Mr Nathan Williams

Preliminary Matters:

Service

1. The Panel was satisfied that the Registrant was notified of the date and time of the hearing via a letter dated 3 October 2019 (the “Notice of Hearing”) which was sent by first class post to his registered address. Accordingly the HCPC had discharged its duty to serve documentation on the Registrant in accordance with the Health and Social Work Professions Order 2001 (“the Order”).

Proceeding in the Absence of the Registrant

2. The Presenting Officer submitted that it was in the public interest for the hearing to proceed in the absence of the Registrant.  She outlined the chronology of the matter, confirming that the Registrant was notified via email and letter on 3 October 2019 of the date, time and venue of the hearing, and how he could access the bundle of papers relied on by the HCPC. Given the sensitive nature of the contents of the bundle, and the fact that the Registrant had not previously engaged with the regulatory proceedings, it was determined that access to the bundle would be provided once there was an assurance that the communication route was secure.  The Presenting Officer invited the Panel to exercise its discretion to proceed with the case in the absence of the Registrant, pointing out that the Registrant is under a professional burden to engage with the proceedings. There was an expectation that regulatory matters would be dealt with expeditiously. The Registrant had not engaged at any stage and there was no indication that, if the matter was adjourned, he would engage in future. The HCPC was ready to proceed with the hearing.

3. The Panel received advice from the Legal Assessor, which it applied, and noted the provisions of the HCPTS practice note in respect of proceeding in absence. There had been no request for an adjournment received, nor had the Registrant indicated any desire to be represented at the hearing. He had provided no explanation for his failure to engage with his regulator in this matter. Included in the Notice of Hearing was confirmation that the hearing could proceed in the absence of the Registrant. He was therefore on notice that the hearing could proceed in his absence.

4. The Panel was satisfied that it was appropriate for it to exercise its discretion to hear the matter in the absence of the Registrant.  Proceeding in absence may disadvantage the Registrant, given the serious nature of the matters to be determined. However he was aware of the hearing (the Panel having already found that there had been good service in relation to the Notice of Hearing), had chosen not to be represented or provide any comment on the matter, and had not engaged with his regulator. There was no evidence to suggest that the Registrant would attend or even engage in the event that the matter was adjourned to an alternative date. The Panel considered that the public interest in proceeding outweighed any potential prejudice which may be suffered by the Registrant. It was satisfied that the Registrant had voluntarily absented himself from the proceedings without making representations.

Consideration of Recusal

5. The Presenting Officer addressed the Panel in respect of content within the HCPC’s bundle of documents which should have been redacted but was not, namely references to an Interim Order of Suspension at pages C10, C16, C29 and C30. She apologised for this error and confirmed that she had attempted to secure appropriate redaction however the bundle had already been distributed to the Panel by that time. She submitted that an experienced Panel with access to legal advice should be able to put irrelevant matters to one side, and referenced the case of Rothnie v Architects Registration Board (2019) in which the Court stated “There is no reason to assume that the fair-minded and informed observer, who is not to be regarded as unduly suspicious, would fail to trust the Committee to put the earlier case out of their minds“.

6. The Panel considered it unfortunate that material which should have been redacted had not been identified prior to it being sent the bundle of documents. Had the Registrant been represented, the Panel considered that an application for recusal may have been advanced on behalf of the Registrant. Given the Panel has a duty to ensure that the hearing is as fair as the circumstances permit, and to make such points on behalf of the Registrant as the evidence permits, it was necessary to determine whether it was appropriate for the Panel to continue with the hearing in the light of the information that had been incorrectly provided to it.

7. The issues in this matter related to an allegation of conviction and did not involve disputed facts. The Panel was satisfied that the information it had inadvertently received was not so prejudicial that it could not be put from its mind – the conviction was not disputed and related to serious offences.  As an experienced and professional panel, it was satisfied that it could put from its mind the references to an interim order when considering the issue of the Registrant’s fitness to practise. It did not therefore consider it necessary for it to recuse itself from this matter. 

Background:

8. The Registrant is registered with the HCPC as a Paramedic. At all material times the Registrant was employed by North East Ambulance Service NHS Foundation Trust (“the Trust”) as a Band 6 Paramedic.   

9. On 29 June 2018 the Registrant was arrested at home on suspicion of downloading indecent images of children from the internet. He was interviewed under caution and admitted that he had accessed such images. Electronic devices were seized from his home and subjected to forensic examination by the Police. He did not inform the Trust of the arrest but relied upon the Police informing them. The Police also advised him to ring in sick for his next shift with the Trust.

10. The Trust suspended the Registrant from his employment on 2 July 2018 and referred the matter to the HCPC. The Registrant did not inform the HCPC of his arrest.

11. The Registrant was convicted of three counts of making indecent photographs / pseudo-photographs of a child at North Tyneside Magistrates Court on 3 April 2019.  He was referred to Newcastle Upon Tyne Crown Court for sentencing. The Court, on 16 May 2019, imposed a sentence of:

- 8 months imprisonment, suspended for 24 months;

- completion of 200 hours of unpaid work;

- participation in Horizon for up to 29 sessions;

- a Sexual Harm Prevention Order for 10 years;

- inclusion on the Sex Offender Register for 10 years;

- inclusion in the barring list maintained by the Disclosure and Barring Service.

12. The Registrant was open with the Trust about his actions and participated in the disciplinary proceedings instigated against him.  

13. The HCPC have provided to the Panel a bundle of documents in relation to this matter. The Registrant has not provided the Panel with any information. 

Decision on Facts and Grounds:

14. The Panel listened carefully to the submissions made to it on behalf of the HCPC.  It received advice from the Legal Assessor, which it applied, and had regard to the bundle of documents provided to it in advance of the hearing. It had regard to the practice notes to which it had been referred, particularly those entitled ‘Fitness to Practise Impairment’ and ‘Conviction and Caution Allegations’.

15. The Panel noted that it was obliged to approach the consideration of an allegation sequentially, determining firstly whether the facts set out in the allegation are proved, then whether those facts amount to the statutory ground set out in the allegation and if so, whether the Registrant’s fitness to practise is impaired.

16. In determining whether an allegation is “well founded” or “proved”, the Panel was required to decide firstly whether the HCPC, which has the burden of persuasion in relation to the facts alleged, has discharged that burden. It was satisfied that the extract of conviction provided to it by the HCPC was sufficient to establish particular 1 as proved on the balance of probability.

17. Having found the first particular proved, the Panel then considered whether it amounted to a statutory ground of impairment, as set out within the Order at article 22(1), noting this was entirely a matter for it to determine. The Panel recognised that it was required to provide a decision in sufficient detail for readers to understand why the facts do or do not amount to the ground alleged.  It was aware that it could not ‘go behind’ the conviction.

18. The Panel was satisfied that the facts (i.e. the conviction) had been proved against the Registrant and that this did amount to a statutory ground under the Order, namely a conviction. The Registrant had admitted the offence during his interview with the Police and been open with the Trust during disciplinary proceedings also. The Panel found that second particular was therefore also proved on the balance of probability. It then moved on to consider whether the Registrant’s fitness to practice is impaired.

Decision on Impairment:

19. The Presenting Officer asked the Panel to have regard to the practice notes provided in respect of conviction and cautions when fulfilling its role of protecting the public and maintaining standards and confidence in the profession. She confirmed that the personal component of impairment related to the competence, behaviour and insight of the Registrant, while the public component related to the need for the regulator to protect service users, declare and uphold standards and maintain confidence in the profession. She referred the Panel to the leading case of Grant in respect of identifying factors relevant to impairment, particularly whether the Registrant could bring the profession into disrepute or had breached a fundamental tenet of the profession. She invited the Panel to particularly consider the public component of impairment, stating that accessing indecent images of children is a serious matter for a regulated professional.

20. The Panel noted that bundle of documents provided to it shows that the Registrant was consistent in his explanations as to when and why he accessed indecent images of children when interviewed by the Police and the Trust. During the police interview he stated that he began accessing such images following a second tour of duty for the military in Iraq in 2006. He described downloading the images in bundles from a filesharing site for sexual gratification. The police investigation had revealed 341 indecent images of children upon the Registrant’s electronic devices. The images had been categorised by the police as falling into all three categories of image (i.e. A – C). The Panel could not “go behind” the conviction, but in any event it noted that the Registrant accepted from the outset of the criminal investigation that he had accessed indecent images over a prolonged period of time when he was feeling down.

21. The Panel reminded itself that the test of impairment is expressed in the present tense in relation to the need to protect the public against the acts and omissions of those who are not fit to practise, and that this cannot be achieved without taking account of the way a person has acted or failed to act in the past. It also recognised that the purpose of the regulatory proceedings is not to punish the Registrant and it had regard to the practice notes published by the HCPTS entitled “Finding Impairment” and “Conviction and Caution Allegations”. It noted that the Registrant remains subject to orders imposed by the criminal court. It had no information as to the Registrant’s level of insight or remorse.

22. The Panel was mindful that a finding of impairment does not automatically follow a finding that the facts proved amounted to the statutory ground of conviction – it could properly conclude the offence was an isolated incident and that the chance of repetition in the future is remote. It also noted the guidance in the case of Cohen v General Medical Council [2008] that it must be highly relevant when determining impairment that the conduct leading to the allegation is easily remediable, has been remedied and is highly unlikely to be repeated as well as the “critically important public policy issues” identified in that case.  Given the prolonged period over which the Registrant admitted accessing indecent images of children, and the fact that he did so when he was having a bad day, the Panel was concerned that there remained a risk of repetition of the behaviour. It noted that he was required to participate in rehabilitation activities targeted at his offending as part of the criminal sentence, and would be subject to a Sexual Harm Prevention Order and required to be included on the Sex Offenders Register for 10 years. He had not supplied any information to the Panel as to the rehabilitation activities he had undertaken, nor had he engaged in the regulatory process or expressed any remorse or apology for his behaviour. However, the Panel was satisfied that offences of this nature are particularly serious and that it would be difficult for any registrant to establish they were not impaired on the personal aspect of the test for impairment even if they did engage fully on the regulatory process. The Panel found that the Registrant’s fitness to practise was impaired on the personal component.

23. In considering the public component of impairment, the Panel had regard to the important public policy issues, particularly the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour. Whilst the Registrant had stated that he only downloaded the images and at no stage personally harmed a child, the Panel was conscious that the Sanctions Policy adopted by the HCPC states that “Any offence relating to indecent images of children involves some degree of exploitation of a child, and so a conviction for such an offence is a very serious matter”.

24. The Panel considered that members of the public and members of the profession, knowing all of the facts, would be extremely concerned to learn that a Paramedic had been convicted of three counts of downloading indecent images of a child and admitted engaging in such behaviour for a prolonged period of time. Further, it considered that his conduct breached Standard 9 the Standards of Conduct, Performance and Ethics (2016) set out by the HCPC for all registered professionals, which requires registered professionals to be honest and trustworthy, and also:

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

25. The Panel determined that public and professional trust and confidence in the profession, professional standards, and the Regulator would be undermined if a finding of impairment was not made. The Panel concluded that the Registrant’s fitness to practise is currently impaired on the basis of the public component as well as the private component.

Decision on Sanction:

26. The Presenting Officer addressed the Panel in relation to sanction, confirming that all sanctions are available to the Panel. She referred to the Sanctions Policy adopted by the HCPC and encouraged the Panel to determine the least restrictive sanction that would afford an appropriate level of protection to the public. She reminded the Panel that the sanction imposed must be proportionate and emphasised that it would not be usual for a Registrant to be allowed to return to practice while subject to a suspended prison sentence, as set out in the case of CRHP v GDC and Fleischmann [2005].

27. The Registrant’s state of remorse, insight and remediation was unknown to the Panel given that he had not engaged with the regulatory proceedings. 

28. The Panel accepted the advice of the Legal Assessor. It was mindful that the purpose of any sanction is not to punish the Registrant, but to protect the public and promote the wider public interest. The public interest includes maintaining public confidence in the profession and the HCPC as its regulator by upholding proper standards of conduct and behaviour. The Panel applied the principle of proportionality by balancing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity.

29. The Panel had regard to the recently updated Sanctions Policy adopted by HCPC and took into account the submissions made to it. It identified the following aggravating factors in relation to the Registrant’s conduct:

-   the offence involved children;

-  the Registrant admitted accessing indecent images of children over a prolonged period;

and the following mitigating factors:

- no other adverse findings have been recorded against the Registrant.

30. The Sanctions Policy provides at paragraph 40 that: 

“There are some concerns which are so serious, that activities intended to remediate the concern cannot sufficiently reduce the risk to the public or public confidence in the profession. Despite the steps the registrant has taken to attempt to remediate the concerns, the panel is still likely to impose a serious sanction. These might include cases involving:

• sexual abuse of children or indecent images of children;

• criminal convictions for serious offences”

Paragraphs 78-79 of the Sanctions Policy state:

“78. Sexual abuse of children involves forcing or persuading them to take part in sexual activities and includes both physical contact and online activity. Each of the four countries has legislation which protects children from sexual abuse. Further  details can be found on the NSPCC website.

79. Sexual abuse of children, whether physical or online, is intolerable, seriously damages public safety and undermines public confidence in the profession. Any professional found to have participated in sexual abuse of children in any capacity should not be allowed to remain in unrestricted practice.”

 Further, the Panel noted the clear provisions in the Sanctions Policy:

 “Although inclusion on the sex offenders’ database is not a punishment, it does serve to protect the public from those who have committed certain types of offences. A panel should normally regard it as incompatible with the HCPC’s obligation to protect the public to allow a registrant to remain in or return to unrestricted practice while they are on the sex offenders’ database.”

31. Given that the Panel did not believe that the Registrant had demonstrated either insight or remorse for his conduct, it therefore remained concerned as to his future practice. As a result, it was not appropriate for the Panel to take no action. It noted that there was no outstanding dispute that mediation would assist with and therefore mediation was also an inappropriate sanction in this matter. It also did not consider a Caution Order to be appropriate given that the behaviour was serious, repeated over a number of years and it had identified a risk of repetition.

32. The Panel therefore moved on to consider whether a Conditions of Practice Order would be appropriate. It noted that conditions will rarely be effective unless the Registrant is committed to resolving the issues to be addressed and can be trusted to make an effort to do so. The Policy points out that conditions of practice are unlikely to be suitable where, as in this case, the Registrant is lacking insight. The Panel considered whether any conditions could be drafted in this case that would adequately protect the public and concluded that it would not be possible to either satisfy the public interest or protect the public by the imposition of conditions given the nature of the offences and the fact that his practice as a Paramedic is not in question. Accordingly, a Conditions of Practice Order was not an appropriate sanction to impose in this case.

33. The Panel then went on to consider whether a Suspension Order could be appropriate. However, it concluded that a Suspension Order would not satisfy the public interest, afford the public sufficient protection or send out a clear message that this breach of a fundamental tenet of the profession is unacceptable. The Panel’s concerns about the risk of repetition had not been allayed, and the Registrant had not shown remorse, apologised, or demonstrated any insight into the serious nature of his misconduct.

34. The Panel determined that the only course of action open to it that would adequately satisfy the public interest, protect the public and maintain confidence in the regulatory process would be an order striking the Registrant from the register. He had been convicted of serious offences of a sexual nature which involved children, and had admitted to accessing similar content since 2006. He showed no insight into the impact his behaviour had on his profession and the public and the Panel was satisfied that any sanction other than striking the Registrant from the register would undermine public and professional confidence in the Regulator. 

Order:  That the Registrar is directed to strike the name of Nathan Williams from the Register on the date this order comes into effect 

Interim Order:

1. Upon the Panel determining the appropriate sanction to be a Striking Off Order, the Presenting Officer requested that the Panel exercise its discretionary power to impose an interim suspension for the time allowed for appealing against the final disposal order or, if such an appeal is made, whilst that appeal is in progress. The Registrant had been given notice of the potential for this application within the Notice of Hearing however the Panel would firstly need to reconsider the issue of proceeding in the absence of the Registrant.

2. The Presenting Officer submitted that an Interim Suspension Order was applied for on the grounds of public protection and in the public interest based on the risk of repetition as identified by the Panel in its decision. She reminded the Panel that the substantive Striking Off Order it had imposed would not take effect until the time for lodging an appeal had elapsed, or when any such appeal is determined, whichever is the later. Given that the Panel had specifically found that the Registrant poses a risk to the public and imposed the Striking Off Order in the public interest, it would be entirely appropriate for an Interim Suspension Order to also be imposed.

3. The Panel carefully considered the submissions of the Presenting Officer and the advice provided by the Legal Assessor, which it accepted. They also noted the provisions of the guidance note issued by the HCPTS in respect of Interim Orders and the provisions of the Sanctions Policy in relation to Interim Orders following the imposition of a order striking a registrant from the Register. It reminded itself that an interim order may be appropriate where:

-   there is a serious and ongoing risk to service users or the public from the registrant’s conduct; or
-   the allegation is so serious that public confidence in the profession or the regulatory process would be seriously harmed if the registrant was allowed to remain in practice on an unrestricted basis.

4. The Panel was mindful that, in imposing a Striking Off Order, it had found that there was an ongoing risk to the public from the actions of the Registrant. The Registrant was aware of the possibility of an Interim Order application and had not made any objection to the same, or commented on the application. The factors which led the Panel to impose the Striking Off Order were still pertinent.

5. Given that the Panel earlier today considered the Registrant’s conviction to be such that striking off was warranted for the protection of public, it believed that public confidence in the regulatory process would be seriously harmed if the Registrant was allowed to remain in practice on an unrestricted basis pending the substantive Striking Off Order coming into effect. Without an Interim Suspension Order, there would be no bar to the Registrant practising. Therefore, the Panel determined that it was appropriate and proportionate to impose an Interim Order of Suspension pursuant to Article 31(2) of the Health and Social Work Profession Order 2001 for a period of 18 months to protect public and otherwise promote the public interest.

History of Hearings for Mr Nathan Williams