Conduct and Competence Committee Substantive Hearing · 2017. 3. 1. · Page 1 of 29 Conduct and...

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Conduct and Competence Committee Substantive Hearing 22-24 February 2017

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

Name of Registrant Nurse: Miss Safia Noor

NMC PIN: 11G0148E Part(s) of the register: RNA, Registered Nurse – Sub Part 1 Adult Nursing (Level 1) 15 September 2012 Area of Registered Address: England Type of Case: Misconduct Panel Members: Ilana Tessler (Chair, Lay member)

Jacqueline Rendell (Registrant member) Annie Hitchman (Lay member)

Legal Assessor: Stephen Mooney Panel Secretary: Rajinder Jagdev Registrant: Not present and not represented Nursing and Midwifery Council: Represented by Barnaby Hone, counsel

instructed by the NMC Regulatory Legal Team

Facts proved: All Facts not proved: None Fitness to Practise: Impaired Sanction: Striking Off Order

Interim Order: Interim Suspension Order – 18 months

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Charges, as read: That you a registered nurse, while working at Northampton General Hospital,

1) On one or more occasions between 11 December 2013 and 22 October 2014:

a) Removed confidential patient documentation from a ward, in relation to one or

more patients;

b) Took confidential patient information home, that related to one or more

patients;

c) Failed to properly dispose of documentation relating to one or more patients.

2) On 28 November 2014 you dispensed an amount of Oramorph for your own

consumption.

3) Your actions at charge 2 were dishonest in that:

a) You knew that the Oramorph you dispensed did not belong to you;

b) You knew that you were not entitled and/ or authorised to dispense Oramorph

to yourself.

4) On 28 November 2014, in relation to the events described at charge 2, you:

a) Asked Student Nurse A not to tell Colleague B about the incident;

b) Said to Colleague B, “please don’t tell anyone” or words to that effect;

c) Asked Colleague B not to tell other individuals working on the ward about the

incident.

5) Your actions in Charges 4 were dishonest in that you sought to conceal the

events described at Charge 2.

And as a result your fitness to practice is currently impaired by reason of your

misconduct.

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Service of Notice of Hearing

The panel was informed at the start of this hearing that Miss Safia Noor (‘Miss Noor’)

was not in attendance and not represented.

Notice of this hearing was sent to Miss Noor on 16 January 2017 by recorded

delivery to her address on the register, which complies with the rules of service. The

correct details of the hearing, including time, date and location were included in the

notice of hearing. In addition to this an email was also sent to Miss Noor on 20

January 2017 and 3 February 2017 setting out the details of this hearing, to which

there was no response.

The panel accepted the advice of the legal assessor.

The panel had regard to Rules 11 and 34 of The Nursing and Midwifery Council

(Fitness to Practise) Rules Order of Council 2004 (as amended February 2012)

(‘The Rules’).

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

hearing had been served in compliance and accordance with the Rules. It noted that

the Rules do not require proof of receipt.

Proceeding in absence The panel then considered proceeding in the absence of Miss Noor. The panel took

account of the submissions made by Mr Hone on behalf of the Nursing and

Midwifery Council (‘NMC’).


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

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“Where the registrant fails to attend and is not represented at the hearing, the

Committee...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...”

The panel was mindful that proceeding in absence was a discretion that must be

exercised with the utmost care and caution.

The panel has decided to proceed in the absence of Miss Noor. In reaching this

decision, the panel has regard to the overall interests of justice and fairness to all

parties. It noted that:

• Miss Noor has not attended today’s hearing and is unlikely to attend in the

near future;

• no application for an adjournment has been made

• there are no guarantees that adjourning this hearing would secure her

attendance at a future date;

• witnesses have attended this hearing to give live evidence;

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

Although the evidence upon which the NMC relies will have been sent to Miss Noor’s

registered address, she has made no response to the allegations since June 2016.

There have been further attempts made by the NMC to contact Miss Noor by email

and telephone, however contact has been unsuccessful.

The panel was satisfied that Miss Noor had chosen to voluntarily absent herself. It

noted that Miss Noor has disengaged with the NMC and is no longer represented by

the Royal College of Nursing (‘the RCN’). Although she may be at a disadvantage by

not attending the hearing, the panel nevertheless concluded that she had waived her

right to attend. There was also a public interest in the expeditious disposal of this

hearing and therefore the panel decided to proceed in Miss Noor’s absence.

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The panel will draw no adverse inference from Miss Noor’s absence in its findings of

fact.

Background

The charges arose whilst Miss Noor was employed as a Registered General Nurse

by Northampton General Hospital NHS Trust (‘the Hospital’). She was employed at

the Trust from November 2013 to 27 August 2014.

The Nursing and Midwifery Council (‘the NMC’) received a referral on 17 September

2015 regarding allegations concerning two separate incidents.

In October 2014, the Trust was notified that Patient Identifiable Data had been found

in a public place. The matter was investigated by MS 1.

It is alleged that Miss Noor was responsible for the breach of confidential data.

Further, the documents found were patient handover documents used by the nurses.

They related to specific days on Dryden and Allebone Ward where Miss Noor

worked.

On the 14 October 2014, Miss Noor was moved from Dryden Ward to Allebone Ward

and documents from both those wards were found in the waste bin. During the

internal investigation, it was substantiated that only Miss Noor had worked on both of

those wards that day. Because of this it is alleged that Miss Noor was responsible for

the breach of confidentiality and data.

Whilst this investigation was ongoing a second incident was raised and investigated.

It is alleged that on 28 November 2014 Miss Noor approached Student Nurse A and

drew up 5mls of Oramorph from the open drugs trolley which the student was with at

the time.

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Oramorph is a liquid form of morphine, it is not classed as a controlled drug, but may

have negative side effects including drowsiness or nausea. When she was

challenged as to what she was doing, Miss Noor replied ‘don’t tell [Colleague B]’ who

was another nurse on shift at that time. Colleague B heard this as she was

approaching the drugs trolley to continue the medication round and asked what was

happening. Miss Noor stated that she had period pains and was going to take

Oramorph. Miss Noor was told not to do this by Colleague B and she then put the

Oramorph back into the bottle and walked away from the trolley.

Miss Noor denies this allegation and has maintained that it was a joke, claiming that

she never intended to take Oramorph.

Application to read a witness statement into the record

The panel heard an application made by Mr Hone on behalf of the NMC to allow the

witness statement of the Ward Sister, who carried out the investigation of the data

breach, to be admitted into evidence.

Mr Hone indicated that the witness statement provided uncontested evidence in

relation to charge 1 and, therefore, the witness was not called to attend this hearing

to give live evidence in person.

The panel accepted the advice of the legal assessor who referred the panel to its

discretion to receive evidence in that manner.

The panel considered that the witness statement was relevant to charge 1 and it

then went on to consider whether it was fair to admit it as evidence.

The panel came to the view that it was fair in the circumstances to accept the

witness statement into evidence and to receive this as uncontested evidence under

the provisions of Rule 31.

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Decision on the findings on facts and reasons In reaching its decision on the facts, the panel considered all the evidence in this

case together with the submissions made by Mr Hone on behalf of the NMC.


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 is satisfied that it was more likely than

not that the incidents occurred as alleged.

The panel heard oral evidence from the following witnesses called on behalf of the

NMC:

• Colleague B, Band 5 Staff Nurse in Accident and Emergency, employed by

Northampton General Hospital NHS Trust

• Student Nurse A, Northampton University at the time (now qualified)

• Ms 1, (at the time of the alleged incidents) Directorate Manager of Medicine at

Northampton Hospital, who had undertaken the investigation

Colleague B - The panel found Colleague B to be an honest and open witness and

had no reason to doubt her credibility. The panel found that she gave evidence to

the best of her recollection of the events, as she sought to clarify inconsistencies in

her witness statement.

Student Nurse A - The panel found Student Nurse A to be an honest, credible and

consistent witness. The panel had no concerns regarding her evidence, as she made

a firm effort to provide evidence based on clear recollections of the events.

Ms 1 – The panel found Ms 1 to be a credible witness.

The panel took into account the written representations of Miss Noor submitted to

the NMC in 2016. It also took into account her response to the questions put during

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the disciplinary investigation by the Trust. The panel gave this evidence due weight

on the basis that it was not repeated on oath.

The panel went on to consider each charge separately and made the following

findings:

1) On one or more occasions between 11 December 2013 and 22 October 2014:

a. Removed confidential patient documentation from a ward, in relation to one or more patients;

In reaching its decision, the panel took into account the documentary evidence in this

case together with the uncontested witness statement of the Ward Sister at the

Hospital.

The panel had regard to the notes of the disciplinary hearing dated 20 May 2015 in

which Miss Noor admitted the facts in relation to “Patient Identifiable

Information…found at a fly tipping site near the home address of a staff nurse…”.

Miss Noor further stated that at the disciplinary hearing “I know it is my responsibility,

I took it from the ward…”

In light of the above, the panel was satisfied that Miss Noor removed confidential

patient documentation from the ward. Therefore, the panel found this charge proved.

This charge is found PROVED.

b. Took confidential patient information home, that related to one or more patients;

In reaching its decision, the panel considered this charge in the same context as that

of charge 1a). The panel further noted Miss Noor’s comments in the disciplinary

hearing notes in which she said:

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“I used to take the handovers home, I forgot when I was rushing. I put the handovers

next to my bed. Because of the stress, I never think of the handover. My mum came

in and cleaned up and put them in the bag. I put the rubbish outside my house.”

In the disciplinary hearing she was further asked “Do you agree all the other

documents in the report were found at your house?” to which she replied “Yes, they

were at house [sic]”.

Based on the documentary evidence before it, the panel determined that Miss Noor,

in her own admission at the disciplinary hearing, took confidential patient information

home in the form of handover sheets. Therefore, the panel found this charge proved.


c. Failed to properly dispose of documentation relating to one or more patients.

In reaching its decision, the panel again referred to the notes of the disciplinary

hearing. It was clear to the panel, for the same reasons set out in charges 1a) and

1b) that Miss Noor removed confidential patient documentation from the ward, took

this home with her and this was then put out with the other rubbish in a black bin

bag.

The panel found that she had clearly failed to properly dispose of the documentation

in the first instance by removing them from the ward and then putting “the handovers

next to [her] bed”. The panel determined that Miss Noor did not ensure that these

documents were safe and kept them in her house. These documents contained

confidential patient information. Miss Noor failed to understand how serious the

breach of information protocols was at the time of the incident. Therefore, based on

the evidence before it, the panel found this charge proved.


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2) On 28 November 2014 you dispensed an amount of Oramorph for your own consumption.

In reaching its decision, the panel took into account the oral evidence of Colleague B

and Student Nurse A, whom the panel found to be credible and honest witnesses.

Colleague B told the panel that, whilst on shift on the ward on 28 November 2014,

she heard Miss Noor say to Student Nurse A “don’t tell [Colleague B]”. At this point

Colleague B told the panel that she noticed Miss Noor had 5mls of liquid in a clear

syringe in her hand. In Colleague B’s witness statement she referred to a purple

syringe, but confirmed to the panel that in fact it was a clear syringe. She also told

the panel that Miss Noor had the bottle of Oramorph in her hand as she was putting

the lid back on. Further to this, the panel was told that Oramorph was the only liquid

drug in the trolley that day and it was obvious to Colleague B that Oramorph had

been dispensed into the syringe.

Colleague B told the panel that when she asked Miss Noor what was in the syringe,

Miss Noor said that it was Oramorph. [PRIVATE] Colleague B said she had no

reason to doubt that this was for her own consumption as Miss Noor told her that

paracetamol and ibuprofen would not work because the pain was really bad.

Colleague B told the panel that Miss Noor then put the Oramorph back into the

bottle, which left no doubt in Colleague B’s mind that it was actually Oramorph that

was dispensed into the syringe for Miss Noor’s own consumption.

The panel went on to consider Student Nurse A’s oral evidence in which she told the

panel that whilst on shift on 28 November 2014, Miss Noor approached the trolley

with a small syringe and said she was in pain. Student Nurse A said that Miss Noor

took the Oramorph bottle out of the drugs trolley and started to draw some into the

syringe.

Student Nurse A told the panel that if a nurse is doing a drug round, they would be

wearing a red apron, which Miss Noor was not. Student Nurse A told the panel that

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at this point Miss Noor had told her “don’t tell [Colleague B]”. It was then established

on Colleague B’s approach that the Oramorph that Miss Noor had dispensed into the

syringe was for her own consumption.

The panel found both witnesses to be consistent in their oral evidence and in their

written witness statements.

In reaching its decision, the panel had no reason to doubt the credibility of both

witnesses and preferred their evidence to that of Miss Noor’s written account. Based

on the evidence heard and tested, the panel found that it was more likely than not

that Miss Noor had dispensed an amount of Oramorph for her own consumption.

Therefore, the panel found this charge proved.


3) Your actions at charge 2 were dishonest in that: a. You knew that the Oramorph you dispensed did not belong to

you; b. You knew that you were not entitled and/ or authorised to

dispense Oramorph to yourself.

The panel had regard to the test of dishonesty as set out in the case of R v Ghosh

[1982] QB 1053 and considered whether Miss Noor’s actions amounted to

dishonesty in accordance with that test.

The panel considered, from the evidence heard and provided in the documents

before it, whether Miss Noor:

(1) Knew that the Oramorph she dispensed did not belong to her (charge

3a)

(2) Knew that she was not entitled and/or authorised to dispense

Oramorph to herself. (charge 3b)

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(3) Whether any such provision of (1) and (2) above was dishonest by the

standards of ordinary and honest nurses, and, if so

(4) Whether Miss Noor realised that such conduct was dishonest by the

standards of ordinary and honest nurses

In reaching its decision, the panel considered whether Miss Noor knew the

Oramorph she dispensed did not belong to her. The panel considered that as a

registered nurse, she would have known that drugs, controlled or not, were the

property of the NHS in the Hospital where she was working, for the purposes of

providing medication to patients.

The panel next considered whether Miss Noor knew that she was not entitled and/or

authorised to dispense Oramorph for herself. The panel accepted that Oramorph

could only have been authorised by a doctor, supported by the oral evidence of

Colleague B who said that only a doctor could authorise Oramorph to patients who

required it.

The panel heard and tested the evidence before it and determined that Miss Noor

knew that the Oramorph she dispensed did not belong to her. The panel also

determined that Miss Noor knew that she was not entitled and/or authorised to

dispense Oramorph to herself.

The facts as found by the panel surrounding Miss Noor’s conduct in charge 2 caused

the panel to conclude that her conduct was dishonest by the standards of ordinary

and honest nurses.

In this regard, the panel was satisfied that the test of dishonesty had been met and

Miss Noor’s conduct was dishonest by the standards of ordinary and honest nurses.



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4) On 28 November 2014, in relation to the events described at charge 2,

you: a. Asked Student Nurse A not to tell Colleague B about the incident;

The panel took into account the oral evidence of Student Nurse A, and for the same

reasons as set out in charge 2, the panel found this charge proved.


b. Said to Colleague B, “please don’t tell anyone” or words to that effect;

The panel took into account the oral evidence of Colleague B, and for the same

reasons as set out in charge 2, the panel found this charge proved.


c. Asked Colleague B not to tell other individuals working on the ward

about the incident.

The panel took into account the oral evidence of Colleague B. Colleague B told the

panel that at the end of the shift, Miss Noor kept trying to talk to her about what had

happened. Colleague B told the panel that Miss Noor told her not to tell two other

members of staff, who also work on the ward, about the incident. She further told the

panel that in her opinion, she felt that at this point, Miss Noor had realised she had

done something wrong and was asking her not to tell anyone.

The panel accepted this account and found that it was more likely than not that Miss

Noor did ask Colleague B not to tell other individuals on the ward about the incident.


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5) Your actions in Charges 4 were dishonest in that you sought to conceal the events described at Charge 2.

The panel adopted the same test as set out in charge 3. The panel considered, from

the evidence heard and provided in the documents before it, whether Miss Noor’s

actions in charge 4 were dishonest in that she:

(1) Sought to conceal the events described at charge 2

(2) Whether any such provision of Miss Noor’s actions above was

dishonest by the standards of ordinary and honest nurses, and, if so

(3) Whether Miss Noor realised that such conduct was dishonest by the

standards of ordinary and honest nurses

In reaching its decision, the panel considered whether Miss Noor sought to conceal

the events described at charge 2. The panel accepted that Miss Noor told Student

Nurse A not to tell Colleague B about the incident and told Colleague B not to tell

anyone or other individuals on the ward about the incident. The panel was satisfied

that she did so to conceal her actions described at charge 2.

The facts as found by the panel surrounding Miss Noor’s conduct in charge 2 caused

the panel to conclude that her conduct was dishonest by the standards of ordinary

and honest nurses. It amounted to a deliberate attempt to conceal her actions by

asking Student Nurse A not to tell Colleague B and asking Colleague B not to tell

anyone or others on the ward about the incident. By doing so, Miss Noor was asking

other colleagues to be dishonest. In this regard, the panel was satisfied that the test

of dishonesty had been met and Miss Noor’s conduct was dishonest by the

standards of ordinary and honest nurses. Therefore, the panel found this charge

proved.

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Determination on misconduct and impairment The panel heard submissions from Mr Hone on behalf of the NMC in relation to

misconduct and impairment.

The panel also considered all the documentary and oral evidence in this case.


Having announced its findings on the facts, the panel proceeded to consider whether

Miss Noor’s actions amounted to misconduct and, if so, whether her fitness to

practise is currently impaired by reason of that misconduct. The NMC has defined

fitness to practise as a registrant’s suitability to remain on the register without

restriction.

Decision and reasons on misconduct The panel accepted that there was no burden or standard of proof at this stage, and

that it was for the panel to exercise its own professional judgement.

When determining whether the facts found proved amounted to misconduct, the

panel had regard to the Code: Standards of Conduct, Performance and Ethics for

Nurses and Midwives 2008 (“the Code”).

The panel determined that Miss Noor’s actions, in all charges, fell significantly short

of the standards expected of a registered nurse, and that her actions represented

breaches of the Code as follows:

From the preamble

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The people in your care must be able to trust you with their health and wellbeing.

To justify that trust, you must:

• Be open and honest, act with integrity and uphold the reputation of your

profession.

As a professional, you are personally accountable for actions and omissions in your

practice and must always be able to justify your decisions.

From the Code

5. You must respect people’s right to confidentiality.

47. You must ensure all records are kept securely.

61. You must uphold the reputation of your profession at all times.

The panel bore in mind that not every breach of professional standards, nor even

every instance of falling short of that which would reasonably be expected in the

circumstances, will, in itself, necessarily constitute misconduct sufficiently serious

that it can properly be described as misconduct going to a nurse’s fitness to practise.

The panel considered the charges in separate sections, dealing first with charge 1.

The panel determined that Miss Noor’s actions, as a registered nurse, in removing

confidential patient documentation from a ward, taking this home with her and failing

to properly dispose of documentation relating to patients, constituted very grave and

serious failings on her part.

This was a serious breach of the Data Protection Act and the Trust Policy in relation

to confidential patient documentation. The panel considered that although there was

no actual harm caused to the patients, there was a risk of psychological harm when

they found out that their confidential documentation been removed from the Hospital

by a registered nurse who was not entitled to do so. Further, if a patient had been

diagnosed with an illness that they were not yet aware of, they would be appalled to

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find out that this information contained within confidential documentation had been

found in a public place.

In the light of the above, the panel considered that this in itself was serious in that a

member of the public had found these documents in a public place and informed the

Trust, bringing both the Trust and the profession into disrepute.

The panel determined that Miss Noor’s actions in charge 1 were sufficiently serious

to amount to misconduct.

The panel moved on to consider charge 2.

On 28 November 2014, Miss Noor dispensed an amount of Oramorph for her own

consumption and told Student Nurse A not to tell Colleague B and then told

Colleague B not to tell anyone else on the ward. Oramorph is a strong form of pain

relief and it may have seriously affected Miss Noor had she consumed this whilst

working on the ward. Miss Noor was not entitled or authorised to self-administer

drugs from the drug trolley.

The panel heard evidence from Colleague B who said that the side effects of

Oramorph include drowsiness, nausea, vomiting and impaired cognition and that it

could have made Miss Noor unfit to work. Miss Noor could have put patients,

colleagues and herself at risk of serious harm if she had taken the Oramorph.

The panel then considered charges 3 to 5. The panel accepted that Miss Noor

sought to conceal the incident by asking Student Nurse A and Colleague B to lie on

her behalf, encouraging dishonest behaviour. The panel found that this dishonesty is

serious. Student Nurse A was in her second year at University at the time of the

incident, and the panel considered that Miss Noor did not set an example of good

practice to that student nurse.

The panel determined that the charges relating to Miss Noor’s dishonesty were

sufficiently serious to amount to misconduct.

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The panel determined that Miss Noor’s actions were so serious that they would

undermine public confidence in the profession as she had departed from the

standards expected of a registered nurse. Her actions breached fundamental tenets

of the nursing profession. The panel considered that this behaviour was

unacceptable and brought the nursing profession into disrepute.

Taking the matters found proved, the panel is satisfied that Miss Noor’s actions

amount to misconduct, and that they are sufficiently serious so as to undermine her

fitness to practise.

Decision and reasons on impairment

The panel moved on to consider whether, as a result of Miss Noor’s misconduct, her

fitness to practise is currently impaired. The NMC has defined fitness to practise as a

registrant’s suitability to remain on the register without restriction.

In reaching its decision on impairment, the panel had regard both to the need to

protect patients and the need to safeguard the public interest, which includes the

maintenance of public confidence in the profession, and the upholding of proper

standards of conduct and behaviour. Nurses occupy a position of privilege and trust

in society and are expected at all times to be professional. Patients and their families

must be able to trust nurses with their care and the care of their loved ones. Nurses

must make sure that their conduct at all times justifies both their patients’ and the

wider public’s trust in the profession.

The panel accepted that there was no burden of proof to be discharged at this stage

and it exercised its own independent judgment.

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

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In determining whether Miss Noor’s fitness to practise is currently impaired, the

panel considered the judgment of Mrs Justice Cox in the case of Council for

Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant

[2011] EWHC 927 (Admin). In paragraph 74 she said;

74. “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 approve the following questions as relevant to the

determination of a nurse’s fitness to practise when considering current impairment, in

paragraph 76:

“Do our findings of fact in respect of the doctor’s misconduct … 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

c. has in the past breached and/or is liable in the future to breach one of the

fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act dishonestly in the

future”

Applying this test, the panel first considered the issue of past impairment. It had

careful regard to its findings of fact and the matters set out above and concluded that

Miss Noor had:

• Put patients at unwarranted risk of harm

• Brought the profession into disrepute

• Breached fundamental tenets of the nursing profession

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• Acted dishonestly.

Although no actual patient harm was caused, there was a real risk that patients could

have been placed at unwarranted risk of harm had Miss Noor taken the Oramorph,

given the side effects it could have had on her and her ability to perform on duty, with

patients in her care. The panel further determined that Ms Noor’s actions in removing

confidential patient documentation from the ward, and failing to properly dispose of

this documentation, would have caused psychological harm to patients, as they were

informed that these documents were found in a public place.

For these reasons, the panel had no doubt that at the time these events occurred,

Miss Noor’s fitness to practise was impaired by reason of her misconduct.

The panel next considered whether Miss Noor’s fitness to practise is currently

impaired and whether she is liable to repeat her misconduct. The panel had careful

regard to the issues of insight, remediation and risk of repetition.

The panel cannot be assured that there is no risk of repetition because Miss Noor

has provided little evidence of insight, reflection or any remedial steps taken by her.

In Miss Noor’s reflection contained within her written representations to the NMC, the

panel found that she shows some insight into her actions in relation to charge 1. With

regard to remediation, there is no evidence before the panel to show that Miss Noor

has undertaken any courses on handling confidential patient documentation nor is

there any evidence of observed practice in this regard. In the absence of sufficient

remediation, the panel found that there remains a risk of repetition.

The panel recognised that while matters of dishonesty are more difficult to

remediate, it was not provided with any evidence of either remediation or insight from

Miss Noor in relation to the dishonesty charges. The panel considered the charge of

dishonesty in relation to Miss Noor dispensing Oramorph for her own consumption

and that she sought to conceal this incident. The panel found that Miss Noor

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demonstrated a repeated pattern of dishonest behaviour and lied throughout the

disciplinary investigations, given that she repeatedly denied the allegations.

The panel found that Miss Noor had not demonstrated insight into the impact her

actions have had on patients, her profession, the NMC as its regulator, her work

colleagues and the wider public. She is a registered nurse; her actions caused

distress to colleagues and have the potential to substantially damage the reputation

of the profession. The panel, therefore, was not satisfied that she understood or

appreciated the severity of her actions and the consequential damage it would have

caused to the profession and the wider public interest.

The panel has considered Miss Noor’s failings in context and has had full regard to

the issues of insight, remediation and risk of repetition. Based on all the evidence

before it, the panel considered that this misconduct has not been remediated and

therefore there remains a risk of repetition.

Furthermore, the panel considered the impact of a finding of no impairment upon the

profession. It regarded Miss Noor’s behaviour as damaging to the profession as well

as having a corrosive effect upon public confidence. It is essential for professional

standards to be maintained. The panel had no doubt that public confidence would be

undermined if a finding of impairment were not made.

Accordingly, the panel has determined that Miss Noor’s fitness to practise is

currently impaired by reason of her misconduct.

Decision and reasons on sanction

Having determined that Miss Noor’s fitness to practise is impaired by reason of her

misconduct, the panel considered what sanction, if any, is appropriate in this case.

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The panel has decided to impose a striking-off order. The effect of this order is that

the NMC register will show that Miss Noor has been struck off the register.

In reaching this decision the panel has had regard to all the evidence that has been

adduced in this case together with the submissions from Mr Hone on behalf of the

NMC.


The panel 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 has had careful regard to the NMC’s Indicative Sanctions

Guidance (“ISG”). The panel was mindful of its duty to protect the public and the

public interest. This includes in this case; maintenance of public confidence in the

professions and in the regulatory body; declaring and upholding proper standards of

conduct and performance. The panel recognised that the decision on sanction is a

matter for its own independent judgement.

The panel first considered the aggravating and mitigating factors in Miss Noor’s

case.

The panel determined that the aggravating factors were:

• Miss Noor has failed to provide any evidence of insight, remorse or

remediation in relation to charges 2-5

• She sought to conceal her actions by encouraging other colleagues to be

dishonest

• Her dishonest behaviour was repeated throughout the investigation process

• This case involved two serious incidents in a short period of time

• She has chosen to disengage from the NMC regulatory process

The panel determined that the mitigating factors were:

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• The data breach, in relation to charge 1, was not planned or premeditated

• Miss Noor had shown some insight into her actions in relation to charge 1

• her actions at the time of the incidents, in relation to charges 2 to 5, may have

been affected by health and personal matters which were addressed during

the disciplinary investigation and within her representations

The panel went on to consider the appropriate sanction.

Under Article 29 of the Nursing and Midwifery Council Order 2001, the panel should

consider the following sanctions in ascending order, beginning with the least

restrictive. It can take no action, make a caution order for one to five years, make a

conditions of practice order for no more than three years, make a suspension order

for a maximum of one year or make a striking off order.

The panel first considered whether to take no further action. It decided that this

would not be appropriate in view of the seriousness of the misconduct found, the

need to protect the public interest and the need to declare and uphold proper

standards of conduct. The panel concluded that taking no further action would be

inconsistent with its previous findings and would not address the issue of public

protection or the public interest in this case.

The panel then considered whether it should make a caution order. It decided that

this would not be appropriate in view of the seriousness of the misconduct found.

The panel considered that this was at the higher end of the spectrum and it

considered that such an order would be inappropriate and insufficient in view of the

seriousness and nature of the charges found proved. Further, making a caution

order would be inconsistent with its findings.

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

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

that any conditions imposed must be relevant, proportionate, measurable and

workable. Miss Noor would also need to be willing to undertake such conditions. The

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panel considered that there are no relevant conditions which could meet the

circumstances of this case.

The panel bore in mind that Miss Noor had chosen to disengage with both the NMC

regulatory process and with her representative of the Royal College of Nursing in

June 2016. Given the nature of the misconduct found, and in the absence of any

indication from Miss Noor that she would comply with conditions, such a sanction

would be inappropriate. Further, the seriousness of the misconduct is such that a

conditions of practice order would be insufficient to protect the public and uphold the

public interest.

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

appropriate sanction. The panel had regard to paragraph 68 of the ISG which states:

68 This sanction may be appropriate where the misconduct is not

fundamentally incompatible with continuing to be a registered

nurse or midwife in that the public interest can be satisfied by a

less severe outcome than permanent removal from the register.

This is more likely to be the case when some or all of the following

factors are apparent (this list is not exhaustive):

68.1 A single instance of misconduct but where a lesser sanction

is not sufficient.

68.2 No evidence of harmful deep-seated personality or attitudinal

problems.

68.3 No evidence of repetition of behaviour since the incident

68.4 The panel is satisfied that the nurse or midwife has insight

and does not pose a significant risk of repeating behaviour.

A suspension order is intended to convey a message to the registrant, the profession

and the wider public as to the gravity of the unacceptable and inappropriate

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behaviour found proved which, in the particular circumstances of a case, falls short

of being such as to require that the registrant’s name be removed from the Register.

A period of suspension can also serve to provide a practitioner with an opportunity to

reflect on their behaviour and to take action to commence or complete the process of

remediation.

Although a suspension order would adequately protect the public, the panel had

doubts as to whether a suspension order would meet the wider public interest

requirements. Any sanction must maintain public confidence and declare and uphold

proper standards. Miss Noor’s actions, in relation to charges 2-5, involved matters of

dishonesty. By virtue of that dishonesty, she brought the profession into disrepute

and breached fundamental tenets of the nursing profession.

Although the panel accepted that Miss Noor’s actions, in relation to charge 1, could

be regarded as that of carelessness and/or negligence, it was not satisfied that she

demonstrated insight, remorse or sufficient remediation. The panel considered that

this indicated a risk of repetition in the future, if similar situations were to occur again.

Further, in relation to charges 2-5, the panel was particularly concerned that had

Miss Noor not been caught and challenged by her colleagues, it was likely that she

would have taken the Oramorph that she had dispensed for her own consumption.

Consequently, not only would she have put herself, patients and colleagues at risk of

harm by continuing to work on the ward, she then sought to conceal her actions by

encouraging Student Nurse A and Colleague B to lie on her behalf. In the

circumstances, the panel was of the view that the gravity and extent of Miss Noor’s

actions, especially the matters of dishonesty and concealment, substantially

outweigh the mitigating factors in this case.

The panel also noted Miss Noor’s lack of engagement with the NMC in these

proceedings, despite being given every opportunity and encouragement to engage.

In the panel’s view, Miss Noor’s actions, taken with the absence of any evidence as

to insight, remorse or remediation, were serious and fundamentally incompatible with

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the expectation that a reasonable member of the public would have of the standards

of a registered nurse.

In these circumstances, the panel has determined that, notwithstanding the

mitigating factors, a suspension order would not be sufficient or appropriate to meet

the public interest.

The panel was therefore left with the sanction of a striking-off order. In considering

this sanction, the panel took note of the following paragraphs of the ISG:

71.1 Is striking-off the only sanction which will be sufficient to

protect the public interest?

71.2 Is the seriousness of the case incompatible with ongoing

registration?

71.3 Can public confidence in the professions and the NMC be

sustained if the nurse or midwife is not removed from the

register?

72 This sanction is likely to be appropriate when the behaviour is

fundamentally incompatible with being a registered

professional, which may involve any of the following …

72.1 Serious departure from the relevant professional

standards as set out in key standards, guidance and

advice …

72.6 Dishonesty, especially where persistent or covered up

72.7 Persistent lack of insight into seriousness of actions or

consequences

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73 The courts have supported decisions to strike off healthcare

professionals where there has been lack of probity, honesty

or trustworthiness, notwithstanding that in other regards

there were no concerns around the professional’s clinical

skills or any risk of harm to the public.

In the panel’s view, Miss Noor’s actions represented significant departures from the

standards expected of a registered nurse, and are fundamentally incompatible with

her remaining on the Register.

The panel considered that its findings in Miss Noor’s case demonstrate the

seriousness of her actions, and to allow her to continue practising would undermine

public confidence in the profession and in the NMC as a regulatory body.

Balancing all of these factors and after taking into account all the evidence, the panel

determined that the appropriate and proportionate sanction is that of a striking-off

order. The panel considered that this order is necessary to mark the importance of

maintaining public confidence in the profession, and to send to the public and the

profession a clear message about the standards of behaviour required of a

registered nurse.

To conclude this matter, the panel took note of Ms 1’s witness statement, with

respect to charge 1, who stated:

“I got the strong impression that the registrant intended to be a good nurse and she

did not set out to do anything wrong or incorrect. It was a shame that in relation to

the data breach she did not acknowledge her wrongdoing from the beginning. The

lack of acknowledgement showed a lack of professionalism.”

It is a matter of regret that despite Miss Noor’s intention to be a good nurse, she will

not be able to apply for restoration to the Register for a period of five years.

However, it is the panel’s view that the public interest in maintaining confidence in

the profession is such that this outcome is proportionate despite the punitive effect

this may have on Miss Noor.

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Without the engagement of Miss Noor in the NMC process and the lack of insight,

remorse and remediation, the panel has determined that in the circumstances of this

case, the only sanction which is sufficient to meet the public interest is one of striking

off.

Decision on interim order and reasons: The panel decided to impose an interim suspension order for a period of 18 months.

Pursuant to Article 29 (11) of the Nursing and Midwifery Order 2001, this panel’s

decision will not come into effect until after the 28 day appeal period, which

commences from the date that notice of the striking off order has been served.

Article 31 of the Nursing and Midwifery Order 2001 outlines the criteria for the

imposition of an interim order. The panel may only make an interim order if it is

satisfied on one or more of three grounds; that it is necessary for the protection of

the public, is otherwise in the public interest or in Miss Noor’s own interests. The

panel may make an interim order for a maximum of 18 months.

The panel has taken into account the principle of proportionality, bearing in mind the

balance it must strike between the interests of the public and Miss Noor’s interests.

The panel has decided to impose an interim suspension order in this case. The

panel is satisfied that such an order is necessary on both public protection and public

interest grounds.

The panel had regard to the seriousness of the misconduct and the reasons set out

in its decision for the substantive order in reaching the decision to impose an interim

suspension order. To do otherwise would be incompatible with its earlier findings.

In the circumstances the panel considered that an interim suspension order for a

period of 18 months would be appropriate to allow an appeal, if made, to be heard.

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If no appeal is lodged then the interim suspension order will be replaced by the

striking off order 28 days after Miss Noor has been sent the decision of this hearing

in writing.

That concludes this determination.

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