Nursing and Midwifery Council: Fitness to Practise Committee Substantive Hearing

Transcription

1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Hearing 1 December 2017 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of registrant: NMC PIN: Part(s) of the register: Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Registrant: Nursing and Midwifery Council: Consensual Panel Determination: Dimple Denzil Wates 01F1750O Registered Nurse - Adult Nursing Lancashire Conviction Melissa D Mello (Chair, Lay member) Florence Mitchell (Registrant member) Georgina Foster (Lay member) Paul Housego Rob James Mrs Wates not in attendance nor represented Represented by Mary-Clare Kennedy, NMC Regulatory Legal Team Accepted Facts proved: Facts not proved: Fitness to practise: Sanction: Interim Order: All None Impaired Striking off order Interim suspension order (18 months) 1

2 Decision on Service of Notice of Hearing The panel was informed at the start of this hearing that Mrs Wates was not in attendance and that written notice of this hearing had been sent to Mrs Wates registered address by recorded delivery and by first class post on 18 October The panel took into account that the notice letter provided details of the allegation, the time, dates and venue of the hearing and, amongst other things, information about Mrs Wates right to attend, be represented and call evidence, as well as the panel s power to proceed in her absence. Ms Kennedy submitted the NMC had complied with the requirements of Rules 11 and 34 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended ( the Rules ). The panel accepted the advice of the legal assessor. In the light of all of the information available, the panel was satisfied that Mrs Wates has been served with notice of this hearing in accordance with the requirements of Rules 11 and 34. It noted that the rules do not require delivery and that it is the responsibility of any registrant to maintain an effective and up-to-date registered address. Decision on proceeding in the absence of the Registrant The panel next considered whether it should proceed in the absence of Mrs Wates. The panel had regard to Rule 21 (2) states: (2) Where the registrant fails to attend and is not represented at the hearing, the Committee 2

3 (a) (b) (c) shall require the presenter to adduce evidence that all reasonable efforts have been made, in accordance with these Rules, to serve the notice of hearing on the registrant; may, where the Committee is satisfied that the notice of hearing has been duly served, direct that the allegation should be heard and determined notwithstanding the absence of the registrant; or may adjourn the hearing and issue directions. Ms Kennedy invited the panel to continue in the absence of Mrs Wates on the basis that she had voluntarily absented herself. She referred the panel to correspondence from Mrs Wates legal representative at the Royal College of Nursing (RCN) dated 29 November 2017, which clarified that she would not be attending nor represented. Ms Kennedy informed the panel that the hearing would be taking place by way of a consensual panel determination and that it is usual for a registrant and their representative not to attend in these circumstances. She further submitted that Mrs Wates legal representative had stated that they would be available on the telephone if this was necessary. Ms Kennedy submitted that there was no reason to believe that an adjournment would secure her attendance on some future occasion. The panel accepted the advice of the legal assessor. The panel noted that its discretionary power to proceed in the absence of a registrant under the provisions of Rule 21 is not absolute and is one that should be exercised with the utmost care and caution as referred to in the case of R. v Jones (Anthony William), (No.2) [2002] UKHL 5 The panel further noted the case of R (on the application of Raheem) v Nursing and Midwifery Council [2010] EWHC 2549 (Admin) and the ruling of Mr Justice Holman that: 3

4 ...reference by committees or tribunals such as this, or indeed judges, to exercising the discretion to proceed in the person's absence "with the utmost caution" is much more than mere lip service to a phrase used by Lord Bingham of Cornhill. If it is the law that in this sort of situation a committee or tribunal should exercise its discretion "with the utmost care and caution", it is extremely important that the committee or tribunal in question demonstrates by its language (even though, of course, it need not use those precise words) that it appreciates that the discretion which it is exercising is one that requires to be exercised with that degree of care and caution. The panel also took note of GMC v Adeogba and Visvardis [2016] EWCA Civ 162 to the effect that the panel should proceed unless there is good reason not to do so. The panel has decided to proceed in the absence of Mrs Wates. In reaching this decision, the panel has considered the submissions of the case presenter, and the advice of the legal assessor. It has had particular regard to the factors set out in the decision of Jones. It has had regard to the overall interests of justice and fairness to all parties. It noted that: A consensual Panel determination has been agreed between the NMC and Mrs Wates; no application for an adjournment has been made by Mrs Wates; there is no reason to suppose that adjourning would secure her attendance at some future date; there is a strong public interest in the expeditious disposal of the case; Mrs Wates expected the hearing to proceed. In these circumstances, the panel has decided that it is fair, appropriate and proportionate to proceed in the absence of Mrs Wates. 4

5 Decision and reasons on application under Rule 19 At the outset of the hearing Ms Kennedy made a request that the hearing of Mrs Wates case be held partly in private on the basis that the CPD contains personal about Mrs Wates health. The application was made pursuant to Rule 19 of the Rules. The legal assessor reminded the panel that while Rule 19 (1) provides, as a starting point, that hearings shall be conducted in public, Rule 19 (3) states that the panel may hold hearings partly or wholly in private if it is satisfied that this is justified by the interests of any party or by the public interest. Rule 19 states 19. (1) Subject to paragraphs (2) and (3) below, hearings shall be conducted in public. (2) Subject to paragraph (2A), a hearing before the Fitness to Practise Committee which relates solely to an allegation concerning the registrant s physical or mental health must be conducted in private. (2A) All or part of the hearing referred to in paragraph (2) may be held in public where the Fitness to Practise Committee (a) having given the parties, and any third party whom the Committee considers it appropriate to hear, an opportunity to make representations; and (b) having obtained the advice of the legal assessor, is satisfied that the public interest or the interests of any third party outweigh the need to protect the privacy or confidentiality of the registrant. (3) Hearings other than those referred to in paragraph (2) above may be held, wholly or partly, in private if the Committee is satisfied 5

6 (a) (b) having given the parties, and any third party from whom the Committee considers it appropriate to hear, an opportunity to make representations; and having obtained the advice of the legal assessor, that this is justified (and outweighs any prejudice) by the interests of any party or of any third party (including a complainant, witness or patient) or by the public interest. (4) In this rule, in private means conducted in the presence of every party and any person representing a party, but otherwise excluding the public. Having heard that there will be reference to Mrs Wates health condition, the panel determined to hold such parts of the hearing, in relation to the CPD, in private. Consensual panel determination (CPD) At the outset of this hearing, Ms Kennedy, on behalf of the NMC, informed the panel that prior to this hearing a provisional agreement of a consensual panel determination had been reached with regard to this case between the NMC and Mrs Wates. The agreement, which was put before the panel, sets out Mrs Wates full admission to the facts alleged in the charges, that Mrs Wates conviction amounted to misconduct, and that Mrs Wates fitness to practise is currently impaired by reason of that conviction. It is further stated in the agreement that an appropriate sanction in this case would be a striking off order. The panel has considered the provisional agreement reached by the parties. That provisional agreement reads as follows: 6

7 Consensual panel determination: provisional agreement Mrs Wates is aware of the CPD hearing. Mrs Wates does not intend to attend the hearing and is content for it to proceed in her and her representative s absence. The parties agree that information relating to Mrs Wates health should be considered by the panel in private under Rule 19. Sections in this agreement dealing with health are marked as private. The Nursing and Midwifery Council and Dimple Wates (the registrant), PIN 01F1750O, agree as follows: 1. The registrant admits the following charges: That you, a registered nurse: 1. On 11 July 2016 were convicted of dishonestly making a false statement or representation to obtain a benefit or other payment or advantage contrary to s.111a of the Social Security Administration Act 1992 And in light of the above, your fitness to practise is impaired by reason of your conviction. The Facts 2. The parties agree that the following facts accurately reflect the charge set out in paragraph On 11 July 2016 the registrant appeared before the Preston Crown Court and pleaded guilty to an offence under s111a of the Social Security Administration Act Her case was adjourned for sentence and on 2 September 2016 she was sentenced to 8 months imprisonment suspended for 24 months, and ordered to pay a victim surcharge of 100. No conditions were attached to her suspended sentence. His Honour Judge Woolmans sentencing remarks are 7

8 attached at appendix 1. On the 7 November 2016 the registrant was made subject to a confiscation Order under the Proceeds of Crime Act 2002 for 50, This conviction related to the fraudulent claim for benefits between March 2011 and July In March 2011 the registrant made a claim to the Department of Work and Pensions (DWP) for benefits but failed to declare income she was receiving as a result of sick pay and assets in the form of two houses. Had she declared these she would not have been entitled to benefits. The registrant returned to work in August 2011 and again failed to declare her change of circumstances to the DWP. As a result of the registrants fraudulent claim she received an over payment of 49, The registrant was interviewed under caution in September During that interview she said that any errors in her initial claim form were genuine errors. She accepted that she knew she was under a duty to inform the DWP of any change of circumstances and that she probably should have informed the DWP of her return to work in Aug When sentenced at Preston Crown Court the factual basis of the Benefit fraud was that it was fraudulent from the outset and therefore the initial claim did not contain genuine errors. His Honour Judge Woolman made the following comment about the registrants interview: When you were interviewed as long ago as September 2014 you weren t entirely frank 7. At her sentencing hearing the registrant was able to provide a number of testimonials these are attached at Appendix 2 and led the judge to conclude: 8

9 you are a highly regarded specialist nurse and I have read numerous references written by mainly work colleagues who have known you over the years and speak extremely highly of you and have all taken the trouble to write moving letters on your behalf. 8. [PRIVATE] Impairment 9. Current impairment or fitness to practise is not defined in the Nursing and Midwifery Order 2001 or The Nursing and Midwifery Council (Fitness to Practice) Rules 2004 (SI2004/1761). The NMC have defined fitness to practise as the suitability to remain on the register without restriction. 10. The question of current impairment is often approached by addressing the questions posed by Dame Janet Smith in her Fifth Shipman Report, as endorsed by Mrs Justice Cox in the leading case of Council for Healthcare Regulatory Excellence v (1) NMC (2) Grant [2011] EWHC 927 (Admin): 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, and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; b. has in the past, and/or is she liable in the future to bring the professions into disrepute; c. has in the past, and/or is she liable in the future to breach one of the fundamental tenets of the professions; 9

10 d. has in the past, and/or is she liable in the future to act dishonestly. It was further stated, when considering impairment: Consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances 11. The parties agree that limbs b d of the questions set out by Dame Janet Smith are engaged in this case. 12. The parties agree that due to the serious nature of the offence the registrant has been convicted of, she has brought the reputation of the profession into disrepute. The general public would not expect a nurse to behave in such manner. 13. The parties agree that the registrant has breached the following paragraphs of The Code: Professional standards of practice and behaviour for nurses and midwives; and, in doing so, has breached fundamental tenets of the profession: 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 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment keep to the laws of the country in which you are practicing. 10

11 14. Finally, the registrant has acted dishonestly over a 40 month period during which she was receiving benefits. 15. In the registrant reflective piece, attached in full at Appendix 4, she begins to describe the offence at paragraph 1: My sister called the benefits helpline number for me in February 2011 and they asked her all the questions which she tried her best to narrate to me, considering my health issues, best to my knowledge I answered them all 16. The registrant has returned to her position when interviewed under caution in September 2014 by suggesting that her actions were done to the best of her knowledge. The registrant goes on to describe her failure to notify the DWP of a change of circumstances in August 2011 as a mistake. 17. Although the registrant s written reflection shows an increased awareness of the impact of her conviction on the reputation of the profession, it shows a diminishing level of insight into her own dishonesty as she continues to minimise her culpability. 18. It is agreed that the registrant has not fully remediated her misconduct. Although His Honour Judge Woolman commented at page 3 paragraph C of his sentencing remarks, I am sure that you will not commit an offence such as this again ; dishonesty is an attitudinal problem which is difficult to remediate. Accordingly, there remains a risk that the registrant will act dishonestly again. The parties therefore agree the registrant is liable to bring the profession into disrepute, breach fundamental tenets of the nursing profession, and act dishonestly in the future. 11

12 19. The parties agree that the finding of impairment is necessary to uphold public confidence in the nursing profession. If a finding of impairment were not made in the particular circumstances of this case, the public confidence in the profession and the NMC, as its regulator, would be undermined. Sanction 20. It is agreed that the following aggravating features are present: a. Conviction for a dishonesty offence. b. Fraudulent activity took place over a significant period of time c. Actions resulted in significant financial gain to the registrant. d. The registrant minimises her culpability and does not have full insight into her misconduct. 21. It is agreed that the following mitigating features are present: a. The dishonesty was not in a clinical or work setting b. The registrant has no previous regulatory findings recorded against her. c. No clinical concerns have been identified. d. Positive testimonials regarding the registrant s clinical practice. e. Personal circumstances set out in paragraph 8. f. The registrant has repaid in full the benefits fraudulently obtained. 22. The public interest must be at the forefront of any decision on sanction. The public interest includes protection of members of the public, including patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour within the profession. 23. The parties have considered the Sanctions Guidelines. In particular under the heading Dishonesty: 12

13 Dishonesty, even where it does not result in direct harm to patients but is related to matters outside of a nurse or midwife s professional practice can undermine the trust the public place in the profession. Honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or midwife s practice. According to Parkinson v NMC: 'A nurse found to have acted dishonestly is always going to be at severe risk of having his or her name erased from the register. A nurse who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than direct erasure.' This does not mean that in dishonesty cases the Fitness to Practise Committee is left with an arbitrary choice between suspension and striking-off, or that in the absence of special circumstances a striking-off order is to be seen as a default outcome. Rather, this decision makes clear that honesty is so integral to the standing of a profession that any departure from it will always risk a striking-off order as a possible outcome. It is nevertheless vital that all Fitness to Practise Committee panels continue to start with the least restrictive sanction, and work upwards in order of restrictiveness. A finding of dishonesty does not remove this responsibility. 13

14 The nature of the dishonest conduct must be carefully assessed. Not all dishonesty is equally serious. Generally, the forms of dishonesty which are most likely to call into question whether a nurse or midwife should be allowed to remain on the register will involve: deliberate dishonesty to conceal clinical issues, particularly those causing harm to patients misuse of power vulnerable victims personal financial gain from a breach of trust direct risk to patients premeditated, systematic or longstanding deception Dishonest conduct will generally be less serious in cases of: one-off incidents opportunistic or spontaneous conduct no direct personal gain no risk to patients incidents in private life of nurse or midwife 24. The parties have also had particular regard to the Sanctions Guidance under the heading Criminal Conviction: The purpose of the sanction is not to punish the nurse or midwife for a second time in relation to a criminal conviction or caution. Sentences previously imposed by the criminal courts are not necessarily a reliable or definitive guide to the seriousness of the conviction as far as professional regulation is concerned. There may have been specific personal mitigation which led the court to its decision on sentence, which 14

15 carries less weight in the regulatory context because of the different public interest considerations that apply. Cases involving criminal offending by nurses and midwives are a good illustration of the principle that the reputation of the profession is more important than the fortunes of any individual member. Membership of a profession brings many benefits, but that is part of the price (see Bolton v Law Society [1994] 1 WLR 512). According to CHRE v (1) GDC and (2) Fleischmann [2005] EWHC 87 (Admin): 'As a general principle (except in cases involving relatively trivial matters such as time allowed for payment of a fine, or disqualification from driving), where a nurse or midwife has been convicted of a serious criminal offence or offences, they should not be permitted to resume their practice until they have satisfactorily completed their sentence. The reasoning behind this principle is not to punish the nurse or midwife whilst they are serving their sentence, but that good standing within the nursing or midwifery professions needs to be earned if the reputation of those profession is to be maintained.' 25. It is agreed that taking no further action would not reflect the seriousness of the charges and would not protect the public interest, as the panel would in effect be taking no action. 26. It is agreed that a caution order would not reflect the seriousness of the charges and would not protect the public interest. It is agreed that this case is not at the lower end of the spectrum of impaired fitness to practice where a caution order may be appropriate. 15

16 27. It is agreed that a conditions of practice order would not reflect the seriousness of the charges and would not protect the public interest. The misconduct is behavioural rather than clinical; therefore, there are no areas of the registrants practice in need of assessment and or retraining. 28. It is agreed that a suspension order would not reflect the seriousness of the charges and, in the absence of any full insight and or remediation, would not protect the public interest. 29. It is agreed that the only sanction that would properly reflect the seriousness of the case and protect the public interest is a striking off order. 30. It is agreed that the registrant s behaviour is fundamentally incompatible with being a registered professional as it involved prolonged dishonesty over a period of 40 months. Interim order 31. It is agreed that it is otherwise in the public interest for there to be an interim suspension order of 18 months to cover any appeal period. The parties understand that this provisional agreement cannot bind a panel, and that the final decision on findings impairment and sanction is a matter for the panel. The parties understand that, in the event that a panel does not agree with this provisional agreement, the admissions to the charges set out at section 1 above, and the agreed statement of facts set out at section 2 above, may be placed before a differently constituted panel that is determining the allegation, provided that it would be relevant and fair to do so. Signed.. Dated 16

17 Registrant Signed.. Dated. For and on behalf of the NMC Here ends the provision agreement between the NMC and Mrs Wates. The provisional agreement was signed by Mrs Wates on 28 November 2017 and the NMC on 30 November The panel had regard to two typographical errors included in the CPD document at paragraphs 18 and 29. At paragraph 18, the panel noted that a surplus the had been added. At paragraph 29 it noted that the word the was missing. Further, the panel noted that the date referred to in line 2 of paragraph 4 should refer to March 2011 rather than March 2014 as stated. These were referred to Ms Kennedy and to Mrs Wates representative, Miss Helen Parkinson, and both agreed that the panel was correct in its observations. The CPD was amended accordingly. 17

18 Decision and reasons on the consensual panel determination: The panel decided to accept the CPD, making three small typographical corrections. The panel heard and accepted the legal assessor s advice. He referred the panel to the NMC Sanctions Guidance (SG) (July 2017) and to the NMC s guidance on Consensual Panel Determinations, January He reminded the panel that they could accept, amend or reject the provisional agreement reached between the NMC and Mrs Wates. Further, the panel should consider whether the provisional agreement would be in the public interest. This means that the outcome must ensure an appropriate level of public protection, maintain public confidence in the profession and the regulatory body, and declare and uphold proper standards of conduct and behaviour. The panel noted that Mrs Wates admitted the the charge. Accordingly the panel was satisfied that the charge is found proved by way of Mrs Wates admission as set out in the signed provisional agreement before the panel. The panel then went on to consider whether Mrs Wates fitness to practise is currently impaired. Whilst acknowledging the agreement between the NMC and Mrs Wates, the panel has exercised its own independent judgement in reaching its decision on impairment. The panel considered whether Mrs Wates fitness to practise is currently impaired by reason of her conviction. The panel determined that Mrs Wates fitness to practise is currently impaired. The panel recognised that Mrs Wates conviction was not something that she would be able to remediate due to its nature. Further, it noted her remorse and had regard to her reflective statement as included in Appendix 1. It had regard to the fact that Mrs Wates referral to the NMC did not relate in any way to her clinical competence as a Registered Nurse and that there had been no adverse comment in this regard. It did, however, recognise that Mrs Wates conviction weighed heavily upon 18

19 the public interest and that to not find her fitness to practice to be impaired would undermine the public confidence in the profession as well as the NMC as its regulator. In this respect the panel endorsed paragraphs 9-19 of the provisional agreement. Having found Mrs Wates 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. The purpose of any sanction is not intended to be punitive even though it may have a punitive effect. The panel had careful regard to the SG. Decision on sanction is a matter for the panel exercising its own independent judgement. The panel has considered this case very carefully and has decided to make a strikingoff order. It directs the registrar to strike Mrs Wates off the register. The effect of this order is that the NMC register will show that Mrs Wates has been struck-off the register. In reaching this decision, the panel has had regard to all the evidence that has been adduced in this case. The panel accepted the advice of the legal assessor. 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 Sanctions Guidance ( SG ) published by the NMC. It recognised that the decision on sanction is a matter for the panel, exercising its own independent judgement. The panel first considered whether to take no action but concluded that this would not be appropriate in view of the seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest for there to be no further action. Next, in considering whether a caution order would be appropriate in the circumstances, the panel took into account the SG, which 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 19

20 not happen again. The panel considered that Mrs Wates conviction for substantial dishonesty was not at the lower end of the spectrum and that a caution order 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 impose a caution order. The panel next considered whether placing conditions of practice on your registration would be a sufficient and appropriate response. The panel is mindful that any conditions imposed must be proportionate, measurable and workable. 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 nature of the charges in this case. Mrs Wates conviction is not something that can be addressed through retraining. Furthermore the panel concluded that the placing of conditions on Mrs Wates registration would not adequately address the seriousness of this case and would not protect the public. The panel then went on to consider whether a suspension order would be an appropriate sanction. The SG indicates that a suspension order would be appropriate where (but not limited to): 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 took into account the aggravating and mitigating factors as outlined in the CPD agreement. It was of the view that Mrs Wates conviction was a significant departure from the standards expected of a registered nurse. The panel found that the 20

21 serious breach of a fundamental tenet of the profession evidenced by Mrs Wates actions is fundamentally incompatible with her remaining on the register. Accordingly, the panel determined that a suspension order would not be a sufficient, appropriate or proportionate sanction. Balancing all of these factors, the panel has determined that a suspension order would not be an appropriate or proportionate sanction. Finally, in looking at a striking-off order, the panel took note of the following paragraphs of the SG: can public confidence in the professions and the NMC be maintained if the nurse or midwife is not removed from the register? is striking-off the only sanction which will be sufficient to protect the public interest? is the seriousness of the case incompatible with ongoing registration (see above for the factors to take into account when considering seriousness)? Mrs Wates actions were significant departures from the standards expected of a registered nurse, and are fundamentally incompatible with her remaining on the register. The panel was of the view that the findings in this particular case demonstrate that Mrs Wates conviction was serious and involved dishonesty over a long period and of a substantial amount. The panel determined that to allow Mrs Wates to continue practising would undermine public confidence in the profession and in the NMC as a regulatory body. Balancing all of these factors and after taking into account all the evidence before it during this case, the panel determined that the appropriate and proportionate sanction is that of a striking-off order and so accepted the CPD. Having regard to the matters it identified, in particular the effect of Mrs Wates actions in bringing the profession into disrepute by adversely affecting the public s view of how a registered nurse should 21

22 conduct herself, the panel has concluded that nothing short of this would be sufficient in this case. The panel considered that this order was 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. Determination on Interim Order The panel has considered the submissions made by the NMC within the CPD that an interim order should be made on the grounds that it is necessary for the protection of the public and is otherwise in the public interest. The panel has also accepted the advice of the legal assessor. The panel was satisfied that an interim suspension order is necessary 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. To do otherwise would be incompatible with its earlier findings. The period of this order is for 18 months to allow for the possibility of an appeal to be made and determined. If no appeal is made, then the interim order will be replaced by the striking-off order 28 days after Mrs Wates is sent the decision of this hearing in writing. That concludes this determination. 22