Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Hearing 11 May 2018 Nursing and Midwifery Council, Temple Court 13a Cathedral Road, Cardiff, CF11 9HA Name of registrant: NMC PIN: Mr Christopher Mattravers 86A0014W Part(s) of the register: RN3: Mental health nurse (Sub Pat 1) - 12 March 1989 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Mr Mattravers: Nursing and Midwifery Council: Order being reviewed: Outcome: Wales Misconduct John Penhale (Chair, Lay member) Jodie Banner (Registrant member) Claire Corrigan (Lay member) Lee Davies Karel Kingsley Present and represented by Oliver Manley Represented by Hannah Smith, Case Presenter Suspension Order 6 months Suspension Order 6 months to come into effect at the end of 15 June 2018 in accordance with Article 30 (1) Page 1
Decision and reasons on review of the current order: The panel decided to impose a further suspension order. This order will come into effect at the end of 15 June 2018 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the first review of a suspension order originally imposed by a Conduct and Competence Committee on 15 November 2017 for six months. The current order is due to expire at the end of 15 June 2018. The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved which resulted in the imposition of the substantive order were as follows: That you, a registered nurse: 1. Whilst employed as a Band 7 nurse at the Caradog Day Unit: a) On unknown dates from 2006 to 2012 spoke to and/or acted towards Colleague A in an inappropriate manner by way of one or more of the following set out in schedule 1 of charge. b) Failed to undertake and/or record a risk assessment prior to Colleague A visiting Patient A at his home. 2. Whilst employed at Pastoral Healthcare between 22 September 2014 to 14 January 2015 you failed to notify them that you were under NMC investigation. 3. Your actions at charge 2 above were dishonest in that you knew you were subject to NMC investigation and deliberately concealed this from your employer. And in light of the above, your fitness to practise is impaired by reason of your misconduct. Page 2
Schedule 1 of charge 1.1 when Colleague A had recently started in her role, told her that he had not wanted her, but he was outnumbered. 1.2 said to colleague A that she was like a rabbit caught in headlights or words to that effect. 1.3 Said to colleague A this must have put your relationship with your husband under great strain or words to that effect 1.4 asked Colleague A in respect of her husband did he wander, did he see other women? or words to that effect 1.5 told Colleague A that she was not a good role model for the wellbeing group as she was grossly overweight and morbidly obese or words to that effect. 1.6 asked a staff member to speak to Colleague A about her weight and/or discussed Colleague A s weight with team members in her absence. 1.7 made comments to or about Colleague A words to the effect of: 1.7.1 that you had never been so disgusted, angry and appalled that she was still eating coming back from morning break 1.7.2 that colleague A was greedy 1.7.3 surely you re not going to eat all of that? 1.7.4 don t you think that s an awful lot of food for one person? 1.7.5 you re greedy and gluttonous Page 3
1.8 said to Colleague A words to the effect of 1.8.1 giving up smoking is a greedy persons way of eating to excess with an excuse 1.8.2 how old she looked for her age 1.8.3 how wrinkled her skin was 1.8.4 what bad condition her skin was 1.8.5 how Colleague A must have had a hard life 1.8.6. how she was only slightly attractive to a very small percentage of the population 1.8.7 I can see the weight loss programme is not working 1.8.8 No luck on the weight loss plan then 1.8.9 How heavy are you now? 1.8.10 that Colleague A did not have a photograph on Facebook she didn t want to put off any potential punters 1.8.11 that Colleague A had OCD 1.8.12 that Colleague A had a door mat personality and that her husband had chosen her for that reason 1.8.13 that Colleague A allow herself to be abused and treated badly because she was grateful to have someone or anyone Page 4
1.8.14 that if she did not take her husband back, that she would be on her own forever 1.8.15 asked Colleague A if she had ever considered having plastic surgery 1.8.16 told her that she had no redeeming features 1.8.17 called Colleague A cheap and tacky 1.8.18 told Colleague A that she had Harrods taste on a Primark budget 1.8.19 told Colleague A that she was a poser, typical valleys woman from the big Methryr Tydfil, all bleached hair and clothes from New Look 1.8.20 that Colleague A was common and had no style 1.8.21 that in the right light and darkened room, you wouldn t be that bad 1.8.22 told Colleague A that she had been around the block a few times 1.8.23 told Colleague A that she was a man-eater 1.8.24 that you would find it extremely frightening and scary if colleague A came on to you in a nightclub 1.8.25 that you found colleague A irritating and annoying and it had taken a long time to get used to her and tolerate her. 1.8.26 that you and me could have had something good going 1.8.27 that some men find tall women like you with fair size boobs intimidating, but I don t Page 5
1.9 Colleague A was made to take her breaks on her own 1.10 Colleague A was mocked for not consuming drugs or alcohol 1.11 Mocked Colleague A s hearing impairment 1.12 Asked Colleague A what her sexual fantasies were 1.13 Asked Colleague A how many men have you tried to snare 1.14 After undergoing a procedure to remove two ingrown toe nails, contacted Colleague A at her home address and asked her to bring in the toenails as proof. 1.15 Made comments to Colleague A about the breakdown of her marriage which included words to the effect that 1.15.1 Life with colleague A must be totally boring and mundane 1.15.2 that Colleague A s husband was looking for more excitement 1.15.3 that Colleague A s weight and appearance had been the problem 1.16 In regard to Colleague A s children made the following comments or words to that effect; 1.16.1 In reference to Colleague A s son said that makes a lot of sense as all front row players are now morbidly obese, he is, isn t he? 1.16.2 In reference to Colleague A s daughter stating God there s a resemblance of your mother and placed his hand on her arm and said Oh, I am sorry; you don t mind me saying that do you? I didn t mean to offend you, I do apologise Page 6
1.17 suggesting the Colleague A left her car and slept overnight in the unit with him 1.18 Asked Colleague A out for a drink 1.19 Asked Colleague A if you could ring her during the evenings and weekends. The original panel determined the following with regard to impairment: In respect of charge 1(a), the panel considered that, although you have demonstrated some developing insight, this is not fully developed. You were unable to demonstrate an understanding of the effect that your inappropriate behaviour had on Colleague A and you were open in that you told the panel that you do not agree with its findings and the context in which the panel had found your comments proved. You said that you would not place yourself in a managerial role in the future in order to avoid a similar situation. However, you were unable to demonstrate an understanding that inappropriate behaviour is not confined to a position of seniority which led the panel to believe you had limited insight in this respect and therefore it could not be satisfied that you would not repeat this behaviour in the future. The panel considered your actions in respect of charge 1(a) to be remediable. The panel noted your evidence that you now take a step back and do not become deeply involved in banter at work. However, it was of the view that until you have developed your insight further, you are unable to demonstrate sufficient remediation. It therefore concluded that there is a real risk of repetition of this behaviour. In respect of charge 1(b), whilst the conduct is remediable, the panel heard no evidence of insight or remediation on your part. On this basis, it concluded that there is a real risk of repetition. In respect of charges 2 and 3, the panel considered that you have shown insight into your actions. The panel noted that you made early admissions to charge 2. Page 7
You accepted that by acting dishonestly you called into question your own integrity and the integrity of the nursing profession. You have apologised for your actions and have demonstrated remorse. You now understand that you must be honest and open with your employers and have told the panel that you have kept your current employers updated as to the NMC investigation against you. The panel noted the recent reference from the Home Manager at The Hollies Care Home where you are currently employed in which she states Chris was honest during interview and informed us of the NMC investigation into his practice, he has kept us informed of the proceedings as they arose and he has always been honest about the reason for his referral to the NMC. The panel bore in mind that dishonesty, in principle, is difficult to remediate. However, it was satisfied that, on the basis of the evidence before it, there is little risk of repetition. The panel therefore decided that a finding of impairment is necessary on the grounds of public protection in respect of charges 1(a) and 1(b) only. The panel is mindful that public protection includes protection of staff. The panel bore in mind that the overarching objectives of the NMC are to protect, promote and maintain the health safety and well-being of the public and patients, and to uphold the wider public interest, which 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, in this case, a finding of impairment on public interest grounds was also required. The panel determined that, as you are yet to demonstrate full insight and remediation into your failure to maintain professional boundaries, and further, in the light of the lack of insight and remediation in respect of your failure to manage risks appropriately, a finding of no impairment on public interest grounds would undermine public confidence in the nursing profession and the NMC as a regulator. Although the panel has found a low risk of repetition in respect of dishonesty, given that you acted dishonestly over a prolonged period, it was of the view that public confidence in the nursing profession and the NMC as a regulator could not be upheld if a finding of impairment on public interest grounds were not made in respect of charges 2 and 3. Page 8
Having regard to all of the above, the panel was satisfied that your fitness to practise is currently impaired. The original panel determined the following with regard to sanction: The panel then went on to consider whether a suspension order would be an appropriate sanction. The SG indicates that a suspension order may be appropriate where some of the following factors are apparent: a single instance of misconduct but where a lesser sanction is not sufficient no evidence of harmful deep-seated personality or attitudinal problems no evidence of repetition of behaviour since the incident the Committee is satisfied that the nurse or midwife has insight and does not pose a significant risk of repeating behaviour The panel determined that, although this was not a single instance of misconduct and there had been a clear breach of a fundamental tenet of the profession, there are in your case mitigating circumstances. As such, the panel considered that the misconduct was not fundamentally incompatible with remaining on the register. Although the panel found that your conduct in respect of Colleague A amounted to bullying, given the evidence before it, it was not satisfied that this amounted to a deep-seated personality or attitudinal problem and there is no evidence of repetition of this type of behaviour since the material time, whilst you have continued to work as a nurse. The panel previously noted that you have gained insight into your dishonesty in respect of charges 2 and 3 and that you have developing insight in respect of charge 1(a). Although the panel previously found that there was a risk of repetition of the conduct found proved in respect of charges 1(a) and 1(b), it was of the view that this risk was not sufficiently great to be classed as significant. The panel considered that the period of suspension would afford you the opportunity to gain full insight and understanding into the importance of maintaining professional boundaries and managing risks, and give you the opportunity to fully remediate your Page 9
misconduct. A suspension order would protect the public whilst it is in force and would be reviewed before its expiry. The panel further considered whether a striking-off order would be proportionate in your case. Taking account of all the information before it, and taking account of the significant mitigation provided to the panel on your behalf, the panel concluded that it would be disproportionate. Whilst the panel acknowledges that a suspension may have a punitive effect, it would be unduly punitive in your case to impose a striking off order. Striking off is not the only sanction which is sufficient to protect the public interest, and public confidence in the profession and the NMC can be satisfied by the imposition of a suspension order. 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 you. However 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 six months was appropriate in this case to mark the seriousness of the misconduct and to afford you the opportunity to develop your insight and remediation. Decision on current fitness to practise At this review hearing, Ms Smith on behalf of the NMC outlined the background to the previous panel s decision. She submitted that it was for the panel to conduct a full review of this matter to determine whether your fitness to practise was currently impaired, and if so, to determine the appropriate and proportionate sanction. Ms Smith submitted that a further period of suspension on both public protection and public Page 10
interest grounds would allow you to continue the progress you have already made. She submitted that conditions of practice could also appropriately address the concerns. Mr Manley submitted that you agree that your practice is currently impaired and invited the panel to impose a further suspension order for a period of six months. He referred the panel to your reflective piece and submitted that you demonstrated considerable insight as highlighted by your request for additional time for further reflection. Mr Manley referred the panel to references from previous colleagues. He submitted that you are a well-respected professional with 32 years of nursing experience. Mr Manley told the panel that it has been extremely difficult for you to adjust from being a team leader to working as a care assistant. Mr Manley submitted that you have increased reflection and insight because you do not feel ready to return to nursing practice and that, in fact, you are considering working away from a clinical setting to give you the time and space needed to further reflect and address any training needs identified by the previous panel. The panel accepted the advice of the legal assessor. The panel has had regard to all of the documentation before it and has taken account of the submissions made by Ms Smith and by Mr Manley. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour. The panel has considered carefully whether your fitness to practise remains impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. The panel took into account that you have in the past put colleagues at potential risk of harm. It considered that the risk of repetition remained. You have provided a reflective Page 11
piece that shows that you developed some insight into your failings. However, it was mindful that you have not taken sufficient steps to remediate your misconduct. The panel took into account that you completed one course and completed one-to-one sessions with a former colleague although you submitted no evidence to support this. It also noted that the course you completed related to malnutrition which is not relevant to the concerns identified. The panel took into account that you have accepted that your fitness to practise is currently impaired and you feel that you are not ready to return to practice. The panel found that your insight has developed but not to the extent that is required to address your misconduct. For these reasons, the panel found that your fitness to practise remains impaired on public protection and public interest grounds. Determination on sanction Having found your fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance (SG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor adequately protect the public or satisfy the wider public interest to take no further action. The panel then considered whether to impose a caution but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor adequately protect the public or satisfy the wider public interest to impose a caution order. Page 12
The panel next considered the imposition of a conditions of practice order. The panel was mindful that you did not feel ready to return to nursing and therefore found that workable conditions could not be formulated to sufficiently protect patients and the wider public interest. The panel considered the imposition of a further period of suspension. It was of the view that a suspension order would allow you time to develop further insight and remediation. Further, it would mark the seriousness of your case and sufficiently address the public protection and public interest concerns. The panel was of the view that a 6 month suspension order would afford you time to achieve this. Before the end of the period of the order, a panel will review it. The panel next considered a striking-off order but determined that it would be disproportionate at this time. The panel noted that you have provided limited evidence of remediation and considered that the following would continue to assist any future reviewing panel: a further written reflective piece, using a recognised model, addressing: the impact your behaviour has had on Colleague A the importance of maintaining professional boundaries, particularly when in a position of seniority and trust; and the importance of managing risks evidence of training in respect of: maintaining professional boundaries; treating people with respect; equality and diversity; and managing risks up to date references from employers in any paid or unpaid work, in a healthcare setting or otherwise; and your continued engagement and attendance at any review hearing. Page 13
This decision will be confirmed to you in writing. That concludes this determination. Page 14