Conduct and Competence Committee. Substantive Hearing September Nursing and Midwifery Council, George Street, Edinburgh, EH2 4LH

Transcription

1 Conduct and Competence Committee Substantive Hearing September 2015 Nursing and Midwifery Council, George Street, Edinburgh, EH2 4LH Registrant: NMC PIN: Eleanor Alexander 92I0397S Part(s) of the register: Registered Nurse Sub Part 1 Adult Nursing October 1995 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Nursing and Midwifery Council: Mrs Alexander: Facts found proved: Fitness to practise: Sanction: Lanarkshire Misconduct Hilary Nightingale Lay member, Chair Helen Bishop Registrant member Sue Wadham Lay member John Moir Josh Dutton Represented by Daniel Brown, NMC Regulatory Legal Team Not present and not represented All Impaired Striking-off order Interim order: Interim suspension order for a period of 18 months Page 1 of 23

2 Decision on service of notice of hearing The panel was informed at the start of this hearing that Mrs Alexander was not in attendance. In coming to its decision, 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 ), as follows: 11. (2) The notice of hearing shall be sent to the registrant (b)..in every case, no later than 28 days before the date fixed for the hearing. 34. (1) Any notice of hearing required to be served upon the registrant shall be delivered by sending it by a postal service or other delivery service in which delivery or receipt is recorded to, (a)..her address in the register. The panel heard and accepted the advice of the legal assessor. Notice of this hearing was sent to Mrs Alexander on 11 August 2014 by first class post and recorded delivery to her address on the register, containing the correct details for today s hearing. In the light of the information available, the panel was satisfied that notice had been served in compliance and in accordance with Rules 11 and 34. Page 2 of 23

3 Proceeding in absence The panel then considered proceeding in the absence of Mrs Alexander. The panel heard the submissions made by Mr Brown on behalf of the Nursing and Midwifery Council (NMC) and took account of the legal assessor s advice. The panel was mindful that this was a discretion that must 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. In deciding whether to proceed in the absence of Mrs Alexander, the panel weighed its responsibilities for public protection and the expeditious disposal of the case with Mrs Alexander s right to a fair hearing. Mr Brown referred the panel to a speedtrace document completed by Beaumont Consultants Limited. This document gave Mrs Alexander s current address which matched her registered address. Along with this document Mr Brown referred the panel to a series of telephone notes, and an , which demonstrated the various attempts by the NMC to make contact with Mrs Alexander. Mr Brown informed the panel that all attempts to contact Mrs Alexander were unsuccessful and that there has been no engagement from her in relation to this matter. In addition, the panel also had regard to a Royal Mail Track & Trace printout showing that the letter was delivered back to the NMC on 2 September The panel considered that the NMC has made all reasonable attempts to make contact with Mrs Alexander. There has been no engagement from Mrs Alexander and it had no reason to believe that an adjournment would result in her future attendance. The panel concluded that Mrs Alexander had voluntarily absented herself from today s hearing. Page 3 of 23

4 The panel also took into consideration the attendance of the witnesses who were present to give their evidence and the length of time that has elapsed since the allegations came to light. The panel also noted the allegations were very serious. Having weighed the interests of Mrs Alexander with those of the NMC and the public interest in an expeditious disposal of this hearing, the panel has determined to proceed in Mrs Alexander s absence. Details of charge: That you, a Registered Nurse: 1. On or before 11 September 2014, applied for and/or attended an interview for a position as a Registered Nurse at Newcross Healthcare: a) Using the name and/or NMC PIN of Nurse A. b) Whilst you were subject to an interim suspension order in respect of your own NMC Registration. 2. Your conduct alleged at Charge 1 was dishonest in that you: a) Knew you were providing false information to Newcross Healthcare and intended to mislead Newcross Healthcare as to your identity. b) Knew that you were subject to an interim suspension order and intended to obtain an offer of employment in the name of Nurse A. And, in light of the above, your fitness to practise is impaired by reason of your misconduct. Page 4 of 23

5 Decision and reasons on the application under Rule 19: Mr Brown informed the panel that he anticipated that in order for the facts of the case to be properly considered private information of Mrs Alexander and of a witness may have to be shared with the panel. He submitted that this information should only be heard in private session. He, therefore, made an application to conduct the hearing partly in private session, under Rule 19 of the 2004 Fitness to Practice Rules, when required by the circumstances of the case. It was mindful that Rule 19 provides that hearings before the Conduct and Competence Committee (CCC) shall generally be conducted in public. However, hearings may be held wholly or partly in private, if the committee is satisfied a) having given the parties, and any third party from whom the committee considers it appropriate to hear, an opportunity to make representations; and b) having obtained the advice of the legal assessor, that this is justified by the interests of any party or of any third party or by the public interest and that this outweighs any prejudice. The panel heard and accepted the advice of the legal assessor. The panel noted Mr Brown s submissions and considered that a departure from the general rule that hearings shall be held in public was justified, as this case involved private information relating to Mrs Alexander and of an NMC witness. The panel is satisfied that those interests justified hearing this case partially in private. Page 5 of 23

6 Background Mrs Alexander has been qualified as an adult nurse since Mrs Alexander is the subject of another linked referral, received by the NMC on 24 June As a result of the linked referral Mrs Alexander is the subject of an 18 month interim suspension order, imposed on 18 July The referrer in this case is Newcross Healthcare. Newcross Healthcare received an application for a staff nurse role from Mrs Alexander on or before 18 June She attended Newcross Healthcare s offices in Hamilton and was interviewed for the position on 19 June 2014 (prior to the interim order). She was not successful in her application. On or before 9 September 2014, Newcross then received a further application from another candidate, (Candidate 2) who was called for interview on 11 September The interviewer recognised the person who attended the interview as Mrs Alexander, who she had interviewed just three months previously. Candidate 2 s application was made in the name (and PIN) of another registered nurse, Ms 1, who is on the NMC register without restriction. Ms 1 did not make the application. Candidate 2 s application also declared Mrs Alexander s information (including a home address and NI number). Mrs Alexander was also listed on Candidate 2 s application as a professional reference. Candidate 2 s application was accompanied by some ID documents. No photographic identification was provided by the interviewee when requested (in the name of candidate 2 or otherwise) at the interview and she withdrew her application shortly afterwards. Page 6 of 23

7 It is alleged that Mrs Alexander would have had access to Ms 1 s employment history and some ID documents from her previous employment as home manager at a home at which Ms 1 had previously worked. Newcross Healthcare did not employ either candidate so a full internal investigation was not carried out. The current employment status of Mrs Alexander is unknown. Page 7 of 23

8 Decision on the findings on facts and reasons In reaching its decisions on the facts, the panel considered all the evidence adduced in this case together with the submissions made by Mr Brown, 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 Mrs Alexander. However, the panel noted that without the engagement of Mrs Alexander it has been provided with no explanation for the incidents alleged. The panel heard live evidence from the following witnesses called on behalf of the NMC: Witness 1: Mr 2, Case Investigation Manager at the NMC. Witness 2: Ms 3, former Staff Allocation Officer at Newcross Healthcare. Witness 3: Ms 1/Nurse A, Staff Nurse. The panel considered the witnesses to be reliable and credible and that they gave consistent accounts of their recollections of the incidents in question. Mr 2 offered amendments to his statement referring the panel to documentation to support the changes. Ms 3 was able to provide the panel with detailed responses to questions without having to refer to her statement. Ms 1 provided a candid response in relation to Page 8 of 23

9 a confusing extract within her statement. The panel considered that there was no reason to doubt the evidence of any of the witnesses and that their accounts were supported by documentary evidence. Findings on facts The panel considered each charge individually and made the following findings: Charge 1 1. On or before 11 September 2014, applied for and/or attended an interview for a position as a Registered Nurse at Newcross Healthcare: a) Using the name and/or NMC PIN of Nurse A. b) Whilst you were subject to an interim suspension order in respect of your own NMC Registration. The panel noted the witness statement of Ms 3 in which she stated, Within a few seconds of her being there, I knew that this candidate was the same person I had interviewed on 19 June 2014 under the name of Eleanor Alexander. On this occasion she was wearing her hair up and she had this down on the earlier interview but I am sure it was the same person. She had the same accent, the same build, the same facial feature and body language, wore the same type of clothes and was fully recognisable as the lady I had interviewed as Eleanor Alexander. The panel considered that the evidence of Ms 3 combined with the documentary evidence indicated that Mrs Alexander had applied for and attended an interview for a position as a Registered Nurse at Newcross Healthcare. In relation to Charge 1a the panel noted the Trained (Nursing) Staff Application Form dated 9 September 2014 which used the name of Ms 1. The panel also had sight of the Qualification Record contained within the same document which stated the PIN number of Ms 1. The panel was provided with an NMC printout which confirmed that the PIN used in this application belonged to Ms 1. The panel used this documentary evidence in coordination with the evidence of Ms 3. Page 9 of 23

10 Ms 3 told the panel that she had interviewed Mrs Alexander in person on 19 June 2014 for a position at Newcross Healthcare. Mrs Alexander was unsuccessful in obtaining this post. Following this Ms 3 was off work for seven weeks and Mrs Alexander s application form had remained on her desk in that time. Ms 3 told the panel that upon meeting Mrs Alexander in person again on 11 September 2014, when she was using the identity of Ms 1, it was not just Mrs Alexander s face that she initially recognised. Ms 3 told the panel it was the fact that Eleanor Alexander was listed as a reference on the application form which jogged her memory. Ms 3 stated, I also noted that in Candidate 2 s application, Eleanor Alexander is listed as a reference. This served as a further reminder of the interview I had had with Eleanor Alexander I went and pulled out the Application form provided by Eleanor Alexander. I compared the two and there were a lot of things that was the same on both application forms or very similar. The applications had different names and different PIN numbers but both candidates, for example had listed the same home address and NI number. With regard to Charge 1b the panel paid particular regard to the evidence of Mr 2 and the documents which he exhibited. The panel had sight of a decision letter dated 25 July 2014 sent to Mrs Alexander, at her address as on the register, which confirmed that the panel had imposed an interim suspension order for a period of 18 months. The panel was aware that Candidate 2 attended an interview for the position at Newcross Healthcare on 11 September 2014, over a month after the imposition of the interim suspension order. In the light of the evidence the panel finds Charge 1 proved, in its entirety. Page 10 of 23

11 Charge 2 2. Your conduct alleged at Charge 1 was dishonest in that you: a) Knew you were providing false information to Newcross Healthcare and intended to mislead Newcross Healthcare as to your identity. b) Knew that you were subject to an interim suspension order and intended to obtain an offer of employment in the name of Nurse A. The panel noted the evidence of Ms 1 who was able to provide a breakdown of the similarities and differences between the application form of Candidate 2 and her own information. There are a number of details on the application form which are correct. The following information from the application form attached at EJM/1 is correct: a. My full name b. My NMC PIN number c. My date of birth d. The college I attended to complete my nursing training and the date I completed that training e. My most recent employer (i.e. RHI) The panel noted that the most striking inaccuracies in the application form were the Candidate s address and NI number. The panel considered the two part test of R v Ghosh [1982] Q.B 1053, as modified by PSA v David [2014] EWHC 4657, namely: the objective test, whether according to the ordinary standards of reasonable and honest nurses what was done by Mrs Alexander was dishonest. If it was not dishonest by those standards, that is the end of the matter and the prosecution fails. If it was dishonest by those standards then secondly: the Page 11 of 23

12 subjective test, namely the panel has to consider whether Mrs Alexander herself in fact knew that what she was doing was, by those standards, dishonest. The panel considered that Mrs Alexander s actions could not have been the result of negligence or a mistake. She had taken a deliberate course of action to use Ms 1 s name and PIN number, and replacing other information with her own. Mrs Alexander must have known what she was doing in order to complete the application form in such a way and the purpose of this was dishonest and must only have been to mislead Newcross Healthcare. The panel considered that without Mrs Alexander being present to provide them with an explanation for her actions the panel were unable to reach another conclusion. The panel also noted that in her statement Ms 3 had stated, Candidate 2 seemed to become quite irritated when I informed her that we needed different documents. Her attitude changed and she became confrontational when we were discussing the requirement to provide a P60 or other official tax document Candidate 2 was probably with me for approximately 10 minutes when she left and she did not seem happy when she left as I had had to turn her away without the correct paperwork. The panel was aware that shortly following this Mrs Alexander withdrew the application. In considering 2b the panel considered the letter which had been sent to Mrs Alexander on 25 July 2014 confirming the imposition of an interim suspension order. The panel also had sight of an response dated 15 August 2014 from Mrs Alexander, entitled Interim suspension appeal. Further, the panel noted the notice of review of interim order letter which was sent to Mrs Alexander on 3 September This letter stated, I write further to your correspondence dated 19 August 2014 when you indicated you would like the interim order to be reviewed at an early hearing. The panel considered that this evidence clearly demonstrates that Mrs Alexander was subject to an interim suspension order at the time she applied for the position under the name of Ms 1 and concluded that Mrs Alexander was well aware of the interim sanction against her. Page 12 of 23

13 In the light of the evidence provided the panel finds Charge 2 proved, in its entirety. Determination on misconduct and impairment: Having announced its finding on all the facts, the panel then moved on to consider first whether the facts found proved amount to misconduct and, if so, whether Mrs Alexander s fitness to practise is currently impaired. The NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. In his submissions Mr Brown invited the panel to conclude that Mrs Alexander s actions amount to a breach of The code: Standards of conduct, performance and ethics for nurses and midwives 2008, the Code. He then directed the panel to the preamable which, in the NMC s view, Mrs Alexander s actions amounted to misconduct. Mr Brown referred the panel to the case of Roylance v General Medical Council (no. 2) [2000] 1 AC 311 which defines misconduct as a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. Mr Brown then moved on to the issue of impairment, and addressed the panel on the need to have regard to protecting the public and the wider public interest. This included the need to declare and maintain proper standards and maintain public confidence in the profession and in the NMC as a regulatory body. Mr Brown referred the panel to the cases of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). The panel has accepted the advice of the legal assessor which included reference to Roylance v GMC and CHRE v NMC and Grant. The panel adopted a two stage process in its consideration as advised. Page 13 of 23

14 Decision on whether the facts found proved amount to misconduct When determining whether the facts found proved amount to misconduct the panel had regard to the terms of the code in force at that time, namely the May 2008 edition. The panel in reaching its decision had regard to the public interest and accepted that there was no burden or standard of proof at this stage and exercised its own professional judgement. The panel was of the view that Mrs Alexander s actions did fall significantly short of the standards expected of a registered nurse, and that her actions amount to a breach of the Code. Specifically the preamble, as follows: 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. The panel appreciated that breaches of the Code do not automatically result in a finding of misconduct. The panel considered the severity of Mrs Alexander s actions and the level of dishonesty she had demonstrated. The panel noted that not only had she attempted to mislead a potential employer, but she had abused her previous position of Home Manager to obtain private information of a staff member. The panel also noted that her actions were a clear attempt to subvert the NMC s regulatory process. The panel was of the view that in light of the facts found proved, Mrs Alexander s actions did fall seriously short of the conduct and standards expected of a nurse and amounted to misconduct. Page 14 of 23

15 Decision on impairment The panel next went on to decide if, as a result of this misconduct, Mrs Alexander s fitness to practise is currently impaired. To assist in making its decision, the panel also considered the judgement of Mrs Justice Cox in the case of Grant in reaching its decision, 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 say in Paragraph 76: 76. I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph she identified the following as an appropriate test for panels considering impairment of a doctor s fitness to practise, but in my view the test would be equally applicable to other practitioners governed by different regulatory schemes. Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as Page 15 of 23

16 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. The panel found that Mrs Alexander s actions had brought the nursing profession into disrepute by breaching the fundamental tenets of the nursing profession. The panel considered Mrs Alexander s dishonest actions to be very serious. She had acted in a way to mislead a potential employer and to circumvent an interim suspension order imposed by a panel of the Investigating Committee at the NMC. The panel considered that such an interim order had been put in place to protect the public and to maintain public confidence in the profession. The panel concluded that by ignoring this interim order and applying for a new nursing position with a false identity, Mrs Alexander could have potentially placed the public at a real risk of significant harm. The panel also considered that Mrs Alexander s actions would have damaged the public s confidence in the profession and in the NMC in its ability to complete its regulatory function. In the light of Mrs Alexander s non-engagement with the NMC process, the panel has no evidence of insight or remorse from her. The panel has not been provided with any evidence of remediation that Mrs Alexander has taken to address her actions which, coupled with there being no evidence of insight led the panel to conclude that there remains a risk that Mrs Alexander may repeat her actions in the future. The panel was mindful that it would be difficult for Mrs Alexander to demonstrate remediation for her dishonesty, but that she has failed to attempt to provide the panel with any evidence of efforts she has made. Page 16 of 23

17 The panel had borne in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding the proper standards and behaviour. The panel was satisfied that the public would expect nurses to act with integrity and honesty at all times. The panel concluded that the public would expect nurses to comply with interim orders imposed by the NMC and that its confidence would be undermined by the actions of Mrs Alexander. Having regard to all of the above, the panel was satisfied that Mrs Alexander s fitness to practise is currently impaired. Page 17 of 23

18 Decision on sanction Having found that Mrs Alexander s fitness to practise is currently impaired, the panel considered what sanction, if any, to impose. In reaching its decision on sanction, the panel considered all the evidence before it including the submissions of Mr Brown on behalf of the NMC. He referred the panel to the NMC s Indicative Sanctions Guidance and submitted that determining the appropriate sanction was a matter for the panel s professional judgment. Mr Brown referred the panel to the case of Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 (Admin) which stated, A nurse who has acted dishonestly, who does not appear before the panel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, forfeits the small chance of persuading the panel to adopt a lenient or merciful outcome and to suspend for a period rather than to direct erasure. The panel heard and accepted the advice of the legal assessor. The panel applied the principles of fairness, reasonableness and proportionality, weighing the public interest with Mrs Alexander s own interests. The public interest includes the protection of the public, the maintenance of public confidence in the profession and the NMC as its regulator, and the declaring and upholding of proper standards of conduct and behaviour. The panel took account of the current Indicative Sanctions Guidance, bearing in mind that the decision on sanction is one for its own independent judgment. The panel recognised that the purpose of a sanction is not to be punitive, although it may have a punitive effect. The panel considered the aggravating factors in this case: Abuse of her previous position as Home Manager. Page 18 of 23

19 Complete lack of engagement in the process. No evidence of insight or remorse. Dishonest conduct relating to a potential employer and to the NMC Regulatory process. Series of dishonest acts which could not be considered as isolated incidents. High risk of repetition. Damaging confidence in the profession and the NMC. The panel also considered the mitigating factors in this case: Long career as a nurse. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the seriousness of the case. The panel decided that such a course would not protect the public and would be neither proportionate nor in the public interest. The panel next considered whether a caution order would be appropriate in the circumstances. The panel was of the view that a caution order would not be sufficient to address the seriousness of Mrs Alexander s misconduct. Further, given that the panel has had no evidence regarding any steps Mrs Alexander may have taken to remedy her actions, a caution order would not adequately protect the public as it would allow Mrs Alexander to practise without restriction. The panel then went on to consider whether placing conditions of practice on Mrs Alexander s registration would be a sufficient and appropriate response. The panel was mindful that any conditions imposed must be proportionate, measurable and workable. The panel considered that Mrs Alexander s dishonest conduct was not conducive with a conditions of practice order. Mrs Alexander had attempted to circumvent an interim order placed on her registration and sought employment by dishonestly using false information of a former colleague. The panel could not be satisfied that Mrs Alexander Page 19 of 23

20 would comply with a conditions of practice order. The panel determined that it could not formulate workable and appropriate conditions. The panel therefore concluded that conditions of practice would not be sufficient to protect the public or to maintain public confidence in the profession or the NMC as its regulator. The panel then went on to consider whether a suspension order would be an appropriate sanction. Paragraph 71 indicates that a suspension order would be appropriate where (but not limited to): 71.1 A single instance of misconduct but where a lesser sanction is not sufficient 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 No evidence of harmful deep-seated personality or attitudinal problems No evidence of repetition of behaviour since the incident The panel is satisfied that the nurse or midwife has insight and does not pose a significant risk of repeating behaviour. The panel considered that Mrs Alexander s misconduct was not a single incident but included repeated failings and a premeditated course of dishonest conduct. The panel concluded that Mrs Alexander had planned this deception by obtaining the private information of Ms 1 whilst still employed in her previous Home Manager position. The panel noted that honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or midwife s practice. The panel considered there to be a harmful deep-seated attitudinal problem in relation to Mrs Alexander. Whilst fully cognisant of the interim suspension order she was subject to, Mrs Alexander attempted to mislead a potential employer to obtain a position of employment, as a nurse, under a false identity. The panel also noted that Ms 3 had Page 20 of 23

21 stated, Her attitude changed and she became confrontational when Mrs Alexander had been challenged in relation to her dishonest conduct. The panel has seen no engagement from Mrs Alexander and therefore has no evidence of insight or remorse for her misconduct. The panel also considered that in the absence of any evidence regarding remediation, there was a significant risk of repetition of the misconduct in this case. The panel therefore determined that, in these circumstances, a suspension order would not be a sufficient, appropriate or proportionate sanction. Mrs Alexander s misconduct was serious and represents a significant departure from the standards expected of a registered nurse. Therefore a suspension order is not sufficient to meet the public interest. The panel considered that Mrs Alexander s dishonesty was so serious that it is fundamentally incompatible with continuing to be a registered nurse. The panel could not be confident that a less severe sanction would protect the public and serve to maintain public confidence as Mrs Alexander has already ignored an interim order placed on her. Mrs Alexander had attempted to conceal her actions including the removal of her application stating that she didn t like how she had been treated when she came into the office for the interview as explained by Ms 3. The panel also had regard to the guidance provided in the case of Parkinson. Having taken into account all this information, the panel determined that the only appropriate and proportionate sanction is that of a striking-off order. A striking-off order would be the only way to protect the public and maintain the strong public interest concerns in this case. The panel noted that such an order is likely to have adverse effects for Mrs Alexander, although the panel had no information about her current financial or employment situation. However, it considered that Mrs Alexander s interests are outweighed by the need to protect the public, and to serve the wider public interest by upholding the proper Page 21 of 23

22 standards expected of a nurse, as well as ensuring the maintenance of public trust and confidence in the profession and in the NMC as a regulator. The panel, therefore, determined that a striking-off order should be made and directed the Registrar to strike Mrs Alexander s name from the Register. This order will come into effect after the 28 day appeal period, which commences upon Mrs Alexander s receipt of the panel s written determination, has expired. At the end of the appeal period if Mrs Alexander has not lodged an appeal, the order will come into effect. Mrs Alexander s record in the NMC register will show that her name has been removed. Mrs Alexander may not apply for restoration until five years after the date that this decision takes effect. Page 22 of 23

23 Decision on interim order The striking off order will take effect 28 days from Mrs Alexander being notified of this decision in writing, unless an appeal is made. The panel considered the submissions made by Mr Brown that an interim order should be made to cover the interim period before the striking off order takes effect, on the grounds that it is necessary for the protection of the public and is otherwise in the public interest. The panel heard and accepted the advice of the legal assessor. In reaching its decision to impose an interim order the panel had regard to the seriousness of the facts found proved and the reasons set out in its decision for the substantive order. The panel was satisfied that an interim suspension order is necessary for the protection of the public and is otherwise in the public interest, to do otherwise would be inconsistent 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 suspension order will be replaced by the striking off order 28 days after Mrs Alexander is sent the decision of this hearing in writing. That concludes this determination. Page 23 of 23