Mrs Mandy Bradley

Preliminary Matters

Application to Amend Particulars

1. At the outset of the hearing, Mr Ferson applied to amend Particular 1 by deleting the words “carry out an adequate assessment” and replacing them with the words “complete a Medical Assessment Form in respect”. Mr Ferson submitted that the proposed amendment would more accurately reflect the case against the Registrant as set out in the witness statement of RF, would narrow the scope of the case against the Registrant and would not prejudice her.

2. The Registrant did not oppose the application.

3. The Panel heard and accepted the advice of the Legal Assessor.

4. The Panel was satisfied that the proposed amendment to Particular 1 would more accurately reflect the case against the Registrant, would narrow the scope of the case against her and would not prejudice her. The Panel allowed the application.

Background

5. In March 2016, the Registrant Paramedic was employed by G4S and practising as a healthcare professional. On 23 March 2016, she was tasked with attending to Patient A, a detainee of the Mansfield Custody Suite. The Registrant conducted an initial assessment of the patient, recording brief notes on the police computer system, NICHE. She noted that the patient had “collapsed to the floor in a controlled manner” on one occasion but did not require a referral to emergency services at that time.

6. The Registrant failed to complete a G4S Medical Assessment Form in respect of Patient A.

7. CCTV footage shows the Registrant in the same cell as Patient A on two occasions. On several other occasions she is seen to walk past or stand outside the patient’s cell but not go in.

8. The healthcare professional who attended to Patient A after the Registrant had finished her shift, observed the patient to be unresponsive and decided that an ambulance was required.

9. The Registrant maintained in a statement dated 24 March 2016 and later during an interview on 29 March 2016, that she conducted two sets of observations of the patient and attended to the patient at regular intervals. She admitted that she failed to complete a Medical Assessment Form but stated that when she left the patient at the conclusion of her shift, he was alert, conscious and talking.

Decision on Facts

10. In considering the particulars, the Panel applied the principles that the burden of proving the facts is on the Council, that the Registrant is not required to prove anything and that a fact alleged is only to be found proven if the Panel is satisfied on the balance of probabilities that it is correct.

11. In reaching its decisions, the Panel had careful regard to all the evidence put before it and to the submissions of Mr Ferson on behalf of the HCPC, as well as to the representations of the Registrant.

12. The documentary evidence before the Panel included:

• Witness statements from LS and RF prepared for the HCPC.

• G4S Investigation Report dated 19 April 2016.

• Disciplinary Hearing Meeting Notes – meeting with MY on 21 April 2016.

• Patient’s Medical Care Observation Log 23 - 24 March 2016.

• Patient’s Medical Assessment Form dated 23 March 2016.

• Patient’s Custody Summary dated 23 March 2016.

• Patient’s Medical Form dated 29 March 2016.

• Registrant’s employment and job role with G4S.

• Video Viewing Log recording Patient’s detention.

• Patient A Medical Records - 25 November 2011.

• Registrant’s Witness Statement prepared for Independent Police Complaints Commission (IPPC) dated 30 August 2017.

• Independent Office for Police Conduct (IOPC) Investigation Report dated 5 February 2018.

• Registrant’s Statement dated 24 March 2016.

13. The Panel was greatly assisted by this evidence, but relied on its own independent viewing of the CCTV footage in preference to the accounts of others.

14. The Panel heard oral evidence from:

i. LS, Independent Office for Police Conduct (IOPC) Lead Investigator - called by the HCPC. The Panel recognised that this witness is not a healthcare professional and that she joined the investigation in May 2017, when she took over from a colleague who had previously held the role of Lead Investigator in this matter. Although the IOPC focus was necessarily on the conduct of police officers involved in this matter, rather than on the healthcare professionals involved, the Panel found her to be a credible and reliable witness. The Panel was assisted by LS’s log of the CCTV footage but relied on its own review of the footage when reaching its decisions.

ii. RF, Investigating Officer on behalf of G4S - called by the HCPC. The Panel noted that RF is a qualified healthcare professional who was able to provide a clinical overview of what would have been expected and helpful context to the evidence put before the Panel. The Panel found her to be a credible and reliable witness.

iii. MVF, Investigating Officer on behalf of G4S and current and former colleague of the Registrant - Called by the Registrant. The Panel noted that MVF is a qualified healthcare professional who was not only one of the Investigating Officers in this matter but also had past and current experience of working with the Registrant. In terms of the factual issues in this case, the Panel did not find the evidence of this witness to be either credible or reliable. For example, he gave the Panel sworn evidence on the layout of the medical room at the times in question, but, when questioned, he said that he had not been there for 8 years and the layout might now be different. Consequently, the Panel did not feel able to reply on his factual evidence. In terms of the non-factual elements of his evidence, the Panel was assisted by and accepted his views on the qualities of the Registrant as a Registered Paramedic during the time he had known and worked with her, both before and after the incidents in question.

iv. The Registrant. The Panel found the Registrant’s oral evidence to be clear and broadly consistent with her original accounts of the matters in question. The Panel noted that during the course of her oral evidence she appeared to give careful consideration to points put to her and was willing to concede points of contention where appropriate.

15. The Panel received evidence from LW in the form of a letter written by him dated 29 September 2017. Part of the letter dealt with matters which the Panel was required to consider in relation to Particular 2(b). The Panel noted that this part of the letter appeared to be at odds with what the Panel observed on the CCTV footage. In the absence of LW, questions could not be put to him by Mr Ferson or the Panel. In those circumstances, the Panel was unable to attach any weight to the evidence contained in his letter.

Particular 1 – Found Proved

On 23 March 2016, you did not complete a Medical Assessment Form in respect of Patient A;

16. The Registrant told the Panel that she accepted that record keeping is an important part of the work of a Registered Paramedic. She accepted that she had not completed a Medical Assessment Form in respect of Patient A when she should have done so. She said that her failure in this regard had been “absolutely stupid” and that she was at a loss to explain how it had occurred. She said she was “very remorseful” for her error which had never happened before or since the incident in question. The Registrant told the Panel that she had learned from this experience and would never make such a mistake again.

17. The Panel noted the evidence of RF that when she had put the failure to the Registrant in the course of their meeting on 29 March 2016, the Registrant had immediately admitted it, had been unable to explain how it had occurred and had been upset and remorseful, telling RF “I could kick myself.”

18. The Panel also noted the evidence of MVF that he had worked with the Registrant before and since the incident in question, and had never known her to fail to complete a Medical Assessment Form.

19. RF told the Panel that the Registrant’s failure to complete a Medical Assessment Form resulted in a lack of detailed information available regarding both the clinical care the Registrant had given to Patient A and the patient’s status when she attended to him. She said that in the absence of such detail it is difficult to ascertain whether an adequate assessment had been carried out. The Panel noted that as a result of the Registrant’s failure there was less information available to health staff taking over from the Registrant when she went off shift than there should have been.

Particular 2(a) – Found Proved

In a 24 March 2016 statement, you stated “I entered the cell on regular intervals” which was not the case;

20. The Registrant accepted that in her 24 March 2016 statement she had stated “I entered the cell on regular intervals.”  The Panel had sight of the Registrant’s 24 March 2016 statement and was satisfied that it did contain the alleged assertion.

21. The Panel noted that in her written statement for the HCPC, LS had recorded in relation to the CCTV footage of the incident only two occasions when the Registrant had entered a cell where the patient was present. These were at 16.07 when the Registrant first viewed Patient A in the holding cell for approximately two minutes after his collapse, and at 16.15 when Patient A had been placed into his own cell and the Registrant had entered that cell and remained with the Registrant for approximately 10 minutes.

22. The Panel had sight of the relevant CCTV footage and RF’s log of the footage and was satisfied that the Registrant had not entered the cell on regular intervals. Rather, she had been in a cell with Patient A on only the two occasions referred to above, although there had been three occasions when she had passed the open door to Patient A’s cell. From the Panel’s own review of the footage it concluded that she had looked into the cell on only two of those three occasions.

23. In her oral evidence the Registrant accepted that the log of the CCTV footage was accurate and that she had not entered the cell on regular intervals. She told the Panel that the 24 March 2016 statement had been written the day after the incident in response to a request to put into writing her account of events. She said she had been stressed when she wrote her account as she had never been in such a situation before. She told the Panel “my choice of words is poor, it is not correct…I don’t know why I used those words. It wasn’t to cover up anything.” She told the Panel that she “had visual at all times” with the Officer charged with keeping the patient under constant Level 4 observation.

Particular 2(b) – Found Not Proved

In a 24 March 2016 statement, you stated "On leaving custody at 18:55 [Patient A] was conscious and alert and talking", which was not the case.

24. In her oral evidence, the Registrant accepted that in her 24 March 2016 statement she had stated “On leaving custody at 18.55 [Patient A] was conscious and alert and talking.” The Panel had sight of the Registrant’s 24 March 2016 statement and noted that it did contain the assertion alleged.

25. The Registrant told the Panel that shortly before she left the Custody Suite she had been informed by the Desk Sergeant, who had visited the Patient in his cell at 18.45, that the Patient had been conscious, alert and talking at that time. She said she trusted the Officer and had accepted his account. When cross examined by Mr Ferson the Registrant accepted that her understanding of the patient’s level of consciousness at that time was based on what she had been told rather than on what she had observed for herself. However, she said “It was my understanding that he was conscious and able to speak to staff. At no time during his detention did I think he was unconscious. I still believe that.”

26. The Panel heard from RF that “It is difficult to ascertain the level of the patient’s consciousness by reviewing the CCTV footage.” The Panel noted that in her log of the CCTV footage RF had recorded in respect of 18.45 “Do not see any movement from [Patient A] or any talking by him to Sgt PO5”; then at 18.53 “[The Registrant] has her coat on and is seen leaving/walking past cell.” 

27. The Panel noted that there was evidence that Patient A had been assessed as unconscious approximately 15 minutes later by the healthcare professional who took over from the Registrant. However, the Panel cannot conclude from that information that Patient A was also unconscious 15 minutes earlier.

28. In considering whether Patient A had been conscious, alert and talking at the time in question, the Panel reviewed the relevant part of the CCTV footage with great care. However, it was unable to reach a clear conclusion.

29. In all the circumstances, the Panel could not conclude that Patient A had been conscious, alert and talking at the time in question; but nor could it be satisfied on the balance of probabilities that this had not been the case and therefore the HCPC has not discharged the burden of proof to the required standard.

Particular 3(a) – Found Proved

In a 29 March 2016 meeting, you stated that you undertook two sets of observations on Patient A, which was not the case;

30. The Registrant accepted that in the 29 March 2016 meeting she had stated that she had undertaken two sets of observations. The Panel heard from RF that “During my interview of [the Registrant] on 29 March 2016, she stated that she had completed two sets of observations of the patient…” The Panel had sight of the notes of Registrant’s 29 March 2016 meeting and was satisfied that the Registrant had been recorded as stating that she undertook two sets of observations on Patient A.

31. RF told the Panel that during the 29 March 2016 meeting the Registrant had told her that she had completed one set of observations in the holding cell and a second set in Patient A’s cell. RF stated that “in the absence of a Medical Assessment Form completed by [the Registrant], there is no record of the number of observations she conducted and the details of any observations she conducted in relation to Patient A.”  In addition, RF noted that the Registrant had not recorded two sets of observations on the police computer system, NICHE. However, in her oral evidence, RF also told the Panel that while the first observation in the holding cell consisted only of a pulse oximetry test and would not be considered a complete set of observations, it was nevertheless an observation separate from the observations subsequently carried out in Patient A’s cell. The Panel accepted this point but did not consider that a single observation could be properly described as a set of observations.

32. In the circumstances, the Panel was satisfied that the Registrant had not carried out two sets of observations. Rather, she had undertaken a single observation in the holding cell and had subsequently carried out a set of observations in Patient A’s cell.

Particular 3(b) – Found Proved

In a 29 March 2016 meeting, you stated that you "kept popping in every 15 to 20 minutes" to check on Patient A, which was not the case;

33. The Registrant accepted that in the 29 March 2016 meeting she had stated that she had "kept popping in every 15 to 20 minutes" to check on Patient A, and that this had not been the case.

34. The Panel had sight of RF’s notes of her 29 March 2016 meeting with the Registrant and was satisfied that the Registrant had been recorded as stating that she kept popping in every 15 to 20 minutes to check on Patient A.

35. RF told the Panel her review of the CCTV footage did not support the Registrant’s assertion.

36. The Panel noted its consideration of the evidence in relation to Particular 2(a) and conducted its own review of the CCTV footage. It was satisfied that the CCTV footage did not support the Registrant’s assertion.

37. The Panel noted that during the course of her cross examination by Mr Ferson, the Registrant had accepted that the words “popping in” meant entering Patient A’s cell. She also accepted that there was a difference between what she said she had done and what she had actually done and that her choice of words had created a false impression. However, she said there had been no intention to mislead or be dishonest. She said the meeting had been very stressful because of what had happened to the patient and because she had never been in such a position before. She said her choice of words had not been the result of worry that her treatment of Patient A might be considered to have been a cause of what had happened to him.

Particular 4 – Found Proved (in relation to 2(a) and 3(b) only)

The actions set out at paragraphs 2 and / or 3 were dishonest.

38. In considering the issue of dishonesty, the Panel had careful regard to the guidance provided in the case of Ivey v Genting Casinos.

39. In respect of Particular 2(a), the Panel’s finding that in a 24 March 2016 statement the Registrant stated “I entered the cell on regular intervals”, when this was not the case: The Panel considered that the Registrant’s words portrayed a very different picture to what had actually occurred. The Panel did not find credible the Registrant’s explanation that this was due to a poor choice of words. Rather, the Panel concluded that the Registrant had deliberately made the false assertion, knowing it to be so, in order to conceal her failure to undertake the checks that she knew were required of her. The Panel had no doubt that ordinary decent people provided with the information that was before the Panel would conclude that the Registrant had acted dishonestly.

40. In respect of Particular 2(b), the Panel did not find proved the facts alleged. Accordingly, that particular could not to be considered in relation to Particular 4.

41. In respect of Particular 3(a), the Panel’s finding that in a 29 March 2016 meeting, the Registrant stated that she undertook two sets of observations on Patient A when this was not the case: The Panel considered that, although the pulse oximetry test conducted by the Registrant in the holding cell could not correctly be described as a set of observations, it was nevertheless an observation. In the Panel’s view, describing it as a set of observations was a poor choice of words on the Registrant’s part, but the Panel did not consider that the Registrant had intended to mislead. The Panel concluded that ordinary decent people, provided with the information that was before the Panel, would not conclude that the Registrant had acted dishonestly.

42. In respect of Particular 3(b), the Panel’s finding that in a 29 March 2016 meeting the Registrant stated that she "kept popping in every 15 to 20 minutes" to check on Patient A when this was not the case: The Panel considered that the Registrant’s words portrayed a very different picture to what had actually occurred. The Panel did not find credible the Registrant’s explanation that this was due to a poor choice of words and it noted that they were a refinement of the assertion in her written statement of 5 days earlier, 24 March 2016 that she had entered the cell on regular intervals. The Panel concluded that the Registrant had deliberately made the false assertion, knowing it to be so, in order to conceal her failure to undertake the checks that she knew were required of her. The Panel had no doubt that ordinary decent people provided with the information that was before the Panel would conclude that the Registrant had acted dishonestly.

Decision on Grounds

43. The Panel had careful regard to the submissions of Mr Ferson and accepted the advice of the Legal Assessor.

44. Mr Ferson referred the Panel to the Privy Council case of Roylance v GMC (No2) [2001] 1 AC 311 in which Lord Clyde stated: “Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a…practitioner in the particular circumstances.”

45. Mr Ferson submitted that the Registrant had fallen seriously below the standards expected of a Registered Paramedic as set out in the HCPC “Standards of conduct, performance and ethics”.

46. The Panel bore in mind that not every breach of the Standards and not every falling short of what would be proper in the circumstances will constitute misconduct; the breach must be serious, or as Elias LJ put it in R (on the Application of Remedy UK Ltd) v GMC [2010] EWHC 1245 (Admin) “sufficiently serious....that it can properly be described as misconduct going to fitness to practise.”

47. The Panel found that the Registrant was in clear breach of the following Standards of the HCPC’s “Standards of conduct, performance and ethics”, 2016 edition:

1 Promote and protect the best interests of Service Users.

9 Be honest and trustworthy.

9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

10 Keep records of your work.

10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.

48. The Panel’s findings on facts highlight one instance where the Registrant failed to record her assessment of a patient and three instances where she provided incorrect information as to the timing and / or extent of her interaction with the same patient. In two of the three instances the incorrect information had been dishonestly provided in order to mislead and to conceal the Registrant’s failings.

49. The Panel considered that completion of the Medical Assessment Form was important to the safety and ongoing care of Patient A and that there had been no justifiable reason for not completing it. The Panel concluded that the Registrant’s failure in this regard had constituted a serious falling short of what was expected of her as a Registered Paramedic.

50. In relation to the Panel’s findings of dishonesty in respect of Particulars 2(a) and 3(b), the Panel considered that the Registrant had been seeking to mislead an investigation and to conceal her own failings. Accordingly, the Panel concluded that the Registrant’s actions constituted a serious falling short of what was expected of her as a Registered Paramedic.

51. The Panel was concerned that not only had the Registrant breached the standards set out above, including the requirement that she act honestly, but that her failings had also diminished the level of information available to others in respect of both the care that had been received by the patient and his status during the Registrant’s period on duty. The Panel had no doubt that the Registrant’s failings found proved are so serious as to amount to misconduct going to her fitness to practise.

Decision on Impairment

52. The Panel went on to consider the issue of impairment by reason of the Registrant's misconduct. It had careful regard to all the evidence before it and to the submissions of Mr Ferson and the representations of the Registrant. It accepted the advice of the Legal Assessor and had particular regard to the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’”.

53. The Panel first considered past impairment. It noted its findings that the Registrant had deliberately misled an investigation, had been dishonest on two occasions and had failed to complete a Medical Assessment Form which was important to the safety of Patient A. It had also found that the Registrant’s misconduct had breached key standards of the HCPC’s “Standards of conduct, performance and ethics” as set out above, had brought the profession into disrepute and had undermined confidence in the profession. In addition, the Registrant’s misconduct had put Patient A at unwarranted risk of harm. In these circumstances, the Panel had no doubt that, at the times in question, the Registrant’s fitness to practise had been impaired by reason of her misconduct.

54. The Panel went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of that misconduct. In addressing the personal component of impairment, the Panel asked itself whether the Registrant is liable, now and in the future, to repeat misconduct of the kind found proved. In reaching its decision, the Panel had particular regard to the issues of insight and remediation.

55. The Panel noted that in the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin) Mrs Justice Cox stated: “When considering whether or not fitness to practise is currently impaired, the level of insight shown by the practitioner is central to a proper determination of that issue.”

56. The Registrant made several formal admissions and attended to give evidence before the Panel by way of telephone link. Further, the Panel has had the benefit of reading the Registrant’s responses to questions put to her in interview with RF. It has also read her own written accounts of the incidents in question.

57. In the Panel’s view the Registrant has demonstrated only limited insight into the seriousness of her misconduct and its impact on colleagues, patients and the profession. The Panel was concerned that the Registrant did not seem to appreciate the seriousness of her failings and their impact on the safety of Patient A and on public confidence in Police Custody Suites and in the paramedics who work in them. The Panel noted that the Registrant had expressed remorse for her failure to complete the Medical Assessment Form but considered that she had minimised the seriousness of that failure, in particular by expressing the view that there had been no consequential risk to Patient A. The Panel was also concerned to note that it had received no evidence of formal reflection by the Registrant on what had occurred, either in terms of its potential impact or in terms of what she should have done to avoid it.

58. The Panel had careful regard to Silber J’s guidance in Cohen v GMC [2008] EWHC 581 (Admin) that Panels should take account of:

• Whether the conduct which led to the charge is easily remediable;

• Whether it has been remedied; and

• Whether it is highly unlikely to be repeated.

59. The Panel recognised that remediation of misconduct which involves dishonesty may be less easy than remediation of misconduct involving clinical failings. However, it considered that with the development of meaningful insight the Registrant’s misconduct is remediable. It noted the Registrant’s assurances that she has learned from this experience and would not repeat the failings found proved. The Panel also noted that the Registrant has continued to work as a Registered Paramedic since the incidents in question, and that there has been no repetition. However, the Panel received no evidence of any specific relevant remediation which the Registrant may have undertaken.

60. In light of its findings in relation to insight and remediation, the Panel considered that there is currently a risk that the Registrant would repeat matters of the kind found proved. For these reasons, the Panel determined that a finding of impairment is required with regard to the personal component, including the need for public protection.

61. The Panel then went on to consider whether a finding of impairment is necessary on public interest grounds.  In addressing this component of impairment, the Panel had careful regard to the critically important public issues identified by Silber J in the case of Cohen when he said:

“Any approach to the issue of whether .... fitness to practise should be regarded as ‘impaired’ must take account of…the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour.”

62. The Panel considered that keeping full and accurate records is a fundamental requirement of the paramedic profession. However, the Panel considered that in light of the Registrant’s long and previously unblemished service as a healthcare professional, a single, isolated failure to complete a Medical Assessment Form would not be regarded by informed and reasonable members of the public as requiring a finding of impairment of fitness to practise on public interest grounds.

63. The Panel considered that acting with honesty and integrity is a fundamental requirement of the paramedic profession. The Panel considered that the public would be concerned to learn of the Registrant’s dishonesty in this matter. Further, the Panel had no doubt that the need to maintain public confidence in the profession, and to declare and uphold proper standards, would be undermined if a finding of impairment of fitness to practise was not made in the circumstances of this case in relation to the Registrant’s dishonesty. 

64. For all the reasons set out above, the Panel determined that the Registrant’s fitness to practise is currently impaired, both on the grounds of public protection and in the public interest.

Decision on Sanction

65. The Panel next considered what, if any, sanction to impose on the Registrant’s registration.

66. Mr Ferson drew the Panel’s attention to the HCPC’s Indicative Sanctions Policy and submitted that the question of sanction is a matter for the Panel’s own independent judgment.

67. The Registrant informed the Panel that she was totally committed to the remediation of her misconduct and would do whatever was required to achieve this.

68. The Panel heard and accepted the advice of the Legal Assessor.

69. In reaching its decision, the Panel had at the forefront of its thinking the principle of proportionality and the need to balance the interests of the Registrant with the protection of the public and the wider public interest in maintaining confidence in the profession and the HCPC, and in declaring and upholding proper standards of conduct and performance.

70. The Panel had regard to all the circumstances, including the following mitigating and aggravating features of the case:

Mitigating:

• The Registrant’s previous good character over a 22 year career in healthcare.

• The Registrant has continued to work as a Registered Paramedic since the incidents and there has been no repetition of misconduct.

• The positive testimonial of MVF.

• The Panel has found the Registrant’s misconduct to be remediable.

• The Registrant has fully engaged with the regulatory process and has assured the Panel that she is totally committed to the remediation of her misconduct. The Panel considered that this reflected a small degree of increased insight during the course of the hearing.

Aggravating:

• The Registrant’s failure to complete the Medical Assessment Form put Patient A at unwarranted risk of harm.

• The matters found proved included two incidents of dishonesty on 24 and 29 March 2016.

• There is a risk of repetition due to the Registrant’s lack of sufficient insight and remediation.

71. The Panel first considered whether it would be appropriate to impose no sanction in this case. It gave careful consideration to Paragraph 8 of the HCPC’s “Indicative Sanctions Policy”. The Panel determined that in light of its findings on insight and remediation and that there remains a risk of repetition, the imposition of no sanction would neither protect the public nor serve the wider public interest in maintaining confidence and declaring and upholding proper standards.

72. The Panel next considered the potential for mediation in this matter. It gave careful consideration to Paragraphs 26 and 27 of the HCPC’s “Indicative Sanctions Policy”. It noted that such a course may only be used if the Panel is satisfied that the only other appropriate course would be to take no further action. The Panel had no doubt that this is not such a case.

73. The Panel went on to consider the imposition of a Caution Order. It gave careful consideration to the factors set out in Paragraphs 28 and 29 of the HCPC’s “Indicative Sanctions Policy”.  The Panel considered that there remains a risk of repetition, the Registrant has demonstrated limited insight and no remediation, and the dishonesty, although isolated was not minor in nature. For these reasons, the Panel determined that a Caution Order would be inappropriate. Further, it would neither protect the public nor be sufficient to mark the wider public interest.

74. The Panel then considered the imposition of a Conditions of Practice Order. It gave careful consideration to Paragraphs 30-38 of the HCPC’s “Indicative Sanctions Policy”. In considering the suitability of a Conditions of Practice Order, the Panel kept in mind its finding that the Registrant’s misconduct is remediable and that there had been no evidence of a general lack of competence. The Panel considered that conditions of practice may be highly appropriate where there is a need to address clinical failings, but may not be so where there are probity issues involved. In this case the Panel was unable to formulate conditions to address the dishonesty found proved. The Panel determined that a Conditions of Practice Order would be neither appropriate nor sufficient at this time.

75. The Panel went on to consider the imposition of a Suspension Order. It gave careful consideration to Paragraphs 39-45 of the HCPC’s “Indicative Sanctions Policy”.

76. The Panel noted that Paragraph 41 of the HCPC’s “Indicative Sanctions Policy” states: “If the evidence suggests that the registrant will be unable to… remedy his … failings then striking off may be the more appropriate option. However, where there are no … difficulties preventing the registrant from understanding and seeking to remedy the failings then suspension may be appropriate.” The Panel had no doubt that the information currently before it is not such that it could reasonably conclude that there are difficulties which would prevent the Registrant from developing full insight and remedying her failings.

77. The Panel considered that a Suspension Order would, in the short term, protect the public and also satisfy the public interest in marking the unacceptability of the Registrant’s misconduct, as well as upholding proper standards and maintaining confidence in the profession.

78. For all the reasons set out above, the Panel considered that a Suspension Order for a period of 12 months is the proportionate and appropriate response at this time.

79. The Panel did consider whether the circumstances are such that a Striking Off Order might be the appropriate sanction in this case. The Registrant’s dishonesty rendered a Striking Off Order a real possibility. However, the Panel noted that a Striking Off Order is a sanction of last resort. In light of its view that, with the development of full insight, the Registrant’s misconduct is remediable, the Panel considered that a Striking Off Order would be disproportionate at this time.

80. The Panel decided to impose a Suspension Order of 12 months duration. That Order will be reviewed before its expiry.

81. The reviewing Panel will have all options open to it and may be assisted by:

• The Registrant’s attendance;

• An up to date reflective piece completed by the Registrant, reflecting as to why when asked to account for her conduct, her response was dishonest; and how she will ensure that this would not happen again in a similar situation. The Registrant’s professional body, journals and the HCPC “Standards of conduct, performance and ethics” may be of assistance to her in this regard;

• Up to date character references from employers or any other person which attest to her honesty and integrity;

• A reflective piece considering the importance of timely and accurate record keeping;

• Evidence of any remedial action the Registrant has taken since the incidents in question;

• Details of any paid or unpaid work undertaken during the period of suspension; and / or

• Any continuing professional development undertaken by the Registrant, including the reading of professional journals.

The Registrar is directed to suspend the registration of Mrs Mandy Bradley for a period of 12 months from the date this Order comes into effect.

Interim Order

1. The Panel heard an application from Mr Ferson to cover the appeal period by imposing an 18 month Interim Suspension Order on the Registrant’s registration. He submitted that such an order is necessary to protect the public and is otherwise in the public interest.

2. The Panel heard and accepted the advice of the Legal Assessor.

3. It had careful regard to Paragraphs 51-54 of the HCPC’s “Indicative Sanctions Policy”.

4. The Panel recognised that its power to impose an interim order is discretionary and that the imposition of such an order is not an automatic outcome of fitness to practise proceedings in which a Suspension Order has been imposed and that the Panel must take into consideration the impact of such an order on the Registrant. However, the Panel was mindful of its findings in relation to the lack of insight and remediation and that there remains a risk of repetition. In the circumstances, it considered that public confidence in the profession and the regulatory process would be seriously harmed if the Registrant was allowed to remain in practice during the appeal period. The Panel considered that, given its substantive findings and Order, it would be perverse not to grant Mr Ferson’s application.

5. For the reasons set out above, the Panel makes an Interim Suspension Order under Article 31(2) of the Health and Social Work Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.  This Order will expire: if no appeal is made against the Panel’s decision and Order, upon the expiry of the period during which such an appeal could be made; or, if an appeal is made against the Panel’s decision and Order, the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Mrs Mandy Bradley