Exploiting an NHS Support Scheme “Within the Rules” Can Still Evidence Lack of Integrity and Professional Unsuitability Justifying Unconditional Disqualification

Court Scottish Court of Session (Second Division, Inner House)
Citation [2026] CSIH 11
Date 12 March 2026
Appeal Section 11 of the Tribunals and Inquiries Act 1992 (point of law only)
Statute National Health Service (Scotland) Act 1978, ss 29(7A), 29B, 29C

1. Introduction

This case concerns the professional consequences for a dentist, Sanjit (Saranjit) Nandhra (“the appellant”), arising from findings by the NHS Tribunal that he was “unsuitable” to remain on NHS dental lists maintained by Lothian Health Board, Fife Health Board and Lanarkshire Health Board (the interested parties).

The Tribunal’s decision (12 May 2025) centred on the appellant’s conduct during the COVID-19 pandemic when the Scottish Government provided emergency financial support (“top-up payments”) to NHS dental practices. The appellant emailed colleagues in January 2021 instructing them to “slow down” patient throughput because “we are still getting the grant whether we see 10 or 100 patients,” and to manage scheduling so as to benefit financially once activity-linked tiering later applied.

Although the Tribunal accepted that the appellant claimed only sums to which he was legally entitled and did not commit “fraud” under the statutory definition, it found his conduct exploited the scheme contrary to its purpose and to professional obligations to prioritise patient care. It imposed unconditional disqualification from the relevant NHS lists. The appellant appealed on seven legal grounds including wrong legal test, irrationality/disproportionality of sanction, evidential misapprehension/speculation, failure to consider mitigation and patient impact, and inadequate reasons.

The Court of Session (Inner House) dismissed the appeal in full, emphasising: (i) the Tribunal’s specialist role and fact-finding advantage; (ii) the centrality of integrity and public confidence; and (iii) that a professional may be “unsuitable” even where conduct technically complies with scheme rules.

2. Summary of the Judgment

• Appeal refused. The court held that none of the seven grounds demonstrated an error of law.
• Correct legal framework applied. The Tribunal properly treated the case as an unsuitability case under s 29(7A) and applied the forward-looking protective purpose of professional regulation.
• “Spirit vs letter” exploitation can found unsuitability. Deliberately reducing NHS patient appointments for financial advantage during remobilisation was a serious breach of professional integrity.
• No patient evidence required for detriment inference. The Tribunal (including a dental member) could infer patient detriment from reduced access during ongoing orthodontic treatment.
• Sanction upheld. Unconditional disqualification was within the Tribunal’s discretion and not “plainly wrong,” notwithstanding the appellant’s long previously unblemished career.
• Reasons adequate. The Tribunal’s explanation left no “real and substantial doubt” as to why disqualification was imposed; the phrase “no mitigation” was read as “no acceptable mitigation/explanation,” not ignorance of background factors.

3. Analysis

3.1 Precedents Cited (and How They Shaped the Decision)

3.2 Legal Reasoning

(a) Statutory structure: unsuitability distinct from “fraud”

The legal route to disqualification mattered. Under s 29(7) (“fraud”), a practitioner must secure (or try to secure) a benefit knowing there is no entitlement. The Tribunal expressly did not proceed on that basis. Instead, it found the appellant “unsuitable (by virtue of professional or personal conduct)” under s 29(7A).

The Inner House endorsed that approach: the absence of fraud or technical rule breach did not immunise conduct from an unsuitability finding where the conduct showed a serious integrity failure and conflict with core professional obligations.

(b) “Letter vs spirit” and professional obligation to put patients first

The Tribunal’s central factual finding—affirmed as open to it—was that the appellant instructed a deliberate reduction in patient throughput because the top-up was “guaranteed,” seeking to maximise income while providing less service. The Inner House accepted the Tribunal’s characterisation that this “demobilised” services when remobilisation was the policy objective.

(c) Integrity: not limited to dishonesty

Without requiring a formal label of “dishonesty,” the court inferred that the Tribunal treated the conduct as demonstrating lack of integrity, adopting the concept as described in Scott v Solicitors Regulation Authority [2016] EWHC 1256 (Admin) (via Fyfe v Council of the Law Society of Scotland [2017] CSIH 6, 2017 SC 283). This matters because it positions unsuitability as a broader ethical assessment, not a narrow “rule-breach” inquiry.

(d) Evidence and inference: detriment to patients need not be proved by patient testimony

The appellant argued that there was no direct evidence of harm (no patient witnesses; no proven adverse outcomes). The court rejected this, holding it was not necessary for the Tribunal—comprised in part of an experienced dentist—to hear patient evidence to infer detriment where ongoing orthodontic patients require regular appointments and the appellant deliberately reduced access.

(e) Mitigation, “unjust” and sanction

Section 29B(4) prohibits disqualification if it would be “unjust.” The appellant argued the Tribunal ignored powerful mitigation: forty-year unblemished career, no repetition risk, adverse impact on 1500 NHS patients. The court’s reasoning was twofold:

• Mitigation was not ignored. The Tribunal’s statement that it had “no material before it that persuaded it that disqualification would be unjust” showed it considered the favourable material but found it insufficient. “No mitigation” was interpreted as “no acceptable mitigation/explanation” for conduct driven by self-interest.
• Integrity/public confidence predominates. By applying Bolton v Law Society [1994] 1 WLR 512, the court held that personal hardship, reputational testimonials, and even some patient disruption do not “touch the essential issue” where integrity is fundamentally compromised.

(f) Appellate restraint and the “plainly wrong” threshold

The appeal lay only on a point of law. The Inner House stressed institutional respect for specialist tribunals, and intervened only where a serious flaw (misdirection, failure to consider relevant factors, irrationality) is shown. It found no such flaw: the Tribunal’s findings were coherent, its legal framework correct, and its reasons adequate.

3.3 Impact

• Reinforcement of an ethics-based “unsuitability” jurisdiction. The decision underscores that s 29(7A) reaches conduct that undermines NHS purpose and patient-first duties even where claims are legally “entitled” and fraud is not established.
• “Spirit of the scheme” can be decisive in professional regulation. Practitioners cannot rely on technical compliance with emergency funding rules where conduct is deliberately engineered to defeat policy objectives and patient interests.
• Tribunals may infer systemic patient detriment. In service-access cases (appointment reduction, backlog creation), direct patient evidence is not always necessary, particularly where the tribunal has relevant professional expertise.
• Mitigation must be considered, but need not be exhaustively enumerated. A reasons challenge will fail where the decision shows the tribunal considered the material in substance, even if it uses shorthand (“no mitigation”) and does not address every point.
• High deference on sanction. The case strengthens the practical reality that appellate courts will rarely disturb professional tribunal sanctions absent clear legal error or a “plainly wrong” outcome.

4. Complex Concepts Simplified

• “Unsuitability” (s 29(7A)): A forward-looking assessment of whether a practitioner’s professional/personal conduct shows they cannot be trusted to provide NHS services consistently with professional obligations and public confidence. It is broader than clinical competence and broader than fraud.
• “Fraud” condition (s 29(7)): Requires knowing lack of entitlement to a benefit. The Tribunal found this not made out; the case turned on ethical/professional unsuitability instead.
• Unconditional vs conditional disqualification (ss 29B, 29C): Unconditional disqualification removes the practitioner from lists when proceedings conclude. Conditional disqualification suspends removal provided conditions are complied with. Here, conditional disqualification was rejected as the issue was not remediable clinical deficiency but deliberate, self-interested conduct and lack of insight.
• “Point of law only” appeal (s 11 of the 1992 Act): The court does not re-try the facts. It checks for legal errors such as misdirection, irrationality, failure to consider relevant matters, or inadequate reasons.
• Adequate reasons (Wordie/South Bucks): Reasons must explain the outcome on the main disputed issues so the reader can understand why the decision was reached; they need not answer every submission line-by-line.
• Integrity vs dishonesty (Fyfe/Scott): A professional may lack integrity even without proof of dishonesty: conduct can be ethically unsound or inconsistent with the profession’s standards of trustworthiness.

5. Conclusion

The Inner House’s decision in [2026] CSIH 11 confirms a robust principle in NHS professional regulation: deliberate exploitation of an emergency NHS funding scheme—though technically within entitlement—can still constitute a serious lack of integrity and justify a finding of “unsuitability” under s 29(7A), including unconditional disqualification.

The judgment also illustrates the limited scope of appellate intervention under a point-of-law appeal: where a specialist tribunal has made coherent findings, applied the correct statutory tests, and provided intelligible reasons, the court will not re-weigh mitigation or substitute its own view of sanction unless the tribunal’s decision is legally flawed or plainly wrong.