Nursing and Midwifery Council determination — substantive hearing

NMC imposes conditions on nurse Stephen Manuel over deteriorating-patient failings

A Nursing and Midwifery Council panel has placed 18 months of conditions on registered nurse Stephen John Manuel's practice after finding his care of a deteriorating patient in 2019 amounted to misconduct and a lack of competence. It did not find an alleged dishonesty proved.

MedicWatch editorial · Published 15 June 2026 · Updated 7 July 2026

Conditions on practice (practising with restrictions) — 18 months

Added to MedicWatch: 7 July 2026Report a correction

What does “practising with restrictions” mean?

Conditions of practice allow the practitioner to keep working but only subject to specific restrictions — for example, supervision, limits on certain procedures, or required reporting to the regulator.

Concerning Stephen John Manuel, nurse (Nursing and Midwifery Council 18H0335O).

Decision date: 15 June 2026 · Hearing started 1 June 2026 and ended 15 June 2026

In plain English

The NMC's Fitness to Practise Committee found that registered nurse Stephen John Manuel's fitness to practise was impaired by reason of misconduct and lack of competence, arising from clinical failings in the care of a deteriorating patient in January 2019 and a later medication error. The panel did not find an allegation of dishonesty proved. It imposed a conditions of practice order for 18 months, with a review.

Charges

The charges alleged that Mr Manuel, a Band 5 registered nurse, had between January 2019 and May 2021 failed to demonstrate the skills, knowledge and judgement required of a Band 5 nurse. In relation to Patient A on 19-20 January 2019, this included failing to administer prescribed medication for a high potassium level, failing to record fluid balance or escalate a catheter concern, failing to carry out observations and a NEWS assessment when the patient appeared 'poorly', and failing to escalate, complete an SBAR form, use the sepsis screening tool or administer oxygen when a very high NEWS score was recorded. Further charges concerned failed medication competency assessments, a diabetes referral and other clinical failings, not achieving a performance improvement plan, and, in May 2021, administering one resident's medication to another. He was also alleged to have incorrectly recorded that Patient A's pressure areas were intact, and that this was dishonest.

Findings

The panel found the incorrect record of pressure areas proved on Mr Manuel's admission, but found the dishonesty charge not proved, concluding a well-informed member of the public would regard the entry as another example of incompetence rather than dishonesty. Of the competence allegations, the panel found that the failures to carry out and record observations and a NEWS assessment, and to escalate, complete an SBAR form, use the sepsis screening tool and administer oxygen for a deteriorating patient, amounted to gross negligence and so misconduct, while the remaining matters were a lack of competence. Applying the Grant test, it found he had put Patient A at unwarranted risk of harm, breached a fundamental tenet of the profession and brought it into disrepute. While noting genuine insight, remorse and five years' incident-free practice, the panel found his practice only partially remediated, with no opportunity to demonstrate competence in an acute setting, and found his fitness to practise currently impaired on public protection grounds by reason of misconduct and lack of competence.

Mitigating factors

The panel took into account the following mitigating features: genuine remorse for the failings identified; insight, including a clear understanding of the omissions, the reasons they occurred, and the risks they created; evidence of steps taken to strengthen and develop practice; and that he had practised for five years since the last incident without any reported concerns or further incidents.

Aggravating factors

The panel took into account the following aggravating features: that Mr Manuel's delayed response to a deteriorating patient amounted to gross negligence; and that Patient A was a vulnerable patient whom his actions placed at a risk of harm.

Source

All facts on this page are drawn from the publicly published Nursing and Midwifery Council determination linked below. MedicWatch does not editorialise the regulator’s findings.

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