Nursing and Midwifery Council Fitness to Practise Committee … · 2020-05-21 · 1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Hearing 27 January 2020

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Nursing and Midwifery Council

Fitness to Practise Committee

Substantive Hearing

27 January 2020 – 3 February 2020 & 18 – 19 May 2020

Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of registrant: Miss Linda Marie Hughes NMC PIN: 05E0027E Part of the register: Registered Nurse – Adult (2005) Area of Registered Address: England Type of Case: Misconduct/Lack of Competence Panel Members: Alexander Coleman (Chair, lay member)

Patricia Lynch (Registrant member) Sarah Tozzi (Lay member)

Legal Assessor: Mrs Lucia Whittle-Martin Panel Secretary: Leigham Malcolm Registrant: Not present and not represented in absence Nursing and Midwifery Council: Represented by Ms Susan Jean, NMC Case

Presenter Facts proved: 1, 2, 3a, 3b, 4, 5, 6, 7a, 7b, 8, and 9 Facts not proved: 10a, 10b, 11 Fitness to practise: Impaired Sanction: Suspension Order (12 months) Interim Order: Interim Suspension Order (18 months)

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Details of charges

That you failed to demonstrate the standards of knowledge, skill, and judgement

required to practise without supervision as a nurse, in that you:

1) On or around 17 January 2016, did not administer IV antibiotics to an unknown

patient.

2) On or before 21 March 2016, did not record that you had noted a pH of 7 when you

aspirated an unknown patient with a naso-gastric tube.

3) On or around 20 April 2016, in relation to an unknown patient:

a) Did not carry out and/or record that you had carried out MRSA swabs;

b) Did not record IV fluids.

4) On or around 15 December 2016, did not promptly administer Ceftriaxone to an

unknown patient.

Whilst you were subject to a Stage 1 capability action plan, you:

5) On 16 March 2017, signed an unknown patient’s records to indicate a controlled

drug had been administered when it had not yet been administered.


6) Between 10 June 2017 and 7 August 2017, were unable to demonstrate that you

could discharge patients correctly.

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7) On 2 November 2017, whilst responsible for the care of Patient A who had had an

unseen fall:

a) Did not promptly carry out neurological observations;

b) Administered anti-coagulant medication.

8) On 2 December 2017, did not administer Patient C’s PEG feed whilst responsible for

their care.

9) On 11 January 2018, did not administer metronidazole as prescribed in a timely

manner or at all.

AND in light of the above, your fitness to practise is impaired by reason of your lack of

competence.

AND that you, a Registered nurse:

10) On 12 December 2016:

a) Informed Colleague D that you had completed observations for one or more

when you had not.

b) Recorded observations for one or more patients when you had not completed

them.

11) Your actions at charge 10 above were dishonest in that you intended to create the

impression you had completed observations when you had not.

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AND in light of the above, your fitness to practise is impaired by reason of your

misconduct.

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Decision on service of notice of hearing

The panel was informed at the start of this hearing that Miss Hughes was not in

attendance nor was she represented in absence. The panel was also informed that

written notice of this hearing had been sent to Miss Hughes’ registered address by

recorded delivery and by first class post on 19 December 2019.

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 Miss

Hughes’ right to attend, be represented and call evidence, as well as the panel’s power

to proceed in her absence.

Ms Jean, on behalf of the Nursing and Midwifery Council (NMC), submitted that 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 Ms Hughes

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.

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Decision on proceeding in the absence of the registrant

The panel next considered whether it should proceed in the absence of Ms Hughes.

The panel had regard to Rule 21 (2) states:

(2) Where the registrant fails to attend and is not represented at the hearing, the

Committee

(a) 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;

(b) 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

(c) may adjourn the hearing and issue directions.

Ms Jean invited the panel to continue in the absence of Ms Hughes on the basis that

she had voluntarily absented herself. Ms Jean referred the panel to a series of records

of telephone conversations between Ms Hughes and an NMC Case Officer. The records

were dated 1 May 2018, 3 December 2018, 21 May 2019, and two records dated 30

May 2019. The record dated 21 May 2019 reported that Miss Hughes confirmed that

she would be unable to attend the hearing as she was now working as a Care Support

Worker and did not have the finances.

Ms Jean also referred the panel to two emails dated 24 December 2019 and 20 January

2020, in which an NMC Case Officer engaged with Miss Hughes and enquired about

her intentions in respect of this hearing.

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Ms Jean submitted that there had been no subsequent engagement from Ms Hughes

since 30 May 2019 nor had she requested an adjournment. She submitted that, as a

consequence, there was no reason to believe that an adjournment would secure her

attendance on some future occasion.


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” as referred to in the case of R. v Jones (Anthony William),

(No.2) [2002] UKHL 5.

The panel had regard to all of the correspondence from Miss Hughes, noting that the

most recent was dated 30 May 2019.

The panel decided to proceed in the absence of Ms Hughes. In reaching this decision,

the panel has considered the submissions of the case presenter, and the advice of the

legal assessor. It has had particular regard to the factors set out in the decision of R v

Jones (Anthony William), (No.2) [2002] UKHL 5. It has had regard to the overall

interests of justice and fairness to all parties. It noted that:

Ms Hughes has not made an application for an adjournment;

there is no reason to suppose that adjourning would secure her attendance on a

future date;

three witnesses had attended today to give live evidence, and others are due to

attend;

the charges relate to events that occurred in 2016, 2017 and 2018;

further delay may have an adverse effect on the ability of witnesses accurately to

recall events;

there is a strong public interest in the expeditious disposal of the case.

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The panel recognised that there would be some disadvantage to Miss Hughes in

proceeding in her absence. She would not be able to challenge the evidence relied

upon by the NMC and would not be able to give evidence on her own behalf. The panel

of its own volition, can explore any inconsistencies in the evidence which it identifies.

Furthermore, this disadvantage is the consequence of Miss Hughes’ decision to absent

herself from the hearing.

In these circumstances, the panel has decided that it is fair, appropriate and

proportionate to proceed in the absence of Miss Hughes. The panel will draw no

adverse inference from Miss Hughes’ absence.

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Decision and reasons on application to amend the charge

The panel heard an application made by Ms Jean on behalf of the NMC, to amend the

wording of charges 9 and 10 a).

The proposed amendment to charge 9 was to insert the words ‘to Patient B’ as set out

below:

9) On 11 January 2018, did not administer metronidazole to Patient B as prescribed in

a timely manner or at all.

It was submitted by Ms Jean that it was clear from paragraph 25 of Ms 3’s witness

statement that this charge relates to Patient B. She submitted that the amendment

would add clarity to the charge.

The proposed amendment to charge 10 a) was to insert the word ‘patients’ as set out

below:

a. Informed Colleague D that you had completed observations for one or more

patients when you had not.

It was submitted by Ms Jean that this was a typographical error and should be amended

so that the sentence made grammatical sense.

The panel accepted the advice of the legal assessor that Rule 28 of the Nursing and

Midwifery Council (Fitness to Practise) Rules 2004, as amended (“the Rules”) states:

28. (1) At any stage before making its findings of fact, in accordance with rule

24(5) or (11), the Investigating Committee (where the allegation relates to a

fraudulent or incorrect entry in the register) or the Fitness to Practise Committee,

may amend

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(a) the charge set out in the notice of hearing; or

(b) the facts set out in the charge, on which the allegation is based,

unless, having regard to the merits of the case and the fairness of the

proceedings, the required amendment cannot be made without injustice.

(2) Before making any amendment under paragraph (1), the Committee shall

consider any representations from the parties on this issue.

The panel was of the view that such amendments, as applied for, were in the interest of

justice. The panel noted that all of the information available to it in the hearing bundle

had previously been provided to Miss Hughes and it was satisfied that there would be

no prejudice caused to her. It was also satisfied that no injustice would be caused to

either party by the proposed amendments being allowed. It was therefore appropriate to

allow the amendments, as applied for, to ensure clarity and accuracy.

Details of charges, as amended

That you failed to demonstrate the standards of knowledge, skill, and judgement

required to practise without supervision as a nurse, in that you:


patient.




a. Did not carry out and/or record that you had carried out MRSA swabs;

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b. Did not record IV fluids.


unknown patient.









unseen fall:

a. Did not promptly carry out neurological observations;

b. Administered anti-coagulant medication.

8) On 2 December 2017, did not administer Patient C’s PEG feed whilst responsible

for their care.



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AND in light of the above, your fitness to practise is impaired by reason of your lack of

competence.



a. Informed Colleague D that you had completed observations for one or more

patients when you had not.

b. Recorded observations for one or more patients when you had not completed

them.



AND in light of the above, your fitness to practise is impaired by reason of your

misconduct.

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Decision on the findings on facts and reasons

Miss Hughes joined the NMC register on 30 May 2005 and began working at Arrowe

Park Hospital (‘the Hospital’) in October 2005.

In January 2016 Miss Hughes began to work on Ward 25 (the ward), which is an

infection control ward. On 20 April 2016 concerns were raised about Miss Hughes when

working on a shift in relation to discharging patients, administration of IV fluids and the

taking of MRSA swabs.

On 14 February 2017 Miss Hughes was placed on a Stage 1 capability plan. On 16

March 2017 a colleague of Miss Hughes’ raised concerns about her and the recording

of the administration of a controlled medication. Ms 1 met with Miss Hughes in relation

to this concern.

On 31 May 2017 Ms Hughes was placed on a formal Stage 2 capability plan and Ms 1

and Miss Hughes met on 18 August 2017 to discuss progress.

On 22 August 2017 a meeting took place between Ms 1, Ms 2 and Miss Hughes about

further concerns. On 1 November 2017 a Stage 3 meeting took place between Ms 2

and Miss Hughes, who was put on a Stage 3 action plan.

On 2 November 2017 concerns were raised about Miss Hughe’s failure to carry out

neurological observations on Patient A following an unwitnessed fall. There were also

concerns that Miss Hughes administered anti-coagulation medication when she should

not have done as the patient may have had a head injury. On 2 December 2017 further

concerns were raised by Ms 6, a Staff Nurse, in relation to her failure to administer a

peg feed to a patient.

On 11 January 2018 there was an incident where Patient B became increasingly unwell

with sepsis as indicated by an increasing MEWS score. The patient was prescribed

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urgent antibiotics and fluids. Miss Hughes allegedly failed to administer the antibiotics

and handed this task over to the night nurse. Miss Hughes was removed from clinical

duties after this incident.

On 11 April 2018 a Stage 4 meeting took place between Ms 3 and Miss Hughes. Miss

Hughes was dismissed as a registered nurse but was, however, offered the role of a

Clinical Support Worker, which she accepted.

In reaching its decisions on the facts, the panel considered all the evidence adduced in

this case together with the submissions made by Ms Jean, on behalf of the NMC.

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 has drawn no adverse inference from the non-attendance of Miss Hughes.

The panel heard oral evidence from eight witnesses tendered on behalf of the NMC.

Arrowe Park Hospital (the Hospital) is part of the Wirral University Hospital Teaching

Hospital NHS Foundation Trust (the Trust).

Witnesses called on behalf of the NMC were:

Ms 1 - Ward Sister on Ward 25 at Arrowe Park Hospital, at the time of the

allegation, and the line manager of Miss Hughes;

Ms 2 – a matron, covering Ward 25, at Arrowe Park Hospital, at the time of the

allegation;

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Ms 3 - Divisional Director of Nursing for the Wirral University Hospital Teaching

Hospital NHS Foundation Trust, at the time of the allegation;

Ms 4 - Ward Sister at the Wirral University Hospital Teaching Hospital NHS

Foundation Trust, at the time of the allegation;

Dr 5 - Locum SHO Doctor at Arrowe Park Hospital, at the time of the allegation;

Ms 6 – Registered Staff Nurse at Arrowe Park Hospital, at the time of the

allegation;

Ms 7 – Highly Specialist Pharmacist in Rheumatology and Medicines Safety

Pharmacist based at Arrowe Park Hospital;

Mr 8 – Trainee Assistant Practitioner at the Wirral University Hospital Teaching

Hospital NHS Foundation Trust, at the time of the allegation;

Ms 9 – Registered Nurse at the Wirral University Hospital Teaching Hospital NHS

Foundation Trust, at the time of the allegation;

Decision and reasons on application under Rule 19

Ms Jean informed the panel that she would be making an application under Rule 31, in

relation to Ms 9 and that in providing context to the application she would be raising

information of a personal and sensitive nature to Ms 9. She stated that therefore the

application under Rule 31 ought to be held in private as it was in the interest of Ms 9’s

privacy. The application was made under Rule 19 of The Nursing and Midwifery Council

(Fitness to Practise) Rules 2004 (as amended) (the Rules).

The legal assessor reminded the panel that while Rule 19 (1) 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.

To protect the privacy of Ms 9 the panel decided to hear the following Rule 31

application in private.

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Decision and reasons on two applications under Rule 31

First, the panel heard an application, in private, made by Ms Jean under Rule 31 of the

Rules to allow the witness statement of Ms 9 into evidence as she was unable to attend

and give oral evidence due to personal and unforeseen circumstances.

Ms Jean invited the panel to find that there is a good and cogent reason for Ms 9’s non-

attendance at this hearing; [Private]. She submitted that Ms 9’s statement is relevant as

she was a live witness to a number of the incidents in question. She further submitted

that no unfairness would be cause to Miss Hughes who has seen the exhibits and

witness statement bundles and has not raised any issues, moreover, she is not in

attendance.

Ms Jean concluded her submissions by inviting the panel to find that, given the

circumstances, it would be reasonable and fair to admit the evidence of Ms 9 as

hearsay.

The panel accepted the legal assessor’s advice on the issues it should take into

consideration in respect of this application. This included that Rule 31 of the Rules

provides that a panel may admit evidence subject to the requirements of relevance and

fairness.

The panel took account of Ms Jean’s submissions. It formed the view that the witness

statement of Ms 9 was relevant to the charges. It could see no unfairness to Miss

Hughes in it being read and admitted as hearsay evidence. Further, the circumstances

surrounding the absence of Ms 9 were both unexpected and indeed tragic. In the

circumstances, the panel accepted the application.

Second, Ms Jean made an application under Rule 31 of the Rules. This was held in

open session. She informed the panel that the NMC had made efforts prior to and

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during the hearing to secure Mr 8’s physical attendance. However, all attempts had,

rather disappointingly, been unsuccessful.

Ms Jean explained the problems that the NMC had had in contacting Mr 8 and she

referred the panel to an email from Mr 8, received at 09:50am on 30 January, in which

he provided periods of time throughout the day during which he would be contactable.

After speaking with Mr 8, Ms Jean informed the panel that he was unable to attend in

person due to work commitments and concerns around his loss of earnings, however,

he had agreed to time limited engagement via video link. Ms Jean therefore made an

application under Rule 31 for Mr 8 to give evidence via video link.

The panel heard and accepted the advice of the legal assessor.

The panel took account of Ms Jeans’ submissions. As Mr 8 was the only witness who

spoke to charges 10a, b) and 11, serious dishonesty charges, the panel was of the view

that, ideally, he should attend in person.

The panel bore in mind the public interest in the expeditious disposal of cases and its

duty to ensure that Miss Hughes received a fair hearing. The panel was of the view that

delaying the hearing in order to make further attempts to secure Mr 8’s attendance was

unlikely to be successful given the difficulties highlighted in the email chain. It reached

the view that although it would be ideal to hear Mr 8’s evidence in person, hearing his

evidence via video link would be acceptable and would not cause any unfairness to

Miss Hughes. The panel considered that Mr 8’s demeanour whist giving evidence could

be sufficiently assessed via video link. Taking into account the competing factors and

bearing in mind the many unsuccessful attempts that the NMC had made to secure the

attendance of Mr 8, the panel decided to allow the application.

In reaching its decisions on the facts, the panel took into account all the oral and

documentary evidence presented in this case. The panel heard oral evidence from eight

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witnesses called on behalf of the NMC and the written statement of Ms 9 was read into

the record by Ms Jean.

The panel next considered the overall credibility and reliability of all of the witnesses it

had heard from.

The panel considered Ms 1 to be a fair and balanced witness. It noted that she was

present at the time of some of the alleged incidents and was able to recall them clearly.

The panel determined that Ms 1 was a credible and reliable witness. Further, as the line

manager of Miss Hughes, the panel accepted that Ms 1 knew Miss Hughes very well.

The panel acknowledged that Ms 2 was an experienced nurse and matron. The panel

reached the view that Ms 2 was also a credible and reliable witness. The panel

considered that she was fair and balanced towards Miss Hughes and acknowledged

that at times during the capability process Miss Hughes did make some improvements.

The panel noted that Ms 3, a very experienced nurse and manager, had less direct

involvement with Miss Hughes on a day-to-day level but was actively involved at a

senior managerial level throughout the capability process. The panel was of the view

that Ms 3 was a fair and balanced witness. The panel found her to be credible and

reliable.

The panel found Ms 4 to be a helpful and objective witness. It noted that her

involvement was as the author of the root cause analysis investigation report which

assisted the panel with two of the charges. The panel found her to be a credible and

reliable witness.

The panel considered that Dr 5 strove to be helpful and to assist but she could not recall

the particular incident and relied upon the medical notes that she made at the time. The

panel considered her to be a credible and reliable witness.

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The panel was of the view that Ms 6 had a clear and good recollection of the incident

concerned. It found her to be credible and reliable.

The panel found Ms 7 to be helpful, particularly in relation to the pharmacy processes

on the ward. She also had a clear recollection of the incident concerned and the panel

considered her to be a credible and reliable witness.

Mr 8 gave his oral evidence to the panel in a reasonable manner. However, the panel

considered that his credibility and reliability were significantly undermined by the tone of

his written NMC statement towards Miss Hughes.

Particularly paragraphs 8, 10, 13, 14, 17, and 19:-

Paragraph 8:

‘My initial impression of Ms Hughes was that she had poor time management

and was always behind on tasks that were part of her role... and I noticed that

she did not have a good bedside manner. By this I mean that she seemingly

never had enough time to listen to her patients. She talked about herself

consistently so it was difficult to have any kind of reasonable conversation with

her’.

Paragraph 10:

‘She [Miss Hughes] was her normal self during this shift’.

Paragraph 13:

‘I am unsure what time Miss Hughes was meant to carry out her observations but

I was sceptical as to whether Miss Hughes had carried out the observations for

several reasons... Miss Hughes had been her usual self during that shift,

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meaning that she was running behind on her tasks, so I suspected that she had

not had time to do them’.

Paragraph 14:

‘You can constantly see on the bay what other staff members are doing, and it

was obvious to me that she had not done the observation’.

Paragraph 17:

‘I therefore asked Miss Hughes if she had done the observations as I wanted to

see whether it was a case of oversight or whether she would lie to me... and

[Miss Hughes] seemed quite ‘put out’ that she was asked this by someone with a

lesser band in the hospital’.

Paragraph 19:

‘I knew Miss Hughes was lying; however, I did not challenge her again since I

had already given her the opportunity to tell me the truth’.

The panel then went on to consider the charges.

The panel considered each charge and made the following findings:

Charge 1:


patient.

In reaching this decision, the panel took into account all of the information before it. The

panel took into account Ms 1’s witness statement and oral evidence, both of which were

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consistent with a contemporaneous note made by her of the incident on 17 January

2016. Ms 1 said that she worked with Miss Hughes on 17 January 2017, when Miss

Hughes told her that she had not administered IV antibiotics to a patient because his

cannula had come out. Ms 1 said that Miss Hughes did not try to replace the cannula or

escalate the matter. Ms 1 told the panel that she would have expected Miss Hughes to

resolve the situation by replacing the cannula or escalating the matter to another

member of staff, which she did not do. On the basis of Ms 1’s evidence the panel found

this charge proved on the balance of probabilities.

This charge is found proved.

Charge 2:



In reaching this decision, the panel had regard to the witness statement of Ms 1 and the

notes of a meeting conducted by her with Miss Hughes on 21 March 2016. Ms 1 said

that in the course of the meeting she discussed an occasion when Ms 1 had taken over

from Miss Hughes the care of a patient who had an NG tube. Ms 1 informed the panel

that before medication can be administered through an NG tube, the NG tube must be

checked to ensure that it is in the correct place, namely the stomach. She said that the

way to check that the tube is in the stomach is to aspirate and check the pH level, which

needs to be acidic. Ms 1 said that Miss Hughes told her that she had done this and

noticed that the pH was alkaline, indicating that the tube may not be in the stomach. Ms

1 said that Miss Hughes told her that she had not completed the documentation but had

aspirated the NG tube and that the pH was 7. This reading was supported by a

contemporaneous note made on the day. The panel concluded that Miss Hughes did

not record that she had noted the pH of 7 and found this charge proved on the balance

of probabilities.

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Charge 3:


a. Did not carry out and/or record that you had carried out MRSA swabs;

In reaching this decision, the panel took into account the witness statement of Ms 1:

‘...On 20 April 2016 Ms Hughes should have seen from the electronic system that

the patient was due for his 30 day swabs that day and she should have done

them. It is extremely important that these swabs are done. I asked Linda if the

MRSA swabs had been done and she said they had been. I know that MRSA

swabs had not been done as they get flagged on the system when they have not

been done and the next morning when I was on my shift, I could see they had not

been done as the system was flagging them as outstanding for that patient...’

The panel also took into account the exhibit bundle which included a contemporaneous

note in respect of MRSA swabs on 20 April 2016:

‘...Mrsa swabs also not done but said that they had been’.

In her oral evidence Ms 1 told the panel that the electronic system was a failsafe

‘system’ in that it generated the labels for the samples and the task could not be

accomplished without the system being used.

In the absence of any evidence to the contrary, the panel concluded that Miss Hughes

did not carry out or record that MRSA swabs had been taken. The panel found this

charge proved on the balance of probabilities.

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b. Did not record IV fluids.

In reaching this decision, the panel again took into account the witness statement of Ms

1:

‘Linda also failed to record IV fluids on this patient’s records. The correct

procedure was for Linda to document what the patient’s IV fluids as she

administered them, and also to record any other oral fluids and urine output on

their fluid chart.’

The panel also took into account the exhibit bundle which included a contemporaneous

note in respect IV fluids on 20 April 2016:

‘Same day one patient had no fluid balance recorded, Including IV fluids, no VIP

scores...’

In the absence of any evidence to the contrary, the panel concluded that Miss Hughes

did not record IV fluids. The panel found this charge proved on the balance of

probabilities.


Charge 4:


unknown patient.

In reaching this decision, the panel took into account the witness statement of Ms 7

which stated:

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‘I remember the incident on 19 December 2016 as I was quite frustrated with the

significant delay in administration of critical medicine. Myself or the pharmacy

technician ordered the urgent prescribed antibiotic (ceftriaxone) as a high priority

in preparation for the STAT dose in the morning. I noted several hours later that

the dose had still not been administered and therefore flagged this to the nurse

and ward manager at the time.’

The panel also had regard to the oral evidence of Ms 1 who described this medication

as critical medication, meaning that the pharmacy should be informed of its urgency and

the medication should be delivered to the ward ready to administer within the hour.

The panel also had regard to an email dated 19 December 2016, from Ms 7 to Ms 1,

which stated:

‘...See below incident re antibiotics delay on 15/12/16... Ceftriaxone dose

prescribed on cerner for 09:00 but dose not given until 16:47 by nursing staff,

despite being ordered by pharmacy tech as priority medicine... Pharmacist

informed at 16:00 and found Ceftriaxone in both medicine cupboards.’

In view of the evidence to indicating that Ceftriaxone was not administered promptly, the

panel found this charge proved on the balance of probabilities.


Charge 5:




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In reaching this decision, the panel again took into account the witness statement of Ms

1:

‘On 16 March 2017 another nurse on the ward, [Private], came to me whilst I was

working and said that Linda had signed on the computer to say that she had

given a controlled drug to a patient whilst she was in the clinic room. When giving

a controlled drug on the Ward, two trained nurses check the medication and

check the dosage. They then sign out of the controlled book and they then take

the drugs along, with the computer (which is on wheels), to the patient. Together,

the two of them check the arm band of the patient and watch the patient take the

drug whilst one of the nurses logs it on the computer... What Linda did instead

was to counter sign the medications by herself in the clinic room (rather than in

the patient’s room along with [Private]) then she quickly went off somewhere

else.’

Ms 1 met with Miss Hughes concerning this. Ms 1 stated in her statement:

‘When I spoke to Linda about this again she just made an excuse and said

something along the lines of having to catch up with a consultant whilst he was

on the Ward.’

This is supported by a contemporaneous note of the meeting:

‘I [Ms 1] had to find Linda and ask her to return to the treatment room and

complete the CD check correctly. Linda said she had left as she wanted to speak

to a doctor when she saw him walk past the treatment room but could not explain

why she had not returned.’

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The panel understood that this charge relied in part on hearsay evidence and gave that

evidence appropriate weight. On the balance of probabilities the panel found this charge

proved.


Charge 6:




In reaching this decision, the panel had regard to Miss Hughes’ capability plan. The

panel noted that a capability plan is a formal document and that Miss Hughes capability

plan contained a section around failing to discharge patients correctly with the correct

medication and district nurse referrals. Ms 1 stated that Miss Hughes had been unable

to demonstrate that she could discharge patients correctly on about three to four

occasions between 10 June 2017 and 7 August 2017, and that Ms 1 had been phoned

by the DN liaison team stating that they had seen patients where no referral had been

made upon discharge from the Ward.

The panel also had regard to the note of a meeting on 18 August 2017 between Miss

Hughes and Ms 1. The note stated:

‘...Ongoing issues with discharge planning omitted to complete D/N referrals for

patients who require support on discharge...’

The panel concluded that the weight of the evidence was that Miss Hughes was not

able to demonstrate that she could discharge patients correctly. On the balance of

probabilities the panel found this charge proved.

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Charge 7:



unseen fall:

a. Did not promptly carry out neurological observations;

The panel heard from a number of witnesses who spoke to this charge. The panel

accepted that there was some discrepancy as to when Miss Hughes became aware that

Patient A had indicated that she had hit her head. In her statement at the time of the

local investigation Miss Hughes stated that Patient A told her that she had not hit her

head. This is supported by a record Miss Hughes made in Patient A’s electronic notes

at 9:01 on 2 November 2017.

The panel noted that Ms 1, who was one of the first staff to attend to Patient A following

the unwitnessed fall, stated that she did not understand why Miss Hughes made that

record because she was 99% sure that she had informed Miss Hughes that Patient A

said that she had hit her head.

The panel considered that, in any event, by 9:44 it was clear, based on the record made

by Dr 5, that Patient A had indicated that she had hit her head.

All of the witnesses were clear in their oral evidence that an unseen fall should have

initiated neurological observations, in line with the Trust’s policy on falls. In her oral

evidence Ms 3 stated that even if a doctor had not requested neurological observations,

Miss Hughes would still have had a duty to carry them out. The panel bore in mind Ms

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4’s statement that carrying out neurological observations is part of a nurse’s

assessment and that if a doctor had advised Miss Hughes not to carry them out (as

Miss Hughes alleged) then she would expect to see that advice documented, which it is

not. Ms 4 further stated that any competent nurse should have started neurological

observations shortly after Patient A fell.

It was undisputed between the witnesses that neurological observations did not begin

until 18:00 and the record provided to the panel indicated the same. The panel noted

the evidence of Ms 4 and the root cause analysis report dated 5 March 2018 which both

indicated that observations commenced at 18:04, which was at least eight hours and

fifteen minutes after the fall.

Based on the evidence before it the panel concluded that Miss Hughes did not carry out

prompt neurological observations on Patient A following the unwitnessed fall. The panel

therefore found this charge proved on the balance of probabilities.


b. Administered anti-coagulant medication.

Ms 3 was clear in her oral evidence that Miss Hughes should not have administered

anti-coagulant medication to patient A, given the circumstances and the lack of clarity

around the fall. The same was stated by Ms 4 who explained that Miss Hughes should

have waited for a doctor to review Patient A before administering anti-coagulants

because of the increased risk of bleeding.

The panel had regard to MAR charts which indicated that both Rivaroxaban and Aspirin

were administered to Patient A by Miss Hughes at 09:28 on 2 November 2017, prior to

Patient A being reviewed by a doctor.

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The panel also had regard to a clinical document signed by Dr 5 at 09:44 on 2

November 2017, subsequent to her review of Patient A, which stated:

‘Has already had morning meds’.

Based on the evidence the panel found this charge proved on the balance of

probabilities.


Charge 8:

8) On 2 December 2017, did not administer Patient C’s PEG feed whilst responsible

for their care.

In reaching this decision, the panel had regard to the evidence of Ms 6 who stated that

she was involved in an incident on 2 December 2017 when Miss Hughes failed to

initiate feeding Patient C via the Percutaneous Endoscopic Gastrostomy (PEG) feed

tube. Patient C was on the ward and was nil by mouth. The only sustenance she got

was from the fluid feed Ms 6 said that the feed was supposed to be started at 9am,

which was outlined in Patient C’s medical charts. However, when Ms 6 took over at the

start of the night shift, she could see that the tube had not been plugged into Patient C’s

PEG tube. Ms 6 said that she had left the feeding equipment in the corner that morning

when she finished her shift, and it appeared not to have been touched that entire day.

Ms 6 said that she spoke to patient C about this who was very vague. Ms 6 was unable

to make contact with Miss Hughes, and was advised to take no action until she was

able to do so. She said that she saw Miss Hughes the next morning and asked her why

she had not put the feed up for Patient C. Miss Hughes replied that she thought the feed

was meant to be given at night.

30

The panel was also provided with an email sent by Ms 6 to the deputy ward manager at

18:28 on 8 December 2017 providing details of the event, which read:

‘When I saw RN Linda Hughes on Monday Morning for handover I asked her why

she hadn’t given Bed 20 her feed and she said because she thought it was given

overnight. I explained to Linda that I had discussed this with her at handover, but

she didn’t comment.’

The panel considered Ms 6 to be clear and confident in her testimony. It had no reason

to disbelieve her and in the light of all the evidence before the panel it found this charge

proved on the balance of probabilities.


Charge 9:



In reaching this decision, the panel had regard to the witness statement of Ms 6:-

Paragraph 15:

‘There was another serious incident which occurred with Linda at around the

same time. This was in relation to [Patient B] who was on the Ward and was

extremely ill with sepsis. [Patient B] had been prescribed antibiotic medication at

15:00 - [this was clarified in oral evidence and medical records that this was

prescribed at 17:04] - by the doctors, which needed to be given to him straight

away. Linda was the nurse on duty on that shift who was responsible for giving

patients B the medication...

31

Paragraph 16:

‘During my shift, which started at 19:45, I got a phone call from my Ward

Manager, Ms 1, who called to ask me whether Patient B had been given the

antibiotics he required by Linda. I believe the phone call would have been at

some point after 20:15, as that was when the handover to start my shift finished.’

Paragraph 18:

‘I told Ms 1 that Linda had not given Patient B his medication and that she had

handed them all over for me to administer when I started my shift at 19:45.

During the handover Linda had told me that Patient B was very poorly and had

had an emergency MET call, which is when a team of emergency doctors come

to assess a patient. During the call, the MET team had diagnosed sepsis and

prescribed Patient B three stat doses of antibiotics to be given to him urgently.

Linda said that she had not had a chance to give Patient B any of the doses and

so she handed them over to me to give.’

Paragraph 19:

...After handover I immediately checked to see what antibiotics [Patient B]

needed and saw on the Cerner that they had been prescribed to him just after

15:00 - [this was clarified in oral evidence as being on or around 17:04] -... Ms 1

called at around 0900pm to see whether Linda had started the antibiotics and I

had to tell her that she had not and that they were now being given by myself. By

the time Ms 1 called I had already given [Patient B] one course of the antibiotics

that he required, which Linda should have given earlier in the day. ’

The panel reached the view that Ms 6 account of events were clear and plausible.

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It was clear to the panel that the medication should have arrived within 30 minutes of

being ordered. But the evidence is that it was not administered until 21:28 by Ms 6. The

panel therefore found this charge proved on the balance of probabilities.


Charge 10:



a. Informed Colleague D that you had completed observations for one or

more patients when you had not.

In reaching this decision, the panel had regard to the oral and written evidence of Mr 8.

Contrary to what was written in his NMC statement, in response to questions Mr 8

accepted that there were periods on 12 December 2016 when he was not in the bay as

he was taking breaks. Further, the panel reached the conclusion that it was highly

unlikely that Mr 8 could have maintained constant observation over Miss Hughes given

that his shift was eight and a half hours long. Mr 8 was unable to recall whether or not

there was a clear line of sight across the bay.

The NMC have not provided the relevant patient records to the panel.

Mr Parkinson informed the panel that Miss Hughes claimed that she had carried out the

observations. For the reasons set out earlier in this determination, the panel found Mr

8’s evidence to be lacking in credibility and reliability. Accordingly, the panel find this

charge not proved on the basis that it could not be satisfied that Miss Hughes did not

carry out the observations.

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The panel reached the conclusion that the NMC had failed to discharge the evidential

burden in relation to this charge and therefore found this charge not proven.

This charge is found NOT proved.

b. Recorded observations for one or more patients when you had not

completed them.

The panel noted the discrepancies in Mr 8’s oral and documentary evidence. In his

handwritten note dated 12 December 2017:

‘I asked the nurse [Miss Hughes] at around 4:30pm if she had carried out her

patient observations, to which she replied ‘yes’ and promptly went on to record

her observations onto Cerna’

By contrast, in his oral testimony to the panel, he merely stated that all he could see

was that Miss Hughes had her computer terminal open at the page where observations

were recorded. Upon clarification from the panel he stated that this difference was due

to the passage of time. Given that the panel do not consider Mr 8 to be a reliable or

credible witness, it did not consider his explanation to be plausible. Further, as

mentioned in charge 10a above, Mr 8 had two breaks away from the bay and the ward.

In addition, as in 10a above, the panel concluded that it is highly unlikely that that Mr 8

could have maintained constant observation over Miss Hughes given that his shift was

eight and a half hours long. The panel’s view on this is supported by his written

statement at paragraph 19 where he states:

‘During that shift I spent a lot of time on discharging patients, doing administrative

work on the computer, and paperwork.’

34

In addition, the NMC have not produced the relevant patient records and there is no

other evidence before the panel to contradict Miss Hughes assertions to Mr 8 that she

did carry out the observations.

The panel reached the conclusion that the NMC had failed to discharge of its evidential

burden in relation to this charge and therefore found this charge not proven.


Charge 11:



As charge 10 in its entirety has not been proved this charge is therefore not capable of

being proved.


The hearing went part heard on 3 February 2020, prior to the panel announcing its

decision on the facts of this case, and it resumed on 18 may 2020.

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Service of notice of resuming hearing

The panel was informed that notice of today’s resuming hearing, dated 24 April 2020,

was sent to Miss Hughes via email on the 30 April 2020 to an electronic mail address

that Miss Hughes had provided the NMC as an address for communications.

The panel accepted the advice of the legal assessor. It took into account that notice of

the resuming hearing outlined that the resuming hearing would be conducted virtually,

due to the COVID-19 pandemic. The notice of the resuming hearing also provided

details of the date, time and a link to access the hearing. Amongst other things, it

included information about Miss Hughes’ right to participate and be represented as well

as the panel’s power to proceed in her absence.

In the light of the information available, the panel was satisfied that the notice period

was reasonable in all the circumstances of this case and was satisfied that notice had

been served in compliance with Rules.

Further, the panel decided to proceed in the absence of Miss Hughes. The panel

concluded that she had voluntarily absented herself from this virtual hearing. She had

not requested an adjournment and there was no information before the panel that she

would attend on another date in the future.

Submissions on lack of competence and impairment

Having announced its findings on the facts, the panel then considered whether, on the

basis of the facts found proved, Miss Hughes’ fitness to practise is currently impaired.

The panel took into account all the evidence before it.

The panel also noted the submissions made by Miss Jean, on behalf of the NMC, and

heard and accepted the legal assessor’s advice.

36

Ms Jean submitted that the charges found proved in this case span a two year period

between, January 2016 and January 2018, and relate to a fair sample of Miss Hughes’

work. She submitted that during that time Miss Hughes’ nursing practice demonstrated

wide ranging and basic competence issues despite her receiving extensive support and

guidance from other employees at the Trust.

Ms Jean referred the panel to the oral evidence of Ms 1, Ms 2, Ms 3, Ms 4, Dr 5, Ms 6

and Ms 7. She submitted the evidence of these witnesses, all clinically experienced

practitioners, supported a finding that the charges found proved demonstrate that the

Miss Hughes’ clinical practice fell below the standards expected of a reasonably

competent Band 5 nurse between January 2016 and January 2018.

Ms Jean referred the panel to a number of paragraphs of The Code: professional

standards of practise for nurses and midwives (2015) (the Code) and identified where

Miss Hughes’ actions amounted to a lack of competence.

Ms Jean referred the panel to the case of Council for Healthcare Regulatory Excellence

v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) and submitted

that there was no evidence before the panel to suggest the Miss Hughes has

remediated her practice. She stated that the last information received from Miss Hughes

indicated she was working as Band 3 Clinical Support Worker. When Miss Hughes

stopped working as a nurse in January 2018 there were serious concerns about her

competence and the period she has spent away from clinical nursing can only have

served to heighten those concerns as her skills atrophy.

Ms Jean submitted that there is no evidence before the panel to demonstrate that Miss

Hughes has any insight into the failings identified by the panel. For these reasons, Ms

Jean invited the panel to find Miss Hughes’ fitness to practice currently impaired on the

grounds of public protection as well as the public interest.


37

The panel adopted a two stage process, as advised. First, the panel must determine

whether the facts found proved amount to a lack of competence. Secondly, only if the

facts found proved amount to a lack of competence, the panel must then decide

whether, in all the circumstances, Miss Hughes’ fitness to practise is currently impaired

as a result of that lack of competence.

Decision on lack of competence

When determining whether the facts found proved amount to a lack of competence the

panel had regard to the terms of the Code.

The panel, in reaching its decision, accepts that there is no burden or standard of proof

at this stage and exercised its own professional judgement.

The NMC has defined a lack of competence as:

‘A lack of knowledge, skill or judgment of such a nature that the registrant

is unfit to practise safely and effectively in any field in which the registrant

claims to be qualified or seeks to practice.’

The panel considered Miss Hughes breached a number of areas of the Code, as

submitted by Ms Jean:

1 Treat people as individuals and uphold their dignity

1.2 make sure you deliver the fundamentals of care effectively

1.4 make sure that any treatment, assistance or care for which you are

responsible is delivered without undue delay

4 Act in the best interests of people at all times

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6 Always practise in line with the best available evidence

6.2 maintain the knowledge and skills you need for safe and effective practice

8 Work co-operatively

8.5 work with colleagues to preserve the safety of those receiving care

10 Keep clear and accurate records relevant to your practice

10.1 complete records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.3 complete records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

13 Recognise and work within the limits of your competence

13.1 accurately identify, observe and assess signs of normal or worsening physical and mental health in the person receiving care

18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations

18.3 make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over-the-counter medicines

19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice

19.3 keep to and promote recommended practice in relation to controlling and preventing infection

The panel considered that the charges found proved cover wide ranging areas of

nursing practices. The panel accepted Ms Jean’s submission that the concerns arose

from a fair sample of Miss Hughes’ work, between January 2016 and January 2018. It

identified deficits within many broad areas of Miss Hughes’ nursing practice and it was

of the view that these deficits in her practice created potential for harm to patients.

39

In consideration of whether or not Miss Hughes was performing to the standard

expected of a Band 5 Registered Nurse, the panel had regard to the evidence of the

NMC witnesses. The panel noted that many of the witnesses stated, categorically, that

Miss Hughes was not performing at the level expected of a registered nurse at Band 5,

despite substantial and ongoing support.

In considering whether the facts found proved amount to a lack of competence, the

panel concluded that Miss Hughes breached the aforementioned paragraphs of the

Code, which is the standard by which every registered nurse is measured. The panel

bore in mind, when reaching its decision, that Miss Hughes should be judged by the

standards of the reasonable and average Band 5 Registered Nurse and not by any

higher or more demanding standard. Taking into account the reasons given by the

panel for the findings of the facts, the panel has concluded that Miss Hughes’ practice

was far below the standard that one would expect of the average Registered Nurse

acting in the role that Miss Hughes was in. In all the circumstances, the panel

determined that Miss Hughes’ performance demonstrated a lack of competence.

Decision on current impairment

The panel next went on to decide if as a result of this lack of competence Miss Hughes’

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 maintain professional boundaries. Patients and their families

must be able to trust nurses with their lives and the lives of their loved ones. To justify

that trust, nurses must be honest and open and act with integrity. They must make sure

that their conduct at all times justifies both their patients’ and the public’s trust in the

profession. 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

40

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

proper professional standards and public confidence in the profession

would be undermined if a finding of impairment were not made in the

particular circumstances.

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 25.67 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

41

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. ...

The panel finds that limbs a, b and c of the Grant test set out above are engaged. The

panel decided that Miss Hughes has in the past acted so as to put patients at

unwarranted risk of harm, has brought the nursing profession into disrepute, and has

breached fundamental tenets of the nursing profession. Her lack of competence was

wide ranging and prolonged despite considerable support.

Further, there was no information before the panel to suggest that Miss Hughes has

taken any action to remedy the deficits in her nursing practice, nor that she has any

insight into them. The panel noted that there had been some short periods of

improvement in Miss Hughes’ nursing practices, however, it had not been sustained.

Senior nurses had expressed concern around Miss Hughes’ skill-set. Many of the

deficits identified by the panel relate to fundamental nursing practice, and there is no

evidence whatsoever that Miss Hughes has undertaken any developmental training.

The panel bore in mind that Miss Hughes has been out of nursing practice for some

time and it considered that this prolonged period away from nursing practice increased

the risk of repetition of the lack of competence found proven.

The panel is of the view that there is a high risk of repetition based on the scope and

breadth of the deficits identified in Miss Hughes’ nursing practice and the absence of

any insight or remediation. The panel therefore decided that a finding of impairment is

necessary on the grounds of public protection.

42

The panel bore in mind that the overarching objectives of the NMC are to protect,

promote and maintain the health safety and well-being of the public and patients, and to

uphold/protect the wider public interest, which includes promoting and maintaining

public confidence in the nursing and midwifery professions and upholding the proper

professional standards for members of those professions.” The panel determined that,

in this case, a finding of impairment on public interest grounds was also required. The

panel determined that the deficits were wide ranging, prolonged, and related to basic

nursing skills.

Having regard to all of the above, the panel was satisfied that Miss Hughes’ fitness to

practise is currently impaired.

Determination on sanction

The panel has considered this case and has decided to make a suspension order. The

effect of this order is that the NMC register will show that Miss Hughes’ registration has

been suspended.

In reaching this decision, the panel has had regard to all the evidence submitted and it

has taken account of the submissions of Ms Jean, on behalf of the NMC. The panel

accepted the advice of the legal assessor. It has borne in mind that any sanction

imposed must be appropriate and proportionate and, although not intended to be

punitive in its effect, may have such consequences. The panel had careful regard to the

Sanctions Guidance (“SG”) published by the NMC. It recognised that the decision on

sanction is a matter for the panel, exercising its own independent judgement.

The panel considered the aggravating factors in Miss Hughes’ case to be:

her complete lack of insight

the absence of any remediation

43

the scope and breadth of deficiencies identified over a considerable period of

time, resulting in a serious risk of patient harm.

The panel could not identify any mitigating factors.

The panel first considered whether to take no action but concluded that this would be

inappropriate in view of Miss Hughes’ lack of competence and the serious risks

identified. The panel therefore decided that it would be neither appropriate nor in the

public interest to take no further action.

Next, in considering whether a caution order would be appropriate in the circumstances,

the panel took into account the SG, 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 considered that the serious and prolonged nature of the

concerns in this case, namely Miss Hughes’ lack of competence, could not be

effectively addressed by a caution order. Such an order would leave her in unrestricted

practice. The panel therefore determined that a caution order would be neither

appropriate nor proportionate in this case.

The panel next considered whether placing conditions of practice on Miss Hughes’

registration would be a sufficient and appropriate response. The panel is mindful that

any conditions imposed must be proportionate, measurable and workable. The panel

took into account the Sanctions Guidance.

The panel bore in mind that Miss Hughes received substantial ongoing support whilst

working at the Trust and although she did make some limited improvements she did not

sustain a safe standard of nursing practice. The panel bore in mind that Miss Hughes

continued to make basic nursing errors and continued to place patients at risk of harm.

The panel considered that it was significant that there was no evidence before it of any

insight into the deficits in her nursing practice nor any evidence of remediation. Further,

44

as Miss Hughes has not substantively engaged throughout these regulatory

proceedings, it could not be satisfied that she would be willing or able to comply with a

conditions of practice order. The panel therefore could not be satisfied that a conditions

of practice would sufficiently protect the public and address the public interest concerns

in this case.

The panel then went on to consider whether a suspension order would be an

appropriate sanction. The SG indicates that a suspension order may be appropriate

where the following factor is apparent:

‘in cases where the only issue relates to the nurse or midwife’s lack of

competence, there is a risk to patient safety if they were allowed to continue to

practise even with conditions’

Given the scope, range and duration of the deficiencies in Miss Hughes’ nursing

practice, combined with a complete lack of insight the panel concluded that the only

appropriate and proportionate sanction is that of a suspension order. The panel decided

that a period of suspension would, in addition, provide Miss Hughes an opportunity to

reflect on her nursing practice and begin to take action towards remediating the deficits

identified. Accordingly, the panel determined that a suspension order for a period of 12

months was appropriate in this case.

The panel considered a suspension order to be necessary to protect the public, uphold

the standards required of a registered nurse and to maintain public confidence in the

nursing profession and in its regulation.

At the end of the period of suspension, another panel will review the order. At the review

hearing the panel may revoke the order, or it may confirm the order, or it may replace

the order with another order. A future reviewing panel may be assisted by:

Miss Hughes’ attendance at the review hearing

45

A reflective statement including Miss Hughes’ insight into the deficits identified

and any steps taken to maintain her knowledge and skills

References or testimonials from employers of any paid or unpaid work.

46

Determination on interim order

The panel has considered the submissions made by Ms Jean that an interim order

should be made on the grounds that it is necessary for the protection of the public and

is otherwise in the public interest.


The panel was satisfied that an interim suspension order is necessary for the protection

of the public and is otherwise in the public interest. The panel had regard to the

seriousness of the facts found proved and the reasons set out in its decision for the

substantive order in reaching the decision to impose an interim order. To do otherwise

would be incompatible with its earlier findings.

The period of this order is for 18 months to allow for the possibility of an appeal to be

made and determined.

If no appeal is made, then the interim order will be replaced by the suspension order 28

days after Miss Hughes is sent the decision of this hearing in writing.

That concludes this determination.

Documents

Nursing and Midwifery Council Fitness to Practise Committee … · 2020-05-21 · 1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Hearing 27 January 2020