Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Meeting 02 October 2017 Nursing and Midwifery Council, 114-116 George Street, Edinburgh, EH2 4LH Name of registrant: NMC PIN: Patrick Bradley 00I3252E Part(s) of the register: Registered Nurse sub part 1 Mental Health Nursing September 2003 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Order being reviewed: Outcome: England Misconduct Andrew Harvey (Chair, lay member) Allwin Mercer (Registrant member) Mhairi Murning (Lay member) Graeme Henderson Marina Jones Suspension order (12 months) Striking off order to come into effect on the expiry of the existing order (at the end of 03 November 2017) in accordance with Article 30(1) 1
Service of Notice of Meeting The panel was informed that the notice of this meeting was sent to Mr Bradley on 24 August 2017 by recorded delivery and first class post to his registered address. The panel accepted the advice of the legal assessor. In the light of the information available the panel was satisfied that notice had been served in accordance with Rules 11A and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules). 2
Decision and reasons on review of the current order: The panel decided to strike Mr Bradley off the register. This order will come into effect at the end of 03 November 2017 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the fourth review of an order originally imposed as two separate orders. In relation to case one, a conditions of practice order was imposed for a period of nine months. In relation to case two a suspension order was imposed for a period of six months on 03 October 2014. The orders were reviewed as one on 29 April 2016 and a further six month suspension order was imposed. That order was reviewed on 29 September 2016 and at that review a 12 month suspension order was imposed. The order is due to expire at the end of 03 November 2017. The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved (case one): That you, whilst employed as a Registered Mental Health Nurse by Search Consultancy and working at Alpha Hospital Bury; 1. On 7 September 2012 incorrectly administered 10mg of Diazepam to Patient A when they had been prescribed 5mg of Diazepam; 2. On 22 September 2012 incorrectly administered 3000mg of Flucloxacillin to Patient A when they had been prescribed 500mg of Flucloxacillin; And in light of the above, your fitness to practise is impaired by reason of your misconduct. The charges found proved (case two): That you, a registered nurse, whilst employed as a Staff Nurse by Pennine Care NHS Foundation Trust; 3
1. On 30 May 2008 whilst speaking to a service user in a psychiatric ward said words to the effect of if you don t get back next door I ll flatten you and/or if you come back to Southside I ll flatten you ; And in light of the above, your fitness to practise is impaired by reason of your misconduct. The last reviewing panel determined the following with regard to impairment: The panel considered whether Mr Bradley s fitness to practise remains currently impaired. The panel took into account that it appears Mr Bradley is currently dealing with a health condition which requires a period of rehabilitation and is preventing him from engaging with NMC proceedings. However, the panel took into account that it had no evidence before it to confirm this information. The panel was of the view that it had no positive evidence before it which shows Mr Bradley has any insight into his misconduct, or remediated it. It acknowledged that as time progresses, it is harder for Mr Bradley to address his medication and safeguarding failings. If these matters are not addressed, this will not naturally improve. Mr Bradley s actions are of a serious nature and the panel is concerned at his limited engagement with the NMC and the absence of any information that demonstrates his insight and remediation. Accordingly, it found there is a continued risk of repetition. In the light of the risk of repetition identified, the panel decided that a finding of current impairment is necessary on the grounds of public protection. 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 and behaviour. 4
For these reasons, the panel finds that Mr Bradley s fitness to practise is currently impaired. The last reviewing panel determined the following with regard to sanction: The panel considered the imposition of a further period of suspension. It was of the view that a suspension order would allow Mr Bradley further time to fully reflect on his failings and remediate his misconduct. It considered that without any material change in the circumstances the order must, at the very least, continue. The panel took into account that it appears Mr Bradley may be unable to engage with these proceedings due to his health, however, as previously mentioned, the panel has no evidence in relation to this. The panel noted that Mr Bradley did not attend his previous review hearing for the same reason and he did not provide evidence of his ill health to that panel either. This panel was of the view that although Mr Bradley s health may be affecting his ability to demonstrate a willingness to engage and return to nursing, in the continuing absence of any documentation to support his statement, a future panel may determine that this demonstrates a persistent lack of insight that is incompatible with a registrant remaining on the register. The panel concluded that further 12 month suspension orders would be the appropriate and proportionate response in Mr Bradley s case and would afford Mr Bradley adequate time to focus on the recovery of his current health condition. It would also give Mr Bradley an opportunity to remediate his misconduct and demonstrate to a future panel that he is willing to return to nursing practice. The panel concluded that the suspension orders will take effect on expiry of the current orders. The panel considered whether striking off orders were appropriate sanctions, however, it concluded that, at this stage, this would be unduly punitive and would not allow Mr Bradley the opportunity to engage with the NMC, remediate and reflect on his misconduct and recover from his recent health condition. 5
Any future reviewing panel would be greatly assisted by: Mr Bradley s attendance at his future review hearings and he is invited to give serious consideration to doing so. A written reflective account from Mr Bradley exploring the misconduct and concerns identified by this panel, including its effect on patients, colleagues and the nursing profession using a reflective cycle, such as the Gibbs Reflective Cycle. Information about any work or relevant activities relating to Mr Bradley s nursing knowledge and practice that he has undertaken since October 2014. Relevant information concerning Mr Bradley s personal circumstances and future career aspirations. Up to date references and testimonials from colleagues, supervisors or relevant others relating to any area of work he has undertaken, whether paid or unpaid. Medical evidence of Mr Bradley s health condition and his prognosis. The orders will be reviewed shortly before their expiry. Mr Bradley is entitled to request an early review of the orders should there be a change in circumstances. Decision on current fitness to practise The panel has considered carefully whether Mr Bradley s 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 decision of the last panel. However, it has exercised its own judgement as to current impairment. The panel has had regard to all of the documentation before it. 6
The panel heard and accepted the advice of the legal assessor. He drew to the attention of the panel the fact that the notice dated 24 August 2017 contains the following warning on the front page: The panel also has the power to impose a more serious sanction, which may include a striking off order. It is important that you consider submitting written representations. 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. The panel considered whether Mr Bradley s fitness to practise remains impaired. The panel had before it no information from Mr Bradley. He has not engaged with the NMC during the course of his 12 month suspension order. Therefore, the panel had no information to suggest that Mr Bradley has attempted to remediate his practice and address the deficiencies in it. As there has been no new information since the last review, the panel concluded that the risk to the public remains and Mr Bradley s fitness to practise is still impaired. Determination on sanction Having found Mr Bradley s 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 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 but concluded that this would be inappropriate. To take no further action would place no restrictions on Mr Bradley s practice and so would not protect the public. The panel then considered whether to impose a caution order but concluded that this would be inappropriate. To impose a caution order would place no restrictions on Mr Bradley s practice and so would not protect the public. 7
The panel next considered imposing a conditions of practice order. Mr Bradley has not engaged with the NMC. The panel has no information from him to suggest that he would be willing to comply with any conditions of practice order. Therefore the panel could not formulate any workable conditions of practice that would sufficiently protect the public. The panel considered imposing a further period of suspension. It noted that Mr Bradley has been the subject of an order for a period of almost 3 years and the last reviewing panel imposed a 12 month suspension. During that 12 month suspension there has been no engagement from Mr Bradley with the NMC whatsoever. The panel noted that there has been some suggestion of health issues but, at the last review, that panel noted in its determination Mr Bradley has not provided any information about this. The panel was of the view that yet a further period of suspension would serve no purpose. Whereas Mr Bradley s original failings were potentially remediable, Mr Bradley has not remediated them despite being the subject of orders for approximately three years. The panel considered that there is no public interest in consistently prolonging a suspension order in the face of a registrant s long-standing non-engagement. Therefore, the panel considered that a suspension order would not be sufficient to protect the public and uphold the public interest in this case. The panel therefore decided to impose a striking off order. This sanction is the only sanction sufficient to both protect the public and uphold the public interest in a case where a registrant has persistently failed to engage with his regulator. Failure to engage with his regulator is not compatible with ongoing registration. This order will come into effect when the existing order expires, namely at the end of 03 November 2017. This decision will be confirmed to Mr Bradley in writing. That concludes this determination. 8