardelli stating that he had been accepted on to the register without having had to demonstrate competence in English, and that subsequently his English had been questioned. The panel noted in the documentation a reference to an administrative error made by the NMC. Mr Harper responded that there were in fact two errors made by the NMC. The first error concerned Mr Cardelli s postcode to which letters were sent. The second error concerned the payment for the IELTS test booked by Mr Cardelli which could not be made by the NMC in time because of a delay by the NMC in making the appropriate payment arrangements. The panel took note that in June 2017 Mr Cardelli had informed the NMC that he had returned to Italy for family reasons and did not intend to return to the UK. The panel noted that the first charge related to competence in English whereas the second charge was one of misconduct; if found proved the two charges would be likely to have different implications. Taking into account the background of these matters and the various events described in the documents, the panel asked Mr Harper to indicate Page 6 of 21

7 whether there had been significant consideration given to the nature and wording of the charges. Mr Harper responded that there had been significant consideration given when drafting the charges. The registrant is currently able to practise in the UK. The reason there is public interest is that, in the NMC view, there would be a potential risk to allow the registrant to practise with an insufficient knowledge of English language. Mr Cardelli was offered a post as a healthcare assistant with potential to move into a registered nurse position upon receipt of appropriate documentation. Although Mr Cardelli says he does not want to currently work in the UK that could change. The NMC had directed Mr Cardelli to sit an English language assessment. It was his duty to do so, and his failure to do gave rise to the charge of misconduct. The panel raised a query relating to the possibility of a voluntary removal application process, given that Mr Cardelli had sought to be removed from the register on a number of occasions. Mr Harper explained that voluntary removal requires a formal admission of all the charges, which could not be presumed from the responses from Mr Cardelli to date. Therefore voluntary removal has not been an option in this case at this moment in time. Background The charges arose from a referral by the NMC registrations department (NMC) because of a telephone call that took place between Mr Cardelli and the NMC on 20 June It was noted during this call that there were concerns about his ability to speak and understand English. In light of these concerns, some months later the registrant was directed to undertake an International English Language Testing System ( IELTS ) assessment. An IELTS test was arranged by Mr Cardelli. However, owing to an administrative error by the NMC, the registrant was unable to take this test. Following that, attempts were made to schedule a new assessment. However, the registrant then indicated that for family Page 7 of 21

8 reasons he no longer intended to work in the UK and would like to be removed from the register. Mr Cardelli never took the assessment, and at various stages indicated that his English was poor, and that he did not intend to return to the UK. Mr Cardelli has not worked in the UK as a registered nurse, and is currently living in Italy. Decision on the findings on facts and reasons The panel has drawn no adverse inference from the non-attendance of Mr Cardelli. The panel heard oral evidence from one witness on behalf of the NMC: Ms 1, who has been employed by the NMC as a Registrations Centre Officer since March Ms 1 described a telephone call that took place on 20 June 2016 with Mr Cardelli and a friend of his. Ms 1 could not speak to the friend of Mr Cardelli who wanted to translate on the phone call as there was no third party authorisation in place. She then spoke to Mr Cardelli but had difficulty making him understand even simple questions such as his date of birth. She also could not understand his responses. The panel found that Ms 1 was a credible and reliable witness and had no reason to doubt her evidence. Charge 1: 1. That you, a Registered Nurse: Do not have the necessary knowledge of English to practise safely and effectively Page 8 of 21

9 The panel took account of the oral and documentary evidence in this case. The panel heard Ms 1 s concerns which gave rise to a concern about Mr Cardelli s knowledge of English. It found the evidence that was given by Ms 1 shows serious concerns as to whether Mr Cardelli can understand English and whether he would then be able to communicate with his peers and patients. The IELTS test has not been taken. Therefore the panel are limited to the phone call and correspondence with the registrant. Mr Cardelli stated in April 2017 that he had been offered a role as a senior care assistant by an employer and presented this as evidence that his English was of a good enough standard that he could practise in the UK. Taking into account the other evidence available to the NMC about his standard of English, the panel agreed that it was not appropriate for the NMC to rely on the offer of a job as evidence of sufficient English language skills. Therefore, an IELTS test was appropriately required as evidence Subsequent to this there is recognition by the registrant that his English is not good enough. He stated in his dated 6 July 2016: my english level isn t higt when I speak I have more difficult rispect to understand it. [sic] Mr Cardelli further states that any correspondence he has had made with the NMC through has been by the use of Google Translate. The panel also had regard to the sent by Mr Cardelli 19 February 2018 in which he accepted his poor English language skills and explains his reasons for not wanting to attend the hearing by stating: I do not want to participate in any way because I would not be able to understand what happens. I repeat my level of English is low. The panel also noted that Mr Cardelli has not taken the IELTS test to demonstrate his level of English. Taking all the above factors into account, the panel has concluded that Mr Cardelli does not have the necessary knowledge of the English language to practise safely and effectively in the UK. The panel found charge 1 to be prove Page 9 of 21

10 Charge 2: 2. Failed to co-operate with NMC investigation in relation to your knowledge of English in that you did not comply with the NMC s direction to take a language assessment. In reaching this decision, the panel again took account of the oral and documentary evidence in this case. It was confirmed by Ms 1 that there was not a requirement to provide evidence of English language skills in place at the time Mr Cardelli was admitted to the register. A direction was made by the registrar on 17 January 2017 for Mr Cardelli to undertake an English language assessment. The panel considered the various events and communications which had taken place after this direction had been made. The NMC acknowledged that the relevant letter dated 17 January 2017 failed to reach Mr Cardelli due to an error made by the NMC in regards to his postcode. This error was repeated twice more by the NMC on 1 February 2017 and 15 February. A letter dated 10 March 2017 was then sent to his correct address asking him to book the IELTS test. Mr Cardelli then responded on 23 March 2017 explaining that he only received the direction to book the test a couple of days prior. On 29 March 2017, the NMC made Mr Cardelli aware that he had a deadline of 12 April 2017 to book an IELTS test and also explained that if he did not comply and book the test he might be subject to further misconduct allegations for failure to cooperate with the NMC s investigation. A telephone call also took place on 29 March 2017 between the NMC and Mr Cardelli in which Mr Cardelli stated that he had never been to the UK but registered as the first steps to find work. He also explained that he wished to make a complaint before booking the IELTS test. This complaint was made by Mr Cardelli on 4 April 2017 in an to the NMC, and expressed his unhappiness in being accepted to the register without having his English language skills tested, and then subsequently being required to have them tested. On 12 April 2017, Mr Cardelli ed explaining that he had booked to sit the IELTS test in Italy on 25 May 2017 and sent the details of the test to the NMC so that they Page 10 of 21

11 could pay for it. He sent a follow up on 18 May 2017 asking why the payment had not been made. The NMC wrote a response to Mr Cardelli on 18 May 2017, apologising for the fact that he could not take IELTS test as arranged as the British Embassy had stated that payment for the test must be made two weeks before the assessment. The panel was informed by Mr Harper that the reason for this was that the NMC had failed to take the necessary steps to make the payment on time. The NMC asked Mr Cardelli to re-book the test at his earliest convenience. Mr Cardelli on 08 June 2017 explained that he would be coming to England on 12 June 2017 and would book the test then. On 22 June 2017, the NMC wrote an to Mr Cardelli giving him a deadline of 26 June to book the IELTS test. On 29 June 2017, Mr Cardelli wrote an in response to an sent by the NMC on 29 June asking him to book the IELTS test by 3 July He explained in the that for serious family reasons he had returned to Italy and would not be returning to England. He thanked the NMC for the kindness and patience it had shown him. On 20 August 2017 Mr Cardelli wrote another that reiterated what he had sent on 29 June 2017 and he stated I solely ask you one thing: I want to be deleted by the NMC. On 14 November 2017, the NMC sent out a letter to Mr Cardelli following a preliminary meeting to give him notice of the decisions made, and on 30 November another letter was sent to Mr Cardelli giving him a notice of direction to take the language assessment by 29 December A further letter chasing up whether Mr Cardelli has booked the test was sent on 18 December On 6 January 2018, Mr Cardelli, wrote an stating again that he wanted to be deleted by the NMC because: You continue to ask to me to do the IELTS TEST but it is useless to continue to urge me because I live in Italy, I work in Italy and there is not and there will never be more danger that I come to work in England and I probably will not even come as a tourist anymore. This was followed by another sent on 8 January repeating that Mr Cardelli that he does not want to work in England as he stated: Page 11 of 21

12 I live in Italy, working in Italy, I have no intention of returning to England for work or even as a tourist; and moreover I ask to withdraw my registration in the NMC. Mr Cardelli on 19 February 2018 sent an in response to an sent by the NMC explaining that Mr Cardelli had a hearing scheduled on 22 February 2018 and could he confirm his attendance. He stated that: I do not want to participate in any way because I would not be able to understand what happens, I repeat my level of English is low and for many months I do not speak to me anymore, every time I write it is because I use Google translator. If it is useful for you I could send you a copy of my work contract. On 19 February 2018 the last correspondence with Mr Cardelli took place by where he stated: I admit that I avoided your invitations to support the IELTS test, but I always had the question of whether to come to the nurse in the UK and my level of English is low. Now as I said several times I m in Italy, I m working in Italy and I will NEVER go back to the UK. My only request is, and I ask you to please, to be removed from the NMC. Thank you. The panel decided that between 17 January 2017 and the end of June 2017, Mr Cardelli had not failed to cooperate with the NMC requirement to take an English Language test. It was noted that the errors made in sending letters to an incorrect address by the NMC delayed his awareness of the direction till 23 March On 12 April 2017 Mr Cardelli did in fact book a test, but errors by the NMC prevented him from taking the test as arranged on 25 May At some stage in May or June, Mr Cardelli came to the UK with intention to take IELTS test in London, but he left again at some point, informing the NMC on 29 June 2017 that he had returned to Italy for family reasons. Taking these Page 12 of 21

13 matters into account, the panel was not satisfied that the NMC had proved that Mr Cardelli had failed to cooperate with the investigation up until the end of June In relation to the period between July 2017 and February 2018, the panel noted that Mr Cardelli did not take any further steps to take the English Language test. The panel notes that no evidence has been provided that Mr Cardelli was directed again to take the English Language test between June 2017, when he said he would not be returning to the UK, and 30 November when he was sent a further direction to sit the assessment. The panel notes that, from 29 June 2017 Mr Cardelli consistently informed the NMC that he did not intend to return to the UK, and that he wanted to be removed from the register. The panel considers that Mr Cardelli genuinely thought that he had explained why he did not need to take the test, as he would not be returning to the UK to take up a nursing position or otherwise. The panel considered that the NMC had not explained to Mr Cardelli why it still required him to take the IELTS test, despite his intention not to practise nursing in the UK and desire to be removed from the register. For example, despite the various communications from Mr Cardelli explaining his position and seeking to be removed from the register, the NMC did not tell Mr Cardelli that they could not prevent him from nursing in the UK if he was to change his mind and that this might put patients at risk of harm. The panel therefore considers that the NMC has not proved that he has failed in his duty to cooperate with the investigation during the period from the beginning of July 2017 to the date of this hearing. For the above reasons the panel considers Mr Cardelli did not fail to co-operate with the NMC investigation in relation to his knowledge of English by not complying with the NMC direction to take a language assessment. This charge is found NOT proved. Page 13 of 21

14 Determination on Interim Order The panel has considered the submissions made by Mr Harper that an interim order should be made on the grounds that it is necessary for the protection of the public. The panel accepted the advice of the legal assessor. The panel had regard to the seriousness of the fact found proved and the reasons set out in the decision. A condition of practice order is not appropriate as Mr Cardelli has stated he does not intend to return to the UK and has implied he does not intend to take an English language test to prove his competence in English. The panel was satisfied that an interim suspension order is necessary for the protection of the public. The period of this order is for 6 months to cover the period until the date of a resuming hearing, and to allow for any unexpected delay. Page 14 of 21

15 Decision on Service of Notice of Hearing The panel was informed by Ms Elcoate May on the resuming date of this hearing, 25 April 2018, that Mr Cardelli was again not in attendance and that written notice of this hearing had been sent to Mr Cardelli s registered address by recorded delivery and by first class post on 9 April The panel was also informed that Mr Cardelli on 28 February 2018 was sent notice that the hearing had adjourned to a later date. Taking this into consideration, the panel were satisfied that Mr Cardelli had been served with notice of hearing in accordance with the requirements of the Rules. Decision on proceeding in the absence of the Registrant Ms Elcoate May invited the panel to continue in the absence of Mr Cardelli on the basis that he had voluntarily absented himself and has not provided any further response since the last hearing. The panel accepted the advice of the legal assessor. The panel decided that it is fair, appropriate and proportionate to proceed in the absence of Mr Cardelli. Submission on impairment Having previously announced its finding on the facts, the panel then moved on to consider whether Mr Cardelli s fitness to practise is currently impaired in relation to Charge 1. There is no statutory definition of fitness to practise. However, the NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. In her submissions, Ms Elcoate May addressed the panel on the need to have regard to protecting the public and the wider 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. Ms Elcoate May referred the panel to the cases of Council Page 15 of 21

16 for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). Ms Elcoate May submitted that the panel had already found in February 2018 that Mr Cardelli does not have the necessary knowledge of the English language to practise safely and effectively. Ms Elcoate May explained that there had been no evidence provided by Mr Cardelli that he has before made any efforts to improve his knowledge of the English language, i.e. to remediate that shortcoming. Ms Elcoate May submitted that Mr Cardelli s fitness to practise is currently impaired under the first two limbs of Grant in terms of future risk and that a finding of impairment is necessary under the grounds of public protection and the wider public interest. The panel has accepted the advice of the legal assessor which included reference to Nicholas-Pillai v GMC [2009] EWHC 1048 (Admin). Decision on impairment The panel considered whether, as a result of the finding of fact that Mr Cardelli does not have the necessary knowledge of the English language to practise safely and effectively, his fitness to practise is currently impaired. Nurses occupy a position of privilege and trust in society and are expected at all times to be professional and to always be in a position to treat their patients safely and effectively. In this regard the panel considered the judgement 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) in reaching its decision, in paragraph 74 she said: In determining whether a practitioner s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold Page 16 of 21

17 proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances. The panel are of the view that the above emphasis on the risk of harm to members of the public in the context of misconduct applies equally to their findings in charge 1, namely that Mr Cardelli does not have the necessary knowledge of English language to practise safely and effectively. Mrs Justice Cox went on to say in Paragraph 76: I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph she identified the following as an appropriate test for panels considering impairment of a doctor s fitness to practise, but in my view the test would be equally applicable to other practitioners governed by different regulatory schemes. Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or Regarding insight, the panel considered that Mr Cardelli showed a good level of insight into his English language skills and deficiencies. However, in relation to remediation, the Page 17 of 21

18 panel noted that Mr Cardelli has repeatedly expressed his intention not to work as a nurse in the UK. He has also not provided any indication of an intention to improve his English language skills. The panel therefore considered that Mr Cardelli has not remediated his shortcomings and does not appear to have any intention to do so in the future The panel considered that Mr Cardelli s lack of ability to communicate effectively in English with patients, their relatives and colleagues would put patients at risk of harm if he were to practise in the UK. The panel considered that the public would expect a nurse to be able to communicate effectively in English, and an inability to do so would be liable to bring the profession into disrepute. Therefore, the panel decided that a finding of impairment is necessary on the grounds of both public protection and the wider public interest. Having regard to all of the above, the panel is satisfied that Mr Cardelli s fitness to practise is currently impaired. Adjournment At 17:05pm the panel noted that no response had been received from the Registrar to the panel s recommendations for voluntary removal. After hearing submissions from the case presenter and having accepted the advice of the legal assessor the panel decided to adjourn the hearing so that the Registrar s decision can be available when the hearing resumes. The panel noted that an interim suspension order was imposed on 23 February 2018 for six months and therefore remains in place. Page 18 of 21

19 The hearing reconvened on 7 June Decision on Service of Notice of Hearing The panel was informed by Ms Elcoate May on the resuming date of this hearing, 07 June 2018, that Mr Cardelli was not in attendance and that written notice of this hearing had been sent to Mr Cardelli s registered address by recorded delivery and by first class post on 31 May Taking this into consideration, the panel were satisfied that Mr Cardelli had been served with notice of hearing in accordance with the requirements of the Rules. Decision on proceeding in the absence of the Registrant Ms Elcoate May invited the panel to continue in the absence of Mr Cardelli on the basis that he had voluntarily absented himself. The panel accepted the advice of the legal assessor. The panel decided that it is fair, appropriate and proportionate to proceed in the absence of Mr Cardelli. Voluntary Removal application and Recommendation Since the last hearing Mr Cardelli has submitted a further application for voluntary removal from the Register. The panel had sight of this application form dated 13 May The panel reviewed all the information before it and considered whether to make a recommendation for voluntary removal to the Registrar, balancing the public interest with the interests and future plans of Mr Cardelli, and based on his formal application on 13 May The panel had regard to the following factors: 1. Mr Cardelli s request for voluntary removal from the Register is consistent with his application made on 1 February 2018, and with his s of 20 Page 19 of 21

20 August 2017, 6 and 8 January 2018, 19 February 2018 and 30 April 2018, in which he has made specific informal requests to be removed from the Register. 2. Mr Cardelli states in the last paragraph of voluntary removal application form dated 13 May 2018, that he admits the allegation found proved (that he does not have the necessary knowledge of the English language to practise safely and effectively) and that his fitness to practice is impaired. 3. Mr Cardelli has repeatedly confirmed that he does not intend to practice as a nurse in the UK. 4. Mr Cardelli is currently working as a nurse in Italy; there are no known concerns regarding his nursing practice; only his ability to speak and understand English 5. The panel had made a previous recommendation for voluntary removal on 25 April 2018, to which it had not received response The panel considered that voluntary removal would protect the public as Mr Cardelli would be removed from the register. It would also meet the wider public interest in this case for the reasons stated above. In the circumstances, the panel decided to recommend to the Registrar that Voluntary Removal is an appropriate course of action in this case. This was done using a Voluntary Removal recommendation form. Voluntary removal granted The panel was informed that the Registrar has granted the application for voluntary removal and that Mr Cardelli s name will be removed from the NMC register. Should the registrant wish to be readmitted to the register, the English language requirements now in place would ensure he had the necessary language proficiency in order to register with the NMC. As a result, the panel decided to take no action under Article 29(4) (b) of the Nursing and Midwifery Order This will have the effect of revoking, with immediate effect, Page 20 of 21

21 the existing interim order that Mr Cardelli has been subject to during the course of the proceedings. Mr Cardelli s Voluntary Removal will therefore also come into effect immediately. That concludes this hearing. Page 21 of 21