Mrs Deena Best

Preliminary matters:

Fair and Impartial Tribunal

1. At the outset of the hearing, the Registrant Panel Member declared that for the last 25 years, he has worked, and continues to work for the London Ambulance Service (LAS) NHS Trust, the Trust at which the Registrant worked, and where the allegations relate to. He was located in a different geographical area to the Registrant and confirmed that he did not know the Registrant or any of the witnesses in the case, nor did he know about the case itself. He declared that he did know of two people who were mentioned in the papers, namely CT, the union representative who had represented the Registrant at the Trust’s disciplinary hearing; and JC, a senior HR Manager, who had been present at the disciplinary hearing. His knowledge of those people was limited to meeting them for unconnected matters approximately four times a year (in respect of CT), and twice a year (in respect of JC).

2. Ms Manning-Rees, on behalf of the HCPC, had no objection to the Registrant Panellist remaining on the Panel, and submitted that a fair-minded and impartial observer would not consider that there was a risk of real or potential bias.

3. The Panel heard and accepted the advice of the Legal Assessor, who advised the Panel in accordance with the case of Porter v Magill; Weeks v Magill [2002] 2 AC 357, that the test was:

‘whether the fair minded and informed observer, having considered the facts, would conclude that there was a real possibility that the tribunal was biased’.

4. The Panel considered that the Registrant Panel member had no knowledge of the case, the witnesses or the Registrant, beyond that gained from the HCPC bundle of statements and exhibits, served on all members of the Panel in advance of the substantive hearing. The two people mentioned in the bundle whom the Registrant Panellist did have knowledge of, played no substantive part in the investigation, and provided no evidence in the case. They were also not key decision makers in the Trust’s disciplinary process. The Panel was satisfied that a fair-minded and informed observer would not conclude that there was a real or perceived risk of bias. It therefore concluded that it was able to act as a fair-minded and impartial Panel at this substantive hearing.

Service

5. The Hearings Officer provided the Panel with a service bundle, which showed that on 1 March 2019, the notice of this hearing was sent by first class post to the Registrant’s registered address. The notice contained the required particulars, in particular the date, time, and venue for the hearing.

6. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied on the documentary evidence provided, that the Registrant, had been given proper notice of this hearing in accordance with the Rules.

Application to Proceed in Absence

7. Ms Manning-Rees, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a Registrant's absence should only be exercised with the utmost care and caution.

8. The Panel had regard to the chronology of communications between the HCPC and the Registrant.

9. On 24 August 2017, the HCPC sent the Registrant written notice that a referral had been made against her. Further correspondence was sent to the Registrant on 12 October 2017, 28 June 2018, and 16 August 2018 about the progress of the case through to the Investigating Committee. On 28 August 2018, a response was received from the Registrant providing written representations for the panel of the Investigating Committee (ICP) to consider in its assessment of whether there was a case to answer. On 29 October 2018, a notice of the allegation confirmed by the ICP was sent to the Registrant, and on 30 October 2018 an ICP follow up letter was sent to her, confirming that the ICP had found that there was a case to answer.

10. On 8 November 2018, the Registrant verified her email address to Kingsley Napley Solicitors, the Solicitors instructed by the HCPC to prepare and present the case. On 17 January 2019, a copy of the proposed amendments to the allegation was sent to the Registrant. On 1 March 2019, the notice of hearing was sent, and on 13 March 2019, the bundle of statements and exhibits to be relied upon by the HCPC at the substantive hearing were sent to the Registrant by recorded delivery.

11. No communications have been received from the Registrant since 8 November 2018. It follows that the Registrant has not applied for an adjournment, nor has she submitted any further representations or documentation since her ICP representations submitted in August 2018.

12. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve the notice on the Registrant in accordance with the Rules.

13. The Allegation dates back to May and June 2017. The Panel was aware that there were two witnesses in attendance to give evidence on the first day of the hearing, and three further witnesses warned to give evidence on day 2.

14. In all the circumstances, the Panel concluded that the Registrant had voluntarily waived her right to attend and there was no indication that she would attend an adjourned hearing. The Panel also considered that it was in the public interest for the hearing to take place, given the age of the allegations, and the impact further delay may have on the recollections of the witnesses. The Panel was mindful of the potential disadvantage to the Registrant in not being present, but in light of its conclusion that she was unlikely to attend a future hearing, it did not see any advantage in adjourning the case.

Application to amend the Allegation

15. Ms Manning-Rees, applied to amend the particulars of the Allegation, which had been notified to the Registrant by letter, dated 17 January 2019. She submitted that the amendments were minor and essentially sought to present the allegations in a manner which made clear which alleged comments were made directly to Person A, and which were allegedly made to other colleagues about Person A. Ms Manning-Rees submitted that there would be no prejudice to the Registrant if the proposed amendments were allowed.

16. The Panel, having heard and accepted the advice of the Legal Assessor, determined to allow the application to amend in its entirety. It took into account that the proposed amendments had been notified to the Registrant in good time, and no objections had been received from her regarding them. The Panel was of the view that the proposed amendments can be made without unfairness to the Registrant. They properly reflect the evidence anticipated to be received according to the witness statements previously served on the Registrant, and, in the Panel’s view, essentially clarify the allegation.

Background:

17. The Registrant is an HCPC registered Paramedic. She joined the London Ambulance Service (LAS) NHS Trust on 7 January 2008, and was based at Bromley station. As a Paramedic she was responsible for responding to both emergency and non-emergency calls and for the care and treatment of patients.

18. On 29 May 2017, Person A was with the Registrant and Paramedic, AF, at Bromley Ambulance Station, talking about Ramadan, which had just started. During this conversation, it is alleged that the Registrant made discriminatory comments, based on race and/or religion, to Person A. It is these alleged comments which are the subject of Particulars 1 and 4.

19. On the same date, PW, who was finishing his shift, was with the Registrant and JM. It is alleged that the Registrant made discriminatory comments, based on race and/or religion to PW and JM about Person A. It is these alleged comments which are the subject of Particulars 2 and 4.

20. On 3 June 2017, PW relayed the alleged comments that the Registrant had made about Person A to Person A. On 5 June 2017, Person A reported the alleged comments made by the Registrant to him, to a senior member of staff.

21. In June 2017, DE was appointed as the Investigating Officer by the Assistant Director of Operations, to investigate the Registrant’s alleged conduct. As part of his investigation, DE interviewed the Registrant on 4 July 2017. During the course of that interview, the Registrant volunteered that she had a jokey relationship with Person B where she would make similar comments to him and he did not take offence. It is these alleged comments which are the subject of Particulars 3 and 4.

22. On 18 July 2017, DE interviewed Person B who confirmed that the Registrant had made comments to him in the past. It is alleged that these comments were discriminatory, based on race and/or religion.

23. On 1 November 2017, the Registrant attended a disciplinary hearing at LAS in relation to gross misconduct. On 18 January 2018, she appealed against the outcome of the disciplinary hearing.

Decision on Facts

24. On behalf of the HCPC, the Panel heard evidence from Person A, a Paramedic, employed at the material time with the LAS; Person B, a Paramedic and Clinical Team Manager at LAS; DE a Location Group Manager (LGM), instructed to conduct an internal investigation into the Registrant; PW, an Emergency Ambulance Crew (EAC) at LAS, and JM, a Paramedic at LAS.

25. The Panel received documentary evidence, including copies of notes of the interviews conducted with the Registrant, Person A, Person B, PW, JM, and AF ( a Paramedic at LAS, but not called as a witness); a copy of DE’s undated investigation report (redacted); copies of emails between members of staff at LAS; handwritten notes of evidence given at the internal disciplinary hearing; the outcome letter of the disciplinary hearing (redacted); minutes of the internal disciplinary appeal hearing (redacted); and extracts of relevant LAS policies.

26. The Panel heard and accepted the advice of the Legal Assessor. The Panel understood that the burden of proving each individual fact rests on the HCPC and that the HCPC will only be able to prove a fact if it satisfies the required standard of proof, namely the civil standard, whereby it is more likely than not that the alleged incident occurred.

27. The Registrant did not attend the hearing, but the Panel did not draw any adverse inferences against her from her absence.

28. At the outset of its deliberations, the Panel considered the credibility of each of the witnesses who gave live evidence.

29. In relation to DE, the Panel considered he was a credible witness, in that he was independent of the Registrant and the other members of staff who he interviewed as part of his investigation. The Panel considered that although he had been appointed as the investigator, he was not always clear about the processes for an independent investigation, and what comprised information gathering as distinct from a disciplinary investigation. The Panel considered that his recollection of events was hazy. The Panel considered that aside from adducing the interviews conducted as part of his investigation, his evidence was of limited value, as he was not a direct witness to events.

30. In relation to Person A, the Panel found him to be a compelling witness. It considered that he was very measured and thoughtful in his answers and his evidence as a whole was fair and balanced, for example confirming that before 29 May 2017 he and the Registrant had a good relationship and would see each other in passing and ask if each other was alright or had had a good shift. The Panel considered that Person A had a good recollection of events, and that the upset which he described the Registrant’s comments as causing him was genuine. The Panel considered that Person A had reflected before reporting the Registrant, and had not rushed to judge her. The Panel considered that it could give considerable weight to his evidence.

31. In relation to Person B, the Panel found him to be a particularly credible witness, who was clear and balanced in his evidence, and open when he could not recall matters. He had been complimentary about the Registrant, stating that she was professional with patients and he always respected her professionally. He was clear about the lack of personal offence that the Registrant’s comments had caused him, and the context in which such comments were made. The Panel considered that he was fair to the Registrant, but Person B also recognised that such comments could cause offence to others and was aware of the Registrant’s shortcomings in her communication skills. The Panel considered that it could give considerable weight to his evidence.

32. In relation to PW, the Panel considered that he was a credible witness. He was mature and measured in his responses. He had supported Person A in deciding whether to report the Registrant to management. The Panel considered that his evidence was reliable.

33. In relation to JM, the Panel considered that he came across as somewhat defensive in his evidence, but recognised that this may have been down to being uncomfortable in this setting as a witness, and the obvious difficulties he was having in recollecting events. He had very little independent recollection of the events that he had described in his internal investigation interview on 19 June 2017. The Panel considered that where JM’s evidence was the only evidence on a point, it would treat that evidence with caution, but where his evidence was on matters which were conceded by the Registrant, the Panel was more confident to accept it.

Particular 1

On or around 29 May 2017, you made the following comments during conversation with Person A and/or about Person A:

a) “I don’t differentiate between people, I don’t like Muslims” or words to that effect.

b) “Mosques are bloody popping up everywhere” or words to that effect.

34. The Panel finds Particulars 1(a) and 1(b) proved.

35. Person A’s evidence was that the conversation was between him and AF, initially, and then the Registrant joined them. He said that they were talking about Ramadan, because he (Person A) was fasting and AF was asking him questions about it, because he was Australian and did not have much knowledge about Muslims. The Registrant then said something along the lines of: “I don’t differentiate between people, I don’t like Muslims”. He said that the Registrant came out with it ‘out of the blue’.

36. Person A said he brushed the comment off and hoped it was a joke. AF then asked the Registrant how many Muslims she knew and she pointed to Person A saying something along the lines of “just [Person A]”. As the conversation continued, AF asked if there were any mosques in the area, which is when the Registrant said “mosques are bloody popping up everywhere”. Person A said he tried to keep the conversation light and make a joke of it so replied “we are taking over”. He hoped that everyone would laugh and move on, however the Registrant said something along the lines of: “You can’t say something like that. I can get you in trouble”. He did not consider that the Registrant was joking.

37. The Registrant, in her ICP representations accepted that she had said she did not differentiate between people, but in the context of treating all people as equals. She denied saying that she did not like Muslims. She accepted saying that “mosques were popping up everywhere” but denied it was said with any malice. Her position was that the conversation was in the context of her asking if the LAS was accommodating Person A with his shifts as it was Ramadan, and if she thought she had upset anyone or said something out of turn, she would have apologised.

38. In light of the Panel’s assessment of Person A, namely that he was a compelling witness, whose evidence could be given considerable weight, the Panel was satisfied to the required standard that the conversation had been as Person A had described it.

Particular 2

On or around 29 May 2017 you made the following comments during conversation with colleagues:

a) “I don’t want to talk to [Person A] anymore as he is a Muslim” or words to that effect.

39. The Panel finds Particular 2(a) proved.

40. PW’s evidence was that as he was finishing up his shift, he was with JM when the Registrant walked up to them both and stood beside PW. He said that there was not much conversation, but the Registrant had said “I don’t want to talk to [Person A] anymore as he is a Muslim”. At first PW was unsure who the Registrant was talking to, and thought the comment was a bit strange and assumed it was a bad joke. He could not recall any other comments made, and soon after the comment left the conversation, leaving the Registrant with JM. He said the only person he was aware of who could hear the conversation was JM.

41. The Registrant, in her ICP representations said that she had no recollection of saying anything that could resemble such a comment.

42. In light of the Panel’s assessment of PW, namely that he was a credible witness, whose evidence it considered to be reliable, and in the absence of the Registrant having a recollection of whether or not she said such a comment, the Panel was satisfied to the required standard that the comment had been made as PW had described it.

b) “I don’t like Muslims” or words to that effect.

43. The Panel finds this particular not proved.

44. PW only recalled or was present for the comment which the Registrant made to the effect that she did not want to talk to [Person A] anymore as he was a Muslim. JM, in his investigation interview had said that the Registrant had said to PW and him that she had told Person A that she did not like Muslims, and said it in a way that it was a joke between her and Person A.

45. The Registrant in her ICP representations denied making such a comment.

46. The Panel was mindful of the difficulties which JM now had in recollecting events, and that in evidence he described himself as having been ‘distracted’ during the conversation with the Registrant and PW as it was time to go home. The Panel did not consider that the HCPC had satisfied it to the required standard that JM had accurately recalled the conversation, or that he was describing a separate part of the conversation described by PW as outlined at Particular 2(a) above.

c) “Person A looks like a bomber because of the way he dresses” or words to that effect.

47. The Panel finds Particular 2(c) proved.

48. JM in his investigation interview said that the Registrant had also said that said to Person A that “he looks like a bomber” because of the way that he dresses. In his witness statement he said that he did have some recollection of the Registrant stating that Person A “looks like a bomber because of the way he dresses”.

49. The Panel noted that the Registrant, in her ICP representations, reported that she had no recollection of saying such a thing, and that she had felt bullied in the disciplinary hearing into saying that she may have said it. The Panel had regard to the handwritten notes of evidence provided to it of the disciplinary hearing. It noted that the Registrant was recorded as initially denying saying that the comment about dressing like a bomber. However, after a short adjournment, the Registrant was recorded as saying she must have said something for PW and JM to have said what they had said. Then, in answer to a question of whether she was accepting having made the comment of looking like a bomber, she is recorded as having answered: “Yes, in a jovial way. I’ve said similar to [Person B] so I must have said it”.

50. Although the Panel recognised that JM had a poor recollection of events now, it considered that his evidence was not undermined by the Registrant’s position at the disciplinary hearing, where she had conceded that she must have made such comments, as she had made such comments to Person B. In all the circumstances, the Panel considered that it was more likely than not, that the Registrant had said the comments about Person A “looking like a bomber” because of the way he dresses.

Particular 3

On unknown date(s) you:

a) Said to Person B “you should be careful running with your Paramedic bag as you could be mistaken for a bomber” or words to that effect.

51. The Panel finds Particular 3(a) proved.

52. Person B said that he was unable to recall the exact date, but he was walking through the ambulance station garage with his paramedic bag on his back, when he had a conversation with the Registrant. In that conversation she had said something along the lines of: “you should be careful running with your Paramedic bag as you could be mistaken for a bomber”. He recalled smirking and replying with something along the line of when her retirement was. Person B said that he took the comment in jest and during his time at LAS, he and the Registrant often had jokes at one another’s expense, but comments such as this one were not frequent.

53. The Registrant, in her ICP representations accepted making such a comment to Person B, saying that the comments were made to a colleague with whom she had a close friendship and which were being represented out of context.

54. In light of the Panel’s assessment of Person B, namely that he was a particularly credible witness, whose evidence could be given considerable weight, together with the fact the Registrant accepted in her ICP representations that she had made such a comment, the Panel was satisfied to the required standard that the comment had been made as Person B had described it.

b) Called Person B “Osama” or words to that effect.

c) Told Person B to ‘shave his beard” or words to that effect.

55. The Panel finds Particulars 3(b) and 3(c) proved.

56. Person B said that he was unable to recall the exact date that these comments were made, but it was in the winter time around two years earlier when he had grown his beard, and it had grown quite long. He said that he recalled the Registrant saying to him that he looked like Osama bin Laden due to the length of his beard. He said that he did not personally take offence at the comment and he received lots of comments about his beard, some people liking it and others not liking it, and a lot of people telling him he looked better without the beard.

57. Person B said that the Registrant said that beards were “horrible” and that she was not a ‘beard person’. On one occasion, when he was in the staff room, the Registrant made a comment that she did not like Person B’s beard and that she should shave it off. Person B said that such a comment was not unique to the Registrant and he did not feel offended by the comment.

58. In light of the Panel’s assessment of Person B, namely that he was a particularly credible witness, whose evidence could be given considerable weight, together with the fact the Registrant accepted in her ICP representations that she had made such a comment, the Panel was satisfied to the required standard that the comment had been made as Person B had described it.

Particular 4

Your comments at particulars 1-3 were discriminatory and/or inappropriate.

59. The Panel finds Particular 4 proved. In respect of each comment found proved, the Panel considered that they were both discriminatory and inappropriate.

60. The Panel considered that the nature of each comment was that of an inherent, derogatory stereotype based on race and/or religion. In the Panel’s view, comments of this type expressed the unjust and prejudicial treatment of individuals, based on their membership or presumed membership of a race and/or religion. The Panel was mindful that race and religion were ‘protected characteristics’ as set out in the Equality Act 2010. In all the circumstances, the Panel was satisfied to the required standard that the comments made were discriminatory. Given that the Panel was satisfied that the comments were discriminatory, it was also satisfied that such comments were inappropriate, particularly within the workplace.

Statutory Ground and Impairment

61. The Panel next considered whether the matters found proved as set out above, amounted to misconduct, and if so, whether by reason thereof, the Registrant's fitness to practise is currently impaired.

62. The Panel considered the submissions made by Ms Manning-Rees on behalf of the HCPC. She submitted that the Registrant's conduct was serious and amounted to misconduct. She further submitted that the Registrant’s fitness to practise is currently impaired, on both the personal and public components as set out in the HCPTS Practice Note.

63. The Panel heard and accepted the advice of the Legal Assessor. The Panel was aware that any findings of misconduct and impaired fitness to practise were matters for the independent judgement of the Panel.

64. The Panel was aware that consideration of impairment only arises in the event that the Panel judges that the facts found proved do amount to misconduct and that what has to be determined is current impairment that is looking forward from today.

Decision on Grounds:

65. The Panel considered whether the facts found proved amounted to the statutory ground of misconduct. The Panel considered that the comments made by the Registrant were derogatory and discriminatory towards Muslims. They portrayed a stereotypical, negative view that all Muslims are extremists or terrorists. The comments also suggested a dislike of an individual based on their race or religion. The Panel did not consider that the Registrant’s assertion that such comments were ‘banter’ amongst colleagues made them any less discriminatory or inappropriate.

66. It was the judgement of the Panel that Paramedics, in a front line emergency service, encounter all manner of individuals, and are expected to be professional and considerate to everyone, regardless of race, religion or any other personal characteristic. The Panel was satisfied that fellow professionals would consider that expressing discriminatory and prejudicial views, particularly towards colleagues, to be deplorable.

67. The Panel was of the view that the Registrant’s behaviour had breached the following HCPC standard of conduct, performance and ethics:

• 1.5 – You must not discriminate against…colleagues by allowing your personal views to affect your professional relationships….

68. The Panel was of the view that the Registrant’s behaviour had breached the following HCPC standards of proficiency for Paramedics:

• 5 – be aware of the impact of culture, equality and diversity on practice;

• 6 – be able to practise in a non-discriminatory manner

69. In the Panel’s judgement the Registrant’s discriminatory and inappropriate comments directly to two colleagues, as well as about one colleague to two other colleagues, were each serious in themselves, and cumulatively they fell far below the standards of conduct and behaviour expected of a Paramedic. In the Panel’s judgement, the Registrant’s behaviour amounted to misconduct.

Decision on Impairment:

70. The Panel had regard to the HCPTS Practice Note on Impairment and in particular the two elements of impairment, namely the ‘personal component’ and the ‘public component’.

71. The Panel first considered the ‘personal component’.

72. The Panel considered that it had limited information from the Registrant before it. It had no recent material or evidence of reflection by her to allow it to assess whether the comments expressed by her were indicative of a prejudicial and discriminatory attitude held by her, or were examples of ill-judged and inappropriate comments, without appreciation of the potential impact on the recipients.

73. The Registrant’s ICP representations and her evidence given at the disciplinary hearing, indicated apparent remorse on the Registrant’s part, if her comments had upset anyone. However, the Panel had no indication of her current level of insight or remediation. There was little evidence that the Registrant had reflected on the impact of her comments on the colleagues themselves to whom the comments were directed. Person A said that he had tried to laugh of the Registrant’s comments. It was clear to the Panel that he had initially tried not to show how they had upset him. The Panel considered that it had no evidence before it to demonstrate that the Registrant now recognised that such comments were discriminatory, and not appropriate topics for ‘banter’, or that she had thought about how expressing such discriminatory views may impact upon the confidence of the public in the profession. In the absence of such information from the Registrant, the Panel concluded there was no evidence that she had remedied her behaviour.

74. In all the circumstances, the Panel could not rule out the risk of repetition by the Registrant, and therefore concluded that in respect of the personal component, her fitness to practise is currently impaired.

75. The Panel went on to consider the ‘public component’.

76. The Panel acknowledged that it had no evidence before it that the Registrant had expressed discriminatory or prejudicial comments to patients. In particular, Person B had told the Panel that he had respect for the Registrant as a Paramedic and that her interaction with patients was professional. Nevertheless, the Panel considered that members of the public would be concerned to hear of a Paramedic expressing views of a discriminatory and prejudicial nature to fellow professionals or about fellow professionals. It considered that a fundamental aspect of the Paramedic profession was the requirement to treat everyone with respect, dignity and sensitivity, and confidence in the profession relied on members of the public being reassured that Paramedics would behave without discrimination or prejudice in all circumstances. In the Panel’s judgement, the reputation of the profession would be undermined if a finding of impairment were not made in this case. Similarly, the Panel concluded that professional standards would be undermined if it did not make a finding of Impairment. Accordingly, in respect of the ‘public component’ the Panel concluded that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction:

77. Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on her registration by way of the imposition of a sanction. It was informed by Ms Manning-Rees that there were no other known regulatory matters against the Registrant.

78. The Panel accepted the advice of the Legal Assessor and it exercised its independent judgement. The Panel had regard to the Indicative Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the wider public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

79. The Panel first identified what it considered to be the principal aggravating and mitigating factors in this case.

80. Aggravating factors:

• the repetition of making discriminatory comments to and about colleagues;

• the risk of repetition; and

• the Registrant’s limited insight.

81. Mitigating factors:

• the Registrant had had an unblemished career, working at LAS since 2008;

• the Registrant was respected as a Paramedic by colleagues, in particular Person B, and there were no issues regarding her patient care; and

• the Registrant’s ICP representations indicated that she had challenging personal circumstances.

82. The Panel noted that the Policy made clear that a Panel was not required to impose a sanction, notwithstanding that it had made a finding of impairment. However, in this case the Panel was of the view that the public interest was strongly engaged and to take no action would send out the wrong message to the public. It would not guard against the risk of repetition of expressing discriminatory views which the Panel had identified at the impairment stage, nor would it reflect the seriousness of making discriminatory and inappropriate comments to and about colleagues in the workplace. The Panel concluded that some form of sanction was necessary to maintain public confidence in the profession as well as to declare and uphold proper standards of conduct and behaviour.

83. The Panel next considered a Caution Order. In doing so it had regard to the relevant factors set out in paragraph 28 which reads:

‘A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate remedial action. A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate. A caution order is unlikely to be appropriate in cases where the registrant lacks insight’.

84. The Panel did not identify that any of the relevant factors for a Caution Order were present in this case. It did not consider that the Registrant’s behaviour could properly be described as a lapse which was isolated, limited or relatively minor in nature. On the contrary her behaviour had been repeated in that she had expressed prejudicial views to two colleagues directly, as well as to colleagues about another colleague. Further, in the absence of recent evidence of reflection, the Panel had concluded that the Registrant had little insight, had not demonstrated remediation, and consequently there remained a risk of repetition. The Panel concluded that a Caution Order was not the sufficient and appropriate response.

85. The Panel moved on to consider the imposition of a Conditions of Practice Order. The Panel did not consider that this was a case in which there were clinical concerns on the part of the Registrant to be addressed. The Panel was mindful of its findings at the impairment stage that it had no recent material or evidence of reflection to allow it to assess whether the comments expressed were indicative of a prejudicial and discriminatory attitude held by the Registrant, or were examples of ill-judged and inappropriate comments, without appreciation of the potential impact on the recipients. In light of this, and given the nature of the misconduct itself, the Panel did not consider that it was possible to formulate workable and verifiable conditions relevant to monitoring her behaviour at work.

86. The Panel also noted the Policy’s observation that panels need to be confident that a Registrant would comply with any conditions imposed. In this case, given the absence of recent information from the Registrant, the Panel had no information to indicate whether or not the Registrant would be willing or able to comply with conditions. In addition, the Panel has no current information about the Registrant’s employment’s status.

87. The Panel next considered a Suspension Order and concluded that this was the appropriate and proportionate sanction. Although the Panel considered that this was not a case involving issues of direct patient safety, it had identified the strong public interest involved in this case, and the risk of repetition. It had regard to paragraph 6 of the Policy which states:

in reaching their decisions, Panels must also give appropriate weight to the wider public interest, which includes:

• the deterrent effect to other registrants;

• the reputation of the profession concerned; and

• public confidence in the regulatory process.

88. The Panel was satisfied that a Suspension Order would achieve this. It considers that a Suspension Order is a severe sanction: it will prevent the Registrant from practising as a Paramedic for the period for which it is in place. Registrants would recognise that it was not acceptable to make discriminatory and prejudicial remarks to or about colleagues, and seek to justify them as a joke or as ‘banter’. The public would see that the profession and the Regulator take such behaviour seriously.

89. The Panel considers that the length of the Order should be for 9 months. The Panel considered that this length was required to mark the seriousness of the misconduct and to demonstrate to the public that such behaviour is unacceptable and will have serious consequences. In the Panel’s view, this is also the minimum period in which the Registrant may be able to demonstrate to a future reviewing panel that she has reflected on her misconduct, has developed insight, and has remediated her behaviour. At this time, and having regard to the Registrant’s ICP representations, the Panel considered that there was little evidence that she has started the process of meaningful reflection into her behaviour, so as to develop good insight and achieve remediation.

90. Given the evidence that the Panel has heard from the Registrant’s colleagues, to the effect that, aside from these matters, she was a respected and professional Paramedic, the Panel is of the view that a Striking Off Order would be disproportionate.

91. This Panel does not seek to fetter the discretion of a future reviewing panel, but it considers that such a panel may be assisted by the Registrant’s attendance at any review (in person or by Skype/telephone). Her attendance may enable a future reviewing panel to explore and assess the level of her insight and the extent of her remediation.

92. This Panel considers that a future reviewing panel might also be assisted by:

• a reflective piece regarding her behaviour, including the potential impact of it on the colleagues to whom it was directed; and how it may impact on public confidence in the profession;

• testimonials; and

• evidence of awareness in equality and diversity matters, (for example: relevant reading, participation in relevant training or completion of relevant courses).

93. Although the Panel had no information as to the Registrant’s current financial situation, it did have an indication from the ICP representations as to the impact that such an Order would have upon her. However, the Panel determined that the reputational interests of the profession, including maintaining confidence in the profession and upholding standards, outweighs the interests of the Registrant.

Order:

The Registrar is directed to suspend the registration of Mrs Deena Best for a period of 9 months from the date this order comes into effect.

Interim Order following Imposition of Sanction

Proceeding with the application in the Registrant’s absence

1. Ms Manning-Rees indicated that in light of the sanction imposed, she wished to apply for an Interim Order. She applied for the hearing to proceed in the Registrant’s absence, submitting that the Registrant had been given notice that the HCPC may make such an application in the notice of hearing dated 1 March 2019.

2. The Panel accepted the advice of the Legal Assessor and decided that it was appropriate to proceed in the Registrant’s absence. It was satisfied that the Registrant had been given sufficient notice in the ‘notice of hearing’ that a Panel may impose an Interim Order if a sanction was imposed which removed, suspended or restricted the Registrant’s right to practise, which would suspend or restrict her right to practise.

3. The Panel considered that the same factors applied as for its decision to proceed with the resumed hearing, namely that the Registrant had voluntarily waived her right to attend and it was unlikely that an adjournment would be unlikely to secure her attendance.

Interim Order Application

4. Ms Manning-Rees applied for an Interim Order of Suspension for 18 months to cover the appeal period before the Suspension Order comes into effect, or if the Registrant appeals, her appeal is finally disposed of.

5. The Panel heard and accepted the advice of the Legal Assessor and had regard to the Practice Note on Interim Orders, in that it must undertake a comprehensive review of the available information in order to conduct a risk assessment.

6. The Panel considered whether an Interim Order was necessary to protect the public. Given the Panel’s view that this was not a case involving issues of direct patient safety rather it was about public confidence, the Panel was not satisfied that an Interim Order was necessary to protect the public.

7. The Panel considered the wider public interest. The Panel was mindful that for an Interim Order on public interest grounds alone, the bar was set high. The Panel had regard to its earlier finding that in the absence of insight and remediation there was a risk of repetition of expressing discriminatory views to or about colleagues. Having concluded that, such behaviour is unacceptable, the Panel considered that the public would be concerned if the Registrant were permitted to practise during the appeal period. The Panel was satisfied that the high threshold had been met in this case. Consequently, it concluded that an Interim Order was required to maintain public confidence in the profession and to uphold proper standards of conduct and behaviour.

8. The Panel considered an Interim Conditions of Practice Order. Given that it had previously considered that a Suspension Order was the appropriate and proportionate sanction to address the strong public interest, and that it was not possible to formulate workable and verifiable conditions, the Panel did not consider that an Interim Conditions of Practise Order was appropriate or proportionate.

9. In all the circumstances the Panel determined to make an Interim Suspension Order for a period of 18 months. In deciding to impose this length, it took account of the fact that if the Registrant were to appeal, that process may take a considerable period of time.

History of Hearings for Mrs Deena Best