Moijueh v Nursing and Midwifery Council (Rev 1) [2015] EWHC 1999 (Admin)

Case No CO/1427/2015[2015] EWHC 1999 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
Venue Royal Courts of JusticeDate Tuesday, 7 July 2015
Strand
London WC2A 2LL
B e f o r e:
MR JUSTICE HOLMAN
Between
AMOS MOIJUEHAppellantv
Between
NURSING AND MIDWIFERY COUNCILRespondent
Computer-Aided Transcript of the Stenograph Notes ofWordWave International Ltd (a Merrill Corporation Company)8th Floor, 165 Fleet Street, London, EC4A 2DYTel: 020 7421 4043 Fax: 020 7404 1424E-mail: mlsukclient@merrillcorp.com(Official Shorthand Writers to the Court)
The Appellant (assisted by Mr Walland, a McKenzie friend) appeared in person for in personMs M Stotesbury (instructed by NMC) appeared for Respondent
J U D G M E N T
[1]This is a statutory appeal by a registrant, Amos Moijueh, from the decision of the Nursing and Midwifery Council reached on 20 February 2015 to strike his name off the register.[2]The appellant had been a registered mental health nurse since October 2000. He had had, until the events which I will shortly describe, an unblemished record, and immediately prior to being struck off he was working in a relatively senior position as a ward manager. So, as so often in cases of this kind, this is a case of both professional and personal tragedy. I am deeply conscious of the gravity of the sanction of being struck off the register and of its severe impact upon this appellant and his family.[3]The essential factual context is as follows. As I have said, the appellant had been registered as a mental health nurse in October 2000. In July 2009 he began employment with the local NHS Trust, working within Pentonville prison in North London.[4]Just as there are people who live and work within the community while suffering some mental or psychiatric ill health, so also there are or may be prisoners detained under the normal prison regime who suffer some mental or psychiatric ill health. More severely mentally ill prisoners may receive inpatient treatment, but less severely ill ones continue to be detained in cells and follow the prison regime. The essential function and duty of this appellant was to attend to mentally or psychiatrically unwell prisoners who were nevertheless living under the normal prison regime and were not detained as inpatients.[5]In June 2013 certain issues came to light with regard to the performance of the appellant. He says today that in fact the disciplinary process was triggered by his own referral. In due course it emerged, as he fully admitted both to his employers and later to the Nursing and Midwifery Council, that in relation to two of the prisoner patients for whom he was responsible he had, on one occasion in relation to each prisoner, copied earlier records made by another nurse by using electronic cut and paste.[6]It also emerged that in relation to a third patient for whom he was responsible and whom he was supposed to review about every four weeks, he had not conducted any regular review between late February and mid June 2013. Those matters were the subject of an initial multidisciplinary meeting on 18 June 2013.[7]A potentially more grave matter arose the following day, 19 June 2013. In the office provided for the appellant and his nursing colleagues within the prison was a bag containing a number of musical instruments. These included a tambourine and two shakers or maracas. Acolleague reported that he had seen the appellant place a tambourine and two maracas in his own private bag, which he had then zipped up. A more senior colleague then claimed to have opened the bag and found the tambourine and two maracas in it. This led to a widening of the disciplinary inquiry so as to investigate whether or not the appellant had effectively stolen or attempted to steal those items.[8]In the course of the internal inquiry process the appellant himself resigned from his employment with the NHS Trust. In due course that Trust referred all these issues to the Nursing and Midwifery Council, who in due course carried out an investigation and initiated the formal process of making charges against the appellant and holding a panel hearing and adjudicating upon those charges.[9]The hearing itself lasted four days during mid February 2015. The panel heard evidence from a number of witnesses, including the nurse who had first alleged that he had seen the appellant place the items into his own bag and the more senior colleague who alleged that she had opened the zipped bag and found the items within it. The appellant himself also gave evidence.[10]There had been five formal charges. The first three were admitted from the outset by the appellant. They were as follows:
"(1) Between 26 February 2013 and 17 June 2013 [you] did not regularly review Patient B, who was one of your allocated patients; (2) On 4 June 2013 [you] made an entry in Patient C's electronic record using copied sections of an entry made by Colleague A in Patient C's electronic record on 26 March 2013; (3) On 14 June 2013 [you] made an entry in Patient A's electronic record using copied sections of an entry made by Colleague B in Patient A's electronic record on 3 June 2013."
[11]Pausing there, those charges accordingly encompass the failure regularly to review Patient B in the period of almost four months between late February and mid June, and the two episodes of cutting and pasting entries in the records of two other patients, namely Patients A and C.[12]From first to last, the appellant has denied charges 4 and 5, which were as follows:
"(4) On 27 June 2013 [you] put musical instruments which did not belong to you in your bag; (5) Your conduct at point (4) was dishonest in that you intended to take the musical instruments from the Trust, when you knew that they did not belong to you."
[13]The all-embracing charge was that in light of charges 1 to 5, the appellant's fitness to practise was impaired by reason of his misconduct.[14]Charges 1 to 3 were admitted. Charges 4 and 5 were denied, but after hearing oral evidence, as I have mentioned, the panel found those charges proved on the balance of probability, which is the correct and appropriate standard of proof for this particular disciplinary body.[15]Having, therefore, found all five charges proved, the panel went on to consider whether or not in their view the appellant's fitness to practise was impaired and concluded that it was. It was then necessary for them to move on to consider whether or not it was necessary to apply any sanction and, if so, what sanction.[16]The sanctions available to the Nursing and Midwifery Council are, in ascending order of gravity, to take no further action, to make a caution order, to make a conditions of practice order, to make a suspension order, or to make a striking-off order.[17]It is very well established indeed that in deciding what, if any, sanction to apply, the panel must have regard to the published "Indicative Sanctions Guidance to Panels" and must consider each sanction in turn in ascending order of gravity as I have just mentioned them.[18]Quite clearly in this case the panel did expressly consider and apply the Indicative Sanctions Guidance, and they clearly did consider each of the available sanctions in ascending order of gravity. In short, they paused to consider in turn whether they could take no further action, or make a caution order, or make a conditions of practice order, or make a suspension order. It was only having rejected each of those outcomes, for reasons which they gave, that they were driven to making the most severe sanction, namely a striking-off order.[19]In their decision letter dated 24 February 2015 the panel did consider that the various charges, separately as well as cumulatively, required or justified a striking-off order. But it is clear from reading their decision letter as a whole that it was the finding of dishonesty in relation to the musical instruments that required and justified the making of the striking-off order. I very much doubt myself whether, if the appellant had faced charges 1 to 3 alone, he would have been struck off, nor indeed that striking off could have been proportionate and justifiable.[20]The appellant has been very well represented indeed before me by Mr Simon Walland, who is a gentleman who has a range of legal qualifications and has been called to the Bar but who appears today in the role of McKenzie friend.[21]Mr Walland has appropriately and with clarity emphasised that the matters in charges 1 to 3 were clearly capable of being marked by a lesser sanction than striking off. He suggests that they could, indeed, have been appropriately and entirely addressed by a conditions of practice order.[22]So far as charge 1 was concerned, the records in relation to Patient B clearly showed a meeting between the appellant and that patient on 25 February 2013 and another on 18 June 2013. There is in fact a record also of a brief meeting on 18 April 2013, which is almost exactly in the middle of the period the subject of the charge. There is a record at 14.20 on 18 April that the patient did not attend the surgery for his mental health clinic appointment with the appellant; and a further record at 15.19 that the appellant reviewed the patient and that "mental state remains the same. No changes in his presentation."[23]So Mr Walland submits that although the charge of not "regularly" reviewing that patient was admitted by the appellant, at worse the appellant failed to see that particular patient for two periods of about eight weeks each when he was supposed to see the patient about every three to five weeks.[24]Further, Mr Walland stresses that the appellant was under enormous pressure at work due to staff shortages. Apparently the team should have been eight people strong, but in fact were only two, and one of the two left. So Mr Walland submits that so far as charge 1 was concerned, responsibility really lies not with the appellant, who was doing his best under great pressure of work, but rather with his employers, who were failing to provide adequate numbers of staff.[25]In relation to charges 2 and 3, I have been shown the precise entries which were cut and pasted in relation to each of Patients C and A. As Mr Walland rightly submits, some of what was cut and pasted was really background information that, in any event, would not change. For instance, there was cut and pasted in relation to Patient A the fact that he is a "slightly built Algerian man wearing prison clothing and speaking with a strong Algerian accent but able to make himself understood". As Mr Walland says, that is really only background information and scarcely a clinical observation at all.[26]Other parts of the cut and pasted record are more clinical. For instance, that his "appetite is quite poor and says he often does not eat other than biscuits". But, as Mr Walland submits, it may be that the patient repeated exactly that same information to the colleague nurse on 3 June and again to the appellant on 14 June.[27]It seems to be accepted by and on behalf of the Nursing and Midwifery Council that it is not necessarily objectionable as such to cut and paste from an earlier electronic record into a later electronic record if the copied over information remains accurate and the same. But the point which they make is that it is vital that, if information is copied over in that way, the original source of it should be clearly noted and recorded. In other words, as I understand it, it would not be objectionable, for instance, to record on 14 June 2013 that the appellant saw the patient today and found on examination, as had been recorded by the colleague nurse on 3 June, that certain features were present. Of course, it would be of the utmost gravity and almost inevitably require striking off if a nurse did not in fact see a patient at all on a certain day, but created a note by cutting and pasting that suggested he had done so. But I make clear, as Mr Walland emphasised, that it is not suggested in this case that this appellant did not see and examine Patients C and A on the dates in question when he made the cut and pasted records.[28]In any event, one of the matters that the panel should have regard to in deciding whether or not to make a conditions of practice order is, by paragraph 67.4 of the Indicative Sanctions Guidance, "potential and willingness to respond positively to retraining". Mr Walland stresses that during January 2015 the appellant voluntarily undertook three one-day courses, which included a course in "record keeping". So he submits that any deficiencies in the appellant's practice and habit with regard to record keeping were well remediable by training and could have been remedied by, at worst, a conditions of practice order.[29]I am prepared to accept all those points made by Mr Walland, although indeed they are points which were made and taken into consideration by the panel. The position with regard to charges 4 and 5 is, however, different since they clearly involve dishonesty.[30]Paragraph 39 of the Indicative Sanctions Guidance provides as follows:
"Dishonesty 39. Dishonesty, even where it does not result in direct harm to patients but is related to matters outside of a nurse or midwife's professional practice, for example, fraudulent claims for monies, is particularly serious because it can undermine the trust the public place in the profession. Honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or midwife's practice."
[31]There is then at paragraph 40 of the Indicative Sanctions Guidance a short quotation from the judgment of Mitting J in the well-known case of Parkinson v NMC which begins:
"A nurse found to have acted dishonestly is always going to be at severe risk of having his or her name erased from the register..."
[32]When the panel were considering sanction on the fourth day of the hearing on 20 February 2015, they received guidance from their legal assessor, Ms Suzanne Parlour. Mr Walland has frankly said today that that advice was fair, balanced and correct. I assume that it is the advice which the panel had firmly in mind and applied, and I will accordingly quote it. I am reading from the present bundle at page G208:
"In terms of dishonesty, dishonesty is always said to be regarded as a particularly serious matter, whether or not it results in any harm to patients and whether or not it takes place within a registrant's professional practice. Honesty, integrity and trustworthiness are often said to be integral to practice and it can be said that a failure in these respects can undermine the trust the public place in the profession. It is against that background that the case of Parkinson v NMC notes that nurses found to have acted dishonestly will always be at severe risk of being struck off, particularly where they do not demonstrate remorse, a realisation that the conduct was dishonest and that there would be no repetition. However, this is in no way to be regarded as an automatic outcome. It remains important for you to consider the case on its own merits and circumstances and with regard to proportionality in the light of those particular circumstances. It will also be relevant to consider such factors as the nature of the dishonesty, its scope, extent and severity, whether it was momentary, one off, whether it was repeated or long term, whether it had an adverse effect on others or was for personal gain. You can of course take into account a registrant's attitude towards the allegations within these proceedings. There is no hard and fast rule as to any approach you should take to dishonesty. It is a serious matter but it is one you must weigh carefully in the light of all relevant circumstances of the case and all the other considerations that you have to bear in mind today."
[33]The panel made a number of references to the dishonesty in their decision letter, but in my view the most significant passage is really that on internal page 8 of the letter, now bundle page A31, in which they describe and explain why they felt unable to make a conditions of practice order, which is the order which Mr Walland suggests they could and should have made. The panel said:
"The panel went on to consider whether a conditions of practice order would be appropriate in the circumstances of this case. The panel took into account its findings on misconduct and impairment. The panel noted that in relation to your clinical practice you have taken steps and undergone relevant training in January 2015 and that you are keen to continue the process of reflective practice. The panel considered that it had received no evidence of general incompetence on your part. However, the panel considered that although conditions of practice could be formulated to address your record keeping and risk management, these would not be sufficient to address the dishonesty found proved...."
[34]Pausing there, it is because of that passage that I have ventured to say earlier in this judgment that if there had not been the charges and finding of dishonesty, this case might well have been resolved by a lesser sanction than striking off, and most probably by the sanction of conditions of practice, for in the passage which I have just read there is clearly recognition that there is no evidence of general incompetence and that problems about record keeping and risk management could be addressed by formulated conditions of practice.[35]However, the passage continues:
"That is dishonesty which you have not admitted, still less developed any reflection or insight. In addition, the panel did not consider that conditions could be formulated to address the attitudinal aspects of this case. Those included the wider issues of your ethics, accountability, judgment, lack of insight into the consequences of your actions, deflection of blame, disregard for your team and the impact of your behaviour on them. The panel has concluded that a conditions of practise order would not be appropriate to meet the wider public interests."
[36]Alittle further on, when considering whether they could make the more severe sanction of a suspension order, the panel quoted a passage from the judgment of Mitting J in Parkinson in which he had said:
"A nurse who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively 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."
[37]The panel themselves continued:
"The panel concluded that this had not been done in this case and that your dishonesty was sustained because of your subsequent denial of what you had done."
[38]I am afraid to say that those passages which I have just quoted are really at the heart of this case, and they are the passages which explain why the panel felt driven to the most severe sanction of striking off.[39]The appellant has at all times resolutely denied that he ever placed the tambourine and maracas in his bag. He said expressly that if they were in the bag at all they must have been placed there by one or other of his colleagues. He said expressly that if, alternatively, they were not actually in the bag, then one or other or both of his colleagues must have conspired together to concoct a false story that they were in the bag.[40]Hence the panel, when considering conditions of practice in the passage I have quoted above, referred to attitudinal aspects of the case including "deflection of blame, disregard for your team and the impact of your behaviour on them". Hence also, when considering a suspension order in the passage I have also quoted above, the panel referred to the dishonesty being "sustained because of your subsequent denial of what you had done.”[41]As I have now said a number of times, even today the appellant maintains his denial that he ever put those instruments into his own bag. I was at pains to clarify, both with Mr Walland and directly with the appellant himself, whether there was any challenge before me to the finding that he had dishonestly placed the items in his bag, and I was firmly told that there is no such challenge. In other words, in the vernacular of a criminal appeal, this is an "appeal against sentence", but not an "appeal against conviction". But although there is no “appeal against conviction" or the finding that he dishonestly placed the items in his bag, nevertheless the appellant continues resolutely to deny that he did so.[42]This, of course, creates a dilemma for him, but also created a dilemma for the tribunal, for the very fact of the appellant’s sustained denial precluded them from taking a more merciful view that he had insight into what he had done and any remorse or contrition. It was, of course, made worse by the necessary implication of his defence that his colleagues had conspired against him or, at any rate, that one colleague had planted the items in his bag.[43]On behalf of the appellant, Mr Walland understandably stresses the very low value of the items in question. I understand that there was evidence that the entire collection of instruments was valued at around £50, and the tambourine and two maracas may only have been valued at a few pounds. So the items in question were on any view of very low value, a point fully appreciated and expressed by the panel.[44]Mr Walland emphasises also the previous unblemished record of the appellant, and emphasises the fact that after ceasing to be employed by the Trust at Pentonville, the appellant had gone on to obtain employment as a ward manager working at the Priory Hospital in Gatwick between February 2014 and February 2015. There are several very positive testimonials by colleagues with whom he worked at the Priory. Mr Walland submits that by the time the panel were considering this matter in February 2015 there was the evidence of a whole year of good and positive employment in a responsible position.[45]On behalf of the Nursing and Midwifery Council, Ms Miranda Stotesbury places particular emphasis upon charges 4 and 5 and the finding of dishonesty. She stresses that the final decision of the panel was itself informed by their view of the attitude taken by the appellant during the course of the hearing.[46]Ms Stotesbury stresses a number of features. First, that the appellant from first to last denied the allegations of dishonesty and continues still to deny them. That in itself, submits Ms Stotesbury, would have made it very difficult for the panel to apply a conditions of practice order since one of the identified factors in paragraph 67.1 of the Indicative Sanctions Guidance is whether or not there is evidence of "harmful... attitudinal problems".[47]Next, the story given by the appellant had changed at various stages between the initial disciplinary investigation by his employing Trust and the actual hearing before the panel itself.[48]Next, Ms Stotesbury stresses that the attitudinal problems were compounded, as the panel observed, by the accusations of conspiracy or plant that the appellant necessarily made against his colleagues.[49]Next, and building on those points, the appellant still displayed before the panel (and Ms Stotesbury would no doubt say, displays also before me today) an absence of insight into what he had done. He still does not appear fully to appreciate the gravity of his shortcomings, despite his seniority and experience.[50]Finally, Ms Stotesbury points out that even after the panel had made and delivered their findings with regard to dishonesty, there was no real attempt by the appellant, through his advocate at the hearing (who I stress was not Mr Walland), to address, explain or apologise for the dishonesty.[51]As I said at the outset, a case of this kind is extremely sad indeed. After a previous unblemished record, this appellant has been struck off and cannot apply for restoration for a minimum of five years. So in mid life he faces, in effect, professional ruin.[52]However, on a statutory appeal of this kind I can only interfere if there was some significant procedural irregularity or error, which there was not, or if the panel reached a decision which I can view as wrong. Clearly, if a sanction is imposed which is definitely disproportionate, then that is wrong and will be set aside by this court on appeal. But it is very well-established that I must attach weight and regard to the decision and reasoning of the panel, first, because they, unlike me, heard themselves all the oral evidence, including that of the appellant, upon which their decision is based. Second, because they are the professional body charged with making decisions in cases of this kind and who acquire over a period of time considerable experience in doing so. So if they are wrong, they are wrong. If they are only arguably wrong, then I cannot and must not interfere.[53]It may seem a high price to pay for attempting to steal a tambourine and two maracas, that the appellant now finds himself struck off. As Mr Walland rightly stresses, these items were not the property of a patient, in which case striking off would have been almost inevitable. But on the other hand they were the property of his employers, and so he stole or attempted to steal them in the course of his employment. Trust between a nurse and his employers is obviously absolutely vital.[54]I am afraid that at the end of this day, and after due and careful consideration of all that Mr Walland has said, I am unable to conclude that any part of the decision or reasoning of the panel is wrong so as to require or justify that I now interfere. It may seem severe that he was struck off, fundamentally, for theft of a tambourine and two maracas, but dishonesty is dishonesty. It is well-established by authority of this court, and also by the Indicative Sanctions Guidance, that dishonesty may require and justify striking off. The panel had been guided by a very fair and balanced direction from the legal assessor that I have already quoted. I am unable to say that their decision and conclusion was wrong. For that reason, this appeal must be dismissed. MR JUSTICE HOLMAN: Where do we go from there? MS STOTESBURY: My Lord, a costs schedule was served on the appellant and the court. MR JUSTICE HOLMAN: I did see that, but I have not studied it. Are you making an application that he should pay your costs? MS STOTESBURY: My Lord, the NMC does seek a costs order in this case. The sum is £2,452. MR JUSTICE HOLMAN: Let me just try and find the schedule. MS STOTESBURY: I have a spare if it assists. MR JUSTICE HOLMAN: No, I have it. It is a question of finding it. (Pause) Does Mr Walland have it? MR WALLAND: Yes, I have. MR JUSTICE HOLMAN: Yes. How long have you or Mr Moijueh had it? MR WALLAND: I received it, I believe, on Friday. MR JUSTICE HOLMAN: On Friday. I see, yes. MR WALLAND: Yes. MR JUSTICE HOLMAN: Right. So you are saying that he should pay your costs. Yes? MS STOTESBURY: My Lord -- MR JUSTICE HOLMAN: You are asking me to assess them in or around your figure of £2,452. Is that it? MS STOTESBURY: My Lord, yes. MR JUSTICE HOLMAN: Yes. Well, let us see what Mr Walland says. First of all, on the principle, can you resist an order in principle that he pays their costs? He has brought this appeal and I am afraid it has been unsuccessful. It has put them to expense. MR WALLAND: Yes, my Lord. The only issue on costs is his inability to meet them. MR JUSTICE HOLMAN: That, I am afraid, is not really a reason for not making an order. MR WALLAND: No. MR JUSTICE HOLMAN: If he can satisfy them that he cannot pay, they would have to consider whether or not and, if so, by what means to try and enforce it. But I do not think it is a reason for not making an order. Possibly as an act of mercy, but really I am a court of law and not of mercy, although I try to be merciful. MR WALLAND: Yes, my Lord. MR JUSTICE HOLMAN: I think I am going to have to order him in principle to pay the costs. MR WALLAND: Yes. MR JUSTICE HOLMAN: Now, the next question is do you invite me to assess them? You are asking me to assess them, are you not? MS STOTESBURY: My Lord, yes. MR JUSTICE HOLMAN: Yes. This has been a one day hearing. The figure, of course, in absolute terms is small and it would not be proportionate really to have a detailed assessment. But I have not studied this yet and I will do so now. Leaving aside ability to pay, do you have any particular comments, Mr Walland, on the amounts claimed? MR WALLAND: I do not, my Lord, no. MR JUSTICE HOLMAN: Well, just let me have a look for myself. Ms Stotesbury, you are in house counsel. This means you are employed by the NMC. Is that right? MS STOTESBURY: My Lord, yes. MR JUSTICE HOLMAN: Yes. So you are a barrister -- MS STOTESBURY: Yes. MR JUSTICE HOLMAN: -- but you work on their behalf. MS STOTESBURY: Yes. MR JUSTICE HOLMAN: So we have work done on documents by Miranda Stotesbury; 7 hours at £196 per hour. So this is just work that you have done in the office, as it were, on the case. MS STOTESBURY: Well, my Lord, yes. MR JUSTICE HOLMAN: I am not minimising it. That is just so I understand. MS STOTESBURY: Yes. Because the appellant was, up until relatively recently, unrepresented -- MR JUSTICE HOLMAN: You have had to do a lot of work. MS STOTESBURY: I put together the bundles -- MR JUSTICE HOLMAN: I know, yes. MS STOTESBURY: -- and so forth. MR JUSTICE HOLMAN: So £196 per hour. This is, to put it rather crudely, what NMC charge your time out -- MS STOTESBURY: Well, my Lord -- MR JUSTICE HOLMAN: -- as. MS STOTESBURY: -- it is according to the White Book. MR JUSTICE HOLMAN: I see. It is according to the White Book. MS STOTESBURY: Yes. MR JUSTICE HOLMAN: Yes. They could have employed a solicitor in private practice to do this who would probably have charged a great deal more. So that is that figure. Then some paralegal did a bit. Then you have preparation prior to the hearing. This presumably is really your work getting the case up. Yes. Then we have you here today. Well, you have been here for a lot more than 2 hours, but anyway, that is what you have claimed. What is the VAT situation on all of this? MS STOTESBURY: My Lord -- MR JUSTICE HOLMAN: You do not pay VAT. MS STOTESBURY: I believe that is correct. MR JUSTICE HOLMAN: Well, you are staff. People do not pay their staff VAT, do they? MS STOTESBURY: Yes. MR JUSTICE HOLMAN: They do not pay VAT on their staff. MS STOTESBURY: We are a charity as well. I do not know whether that affects it. MR JUSTICE HOLMAN: Well, I do not think that is the point, is it? If you were a barrister in private practice or a solicitor, you have to charge VAT to a client, but they have used you. You are an employee and they pay your wage, I hope. MS STOTESBURY: Yes. MR JUSTICE HOLMAN: They probably pay your NI and so on -- MS STOTESBURY: Yes. MR JUSTICE HOLMAN: -- or the employer's contribution, but they do not pay VAT. MS STOTESBURY: That is correct. There will be no VAT added on top of this. MR JUSTICE HOLMAN: No. MS STOTESBURY: That is the final and total sum. MR JUSTICE HOLMAN: Well, I think, Mr Walland, it is very difficult to pick a hole in any of this, is it not? The total amount of preparation that Ms Stotesbury has put in is 10 hours, which is not an enormous amount. It is just one good day’s work on this. I spent some time reading up myself; not 10 hours, but some hours. She has been here today. She has actually been here for a lot longer than 2 hours, but they are going to be stuck with the 2 hours. I think it looks to me very reasonable, if not modest. MR WALLAND: Yes, I would agree, my Lord. MR JUSTICE HOLMAN: Then there will be an order that the appellant is to pay the costs of the Nursing and Midwifery Council of and incidental to this appeal, summarily assessed in the sum of £2,452. Are there any other matters that should be dealt with in an order, Ms Stotesbury? MS STOTESBURY: My Lord, no. MR JUSTICE HOLMAN: Can you think of any other matters, Mr Walland? MR WALLAND: No, my Lord. MR JUSTICE HOLMAN: No. All right. Well, would you, Ms Stotesbury, in conjunction with Mr Walland, if he is willing to extend his help to his client to this extent, draft up some precise form of wording to give effect to all of this? Type it up, lodge it with today's associate and that will be the order. MS STOTESBURY: My Lord, yes. MR JUSTICE HOLMAN: A transcript will be made. It will have to come back to me to correct it. I will keep the case-specific documents so I can correct references and quotations and the like. I will just remove Indicative Sanctions bit, but the rest of your bundle of authorities I will return because you may wish to use it on another day in some other case. All right. Is there anything else you wish to raise or say? MS STOTESBURY: No. MR JUSTICE HOLMAN: I am hearing another of these tomorrow. Are you appearing in that one too? MS STOTESBURY: My Lord -- MR JUSTICE HOLMAN: The NMC definitely is, but not -- MS STOTESBURY: -- the lady who sits behind me is, in fact, presenting that case. MR JUSTICE HOLMAN: Is she? I see. MS STOTESBURY: She is here today to observe. MR JUSTICE HOLMAN: I see. Well, I look forward to seeing you tomorrow. Another day, another case. It may be a very different outcome. I do not know because I have not read into it yet. I am very sorry, Mr Moijueh. I hope you understand I am only a court of review. For the reasons I have endeavoured to give, I cannot say that they were wrong. It is their decision ultimately and I cannot say that it was wrong. I know it is very hard on you. I am very sorry. Thank you for coming. I hope you will feel a huge debt of gratitude to Mr Walland because nobody could have represented you with greater clarity or balance than he has done. Thank you very much, Mr Walland. MR WALLAND: Thank you, my Lord.