Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 2 April 2019 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Florin Silaghi 15J0623C Part(s) of the register: Registered Nurse Sub Part 1 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Nursing and Midwifery Council: Mr Silaghi: Order being reviewed: Outcome: England Lack of knowledge of English Clive Chalk (Chair, Lay member) Anita Underwood (Registrant member) Michael Glickman (Lay member) Gillian Hawken Charlie Russell Represented by Ben Wild, Case Presenter Attending via telephone and unrepresented Suspension Order (12 months) Suspension Order (6 months) to come into effect on 29 April 2019 in accordance with Article 30 (1) 1
Decision and reasons on review of the current order The panel decided to extend the current suspension order by six months. This order will come into effect at the end of 29 April 2019 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is a mandatory review of a suspension order, originally imposed by a panel of the Conduct and Competence Committee on 24 February 2017 for a period of 12 months. On 16 February 2018, this order was reviewed by a panel of the Fitness to Practise Committee and a further suspension order was imposed for 12 months. A further review took place on 22 February 2019 and, due to logistical issues at the hearing, the order was extended for one month. An early review subsequently took place on 28 March 2019 at the request of the NMC, where this order was confirmed. The current order is due to expire on 29 April 2019. The panel is reviewing the order pursuant to Article 30(1) of the Order. The charge found proved which resulted in the imposition of the substantive order was as follows: That you, a Registered Nurse: 1. Do not have the necessary knowledge of the English language to practise safely and effectively; AND in light of the above, your fitness to practise is impaired by reason of your lack of knowledge of English. The previous reviewing panel determined the following with regard to impairment: In its consideration of whether Mr Silaghi has remedied his English language deficiencies, the panel took into account the information provided by Mr Silaghi, including his certificates of mandatory training, and transcript of his course at the London School of Science & Technology dated 18 February 2019. The panel 2
acknowledged the fact that Mr Silaghi continues to take measures to update his knowledge. However, it noted that undertaking academic work does not, necessarily, demonstrate his improved knowledge of the English language or his ability to communicate effectively to ensure safe practice. In the absence of any certificates of completion from an approved course in English language, the panel concluded that Mr Silaghi has not demonstrated full remediation of his English language abilities. Regarding Mr Silaghi s insight, the panel noted that he considers his study at the London School of Science & Technology to be sufficient to demonstrate his improved English language skills and that he does not feel the need to undertake an IELTS course. Mr Silaghi has also not submitted a reflection outlining why it is important for a registrant to have the required knowledge of the English language to practice safely and effectively and the potential risks involved, as requested by the panel on 16 February 2018. The panel considered that communication (verbal and written) goes to the heart of nursing practice, including speaking with patients and ensuring accurate record keeping. Given the lack of information provided to it from Mr Silaghi demonstrating his awareness of the importance of effective communication, the panel concluded that his insight remains low. The panel had some concern about Mr Silaghi s failure to comply with the requirements that have been clearly indicated by previous panels. The panel had regard to the case of CHRE v NMC and Grant [2011] EWHC 927 (Admin), and considered that, as a result of Mr Silaghi s lack of insight and full remediation, he remains liable to place patients at unwarranted risk of harm, bring the profession into disrepute, and breach fundamental tenets of the profession. In light of this, the panel concluded Mr Silaghi remains a risk to the public should his registration not be subject to some form of restriction. The panel therefore decided that a finding of current impairment remains necessary on public protection grounds. The panel bore in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing 3
profession and upholding proper standards of conduct and performance. The panel considered that members of the public with full knowledge of this case would expect the NMC as regulator to take action to uphold proper professional standards for members of the profession. The panel therefore decided that, in this case, a finding of current impairment on public interest grounds is also required. For these reasons, the panel decided that Mr Silaghi s fitness to practise remains impaired. The previous reviewing panel determined the following with regard to sanction: The panel first considered whether to take no action or impose a caution order. The panel considered that either option would be inappropriate in view of Mr Silaghi s significant English language deficiencies. The panel decided that it would be neither proportionate nor in the public interest to take no further action or impose a caution order, and that neither option would suitably protect the public. The panel then considered substituting the current suspension order with a conditions of practice order. The panel considered that, in the absence of Mr Silaghi demonstrating a sufficient level of English language, there would be no conditions that could be formulated that would be appropriate, proportionate, practicable or workable. Mr Silaghi has not yet managed to demonstrate this. The panel considered that imposing conditions of practice would not suitably protect the public, through exposing patients to a nurse who is unable to communicate technically, or uphold the public interest, as members of the public expect all registered nurses to be able to communicate effectively with patients, colleagues and the public as a whole. For these reasons, the panel concluded that it would not be appropriate to substitute the current order with a conditions of practice order. 4
The panel then considered whether it would be appropriate to confirm the current suspension order. Given the context of this case, the panel considered that confirming the current suspension order would suitably protect the public and uphold the public interest while the order was in force. The panel considered that a mandatory review of this order is due to be held on 2 April 2019, at which Mr Silaghi has indicated that he hopes to be in attendance. Until such time as that review takes place, the panel considered that suspending Mr Silaghi s registration is the appropriate and proportionate sanction. The panel noted that, at this hearing, it does not yet have the power to strike Mr Silaghi s name from the register, but that power would be available to a future panel on 2 April 2019. In accordance with Articles 30(2) and (4)(a), the panel decided to confirm the current suspension order. This order will expire at the end of 29 April 2019. Decision on current fitness to practise The panel has considered carefully whether your fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decisions of the previous panel s. However, it has exercised its own judgment as to current impairment. The panel has had regard to all of the documentation before it including the on table documents and bundle. These documents include various training certificates and qualifications in relation to your Public Health and Social Care course, at London Metropolitan University. It has taken account of the submissions made by Mr Wild on behalf of the NMC and those made by you via telephone. Mr Wild briefly outlined the history of this case for the panel, highlighting issues with the clarity of previous determinations. He took the panel through the various documents submitted by you to the panel, which included evidence of you undertaking a Public 5
Health and Social Care course at London Metropolitan University. He added however, that you are yet to provide the NMC with evidence of passing the required International English Language Testing System (IELTS) test or equivalent. Mr Wild asked that the panel consider the case of Abrahim v GMC [2008] EWHC183 when making its decision, highlighting that there is a persuasive burden placed upon the registrant to demonstrate that they are no longer impaired, and no longer pose a risk to the public. He submitted that, to date, there remains no new evidence to suggest that you have completed the IELTS test, or any other NMC-recognised language assessment suggesting a continued lack of insight and reflection into your standard of English. Mr Wild concluded that there is reason to believe that you lack appreciation of the importance of English language knowledge both verbal and written in your nursing practice. In light of these circumstances, Mr Wild invited the panel to consider a continuation of the current suspension order for an additional six months, as it will allow for completion of your Public Health and Social Care course, which Mr Wild added you see as a priority at this time. This course will end on 15 May 2019. He concluded that although a strikingoff order is available to this panel, given your level of engagement and evidence of updated skills, a suspension order would be the most reasonable response. You submitted to the panel that the last two years have, at times, proved difficult for you. It is because of this, that you have found yourself unable to complete the IELTS test. You informed the panel that you wish to retake the IELTS test at a more convenient time, as you feel confident that you will pass. You added that you therefore agree with the NMC s proposal of a six month extension, as you feel this would give you adequate time to achieve the standards required by the NMC. The panel heard and accepted the advice of the legal assessor. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. 6
The panel first considered whether your fitness to practise remains impaired. Regarding your insight, the panel noted the numerous certificates provided to it, verified by ExcelCare. Such certificates demonstrate an 80-100 per cent pass rate on nursing topics such as: - Equality & Diversity in the Workplace - Safeguarding Adults - Infection Prevention and Control - Fluid and Nutrition It also had regard to the NMC s guidance on registration language requirements, updated in January 2019. It noted that there are three types of evidence which are accepted by the NMC, and demonstrate the necessary knowledge of English to practise safely in the UK. They are: - Recent practice for one year in a majority English-speaking country - Completion of a pre-registration nurse, midwife or nursing associate programme, taught and examined in English. - Achievement of the required score in the International English Language Testing System (IELTS) test or any other English language tests accepted by the NMC. The required score must be achieved in reading, writing, listening and speaking. The panel acknowledged the evidence you have submitted of training courses, demonstrating your commitment to the profession. However, it noted that although you continue to provide the NMC with evidence of updating your skills through training and educational courses, you continue to fail to provide evidence of completion of the IELTS test, or any other NMC-recognised language assessment. On this basis, the panel was not satisfied that there is evidence to alter the previous panel s decision and for it to conclude that you do have the necessary knowledge of English to be capable of safe practice as a nurse in the UK. 7
The panel took into account the level of commitment and engagement you demonstrated throughout the regulatory process. It was appreciative of the fact that you took time out of work to engage with today s hearing via telephone. It was satisfied that you exhibit a clear interest in the profession. However, it reminded itself of Mr Wild s earlier comments in relation to the case of Abrahim v GMC [2008] EWHC183, and that there is a persuasive burden upon you to demonstrate that your fitness to practise is no longer impaired. Given that there is no new evidence demonstrating a good level of written or verbal English submitted, there remains a risk to the public. The panel has borne in mind that its primary function is to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on both public protection and public interest grounds is therefore required. Determination on sanction Having found your fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to take no action and allow the order to lapse, but concluded that this would be inappropriate in view of the public protection concerns identified. The panel decided that it would be neither proportionate nor in the public interest to take no further action. The panel then considered whether to impose a caution order, however concluded that this would be inappropriate given the particular circumstances of your lack of knowledge of the English language. The panel concluded that a caution order would neither protect the public, nor address the public interest concerns in this case as you would be allowed to practise unrestricted. 8
The panel moved on to consideration of a conditions of practice order. It was of the view that despite your level of engagement and commitment to practise as a nurse, workable conditions could not be formulated given that you have not yet met the required standard of English to practise as a nurse in the UK. The panel considered the imposition of a further period of suspension. It was of the view that a suspension order would enable the public to remain protected and would allow you the opportunity to complete your current course before taking the IELTS test, or another NMC-recognised English language assessment. The panel concluded that a further 6 month suspension order would be the appropriate and proportionate response and would afford you sufficient time to do this. The panel felt that although a striking-off order was now an option, this would neither be proportionate nor appropriate given your continued engagement and stated commitment to undertake an NMC-recognised English Language Assessment. If you are able to complete an NMC-recognised English language assessment before the six months have elapsed, you may apply to the NMC for an early review of this suspension order. This decision will be confirmed to you in writing. That concludes this determination. 9