Mr Mark Higgins

Profession: Paramedic

Registration Number: PA39505

Interim Order: Imposed on 29 Nov 2016

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 01/08/2018 End: 16:00 03/08/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

 

Whilst registered as a Paramedic:

 

1. During the course of your employment as a Paramedic at South Central

 

Ambulance Service NHS Trust, on 16 October 2015, you attended to Patient

 

A during an emergency call and you:

 

a) did not conduct an appropriate diagnostic and/or monitoring procedure

 

and treatment for Patient A, in that you:

 

i) did not check Patient A's pain response;

 

ii) did not place Patient A in a lateral position and then open the airway using

 

the head tilt and chin lift;

 

iii) did not place a monitor or defibrillator on Patient A.

 

b) did not accurately and/or adequately complete the Electronic Patient

 

Record (ePR), in that you:

 

i) did not record that oxygen had been administered;

 

ii) recorded the wrong time when treatment was administered;

 

iii) did not record the time you started Cardio Pulmonary Resuscitation (CPR);

 

iv) did not record the DC Shock;

 

v) did not record the Rhythm Strip;

 

vi) did not record the treatment that you provided Patient A with.

 

c) did not recognise that Patient A was in the early stages of respiratory

 

arrest.

 

d) did not recognise the following symptoms which Patient A had:

 

i) a pulse of 40 beats per minute;

 

ii) a state of bradycardia; and

 

iii) early stages of deterioration.

 

e) did not take leadership of Patient A's treatment;

 

f) did not communicate your treatment plan with Colleague A;

 

g) did not assess Patient A’s heart rhythm prior to putting defibrillator pads on

 

them;

 

h) did not follow appropriate guidelines for a shockable rhythm, in that you did

 

not reassess Patient A’s heart rhythm and/or feel his pulse;

 

i) did not maintain Patient A’s airway;

 

j) failed to recognise that Patient A was not breathing.

 

2. During the course of your employment as a Paramedic at South Western

 

Ambulance Service NHS Trust, you attended a development Day on 21 June

 

2016 and you were unable to meet safe practice for paediatric advanced life

 

support, in that you:

 

a) elected to intubate a conscious child with a gag reflex when it was not

 

required;

 

b) did not reassess the patient’s airway;

 

c) did not check for signs of life;

 

d) did not deliver any rescue breaths.

 

3. During the course of your employment as a Paramedic at South Western

 

Ambulance Service NHS Trust, you attended an assessment on 26 July

 

2016 and you:

 

a) were unable to achieve the standard to deliver a safe paediatric advanced

 

life support assessment;

 

b) were unable to manage complex situations requiring paramedic

 

interventions in a timely manner;

 

c) lacked certainty around drug administration impacting on timeliness of

 

care;

 

d) lacked consistency of approach, particularly in more time-critical patients;

 

e) became fixated on tasks or actions at the possible detriment of the patient;

 

f) did not re-assess the patient after completing interventions.

 

4. The matters set out in paragraphs 1 -3 constitute misconduct and/or lack of

 

competence.

 

5. By reason of your misconduct and/or lack of competence your fitness to

 

practise is impaired.

 

Finding

Preliminary matters

Application by HCPC to amend the Allegation

1. In respect of the Allegation, Mr Millin made an application to amend the allegation. He referred to his skeleton submissions and submitted that these amendments made the allegation clearer, more specific and properly reflected the evidence. They had been sent to the Registrant in November 2017 and were not opposed. There was no objection from Ms Hennessy. The Panel took the advice of the Legal Assessor who reminded it about fairness and the interests of justice.

2. The Panel concluded that the proposed amendments did not change the character of the allegation and were not prejudicial to the Registrant. He was aware of them and was legally represented. The Panel granted the application to amend as it was fair and in the interests of justice to do so.

Background

3. At the time of particular 1 of the Allegation, the Registrant was working his first shift as a newly qualified Paramedic. He was called to an emergency for Patient A on 16 October 2015. Fitness to practise concerns were subsequently raised by his crew mate, LD. The Registrant was also unable to meet safe practice for paediatric advanced life support on 21 June 2016 and 26 July 2016 during two assessment days.

4. Ms Hennessy advised as the Registrant’s position on the Allegation. The Registrant admitted the following :- Particulars 1 a i), ii), 1b i) - vi); 1 e); 1 f); 1 i); 2 a); 2 b); 3 a) ; 3 b) ; 3 c); 3 d) ; 3 e); 3 g); 3 h); 3 i)

5. The Registrant had not denied the following :- Particular 1 c) and 1 d) i) - iii); 1g); 1 h); 1 j); 2 c) ; 2 d); 3 f).
 
6. Misconduct and impairment were not admitted. Lack of competent in respect of particulars 2 and 3 was admitted. The Panel heard from four witnesses. DB was the investigating officer in relation to particular 1; LD is an emergency medical technician (EMT); DM was the investigating officer in relation to particulars 2 and 3; and JH was the Assessor on 26 July 2016 with regard to particular 3.

Application - Hearing in Private

7. The Panel heard an application from Ms Hennessy to hear parts of the evidence in private as some evidence to be heard may touch on private, family issues. There was no opposition by Mr Millin. The Panel accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Conducting Hearing matters in Private. It determined that, where appropriate, the hearing would be held in private, it being in the interests of justice to do so.

8.  Mr Millin opened the case for the HCPC and summarised the evidence to be heard. He referred to his Skeleton Submissions.

Witness 1 – DB

9. DB is a registered Paramedic and a Senior Lecturer in Clinical Practice and in Kingston University Education Team Manager at the South Central Ambulance Service (“SCAS”). His Witness Statement was accepted as his evidence in chief. He mentioned that he is now a Senior Education Manager at SCAS.

10. DB said he investigated the circumstances about particular 1 of the Allegation. He told the Panel that he had done several investigations before. His report was in the bundle and he was referred to it. He explained the Zoll machine. This is a defibrillator and monitoring device. He understood that the Registrant had not had full training on that piece of equipment, but that was not unusual. That would be declared by the Paramedic to their team leader.

11. Regarding the Zoll machine in relation to Patient A, DB explained the process and the “rhythm strip.” This recorded a “snapshot” of the heart rhythm which was an important record and part of the handover required at the hospital. This record had not appeared in the records made by the Registrant for Patient A.

12. DB explained that a Paramedic is expected to take the lead when working with a technician (EMT). DB said the Registrant was the Paramedic but the  technician, LD, was the most experienced. She was not a Paramedic. DB recalled that the Registrant had confirmed that he had been the Paramedic on that 16 October 2015. It was his first date acting in the role of a Paramedic.

13. Mr Millin said these events took place on one of the Registrant’s first emergency events. DB said that during paramedic training there was a clinical mentor, you assessed patients and did hospital handovers. As a student Paramedic he had undertaken the minimum 750 hours per year on clinical placement, as required for HCPC registration. Communication was part of that process.

14. Mr Millin explained that particular 1 h) of the Allegation was denied by the Registrant. DB explained that during training there was an assessment of a paediatric patient and you have to pass those exams as part of the university training. DB said it was not completely unusual for an ambulance technician to advise a Paramedic, but the Paramedic was always the clinical lead.

15. In response to questions by Ms Hennessy for the Registrant, DB explained he investigated the shift events of 16 October 2015 covered by particular 1 of the Allegation. That had been the Registrant’s first shift as a Paramedic, and DB had known that at the time of his investigation. The Registrant had registered with the HCPC in September 2015. DB knew that the Registrant had previously worked as an “ECA”, an Emergency Care Assistant. That was not a clinical role, and involved on 18 weeks training. An Ambulance Technician was a clinical role and they could administer some oral drugs.

16. DB told the Panel that to becoming a Paramedic required a degree and completing clinical placements. When you qualified as a Paramedic at SCAS there was a 6 to 12 month period of preceptorship. DB said that on the Registrant’s first day as a Paramedic he was not supervised. Ideally the Registrant should have been accompanied by an experienced Paramedic for the first 6 to 8 shifts, known as “front loaded shifts”. When the Registrant joined SCAS, DB explained that he also had a period of several days induction. DB accepted that the Registrant had not become a Paramedic through one of SCAS’s approved university routes.

17. On the 16 October 2015 shift, DB told the Panel that the Registrant had not yet undergone his preceptorship, his front loaded shifts, or his induction training. DB said that was not usual but was not what should have happened.

18. The Registrant had handed in his resignation in September 2015. DB said that he did not know what happened after 16 October 2015 or whether the Registrant had completed his preceptorship. During the investigation the Registrant made clear that he had felt unsupported, and that was reflected in DB’s investigation report.

19. DB said that the Registrant had not received the support he should have and that had contributed to the events alleged. During his investigation he found that both the Registrant and LD, the Ambulance Technician, had fallen below the standards to be expected of their respective roles. DB was aware of the Registrant’s allegation about bullying but he did not make a formal complaint.
20. With regard to the Zoll machine, DB said that training should be given, but that was an ideal that was not always reached. The Registrant should have been trained but was not. A Paramedic would be aware of the machine but may not be fully trained. DB accepted that sometimes the “Bluetooth” connection between the Zoll machine and the iPad tablet (which contains the Electronic Patient Record (EPR)) did not work as there could be compatibility issues. That would result in a failure to record vital signs.

21. DB told the Panel that his investigation had largely relied upon his interview with the Registrant by telephone and his live interview with LD. One of DB’s concerns was that Patient A was in the early stages of respiratory arrest. LD had reported this to DB and DB reached this view from the interview with LD and the reference to “Cheyne Stokes” breathing recorded in Patient A’s paperwork which was completed by both LD and the Registrant. DB was aware that the Registrant did not agree with this particular assessment. DB’s finding was that Patient A also deteriorated but DB accepted in live evidence this was LD’s account, rather than the Registrant’s. The Registrant had reported to him a heart rate of 40 and bradycardia.

22. DB explained that he understood that no ECG had been taken from Patient A when he was assessed. DB accepted that if the Registrant had done so, that was the correct approach. Once in the ambulance the Patient could be  defibrillated, and assessment at that point was the correct approach.

23. On the issue of communication, DB explained that was part of the course undertaken by Paramedics and was part of the role. Communication skills would form part of preceptorship and mentoring. DB agreed that the lack of preceptorship was an issue, but the Registrant had been crewed with another clinician. DB accepted that the front loaded shifts should have taken place and he had raised the issue with the Clinical Director of SCAS after these events. DB accepted that LD, although not a Paramedic, had 17 years of experience as an Ambulance Technician (EMT).

24. DB was re-examined by Mr Millin. On the investigation he carried out, DB said he had listened to both the Registrant and LD and he had not preferred one over the other.

25. As regards SCAS’s preceptorship policy, DB explained that the Registrant was never given a formal preceptorship. DB was aware that the Registrant felt unsupported and he accepted there was a lack of consistency in the Registrant’s mentorship. DB said that the SCAS had failed to provide consistency to the Registrant and DB had reported that to them. He said the Registrant had “fallen through the net”.
26. On the Zoll machine, DB said he had assumed that as a student, the Registrant would have had some level of exposure to using the machine. In the investigation report, it is reported that there was no record of the Registrant having trained on the Zoll machine. DB said that it was unacceptable that the Registrant had not received this training. LD is noted as having completed training on the Zoll machine.

27. Ms Hennessy asked further questions in clarification. DB confirmed that the Registrant should have had in place a preceptorship programme and he should not have been crewed without a mentor on the 16 October 2015 shift. DB accepted that SCAS had failed to provide the Registrant with a preceptorship programme and it should have done so. It was not part of DB’s investigation to look at the position around the Registrant’s resignation. DB had met with LD and had carried out a telephone interview with the Registrant. On the issue of clinical mentors, DB accepted the policy was not followed although the infrastructure was in place. DB accepted that the clinical mentor system did not work for the Registrant.

Witness 2 – LD

28. LD explained her role is as an Ambulance Technician (EMT) at SCAS. Her witness statement was accepted as her evidence in chief.

29. LD explained that the shift on 16 October 2015 was the first time she had worked with the Registrant as a Paramedic, with whom she got on well. She said she was confused on the day as to whether or not the Registrant was working as a Paramedic that day. The Registrant made it clear to her that he was working as a Paramedic. LD said she was, and is, an experienced Ambulance Technician (EMT). She said she had very little training on the Zoll machine. It was a new machine.

30. LD said that Patient A was clearly unwell as he had poor colour. She said the Registrant was with the patient but did not seem to be doing anything. She thought action was needed to maintain an airway. She considered that the patient was very unwell as he had very low breaths per minute. She thought the patient was going into respiratory arrest. When the patient was in the carry chair he stopped breathing. LD said she was facing the patient. She said the Registrant would not have been in a position to have seen the patient breathing at this time.

31. LD told the Panel that the Zoll machine was not attached to the patient, as it was extremely heavy and could not be carried with the patient. She said she thought that the Registrant should not have stopped at that point to check the patient’s pupils, but should have prioritised getting the patient into the ambulance. She did not recall any discussion with the Registrant at that point.LD said both she and the Registrant had difficulties attaching the Zoll machine to the patient. She understood the Zoll could work without being connected to the “EPR”, and she did not know if it was at that point. LD said the Registrant “just stood there” and did nothing.

32. LD said that when she was driving to the hospital, the Registrant stood at the side of the patient and she did not think he was maintaining the patient’s airways. She said that the Registrant did not take leadership in the circumstances and did not communicate a treatment plan. She said that the Registrant did not seem to realise that the patient was very unwell.

33. Ms Hennessy cross examined LD. LD confirmed that she now had 20 years as an Ambulance Technician. She said she had worked as a technician many times with the Registrant, before he had qualified as a Paramedic. LD said there was a hierarchical structure, but the Paramedic and Technician should work as a team. She did not recall whether the Registrant had said on 16 October 2015 that he had not been trained on the Zoll machine. She said there was little training across the service on the Zoll machine, and she was not confident using it. LD said that she did not recall receiving training on the Zoll machine, but accepted that DB had recorded in his investigation report that she had received training on 2 January 2015. She said it was “well known” that the training was inadequate.

34. LD said she recalled some aspects of the October 2015 incident clearly, others not. LD said she recalled the patient’s position, he was on his right side on the floor next to the double bed. He had been facing the wall and was naked apart from underwear. He had poor colour. She could not see his face.

35. LD said she did not recall having approved the interview notes made at the meeting with DB on 5 January 2016, which she had not seen before the HCPC hearing. She was referred to her witness statement which indicated that she had seen this interview note. She said that she was sure the patient had been lying on the floor and not on the bed. She accepted that she could be wrong about her recollection. The witness accepted that she cannot clearly recollect the patient and she accepted her memory of the incident was hazy.

36. LD said she spoke to the relatives of Patient A in the hallway in the patient’s house and took a brief history. She then went into the bedroom. LD said it had all happened very quickly, in about one minute. She could see the bedroom from the hall. LD explained that she later moved the ambulance to gain better access. LD could not now recall how long she had been in the patient’s house. When referred to the records, she said the time recorded was likely correct. Those records indicated that she was at the patient’s house for about 23 minutes and LD did not disagree with that. She thought she was probably in the bedroom for all but 2 to 3 minutes.

37. LD said she could not see the patient’s face so could not assess breathing. She said she would have most likely moved the patient onto his back by pushing him by the shoulder, as that was her usual practice. She was sure she did not pick the patient up. She said she had not assessed the patient so she could not say whether he deteriorated. LD said that she had assessed the patient and he had been “Cheyne Stoking” breathing. On the issue of the ECG, LD was sure she had not seen a 12 lead ECG. It could have been a 3 or 12 lead ECG that was used. LD said she did not remove the leads from the patient. LD said she was not frantic and was calm. She denied that she had fallen over when moving the patient but did admit to losing her footing, or that she had shouted at the Registrant.

38. Once in the ambulance, LD explained that she and the Registrant struggled to apply the defibrillator but there was no shockable rhythm. She agreed that the patient was assessed before applying the defibrillator. She did not know about the pulse at that point. When LD was driving she thought that the Registrant was not doing enough to help the patient as he was not in the correct position to do so. She accepted that she was driving at 70 to 80 mph and could not fully observe the Registrant. She accepted she could not see the Registrant during part of the journey, she had been highly assertive at times and did not communicate well with the Registrant.

39. On re-examination, LD said she did not draft some of the words used in her witness statement, but understood that the allegation was drawn from what she had said. LD said she was not able to tell what the Registrant was doing in the ambulance as regards heart rhythm or pulse.

40. In response to Panel questions, LD said that the patient was asystole and so they could not deliver a shock. LD could not say whether a shock was given at any stage by the Registrant but confirmed that she only saw appropriate guidelines being followed by the Registrant. She agreed that a Paramedic and an Ambulance Technician may not approach the treatment of a patient in the same way, as they had different skills and so may think differently. She could not say what the Registrant was thinking at the time.

41. LD said she did not believe that the Registrant had grasped that the patient was as ill as he was. LD believed that the patient was peri-arrest, this is when the patient’s breathing may stop imminently. LD told the Panel that she had no input in completing the patient report form, which was for the Paramedic to complete. She did not discuss it with the Registrant. She agreed with DB’s interview notes that her concerns were that the Registrant did not appear to intervene to ensure an effective airway. She accepted she had been driving the ambulance at this point. She agreed it was possible that the Registrant was out of her view in the ambulance as he may have been obtaining equipment to maintain an airway.


42. LD said she did not feel that the Registrant acted as a Paramedic should have done. She did not think that her new position working with the Registrant as a Paramedic had impeded their communication that day.

Application by the HCPC

43. Mr Millin applied to produce opinion evidence regarding the Registrant’s learning since the date of the Allegation. Mr Millin submitted that he considered it would assist the Panel if it were to hear from both of the witnesses still to be heard DM and JH, about the courses undertaken by the Registrant. He referred the Panel to the HCPTS Practice Note on Opinion Evidence, Experts and Assessors. He submitted that such evidence may be of assistance to the Panel and was not prejudicial to the Registrant.

44. Mr Hennessy opposed the application. She said that DM and JH were not expert witnesses. Ms Hennessy accepted that JH was a quasi-expert who could speak only to the assessment of the Registrant on the particular day. DH was not an expert and had no proper basis to speak to the documents regarding the Registrant’s assessment or CPD. Ms Hennessy submitted questions about the Registrant’s remediation and practice were for the Panel and not for these witnesses. She submitted that the evidence could be prejudicial to the Registrant.

45. The Panel took advice from the Legal Assessor who referred the Panel to the HCPTS Practice Note on Opinion Evidence. He reminded the Panel that it must consider the question of whether such evidence is admissible and part of that analysis was whether the Panel would find the evidence of assistance bearing in mind its statutory role. It was ultimately a question of fairness to both parties and it was for the Panel to weigh and assess all the evidence, if and when it was admitted.

46. The Panel decided to refuse the application. On balance the Panel determined that it would not be of assistance to it to have either DM or JH comment on the Registrant’s courses or his CPD log as contained in the bundles.

Witness 3 - DM

47. DM is a registered Paramedic. His statement was adopted as his evidence in chief.

48. DM said he got on well with the Registrant who joined South Western Ambulance Service NHS Foundation Trust (SWASFT) in October 2015 as a Paramedic. DM explained the Registrant was presently employed by SWASFT as an Emergency Care Assistant (ECA) and DM was his direct line manager. He explained it was normal practice that there would be a number of observed shifts in which an extra member of staff would join the ambulance crew to observe clinicians operating. DM explained there were some concerns expressed by the Learning and Development Officer who was part of the crew in May 2016 about the Registrant’s ability and skills which needed developing. Concerns were expressed about the degree of communication between the Registrant both with his lead Paramedic, and with patients.

49. DM outlined to the Panel the training day on 21 June 2016 which the Registrant attended. He explained the issues regarding the unsafe manner in which the Registrant had dealt with a training scenario involving an unwell child whom he had wrongly tried to intubate. DM said that a four week training plan was arranged for the Registrant. He was not aware that such a plan had been put in place for any another Paramedic. He explained that only a small number of Paramedics typically required a second day for training and development.

50. As regards to the Registrant’s request to work additional hours externally to SCAS as a Paramedic, known as secondary employment, DM explained that was a matter for the Head of Operations. This had been refused but DM could not advise why. As to support required for the Registrant to practice safely, DM said that much training had been invested in the Registrant. He could not say what more could have been done to support the Registrant, given the training already undertaken. He understood there was nothing further that could be done for the Registrant. The difficulty was the consistency of the Registrant putting his skills into practice.

51. Ms Hennessy cross examined DM. He agreed that it was not a case that nothing further could ever be done for the Registrant, but he said that SWASFT had done all they could reasonably could have done. DM agreed that the Registrant started with SWASFT in October 2016 and had completed his preceptorship. This took place for a reasonable period and the Registrant completed it in January 2017.

52. DM explained his understanding of the assessment the Registrant undertook on 21 June 2016 where the Registrant seemed wrongly to follow an earlier scenario. DM said his evidence on the step wise “ABC” approach had come from the training team. He said he knew that the Registrant had raised matters with SWASFT’s support team and was seeking additional support. DM confirmed that SWASFT now no longer required Paramedic’s to intubate paediatric patients.

53. From October 2016 until 12 May 2017, there were no issues with the Registrant’s practice. His impression was that the Registrant was reaching the required standard. DM said that he was aware the Registrant was very keen and willing to improve his practice as a Paramedic. There was no question about the Registrant’s willingness.

54. DM confirmed that the Registrant joined SWASFT as a Paramedic but later, having failed the assessments referred to in particulars 2 and 3, he ceased to practice as a Paramedic and was subsequently employed as an ECA. He had conditions of practice imposed by the HCPC but was not suspended from practice as a Paramedic.

Witness 4 - JH

55. JH is a registered Paramedic and is a Practice Educator at SWASFT. Her statement was adopted as her evidence in chief.

56. JH said she was not aware why the assessment was being carried out on 26 July 2016 with the Registrant. She was not told the reason for the assessment. She created the scenarios but had been asked to create resuscitation scenarios including a paediatric scenario.

57. JH confirmed her feedback after the assessment was that the Registrant required further training. The Registrant did not pass scenario 4, the paediatric cardiac arrest scenario and there were concerns regarding scenario 3 the paediatric medical scenario. She said there was a prolonged period of not oxygenating the patient whilst intubated in scenario 4. She explained this situation would have the effect of starving the brain of oxygen and reduce survival and recovery rates. She also recalled there was a prolonged period when that the Registrant was checking the drug book (JRCALC Guidelines) and not providing clinical care. There was also a point where the assistant to the Registrant was not used appropriately and this affected the timeliness of the resuscitation.

58. Regarding the JRCALC drug book, JH said that it was best practice to look at the book before giving any drug. Reference should, however be a few seconds to a minute. It was a quick reference guide that contained an age per page section to provide drug doses. In this scenario she would expect this check to take about 20 -30 seconds, but the Registrant took 4 minutes, which in  resuscitation was a considerable time.

59. Scoring of the assessment was based on clinical guidelines which set the standard expected of a Paramedic. JH said that the Registrant failed to apply the abdominal assessment (known as PQRST) that he ought to have known. This system was used to assess the effectiveness of the pain relief given. This was a system one would use on a daily basis. JH explained her view that the Registrant had become fixated on a particular diagnosis, that of meningitis, and did not consider a differential diagnosis.

60. On the issue of communication, JH explained her concerns about the Registrant’s performance and use of their crew mate in the resuscitation scenarios. The Registrant had not followed guidelines, and did not follow the current guidelines which suggest the use of adrenaline. The failure to do so can result in a poorer prognosis. The Registrant had also failed to follow best practice in the heart rhythm check and so he could have failed to recognise changes to the patient’s condition. JH said that two minute rhythm checks have to take place, that was mandatory, and the Registrant had not done so. The Registrant also failed to take a blood pressure which was required before giving sodium chloride.

61. JH said the period of hypoxia was a key failure as that would decrease the likelihood of patient survival. She said the Registrant seemed not to understand why he carrying out certain interventions. Further, there had been little communication between the Registrant and their crew mate during the ventilation procedure. JH said that the Registrant had not carried out a full assessment, and there was a lack of structure in the Registrant’s approach.

62. JH said that she had expected that a planned package of remediation training would take place following this assessment. She was not aware of the Registrant’s training history and she had made some recommendations including training in medicines management and in the timeliness of providing treatment. Normally a further assessment would then take place by a different member of the training team to avoid bias.

63. Ms Hennessy cross examined the witness. JH said that she thought the Registrant had appeared nervous at the start of the assessment day, but that was typical given the importance of the assessment. She said he was no more nervous than many candidates, and appeared less nervous as the day went on.

64. JH explained that the scenario used a manikin and was as close to reality as was possible. The candidates were asked if there were any issues before the scenario started. Once commenced, JH did not intervene in the scenario unless questions were raised by the candidate. The candidate could ask questions at any point. She accepted that intubation of paediatric patients was no longer a core skill for Paramedics.

65. On communication, JH said she recalled that at the fourth scenario the Registrant had the same crew mate as the three earlier scenarios. She would be surprised if he had misunderstood this position. In the other scenarios, he had not communicated frequently with his crew mate but they had not been so time critical. JH said all candidates were asked if they understood the position after they were briefed.

66. JH did not know how the Registrant’s qualifications were gained. She told the Panel that she did not know whether her recommendations were put in to effect following the assessment. She said she recalled being told that a decision would be made about the Registrant’s practice, but she was not involved in that.

67. JH said that SWASFT had recently adopted the Newly Qualified Paramedic Programme (NQPP). She explained that now there was a two year probationary period. As of March 2017 there were periodic reviews by a Practice Educator and a supervised training shift. In the first 6 to 9 months of practice, JH said that a newly qualified Paramedic could work with an ECA, and can also have a preceptorship for varying periods. She said there were different practices depending on the individual and the Operations Manager. She was not aware why the NQPP had been introduced, or whether it was better than the previous arrangements.JH explained her conclusions at the time about the Registrant’s practice. With the new process for training now available, she said that a training plan would have required her to have a much fuller picture about his history and practice and that a plan would be devised on an individual basis. JH said she was mindful that the assessment may have a big impact on the Registrant but that would not have influenced her approach to the assessment. The scenarios were standard tests used that year. She did not know whether the Registrant had done his annual mandatory training day at that point.

68. In response to questions from Ms Hennessy, JH explained the portfolio evidence system which is now part of the NQPP. She said the portfolio was now assessed as part of that programme, but previously it had been for the Paramedic to maintain. She understood that the portfolio was marked as part of the programme. She accepted that the newly qualified Paramedic system appeared to be more robust than the old preceptorship system. She said that she could not say what action she would recommend for the Registrant today in relation to the NQPP.

Half Time Submissions for the Registrant

69. Ms Hennessy made submissions that the Registrant had no case to answer in respect of parts of particular 1 of the Allegation. She referred to the HCPTS Practice Note on Half Time Submissions and to R v Galbraith [1981] 1 WLR 1039. She submitted that HCPC must prove the case. She said that the evidence heard to so far does not support those parts of the particular 1 of the Allegation that are presently denied by the Registrant.

70. Ms Hennessy submitted that there was not sufficient evidence before the Panel to find that particulars 1 c), d), g), h) and j) are proved. She said LD had accepted that important elements of her evidence were “hazy and confused” in relation to these particulars of the Allegation. She referred to her written submissions.

71. Ms Hennessy made submissions that, in respect of each of the identified particulars, the evidence of LD and DB did not support them. She said there was no evidence at all in respect of 1 c). The particular was also vague and unclear. Similarly 1 d) was not supported by the evidence. The evidence was that the Registrant reported to DB the pulse and bradycardia in 1 d) i) and ii). On 1 d) iii) again DB said in evidence that the Registrant had reported the early stages of deterioration.

72. Ms Hennessy submitted there was no evidence to support particulars 1 h) and 1 g). LD’s evidence did not support these particulars. She said she considered the guidelines had been followed and she had been driving. In respect of particular 1 j), she submitted that LD’s evidence was that the Registrant was not facing the patient and he therefore did not notice the patient’s breathing. The allegation was also vague as to when in time it related.

73. Ms Hennessy submitted that these particulars of the Allegation should fall at this stage given the lack of evidence. There was no submission regarding particulars 2 or 3.

HCPC Reply to Half Time Submissions

74. Mr Millin for the HCPC replied. He also referred the Panel to the HCPTS Practice Note on Half Time Submissions and to the Galbraith case. The Panel should take the HCPC’s case at its highest and it bore the burden of proof. He stressed that it was for the Panel to stop the matter only if it could not, rather than would not, find the allegation proved. In R v Shippey [1988] Crim L.R. 767 it was made clear that the Panel must not “cherry pick” the evidence it has heard, but look at it as a whole. Mr Millin submitted that if the Panel grants the application at this stage, it deprives itself of the ability to hear from the Registrant.

75. Mr Millin submitted that these were inquisitorial proceedings and it ought to hear from the Registrant as there were dangers in accepting there was no case to answer. This was an exceptional application and given the purpose of fitness to practise proceedings the Panel should be slow to grant it.

76. Mr Millin referred to the evidence of LD. He submitted she was a reluctant witness and was very nervous. He submitted that she readily conceded matters under cross examination but she was honest and credible and did her best to assist. LD’s answers were often “if you say so” and that must be seen in the context of careful cross examination.

77. Mr Millin submitted that the Allegation was clear and was not vague. No request for further and better particulars had been made by the Registrant and he was well aware of the Allegation he faced. No objection had been made when the Notice of Allegation was sent to the Registrant, or at the start of this hearing. The Registrant knew the case against him and he had responded.

78. Mr Millin submitted that in order to grant the application, the Panel must take the case at is highest and find that it could not find it proved. He said that the Registrant is not prejudiced by refusal of the application as cross examination was part of the Panel’s proper examination of all the evidence. He referred to the evidence of LD and DB in support of the Allegation and submitted the no case to answer submission was not strong enough at this stage.

79. Ms Hennessy replied and submitted that half time submissions were permitted by the HCPC. That was clear from the HCPTS Practice Note referred to. The Panel is not depriving itself of the evidence of the Registrant, but is properly stopping the case in respect of the particulars where there was no evidence. Admissions made by the Registrant did not weaken the half time submission. There was prejudice to the Registrant in requiring him to give more extensive evidence.

Decision on Half Time Submission

80. The Panel accepted the advice of the Legal Assessor who reminded it of the terms of the HCPTS Practice Note on Half Time Submissions, and the Galbraith case. He also referred it to guidance in the cases of Shippey and Benham v Kythira Investments Ltd [2003] EWCA (Civ) 1794. The Panel must carefully consider the evidence at its highest. He referred to the four steps which the Panel ought to follow, as set out in the Practice Note. He reminded it that this was an exceptional application and that it ought to be mindful of the overarching purpose of regulatory proceedings.

81. The Panel accepted the advice of the Legal Assessor and the case law. It considered the submissions from both parties and all the evidence heard to date. It carefully applied the guidance. The Panel noted that there is no time scale in any part of particular 1, other than the day of 16 October 2015. It considered each of the particulars challenged in turn.

82. Particular 1 c) :- The Panel noted that the early stages of respiratory arrest is not simply a question of breathing or not breathing. The Panel carefully considered all the evidence, particularly that of LD and the investigation by DB. The Panel noted the terms of the record of the Registrant’s telephone interview on 18 January 2016 with DB. That records that the Registrant told DB that he did recognise the early stages of respiratory arrest. The electronic patient record (EPR) does not contradict this. The Panel found no evidence that the Registrant did not recognise the early stages of respiratory arrest. The Panel determined that the HCPC not produced any evidence that the Registrant did not recognise that Patient A was in the early stages of respiratory arrest.

83. Particular 1 d) i) – The Panel noted the evidence of DB. DB reported that it was the Registrant who told him that Patient A’s pulse was 40 beat per minute. The Panel found no evidence that the Registrant did not do so. It determined that the HCPC has not produced any evidence that the Registrant did not recognise the pulse of 40 beats per minute.

84. Particular 1 d) ii) – The Panel noted that DB recorded in his interview with the Registrant that it was the Registrant who reported to him that the patient exhibited bradycardia. There is no evidence the Registrant did not recognise a state of bradycardia.
85. Particular 1 d) iii) – The evidence from the DB interview was that the Registrant did check the carotid pulse, and that he noted ventricular fibrillation in the patient. This evidence suggests that the Registrant did recognise the early stages of deterioration. The EPR does not contradict this. There is no evidence the Registrant did not recognise the early stages of deterioration.

86. Particular 1 g) – The evidence in the EPR was that the Registrant had assessed the heart rhythm and recorded its rate, and this is supported by the Registrant’s interview with DB. The evidence from LD was that the defibrillator pads were also used to assess the heart rhythm. She said in evidence that at that time a non-shockable heart rhythm was then found. There is no evidence the Registrant did not assess the heart rhythm prior to putting defibrillator pads on the patient.

87. Particular 1 h) - There is evidence in the contemporaneous EPR that the Registrant did assess the patient for a shockable rhythm. That is in accordance with the appropriate guidelines. The HCPC has not presented evidence that the Registrant did not follow appropriate guidelines for a shockable rhythm, in that he did not reassess the patient or feel his pulse.

88. Particular 1 j) – The Panel takes this particular to relate to the time when the patient was being transferred to the ambulance. Whilst LD’s witness statement does support the particular to some extent, LD clarified in live evidence that the Registrant would not have been in a position to see the patient during the transfer to the ambulance, as the Registrant was not facing the patient. That could not amount to a failure. Further, the evidence from the interview with DB is that the Registrant did recognise that the patient was not breathing in the ambulance. There is no evidence the Registrant failed to recognise that Patient A was not breathing on transfer or in the ambulance.

89. The Panel determined that there is, in respect of each particular considered, no case to answer and it grants the Registrant’s application.

The Registrant’s Evidence

90. The Registrant’s witness statement was accepted as his evidence in chief.

91. Ms Hennessy referred the Registrant to his witness statement. He confirmed that on 16 October 2015 he had been working as a Paramedic. He had worked with LD many times when he was an ECA. He confirmed that he had admitted all the remaining parts of Particular 1.

92. He said he now understood why one would not intubate a conscious child. He had a poor recollection of the assessment day with JH and was rather confused about his role with the crew mate in the assessment. He accepted that his communication had not been good.
 
Cross Examination of the Registrant.

93. Mr Millin questioned the Registrant. He asked about those parts of the Allegation which the Registrant did not recall and could not respond to. He said he hoped JH’s evidence was accurate as to the assessment. He accepted JH was objective and impartial, and he had no reason to doubt her evidence.

94. As regards delegation and communication, the Registrant said that he was perhaps not as communicative as he should be in an assessment scenario. He said he did not have difficulties “in the real world.” He said he was comparable with others in his profession.


95. In response to Panel questions, the Registrant explained he had done a 2 year foundation degree course and had been a student Paramedic at SCAS. He said he started at SCAS as an ECA. Once he was a student Paramedic he was on a student Paramedic contract. He could work with a Paramedic and use Paramedic skills on which he had been “signed off”. He worked in that role for a year prior to qualification. He said he had little exposure to seriously ill patients that year but he had completed his required hours. He had also done a portfolio which was “signed off” by his clinical mentor at SCAS. He had been required to demonstrate that he had completed all the course modules and patient assessments. He had to pass an adult cardiac arrest scenario and an airway management assessment. The Registrant did his preceptorship at SWASFT, not at SCAS.

96. The Registrant had not been the lead Paramedic until 16 October 2015. In the first two minutes of entering Patient A’s bedroom, the Registrant said that he looked at the colour and respiration of the patient. He was trying to build up a picture of the patient. He saw that the patient was breathing and he did check, but was not concerned about the airway. He had put on some oxygen. He did not otherwise intervene or move the patient. He did speak to the patient and shake him. The Registrant said he had struggled to complete the EPR on arrival at the hospital but would have wished to put more into it. He said at that point LD was being aggressive and he was unable to concentrate as she kept interrupting.


97. Regarding the JRCALC drug book, the Registrant explained that he had been taught to be very thorough by his previous employer, but his new employer did not seem to want that approach. He did not realise he could delegate that task in the assessment to an ECA. He did not recall the issues with the “Thomas tube holder” task but accepted that he may have lost track of the time. He realised it was very important not to become task focussed as it may cause harm to the patient. He agreed communication was important and covered a host of people.

98. Regarding the assessment involving a child manikin, the Registrant said he found the lack of reality difficult. With hindsight he said he ought to have questioned the assessor more. He said that other assessment scenarios differed as they involved a demonstrative assessment, not a real time scenario.

99. The Registrant explained his experience at SCAS and his move to his new job at SWASFT. He had no problems initially. He explained that at SCAS he had learnt a particular way of doing things and recording patient details on the system they used. That had worked for him.


100. The Registrant said that on the 22 June 2016, his manager had come to his house and explained that he was to restrict his practice given the outcome of the assessment the day before. He said this knocked his confidence and he did not know what would happen next. He did not get any feedback and he had never seen the reports the assessor had done. He said he was stressed about the assessment as his career was “on the line”. It was a full day assessment. He said he felt concerned about the child scenarios.

101. The Registrant said he had not felt able to communicate effectively at the July 2016 assessment as the crew mate sat down and the Registrant thought that he was no longer part of the scenario. He recalled the instructions given were verbal instructions and did not dispute he was asked if he understood.

102. Mr Millin asked the Registrant about the 750 hours he completed, and the Registrant confirmed that was completed whilst he was a student Paramedic. Regarding his relationship with LD on 16 October 2015, the Registrant said LD was a very different person that day and her attitude had changed at the patient’s home.
103. Ms Hennessy clarified with the Registrant that from 2007 – 2014 the Registrant was an ECA, from 2014 - 2015 he was a student Paramedic and that he qualified in August 2015. The Registrant explained he had asked to review his July 2016 assessment to work out what had gone wrong and put it right. He said JH was not there, her feedback was not given to him on the day and he did not see her written assessment notes. He said he knew that he had failed the final assessment before he received the result as he knew that he had not met the required standard that day.

104. The Registrant said that on the 16 October 2015 he had found it difficult to manage LD as his colleague and could not understand it. With more experience he would handle it better.

Closing Submissions for the HCPC

105. Mr Millin summarised the HCPC case. He referred to his written submissions and confirmed he made out no case on misconduct. He said that the only outstanding particulars were now 2 c), 2 d), and 3 f).

106. On particular 2 c), Mr Millin referred to DM’s evidence in his witness statement and clarified in his live evidence. On particular 2 d), he submitted that the evidence came from DM and JH. He submitted that DM had explained in his evidence why the Registrant had failed the assessment and typically the small numbers of candidates that failed. He also referred to LD’s evidence about the presentation of Patient A in respect of 1 a) ii) and Mr Millin submitted that “lateral” meant the patient was on his back.

107. Mr Millin referred to the case law in his written submissions and the definition of competence. He submitted that it was irrelevant that the Registrant had not had sufficient training and relied upon Holton v GMC [2006] EWHC 2960. The evidence of JH was clear that allowance could not be made for a candidate’s personal circumstances given the importance of patient safety. He submitted that in this case there was a serious lack of competence. Mr Millin also referred to Calhaem v GMC [2007] EWHC 2606 (Admin). He submitted that the Particulars related to a fair sample of the Registrant’s work.

Closing Submissions for the Registrant

108. Ms Hennessy reminded the Panel to consider the Registrant’s admissions but it must be satisfied that the particulars are proved notwithstanding the admissions made by the Registrant.

109. On particular 1 a) ii), Ms Hennessy submitted that it was for the Panel but she understood that “lateral” meant on the patient’s side not on the patient’s back. She referred to LD’s evidence. Particular 1 b) was admitted and DM’s evidence was relevant. On 1 i) she submitted that the Panel had the Registrant’s evidence and it may indicate that these particulars were not proved.

110. Ms Hennessy referred to 2 c) and 2 d). She referred to DM’s evidence and submitted that the Panel should find that these particulars are not proved on the balance of probabilities. The lack of recollection by the Registrant did not prove the particulars.

111. Ms Hennessy asked the Panel to consider DB’s evidence and his view that he had preferred LD’s evidence to that of the Registrant in his investigation. The Panel had the Registrant’s and DM’s evidence about the circumstances on 16 October 2015 and that the Registrant did not have proper support. DM’s evidence was that the preceptorship policy was not followed. Ms Hennessy submitted that at time DB was somewhat evasive and defensive. It was clear the Registrant had not been properly supported or trained at SCAS.

112. Ms Hennessy submitted that LD was not a compelling witness and accepted her recollection was “hazy and confused”. She said the Panel had heard LD’s evidence about her demeanour on 16 October 2015, which she said had been forthright. LD had accepted that she had also fallen short in her own standards that day. Ms Hennessy submitted that LD was not a credible or clear witness.

113. On the issue of competence, Ms Hennessy submitted that the Panel could look at the particulars as a whole or separately. In particular 1, Ms Hennessy submitted that there was little more than the Registrant's version of events. The events of one day could not be a fair sample of the Registrant’s work. On the two assessment days in particulars 2 and 3, the Registrant accepted that this could amount to lack of competence. He accepted he had fallen short on those days. It may be that two assessment days could be a harsh view in terms of a fair sample of work, but the Registrant did accept that he did not meet the required standards. The Registrant did not suggest that his personal circumstances should alter that, but she submitted that his personal issues were relevant.


Decision on Facts

114. The Panel accepted the advice of the Legal Assessor and applied the relevant principles. The Legal Assessor advised the Panel on the approach to facts. It was mindful that the civil burden of proof, the balance of probabilities, rests on the HCPC, and that the Registrant need prove nothing. He reminded the Panel that on the question of grounds, there was no burden of proof and that was a matter for its own professional judgement. He referred it to the guidance on lack of competence in the Holton and Calhaem cases.


115. The Panel accepted the advice from the Legal Assessor. It carefully considered all the evidence and the documents before it, together with the submissions for both parties.

The Witnesses

116. The Panel assessed all the witnesses. It found that, whilst DB had preferred the evidence of LD during his investigation, during his live evidence DB took a more balanced view of the Registrant. He had raised concerns about the Registrant’s lack of preceptorship training. He sought to assist the Panel and was reliable, but at times appeared somewhat defensive.

117. The Panel found that LD after the passage of time struggled to remember little more than her witness statement. She appeared nervous and her evidence lacked consistency. The Panel placed less weight on her live evidence than that of the other witnesses.

118. The Panel considered the evidence of DM, the Registrant’s line manager. His live evidence was consistent with his witness statement. He was somewhat guarded. The Panel noted that whilst DM was in charge of the development of the Registrant’s career, he did not appear to involve himself in the decision on the secondary employment issue. His evidence was largely reporting on what others had done. He sought to assist the Panel so far as he could do so.

119. JH, the assessor on 26 July 2016, was credible, consistent, clear and very knowledgeable in her field. She assisted the Panel as far as she was able to do so. The Panel noted that there was no live evidence from the assessor who carried out the 21 June 2016 development day in particular 2.

120. The Panel found the Registrant sought to assist the Panel and readily acknowledged his shortcomings. He was clear and consistent with his evidence and accepted where he was unable to recall matters. The Panel found the Registrant credible.

121. The Panel noted the exceptional circumstances of 16 October 2015. This was the very first day the Registrant had primacy of care, in that it was his first shift as clinical lead. He also at the time of this incident had not had the benefit of a preceptorship or the support of a clinical mentor. DB accepted the Registrant ought to have had that support, but had not received it.

Finding on Facts
122. The Panel considered each of the particulars of the allegation and found as follows.

Particular 1 (a) i) - Proved


123. This is admitted by the Registrant. There was no evidence that the Registrant followed the appropriate diagnostic procedure to ascertain the patient’s consciousness level (known as AVPU). In his live evidence the Registrant explained why he had concluded the patient was unconscious. That did not include him checking the pain response. The Panel found the particular proved.

Particular 1 (a) ii) – Proved

124. In her live evidence LD was very clear that Patient A was lying on his side. That is consistent with her earlier statement to DB in his investigation. The Panel understand that the HCPC case is that “lateral” meant lying on the back. Lateral in fact means on the patient’s side. The Registrant did not place Patient A in a lateral position as the patient was already in the lateral position, that is on his side.

125. The Registrant admits to not opening the airway by using the head tilt and chin lift method. He accepts that this ought to have been done, and that it would have maintained and optimised the airway. The Panel found the particular proved.

Particular 1 b) i), ii) ,iii) iv), & vi) - Proved

126. The Registrant admits these parts of the Particular. The Panel accepted the evidence from DB and determined that the Zoll machine was not communicating with the EPR. There was no evidence that the Zoll and EPR were compatible on that day. There are some significant patient observations and interventions which the Registrant could have inputted on the EPR manually, but he did not do so. These are important records, particularly with regard to seriously ill patients. The Panel found the particulars proved.

Sub-particular 1 b) v) - Not Proved

127. The Panel accepted the evidence of the Registrant where he said in his written response to the Allegations, that in respect of the Rhythm strip it was not possible to record that manually. It has found there was a compatibility issue between the Zoll machine and the EPR and so the Rhythm strip could not have been recorded. The Panel found sub-particular 1 b) v) not proved.

Particular 1 e) & f) - Proved

128. The Registrant admits these particulars. The Registrant was the clinical lead. LD was clear in her evidence that the Registrant had not taken leadership and had not communicated the treatment plan. The Panel found these particulars proved.

Particular 1 i) - Not Proved
129. The Panel noted that in this particular it is not specified when, in this time critical incident, this is alleged to have happened. The HCPC relied solely on the evidence of LD which was that, when she was driving at 70 to 80 mph, she had looked into the back of the ambulance through a small window to observe the Registrant. She had said that she thought that the Registrant was doing nothing. However, in her live evidence she accepted that when driving at speed she was not actually in a position to observe the Registrant more than momentarily. The Panel did not find LD’s evidence credible or consistent. On the balance of probabilities, the Panel found this particular not proved.

Particular 2 a) - Proved

130. The Registrant admits this particular. The Panel considered and accepted the records of the paediatric advanced life support assessment on 21 June 2016. It did not hear live evidence from the assessor. The assessment records set out the evidence of the Registrant’s failure of this test, and it is not contested. The Panel considered this was a serious matter. It found this particular proved.

Particular 2 b), c) & d) - Proved

131. The Panel considered and accepted the documentary evidence of the assessment. The records show the Registrant did not do what is alleged at 2 b), 2 c) or 2 d). The Registrant admits 2 b) and cannot recall 2 c) or 2 d). The Panel found these particulars, and the stem of the particular, proved.

Particular 3 - Proved

132. The Panel noted the two assessment scenarios to which these particulars relate. Scenario 3 concerned a child presenting with abdominal pain, which the Registrant wrongly diagnosed as meningitis. The correct diagnosis was a ruptured appendix. The Panel noted that the Registrant passed this scenario although concerns were raised. Scenario 4 concerned a child presenting in cardiac arrest. The Registrant failed this scenario.

Particular 3 a) - Proved

133. The Registrant admits this particular and the documentary report and evidence of JH support the particular. The Panel accepted JH’s evidence and found this particular proved.

Particular 3 b) - Proved

134. This is admitted by the Registrant and the Panel accepted the evidence from JH. The Panel also accepted the evidence of JH that personal circumstances were not relevant in these standardised assessment scenarios, which required an objective approach to ensure safe and effective practise by all candidates. The Panel found this particular proved.

Particular 3 c), d) & e) – Proved

135. These parts of the Particular are admitted. The Panel noted that these are all elements of time critical assessments. The Panel accepted the evidence of JH and found these particulars proved.

Particular 3 f) - Proved

136. The Registrant cannot recall this particular, but did not deny it. The Panel considered and accepted the evidence of JH in her live evidence and in her reports on the assessment. She said that the Registrant did not reassess the patient after interventions. JH gave the example that the Registrant did not check the defibrillator and check the heart rhythm every two minutes. Further he did not take a blood pressure before administering sodium chloride. The Panel found this particular proved.

Particular 3 g) – Proved

137. The Registrant admits this particular. The Panel considered the evidence of JH and noted that this particular relates to scenario 3, which related to an abdominal assessment. The Panel accepted JH’s evidence in her witness statement that the Registrant did not utilise the abdominal pain assessment pneumonic “PQRST” approach. The Panel found this particular proved.

Particulars 3 h) & i) - Proved

138. The Registrant admits these particulars, although he said he was unclear about utilising a colleague in the assessment. The Panel considered and accepted the evidence of JH. She said in her witness statement that she had concerns about the Registrant’s communication and delegation in both scenarios 3 and 4 of the assessment. The Panel found these particulars proved.

The HCPC Standards

139. The Panel considered the 2012 HCPC Standards of conduct, performance and ethics (the Standards) for particular 1, and the 2016 version of the Standards for particulars 2 and 3.

140. The relevant 2012 Standards are;

5 You must keep your professional knowledge and skills up to date.

7 You must communicate properly and effectively with service users and other practitioners.
10 You must keep accurate records.

141. In light of the findings of fact on the Registrant’s communication with his colleague, LD, and his standards of practise in particular 1, the Panel finds the Registrant breached standard 5 and 7. The Panel also found Standard 10 was breached given its findings in Particular 1, given the time critical emergencies in which the Registrant must practise safely.


142. With regard to particulars 2 and 3, the Panel considered the following 2016 Standards to be relevant:

2.5 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
2.6 You must share relevant information, where appropriate, with colleagues involved in the care, treatment or other services provided to a service user.
4 Delegate appropriately


143. The Panel found that, in respect of its findings in particular 3 about the Registrant’s communication with his colleague, that Standards 2.5 and 2.6 were breached by the Registrant. The Panel determined that Standard 4 was breached by the Registrant, given its findings on his failure to delegate to colleagues in the assessments.

144. The Panel also considered the following HCPC Standards of proficiency for Paramedics to be engaged:

1 be able to practise safely and effectively within their scope of practice
1.4 be able to work safely in challenging and unpredictable environments, including being able to take appropriate action to assess and manage risk
4 be able to practise as an autonomous professional, exercising their own professional judgement
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
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
4.3 be able to initiate resolution of problems and be able to exercise personal initiative
 
4.4 recognise that they are personally responsible for and must be able to justify their decisions
4.5 be able to use a range of integrated skills and self-awareness to manage clinical challenges effectively in unfamiliar and unpredictable circumstances or situations

8 be able to communicate effectively
9 be able to work appropriately with others 10 be able to maintain records appropriately
14 be able to draw on appropriate knowledge and skills to inform practice

145. The Panel determined that the Registrant breached Standard 1 given the facts found proved in particular 2. Standard 1.4 was breached by the Registrant given its findings on particular 3. Given its findings of fact in all three particulars of the Allegation, the Panel determined that Standards 4.1 to 4.5 were breached by the Registrant. The Panel determined that Standard 8 was also breached for the reasons set out above regarding communication.

146. The Panel found, given its finding of fact, that Standard 9, regarding working with colleagues, and Standard 10, requiring accurate record keeping, were also breached by the Registrant. Standard 14 was breached with regard to its findings on particular 2.

147. The Panel carefully considered all the facts found proved and its findings as to the breach of Standards. The Panel considered the guidance in Roylance v GMC [2000] 1 AC 311 as to misconduct. The Panel exercising its independent professional judgement, found that its findings were not sufficiently serious as to amount to misconduct. The Panel noted that the HCPC made out no case for misconduct.

Decision on Lack of Competence

148. The Panel exercised its professional judgment and was mindful of the guidance in the Holton and Calhaem cases. The Panel accepted the advice of the Legal Assessor and considered the submissions from both parties. The Registrant accepts lack of competence for particulars 2 and 3. It was mindful that lack of training was not relevant to the assessment of competence given the guidance in the Holton case.

149. The Panel determined that the very nature of the 26 July 2016 assessment was to assess the Registrant’s ability to practice safely and effectively. The Panel also determined that the significant and wide ranging breaches of the Standards it has found showed a pattern of conduct by the Registrant which indicate a lack of competence.
150. The Panel considered its findings in particular 1 as to the Registrant’s communication, delegation, clinical leadership and not recording accurately or adequately. It determined that these findings cumulatively amount to a lack of competence.

151. The Panel’s findings on particulars 2 and 3 also amount to a lack of competence given that these assessments were specifically designed to assess the Registrant’s competence. The Panel noted that the Registrant does accept that particulars 2 and 3 are capable of demonstrating a lack of competence.

152. The Panel concluded that in light of its factual findings on all three particulars, and its findings on a wide range of breaches of the relevant professional standards, that its findings as a whole constitute a lack of competence.

153. The Panel reconvened on 1 August 2018. Mr Millin provided the Panel with a witness statement by JD at SWASFT attaching a report of assessments undertaken by the Registrant in June 2018 following a two week supervised Paramedic Placement (“the SWASFT Assessment Report”).

Application for Expert Evidence

161. Ms Hennessy made an application to receive in to the evidence the expert report of William Broughton dated 26 July 2018. She explained the chronology leading to the expert report. She explained that the Registrant’s relationship with his employers, SWASFT, was strained and he considered the SWASFT Assessment Report whilst making many positive comments was still critical and not fair. This led to the decision that the Registrant obtain his own, independent expert assessment of his clinical competence which she now sought to place before the Panel. Ms Hennessy told the Panel that the Registrant had funded the report himself and he was not in a position to afford to have the author of the report attend and give live evidence.

162. Ms Hennessy told the Panel an expert report had been prepared formally and the expert, Mr Broughton, had provided his professional opinion to assist the Panel.  She submitted it would be unfair for the Panel not to consider the expert report. 

163. Mr Millin referred to the SWASFT Assessment Report produced by JD.  It concluded that there remained concerns about the Registrant’s fitness to practise.  He submitted there was a conflict between that position and that of the Registrant’s expert, Mr Broughton.  JD had not seen the expert report but Mr Broughton had seen the SWASFT assessment report.  He submitted it was difficult to see how the conflict could be resolved by the Panel in the absence of the examination of the expert. He submitted that in the absence of testing the evidence, any conflict should be resolved in favour of the HCPC.

164. Mr Millin referred to the law as to hearsay evidence and the requirement for fairness. He accepted that both the assessment report by SWASFT and the expert report may be of assistance to the Panel.


165. Ms Hennessy submitted that JD was not an expert and was not the person who had carried out the assessments. She questioned how useful his evidence would be in those circumstances. She submitted that it was fair and reasonable for the Panel to consider both the SWASFT report from JD and the expert report and she said that the reports were not in conflict as regards the Registrant’s fitness to practise.

Decision on Expert Evidence

166. The Panel heard and accepted the advice of the Legal Assessor. He referred the Panel to the guidance and factors on the admissibility of hearsay evidence in Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565 (Admin).   He advised the Panel on the discretion it has as to the weight it may attach to any evidence it decides to allow into evidence, and reminded the Panel of the central importance of fairness. He reminded the Panel that the decision on impairment was one for its own professional judgement and there was no burden of proof on either the HCPC or the Registrant.

167. The Panel considered the submissions and the Thorneycroft case carefully.  It determined that it would be helpful and of assistance to receive the evidence of the expert, Mr Broughton.  The Panel has been told that he has produced a formal expert report containing the appropriate declarations and the Panel has had an acceptable explanation as to his non-attendance.  The Panel noted that this is an expert report expressing a professional opinion appropriately addressed to the Panel. Whilst the Panel are advised by the parties that there is some contention about the expert report, that is a matter that the Panel consider it can fairly and appropriately deal with when assessing all the evidence, including the evidence of the SWASFT assessment report produced in evidence by Mr Millin for the HCPC. No factual conflict arises. 

168. The Panel also considered the seriousness of the allegation and the impact of an adverse finding on the Registrant’s career and determined that it would be unfair to exclude this expert evidence in the circumstances. The Panel noted that the HCPC had received prior notice of the expert report and Mr Millin told the Panel that the HCPC did not seek to obtain their own expert report. 

169. The Panel is mindful of the need to act fairly and that, importantly, impairment is a matter for its own professional judgement and there is no burden of proof. The Panel is satisfied that it is fair, relevant and of assistance to the Panel to admit the expert evidence of Mr Broughton.  The Panel will weigh and consider that evidence along with all the other evidence bearing upon impairment, and it shall apply its own professional judgement to that issue.

170. The Panel received the Witness Statement of JD and the SWASFT Assessment Report. Ms Hennessy told the Panel that she did not seek to call JD as a witness. Mr Millin closed the case for the HCPC.

Witness BC

171. The witness BC took the oath and spoke to his witness statement. He is a Band 6 Paramedic for South Central Ambulance Service (SCAS).  BC told the Panel he had worked very frequently with the Registrant at SCAS, some three years ago when the Registrant was an Emergency Care Assistant (ECA). He considered the Registrant’s clinical knowledge to be particularly good and he told the Panel that he found the Registrant, as an ECA, had clinical knowledge above that of a non-clinician.

172. BC said the Registrant was good with patients and communicated well. He considered the care he and the Registrant had delivered was always of a high standard.  He had no concerns about the timeliness of his practice and care as an ECA and considered the Registrant was “more than competent” and understood guidelines and procedures. BC did not find the Registrant had been overly task focussed and he had communicated well with him.  He provided a high level of care and supported BC as the Paramedic and clinical lead. He told the Panel about a particular case regarding a child with life threatening anaphylaxis. BC told the Panel that the Registrant was highly committed to his work and did not recall the Registrant ever calling in sick or being late. He put patients first, even to his own detriment. BC was confident in his view of the Registrant.

173. In response to questions from Mr Millin, BC told the Panel that there were some staff members in SCAS who had alienated the Registrant and had not supported him. BC knew the Registrant had not completed his Preceptorship and he considered that he ought not to have been placed as a Paramedic with an ECA at the time that he was.  BC told the Panel he considered that the Registrant had not been supported during a difficult time for him personally.

The Registrant’s evidence on impairment

174. The Registrant affirmed and gave his evidence. He told the Panel about his career history and his time as an ECA at SCAS.  During that time he took his degree in Paramedic Science graduating in 2015. He left SCAS in October 2015 as a Paramedic and then joined SWASFT. From August 2016 the Registrant has been working as an ECA at SWASFT, except for the two week supervised Paramedic Placement in June 2018. 

175. The Registrant told the Panel about his reflective pieces relating to a number of specific cases he recently attended both as a Paramedic and as an ECA. He explained he has kept a log of his supervised Paramedic Placement activity (in accordance with his conditions) but his supervisors had not signed off all of these as they had been told by a senior colleague not to do so.

176. The Registrant told the Panel that he had recently attended a two day Paediatric Advanced Life Support (PALS) course accredited by the Resuscitation Council (UK). He told the Panel that the course he had attended had greatly improved his confidence dealing with a host of paediatric scenarios. The Registrant went on to explain that he had passed the practical element of the course but initially failed the written assessment by one mark but said that he had passed on the second attempt within the three month resit deadline. He told the Panel about the letter of thanks that he had received from the daughter of a patient he had treated recently, in July 2018. The Registrant referred to his reflective piece about the whole situation over the last few years. He was conscious of the reputation of the profession.

177. The Registrant told the Panel about his training and obtaining his degree. He worked full time as an ECA throughout and this had involved long hours and disruption to his family life. He had reflected on his communication skills and the issue of fixation on tasks in his Paramedic role and felt more confident about those issues. He said he was working with a good team and had gained confidence whilst working for the last two years as an ECA.  He had also carried out professional development, including a PALS course. He said he has done as much as he can to keep his Paramedic skills up to date. He said he had worked very hard to qualify and he was very keen to return to his role as a Paramedic.

178. In response to cross examination by Mr Millin, the Registrant explained his understanding regarding the reputation of the profession. He referred to his recent reflective statement  where he acknowledges the impact on the family regarding the incident involving Patient A and the impact on public confidence in the profession as a whole. The Registrant did not agree that he got “fixated” on tasks and said that he did not struggle with taking on board criticism and the views of colleagues. The Registrant said that he did not agree with the SWASFT Assessment Report which stated that he had not yet reached the required standard to work as an autonomous Paramedic. He said his work was consistent. He accepted that he sometimes can take longer to do some tasks than others Paramedics but that the context of his work was relevant.

179.  In response to Panel questions, the Registrant initially said he considered he was at the standard of an autonomous Paramedic following his recent period of support. He accepted that he still had room for improvement in his skills.  When questioned further by the Panel he stated, “I can’t walk out of here as a Band 6 [Paramedic], that would be stupid”. As regards the support he needed, the Registrant said that he would want several months of support and possibly work in an A&E department as part of a team. The Registrant said that he accepted he could not immediately return to autonomous practice and that a hospital setting would be one good way to return to practise. He did not think he would need the full two years as a newly qualified Paramedic. He wanted to make sure he was safe to practise and the public was protected.

180. When referred to the expert report regarding forward planning, the Registrant said that he felt that in a supervised scenario his calm approach could be misconstrued.  On assertiveness, the Registrant said that he had not found that was ever an issue and that he could be assertive when required.

Submissions on Impairment

181. Mr Millin for the HCPC referred to his skeleton submissions.  He set out the law on impairment and referred to the case law. He submitted that the Registrant had brought the profession into disrepute and the Panel had already identified that he had breached a number of parts of the relevant professional standards. He reminded the Panel about the need for evidence of remediation by the Registrant.  Mr Millin accepted that the Registrant has made efforts to remediate his practise.

182. Mr Millin submitted there was still a risk to patient safety, and in any event the public interest demanded a finding of impairment in order to uphold proper standards in the profession. He invited the Panel to make a finding of impairment.

183. Ms Hennessy submitted that the Registrant’s current fitness to practise is not impaired.  The Registrant is not a risk to the safety of the public and as of today was at the level of a newly qualified Paramedic and he required no formal restrictions on his practise. She submitted that the concerns about lack of competency have been remedied and any concerns appear to be fairly narrow and those are areas that can be dealt with by practice. He has passed the PALS course despite his absence from practise as a Paramedic. Ms Hennessy referred to the Registrant’s personal circumstances at the time of the allegation which provided context. Ms Hennessy submitted that the Registrant was now better able to cope. 

184. Ms Hennessy submitted that the Registrant was highly dedicated and had been very nervous at the second assessment in July 2016. She told the Panel that the Registrant had a high level of insight and would seek employment in a supportive environment. She said that he knows he will require support in any new role and a period of induction, and any new employer will be aware of his absence from the profession and will require him to complete between 30 – 60 days of updating. The Registrant was a highly reflective and considered person.  She referred to the reflective pieces and testimonials. She reminded the Panel that the Registrant has worked as an ECA for the last two years and she referred the Panel to the evidence it has heard about his practice and his CPD record. She referred the Panel to the many testimonials in support of the Registrant and to the SWASFT Assessment Report.

185. Ms Hennessy referred the Panel to the assessments carried out by the expert, Mr Broughton, and his report. She reminded the Panel that the expert, not the employer, had been fully impartial and independent.  She submitted that the expert sets out his methodology clearly.  She referred to the expert’s summary and that the Registrant was able to demonstrate safe and effective clinical practice to the level of a newly qualified Paramedic.

Decision on Impairment

186. The Panel considered the submissions of both Mr Millin and Ms Hennessy and it carefully looked at all the documentary evidence.  It heard and accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Finding Fitness to Practise Impaired.  He reminded it to keep in mind the importance of protecting the public and the wider public interest. He referred the Panel to the guidance in Council for Healthcare Regulatory Excellence v NMC and Grant [2011] EWHC 927 (Admin) on the consideration of insight, remediation and the risk of repetition, and the assessment of current impairment of fitness to practise. The Legal Assessor also reminded the Panel as to the approach to the weight it might attach to the expert report.

187. The Panel found that the expert report was helpful.  It appeared to  be impartial and was  thorough and detailed. It clearly expressed an independent professional opinion based upon a number of assessments of the Registrant by its author, Mr Broughton. The Panel reminded itself that, whilst it attached some weight to the expert report and it was of some assistance, the report was hearsay.  It had not been fully tested in evidence and the Panel did not hear from Mr Broughton.  The Panel was mindful that the decision on impairment was one for its own professional judgement and it proceeded on that basis.   

188. The Panel found that whilst BC sought to assist the Panel, and was credible, he had only worked with the Registrant as an ECA at SCAS.

189. The Panel first considered the Registrant’s insight and his reflective pieces.  It was impressed by his reflections and his grasp of the importance of public confidence in the profession.  He had clearly reflected  on the impact on the family of patient A and stated :- “I can only hope that should they ever need to call upon an ambulance again in the future, they will feel able and confident in doing so”.

190. The Panel noted that the Registrant had reflected on his practise both as an ECA, and as a Paramedic on his recent two week supervised Paramedic Placement at SWASFT.  The Registrant gave seven reflective examples of his role as a Paramedic and he appears to have applied these to the particular concerns found in the allegation.  The Panel noted that all the testimonials related to the Registrant’s practice as an ECA.

191. The Panel found that the evidence indicated that the Registrant has a high level of knowledge and it is clear to the Panel, from his evidence, that the Registrant is well motivated and he is willing to learn and to remediate his practice.

192. The Panel considered remediation. It found that the lack of competence found proved is remediable and that the Registrant has taken steps to remediate aspects of his practice.  It considered the Registrant’s evidence, the SWASFT Assessment Report and the expert report.  The Panel found that the Registrant does appear to have remediated his practice in respect of adequate recording, which the Panel found included both timely and accurate recording.

193. The Registrant has taken steps to remediate his communication skills.  The Registrant’s evidence was that his communication skills had improved. The SWASFT assessments of the two week supervised Paramedic Placement in June 2018 deal, in part, with communication. It comments both positively and negatively on the Registrant’s communication skills. It states that at times the Registrant’s communication was “muddled” and that his history taking was not effective in that there was no structure to it when examining a patient. The expert states that that the Registrant’s communication was “good”.

194. In respect of communication the Panel found that the Registrant had developed and significantly remediated his practice, but this was ongoing and was not fully remediated.

195. The Panel considered remediation in relation to particular 3 of the allegation, being the issues of time critical interventions and managing complex situations.  This particular was admitted by the Registrant and was found proved. The expert states that the Registrant lacked a sense of urgency in time critical situations. The SWASFT Assessment Report found there was  a “slight improvement” with the Registrant’s management of complex decision making, however he became task focussed when confronted with unexpected difficulties.  BC, states in his testimonial letter of 18 December 2016 that the Registrant was “fastidious” but that “this only serves as a hindrance when he is not given clear direction.”  The Panel noted that this observation was in relation to the Registrant’s practice as an ECA. In practice as an autonomous Paramedic, the Registrant will be the clinical lead and will not subject to direction from other clinicians. In the testimonial from a Paramedic Team Leader dated 15 December 2016, the Panel noted that concern was expressed about the Registrant’s lack of confidence when under pressure.

196. The expert report deals with a paediatric advanced life support simulation. The expert expresses the opinion that the Registrant’s decision making process was delayed whilst the information was processed both in this simulation and in the Registrant’s ability to manage complex situations requiring interventions in a timely manner.

197. The expert concluded in his report that the Registrant “has demonstrated competency equivalent to that of a newly qualified Paramedic”.  The Panel is mindful, however, that the Registrant is not a newly qualified Paramedic.  The Registrant himself said in his evidence that “I think it would be stupid to go out of here as a band 6 Paramedic”.  He acknowledged that he would need support and would need to work with another qualified member of staff for a period of time.  The Registrant told the Panel that he would need a package in place to reach the required standard. 

198. The Panel recognised that the Registrant has good insight and has worked very hard to remediate this practise.  He has improved his practise.  However, the Panel remained concerned that remediation is still developing and is not complete. The Panel found that the Registrant himself appears to recognise this in his own evidence.  The Panel determined that there remains a risk of repetition in respect of deficient communication skills and in the management of time critical and complex situations.

199. The Panel determined that the evidence indicates that deficiencies remain in the Registrant’s practice, particularly with respect to communication skills and in the management of time critical and complex situations. Applying its own professional judgement to all the evidence, including that of the Registrant, the SWASFT assessment and the expert report, the Panel concluded that whilst there has been significant remediation, there remains a risk of repetition of the deficiencies identified. The Panel accordingly found that the Registrant’s fitness to practice is currently impaired.  

200. The Panel also considered the public interest aspect of impairment.  The Panel has found there is a risk of repetition of deficiencies that impact on the wider public interest.  Given its findings in respect of risk of repetition, the Panel considered that a member of the public properly informed of the facts would be concerned were the Registrant to be allowed to return to practise on an unrestricted basis. The Panel determined that the public interest required a finding of current impairment in order to protect the public, to uphold proper standards and to maintain confidence in the profession and the regulator.


Submissions on Sanction

201. Mr Millin submitted that the HCPC took a neutral stance on sanction  and he reminded the Panel about the law as to sanction and the HCPC Indicative Sanctions Policy (ISP).  He referred to the Panel’s findings on insight and remediation and submitted that the risk of repetition, potential for patient harm and the lack of fully developed insight were aggravating factors.

202. Ms Hennessy referred to the ISP and the need to apply the least restrictive means to protect the public, balanced with the interests of the Registrant.  She submitted that the Registrant has made a determined effort to remediate his practise and he is willing to comply with any Conditions of Practice Order which, she submitted was the most appropriate sanction.

203. Ms Hennessy told the Panel that the Registrant would want to seek employment in a hospital setting but direct supervision would not be workable in such a setting.  She submitted that some element of support would be appropriate and that would be workable in a hospital setting.  Ms Hennessy sought that the Panel avoid conditions that require direct supervision.  She submitted that the concerns had narrowed since the interim order was imposed in April 2018. The Registrant has now successfully completed a PALS course and remediation is underway and there is a high level of insight by him. She submitted that a Suspension Order would be disproportionate and go further than required to deal with the risk identified.

204. Ms Hennessy suggested that conditions of practice be imposed with direct supervision if in an ambulance setting, but with general supervision if the Registrant were to be in a hospital setting. She placed before the Panel suggested conditions of practice.

 

 Decision on Sanction


205. The Panel heard and accepted the advice of the Legal Assessor.  He  referred the Panel to the ISP and reminded it to act proportionately, that is balancing the public interest with that of the Registrant.  He advised the Panel to consider the sanctions in ascending order and to apply the least restrictive sanction necessary to protect the public. It should also consider any aggravating and mitigating factors and bear in mind the public interest and that the primary purpose of sanction was protection of the public. 

206. The Panel was mindful that the purpose of sanctions is to protect the public and not to punish the Registrant.  The Panel also kept in mind the need to protect the wider public interest and the need to act proportionally.

207. The Panel considered that the mitigating factors were the Registrant’s significant insight and the substantial remediation achieved to date. The Panel took account of the evidence of the Registrant’s extensive CPD, the positive testimonials and the Registrant’s personal circumstances at the time. It also noted that appeared to be some lack of support at times from employers. The Registrant has also fully engaged with the HCPC.

208. As to aggravating factors, the Panel found that the Registrant’s failings related to core skills of a Paramedic and that there was a risk of potential harm to patients.

209. The Panel approached sanction, beginning with the least restrictive first, bearing in mind the need for proportionality. Taking no further action and the sanction of a Caution Order would not reflect the seriousness of the allegation found proved and the finding of impairment.  The Panel has found deficiencies in the Registrant’s practise and has identified a risk of repetition.  The Registrant has been found not to be at the standard required of an autonomous Paramedic, and in those circumstances a Caution Order would not be appropriate or proportionate as it imposes no restriction on the Registrant’s practice and would place members of the public at potential risk of harm.  Further, given the findings of the Panel, a Caution Order would not satisfy the wider public interest in upholding proper standards and maintaining public confidence in the profession and the regulator.

210. The Panel next considered a Conditions of Practice Order. The Panel has found that the Registrant’s fitness to practise is impaired and there is a risk of repetition. It has identified particular areas of concern. It also carefully considered the conditions suggested by Ms Hennessy. The Panel considered paragraphs 30 and 31 of the ISP and decided that workable, realistic, verifiable and proportionate conditions of practice were capable of being formulated to deal with the areas of concern identified by the Panel.  The issues which the conditions seek to address are capable of correction and the Registrant has clearly demonstrated his willingness to comply with conditions.  

211. The Panel considered two different settings in which the Registrant  might work and it was mindful of  the need to avoid imposing Conditions of Practice that amount to a Suspension.  It accepted that in hospital settings, or other definitive care settings, there are adequate support systems and safeguards in place.  In that setting, certain conditions of practice were appropriate and proportionate and would protect the public.  The Panel determined that it was appropriate and proportionate that an alternative form of conditions would apply if the Registrant were to find employment in an NHS Ambulance Trust, where there is likely to be less support.

212. The Panel accordingly determined to impose the Conditions of Practice as set out in the Order.

213. The Panel determined that the conditions shall be imposed on the Registrant for a period of 18 months.  It decided to impose that period in order to allow the Registrant to demonstrate full remediation and to successfully complete the supervisory requirements in both settings.  The Panel noted that these conditions will be reviewed before they expire, and the Registrant may also apply for an early Review of the substantive order.


214. The Panel considered the terms of the paragraph 42 of the HCPC Sanctions Policy.  With that in mind, the Panel determined that Conditions of Practice are adequate to protect the public and satisfy the wider public interest and that a Suspension Order would not be proportionate or appropriate.

215. A reviewing Panel may be assisted by the Registrant providing the following before the review hearing :-

• Any further reflective pieces
• Records of any further relevant CPD
•  Testimonials

Order

ORDER: The Registrar is directed to annotate the HCPC Register to show that, for a period of eighteen months from the date that this Order takes effect (“the Operative Date”), you, Mark Higgins must comply with the following conditions of practice at any time that you are working as a Paramedic :-

1. You must confine your professional practice to working in either a hospital, or other definitive care setting (Setting A); or for an NHS Ambulance Trust (Setting B).

Setting A:

2. In relation to any work that you undertake as a Paramedic in a hospital or other definitive care setting, you must place yourself under the general supervision of a Paramedic registered by the HCPC or a doctor registered by the GMC or a nurse registered by the NMC.  This means that on any shift you have a named supervisor who must be based at the site where you are undertaking that particular shift.  The supervisor can be a different person on different shifts.  

3. You must satisfactorily complete and pass an accredited course on Advanced Life Support provided by the UK Resuscitation Council or similar body and;
• forward a copy of proof of your attendance and your successful completion at that course to the HCPC
• provide a reflective piece detailing your developed understanding, following conclusion of the ALS course. This should also be forwarded to the HCPC prior to any review of these conditions
4. You must have a practice placement educator (or equivalent person) who is suitably qualified to provide further support and guidance. They must be available on a regular basis to speak to you (which can be by telephone), and meet with you to discuss your progress and development.  

5. You must devise and develop an individual development plan with your practice placement educator to address the deficiencies in the following areas of your practice:
• Communication skills
• Time critical interventions
• Clinical decision making

You must provide evidence of your progress on this programme to the HCPC prior to any review hearing.

6. You must not work as an autonomous clinician in this setting unless and until after a minimum of 6 months of general supervision, your practice placement educator has assessed you as competent to do so. You must provide a report from your practice placement educator of this assessment to the HCPC prior to any review hearing.

Setting B

7. In relation to any work you undertake with any NHS Ambulance Trust, you must undertake and complete the Newly Qualified Paramedic Consolidation of Learning Programme (NQP Programme).

8. You must comply with all the principles of this NQP Programme as set out at www.nhsemployers.org (the Principles).

9. As part of your NQP Programme, you must initially undertake a 6 month period of supervised support working alongside an experienced Paramedic, as defined in the Principles.

10. You must ensure that your employer undertakes a formal review of your progress set against the NQP Programme’s themes and expectations following the 6 months of supervised support.

11. You must promptly forward a copy of the report mentioned in Condition 10 to the HCPC.

12. You must continue on the NQP Programme until you have successfully transitioned to a Band 6 Paramedic.

Conditions applicable to Settings A and B:

13. You must allow your employer to exchange information with the HCPC about your progress.

14. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

15. You must promptly inform the HCPC of any disciplinary or capability proceedings taken against you by your employer.

16. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;

B. any agency you are registered with or apply to be registered with (at the time of application); and

C. any prospective employer (at the time of your application).

Notes

 

 

 

 

Hearing History

History of Hearings for Mr Mark Higgins

Date Panel Hearing type Outcomes / Status
01/08/2018 Conduct and Competence Committee Final Hearing Conditions of Practice