Nurrish v Nursing and Midwifery Council: When Process Fails, Outcomes Cannot Be Trusted.
The High Court judgment in Nurrish v Nursing and Midwifery Council is the latest in a long line of appellate decisions exposing serious flaws in the way fitness to practise (FtP) panels approach dishonesty, fairness and review hearings. While this time the registrant succeeded in overturning a striking-off decision, the case raises deeper concerns about systemic weaknesses that continue to place unrepresented nurses at particular risk.
At its core, the judgment is a reminder that FtP proceedings are not simply about outcomes. They are about process, fairness and careful reasoning at every stage. If the regulatory process were genuinely robust, outcomes would not turn on whether a nurse had legal representation. Yet time and again, High Court scrutiny reveals that unrepresented registrants bear the heaviest consequences of procedural failure.
Background to the case
Ms Nurrish was a registered nurse who, in February 2024, received a 12-month suspension after admitting a number of serious misconduct allegations. These included dishonest behaviour such as working for one NHS trust while on sick leave from another, failing to attend to a patient, poor record-keeping, and falsely claiming to have taken a Covid-19 test.
At the substantive hearing, the panel accepted that this misconduct occurred during a period when Ms Nurrish was subject to domestic abuse and coercive control. That context was treated as highly relevant. The panel acknowledged her remorse, her insight, and the steps she had taken to remove herself from the abusive environment. On that basis, it imposed a suspension rather than the more severe sanction of striking off.
The case returned to the NMC in January 2025 for a mandatory review hearing before a newly constituted panel. That panel reached a radically different conclusion. It found that Ms Nurrish had been dishonest in her oral evidence at the review hearing, particularly in relation to two positive testimonials she had submitted to demonstrate remediation and progress. On the strength of that dishonesty finding alone, the panel concluded that her fitness to practise remained impaired and imposed the most serious sanction available: striking her off the register.
Ms Nurrish represented herself both at the review hearing and on appeal. Despite the obvious inequality of arms, the High Court allowed her appeal, quashed the striking-off order and remitted the case to a differently constituted panel.
Review hearings are not second bites at the cherry
A central theme of the judgment is the proper purpose of a review hearing. A review is not an opportunity to re-litigate the case or to increase punishment because a previous panel’s sanction is viewed as insufficient. Its function is limited: to assess whether the registrant remains impaired and whether they continue to pose a risk to the public, or whether they have remediated and can safely return to practice, with or without restrictions.
In practice, however, review hearings are too often treated as a second bite at the cherry. Where case presenters are dissatisfied with an original outcome, reviews become vehicles for escalation. That approach fundamentally undermines fairness and turns what should be a protective mechanism into a punitive one.
An unsafe finding of dishonesty
The appeal turned on two key questions: whether the review panel was entitled to find Ms Nurrish dishonest, and whether the striking-off sanction could stand if that finding was unsafe. The High Court answered both in the negative.
Ms Nurrish was never told that her honesty was in issue. She was not warned that dishonesty was being examined, nor was she given a clear opportunity to respond to such an allegation. The panel did not expressly put the question of dishonesty or credibility to her, a basic requirement of procedural fairness in contested regulatory proceedings. Nor did the panel seek or receive targeted legal advice on how dishonesty should be assessed or on the applicable legal test.
Instead, the dishonesty finding emerged from intense and repetitive questioning during a remote hearing that began late and was conducted under obvious time pressure. The panel asked approximately 44 questions in a 22-minute block, often returning to the same topic in different forms. Ms Nurrish appeared anxious and confused. Confusion created by questioning of this nature is not evidence of dishonesty; it is the predictable product of the process itself.
The High Court was clear that confusion, stress or nervousness—particularly in a virtual hearing—cannot safely be relied upon as proof of deliberate untruthfulness.
The “testimonial trap”.
The dishonesty finding rested largely on what can fairly be described as a testimonial trap. Ms Nurrish submitted positive references to demonstrate remediation. Those references used supportive, non-technical language describing her as a “professional carer.” Rather than seeking clarification from the referees about what they meant, the panel inferred that this wording implied paid caring work and treated perceived inconsistencies with Ms Nurrish’s oral evidence as proof of dishonesty.
This approach was fundamentally unsafe. People routinely use generous or informal language in references. If a panel intends to rely on third-party wording to make a finding of dishonesty, it must first establish what that wording actually means. Without calling the referees or otherwise clarifying the language used, the panel was not assessing evidence but constructing an interpretation and then punishing the registrant for failing to meet it.
The High Court rejected this reasoning, noting the inherent implausibility of deliberate dishonesty based on evidence the registrant herself had chosen to submit.
Trauma-informed practice applied inconsistently
One of the most troubling aspects of the case was the inconsistent application of trauma-informed practice. At the substantive hearing, the panel accepted that Ms Nurrish’s misconduct occurred in the context of domestic abuse and coercive control. That context directly affects memory, communication, confidence and the ability to articulate clearly under pressure.
By the time of the review hearing, that context appeared to have disappeared. Behaviours that were previously understood through a trauma-informed lens—anxiety, confusion, difficulty expressing oneself—were re-characterised as indicators of dishonesty. Trauma-informed practice is not a one-off exercise. If trauma is accepted as relevant at the outset, it must remain part of the interpretive framework at review.
Inequality of arms and the risks of being unrepresented
The case starkly illustrates the ongoing risks faced by unrepresented registrants. Ms Nurrish had to navigate a complex legal process alone. A legally represented registrant would be far more likely to insist on clarity about allegations, challenge unfair questioning, object to adverse inferences and ensure that the panel applied the correct legal tests.
Without representation, confusion was misread as evasiveness. Repeated questioning went unchallenged. Alternative, benign explanations were not articulated in a structured way. The High Court explicitly recognised that the absence of an advocate increased the risk of misinterpretation and procedural unfairness.
This inequality is baked into the system. The regulator is permanently resourced. Registrants, often restricted from working and without income, must either self-represent or fund legal support privately. That reality is incompatible with a system whose legitimacy depends on fairness.
Remote hearings and credibility
The judgment also feeds into the ongoing debate about remote hearings. The judge cautioned against over-reliance on demeanour in virtual settings and highlighted deficiencies in automatically generated transcripts. However, the deeper issue is not simply whether hearings are remote or in person. Anxiety, stress and confusion are influenced by power imbalance, unfamiliar processes and the fear of career-ending consequences. A properly trained panel should be able to distinguish between trauma-driven distress and credibility concerns in any setting.
A wider pattern of concern
This case does not stand alone. High Court criticism of the NMC’s approach to dishonesty has been repeated in El Karout, Lusinga and Watters, among others. The recurrence of the same errors over many years raises serious questions about learning, accountability and systemic reform.
Ongoing harm despite a successful appeal
Although the striking-off order was quashed, Ms Nurrish now faces further delay and uncertainty as the case returns to the NMC. There is no automatic urgency for remitted hearings, and no compensation for lost income, reputational harm or psychological impact. Even if she ultimately succeeds again, returning to practice may remain extremely difficult.
Conclusion
Nurrish v Nursing and Midwifery Council should stand as a clear warning. Confusion under pressure is not dishonesty. Review hearings are not opportunities to escalate punishment. Trauma context cannot be selectively applied. Fair process is not an obstacle to public protection—it is a fundamental requirement of it.
We hope the registrant will reach out for support from us so that she can ensure the new panel are held to account, made to review the facts carefully and assure everyone that an fair and reasonable outcome is placed.
If the regulator is serious about reform, it must demonstrate that it can learn from repeated High Court judgments. A registrant who repeatedly made the same mistakes would face severe sanction. The same standard should apply to the system itself.
The full appeal hearing recording can be found here:
https://www.bailii.org/ew/cases/EWHC/Admin/2026/2.html
The NMC hearing outcome for strike off can be found here: https://www.nmc.org.uk/globalassets/sitedocuments/ftpoutcomes/2025/january-2025/reasons-nurrish-ftpcsorh-80687-80991-20250121.pdf?_t_id=rYSMkpZPgM-vDKRimNjqiQ%3d%3d&_t_uuid=S7oc6oNHQl6jPVPdfqKu9Q&_t_q=nurrish&_t_tags=language%3aen%2csiteid%3ad6891695-0234-463b-bf74-1bfb02644b38%2candquerymatch&_t_hit.id=NMC_Web_Models_Media_DocumentFile/_41ed4333-d080-4eeb-a9c5-caea617664e1&_t_hit.pos=1
