Case Comment: Ibrahim, R (On the Application Of) v Nursing and Midwifery Council [2024] EWHC 2991 (Admin)
Background
This case involved an appeal by a Registered Mental Health Nurse (RMN) against a 12-month conditions of practice order imposed by the Nursing and Midwifery Council (NMC). The charges related to incidents during a night shift in 2017, including preventing a patient from leaving her room and raising his voice to colleagues. Some charges were dismissed, but the remaining ones were found proved, and the panel determined the nurse’s fitness to practise was impaired due to misconduct.
The appellant challenged the decision on two grounds:
- The panel failed to engage with his submissions about the challenging circumstances he faced, including systemic failings.
- The panel placed undue emphasis on a perceived lack of insight at the impairment stage.
Decision
The High Court, presided over by Richard Kimblin KC, allowed the appeal on both grounds, focusing heavily on the adequacy of the panel’s reasoning. There were no issues of law in this appeal, nonetheless, the judgment provides a helpful summary of the established principles concerning reasons in appeal cases; where a tribunal’s reasons are unclear, appellate courts may examine the evidence and submissions to infer reasoning and identify whether the decision is justified. However, an appeal should succeed if, even with this exercise, the court cannot understand the basis for the decision (English v Emery Reimbold & Strick [2002] 1 WLR 2409). The standard for reasons should not be set too high; not every point needs to be recorded, but parties must be able to understand why they have won or lost (General Medical Council v Awan [2020] EWHC 1553 (Admin)). Giving reasons is not a slavish exercise but must ensure fairness and clarity (Re F (Children) [2016] EWCA 546).
On this issues of misconduct and insight, the Judge noted that appropriate respect should be given to the specialist assessment made by the panel but only to the extent warranted by the circumstances (Ghosh v GMC [2001] 1 WLR 1915). Insight is primarily concerned with assessing the risk of repetition. Denial of misconduct does not preclude a finding of insight, nor is an admission of misconduct a precondition for demonstrating low risk of recurrence (Sawati v GMC [2022] EWHC 283 (Admin)).
Ground 1: Failure to Engage with the Registrant’s Case
The court found that the panel failed to properly engage with the appellant’s submissions about the systemic issues and the context of his actions. The appellant argued that systemic issues, including understaffing and the lack of a care plan, left him unsupported and justified his actions. The Judge had considerable sympathy for these arguments and found, at para 40, that the panel had not sufficiently addressed these points in its decision:
“It is relevant that the Appellant was new to the ward and had no care plan from which to work. These matters show that the Appellant was put into a challenging situation with arguable systemic failings which were not of his making… Arguments arising from the above were clearly and cogently articulated on the Appellant’s behalf via written submissions and supplemented orally. Given that the Appellant recorded absconding behaviour in the clinical notes and that is consistent with the similar absconding behaviour referred to in the DOLS notes, which the Appellant had not seen when he made his entry, the Panel had to engage with the reality of what the Appellant faced and the extent to which that was a situation which, arguably, he should not have had to face, alone.”
The court held that the panel’s failure to address these arguments undermined the fairness of its decision. As the judge noted, the panel’s reasoning was “one-dimensional,” lacking the necessary “colour and perspective” to fairly evaluate the appellant’s case.
Ground 2: Misapplication of Insight
The panel was also found to have misapplied the concept of insight. While the appellant acknowledged some failings, he disputed the findings of misconduct and argued his actions were in the patient’s best interest. The court found the panel’s conclusions on insight were flawed, particularly its claim that the appellant showed no remorse or reflection when his submissions demonstrated otherwise.
From paragraph 54 of the judgment:
“Again, the Appellant’s case has not been grappled with… If clear findings are going to be made about recognising effects on others, how he has developed as a result of these events and whether there is remorse or not, the Appellant’s evidence needs to be taken into account and at least some sense of the reason for rejecting it is necessary.”
The appeal succeeded on both grounds. The court quashed the findings of fact, misconduct, and impairment. Notably, the judge declined to remit the case to a fresh panel, reasoning that the interim conditions of practice order had already served its purpose and, given that there were no further allegations against the appellant since the 2017 incident, a rehearing would be disproportionate and unlikely to result in any sanction.
Comment
This case highlights the importance of panels fully addressing the context that may justify a registrant’s actions, particularly where the registrant does not dispute the factual basis of the charges. It also reinforces the need for clear and transparent reasoning that properly demonstrates a panel has fully considered the registrant’s case, even if ultimately rejecting it.
The full judgment can be read here: https://www.bailii.org/ew/cases/EWHC/Admin/2024/2991.html