Joel Warwick

Preliminary Matters
Application to amend the charges
1) Ms O’Connor made an application to amend a number of the Particulars as set out above. The Registrant had been put on notice of the proposed amendments in a letter dated 25 April 2022. In summary, she submitted that the proposed amendments were minor in nature, merely corrected dates and added specificity to the Particulars. She submitted that the proposed amendments did not change the substance of the allegation against the Registrant, but merely ensured that the allegation better reflected the evidence available.

2) Mr Padley, on behalf of the Registrant, did not oppose the application.

3) The Panel accepted the advice of the Legal Assessor and carefully considered the HCPC’s application to amend the Particulars. The Panel concluded, after reviewing each of the proposed amendments, that it would agree to the Particulars being amended for the following reasons:

a) the Registrant had been provided with significant notice of the HCPC’s intention to amend the Allegation, having been put on notice on 25 April 2022, approximately nine months before the commencement of the substantive hearing;
b) the Registrant has not objected to the proposed amendments; and
c) the proposed amendments do not materially widen the scope of the allegation, but merely seek to better reflect and particularise the evidence.

4) The Panel concluded that the proposed amendments of the paragraphs did not materially affect the nature or seriousness of the allegation. In all the circumstances, there was no likelihood of unfairness or injustice to the Registrant. The Panel therefore agreed to the proposed amendments and granted the HCPC’s application.
Background
5) The Registrant was employed by Central Medical Services, a private ambulance provider based in Nottinghamshire.

6) Between 24 October 2019 and 17 November 2019, the Registrant was videoed on multiple occasions allegedly using his mobile phone whilst driving an ambulance. On one occasion, in a video which was provided to the HCPC as part of their investigation, it is alleged that at the same time the Registrant was driving the ambulance and using his mobile phone, a patient was also being transported in the back of the ambulance.

7) The incidents were reported to the Nottinghamshire Police, who passed the matter on to Cambridgeshire Police as the alleged incidents occurred in their area. However no further action was taken on the advice of the Crown Prosecution Service.

8) The Registrant was suspended from work on 25 November 2019. An internal investigation was undertaken and the Registrant was spoken to by his Line Manager, Graham Kelman. The matter was referred for a disciplinary hearing which was held on 27 November 2019.

9) A referral was made to the HCPC on 28 November 2019 by Graham Kelman. In addition, the Registrant made a self-referral on 28 November 2019.

10) At its meeting on 11 October 2021, a panel of the HCPC’s Investigating Committee determined that there was a case to answer in relation to the allegation of impairment of the Registrant’s fitness to practise.
Decision on Facts
Evidence received
11) The Panel has had sight of a number of documentary exhibits which included, but was not limited to:

• A statement of Clementine Baldwin of Kingsley Napley LLP producing a number of exhibits;
• A statement of Graham Kelman, currently Head of Operations for Polaris Medical Services;
• The Registrant’s self-referral form dated 18 November 2019;
• Various correspondence from the Registrant’s employer to the Registrant;
• A copy of the Investigation Summary Report;
• 5 video clips.

12) The Panel also considered the documentation provided by the Registrant which included:

• A reflective piece; and
• A number of character references.

13) The Panel heard live oral evidence from the Registrant but at the impairment stage of the hearing.
Panel’s Approach
14) The Panel was mindful that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual paragraphs of the Allegation could only be found proved if the Panel was satisfied that that was the case on the balance of probabilities.

15) In reaching its decision, the Panel took into account all the evidence as well as the oral submissions made by the parties. The Panel also accepted the advice of the Legal Assessor which is a matter of record.
Particulars 1a) – 1d)
16) The Panel found the facts of Particular 1a), 1b), 1c) and 1d) proved for the following reasons.

17) The Panel had regard to the statement of Mr Kelman. He stated that he had been contacted by Martin Jackson, an Emergency Care Assistant who raised concerns about the Registrant that he considered should be escalated. He stated that Mr Jackson told him that he had witnessed the Registrant using his mobile phone on numerous occasions whilst driving.

18) He stated that Mr Jackson had said that he had spoken to the Registrant on several occasions to say that he should not be doing that, but that the Registrant nevertheless continued to do so. He stated that Mr Jackson then videoed the Registrant on 5 separate occasions whilst the Registrant was driving an ambulance, which video clips have been produced to the Panel.

19) One clip showed the Registrant driving in the rain whilst taking a call on his telephone. As he was holding the telephone to his ear, he only had one hand on the steering wheel. At one point, the Registrant was seen removing both hands from the steering wheel.

20) One clip evidenced the Registrant watching video footage on his phone whilst driving the ambulance under blue lights in bad weather conditions. The Panel was able to see from the video clip in question the blue lights reflecting outside of the vehicle.

21) Another clip evidenced the Registrant driving whilst texting, but in this video, the Panel was able to see that there was also a patient in the ambulance whilst he is doing so.

22) The dates of the videos produced taken of the Registrant using his telephone whilst driving occurred on:

a) 17 November 2019 at 18:54
b) 17 November 2019 at 18:53
c) 9 November 2019 at 18:56
d) 3 November 2019 at 19:14
e) 24 October 2019 at 20:51

23) Mr Kelman attended a disciplinary meeting on 27 November 2019, which the Registrant also attended, albeit without representation. He stated that the Registrant accepted that he had been “stupid”, and that the Registrant described the incidents as a “moment of madness”. Mr Kelman observed that there were several moments, not just one.

24) The Panel was satisfied, having viewed the video clips, that they show the Registrant acted as alleged. The Panel concluded that by driving an ambulance whilst on duty using his mobile phone to make / receive calls, to message and to watch video content, that the Registrant acted in an unsafe and unprofessional manner.

25) The Panel has also taken into account the Registrant’s admissions to the facts alleged. He accepted when giving evidence, that his driving at the relevant time was unsafe and unprofessional. He conceded that when distracted by his phone, his driving posed a risk to other road users and the patient shown in the video in the back of the ambulance.

26) The Panel therefore found the facts of Particulars 1a) – 1d) proved.
Decision on Grounds
Evidence heard
27) The Registrant gave oral evidence.

28) In summary, he gave details of his career background and of his role at Central Medical Services (“CMS”) where he was working at the time in question.

29) He accepted that he had been foolish in behaving as alleged and that his actions were ‘regrettable’ and ‘silly’. He stated that he had done an online driving refresher course. He now used the ‘do not disturb’ feature on his phone to avoid a repetition of the incident in question, and that he now uses a standalone navigation system when required.

30) He accepted that by acting as alleged, he had put others at risk of harm, and ‘not best practice’. In response to questions put to him by Ms O’Connor, he accepted that his actions were unsafe and he also accepted that he may have been texting on his mobile phone whilst driving. He confirmed that the videos watched on his phone were of Formula 1 racing and an episode of ‘The Apprentice’, but that his intention was simply to hear the audio of the programmes through the Ambulance’s stereo system.

31) He stated that he had admitted everything in his investigation interview. He told the Panel that he felt under pressure to accept work calls on his mobile as he believed that, being on-call, there was an expectation that he would be required to take work calls during that on-call period.

32) He stated that he has since gone on an online driving course, he no longer uses his phone whilst driving, whether in the course of work or in his private life, and that he hoped to continue his career as a Paramedic.
HCPC’s submissions
33) Ms O’Connor invited the Panel to bear in mind the explanation of that term given by the Privy Council in the case of Roylance v GMC (No.2) [2000] 1 AC 311, where it was stated that:

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

34) She referred to the case of Nandi v GMC [2004] EWHC 2317 (Admin) where the Court described misconduct as “a falling short by omission or commission of the standards of conduct expected among medical practitioners, and such falling short must be serious” such that it would be “regarded as deplorable by fellow practitioners”.

35) She submitted that the Registrant’s conduct marked a serious departure from the standards expected of a registered Paramedic and was sufficiently serious to amount to misconduct.

36) She submitted that the Registrant’s conduct was not a one-off incident, and that his behaviour put colleagues, other road users and a patient at risk. She also submitted that the Registrant had demonstrated limited insight, in that, whilst he had made admissions, he had considered his actions were “not best practice”, but in fact, his actions had gone beyond that.

37) She invited the Panel to conclude that the Registrant had breached standards 1, 6 and 9.1 of the HCPC Standards of Conduct, Performance and Ethics (2016):

“Standard 1: Promote and protect the interests of service users and carers;
Standard 6: Manage risk;
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
9 Be honest and trustworthy
Personal and professional behaviour
9.1You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

and standards 2, 3, 9, 12 and 15 of the Standards of Proficiency for Paramedics (published September 2014):

“2 be able to practise within the legal and ethical boundaries of their profession
2.1 understand the need to act in the best interests of service users at all times

3 be able to maintain fitness to practise
3.1 understand the need to maintain high standards of personal and professional conduct

9 be able to work appropriately with others
9.1 be able to work, where appropriate, in partnership with service users, other professionals, support staff and others

12 be able to assure the quality of their practice

15 understand the need to establish and maintain a safe practice environment
15.1 understand the need to maintain the safety of both service users and those involved in their care
15.2 be aware of applicable health and safety legislation, and any relevant safety policies and procedures in force at the workplace, such as incident reporting and be able to act in accordance with these
15.3 be able to work safely, including being able to select appropriate hazard control and risk management, reduction or elimination techniques in a safe manner and in accordance with health and safety legislation”.

The Registrant’s submissions
38) Mr Padley, on behalf of the Registrant, conceded that the matters admitted marked sufficiently serious departures of the standard expected of a Paramedic to amount to misconduct and did not seek to argue that the statutory ground had not been made out.
39) He conceded that driving an ambulance whilst distracted as alleged, did amount to misconduct, but invited the Panel to bear in mind that there were no concerns about the Registrant's clinical competence, and that his failings were only a small part of his practice.
Decision on misconduct

40) On the basis of the facts found proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct or a lack of competence. It took into account all the evidence received together with the submissions made by Ms O’Connor and Mr Padley.
41) In considering this matter, the Panel exercised its own judgement. The Panel also took into account the public interest, which includes protection of the public, maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.

42) When considering whether the facts found proved amounted to misconduct, the Panel noted that not all breaches of the HCPC’s Standards of Performance, Conduct and Ethics need to result in a finding of misconduct.

43) The Panel heard and accepted the advice of the Legal Assessor, which included reference to the cases of: Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, Remedy UK v GMC [2010] EWHC 1245 (Admin) and Nandi v GMC [2004] EWHC 2317 (Admin).

44) The Panel adopted a two-step process in its consideration. Firstly, the Panel considered whether the facts found proved amount to misconduct. Secondly, and only if the facts proved were found to amount to misconduct, would the Panel then go on to consider whether the Registrant’s fitness to practise is currently impaired as a result of that misconduct.

45) Given the Panel’s findings in relation to the facts found proved, it has found that the Registrant deliberately and repeatedly used his mobile phone whilst driving an ambulance on duty. He received phone calls, messaged, and watched video content while driving an ambulance. Although the Panel accepted Mr Padley’s submissions that driving may only form a small part of a Paramedic’s role, it is a high risk activity, especially when carried out on emergency conditions, and/or when a patient is being transported.

46) The Panel did not find any reasonable explanation for the watching of videos or television programmes whilst driving the ambulance. Had the reason for this been, as the Registrant contended, to play the audio through the ambulance speakers, then the telephone could have easily and safely been stored elsewhere where the screen would not have been visible and would not have caused a distraction to the Registrant. Indeed, on more than one occasion, the Registrant can be seen looking down at the screen on the dashboard.

47) With regards to the Registrant receiving phone calls, it was open to the Registrant to ask his colleague to answer his phone on his behalf and say he would call back later or to take a message, but he did not do so. It was apparent from the video evidence that the Registrant was, on one occasion, using a messaging service whilst travelling at speed with a patient in the back of the ambulance.

48) As such, it concluded that the Registrant’s conduct amounted to a serious breach of standards 1, 6.1, 6.2 and 9.1 of the HCPC’s Standards of Conduct, Performance and Ethics. It considered that any potential breaches of the Standards of Proficiency for Paramedics, as submitted by Ms O’Connor, were more appropriately categorised as breaches of the HCPC’s Standards of Conduct, Performance and Ethics.

49) However, the Panel was mindful that a finding of misconduct does not necessarily follow as a result.

50) The Panel nevertheless concluded that the Registrant’s conduct and subsequent breaches of the HCPC’s Standards of Conduct, Performance and Ethics, both individually and collectively, marked serious departures from the standards expected of a Paramedic. The Registrant’s inappropriate use of his mobile phone occurred on a number of days, including, on one occasion, with a patient in the back of the ambulance. It was conceded on behalf of the Registrant, that his use of the phone to make/receive calls, message, and watch video content, was distracting and his driving would have posed a risk to patients, colleagues, and other road users, as well as to himself.

51) In all the circumstances, and having carefully considered the advice received from the Legal Assessor, the Panel therefore found that the Registrant’s behaviour fell sufficiently far short of the standard expected of him such that it amounted to misconduct.

Decision on Impairment

52) The Panel went on to decide whether, as a result of his misconduct, the Registrant’s fitness to practise is currently impaired.

HCPC submissions

53) Ms O’Connor reminded the Panel to consider the ‘public’ and ‘personal‘ components of impairment.

54) She submitted that Paramedics are expected at all times to act in a professional manner. They must make sure that their conduct at all times justifies both service users’ and the public’s trust in the profession.

55) Ms O’Connor reminded the Panel that, in relation to the personal component, the Panel should have particular regard to the level of the Registrant’s insight. She reminded the Panel that the Registrant’s comment that his actions were “not best practice” was indicative of him not appreciating the gravity of his failings.

56) On the basis of the public component, Ms O’Connor submitted that public confidence in the profession would be undermined if a finding of impairment were not made given the serious nature of any misconduct found proved

57) In all the circumstances, she submitted that the Registrant’s fitness to practise is currently impaired.

The Registrant’s submissions

58) Mr Padley conceded that the Registrant’s fitness to practise was impaired on the public component of impairment. He accepted that the video evidence was self-evident and that it was not appropriate to drive whilst using a mobile phone which is why the law prevented it. He further accepted that driving in the manner admitted by the Registrant, posed an unwarranted distraction posing a risk of harm to other road users.

59) However, he submitted that the Registrant had expressed remorse, making full admissions at the investigation interview, and he had taken steps to ensure that there would be no repetition of such behaviour.

60) He referred the Panel to the supporting character references which gave an insight into the Registrant’s current behaviour and driving practices, noting that there had been no repetition of his poor driving and that the Panel could be confident that it would not be repeated in future.

The Panel’s Decision on Impairment

61) The Panel had regard to all the evidence presented in this case, including the submissions of both Counsel. The Panel heard and accepted the advice of the Legal Assessor and took into account the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’”.

62) The Panel has had regard to the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) where, at paragraph 74, she said:

“In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”

63) It further considered the observations of Dame Janet Smith in the fifth Shipman Report, Mrs Justice Cox went on to say in Paragraph 76:

“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

d. …..”.

64) Given its findings regarding ‘seriousness’, the Panel considered that limbs a, b and c of Grant were all engaged by the Registrant’s actions. The Panel had regard to the fact that maintaining patient safety and maintaining the confidence and trust of the public were core values of the Paramedic profession which the Registrant had breached as set out in its determination on facts.

65) However, in assessing future risk, the Panel noted that the Registrant had developed some insight into his failings and was mindful of the contents of his reflective statement in which he stated:

“Feelings and evaluation

I have had time to reflect on my actions, and acknowledge that they were wrong. I have worked on improving my driving, especially in relation to mobile phone usage.

Analysis

I understand the importance of not only driving safely, given the responsibility of driving an emergency response vehicle, especially as a paramedic, but also of the reputation of the ambulance service.

Conclusion and Action Plan

With the above in mind, and in response to the 3 allegations recorded against me, I have actioned as follows:

A) Placing a mobile phone on the dashboard whilst playing video content – I always now turn my phone on to ‘do not disturb’ and place out of my sight into the glove compartment as I fully understand it is not appropriate to have sight of anything on my phone whilst driving
B) Holding the handset whilst on a call – as above, I place my ‘do not disturb’ option on my phone and put it away whilst driving so never respond to calls or texts. I also felt it would be useful for me to understand better the potential consequences of such behaviour and the law so I completed an on-line Mobile Phones & Driving course. I found it very useful and informative and I have a certificate of completion.
C) Holding the handset and operating it - I accepted immediately this was not appropriate and refer to my actions at points A and B which ensure I no longer have access to or use my phone whilst driving.

In summary, I am extremely regretful of my actions, the consequences of which caused me to lose a job I love and had a significant effect on my family, especially my wife and children. I take full responsibility for this and fully understand this is not acceptable behaviour. I now work as a Clinical
Advisor for 111. This is also a job I love and I am extremely dedicated to. I have worked for them for 3 years and have worked my way up to Team Leader and await my Audit Training. I feel I am respected in my new role and that l I am part of a team performing worthwhile work for the NHS, in sometimes very challenging circumstances, the global pandemic being one example. DI really hope to be able to continue this important work.”

66) In reaching its determination, the Panel has assessed the extent of the Registrant’s insight and steps taken to remediate his failings. In that regard, the Panel concluded that the Registrant’s failings were capable of remediation.

67) Whilst recognising that the Registrant has made admissions and taken some steps to avoid a repetition of his conduct, the Panel remained concerned that the Registrant’s reflections focussed on the impact of his actions on himself. The Panel was not satisfied that he had meaningfully reflected on the impact of his actions on his colleagues, patients, or other road users, or on the extent to which the gravity of his failings impacted on the reputation generally. The Panel considered that the Registrant’s assessment of his actions as being ‘not best practice’ was indicative of him failing to appreciate the seriousness of the risk he posed to himself, colleagues, patients or other road users to the reputation of the profession. The Panel noted that the Registrant stated that he felt “let down” when his colleague, Mr Jackson, made the complaint about him, rather than recognising the potential risk his driving posed.

68) Given the limitations to the Registrant’s insight, the Panel concluded that, notwithstanding the practical steps he had taken regarding his use of his mobile phone while driving, there nevertheless remained an ongoing risk of repetition of his misconduct if he found himself in a similar position again in future. In the circumstances, the Panel did not therefore conclude that it was highly unlikely that his misconduct would be repeated.

69) In all the circumstances, the Panel therefore determined that a finding of impairment was required on the personal component of impairment and it therefore makes such a finding.

70) The Panel also took into account the overarching objective of the HCPC to protect, promote and maintain the health, safety, and wellbeing of the public and patients, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Paramedic profession and upholding proper professional standards for members of the profession. The Panel therefore considered that, given the nature and gravity of the misconduct found proved, public confidence in the profession would be undermined if a finding of impairment were not made in all the circumstances.

71) Having regard to all of the above, the Panel finds that Registrant’s fitness to practise is currently impaired on both the personal and public components of Impairment.

Sanction

HCPC’s submissions

72) Ms O’Connor made submissions to the Panel on sanction. She referred to the HCPC’s 2019 updated Sanctions Policy (“SP”) and reminded the Panel to start from the least restrictive sanction, bearing in mind the need to act proportionately.

73) She reminded the Panel that its role was not to punish a Registrant but to protect the public and the public interest. It was, she submitted, an exercise in addressing public safety and managing the risk to those who use the Registrant’s services. She submitted that the Panel should have regard to the wider public interest, the deterrent effect of any sanction, the reputation of the profession and confidence in the regulatory process. She referred to the available sanctions open to the Panel, reminding it that it should consider these in an ascending order of seriousness, not imposing any more severe a sanction than is necessary to achieve its objective. In doing so, the Panel should balance the public interest with the Registrant’s interests.

74) She invited the Panel to take into account any aggravating and mitigating factors. In relation to aggravating factors, she submitted that the Panel should have regard to the Registrant’s pattern of unacceptable behaviour by his repeated use of his mobile phone whilst driving an ambulance which posed a risk of service user harm. She also reminded the Panel that, in respect of the Registrant’s previous adverse regulatory finding, that it related to matters different in nature and dated back to 2016, with the suspension being imposed in 2017.

75) In conclusion, she stated that she was not advocating for any particular sanction but stated that the HCPC was neutral on this matter and that this remained a matter for the Panel’s judgement.

The Registrant’s submissions

76) Mr Padley reminded the Panel of its obligation to act proportionately, and that the purpose of imposing a sanction was not to be punitive. He acknowledged the limitations of the Registrant’s insight but reminded the Panel that the Registrant had taken a number of positive steps towards remediating his failings.

77) He submitted that both a striking off order and suspension were disproportionate sanctions to impose given that the Registrant was an otherwise competent Paramedic and that driving represented only a small part of a Paramedic’s role. The Registrant’s errors were foolish and have not been repeated in the intervening three years. He referred the Panel to the Registrant’s supporting references.

78) He submitted that the Registrant’s misconduct could be addressed by imposing conditions on his practice. Conditions could address his personal development and give an opportunity to demonstrate further reflection by writing a reflective piece addressing what he has learned and how he has adapted his driving. Anything beyond that, he submitted, was disproportionate given that the Registrant has continued in practice for the last three years without incident.

79) In relation to a caution, Mr Padley accepted that the Panel had identified concerns about the level of the Registrant’s insight and that, whilst this may not appear at first sight to be an appropriate outcome, he submitted that if there was a realistic risk of repetition of his failings, then it might have happened by now. The Panel should therefore give some consideration to imposing a Caution Order.

80) Mr Padley conceded that this was not a case suitable for taking no action against the Registrant.

Decision on Sanction

81) The Panel accepted the advice of the Legal Assessor who referred it to the SP. He reminded the Panel it should consider any sanction in ascending order, and to apply the least restrictive sanction necessary to protect the public and the public interest. It should also consider any aggravating and mitigating factors and bear in mind proportionality. He reminded the Panel that the primary purpose of imposing a sanction was protection of the public and the public interest and that there was a need to balance those interests with the interests of the Registrant.

82) In reaching its decision on whether to impose a sanction, and if so, which one, the Panel has considered all the information before it. Having done so, it has identified the following aggravating factors:

• That the Registrant’s use of his mobile phone was repeated on a number of occasions;
• That he put a service user, and others at risk of harm by driving in an unsafe manner;
• That as a Team Leader and therefore, as a role model to others, he failed to adhere to the high standards expected of him;
• Recognising that the Registrant had demonstrated some insight, as set out earlier in this determination, the Registrant’s insight was found to be lacking in relation to his reflection on his wider responsibilities;
• That the Registrant had a previous adverse regulatory finding against him. The Panel is mindful that there is no factual connection between the facts of this case and the matter for which he received a previous sanction, but having been made the subject of a suspension order in 2017, the Registrant should have had a heightened awareness of the obligations placed on him to comply with his professional obligations generally.

83) The Panel considered the repeated use of his mobile phone, and doing so whilst transporting a patient, and the risk posed as a result, to be particularly aggravating features of this case.

84) In terms of mitigating factors, the Panel identified the following mitigating factors:

• Three years has elapsed without his misconduct being repeated;
• The Registrant had demonstrated some insight as set out earlier in this determination, albeit limited;
• He had taken some practical steps towards remediating his failings, for example by attending an online course and using his mobile phone’s ‘do not disturb’ function;
• The Registrant has positively engaged with the regulatory process and made timely admissions both at the start of this hearing and in his investigation interview;
• The Registrant has provided a number of positive testimonials attesting to his character and clinical/driving competence, about which no concerns have been raised in this hearing.

85) The Panel approached the issue of sanction starting with the least restrictive first, bearing in mind the need for proportionality and to take into account the Registrant’s interests. Having done so, it concluded that taking no further action would not reflect the nature and gravity of the misconduct found proved. The Panel concluded that taking no action would not be adequate to protect the public or the wider public interest of maintaining confidence in both the profession and the regulatory process. Such an outcome was therefore neither appropriate nor proportionate in the circumstances.

86) The Panel next considered mediation, but having had due regard to the circumstances of this case, concluded that such an outcome was inappropriate as it had no relevance to the facts of this case.

87) The Panel then considered whether to impose a Caution Order and had regard to paragraphs 99-102 of the SP. The Panel concluded that this was also not an appropriate outcome because:

a) For the reasons set out in its determination on misconduct and impairment, the Panel did not consider the Registrant’s conduct to be minor in nature;
b) The Registrant has demonstrated limited insight;
c) The Panel considered that there remained an ongoing risk of repetition.

88) The Panel next considered whether a Conditions of Practice Order was appropriate. It had regard to paragraphs 105-109 of the SP. Having done so, it has concluded that such a sanction would neither be appropriate nor proportionate to address the public interest concerns identified. The Panel considered that it would be impracticable to impose conditions where the issue to be addressed related to the Registrant’s insight rather than a clearly identifiable area of his clinical practice that would benefit from support or retraining.

89) In the circumstances, the Panel concluded that imposing a Conditions of Practice Order was not the appropriate sanction to impose.

90) The Panel next considered the sanction of suspension. It has borne in mind paragraphs 118 – 126 of the SP. The Panel has borne in mind that this would be an appropriate sanction to impose where, even though the allegation is serious, striking off order is not merited.

91) The Panel considered that this was the appropriate sanction to impose because:

a) The matters found proved represented serious breaches of the Standards of Conduct Performance and Ethics;
b) The Registrant has demonstrated some insight, albeit limited into his failings as identified earlier in this determination;
c) The Panel considered that the Registrant's failings were remediable and were not so serious that they were fundamentally incompatible with remaining on the register. The Panel noted that the Registrant, as stated above, had taken some steps to address his failings, even though that process was not as yet complete. It has had regard to paragraph 121 of the SP which states that a Suspension Order may be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. It has also had regard to paragraph 124 of the SP which states “Short-term suspensions can also be appropriate in cases where there is no ongoing risk of harm, but where further action is required in order to maintain public confidence in our professions”;
d) The Registrant’s actions, particularly in relation to watching video clips on his mobile phone whilst driving an ambulance, and messaging whilst transporting a patient, were sufficiently serious that such a sanction was appropriate and proportionate to meet the public interest and to send a message that such conduct was wholly unacceptable.

92) To satisfy itself that a Suspension Order was the appropriate and proportionate sanction to impose, the Panel considered whether a Striking-off Order was justified. It had regard to paragraph 130 of the SP which states that: “A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts” whilst setting out a non-exhaustive list of applicable circumstances. The Panel was satisfied that the facts of this case were not of such gravity so as to merit such a restrictive sanction. It concluded that the public protection, and the public interest concerns could be adequately met by the imposition of a Suspension Order which would restrict the Registrant’s ability to practise as a Paramedic until such time as a reviewing panel determined that he was fit to do so.

93) The Panel therefore imposes a Suspension Order for a period of 6 months. The Panel concluded that that was an appropriate and proportionate period of time to reflect the nature and gravity of the misconduct found proved and allow the Registrant an adequate period of time to address his failings.

94) The Panel makes no order pursuant to Article 29(7)(b) of the Health Professions Order 2001.

95) So far as any future review is concerned, the Panel considered a future reviewing panel would be assisted by:

a) Evidence of reflection on his conduct demonstrating meaningful insight into the impact of his failings on others;
b) Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.

ORDER: The Registrar is directed to suspend the registration of Mr Joel Warwick for a period of 6 months from the date this Order comes into effect.

This order will be reviewed again before its expiry on 22 August 2022

History of Hearings for Joel Warwick