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Appeal under section 11 of the Tribunal Inquiries Act 1992 by Sanjit Nandhra against a decision and associated order of the NHS Tribunal dated 12 May 2025 and Lothian Health Board, Fife Health Board and Lanarkshire Health Board (Court of Session)

Scottish Court of Session

Mar 12, 2026

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Summary of Opinion — Appellant v. The Tribunal (appeal under s.11 Tribunals and Inquiries Act 1992)

Factual and Procedural Background

The Appellant, a dentist included on dental lists maintained by Company A, Company B and Company C, appealed under section 11 of the Tribunals and Inquiries Act 1992 against a decision and associated order of the NHS Tribunal dated 12 May 2025. The Tribunal found (on civil standard) that the Appellant was "unsuitable" under the National Health Service (Scotland) Act 1978 s.29(7A) because he had exploited the Scottish Government's emergency top-up payment scheme during the COVID-19 pandemic by deliberately limiting the number of NHS patients seen at Company D so as to maximise receipt under the scheme. The Tribunal therefore made an unconditional disqualification order removing the Appellant from the relevant health-board lists. The Appellant challenged that decision on seven stated grounds (see Legal Issues Presented). The three health boards entered as interested parties. The Tribunal's hearing process, its factual findings (including reliance on contemporaneous emails from January 2021), and its reasons for finding unsuitability and for refusing conditional disqualification are recorded in the judgment below. The appellate court heard submissions and rejected the appeal.

Legal Issues Presented

Whether the Tribunal applied the correct legal test (holistic assessment required by authority) in determining "unsuitability".
Whether the Tribunal erred in law in finding the Appellant unsuitable to provide NHS dental services.
Whether the Tribunal failed to take into account relevant mitigating factors (including the Appellant's long unblemished career and impact on patients if disqualified).
Whether the Tribunal took into account an irrelevant factor or otherwise misapplied evidence.
Whether the Tribunal proceeded on a misapprehension of the evidence (including absence of direct patient evidence of harm).
Whether the sanction (unconditional disqualification) was irrational or disproportionate and whether conditional disqualification would have been appropriate.
Whether the Tribunal failed to provide adequate reasons for its decision.

Arguments of the Parties

Appellant's Arguments

The Tribunal applied the wrong or incomplete legal approach and failed to carry out the holistic assessment required by authority; it did not properly weigh public interest against the Appellant's career prospects.
The Appellant lawfully claimed sums he was entitled to; at final tiering he met the required throughput so there was no wrongful conduct.
The Tribunal failed to give sufficient weight to mitigation: a 40‑year unblemished career, lack of repetition risk, and absence of clinical failings; personal and patient hardship argued as mitigation.
The Tribunal engaged in impermissible speculation about detriment to patients and mischaracterised the evidence (e.g. treating workforce-welfare comments as profit-motivated instructions).
The Tribunal failed to address mitigation set out in submissions and therefore gave inadequate reasons; the decision was irrational to the extent of unlawfulness.
If interference is required, remit was invited rather than outright substitution of sanction.

Interested Parties' Arguments

The Tribunal applied the correct legal tests, made findings open on the evidence, and was entitled to institutional deference as a specialist tribunal.
Sanction is an area where professional tribunals' judgments attract great respect; the Tribunal reasonably concluded the Appellant acted deliberately and to the detriment of patients and the NHS.
The Tribunal's observation of "no mitigation" referred to absence of an acceptable explanation for the conduct; personal hardship is not strong mitigation where public confidence and professional reputation are engaged.
If the appellate court were to allow any appeal, a remit to the Tribunal for reconsideration was an available remedy; otherwise the decision should stand.

Table of Precedents Cited

Precedent	Rule or Principle Cited For	Application by the Court
Kelly v Shetland Health Board [2009] CSIH 3, 2009 SC 248	Holistic assessment in determining unsuitability and duty to give intelligible reasons; balancing public interest and practitioner's career.	The court held the Tribunal did not misdirect itself and applied Kelly's approach in assessing suitability and sanction.
Bawa‑Garba v General Medical Council [2018] EWCA Civ 1879, [2019] 1 WLR 1929 at [93]	Consideration of impact on patients when assessing fitness/unsuitability.	The Appellant relied on it; the court noted the Tribunal had considered patient impact and mitigation but found it insufficient.
Cheatle v General Medical Council [2009] EWHC 645 (Admin)	Looking forward assessment of fitness to practise; misconduct assessed in context of whole career.	The court applied the principle that misconduct must be assessed in context and concluded the Tribunal could lawfully find the Appellant unsuitable despite a long prior career.
Watters v Nursing and Midwifery Council [2017] EWHC 1888 (Admin) at [38]	Mitigation and its assessment in sanction decisions.	Referenced by the Appellant; the court found the Tribunal's assessment of mitigation was permissibly critical and not legally flawed.
Hoodless v Financial Services Authority [2003] UKFTT FSM007 at [19]	In "grey area" cases, findings of lack of integrity may be inappropriate.	The court considered this submission but accepted the Tribunal's finding of serious lack of integrity on the facts presented.
Wingate & Evans v Solicitors Regulation Authority [2018] EWCA Civ 366, [2018] 1 WLR 3969 at [102]	Tribunal should not demand paragon standards; fairness in evaluating conduct.	The court held the Tribunal did not set unrealistically high standards and its conclusions remained open on the evidence.
Professional Standards Authority v Nursing & Midwifery Council [2017] CSIH 29; 2017 SC 542	Deference to specialist tribunals; appellate restraint.	The court emphasised institutional respect and applied deference to the Tribunal's specialist findings.
South Bucks District Council & Anor v Porter (No 2) [2004] UKHL 33, [2004] 1 WLR 1953	Appellate court should not lightly infer tribunal error; interference only if plainly wrong.	The court applied the principle of restraint and refused to overturn the Tribunal absent a serious legal flaw.
Black v General Dental Council [2013] CSIH 39	Non-clinical conduct can nonetheless engage tribunal's specialist knowledge.	The court accepted that the Tribunal, with dental expertise, was entitled to infer detriment to patients without direct patient evidence.
Fyfe v Council of the Law Society of Scotland [2017] CSIH 6, 2017 SC 283	Sanction is an area where tribunal views merit the utmost respect; guidance on appellate approach to sanction.	The court relied on Fyfe to support deference to the Tribunal's sanction decision and its specialist assessment.
Bolton v Law Society [1994] 1 WLR 512 at 517-519	Personal hardship is limited mitigation when public confidence and professional reputation are at stake.	The court endorsed the view that personal hardship does not outweigh the need to protect public confidence in the profession.
Wordie Property Co Limited v Secretary of State for Scotland 1984 SLT 345	Reasons must be intelligible and adequate; informed reader should not be left in real and substantial doubt.	The court found the Tribunal's reasons met this standard and rejected the reasons challenge.
O v Nursing & Midwifery Council [2015] EWHC 2949 (Admin) at [75]	Failure to evaluate mitigatory factors can be an error of law.	The court considered the Appellant's criticism but concluded the Tribunal had evaluated mitigation and reasonably found it insufficient.
Bijl v General Medical Council [2001] UKPC 42 at [13]	Regulatory decisions should not be driven by a demand for blame at the expense of fair assessment.	The Appellant cited Bijl; the court concluded the Tribunal's decision was not a punitive sacrifice of career but a protective regulatory measure.
Meadow v General Medical Council [2006] EWCA Civ 1390; [2007] 1 QB 462 at [32]	The point of assessment is the date of decision; regulators look forward when assessing fitness.	The court applied the forward‑looking principle in upholding the Tribunal's view that the Appellant's conduct rendered him unsuitable going forward.
Scott v Solicitors Regulation Authority [2016] EWHC 1256 (quoted in Fyfe)	Definition of "lack of integrity" (Sharp LJ): falling short of dishonesty but lacking moral soundness and ethical adherence.	The court adopted the formulation via Fyfe to support the conclusion that the Appellant's conduct showed lack of integrity.

Court's Reasoning and Analysis

The court proceeded on the following legal and factual analysis, as stated in the opinion:

The appeal was a point‑of‑law appeal under section 11 of the 1992 Act; the court affords respect to specialist tribunals and will only overturn decisions for serious legal error or if plainly wrong.
The Tribunal comprised members with relevant dental and health‑service experience; it traced the evolution of permitted dental services and payment arrangements during the pandemic and assessed the Appellant's contemporaneous emails in that context.
The Tribunal found, on the evidence (including the Appellant's emails), that the Appellant deliberately instructed staff to "slow down" patient throughput to maximise financial benefit from the top‑up scheme; it rejected the Appellant's explanation that the measures were staff‑welfare motivated.
The Tribunal concluded the conduct, though within the letter of the rules, contravened the spirit of the remobilisation and top‑up arrangements and undermined the NHS purpose by drawing funds without providing the expected volume/quality of care and by increasing waiting times.
On mitigation and sanction the Tribunal found no cogent material persuading it that disqualification would be unjust; conditional disqualification was unsuitable because the conduct was non‑clinical, deliberate, and showed no insight or remediable failing.
The appellate court examined each ground of appeal and found no legal error: the Tribunal had applied the correct legal tests (including Kelly), had not ignored mitigation or taken irrelevant matters into account, and its inferences about detriment to patients were open to a specialist tribunal with dental expertise even absent direct patient evidence.
The court found the Tribunal's reasons intelligible and adequate for an informed reader and concluded that institutional deference and the principles governing regulatory sanction supported refusal of the appeal.

Holding and Implications

APPEAL REFUSED

Holding: The appellate court rejected each ground of appeal and refused the appeal, thereby upholding the NHS Tribunal's finding that the Appellant was unsuitable under s.29(7A) of the National Health Service (Scotland) Act 1978 and its order for unconditional disqualification from the relevant health‑board dental lists.

Implications: The direct effect is that the Tribunal's disqualification order stands; the court found no legal basis to remit or quash the finding. The opinion applies established principles of deference to specialist tribunals, reasoned assessment of mitigation, and the forward‑looking assessment of suitability; it does not purport to establish a new legal precedent beyond application of those authorities.

Note: All substantive factual and legal material in this summary is drawn exclusively from the provided opinion. Identifying particulars in the source have been anonymised in accordance with the summary instructions.

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