AC-LON-2023-002572 - [2025] EWHC 2324 (Admin)

The principles applicable to adjournments have been set out in detail by the Court of Appeal in General Medical Council v Adeogba [2016] EWCA Civ 162 (“Adeogba”) and General Medical Council v Hayat [2018] EWCA Civ 2796 (“Hayat”), both of which are included in the joint authorities bundle. I have had full regard to them and their replication is not necessary here. However, I make a few comments, without detracting from observance of the Court of Appeal’s clear guidance. These are not criminal proceedings and therefore the principles that govern adjournment applications in that jurisdiction do not apply with the same force in regulatory matters. There is also helpful guidance (CMT/11; “the Guidance”) on how the relevant disciplinary panel (“we”) should approach questions of adjournment:

“When we postpone or adjourn hearings

‘If a nurse, midwife or nursing associate is unable to attend the hearing for medical reasons, they’ll need to provide evidence that they’re unfit to participate in the hearing. That evidence should:

• be an independent opinion following a proper examination of the nurse, midwife or nursing associate

• identify what exactly is wrong with the nurse, midwife or nursing associate, and why their health condition prevents them from participating in a hearing

• identify the practitioner making this assessment, and how familiar they are with the nurse, midwife or nursing associate’s health condition

• include a view on the outlook of the health condition

Where consideration is being given to granting an adjournment, the panel should only make the decision to adjourn if no injustice is caused to the parties, and after hearing representations from us and the nurse, midwife or nursing associate, or their representative (where present) and after taking advice from the legal assessor”

As previously indicated, the respondent sent the appellant a detailed email in December 2022 setting out the requirements for proper medical evidence to form the basis of an adjournment. The Grounds (para 7(i)) state that the instant case can be distinguished from the case law as here the medical evidence was not challenged. This misses the point. As highlighted in Coulson LJ’s judgment in Hayat at para 37 (preceded by the subtitle: “b) The Required Standard of Medical Evidence”):

“There must be evidence that the individual is unfit to participate in the hearing: see Governor and Company of the Bank of Ireland v Jaffery [2012] EWHC 724 (Ch) at [19]. That evidence must identify with proper particularity the individual's condition and explain why that condition prevents their participation in the hearing: see Levy v Ellis Carr [2012] EWHC 63 (Ch) at [36]. Moreover, that evidence should be unchallenged: see Brabazon-Drenning at [18].”

The passage continues with citation from Norris J in Levy v Carr Ellis at para 36, which Coulson LJ found “Of particular importance”:

“Such evidence should identify the medical attendant and give details of his familiarity with the party's medical condition (detailing all recent consultations), should identify with particularity what the patient's medical condition is and the features of that condition which (in the medical attendant's opinion) prevent participation in the trial process, should provide a reasoned prognosis and should give the court some confidence that what is being expressed is an independent opinion after a proper examination. It is being tendered as expert evidence. The court can then consider what weight to attach to that opinion, and what arrangements might be made (short of an adjournment) to accommodate a party's difficulties. No judge is bound to accept expert evidence: even a proper medical report falls to be considered simply as part of the material as a whole (including the previous conduct of the case). The letter on which the Appellant relies is wholly inadequate.”

It was pointed out that this passage was cited with approval by the Court of Appeal in Forrester Ketley v Brent & Another [2012] EWCA Civ 324 at para 26. As said by Lord Dyson MR in Mohun-Smith & Another v TBO Investments Limited [2016] 1 WLR 2919:

“Generally, the court should adopt a rigorous approach to scrutinising the evidence adduced in support of an application for an adjournment on the grounds that a party or witness is unfit on medical grounds to attend the trial."

Coulson LJ then stated at para 41:

“41.

This court has said repeatedly that a pro-forma sick note (of the kind provided here) may well be insufficient to justify non-attendance at a hearing, particularly if it refers only to an unfitness to attend work. Thus, in Andreou v The Lord Chancellor's Department (22 July 2002), Peter Gibson LJ at [41] said:

“The fact that a person is certified on medical grounds is not fit to attend work does not automatically entail that that person is not fit to attend a Tribunal hearing, though very often that will also be the advice of the medical practitioner.””

One then examines the content of the medical evidence put before the Panel by the appellant. It is a “Statement of Fitness for Work, For society security of Statutory Sick Pay”. It is signed by Dr Andrew Harper on 13 July 2023. He assessed the appellant “because of the following condition(s)” and states in the adjacent box “unwell”. Dr Harper put an “X” in the next box “you are not fit for work”. This is for two weeks from 7 to 20 July 2023. The only other relevant information is that Dr Harper did not need to reassess the appellant at the end of the two-week period.

I adopt the “rigorous approach” to its scrutiny. It is a pro-forma sick note for fitness for work. It provides no indication whatsoever of the medical condition that the appellant was experiencing. It does not say that she is unfit to attend court. The court is not bound by its conclusion or obliged to follow it in any event: it offers a medical opinion about fitness for work. As such, it must be viewed in the context of all the other available evidence. Presented with this pro-forma sick note, and following Hayat and the authorities cited by the Court of Appeal in it, this evidence comes nowhere near being sufficient to justify an adjournment. In fact, it is fundamentally deficient in the essential requirements as set out clearly by the Court of Appeal.

I turn to consider the sick note dated 18 July 2023 from Dr Minahil Rashid. It is the same pro-forma. It states that the appellant is unfit for work from 18 to 27 July because of “anaemia”. Once more, the doctor did not need to reassess the appellant at the end of the period.

Adopting the same rigorous approach, the sick note suffers from the same deficiencies. There is no indication that the appellant is unfit to attend a disciplinary hearing or to engage with it. There is a wide range of symptoms of anaemia. None of them is mentioned. There is no indication of the severity of the condition, but it is noteworthy that Dr Rashid did not need to see the appellant again at the end of the ten-day period. The anaemia pro-forma sick note provides no basis for adjournment. Further, putting the two pro-forma notes together (“unwell” and “anaemia”), there is no proper basis for an adjournment. In any event, the anaemia resolved by the next medical appointment in August 2023.

It is submitted (Grounds, para 7(ii)) that the fact that the appellant was a litigant in person is significant. In fact, it changes little. The regulator emailed the appellant on 10 July 2023 informing her what medical evidence is required. This is very similar to the email sent to her by the respondent in December 2022. The July 2023 email said:

“I note your request for your substantive hearing to be postponed.

What we need is a letter from your treating clinician which explains that you’re unfit to participate in your substantive hearing. The letter should:

Identify the doctor (name, GMC pin, etc) and give details of their familiarity with your medical condition(s), including detailing all recent consultations.

Identify with proper particularity your medical condition and explain to what extent your condition(s) affects your participation in the hearing.

Provide a reasoned prognosis and give the panel some confidence that what is being expressed is an independent opinion after a proper examination.

Kindly note that the onus is on you to obtain and provide the letter.”

She failed to comply.