Conduct and Competence Committee
Substantive Hearing
9 – 11 November 2016
NMC, 2 Stratford Place, London, E20 1EJ
Name of Registrant Nurse:
Rangarirai Chikoto
NMC PIN:
07F2277E
Part(s) of the register:
RNMH Registered Nurse – Sub part 1
Mental Health (11 April 2008)
Area of Registered Address:
England
Type of Case:
Misconduct
Panel Members:
Jacki Pearce
(Chair, Lay member)
Alison Hobden (Registrant member)
Adarsh Kapur
(Lay member)
Legal Assessor:
Nigel Ingram
Panel Secretary:
Vicki Watts
Mr Chikoto:
Not present and not represented
Nursing and Midwifery Council:
Represented by Phillip Law, Case Presenter, NMC
Regulatory Legal Team
Facts proved by admission:
Charges, 3,4,7 and 8
Facts proved:
Charges, 1, 2, 5 and 6
Fitness to practise:
Impaired
Sanction:
Striking off order
Interim Order:
Interim suspension order – 18 Months
Page 1 of 24
Decision on Service of Notice of Hearing:
The panel was informed at the start of this hearing that Mr Chikoto was not in attendance.
In the light of the information available, the panel was satisfied that notice had been served, as
advised by the legal assessor, in compliance and accordance with Rules 11 and 34 of The
Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended
2012) (‘the Rules’).
11.— (2) The notice of hearing shall be sent to the registrant—
(b) in every case, no later than 28 days before the date fixed for the hearing.
34.—(1) Any notice of hearing required to be served upon the registrant shall be
delivered
by sending it by a postal service or other delivery service in which delivery or receipt is
recorded to,
(a) her address in the register
Notice of this hearing was sent to Mr Chikoto on 15 September 2016 by recorded delivery to his
address on the register, which complies with the rules of service. In addition the NMC was in
receipt of subsequent correspondence from Mr Chikoto.
Proceeding in the absence of Mr Chikoto
The panel then considered continuing in the absence of Mr Chikoto.
The panel heard the submissions made by Mr Law on behalf of the Nursing and Midwifery
Council (NMC) and took account of the legal assessor’s advice.
The panel was mindful that this was a discretion that must 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.
Page 2 of 24
In deciding whether to proceed in the absence of Mr Chikoto, the panel weighed its
responsibilities for public protection and the expeditious disposal of the case with Mr Chikoto’s
right to a fair hearing.
The panel was referred to an email from Mr Chikoto dated 7 November 2016 which he
confirmed that he would not be attending the hearing. The panel also had before it written
representations dated 8 November 2016 from Mr Chikoto in respect of the charges
Mr Chikoto had been sent notice of today’s hearing and the panel was therefore satisfied that
he was aware of today’s hearing.
The panel was of the view that he has chosen to voluntarily absent himself.
The panel had no reason to believe that an adjournment would result in Mr Chikoto’s future
attendance and was satisfied that Mr Chikoto had not applied for an adjournment. Having
weighed the interests of Mr Chikoto with those of the NMC and the public interest in an
expeditious disposal of this hearing, the panel has determined to proceed in Mr Chikoto’s
absence.
Page 3 of 24
Charges as read :
That you, a registered nurse:
1. On or around 13 May 2015, provided incorrect information on your CV to Remedy
Recruitment Agency that you had been working as a registered mental health nurse at
Temploy Connection since June 2012.
2. On or around 14 May 2015 incorrectly stated to Remedy Recruitment Agency that you
had been working as a nurse at Rotherham Doncaster and Humber NHS Foundation
Trust.
3. Worked as a nurse at Devon Partnership NHS Trust whilst suspended from the Nursing
and Midwifery Council register on:
a. 6 August 2014;
b. 7 August 2014;
c. 8 August 2014;
d. 11 August 2014;
e. 12 August 2014.
4. Failed to inform your employer Plan B that you were subject to a suspension order from
the Nursing and Midwifery Council register from 1 August 2014.
5. Your actions at charge 1 above were dishonest in that you knew you had not been
working as a nurse and deliberately sought to mislead Remedy Recruitment Agency.
6. Your actions at charge 2 above were dishonest in that you knew you had not been
working as a nurse and deliberately sought to mislead Remedy Recruitment Agency.
7. Your actions at charge 3 above were dishonest in that you knew you had been
suspended and yet deliberately worked as a nurse.
8. Your actions at charge 4 above were dishonest in that you deliberately sought to
conceal the fact that you were subject to a suspension order.
AND, in light of the above, your fitness to practice is impaired by reason of your misconduct.
Page 4 of 24
Admissions to charges
At the outset of this hearing, Mr Chikoto in response to the NMC’s Standard Directions Form
dated 19 July 2016 made admissions to the following charges.
That you, a registered nurse:
3. Worked as a nurse at Devon Partnership NHS Trust whilst suspended from the Nursing
and Midwifery Council register on:
a. 6 August 2014;
b. 7 August 2014;
c. 8 August 2014;
d. 11 August 2014;
e. 12 August 2014.
4. Failed to inform your employer Plan B that you were subject to a suspension order from
the Nursing and Midwifery Council register from 1 August 2014.
7. Your actions at charge 3 above were dishonest in that you knew you had been
suspended and yet deliberately worked as a nurse.
8. Your actions at charge 4 above were dishonest in that you deliberately sought to
conceal the fact that you were subject to a suspension order.
The panel therefore announced these charges as proved by Mr Chikoto’s own admissions.
Page 5 of 24
Background
The NMC received a referral concerning Mr Rangarirai Chikoto in May 2015 from the Devon
and Partnership NHS Foundation Trust.
At the relevant times Mr Chikoto was working either as a registered nurse or as a health care
assistant for various employment agencies.
It is alleged that Mr Chikoto worked as a registered nurse at Devon Partnership NHS
Foundation Trust despite being suspended from the NMC register on five days between 6
August and 12 August 2014. It is further alleged that Mr Chikoto failed to inform his then
employer, The Plan B Employment Agency, that he was subject to a suspension order from the
NMC register from 1 August 2014.
It is also alleged that in May 2015 Mr Chikoto falsely indicated on his CV that he had worked as
a registered mental health nurse for a nursing agency Temploy Connection since June 2012. It
is further alleged that in May 2015 Mr Chikoto incorrectly informed Remedy Recruitment Agency
that he had been working as a nurse at Rotherham Doncaster and Humber NHS Foundation
Trust.
It is alleged that the allegations demonstrate dishonest behaviour in that Mr Chikoto sought to
deliberately mislead others about his employment history and his NMC registration status in that
he knew he should not be working as a nurse whilst his registration was suspended.
Page 6 of 24
Decision on the findings on facts
In reaching its decisions on the facts, the panel considered all the evidence adduced in this
case together with the submissions presented by Mr Law, on behalf of the NMC, the written
representations of Mr Chikoto and all the documentary evidence before it.
The panel heard evidence from the following witness called on behalf of the NMC:
•
Ms 1:
Healthcare Manager employed by
Connection Recruitment Limited
(trading as Temploy Connection); and
•
Mr 2:
Senior Mental Health Recruitment
Consultant at Remedy Recruitment
Group Ltd.
The panel read the NMC witness statements of the following:
Mr 3, NMC Case Investigation Manager.
Ms 4, Clinical Nurse Manager for Plan B.
Ms 5, Ward Manager of Meadow View Ward Devon Partnership NHS Trust.
The panel assessed the evidence of the two witnesses on behalf of the NMC and found both
witnesses provided clear and consistent evidence. The panel considered their recollection of the
events to be clear and consistent.
In determining the facts, the panel also considered the Standard Directions Form (SDF)
provided by Mr Chikoto dated 19 July 2016 and his response to the allegations dated 8
November 2016.
The panel heard and accepted the advice of the Legal Assessor. He reminded the panel of the
test in the case of Ghosh: “Firstly, the objective test: whether according to the ordinary
standards of reasonable and honest nurses what was done by the registrant was dishonest. If it
is not dishonest by those standards, then that is the end of the matter. If it is dishonest by those
standards then secondly, the subjective test: the panel have to consider whether the registrant
must have known that what he was doing was, by those standards, dishonest”.
Page 7 of 24
He also cited the case of Hussain v GMC [2014] ECWA Civ 2246.
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 the facts will be found
proved if the panel is satisfied that it is more likely than not that the incidents occurred as
alleged.
In reaching its decision on the facts, the panel has drawn no adverse inference from the nonattendance of Mr Chikoto.
As charges 3, 4, 7 and 8 had been proved by Mr Chikoto’s own admissions the panel went on to
consider the remaining charges:
Charge 1
1. On or around 13 May 2015, provided incorrect information on your CV to Remedy
Recruitment Agency that you had been working as a registered mental health nurse at
Temploy Connection since June 2012.
The panel found this charge proved.
In finding this charge proved the panel first considered the evidence of Ms 1. Ms 1 told the
panel that Mr Chikoto was first interviewed and registered for work as a Registered Mental
Health Nurse with Temploy Agency (Temploy) on 26 June 2012. Ms 1 was clear in her
evidence that Mr Chikoto did not actually start work with the agency until 19 December 2012,
Ms 1 explained that the reason for the 6 month delay between registering with the agency and
Mr Chikoto commencing work was because the agency had to carry out reference checks and
Mr Chikoto had to undertake a period of induction.
The panel considered Mr Chikoto’s response to the allegations dated 8 November 2016, in
which he states: “My un updated CV was accurate at the time of posting on line in June 2012. I
registered with Temploy as a registered mental health nurse and worked for them as a nurse.
When I was suspended, I informed them so I continued working for them as a nurse aid. The
CV on line has not been updated up to now as I can’t retrieve it. As a nurse aid, Temploy got
me shifts with Rotherham NHS trust where I worked till my suspension was lifted on 6 June
2015. I have submitted evidence that I was working for Rotherham NHS in the form of some
invoices and a log of tasks that I did on the wards on which I worked, I did not deliberately
sought to mislead Remedy as alleged”.
Page 8 of 24
The panel considered that it was Mr Chikoto’s duty as a registered nurse to ensure that any
information provided to a prospective employer must be accurate. The panel considered Ms 1’s
evidence in which she stated that upon Mr Chikoto advising her on 25 April 2013 that his NMC
registration was subject to a supervision order [sic] for a period of 12 months, she advised Mr
Chikoto that he could no longer continue working with Temploy as a registered mental health
nurse but that he could work as a Health Care Assistant (HCA). Ms 1 told the panel that Mr
Chikoto declined this offer and chose to no longer work for Temploy as of 25 April 2013.
Ms 1 also told the panel that Mr Chikoto contacted Temploy at the beginning of November 2013
and that he re-registered with the company as a HCA. Ms 1 said that Mr Chikoto worked as a
HCA from 8 November 2013 until 29 October 2015 and that at no time during this period did he
work as a registered mental health nurse.
In light of the evidence provided by Ms 1, the panel rejected Mr Chikoto’s explanation in respect
of this charge and preferred the evidence of Ms 1.
The panel determined that there could be no doubt that Mr Chikoto was aware that he had not
been employed by Temploy as Registered Nurse from June 2012 until May 2015.
The panel therefore concluded that Mr Chikoto intended to conceal the fact that he had not
been working as a registered mental health nurse for the period of time alleged by him from
Remedy.
Accordingly, the panel found charge 1 proved.
Charge 2
2. On or around 14 May 2015 incorrectly stated to Remedy Recruitment Agency that you
had been working as a nurse at Rotherham Doncaster and Humber NHS Foundation
Trust.
The panel found this charge proved.
In reaching this decision, the panel first considered the evidence of Mr 2. Mr 2 told the panel
that on 13 May 2015, he received an application from Mr Chikoto for the position of locum
registered mental health nurse and that on the same day, he contacted Mr Chikoto by telephone
to discuss his application. Mr 2 said that during the telephone call Mr Chikoto told him that he
was looking for work as a registered mental health nurse. Mr 2 said that after the telephone
Page 9 of 24
conversation with Mr Chikoto, he sent a copy of his CV to Devon NHS Trust and also sent Mr
Chikoto’s details to the compliance department for background checks to be carried out. Mr 2
explained that this was a standard procedure for all new applicants registering with Remedy
Recruitment Agency (Remedy).
Mr 2 told the panel that the following day, he received a telephone call from a Service Manager
at Devon NHS Trust who advised him that Mr Chikoto had been escorted off the premises whilst
working there because of a condition placed on his registration by the NMC. Mr 2 went on to
tell the panel that he also received a response from the Agency’s compliance team who advised
that the checks carried out on Mr Chikoto had revealed that he had a condition on his NMC
registration.
Mr 2 told the panel that after he received the information from the compliance department, he
telephoned Mr Chikoto to make further enquiries about his CV and where he was currently
working. Mr 2 said that during the telephone call, Mr Chikoto was evasive. Mr 2 said that Mr
Chikoto failed to tell Mr 2 which Ward he was working on at Rotherham Doncaster and South
Humber NHS Trust or provide the name of his Line Manager.
Mr 2 said that after the telephone call with Mr Chikoto, he immediately telephoned The Human
Resources Department of Rotherham Doncaster and South Humber NHS Trust in order to alert
them that there was a member of staff working there claiming to be a registered mental health
nurse.
The panel considered Mr Chikoto’s explanation in respect of this charge as set out in his
response to the charges dated 8 November 2016 and in which he states: “I stated I was working
as a nurse aid at Rotherham NHS, not as a registered nurse. Temploy and Rotherham NHS
were going to provide references about where I was working and in what role anyway, so this is
going to be clarified if Remedy had proceeded with the registration. I did not deliberately seek
to mislead Remedy as alleged”.
During questions put to Mr 2 whilst he was giving evidence under oath, he was asked whether
he recalled Mr Chikoto ever telling him that he had been employed as a nurse aid at Rotherham
Doncaster and South Humber NHS Trust. Mr 2 was clear in his evidence, that at no time did Mr
Chikoto say that he had been employed as a nurse aid. Mr 2 said that had Mr Chikoto said he
was working as a nurse aid, it would have stuck in his mind as nurse aid was an unusual term
that he had not come across before and it was not a role that Mr 2’s department at Remedy
Page 10 of 24
recruited. Mr 2 also told the panel that only candidates applying for roles as registered mental
health nurses would come through to him as it was his role to match registered mental health
nurses with prospective employers.
In reaching its decision, the panel bore in mind Mr Chikoto’s explanation in respect of this
charge. The panel preferred the evidence of Mr 2’s in that Mr Chikoto did state that he had been
working as a nurse at Rotherham Doncaster and Humber NHS Foundation Trust. The panel
reject the assertion put forward by Mr Chikoto.
The panel therefore concluded that Mr Chikoto intended to conceal the fact that he had not
been working as a registered mental health nurse at Rotherham Doncaster and Humber NHS
Foundation Trust, and therefore to mislead Remedy.
Accordingly, the panel found charge 2 proved.
5. Your actions at charge 1 above were dishonest in that you knew you had not
been working as a nurse and deliberately sought to mislead Remedy
Recruitment Agency.
The panel found this charge proved.
In reaching this decision the panel had regard to the evidence of Ms 1 and Mr 2 and the
assertions made by Mr Chikoto, already rejected by the panel.
The panel determined that Mr Chikoto had applied for a locum post as a registered mental
health nurse with Remedy and that by uploading his CV, he sought to mislead them by stating
that he had worked as a registered mental health nurse since 2012. The panel considered that
Mr Chikoto uploaded his CV knowing that he was working as a HCA and not as a registered
mental health nurse at Rotherham and Doncaster NHS Foundation Trust.
The panel applied the test as set out in R v Ghosh [1982] Q.B. 1053, as modified. This is a two
part test in relation to dishonesty. First, the panel had to determine whether Mr Chikoto’s actions
were dishonest according to the standards of reasonable and honest nurses and members of
the public. Secondly, and only if the first test was met, the panel had to determine whether it is
more likely than not that Mr Chikoto realised that what he was doing was, by those standards,
dishonest.
Page 11 of 24
The panel found the evidence of both NMC witnesses, and the documentary evidence before it,
to be compelling and cogent. Setting this against the explanation of Mr Chikoto, the panel
comparing the two accounts of Mr Chikoto and the NMC witnesses preferred the evidence of
the NMC. The panel concluded that in providing misleading information about his employment
status, Mr Chikoto would have realised that his actions were dishonest.
Accordingly, the panel found charge 5 proved.
6. Your actions at charge 2 above were dishonest in that you knew you had not
been working as a nurse and deliberately sought to mislead Remedy
Recruitment Agency.
The panel found this charge proved.
In reaching this decision as with Charge 5, the panel applied the test as set out in R v Ghosh
[1982] Q.B. 1053, as modified.
The panel considered the evidence of Mr 2 and in which he was clear that Mr Chikoto told him
that he had been working as a registered mental health nurse at Rotherham Doncaster and
Humber NHS Foundation Trust and that at no time did he say he had worked there as a nurse
aid.
The panel considered Mr Chikoto’s response to the allegations dated 8 November 2016 and in
which he sets out his response in relation to charge 3. Mr Chikoto stated that he worked 5
shifts in August 2014 whilst knowing that his registration had been suspended on the NMC
register. The rationale given by Mr Chikoto’s for this was that it was “a stupid act of
desperation, to pay for debts that he had incurred”. The panel determined that Mr Chikoto
provided misleading information to Remedy for the same reasons as he gave in relation to
charge 3 as he had mounting debts and that he needed to earn more money, hence why he
applied for a position as a registered mental health nurse with Remedy.
The panel found as a fact that Mr Chikoto had sought to mislead Remedy by saying that he had
been working as a nurse at Rotherham Doncaster and Humber NHS Foundation Trust when he
had not. The panel also rejected Mr Chikoto’s assertion that he told Mr 2 that he had been
working as a nurse aid.
Page 12 of 24
The effect of Mr Chikoto’s actions was to give a misleading account of his employment status to
Remedy. The panel has concluded that in doing so Mr Chikoto was, by any objective standards,
dishonest and that he would have realised that his actions were dishonest by those standards.
Accordingly, the panel found charge 6 proved.
Determination on Misconduct and Impairment
In determining whether or not Mr Chikoto’s fitness to practise is currently impaired, the panel
has borne in mind that this is a two stage process. It first considered whether the facts found
proved amount to misconduct and, if so, whether, as a result of that misconduct, his fitness to
practise is currently impaired. The panel bore in mind that there is no burden or standard of
proof and that this is a matter for the panel’s own judgement.
The panel reminded itself of its duty to protect patients and to maintain public confidence in the
profession and the regulatory process, which includes the declaring and upholding of proper
standards of conduct and behaviour.
The panel has considered the submissions of Mr Law, on behalf of the NMC. It has had regard
to all of the oral, written and documentary evidence adduced, including Mr Chikoto’s the SDF
dated 19 July 2016, the notice of hearing dated 2 November 2016 and the written responses to
the charges dated 8 November 2016,
Mr Law submitted that Mr Chikoto’s actions fell well short of the standards expected of a
registered nurse and as such, amounted to misconduct. He referred the panel to the case of
Roylance v GMC (No 2) [2000] 1 A.C. 311 and to the NMC Code: Standards of Conduct,
Performance and Ethics for Nurses and Midwives 2008 (“the Code”) and the 2015 version.
Mr Law submitted that Mr Chikoto’s fitness to practise is currently impaired. He further
submitted that the public interest in upholding proper professional standards and public
confidence in the NMC as a regulator would be undermined if a finding of impairment was not
made in the circumstances. Mr Law referred the panel to the case of CHRE v NMC and Grant
[2011] EWHC 927 (Admin).
Page 13 of 24
The panel accepted the advice of the legal assessor. He referred the panel to the cases of
Grant, Nandi v GMC [2004] EWHC 2317 (Admin), and Parkinson v NMC [2010] EWHC 1898
(Admin).
The panel first considered misconduct and had regard to the definition given by Lord Clyde in
the case of Roylance v GMC [2000] 1 AC 311:
“Misconduct is a word of general effect, involving some act or omission which falls short of what
would be proper in the circumstances. The standard of propriety may often be found by
reference to the rules and standards ordinarily required to be followed by a [registrant] in the
particular circumstances...”
When determining whether the facts found proved amounted to misconduct the panel had
regard to the 2008 Code, on the basis that charges 3 and 4 referred to August 2014. In relation
to charges 1 and 2, the panel gave consideration to the 2015 edition of the Code, which came
into force in April 2015.
The panel considered that from the 2008 Code the following paragraph of the preamble was of
relevance:
The people in your care must be able to trust you with their health and wellbeing
To justify that trust, you must:
-
be open and honest, act with integrity and uphold the reputation of your
profession
The panel found that the numbered parts of the 2008 Code that were breached were:
51 You must inform any employers you work for if your fitness to practise is called into
question.
61 You must uphold the reputation of your profession at all times.
Page 14 of 24
The panel considered that from the 2015 Code the following paragraphs were of relevance:
Promote professionalism and trust
You uphold the reputation of the profession at all times. You should display a personal
commitment to the standards of practice and behaviour set out in the Code. You should be a
model of integrity and leadership for others to aspire to. This should lead to trust and
confidence in the profession from patients, people receiving care, other healthcare
professionals and the public.
The panel found that the numbered standards of the 2015 Code breached were
Standard
21. Uphold your position as a registered nurse or midwife
To achieve this, you must:
21. 3. Act with honesty and integrity in any financial dealings you have with everyone you
have a professional relation with…
23.3. Tell any employers you work for if you have had your practice restricted or had any
other conditions imposed on you by us or any other relevant body.
Mr Chikoto misrepresented his status as a registered mental health nurse and sought to
deceive prospective employers by submitting a CV containing incorrect information, this was for
his own financial advantage. Mr Chikoto was present at the hearing on 1 August 2014 when a
panel of the Conduct and Competence Committee imposed a suspension order on his
registration for a period of nine months. That panel found three charges proved against him,
including one of dishonesty. Mr Chikoto would have been in no doubt of that panel’s decision.
However, five days after the suspension order was imposed, Mr Chikoto worked five separate
shifts as a registered nurse in the full knowledge of the fact that his registration had been
suspended. The panel found this to be wholly unprofessional and that in working as a nurse
Page 15 of 24
when he was not registered to do so put the patients in his care, the Trust and his colleagues at
risk of harm.
The panel also considered that a registered nurse who acts in such a way falls far short of the
standards expected of him or her.
The panel was satisfied that the facts found proved do constitute serious misconduct. Mr
Chikoto’s behaviour breached the duties in the preamble to the 2008 and 2015 Codes and the
specific paragraphs and standards referred to above. The panel is in no doubt that the facts
found proved (individually and collectively) are sufficiently serious to represent significant
departures from the standards expected of a registered nurse.
Additionally, the panel concluded that fellow professionals would class Mr Chikoto’s behaviour
as “deplorable”.
The panel next considered, on the basis of the misconduct found, whether Mr Chikoto’s fitness
to practise is currently impaired. The NMC defines fitness to practise as a registrant’s suitability
to remain on the register without restriction. The panel reminded itself that it should consider not
only the risk that Mr Chikoto presents to members of the public, but also the public interest in
upholding proper professional standards and public confidence in the NMC as its regulator.
Accordingly, the panel considered whether that confidence would be undermined if a finding of
impairment were not made in the circumstances.
Nurses occupy a position of privilege and trust in society and are expected at all times to be
professional. 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 judgment of Mrs Justice Cox in the case of CHRE v
NMC & Grant [2011] EWHC 927 (Admin) including the test formulated by Dame Janet Smith in
the fifth Shipman report:
76. “Do our findings of fact in respect of the [registered nurse’s] misconduct…show
that his fitness to practise is impaired in the sense that he:
Page 16 of 24
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 [nursing] 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 [nursing] profession; and/or
d. has in the past acted dishonestly and/or is liable to act dishonestly in the future”
The panel concluded that the criteria contained in paragraphs a, b, c and d above are engaged
in this case.
The panel noted that Mr Chikoto has engaged with the NMC by providing written
representations for this substantive hearing. However, the panel considered that he has shown
no insight into the effects of his dishonest behaviour nor given any explanation for this
behaviour beyond saying that it was to improve his financial situation.
Whilst there were no charges relating to Ms Chikoto’s clinical practice, the panel considered that
by working as a registered mental health nurse in the full knowledge that he had been
suspended from the NMC register, Mr Chikoto had in the past put patients at unwarranted risk
of harm. The panel has not been provided with any evidence from Mr Chikoto to satisfy itself
that patients would not be put at risk of harm in the future.
The panel considered the findings of the substantive panel in August 2014, when the
suspension order was imposed on Mr Chikoto’s registration. During the hearing in August 2014,
Mr Chikoto convinced that panel that he understood the importance of disclosing information to
potential employers as stated:
“Furthermore, you said you understand the importance of disclosing investigations and/or NMC
matters to potential employers as it demonstrates honesty, even if those matters “are against
you”. You understand that these matters must be disclosed to allow employers to check your
suitability for employment, your ability as a nurse, and whether you pose a risk to patients. You
Page 17 of 24
acknowledged that patients are entitled to expect registered nurses to be honest at all times.
You recognised that the Code reinforces the importance of honesty”.
The panel also bore in mind the comments of the previous panel regarding insight
demonstrated by Mr Chikoto at that hearing as follows:
“You have demonstrated some insight – you made admissions to charges 2 and 3; you admitted
misconduct and impairment in respect of those charges; you accepted and reflected on the
seriousness of your dishonesty, that it was “very wrong”, that you made a “very very big
blunder”
This panel found that in spite of the assurances given by Mr Chikoto to the previous panel he
showed a flagrant disregard to the findings of that panel by continuing to work as a registered
nurse whilst his registration was subject to suspension thereby compounding his dishonest
behaviour.
Honesty is a fundamental tenet of the nursing profession and is often described as the bedrock
of a nurse’s practice. All registered nurses are expected to act with honesty and integrity at all
times.
The panel considered that the dishonesty found proved in this case would be fundamentally
difficult for Mr Chikoto to remediate, as it was a failing that was attitudinal in nature. Although no
clinical issues were contained in the charges, because Mr Chikoto was working as a nurse in
the absence of his registration, and without any evidence of the clinical updating he had
previously said he needed after a significant period away from the clinical duties of a nurse,
patients were put at significant risk of harm. The panel bore in mind that Mr Chikoto had shown
a lack of insight into his failings and that in his written submissions he cited financial pressures
as the reason he worked five shifts in the knowledge that he was suspended. The panel
considered that this did not address the seriousness of his failings and demonstrated a
significant lack of insight.
The panel determined that Mr Chikoto had not taken any steps to remediate any of his
misconduct. The panel therefore considered that there was a risk of repetition.
In addition to its concerns regarding public interest, public protection and patient safety, the
panel concluded that Mr Chikoto’s departure from proper standards of nursing practice served
Page 18 of 24
to undermine public confidence in the nursing profession. The panel considered that these
public interest requirements also demanded a finding of current impairment, as the public would
expect a nurse to behave in an honest manner.
For these reasons the panel has found that Mr Chikoto’s fitness to practise is currently impaired
by reason of his misconduct.
Decision on Sanction
Having determined that Mr Chikoto’s fitness to practise is impaired, the panel next considered
what sanction, if any, it should impose in relation to his registration.
In reaching its decision on sanction, the panel has considered all the evidence that has been
placed before it.
The panel heard submissions from Mr Law, on behalf of the NMC. He submitted that this case
involved repeated dishonesty.
Mr Law also referred the panel to the Indicative Sanctions Guidance (“ISG”). He submitted that
sanction was a matter for the judgement of the panel.
The panel heard and accepted the advice of the legal assessor who referred the panel to the
guidance and the case of Abraham v GMC 2004 EWHC 279 (Admin) and Parkinson v NMC
[2010] EWHC 1898 (Admin).
The panel applied the principle of proportionality. It weighed the public interest with Mr Chikoto’s
own interests and took into account the mitigating and aggravating factors in the case.
The public interest includes the maintenance of public confidence in the profession and the
declaring and upholding of proper standards of conduct and behaviour within the profession.
The panel has taken account of the ISG, bearing in mind that any sanction imposed should be
no more restrictive on Mr Chikoto than is necessary to meet the public interest.
The panel considered the mitigating and aggravating factors in this case to be:
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Mitigating Factors
•
Mr Chikoto asserts in his response to the charges 2 November 2016 that he, at the time
of the misconduct, was suffering financial pressures due to mounting debts. The panel
however placed very limited weight on this assertion.
•
None of the charges relate to clinical errors.
Aggravating Factors
•
Mr Chikoto has shown a flagrant and consistent disregard of the prohibition placed on
his registration by his regulator.
•
The significant lack of insight demonstrated by Mr Chikoto.
•
No evidence of Mr Chikoto’s understanding of how his dishonest actions undermined the
public's confidence in the profession and the authority of the NMC as regulator.
•
Mr Chikoto’s dishonest actions were repeated on multiple occasions over a time span of
around 12 months and were for his own financial gain.
•
The panel have identified a high risk of repetition.
•
Mr Chikoto worked as a register mental health nurse whilst his registration was
suspended therefore inevitably putting patients at a risk of harm,
•
This is the second referral to the NMC where charges of dishonesty have been found
proved.
The panel then went on to consider the potential sanctions in ascending order.
The panel first considered taking no further action. The panel had no hesitation in rejecting this
in view of the seriousness of the misconduct found.
The panel next considered whether to make a caution order. The panel considered that Mr
Chikoto misconduct is at the highest level and had no doubt that this would be an inappropriate
sanction in this case. A caution order would be wholly insufficient to mark the seriousness of the
misconduct and to meet the public interest in this case.
The panel next considered whether to make a conditions of practice order.
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Mr Chikoto’s failings included deep seated attitudinal issues and involved dishonesty. The panel
concluded that given the seriousness of the misconduct and dishonesty demonstrated by Mr
Chikoto, there were no conditions that would be practicable, workable or sufficient to uphold the
public interest.
The panel next considered whether to make a suspension order. The panel noted the following
paragraphs in ISG concerning cases in which such a sanction may be appropriate;
‘67. This sanction may be appropriate where the misconduct is not fundamentally
incompatible with continuing to be a registered nurse or midwife in that the public
interest can be satisfied by a less severe outcome than permanent removal from the
register. This is more likely to be the case when some or all of the following factors are
apparent (this list is not exhaustive):
67.1 A single instance of misconduct but where a lesser sanction is not sufficient.
67.2 No evidence of harmful deep-seated personality or attitudinal problems.
67.3 No evidence of repetition of behaviour since the incident.
67.4 The panel is satisfied that the nurse or midwife has insight and does not pose a
significant risk of repeating behaviour’.
The panel has found that Mr Chikoto’s misconduct was not a single instance, demonstrated an
attitudinal problem and was repeated. There is no evidence of Mr Chikoto having insight as to
the implications of his behaviour nor of him having demonstrated any remediation of his failings.
Further, the panel was of the view that there was a significant risk that Mr Chikoto would repeat
his dishonest conduct.
Mr Chikoto has already been the subject of a suspension order and by continuing to work as a
registered mental health nurse some five days after the imposition of that suspension order he
undermined and failed to adhere to the authority of the NMC as his regulator.
The panel was mindful of paragraph 35 of the ISG.
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Dishonesty
‘35. Dishonesty, even where it does not result in direct harm to patients but is related to matters
outside of a nurse or midwife’s professional practice, for example, fraudulent claims for monies,
is particularly serious because it can undermine the trust the public place in the profession.
Honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or
midwife’s practice’.
In light of all the above considerations the panel decided that a suspension order would not be
sufficient to protect the public interest in this case.
The panel then considered a striking off order and noted the following ISG paragraphs:
‘71 This sanction is likely to be appropriate when the behaviour is fundamentally incompatible
with being a registered professional, which may involve any of the following (this list is not
exhaustive):
71.1 Serious departure from the relevant professional standards as set out in key standards,
guidance and advice including (but not limited to):
71.1.1 The code…
71.6 Dishonesty, especially where persistent or covered up
71.7 Persistent lack of insight into seriousness of actions or consequences
72 The courts have supported decisions to strike off healthcare professionals where there has
been lack of … trustworthiness, notwithstanding that in other regards there were no concerns
around the professional’s clinical skills or any risk of harm to the public. Striking-off orders have
been upheld on the basis that they have been justified for reasons of maintaining trust and
confidence in the professions’.
In view of the nature and seriousness of Mr Chikoto’s misconduct and the aggravating factors
referred to above, the panel was satisfied that Mr Chikoto’s behaviour was a significant
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departure from the standards to be expected of a registered nurse. Mr Chikoto had also
breached fundamental tenets of the nursing profession.
The panel concluded that the only appropriate and proportionate sanction was that of a striking
off order.
The panel considered the comments made by Mr Chikoto in the response to the notice of
hearing regarding his mounting debts. The panel notes that the purpose of a sanction is not to
be punitive, however, the panel was satisfied that this is a case where the interests of the public
substantially outweigh Mr Chikoto’s personal interests.
The panel was satisfied that the need to uphold proper professional standards and maintain
public confidence in the profession would be severely undermined if any lesser sanction than a
striking-off order were imposed in this case.
The panel therefore directs the Registrar to strike Mr Chikoto’s name off the Register.
Right of Appeal:
Mr Chikoto will have 28 days from the date when written notice of the result of this hearing is
deemed to have been served upon him in which to exercise his right of appeal. A note
explaining that right of appeal will be supplied to Mr Chikoto. Unless Mr Chikoto exercises his
right of appeal, the direction imposing the striking off order on his registration will take effect 28
days from when written notice of the decision is served upon him.
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Decision on interim order and reasons:
Mr Law invited the panel to impose an interim suspension order on the grounds of public
protection and being otherwise in the public interest. He submitted that an interim order should
be imposed for 18 months.
The panel accepted the advice of the legal assessor.
The panel was satisfied that an interim order was necessary for the protection of the public and
was otherwise in the public interest. In reaching the decision, the panel had regard to the
seriousness of the facts found proved and the reasons set out in its decision for the substantive
order. To do otherwise would be inconsistent with its earlier findings.
The panel decided to impose an interim suspension order for the same reasons as it imposed
the substantive order.
The period of this interim suspension 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 Mr Chikoto is sent the decision of this hearing in writing.
That concludes this determination.
This decision will be confirmed to Mr Chikoto in writing.
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