nursing and midwifery council fitness to practise ... · application form and curriculum vitae...

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Nursing and Midwifery Council Fitness to Practise Committee

Substantive Meeting

Wednesday, 27 May 2020 and Monday, 8 June 2020

Nursing and Midwifery Council Virtual Meeting

Name of registrant: Miss Kuldip Kaur Cheema NMC PIN: 04H0562O Part(s) of the register: Nursing, sub part 1 Registered Nurse – Adult (18 August 2004) Area of registered address: Kent Type of case: Misconduct Panel members: John Penhale (Chair, lay member)

Kevin Hope (Registrant member) Suzanna Jacoby (Lay member)

Legal Assessor: Nina Ellin Panel Secretary: Tara Hoole Facts proved: All Facts not proved: None Fitness to practise: Impaired Sanction: Suspension order (12 months) Interim order: Interim suspension order (18 months)

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Decision and reasons on service of Notice of Meeting The panel has considered all the information provided.

It noted that the letter of notice of this substantive meeting was sent to Miss Cheema’s

email address on the register on 27 April 2020. The panel took into account that the Notice

of Meeting provided details of the allegations against her. Further, the notice informed

Miss Cheema that her case would be considered at a meeting on or after 25 May 2020.

The panel also noted that by email dated 22 April 2020, Miss Cheema had previously

indicated that she would waive the 28 day notice period.

The panel accepted the advice of the legal assessor who reminded the panel that as of 31

March 2020 a number of temporary amendments to The Nursing and Midwifery Council

(Fitness to Practise) Rules Order of Council 2004 (as amended) (the Rules) came into

force, in response to the current Covid-19 pandemic, including the ability to hold hearings

and meetings virtually and to serve notice by email.

In the light of all of the information available, the panel was satisfied that Miss Cheema has

been served with notice of this meeting in accordance with the requirements of Rules 11A

and 34 of the Rules.

Details of charge [as amended]

That you a registered nurse,

1. On an unknown date in 2018, sent an application form with inaccurate information

to East Kent Hospitals University NHS Foundation Trust, in that you:

1.1. recorded that you were employed as a nurse at Queen Elizabeth Queen Mother

Hospital, Endoscopy department from July 2015 - March 2016 when you were

employed from 24 August 2015 to 27/28 December 2015.

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2. On an unknown date in 2018 sent a CV with inaccurate information about your

employment history to TFS Healthcare, in that you:


Hospital, Endoscopy department from “2012 -2015” when you were employed

from 24 August 2015 to 27/28 December 2015.

2.2. recorded that you were employed as a nurse at William Harvey Hospital,

Emergency department from “September 2015 until present”, when you were

employed from 8 August 2016 - 10 March 2017

3. On an unknown date in September 2016 provided inaccurate information in an

application form and or CV, about your employment history to Nurseplus in that

you:

3.1. recorded and or informed Nurseplus that you were previously employed as a

nurse at East Kent Hospital Trust, Endoscopy department from July 2015 –

March 2016, when you were actually employed from 24 August 2015 to 27/28

December 2015

4. In May 2018, sent a CV with inaccurate information to Appoint Group in that you:

4.1. recorded that you were previously employed as a nurse at Queen Elizabeth

Queen Mother Hospital from “2012 -2015” when you were employed from 24

August 2015 -27/28 December 2015

4.2. recorded that you were employed at William Harvey Hospital, A&E from

“September 2015 until present”, when you were employed from 8 August 2016-

10 March 2017

5. In May 2018, during a telephone consultation with Appoint Group, you informed the

agent that you were employed in a full time position at William Harvey Hospital,

when you were not.

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6. Your actions at one or more of charges 1-5 above were dishonest in that you

attempted to mislead your employers/agencies about the length of time you had

previously worked.

AND in light of the above your fitness to practise impaired by reason of your

misconduct.

Decision and reasons to amend charge 3.1 and charge 6 The panel determined to amend charge 3.1 as there was a clear error in the timeline.

Original charge:

3.1 recorded and or informed Nurseplus that you were previously employed as a

nurse at East Kent Hospital Trust, Endoscopy department from July 2016 –March

2016, when you were actually employed from 24 August 2015 to 27/28 December

2015

Proposed charge: 3.1 recorded and or informed Nurseplus that you were previously employed as a

nurse at East Kent Hospital Trust, Endoscopy department from July 2015 –March

2016, when you were actually employed from 24 August 2015 to 27/28 December

2015

From reviewing the evidence before it, the panel was satisfied that the documentary

evidence in the application form completed by Miss Cheema for Nurseplus, showed the

dates July 2015 – March 2016 against the Endoscopy Nurse at East Kent Hospital Trust

entry.

The panel accepted the advice of the legal assessor that Rule 28 of the Rules states:

28. (1) At any stage before making its findings of fact, in accordance with rule 24(5)

or (11), the Investigating Committee (where the allegation relates to a fraudulent or

incorrect entry in the register) or the Fitness to Practise Committee, may amend

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(a) the charge set out in the notice of hearing; or

(b) the facts set out in the charge, on which the allegation is based,

unless, having regard to the merits of the case and the fairness of the

proceedings, the required amendment cannot be made without injustice.

The panel was satisfied that there would be no prejudice or injustice caused by amending

this charge to correct what is an obvious typographical error. It therefore decided to amend

the charge, as above, to ensure clarity and accuracy. The panel further noted a minor

typographical error in charge 6 and added a “you” to ensure clarity and accuracy.

Facts At the outset of the meeting, the panel noted the written response to the charges

completed by Miss Cheema, dated 17 March 2020, in which she has made admissions to

the charges. However, the panel noted that the charges have been amended slightly since

this admission. Further, the panel considered that Miss Cheema has made various

responses and given different explanations in regards to the allegations against her.

In particular, the panel was concerned that Miss Cheema has responded that she

accepted the charge of dishonesty but has provided various alternative explanations

stating that it was ‘a mistake’ or ‘an error’.

The panel therefore decided that it was appropriate to consider the evidence before it on

each charge, taking into consideration Miss Cheema’s responses, to determine the facts of

this case.

In reaching its decisions on the facts, the panel took into account all the documentary

evidence in this case. 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 a fact will be proved if a panel is satisfied that it is more likely than not that

the incident occurred as alleged.

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The panel had regard to the written statements of the following witnesses on behalf of the

NMC:

• Ms 1 – Practice Development Nurse at William Harvey Hospital at the time of the

allegations;

• Ms 2– Compliance Manager at TFS Healthcare;

• Ms 3 – Branch Manager of Nurseplus;

• Ms 4 – HR advisor at Spencer Private Hospitals;

• Ms 5 – Operations Manager at Appoint Group.

The panel also had regard to the written representations from Miss Cheema.

Background

On 6 July 2018, the NMC received a referral about Miss Cheema’s fitness to practise from

East Kent Hospital University Foundation Trust (‘the Trust’).

Miss Cheema first commenced employment with the Trust in August 2016. Ms 1 met Miss

Cheema at the William Harvey Hospital (WH) at that time, in her role as practice

development nurse and saw Miss Cheema two-three times per week. As a result of

concerns with her clinical practice, Ms 1 wanted to place Miss Cheema on an action plan.

However, prior to this being implemented Miss Cheema [PRIVATE] resigning in March

2017.

In July 2018, Ms 1 discovered that Miss Cheema was working in the Emergency

Department (ED) at WH, as an agency nurse through TFS Healthcare (TFS). Ms 1 was

concerned by this and contacted TFS to ascertain whether Miss Cheema had gained any

further experience to allow her to work in the ED. She also requested Miss Cheema’s

application form and Curriculum Vitae (CV). Upon reviewing these along with the Trust’s

records Ms 1 noted some discrepancies in Miss Cheema’s CV. Miss Cheema claimed to

have worked at WH in the ED from September 2015 until ‘present’ and that she was

employed by the Queen Elizabeth the Queen Mother Hospital (QEQM) as an Endoscopy

Nurse from 2012 -2015. This did not correspond with the Trust’s HR records.

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Further investigations were undertaken by the agencies Miss Cheema has worked for,

namely Nurseplus Agency (Nurseplus) and Spencer Private Hospitals via Appoint Group

(Appoint), and additional discrepancies in her CV and application forms came to light.

Miss Cheema has engaged with the NMC investigation and provided a response to the

regulatory concerns. During an interim order hearing in August 2018, Miss Cheema raised

a defence, via her representative that the reason for the inaccuracies was because an

agency had completed her CV on her behalf. She later alleged that the representative at

the interim hearing was not acting on her instructions and that this was an error.

In a further response, she stated that [PRIVATE] had previously drafted her CV, and that

“a friend from IT” had assisted in its creation.

In her response to Regulatory Concerns statement, she stated that it had always been her

case that [PRIVATE] prepared the CV and that this is how the errors were made. Miss

Cheema stated that the errors in her CV application forms were a mistake and not an

attempt to deceive. In January 2020 Miss Cheema indicated that she desired to be

voluntarily removed from the register.

Before making any findings on the facts, the panel accepted the advice of the legal

assessor. It considered the documentary evidence provided by both the NMC and Miss

Cheema.

The panel noted that the first five charges all pertained to alleged discrepancies regarding

employment at the Trust, namely QEQM and WH. The panel decided it would be helpful to

establish where and when Miss Cheema was employed at these hospitals.

From reviewing the documentation before it, in particular the Trust’s HR records, the panel

determined the following:

• Miss Cheema was employed at QEQM as an Endoscopy Nurse from 24 August

2015 to 27/28 December 2015.

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• Miss Cheema was employed at WH in the ED from 8 August 2016 to 10 March

2017.

The panel then considered each of the charges and made the following findings.

Charge 1

1. On an unknown date in 2018, sent an application form with inaccurate information to

East Kent Hospitals University NHS Foundation Trust, in that you:


Hospital, Endoscopy department from July 2015 - March 2016 when you were

employed from 24 August 2015 to 27/28 December 2015.

This charge is found proved.

In reaching this decision, the panel took into account Miss Cheema’s application form and

the Trust’s HR records.

The panel had regard to the application form submitted by Miss Cheema to the Trust in

which under her employment history for her role as Endoscopy Staff Nurse at QEQM she

has input a start date of ‘07/2015’ and an end date of ‘03/2016’.

The panel considered that in entering these start and end dates in her application form to

the Trust that Miss Cheema had recorded that she was employed at QEQM in the

endoscopy department from July 2015 until March 2016.

The panel has already determined that Miss Cheema was employed in this role from 24

August 2015 to 27/28 December 2015.

The panel therefore concluded that Miss Cheema had submitted an application form

containing inaccurate information to the Trust.

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The panel therefore found this charge proved.

Charge 2.1

2. On an unknown date in 2018 sent a CV with inaccurate information about your

employment history to TFS Healthcare, in that you:


Hospital, Endoscopy department from “2012 -2015” when you were employed

from 24 August 2015 to 27/28 December 2015.


In reaching this decision, the panel took into account Ms 2’s witness statement and the CV

provided to TFS.

The panel had regard to its findings at charge 1.1 above. It has accepted that Miss

Cheema was employed at the QEQM endoscopy department between 24 August 2015

and 27/28 December 2015.

Ms 2, in her witness statement, explains the process of applying to work for TFS. This

includes completing an application form, providing a CV and two references. She confirms

that they would not draft a CV for someone they employed.

The panel considered the CV Miss Cheema provided to TFS. Under the heading

Experience, Miss Cheema lists ‘2012-2015: Queen Elizabeth Queen Mother (QEQM)

Hospital… ICCU Theatre and Endoscopy’.

The panel concluded that Miss Cheema had sent a CV with inaccurate information about

her employment history to TFS in that she recorded she had been employed at the QEQM

from 2012-2015 when she was employed from 24 August 2015 to 27/28 December 2015.


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Charge 2.2

2.2. recorded that you were employed as a nurse at William Harvey Hospital,

Emergency department from “September 2015 until present”, when you were

employed from 8 August 2016 - 10 March 2017


In reaching this decision, the panel took into account Ms 2’s witness statement and the CV

provided to TFS.

Ms 2, in her witness statement, explains the process of applying to work for TFS. This

includes completing an application form, providing a CV and two references. She confirms

that they would not draft a CV for someone they employed. The documentary evidence is

clear that Miss Cheema’s application was in 2018.

The panel considered the CV Miss Cheema provided to TFS. Under the heading

Experience, Miss Cheema lists ‘09:2015 – Present: William Harvey Hospital… Accident

and Emergency Staff Nurse’.

The panel has already determined that Miss Cheema was employed at WH in the ED from

8 August 2016 to 10 March 2017.

Miss Cheema, in an email to the NMC dated 20 July 2018, states: ‘I only had a my [sic]

past CV which says present experience with A&E .I have no intention of hurting or Fraud

some one [sic] so I forward my old CV to TFS’.

The panel concluded that Miss Cheema had sent a CV with inaccurate information about

her employment history to TFS in that she recorded she had been employed as a nurse at

William Harvey Hospital, Emergency department from September 2015 until ‘present’

when she was employed from 8 August 2016 to 10 March 2017.

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Charge 3

3. On an unknown date in September 2016 provided inaccurate information in an

application form and or CV, about your employment history to Nurseplus in that you:

3.1. recorded and or informed Nurseplus that you were previously employed as a

nurse at East Kent Hospital Trust, Endoscopy department from July 2015 –

March 2016, when you were actually employed from 24 August 2015 to 27/28

December 2015


In reaching this decision, the panel took into account Ms 3’s witness statement and Miss

Cheema’s application form to Nurseplus.

Ms 3, in her witness statement explains the procedure for applying to Nurseplus.

The panel considered the application form completed by Miss Cheema when she applied

to Nurseplus. Under the heading Work Experience and Education, Miss Cheema lists ‘East

Kent Hospital Trust QEQM Hospital, Margate Endoscopy Unit’ Position ‘Staff Endoscopy

Nurse’ Date from ‘July 2015’ Date to ‘March 2016’.



The panel had regard to Miss Cheema’s written correspondence dated 5 August 2019, in

which she states ‘3.1 Nurseplus Application was hand written, that is my handwriting and

the information provided truly. The year being wrong written by Error not on purpose. I did

not had [sic] exact date in front of me, I remember sometime in July so I put down July

2016 to March 2017. I have not provided any wrong information neither I will in future

(March 2016) was written in ERROR please note. I have not mislead any of my employers.

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I am confident with my skill and always will be. I sincerely apologise that I trusted

[PRIVATE] to create my CV but [PRIVATE] done everything wrong’.

The panel concluded that Miss Cheema had provided inaccurate information in an

application form, about her employment history to Nurseplus in that she recorded she had

been employed as a nurse at QEQM in the Endoscopy department from July 2015 –March

2016, when she was employed from 24 August 2015 to 27/28 December 2015.


Charge 4.1

4. In May 2018, sent a CV with inaccurate information to Appoint Group in that you:

4.1. recorded that you were previously employed as a nurse at Queen Elizabeth

Queen Mother Hospital from “2012 -2015” when you were employed from 24

August 2015 -27/28 December 2015


In reaching this decision, the panel took into account Ms 4’s and Ms 5’s witness

statements and Miss Cheema’s CV provided to Appoint Group.

Ms 5, in her witness statement, explains the procedure for applying to Appoint Group.

The panel had regard to the CV Miss Cheema provided to Appoint Group. Under the

heading Experience, Miss Cheema lists ‘2012-2015: Queen Elizabeth Queen Mother

(QEQM) Hospital… ICCU Theatre and Endoscopy’.



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The panel concluded that Miss Cheema had sent a CV with inaccurate information to

Appoint Group in that she recorded she had been employed as a nurse at QEQM in from

2012 - 2015, when she was employed from 24 August 2015 to 27/28 December 2015.


Charge 4.2

4.2. recorded that you were employed at William Harvey Hospital, A&E from

“September 2015 until present”, when you were employed from 8 August 2016-

10 March 2017


In reaching this decision, the panel took into account Ms 4’s and Ms 5’s witness

statements and Miss Cheema’s CV provided to Appoint Group.

The panel considered the CV Miss Cheema provided to Appoint Group. Under the heading

Experience, Miss Cheema lists ‘09:2015 – Present: William Harvey Hospital… Accident

and Emergency Staff Nurse’.

The panel has already determined that Miss Cheema was employed at WH in the ED from

8 August 2016 to 10 March 2017.

The panel concluded that Miss Cheema had sent a CV with inaccurate information to

Appoint Group in that she recorded she had been employed as a nurse at WH in the ED

from September 2015 until present, when she was employed from 8 August 2016 to 10

March 2017.


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Charge 5

5. In May 2018, during a telephone consultation with Appoint Group, you informed the

agent that you were employed in a full time position at William Harvey Hospital, when

you were not.


In reaching this decision, the panel took into account Ms 5’s witness statement and a

transcript of a telephone call between an employee (the agent) at Appoint Group and Miss

Cheema.

Ms 5 confirms in her witness statement that Miss Cheema contacted Appoint group on 23

May 2018 to enquire about a part-time nurse role she had seen advertised. Ms 5 confirms

that an agent at Appoint Group had a conversation with Miss Cheema regarding potential

employment. Ms 5 provided a transcript of this telephone call.

The panel had careful regard to the transcript of the telephone consultation between Miss

Cheema and the agent at Appoint Group in May 2018. It noted the following:

• Miss Cheema states that ‘at present I’m in Ashford William Harvey’, she later states

‘I was hoping to resign and get a part time…’.

• Miss Cheema goes on to say ‘… at present because I’m band 6, I’m full time…’ and

then she states ‘At present in William Harvey I get 34,000 a year. With my NHS

experience you see because I work full time, this is my salary on based on full time.’

The panel concluded that during a telephone consultation with Appoint Group in May

2018, Miss Cheema informed the agent on several occasions that she was employed in a

full time position at WH. The panel has already determined that Miss Cheema was

employed at WH in the ED from 8 August 2016 to 10 March 2017.

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The panel concluded that, in May 2018, during a telephone consultation with Appoint

Group, Miss Cheema informed the agent that she was employed in a full time position at

WH, when she was not.


Charge 6

6. Your actions at one or more of charges 1-5 above were dishonest in that you attempted to mislead your employers/agencies about the length of time you had

previously worked.


In reaching this decision, the panel took into account the witness statements and

supporting evidence along with its previous determinations in relation to charges 1 – 5 as

well as Miss Cheema’s written correspondence with the NMC.

In a letter to the NMC, in December 2019, Miss Cheema states:

‘I think my punishment was very harsh. I have not hurt anyone or neither I put anyone

in danger…Just to let you know I never created my CV. Previously [PRIVATE] made

one for me and then my friend from IT created my CV.’

Miss Cheema has denied the allegations until her most recent correspondence. In a

response dated 5 August 2019, she said that she did not accept or agree with the charges

against her as she did not make any changes to her CV herself but that these were made

by [PRIVATE]. Further, she states:

‘3.1 Nurseplus Application was hand written, that is my handwriting and the

information provided truly. The year being wrong written by Error not on purpose. I

did not had [sic] exact date in front of me, I remember sometime in July so I put down

July 2016 to March 2017. I have not provided any wrong information neither I will in

future (March 2016) was written in ERROR please note. I have not mislead any of my

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employers. I am confident with my skill and always will be. I sincerely apologise that I

trusted [PRIVATE] to create my CV but [PRIVATE] done everything wrong’.

In Miss Cheema’s response to the charges, dated 17 March 2020, she has admitted all of

the charges. Further in a statement she has written ‘I really regret everything that has

happened’. ‘I sincerely apologise for my mistakes and will regret that I have missed my

nursing for almost 19 to 20 months’.

On 15 April 2020 Miss Cheema emailed the NMC. She attached an application for

Voluntary removal from the NMC register. She stated:

‘Please I beg of you to leave me alone… Have I murder or cause harm to

someone?? NO NO NO. You have treated me worse that criminals for my mistake

and continue to torture me, this is how I feel. I was really hoping for a positive reply

so I can help during the outbreak but no !... I have given 15 yrs [sic] of my life to

nursing and never made any mistake.’

The panel was of the view that Miss Cheema has not accepted that she acted dishonestly,

despite the apparent admission to this charge. She has repeatedly stated that it was a

mistake or an error and has blamed others for making these mistakes.

When considering the question of dishonesty the legal assessor referred the panel to the

legal authority of Ivey v Genting Casinos [2017] UKSC 67 which at Paragraph 74 states:

‘When dishonesty is in question the fact-finding tribunal must first ascertain

(subjectively) the actual state of the individual’s knowledge or belief as to the facts.

The reasonableness or otherwise of his belief is a matter of evidence (often in

practice determinative) going to whether he held the belief, but it is not an additional

requirement that his belief must be reasonable; the question is whether it is genuinely

held. When once his actual state of mind as to knowledge or belief as to facts is

established, the question whether his conduct was honest or dishonest is to be

determined by the fact-finder by applying the (objective) standards of ordinary decent

people. There is no requirement that the defendant must appreciate that what he has

done is, by those standards, dishonest.’

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The panel considered that Miss Cheema’s explanations have changed over the course of

the NMC investigation. Further, all of her actions relating to the charges which she

attributed to ‘mistakes’ or ‘errors’ depict a pattern of behaviour and have been to her

advantage and, in the panel’s view, made her look more employable.

The panel had particular regard to the transcript of the conversation between Miss

Cheema and the agent at Appoint Group in respect of charge 5. The panel accepted that

this conversation took place in May 2018. The panel has accepted that Miss Cheema’s

employment at WH ended on 10 March 2017. However, in the course of the telephone

conversation Miss Cheema on several occasions provided information to suggest she was

still employed by WH and was working there on a full time basis. The panel considered

that the transcript of this telephone conversation demonstrated Miss Cheema’s disregard

for truthfulness; she repeatedly stated that she was currently working full time in a position

she had not worked in for over a year. The panel regarded this as deliberate dishonesty

which could not be attributed in any way to an error or mistake.

The panel was of the view that Miss Cheema knew that she was providing incorrect

information to potential employers. The panel noted this was not a one off reference and

an incorrect month but that Miss Cheema had, at points, added years on to her

employment history. Further, Miss Cheema had submitted incorrect information to different

potential employers over a significant period of time.

The panel determined that Miss Cheema knew what she was doing when she provided

incorrect information to the Trust, Nurseplus, TFS, and Appoint Group.

The panel further determined that ordinary, decent people would regard the providing of

incorrect information in a telephone call, or on a CV or application form, in this manner to

be dishonest.

The panel therefore determined that Miss Cheema was dishonest in that she deliberately

sought to mislead potential employers by providing inaccurate information during the

application process.

Accordingly this charge is found proved in respect of charges 1 - 5.

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Fitness to practise

Having reached its determination on the facts of this case, the panel then moved on to

consider, whether the facts found proved amount to misconduct and, if so, whether Miss

Cheema’s fitness to practise is currently impaired. There is no statutory definition of fitness

to practise. However, the NMC has defined fitness to practise as a registrant’s suitability to

remain on the register unrestricted.

The panel, in reaching its decision, has recognised its statutory duty to protect the public

and maintain public confidence in the profession. Further, it bore in mind that there is no

burden or standard of proof at this stage and it has therefore exercised its own

professional judgement.

The panel adopted a two-stage process in its consideration. First, the panel must

determine whether the facts found proved amount to misconduct. Secondly, only if the

facts found proved amount to misconduct, the panel must decide whether, in all the

circumstances, Miss Cheema’s fitness to practise is currently impaired as a result of that

misconduct.

Representations on misconduct and impairment

In coming to its decision, the panel had regard to the case of Roylance v GMC (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.’

The NMC invited the panel to take the view that the facts found proved amount to

misconduct. The panel had regard to the terms of ‘The Code: Professional standards of

practice and behaviour for nurses and midwives 2015’ (the Code) in making its decision.

The NMC submitted:

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‘Misconduct also covers actions which would be considered ‘deplorable’ by fellow

practitioners. In considering what is deplorable, the panel may address this question

by considering whether a reasonable member of the public would consider that the

Registrant’s actions or omissions in the particular circumstances to be clearly

unacceptable;

Not every breach of the code and not every falling short in the particular

circumstances will amount to misconduct. It must be serious or as Elias LJ put it in

the case of R (on the Application of Remedy UK Ltd) v GMC [2010] EWHC 1245

(Admin) “sufficiently serious….that it can properly be described as misconduct going

to fitness to practise.”

[Miss Cheema’s] actions breached the following provisions of ‘The Code…

20 Uphold the reputation of your profession at all times To achieve this, you must:

20.1 Keep to and uphold the standards and values set out in the Code

20.2 Act with honesty and integrity at all times, treating people fairly and without

discrimination, bullying and harassment;

It is submitted that [Miss Cheema’s] conduct fell seriously short of what would have

been expected of a Registered Nurse. [Miss Cheema] has acted dishonestly multiple

times and to a number of employers. Acting with integrity and honesty are integral to

the standards expected of a registered nurse and central to the Code.’

The NMC invited the panel to find Miss Cheema’s fitness to practise impaired. It submitted:

‘In relation to impairment, the general approach to what might lead to a finding of

impairment was provided by Dame Janet Smith in her Fifth Shipman Report. A

summary is set out in the case of CHRE v NMC & Grant [2011] EWHC 927 at

paragraph 76 in the following terms:

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“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 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 should consider all four limbs.

The concerns relate to misinformation about [Miss Cheema’s] employment history,

one of which, relates to a period of employment where there were concerns about

[Miss Cheema’s] clinical practice. It is also of note, that the employment dates

provided by [Miss Cheema] suggest she has been employed in roles for significantly

longer than was the case. This provides a misleading picture to prospective

employers who need an accurate record of past employment in order to identify and

manage any risks to patient safety and the appropriateness of any assignment.

It is further submitted that [Miss Cheema’s] conduct has brought the nursing

profession into disrepute and breached fundamental tenets of the profession. Acting

with integrity and honesty are cornerstones of the nursing profession. [Miss

Cheema’s] actions are plainly dishonest. [Miss Cheema] provided misleading

information repeatedly and to multiple employers.

Insight, remediation, remorse and current practice

[Miss Cheema] is engaging with the NMC and has demonstrated some insight into

her misconduct.

[Miss Cheema] states that she has had time to reflect since the interim order hearing

and that she understands the possible consequences in terms of patient safety and

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public trust, of her employers believing that she had more relevant experience than

she actually has.

In Cohen v GMC [2007] EWHC 581 (Admin), the court set out three matters which it

described as being ‘highly relevant’ to the determination of the question of current

impairment:

1. Whether the conduct that led to the charge(s) is easily remediable

2. Whether it has been remedied

3. Whether it is highly unlikely to be repeated

NMC Guidance indicates that some types of concerns which relate to one’s character

and integrity may be more difficult to remedy as noted below.

‘A small number of concerns are so serious that it may be less easy for the nurse

or midwife to put right the conduct, the problems in their practice, or the aspect of

their attitude which led to the incidents happening deliberately using false

qualifications or giving a false picture of employment history which hides clinical

incidents in the past, not telling employers that their right to practise has been

restricted or suspended, practising or trying to practise in breach of restrictions or

suspension imposed by us’

The misconduct has not yet been remedied by the [Miss Cheema]. Although the

[Miss Cheema] has shown some insight, she has continued to deny the allegations

whilst placing blame on third parties. There is no independent information attesting of

her character of integrity. The registrant is currently subject to a suspension order

and has expressed that she no longer wishes to practise as a nurse.

At present, the concerns are highly likely to be repeated should [Miss Cheema] be

permitted to practise on an unrestricted basis.

It is submitted that the reputation of the nursing profession would be damaged if the

[Miss Cheema] were to be permitted to practise unrestricted due to the seriousness

of the dishonest conduct.

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It is further submitted that members of the public appraised of [Miss Cheema’s]

dishonest conduct would also expect a finding of impairment to mark the conduct as

unacceptable and that a finding of current impairment is necessary to declare and

uphold proper standards.

For the reasons above, it is submitted that [Miss Cheema]’s fitness to practise is

currently impaired, both on the grounds of public protection and the wider public

interest.’

Miss Cheema has not accepted that her fitness to practise is impaired.

The panel accepted the advice of the legal assessor which included reference to a number

of relevant judgments.

Decision and reasons on misconduct

When determining whether the facts found proved amount to misconduct, the panel had

regard to the terms of the Code.

The panel was of the view that Miss Cheema’s actions did fall significantly short of the

standards expected of a registered nurse, and that Miss Cheema’s actions amounted to a

breach of the Code. Specifically:

20 Uphold the reputation of your profession at all times To achieve this, you must:

20.1 Keep to and uphold the standards and values set out in the Code

20.2 Act with honesty and integrity at all times…

The panel appreciated that breaches of the Code do not automatically result in a finding of

misconduct. However, the panel was of the view that Miss Cheema’s behaviour would be

seen as deplorable by both fellow professionals and members of the public. The panel has

found that Miss Cheema submitted misleading information to prospective employers and in

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doing so acted dishonestly. The panel considered it is the responsibility of an individual to

ensure that information submitted to any potential employer is accurate. Further, it is the

panel’s view that the commonality of the inaccuracies in her employment history is that

they made Miss Cheema appear more employable.

The panel therefore found that Miss Cheema’s actions, both individually and collectively,

did fall seriously short of the conduct and standards expected of a nurse and amounted to

misconduct.

Decision and reasons on impairment The panel next went on to decide if as a result of the misconduct, Miss Cheema’s fitness

to practise is currently impaired.

Nurses occupy a position of privilege and trust in society and are expected at all times to

be professional. Patients and their families must be able to trust nurses with their lives and

the lives of their loved ones. To justify that trust, nurses must be honest and open and act

with integrity. They must make sure that their conduct at all times justifies both their

patients’ and the public’s trust in the profession.

In this regard the panel considered the test set out in the case of Grant, and referenced

above. In Miss Cheema’s case the panel concluded that all four limbs of the test are

engaged.

The panel has already found that Miss Cheema acted dishonestly. The panel is of the view

that Miss Cheema’s actions in providing misleading information regarding her employment

history breached the fundamental tenets of the nursing profession and therefore brought

the reputation into disrepute. Further, the panel considered that by presenting herself as

more experienced than she was, Miss Cheema had put patients at potential risk of harm.

The panel considered that a person purporting to have more experience than they do, had

the potential to impact on patient care because they might not have the proper skills or

experience to care for these patients.

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Regarding insight, the panel considered that Miss Cheema has limited insight. Whilst Miss

Cheema has made admissions to the NMC for all charges, including dishonesty, she

contradicted herself by attributing her dishonest actions to ‘errors’ and ‘mistakes’.

Furthermore, the admissions she made to the NMC came at a late stage of the NMC

investigation.

The panel determined that Miss Cheema has not demonstrated a genuine understanding

of how her actions had the potential to put patients at a risk of harm. Further, Miss

Cheema has not adequately recognised the impact of her actions on colleagues or the

reputation of the profession.

The panel considered that Miss Cheema has repeatedly attempted to shift blame for

‘mistakes’ and ‘errors’ onto others and has sought to displace responsibility for the

misleading information contained within her CV and application forms. In addition Miss

Cheema has continually minimised her actions. As recently as 15 April 2020 in an email to

the NMC Miss Cheema stated:

‘… Have I murder or cause harm to someone?? NO NO NO. You have treated me

worse that criminals for my mistake and continue to torture me, this is how I feel...’

The panel considered this a further indication that Miss Cheema has focussed on herself,

and that she has not appreciated the impact of her actions on the public perception of the

profession or the potential risk of harm her actions could have posed to patients.

Whilst dishonesty is inherently difficult to remediate, the panel was of the view that the

misconduct in this case is potentially capable of remediation. Therefore, the panel carefully

considered the evidence before it in determining whether or not Miss Cheema has

remedied the concerns identified. The panel concluded that, due to Miss Cheema’s lack of

reflection, insight or full acceptance of her misconduct, the concerns identified have not

been remedied.

The panel therefore is of the view that there is a risk of repetition based on Miss Cheema’s

lack of insight or remediation. Miss Cheema knew the standards expected of a nurse and

has breached these by misleading potential employers as to her experience and

employment history. At the time Miss Cheema was applying for the positions detailed in

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the charges she had not been working in a substantive post for over a year but was

portraying that she was currently working in a full time position. The panel considered that

this may lead to an employer believing that she was more experienced than she was and

may have impacted on patient care. The panel therefore determined that a finding of

impairment is necessary on the grounds of public protection.

The panel bore in mind that the overarching objectives of the NMC; to protect, promote

and maintain the health, safety, and well-being of the public and patients, and to uphold

and protect the wider public interest. This includes promoting and maintaining public

confidence in the nursing and midwifery professions and upholding the proper professional

standards for members of those professions.

The panel determined that a finding of impairment on public interest grounds is required.

Miss Cheema has breached fundamental tenets of the profession and her dishonest

actions have brought the profession into disrepute. The panel concluded that public

confidence in the profession and in the NMC as its regulator would be undermined if a

finding of impairment were not made in this case.

Having regard to all of the above, the panel was satisfied that Miss Cheema’s fitness to

practise is currently impaired.

Sanction The panel has considered this case very carefully and has decided to make a suspension

order for a period of 12 months with a review. The effect of this order is that the NMC

register will show that Miss Cheema’s registration has been suspended.

In reaching this decision, the panel has had regard to all the evidence that has been

adduced in this case and had careful regard to the Sanctions Guidance (SG) published by

the NMC. The panel accepted the advice of the legal assessor.

Representations on sanction

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The panel noted that in the documentation sent with the Notice of Meeting, dated 27 April

2020, the NMC had advised Miss Cheema that it would seek the imposition of a

suspension order for a period of 12 months with a review, if Miss Cheema’s fitness to

practise was found to be currently impaired.

Decision and reasons on sanction

Having found Miss Cheema’s fitness to practise currently impaired, the panel went on to

consider what sanction, if any, it should impose in this case. The panel has borne in mind

that any sanction imposed must be appropriate and proportionate and, although not

intended to be punitive in its effect, may have such consequences. The panel had careful

regard to the SG. The decision on sanction is a matter for the panel independently

exercising its own judgement.

The panel took into account the following aggravating features:

• There is a clear pattern of misconduct over a significant period of time in respect of

repeated dishonesty to more than one employer and by means of misleading

information being given in application forms, CV’s and during a telephone

conversation;

• There was a potential risk to the public in Miss Cheema purporting to have more

experience than she did;

• Miss Cheema’s actions were for her own financial gain;

• Miss Cheema has repeatedly sought to minimise the seriousness of her actions;

• Miss Cheema has repeatedly sought to displace responsibility and shift blame to

others.

The panel also took into account the following mitigating features:

• Miss Cheema has demonstrated some insight, albeit limited.

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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 it would be

neither proportionate nor in the public interest to take no further action.

It then considered the imposition of a caution order but again determined that, due to the

seriousness of the case and the public protection issues identified, an order that does not

restrict Miss Cheema’s practice would not be appropriate in the circumstances. The SG

states that a caution order may be appropriate where ‘the case is at the lower end of the

spectrum of impaired fitness to practise and the panel wishes to mark that the behaviour

was unacceptable and must not happen again.’ The panel considered that Miss Cheema’s

misconduct was not at the lower end of the spectrum and that a caution order would be

inappropriate in view of the issues identified. The panel decided that it would be neither

proportionate nor in the public interest to impose a caution order.

The panel next considered whether placing conditions of practice on Miss Cheema’s

registration would be a sufficient and appropriate response. The panel is mindful that any

conditions imposed must be proportionate, measurable and workable.

The panel also considered the seriousness of a finding of dishonesty. The panel took into

account the SG.

The panel is of the view that there are no practical or workable conditions that could be

formulated, given the dishonest nature of the charges in this case. In the panel’s view

dishonesty is not something that can be addressed through retraining.

The panel was satisfied that Miss Cheema’s actions required removal from the NMC

register on either a temporary or more permanent basis. The panel therefore went on to

consider whether a suspension order or a striking-off order would be the more appropriate

sanction in this case. The panel had regard to the SG in respect of both orders.

The panel was not satisfied that there was no evidence of a harmful deep-seated

attitudinal problem. It noted that this was not a single instance of misconduct and that the

dishonesty was for financial gain. Further, the panel had determined, at the impairment

stage, that Miss Cheema had limited insight. However, the panel noted that Miss Cheema

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made recent admissions to the charges and has taken early steps in developing her

insight. Miss Cheema had also engaged with the NMC to some extent. It concluded

therefore that Miss Cheema may develop further insight to help her remediate her actions.

The panel therefore considered that it was possible at this stage to maintain public

confidence in the profession without removing Miss Cheema permanently from the

register. The panel was of the view that a striking-off order was not the only sanction which

would be sufficient to protect patients, members of the public or maintain professional

standards. It considered that a suspension order would be sufficient to address the public

protection and public interest issues identified.

In the panel’s view a suspension order for the maximum period of 12 months with a review

is the appropriate and proportionate sanction. A suspension order would allow Miss

Cheema an opportunity to undertake meaningful reflection, to develop and demonstrate

full insight into the dishonest conduct found proved, and provide evidence of remediation

of her past misconduct to a future reviewing panel should she wish to continue in her

nursing career.

The panel considered a striking-off order but decided it would be disproportionate at this

stage. Whilst the panel acknowledged that a suspension order may have a punitive effect,

it would be unduly punitive in Miss Cheema’s case to impose a striking-off order at this

time. Balancing all of these factors the panel has concluded that a suspension order would

be the appropriate and proportionate sanction.

The panel noted the hardship such an order will inevitably cause Miss Cheema. However it

considered that this is outweighed by the public interest in this case.

The panel considered that this order is necessary to mark the importance of maintaining

public confidence in the profession, and to send to the public and the profession a clear

message about the standard of behaviour required of a registered nurse.

The panel determined that a suspension order for a period of 12 months was appropriate

in this case to mark the seriousness of the misconduct.

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At the end of the period of suspension, another panel will review the order. At the review

hearing the panel may revoke the order, or it may confirm the order, or it may replace the

order with another order.

Any future panel reviewing this case would be assisted by:

• Miss Cheema’s continued engagement with the NMC;

• Miss Cheema’s attendance at any future hearing;

• A written reflective piece using a recognised model of reflection, with particular

reference to this panel’s findings, and demonstrating insight and remediation of the

concerns identified;

• Evidence of any professional development, including documentary evidence of

completion of any courses, or how Miss Cheema is keeping her skills and

knowledge up to date;

• Any professional references/testimonials from any paid or unpaid work.

This will be confirmed to Miss Cheema in writing.

Interim order As the suspension order cannot take effect until the end of the 28-day appeal period, the

panel has considered whether an interim order is required in the specific circumstances of

this case. It may only make an interim order if it is satisfied that it is necessary for the

protection of the public, is otherwise in the public interest or in Miss Cheema’s own

interest. The panel accepted the advice of the legal assessor.

Representations on interim order

The panel took account of the representations made by the NMC that, given ‘...there is a

risk that patients would be placed at an unwarranted risk of harm should [Miss Cheema]

be permitted to practise without any restrictions and the public interest is engaged, it is

submitted that an interim order is necessary for the protection of the public and is

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otherwise in the public interest. It is further submitted that an interim suspension order for

a period of 18 months should be imposed to allow for any potential appeal period.’

Decision and reasons on interim order

The panel was satisfied that an interim order is necessary for the protection of the public

and is otherwise in the public interest. The panel had regard to the seriousness of the facts

found proved and the reasons set out in its decision for the substantive order in reaching

the decision to impose an interim order.

The panel concluded that an interim conditions of practice order would not be appropriate

or proportionate in this case, due to the reasons already identified in the panel’s

determination for imposing the substantive order. The panel therefore imposed an interim

suspension order for a period of 18 months.

If no appeal is made, then the interim suspension order will be replaced by the substantive

suspension order 28 days after Miss Cheema is sent the decision of this hearing in writing.

That concludes this determination.

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