High court upholds strike-off in key fitness to practise case

A recent High Court ruling has reinforced the strict approach taken in fitness to practise cases, particularly where dishonesty and lack of insight are involved. In Hough v Health and Care Professions Tribunal Service [2026] EWHC 743 (Admin), the court dismissed an appeal against a decision to strike a healthcare professional off the register.

The case arose from disciplinary proceedings before the Health and Care Professions Tribunal Service (HCPTS), where allegations of clinical misconduct and dishonesty were made. The tribunal found that the practitioner had falsified or misleadingly recorded information relating to patient care, including issues surrounding the administration of medication. As a result, the panel concluded that the practitioner’s fitness to practise was impaired and imposed the most severe sanction available—striking off.

On appeal, the claimant challenged the tribunal’s findings on several grounds, including alleged errors in fact-finding, unjustified conclusions of dishonesty, and the proportionality of the sanction. A further argument suggested potential bias due to a connection between a witness and the tribunal.

However, the High Court rejected all grounds of appeal. Emphasising the principle of judicial restraint in professional discipline cases, the court reiterated that specialist tribunals are best placed to assess evidence and credibility. It held that the HCPTS panel’s findings were well-reasoned, supported by evidence, and fell within the range of reasonable conclusions.

Central to the court’s decision was the issue of insight, a key factor in fitness to practise assessments. The tribunal had found that the practitioner demonstrated limited insight into their misconduct, raising concerns about the risk of repetition. The High Court agreed, confirming that a lack of insight can justify a finding of ongoing impairment.

The court also upheld the sanction of striking off, noting that dishonesty in a healthcare context fundamentally undermines public trust. While mitigation was considered, including the practitioner’s career history, the tribunal was entitled to conclude that lesser sanctions would not sufficiently protect the public or maintain confidence in the profession.

The judgment underscores several important principles in fitness to practise law. Appeals against tribunal decisions face a high threshold, particularly where findings of dishonesty are involved. Courts will rarely interfere with sanctions unless they are clearly disproportionate. Additionally, allegations of bias must meet the strict test of demonstrating a “real possibility” of unfairness.

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