“You made full admissions to all of the charges; At the time the charges arose, you were experiencing very difficult personal circumstances; You have expressed remorse for your misconduct; You have demonstrated developing insight; and You have repaid the money you fraudulently obtained.”
“• Your attendance at the review hearing; • Evidence of any coping mechanisms you have developed and any support you have utilised in order to prevent a similar situation arising again; • Testimonials from current and/or previous employers, attesting to your honesty and integrity; • A reflective piece demonstrating insight into the misconduct found proved, including your dishonesty, and how your actions and behaviour affected colleagues, patients in your care and the public confidence in the nursing profession; and • Any evidence of professional development focused on areas of concerns found proved, including honesty and record keeping.”
“I met Stacey when she cared for my mother who was unable to care for herself in any way. ... My mother was so important to me and to hand over her care to a stranger was so hard. ... The excellent care both physically and emotionally Stacey gave my mother was in my opinion was excellent. Right from the start she built a good rapport with my mother. She engaged her in conversation, Listening and responding, encouraging my mother to have conversations and recount her memories of her life. As my mother was 90 years old and being housebound, she did not have much contact with the outside world. She made my mother’s life more bearable. ... I do have to say she made me comfortable in leaving her to care for my mother... Stacey’s communication skills are excellent. She gave me reports on mom’s condition, she also had some suggestions that would benefit her.”
“I have been asked to provide a reference regarding Stacey NURRISH in relation to the period that she was engaged caring for my elderly mother. ... My mother Eileen Hopkins, was, at the time in question, some 99 years of age but still living at home and had been living independently. ... Understandably given her age Eileen is not always the easiest to care for/ Accordingly we sought a professional carer to visit her on a daily basis to manage her needs in relation to hygiene, nutrition, shopping and personal requirements. This presented a problem, in that being fiercely independent, Eileen resisted the idea of having personal help. To overcome this Stacey agreed to attend to my mother in the guise of helping her with some cleaning. Having been recommended to us Stacey undertook the task enthusiastically and quickly forged a close relationship with Eileen. She met all of her personal needs in such a manner that Eileen did not feel that she was losing her independence. Stacey kept a full daily log of her interactions with Eileen and also accounted for the use of monies provided for shopping. My siblings and I were extremely happy with the way Stacey cared for our mother and more importantly, Eileen was herself happy with the arrangement and and looked forward to Stacey's arrival. Sadly as her condition deteriorated Eileen moved into a residential home. Stacey even took the trouble to visit Eileen at the home and even now maintains contact with her.”
“What this panel's duty today is to do is to look at current impairment. Is your practice currently impaired? And if we decided it is, then to take matters further, so those are the areas that we're looking at. We're looking at particularly progress since the last hearing and reassurance if that's available and possible of the issues that the previous panel highlighted. No doubt those are the areas you want to concentrate on.”
“That's OK. Just take a moment. We've got plenty of time I don't feel under any pressure.”
“All right That’s’ very good Thank you and thank you for answering all our questions It is difficult and these events happened some time ago It’s hard to remember days. We appreciate that.”
“And you ask yourselves a number of other questions then. Has [the Appellant] shown insight into the failings of the seriousness of her past misconduct? Has that level of insight improved or gotten worse since the original hearing? Has she taken steps, effective steps to maintain her skills and knowledge? Does she have a record of safe practice without further incident?”
“You were referred to a reference where Mr 1, who you said was a family friend, stated that you cared for his mother. You said that you volunteered to help her with daily living. You said that the author was aware of your NMC case. You said that you were not paid for this role and the author’s mother was alone and lived near you. The author did not live nearby. You said that you cared for her two days a week for a period of six months. You said that you were not undertaking any other work during this time and you were claiming benefits. ... You were referred to another reference where you cared for the Ms 2’s mother. You said that she was another family friend, and you cared for her once a week overnight. You said that your mother normally provided this care and you were helping her out. You said your mother was caring for your children during this time. The panel referred to the fact that you are described in the testimonials as undertaking ‘professional caring work’ in reference to your caring duties. You stated that these were voluntary roles and received no financial reward.”
“The panel also took account of two testimonials describing care you provided to two individuals. The panel noted that while the testimonials are positive, there appeared to be discrepancies between what the testimonials say and the oral evidence you provided to support it. The panel noted that Ms 2’s testimonials stated, ‘I met Stacey when she cared for my mother… My mother was so important to me and to hand over her care to a stranger was so hard. I do have to say she made me comfortable in leaving her to care for my mother…She gave me reports on mom’s condition, she also had some suggestions that would benefit her’. However, in your oral evidence you stated that you only went to see her occasionally in the evening and stayed overnight with her. You also stated that your mother was the main provider of care but there is no mention of your mother in the testimonial. With regards to the testimonial from Mr 1, it stated, ‘Accordingly we sought a professional carer to visit her on a daily basis to manage her needs in relation to hygiene, nutrition, shopping and personal requirements.’ However, the panel bore in mind that you stated you visited this particular person two days a week. The panel also noted that following further questions, you changed your answer with regards to the time spent Mr 1’s mother to say that you provided care during the evenings only. However, it noted that this is contradicted by Mr 1 stating that you ‘kept a full daily log’ of your interactions with their mother. The panel bore in mind that the NMC case against you included charges of dishonesty. It noted that you presented the aforementioned testimonials to the panel to persuade it that you were not currently impaired. It bore in mind that it had to make a decision as to whether these testimonials support your case that you are no longer currently impaired and you now have full insight into the dishonesty found by the original panel. The panel determined that the inconsistencies between your oral evidence and the testimonials you provided has caused it to have concerns about your openness and honesty. As a result, the panel could not be satisfied that you have fully addressed the attitudinal concerns that led to the original panel’s findings of dishonesty. In light of this, this panel determined that you are liable to repeat matters of the kind found proved. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection.”
“The panel was of the view that this was not a single instance of misconduct and your dishonesty today is evidence of attitudinal problems and evidence of repetition of the dishonesty since the incident. The panel was also of the view that an ordinary member of the public would not expect you, as a registered nurse, to stand before an NMC panel to give evidence on how you have remediated dishonesty, and be dishonest in the giving of this evidence.”
“How is this submission to be approached? First, as a matter of general law, it is very well established that findings of primary fact, particularly if founded upon an assessment of the credibility of witnesses, are virtually unassailable (see Benmax v Austin Motor Co Ltd[1955] AC 370 ); more recently, the test has been put that an appellant must establish that the fact-finder was plainly wrong (per Stuart-Smith LJ in National Justice Cia Naviera SA v Prudential Assurance Co Ltd (The Ikarian Reefer)[1995] 1 Lloyd’s Rep 455 at 458). Further, the court should only reverse a finding on the facts if it “can be shown that the findings … were sufficiently out of tune with the evidence to indicate with reasonable certainty that the evidence had been misread” (per Lord Hailsham of St Marylebone LC in Libman v General Medical Council[1972] AC 217 at 221F more recently confirmed in R(Campbell) v General Medical Council[2005] 1 WLR 3488 at [23] per Judge LJ). Finally, in Gupta v General Medical Council[2002] 1 WLR 1691 , Lord Rodger put the matter in this way (at [10] page 1697D): ‘In all such cases the appeal court readily acknowledges that the first instance body enjoys an advantage which the appeal court does not have, precisely because that body is in a better position to judge the credibility and reliability of the evidence given by the witnesses. In some appeals that advantage may not be significant since the witnesses’ credibility and reliability are not in issue. But in many cases the advantage is very significant and the appeal court recognises that it should accordingly be slow to interfere with the decisions on matters of fact taken by the first instance body. This reluctance to interfere is not due to any lack of jurisdiction to do so. Rather, in exercising its full jurisdiction, the appeal court acknowledges that, if the first instance body has observed the witnesses and weighed their evidence, its decision on such matters is more likely to be correct than any decision of a court which cannot deploy those factors when assessing the position...’” ‘In all such cases the appeal court readily acknowledges that the first instance body enjoys an advantage which the appeal court does not have, precisely because that body is in a better position to judge the credibility and reliability of the evidence given by the witnesses. In some appeals that advantage may not be significant since the witnesses’ credibility and reliability are not in issue. But in many cases the advantage is very significant and the appeal court recognises that it should accordingly be slow to interfere with the decisions on matters of fact taken by the first instance body. This reluctance to interfere is not due to any lack of jurisdiction to do so. Rather, in exercising its full jurisdiction, the appeal court acknowledges that, if the first instance body has observed the witnesses and weighed their evidence, its decision on such matters is more likely to be correct than any decision of a court which cannot deploy those factors when assessing the position...’”
“195. When the Court of Appeal heard appeals on questions of fact the court was essentially conducting a review of the findings made by the judge below in as much as the Court of Appeal examined that judgment in the light of the evidence which had been presented to the court below without (save exceptionally) hearing evidence in this court. Mr Boyd Q.C. submits that the change of language compels a different approach to be adopted. I do not agree. Our task is essentially no different from what it was – we consider the judgment testing it against the evidence available to the judge and we ask, as we used to ask, whether it was wrong. The Court of Appeal can only interfere if the decision of the lower court was wrong and in deciding whether or not findings of fact were wrong, we take a retrospective look at the case and do not decide it afresh untrammelled by the judge’s conclusion. 196. The trial judge’s view inevitably imposes a restraint upon the appellate court, the weight of which varies from case to case. Two factors lead us to be cautious about interfering. First, the appellate court recognises that judging the witness is a more complex task than merely judging the transcript. Each may have its intellectual component but the former can also crucially rely on intuition. That gives the trial judge the advantage over us in assessing a witness’s demeanour, so often a vital factor in deciding where the truth lies. Secondly, judging is an art not a science. So the more complex the question, the more likely it is that different judges will come to different conclusions and the harder it is to determine right from wrong. Borrowing language from other jurisprudence, the trial judge is entitled to ‘a margin of appreciation’. 197. Bearing these matters in mind, the Appeal Court conducting a review of the trial judge’s decision will not conclude that the decision was wrong simply because it is not the decision the appeal judge would have made had he or she been called upon to make it in the court below. Something more is required than personal unease and something less than perversity has to be established. The best formulation for the ground in between where a range of adverbs may be used – ‘clearly’, ‘plainly’, ‘blatantly’, ‘palpably’ wrong, is an adaptation of what Lord Fraser of Tullybelton said in G v G (Minors: Custody Appeal) [1985] 1 W.L.R. 642, 652, admittedly dealing with the different task of exercising a discretion. Adopting his approach, I would pose the test for deciding whether a finding of fact was against the evidence to be whether that finding by the trial judge exceeded the generous ambit within which reasonable disagreement about the conclusion to be drawn from the evidence is possible. The difficulty or ease with which that test can be satisfied will depend on the nature of the finding under attack. If the challenge is to the finding of a primary fact, particularly if founded upon an assessment of the credibility of witnesses, then it will be a hard task to overthrow. Where the primary facts are not challenged and the judgment is made from the inferences drawn by the judge from the evidence before him, then the Court of Appeal, which has the power to draw any inference of fact it considers to be justified, may more readily interfere with an evaluation of those facts. The judgment of the Court of Appeal in The Glannibanta (1876) 1 P.D. 283, 287, seems as apposite now as it did then:- ‘Now we feel, as strongly as did the Lords of the Privy Council in the cases just referred to [The Julia 14 Moo P.C. 210 and The Alice L.R. 2 P.C. 245], the great weight that is due to the decision of a judge of first instance whenever, in a conflict of testimony, the demeanour and manner of the witnesses who have been seen and heard by him are, as they were in the cases referred to, material elements in the consideration of the truthfulness of their statements. But the parties to a cause are nevertheless entitled, as well on question of fact as on questions of law, to demand the decision of the Court of Appeal, and that court cannot excuse itself from the task of weighing conflicting evidence and drawing its own inferences and conclusions, even though it should always bear in mind that it has neither seen nor heard the witnesses, and should make due allowance in this respect.’” ‘Now we feel, as strongly as did the Lords of the Privy Council in the cases just referred to [The Julia 14 Moo P.C. 210 and The Alice L.R. 2 P.C. 245], the great weight that is due to the decision of a judge of first instance whenever, in a conflict of testimony, the demeanour and manner of the witnesses who have been seen and heard by him are, as they were in the cases referred to, material elements in the consideration of the truthfulness of their statements. But the parties to a cause are nevertheless entitled, as well on question of fact as on questions of law, to demand the decision of the Court of Appeal, and that court cannot excuse itself from the task of weighing conflicting evidence and drawing its own inferences and conclusions, even though it should always bear in mind that it has neither seen nor heard the witnesses, and should make due allowance in this respect.’”
“During the meeting I was asked a large number of questions regarding the references I had provided. I was extremely anxious during the meeting and felt I was not explaining myself as well as I could have due to this. The meeting also started 2 hours later than it should have which also exacerbated my anxiety. I was not informed of the fact that my meeting had been delayed or given any indication as to why. I tried to explain the impact that my anxiety has on my ability to communicate clearly and this did not seem to be taken into account. I feel I was not given the opportunity to show the work and effort that I have done to improve myself, as well as to show how I have strived to make sure similar instances that led to my suspension would not be repeated within my professional role. The panelists instead continued to question me on the same topics which were discussed multiple times, leading to me not feeling as though I was being listened to which again increased my levels of anxiety which meant I was unable to think clearly and answer in the way that I had wanted to. The persistence of the same line of questioning led me to panic and change some answers which led to the panel pointing out inconsistencies which would not have happened otherwise.”
“The panel just got a couple of questions. Couple of areas we want to look at in a bit more detail. So I'll ask my colleagues to ask you one or two more questions. We'll start with Miss Reddy.”
“OK. Thank you. And then just a question around the reference that was submitted by Derek around caring for, I think it was his mother, Eileen. Could you just tell us a little bit more around how your role developed, how it started and then what it developed into?”
“So Derek is a fam like a family friend. His mum [became] ill and I used to go and help her with like our jobs around the house. I used to help her [with], like with a personal hygiene. I used to help [cook her] meals [and] to take her out shopping. Yeah, she had. She was very aware of everything. She didn't have any dementia. And yeah, basically it was just to go and help her with daily living, basically. I volunteered to go and help her.”
“You say you volunteered to help.”
“Scott Handley: Thank you. Miss [Nurrish], I just want to go back. Just one thing that I'm not quite clear about. You've explained to us the situation with Eileen, family friend, etcetera.”
“Yeah. I just would like to know time scale way. It's time scale wise.”
“OK. And then the work in the college? When did that start?”
“That started.April 20. No, it didn't. It was September 3.”
“OK. Yeah. So that was, that was well after Eileen. And so I think you said to my colleague this what I just wanted to be sure on the dates that you were looking after Ireland at the same time you're working in the college.”
“Yeah, yeah. Know that I was.It was when I was with the two ladies. I'm getting my dates mixed up now.”
“Yeah, it's difficult. It's a long time ago, I know. I just want to be sure that you said originally your evidence was that you were. You're out of work, you were claiming benefits because you weren't working and you enjoyed helping people. You volunteered to help these two ladies.”
“Yeah, I'm getting, oh, hot and flustered.”
“That's OK is that? Is that how it was that you were not working at that time? And then you got the job at the college?”
“Yeah, yeah. Yeah, yeah.”
“And was that after these, after the ladies, OK.”
“Yeah, it was AF though.”
“So there was no overlap[?]”
“Miss Nourish, then finally, it's your opportunity. Is there anything else you want the panel to be aware of? We will take account of all the information you've provided. Is there anything else you'd like us to hear? The Appellant: “I don't think so.”
“All right. That's very good. Thank you and thank you for answering all our questions. It is difficult and these events happen some time ago. It's hard to remember days. We appreciate that.”