Jayne M Denton

Preliminary Matters

Service

1. The Panel was satisfied based on the documents contained in the service bundle that the Registrant had been properly served with notice of the hearing by email on 20 November 2023 in accordance with the rules. The Panel had sight of an email which confirmed delivery to the Registrant’s registered email address on 20 November 2023. In addition, an email confirming receipt of the notice of hearing was sent by the Registrant to the HCPC on the 19 December 2023 which stated; “I am replying to your email regarding the upcoming hearing on 8 January 2024. … I will not be engaging or participating with the HCPC to attend the hearing in case my details are again released to the press.”
In these circumstances the Panel was satisfied that the Registrant had been properly served with the notice of hearing.

Proceeding in the absence of the Registrant

2. Ms Welsh made an application for the Panel to proceed with the hearing in the absence of the Registrant. She informed the Panel that the Registrant did not wish to attend the proceedings and was not making an application to adjourn. Ms Welsh submitted that it was relevant to consider the history of non-attendance in this matter and that it was unlikely that an adjournment would secure the Registrant’s attendance at any future hearing. She submitted that, given the time left before the expiry of the order and the Registrant’s confirmation of non-attendance, it was in the public interest to proceed with the review hearing without delay.

3. The Panel considered the HCPTS Practice Note on “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor. The Panel was satisfied that the Registrant was aware of today’s hearing, had chosen not to attend and was not applying for the hearing to be adjourned. The Panel considered that the Registrant had voluntarily absented herself and waived her right to attend. The Panel further considered that an adjournment of today’s hearing would be unlikely to secure the Registrant’s attendance at a future date, and therefore no useful purpose would be served by an adjournment. The Panel considered the order was due to expire relatively shortly and there was a need to determine matters without undue delay. In the circumstances the Panel was satisfied that it was in the public interest for the hearing to proceed in the absence of the Registrant.

Background

4. The Registrant is a registered Paramedic. At the time of the events, she was working as a self-employed Emergency Care Practitioner (ECP) for Care UK Ltd (Care UK Ltd now trades as Practice Plus Group). The Registrant’s ECP role involved participation in the out of hours service during periods in the evening, overnight, at weekends and on bank holidays when GP services are not available.

5. In February 2020, the Registrant moved from Gloucestershire out of hours service to the Worcestershire out of hours service. She ceased to work for Care UK in April 2020. As a self-employed ECP the Registrant was not subject to line management, but the quality of her work was overseen and monitored by LB the Lead Nurse at Care UK/Practice Plus Group.

6. On 30 April 2020, the HCPC received a referral from Care UK. LB had undertaken a routine audit of the Registrant’s work for March 2020. This routine audit involved a review of a randomly selected single case, Patient A There were concerns arising from this single case, and therefore an enhanced audit was undertaken of five further randomly selected cases (Patients B-F). In all five cases, further concerns were highlighted in the audit and none of the cases were assessed as meeting a satisfactory standard. LB invited another manager, CP, the Medical Lead, to conduct a “blind” audit without sight of LB’s comments. In this further review CP had similar concerns to those of LB.

7. The concerns related to a poor standard of history taking and lack of attention to and awareness of “red flag” symptoms. The Registrant’s examination skills or her completion of documentation reflected a lack of ability to confirm or exclude red flag symptoms and then to act upon them. The audit also found consistent and concerning prescribing errors.

8. The above allegation was brought before the Conduct and Competence Committee of the Health and Care Professions Council on 10-12 January 2022.

9. The original panel found allegations 1a, 1b, 1c, 2a, 2b, 3a, 3b, 4, 5a, 5b, 5c, 5d, 6a, 6b, 7a, 7b, 7c, 8a, 8b, 8e, 9a, 9b proved.

10. The panel considered that the findings of fact demonstrated a pattern of failings. In particular, the following themes were repeated in the facts found proved:

• Failures to obtain and record medication history to establish a baseline. This failure involved the potential for harm to patients if patients were to be prescribed medication which was inappropriate or establish whether the patient was at saturation level for the type of medication. When Care UK contacted Patient B’s GP, the GP reported that Patient B had stopped taking Naproxen due to gastro- intestinal upset.
• Failures to carry out investigation into symptoms, particularly “red flags”. A particularly serious example was the Registrant’s failure to consider and investigate the possibility of Pulmonary Embolism for Patient E.
• Failures to provide patients with sufficient “safety netting” advice.
• Prescribing medication when it was not appropriate to do so, either because of insufficient investigation of medication history, insufficient advice to the patient, or prescribing medication not permitted under the PGDs.

11. The panel found that the repeated failings all involved the potential for serious harm to vulnerable patients. There was a risk that patients might be prescribed medication which was harmful, and a risk that the Registrant would fail to identify a potentially serious condition such as Pulmonary Embolism, which can be fatal if it is not treated immediately.

12. The panel considered that the Registrant’s actions and omissions were a breach of the following HCPC Standards;

• Standards of Conduct, Performance and Ethics (2016)
• Standard 2.3 You must give service users the information they want or need, in a way they can understand
• Standard 3.1 You must keep within your scope of practice by only practising in areas you have appropriate knowledge, skills and experience for
• Standard 3.3 You must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development
• Standard 6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
• Standard 10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
• Standard 10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.
• Standards of Proficiency for Paramedics
• Standard 1.1 Know the limits of their practice and when to seek advice or refer to another professional.
• Standard 2.1 Understand the need to act in the best interests of service users at all times.
• Standard 2.2 Understand what is required of them by the Health and Care Professions Council.
• Standard 2.6 Be able to practise in accordance with current legislation governing the use of medicines by paramedics.
• Standard 3.3 Understand both the need to keep skills and knowledge up to date and the importance of career-long learning
• Standard 4.1 Be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem.
• Standard 4.2 Be able to make reasoned decisions to initiate, continue, modify or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately.
• Be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines.
• Recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.
• 14.9 Be able to gather appropriate information.
• 14.11 Be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment.
• 14.12 Be able to conduct a thorough and detailed physical examination of the patient using appropriate skills to inform clinical reasoning and guide the formulation of a differential diagnosis across all age ranges.

13. The original panel concluded that the facts found proved demonstrated a standard of professional performance by the Registrant which was unacceptably low and amounted to the statutory ground of lack of competence.

14. The original panel then went on to consider whether the Registrant’s fitness to practise was currently impaired by reason of her lack of competence. The panel determined the Registrant had not engaged with the hearing and had not provided any submissions for the panel to consider. There was therefore no information before the panel on which to assess her current level of insight.

15. The original panel noted that on 28 April 2020 the Registrant said she was “embarrassed and feels upset and she has let people down”. In the same meeting LB recorded her concern that the Registrant didn’t appear to “understand the seriousness of review”. When the concerns were raised and explained, the Registrant appears to have accepted and expressed some regret, but her understanding at that time was limited.

16. The original panel concluded the Registrant had demonstrated no understanding of the seriousness of her lack of competence and its potential impact on patients, her colleagues, the public, or the profession. The panel concluded that the Registrant has not demonstrated a sufficient level of insight.

17. In the original panel’s judgment, the panel noted the Registrant’s lack of competence was remediable, but she had not provided the panel with any evidence of remedial steps. In the absence of evidence of remediation or a sufficient level of insight the original panel concluded that there is a high risk of repetition of similar concerns. In its decision on the statutory ground of lack of competence the panel explained that the Registrant’s lack of competence involves the risk of serious harm to patients. The panel found there was therefore an ongoing risk of harm to vulnerable service users and a finding of impairment was required to protect the public against the risk of repetition.

18. The original panel considered the aspects of this case that might concern an informed member of the public. They determined an informed member of the public would be concerned that the Registrant’s failures involved the basic requirements for Paramedics in conducting appropriate assessments and investigations of patients, giving appropriate advice to patients, and prescribing medication. The panel found there would also be a concern about the potential for harm to patients. This concern involved the risks highlighted by LB in her witness statement and oral evidence, including the risk of Pulmonary Embolism for Patient E.

19. The original panel concluded that public confidence in the profession would be undermined if a finding of current impairment were not made. The panel therefore decided that the Registrant’s fitness to practise was impaired on the basis of the personal component and the public component.

20. The original panel then considered what if any sanction to impose on the Registrant and having considered the sanctions in order of severity determined that in light of the Registrants lack of engagement a Suspension Order should be imposed. The panel determined a Suspension Order provided sufficient protection for the public because the Registrant would not be permitted to practise as a Paramedic. The panel determined that a Suspension Order would also maintain public confidence in the profession and upholds the required professional standards for Paramedics.

21. The original panel considered that a Suspension Order was fair and proportionate, and it would give the Registrant an opportunity to reflect on the panel’s decision and to engage with the process if she wishes to do so.

22. Within the original panel’s decision, the panel set out that the Suspension Order would be reviewed before it expires. That panel noted a future reviewing panel would be likely to be assisted by the following:

• the attendance of the Registrant to provide an update on her circumstances;
• a written reflective piece from the Registrant including consideration of the impact of her acts and omissions on patients, colleagues, and the profession;
• evidence of remedial action e.g. any Continuing Professional Development and/or relevant training;
• references or testimonials from employment (paid or unpaid).

Review of the Substantive Order on 6 January 2023

23. On the 6 January 2023 a panel of the Conduct and Competence Committee (“the reviewing panel”) carried out a review of the suspension order. The Registrant did not attend and was not represented.

24. The reviewing panel noted that the Registrant had not provided it with any of the material as suggested by the original panel. The reviewing panel determined that the Registrant had not shown evidence of remediation or a sufficient level of insight, nor had she engaged in Continuing Professional Development and/or relevant training.

25. The reviewing panel concluded that there was a high risk of repetition of similar concerns if the Registrant were to continue practice. The Registrant’s lack of competence involved the risk of serious harm to patients.

26. The reviewing panel noted that there was therefore an ongoing risk of harm to vulnerable service users and concluded that a finding of impairment was required to protect the public against the risk of repetition.

27. The reviewing panel concluded that the Registrant had not demonstrated that she had reflected on the impact that her lack of competence would have on members of the public and the confidence that members of the public placed in Paramedics, or on the reputation of the profession. The reviewing panel concluded that the Registrant had continued in her failure to demonstrate a sufficient level of insight.

28. While the reviewing panel considered that the Registrant’s lack of competence was potentially remediable, it determined that the Registrant had not provided the reviewing panel with any evidence of remedial steps, despite clear guidance.

29. The reviewing panel considered that public confidence in the profession would be undermined if a finding of current impairment were not made. The reviewing panel therefore, decided that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component.

30. The reviewing panel determined a Suspension Order would provide sufficient protection for the public because the Registrant would not be permitted to practise as a Paramedic. A Suspension Order also maintains public confidence in the profession and upholds the required professional standards for Paramedics. The Panel therefore considered that a Suspension Order was fair and proportionate.

31. The reviewing panel decided that the Suspension Order should be for the maximum period of twelve months. The reviewing panel considered that this was proportionate because of the lack of engagement, lack of remediation and the serious and wide-ranging nature of the Registrant’s lack of competence. The reviewing Panel also noted that twelve months would allow the Registrant the opportunity to consider the Panel’s decision, reflect on her position, and begin to take remedial steps, if she chose to do so.

32. The reviewing panel re-stated that a future reviewing panel is likely to be assisted by the following:

• the attendance of the Registrant to provide an update on her circumstances;
• a written reflective piece from the Registrant including consideration of the impact of her acts and omissions on patients, colleagues, and the profession;
• evidence of remedial action e.g. any Continuing Professional Development and/or relevant training;
• references or testimonials from employment (paid or unpaid).

Today’s Substantive Review

33. Under Article 30 of the Health Professions Order 2001, where a Panel has imposed a sanction order, the order must be reviewed by a Panel before it expires. The Registrant’s suspension order is due to expire on 9 February 2024. The Panel noted all the documentation presented in support of the substantive order review and it heard submissions by Ms Welsh on behalf of the HCPC.

Submissions

34. Ms Welsh on behalf of the HCPC referred the Panel to documents within the hearing bundle which outline the background and the circumstances leading to the suspension order.

35. Ms Welsh set out that the Panel should have regard to the sanction policy and act proportionately. Ms Welsh submitted that a further short suspension would be a proportionate response to allow the Registrant a further opportunity to engage should she wish to. On the next review the panel would have the option of a striking off order as by that point the Registrant would have been the subject of an order for a period of over two years.
Ms Welsh stated that it was the HCPC’s position that a further 3 months’ suspension should be imposed in the present case. She submitted that the Registrant had not effectively engaged with the regulator since the last hearing and had retired. She referenced the case of Abraheam V GMC [2004] EWHC 279 (Admin) which indicates, in practical terms that a “persuasive burden” is placed on the Registrant to demonstrate at a review hearing that they have fully acknowledged the deficiencies which led to the original finding and have addressed that impairment sufficiently “through insight, application, education, supervision or other achievement...”. She noted that the original panel had provided clear indicators of the type of information and documentation which would be of assistance and none of which had been presented by the Registrant.

36. Ms Welsh submitted that there was no evidence of remedial steps taken by the Registrant and therefore there continued to be a high risk of repetition, as such she submitted the Registrant was currently impaired, and a sanction ought to be imposed for the protection of the public.

Decision

37. The Panel accepted the advice of the legal assessor and took account of the HCPTS Practice Notes on Review of Article 30 Sanction Orders, Impairment and the Sanction Policy. The Panel noted the review process is not a mechanism for appealing against the original finding that the Registrant’s fitness to practise is impaired. The purpose of the review is to consider whether the Registrant’s fitness to practise remains impaired; and if so, whether the existing order or another order needs to be in place to protect the public.

38. The Panel carefully considered the documentation before it and the submissions made on behalf of the HCPC by Ms Welsh.

39. The Panel observed that the original panel and the reviewing panel had given clear guidance on the types of information and documentation which would be of assistance for the purpose of the present substantive review hearing, and despite this clear guidance the Registrant had not produced such information or documentation.

40. The Panel noted that the Registrant has stated that she has retired from the profession and is now working in retail. It appeared from the Registrant’s correspondence that she had no desire to return to the profession.

41. The Panel determined that the Registrant has not shown evidence of remediation or a sufficient level of insight, nor has she engaged in Continuing Professional Development and/or relevant training.

42. The Panel therefore concluded that there is a high risk of repetition of similar concerns if the Registrant were to continue practice. The Registrant’s lack of competence involves the risk of serious harm to patients and there is no evidence that she has taken any steps to address the lack of competence.

43. The Panel noted that there is therefore an ongoing risk of harm to vulnerable service users and the Panel concluded a finding of impairment is required to protect the public against the risk of repetition.

44. The Panel concluded that the Registrant has not demonstrated that she has reflected on the impact that her lack of competence would have on members of the public and the confidence that members of the public placed in Paramedics, or on the reputation of the profession. The Panel noted the finding of the original panel that the lack of competence of the Registrant might concern an informed member of the public and the Panel concluded that the Registrant has continued in her failure to demonstrate a sufficient level of insight. The Panel noted the Registrant’s regret expressed to the original panel. However, it did not consider that the Registrant has demonstrated any real insight into her failings.

45. While this Panel agrees with the original panel and the reviewing panel that the Registrant’s lack of competence is potentially remediable, it determined that the Registrant has not provided the Panel with any evidence of remedial steps, despite clear guidance.

46. The Panel therefore concluded that the public would remain concerned that the Registrant’s failures which were wide ranging and related to basic requirements for Paramedics had not been remedied.

47. The Panel noted that public confidence in the profession would be undermined if a finding of current impairment were not made. The Panel therefore decided that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component.

48. The Panel applied the guidance in the Sanctions Policy and the advice of the Legal Assessor. The Legal Assessor reminded the Panel on its powers in respect of sanction. The option of a striking off order is not currently available under the Health Professions Order 2001 paragraph 29(6) as the allegation found proven relates to a lack of competence only, and the Registrant has not been continuously suspended or subject to a conditions of practice order for two years.

49. The Panel are aware that the primary function of any sanction is to address public safety. The Panel should also give appropriate weight to the wider public interest which includes maintaining confidence in the profession and setting the proper professional standards.

50. The Panel applied the principle of proportionality and balanced the Registrant’s interests against the public interest. The Panel noted that the sanction should be the least restrictive which is sufficient to provide the necessary degree of public protection.

51. The Panel considered the sanctions in ascending order of severity. The Panel decided that the Registrant’s lack of competence is of a nature and gravity that the option of taking no action would be insufficient to protect the public and to maintain public confidence in the profession.

52. The Panel considered imposing a Caution Order but decided that it would provide insufficient protection to the public. The Registrant has not demonstrated any insight into her lack of competence which is not minor in nature and the Panel has found that there is a high risk of repetition. A Caution Order would not restrict the Registrant’s practice and would not therefore provide sufficient protection for the public.

53. The Panel next considered the option of a Conditions of Practice Order. Although the Panel considered that the concerns are remediable, the Panel concluded that conditions of practice would not be appropriate because the Registrant has not engaged with the process, currently has no desire to practice and has not provided her commitment to comply with conditions of practice. Further, the Panel did not consider that the Registrant has demonstrated a sufficient level of insight for conditions of practice to be an effective means of addressing the risk of repetition.

54. The Panel agrees with the original panel that the lack of competence in this case is serious and wide ranging, rather than limited to one area of practice. Given the current absence of any evidence of remedial steps or any insight, the Panel decided that any conditions of practice would need to be so restrictive that they would be tantamount to a suspension. The Panel therefore decided that conditions of practice would be insufficient to protect the public and inappropriate.

55. The Panel then considered the guidance on a Suspension Order. The Panel noted Registrant has not demonstrated insight, and the Panel was of the view that there is a high risk of repetition. However, a Suspension Order is the most restrictive order available to the Panel at this stage as a striking off order is not available.

56. The Panel determined a Suspension Order provides sufficient protection for the public because the Registrant will not be permitted to practise as a Paramedic. A Suspension Order also maintains public confidence in the profession and upholds the required professional standards for Paramedics. The Panel therefore considered that a Suspension Order was fair and proportionate.

57. The Suspension Order will prevent the Registrant practicing as a Paramedic and the Panel acknowledged that it may have a detrimental impact on her financial and reputational interests. The Panel decided that the Registrant’s interests were outweighed by the need to protect the public and the wider public interest.

58. The Panel decided that the Suspension Order should be for a short period of three months. The Panel considered that this was proportionate because of the lack of engagement, lack of remediation and the serious and wide-ranging nature of the Registrant’s lack of competence. The Panel considered that a longer period of suspension would serve no useful purpose as the Registrant has already been suspended for almost two years.

59. Three months will allow the Registrant a further opportunity to consider the Panel’s decision, reflect on her position, and begin to take remedial steps, if she chooses to do so. The Panel agreed that the material set out by the original panel and the reviewing panel in the previous decisions would be a helpful starting point for any future reviewing panel should the Registrant wish to return to the profession.

60. The Panel noted that the Suspension Order would be reviewed before it expires. The Panel noted that at that stage a striking off order would be available to a reviewing panel. The Panel considered that in the absence of any engagement or demonstration of remediation from the Registrant a striking off order was a likely outcome.

ORDER: The Registrar is directed to suspend the registration of Mrs Jayne M Denton for a further period of 3 months on the expiry of the existing order.

This Order will be reviewed again before its expiry on 9 May 2024.

History of Hearings for Jayne M Denton