Mr Mark Higgins

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

The substantive fitness to practise hearing
2. The Registrant admitted the following; Particulars 1 a i), ii), 1b i) - vi); 1 e); 1 f); 1 i); 2 a); 2 b); 3 a) ; 3 b) ; 3 c); 3 d) ; 3 e); 3 g); 3 h); 3 i).

3. The Registrant did not deny the following: Particulars 1 c) and 1 d i) - iii); 1g); 1 h); 1 j); 2 c) ; 2 d); 3 f).

4. Misconduct and impairment were not admitted by the Registrant. The Registrant did admit lack of competence in respect of Particulars 2 and 3 of the Allegation.

5. Having found facts proved as set out above, the panel considered the statutory grounds. The panel concluded that its findings as to the Registrant’s failings were not sufficiently serious as to amount to misconduct. Indeed the panel noted that the HCPC had not made a case for misconduct. However the panel concluded that its findings as a whole did constitute a lack of competence. The panel explained its reasons for these conclusions in the following terms:
“The Panel carefully considered all the facts found proved and its findings as to the breach of Standards. The Panel considered the guidance in Roylance v GMC [2000] 1 AC 311 as to misconduct. The Panel exercising its independent professional judgement, found that its findings were not sufficiently serious as to amount to misconduct. The Panel noted that the HCPC made out no case for misconduct.
Decision on Lack of Competence
The Panel exercised its professional judgment and was mindful of the guidance in the Holton and Calhaem cases. The Panel accepted the advice of the Legal Assessor and considered the submissions from both parties. The Registrant accepts lack of competence for particulars 2 and 3. It was mindful that lack of training was not relevant to the assessment of competence given the guidance in the Holton case.
The Panel determined that the very nature of the 26 July 2016 assessment was to assess the Registrant’s ability to practice safely and effectively. The Panel also determined that the significant and wide 42 ranging breaches of the Standards it has found showed a pattern of conduct by the Registrant which indicate a lack of competence.
The Panel considered its findings in particular 1 as to the Registrant’s communication, delegation, clinical leadership and not recording accurately or adequately. It determined that these findings cumulatively amount to a lack of competence.
The Panel’s findings on particulars 2 and 3 also amount to a lack of competence given that these assessments were specifically designed to assess the Registrant’s competence. The Panel noted that the Registrant does accept that particulars 2 and 3 are capable of demonstrating a lack of competence.
The Panel concluded that in light of its factual findings on all three particulars, and its findings on a wide range of breaches of the relevant professional standards, that its findings as a whole constitute a lack of competence.”

6. The panel next considered whether the Registrant’s fitness to practise was impaired. It decided that there was a risk of repetition of the deficiencies identified and for that reason the Registrant’s fitness to practise was impaired. The panel also determined that the public interest required a finding of current impairment. The panel explained its reasons for these conclusions in the following terms:
“The Panel considered the submissions of both Mr Millin and Ms Hennessy and it carefully looked at all the documentary evidence. It heard and accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Finding Fitness to Practise Impaired. He reminded it to keep in mind the importance of protecting the public and the wider public interest. He referred the Panel to the guidance in Council for Healthcare Regulatory Excellence v NMC and Grant [2011] EWHC 927 (Admin) on the consideration of insight, remediation and the risk of repetition, and the assessment of current impairment of fitness to practise. The Legal Assessor also reminded the Panel as to the approach to the weight it might attach to the expert report.
The Panel found that the expert report was helpful. It appeared to be impartial and was thorough and detailed. It clearly expressed an independent professional opinion based upon a number of assessments of the Registrant by its author, Mr Broughton. The Panel reminded itself that, whilst it attached some weight to the expert report and it was of some assistance, the report was hearsay. It had not been fully tested in evidence and the Panel did not hear from Mr Broughton. The Panel was mindful that the decision on impairment was one for its own professional judgement and it proceeded on that basis.
The Panel found that whilst BC sought to assist the Panel, and was credible, he had only worked with the Registrant as an ECA at SCAS.
The Panel first considered the Registrant’s insight and his reflective pieces. It was impressed by his reflections and his grasp of the importance of public confidence in the profession. He had clearly reflected on the impact on the family of patient A and stated:- “I can only hope that should they ever need to call upon an ambulance again in the future, they will feel able and confident in doing so”.
The Panel noted that the Registrant had reflected on his practise both as an ECA, and as a Paramedic on his recent two week supervised Paramedic Placement at SWASFT. The Registrant gave seven reflective examples of his role as a Paramedic and he appears to have applied these to the particular concerns found in the allegation. The Panel noted that all the testimonials related to the Registrant’s practice as an ECA.
The Panel found that the evidence indicated that the Registrant has a high level of knowledge and it is clear to the Panel, from his evidence, that the Registrant is well motivated and he is willing to learn and to remediate his practice.
The Panel considered remediation. It found that the lack of competence found proved is remediable and that the Registrant has taken steps to remediate aspects of his practice. It considered the Registrant’s evidence, the SWASFT Assessment Report and the expert report. The Panel found that the Registrant does appear to have remediated his practice in respect of adequate recording, which the Panel found included both timely and accurate recording.
The Registrant has taken steps to remediate his communication skills. The Registrant’s evidence was that his communication skills had improved. The SWASFT assessments of the two week supervised Paramedic Placement in June 2018 deal, in part, with communication. It comments both positively and negatively on the Registrant’s communication skills. It states that at times the Registrant’s communication was “muddled” and that his history taking was not effective in that there was no structure to it when examining a patient. The expert states that that the Registrant’s communication was “good”.
In respect of communication the Panel found that the Registrant had developed and significantly remediated his practice, but this was ongoing and was not fully remediated.
The Panel considered remediation in relation to particular 3 of the allegation, being the issues of time critical interventions and managing complex situations. This particular was admitted by the Registrant and was found proved. The expert states that the Registrant lacked a sense of urgency in time critical situations. The SWASFT Assessment Report found there was a “slight improvement” with the Registrant’s management of complex decision making, however he became task focussed when confronted with unexpected difficulties. BC, states in his testimonial letter of 18 December 2016 that the Registrant was “fastidious” but that “this only serves as a hindrance when he is not given clear direction.” The Panel noted that this observation was in relation to the Registrant’s practice as an ECA. In practice as an autonomous Paramedic, the Registrant will be the clinical lead and will not subject to direction from other clinicians. In the testimonial from a Paramedic Team Leader dated 15 December 2016, the Panel noted that concern was expressed about the Registrant’s lack of confidence when under pressure.
The expert report deals with a paediatric advanced life support simulation. The expert expresses the opinion that the Registrant’s decision making process was delayed whilst the information was processed both in this simulation and in the Registrant’s ability to manage complex situations requiring interventions in a timely manner.
The expert concluded in his report that the Registrant “has demonstrated competency equivalent to that of a newly qualified Paramedic”. The Panel is mindful, however, that the Registrant is not a newly qualified Paramedic. The Registrant himself said in his evidence that “I think it would be stupid to go out of here as a band 6 Paramedic”. He acknowledged that he would need support and would need to work with another qualified member of staff for a period of time. The Registrant told the Panel that he would need a package in place to reach the required standard.
The Panel recognised that the Registrant has good insight and has worked very hard to remediate this practise. He has improved his practise. However, the Panel remained concerned that remediation is still developing and is not complete. The Panel found that the Registrant himself appears to recognise this in his own evidence. The Panel determined that there remains a risk of repetition in respect of deficient communication skills and in the management of time critical and complex situations.
The Panel determined that the evidence indicates that deficiencies remain in the Registrant’s practice, particularly with respect to communication skills and in the management of time critical and complex situations. Applying its own professional judgement to all the evidence, including that of the Registrant, the SWASFT assessment and the expert report, the Panel concluded that whilst there has been significant remediation, there remains a risk of repetition of the deficiencies identified. The Panel accordingly found that the Registrant’s fitness to practice is currently impaired.
The Panel also considered the public interest aspect of impairment. The Panel has found there is a risk of repetition of deficiencies that impact on the wider public interest. Given its findings in respect of risk of repetition, the Panel considered that a member of the public properly informed of the facts would be concerned were the Registrant to be allowed to return to practise on an unrestricted basis. The Panel determined that the public interest required a finding of current impairment in order to protect the public, to uphold proper standards and to maintain confidence in the profession and the regulator.”

7. The panel next considered what sanction to impose. It concluded that to take no action or to impose a Caution Order would not reflect the seriousness of the allegation found proved and the finding of impairment. It concluded that in all the circumstances a Conditions of Practice Order could be formulated that would be adequate to protect the public and satisfy the wider public interest. It further concluded that a Suspension Order would not be proportionate or appropriate. The panel explained its reasons in the following terms:
“The Panel heard and accepted the advice of the Legal Assessor. He referred the Panel to the ISP and reminded it to act proportionately, that is balancing the public interest with that of the Registrant. He advised the Panel to consider the sanctions in ascending order and to apply the least restrictive sanction necessary to protect the public. It should also consider any aggravating and mitigating factors and bear in mind the public interest and that the primary purpose of sanction was protection of the public.
The Panel was mindful that the purpose of sanctions is to protect the public and not to punish the Registrant. The Panel also kept in mind the need to protect the wider public interest and the need to act proportionally.
The Panel considered that the mitigating factors were the Registrant’s significant insight and the substantial remediation achieved to date. The Panel took account of the evidence of the Registrant’s extensive CPD, the positive testimonials and the Registrant’s personal circumstances at the time. It also noted that appeared to be some lack of support at times from employers. The Registrant has also fully engaged with the HCPC.
As to aggravating factors, the Panel found that the Registrant’s failings related to core skills of a Paramedic and that there was a risk of potential harm to patients.
The Panel approached sanction, beginning with the least restrictive first, bearing in mind the need for proportionality. Taking no further action and the sanction of a Caution Order would not reflect the seriousness of the allegation found proved and the finding of impairment. The Panel has found deficiencies in the Registrant’s practise and has identified a risk of repetition. The Registrant has been found not to be at the standard required of an autonomous Paramedic, and in those circumstances a Caution Order would not be appropriate or proportionate as it imposes no restriction on the Registrant’s practice and would place members of the public at potential risk of harm. Further, given the findings of the Panel, a Caution Order would not satisfy the wider public interest in upholding proper standards and maintaining public confidence in the profession and the regulator.
The Panel next considered a Conditions of Practice Order. The Panel has found that the Registrant’s fitness to practise is impaired and there is a risk of repetition. It has identified particular areas of concern. It also carefully considered the conditions suggested by Ms Hennessy. The Panel considered paragraphs 30 and 31 of the ISP and decided that workable, realistic, verifiable and proportionate conditions of practice were capable of being formulated to deal with the areas of concern identified by the Panel. The issues which the conditions seek to address are capable of correction and the Registrant has clearly demonstrated his willingness to comply with conditions.
The Panel considered two different settings in which the Registrant might work and it was mindful of the need to avoid imposing Conditions of Practice that amount to a Suspension. It accepted that in hospital settings, or other definitive care settings, there are adequate support systems and safeguards in place. In that setting, certain conditions of practice were appropriate and proportionate and would protect the public. The Panel determined that it was appropriate and proportionate that an alternative form of conditions would apply if the Registrant were to find employment in an NHS Ambulance Trust, where there is likely to be less support.
The Panel accordingly determined to impose the Conditions of Practice as set out in the Order.
The Panel determined that the conditions shall be imposed on the Registrant for a period of 18 months. It decided to impose that period in order to allow the Registrant to demonstrate full remediation and to successfully complete the supervisory requirements in both settings. The Panel noted that these conditions will be reviewed before they expire, and the Registrant may also apply for an early Review of the substantive order.
The Panel considered the terms of the paragraph 42 of the HCPC Sanctions Policy. With that in mind, the Panel determined that Conditions of Practice are adequate to protect the public and satisfy the wider public interest and that a Suspension Order would not be proportionate or appropriate.”

8. Accordingly the panel made a Conditions of Practice Order for a period of 18 months in the following terms:
1. You must confine your professional practice to working in either a hospital, or other definitive care setting (Setting A); or for an NHS Ambulance Trust (Setting B).
Setting A:
2. In relation to any work that you undertake as a Paramedic in a hospital or other definitive care setting, you must place yourself under the general supervision of a Paramedic registered by the HCPC or a doctor registered by the GMC or a nurse registered by the NMC. This means that on any shift you have a named supervisor who must be based at the site where you are undertaking that particular shift. The supervisor can be a different person on different shifts.
3. You must satisfactorily complete and pass an accredited course on Advanced Life Support provided by the UK Resuscitation Council or similar body and;
• forward a copy of proof of your attendance and your successful completion at that course to the HCPC
• provide a reflective piece detailing your developed understanding, following conclusion of the ALS course. This should also be forwarded to the HCPC prior to any review of these conditions
4. You must have a practice placement educator (or equivalent person) who is suitably qualified to provide further support and guidance. They must be available on a regular basis to speak to you (which can be by telephone), and meet with you to discuss your progress and development.
5. You must devise and develop an individual development plan with your practice placement educator to address the deficiencies in the following areas of your practice:
• Communication skills
• Time critical interventions
• Clinical decision making
You must provide evidence of your progress on this programme to the HCPC prior to any review hearing.
6. You must not work as an autonomous clinician in this setting unless and until after a minimum of 6 months of general supervision, your practice placement educator has assessed you as competent to do so.
You must provide a report from your practice placement educator of this assessment to the HCPC prior to any review hearing.
Setting B:
7. In relation to any work you undertake with any NHS Ambulance Trust, you must undertake and complete the Newly Qualified Paramedi Consolidation of Learning Programme (NQP Programme).
8. You must comply with all the principles of this NQP Programme as set out at www.nhsemployers.org (the Principles).
9. As part of your NQP Programme, you must initially undertake a 6 month period of supervised support working alongside an experienced Paramedic, as defined in the Principles.
10. You must ensure that your employer undertakes a formal review of your progress set against the NQP Programme’s themes and expectations following the 6 months of supervised support.
11. You must promptly forward a copy of the report mentioned in Condition 10 to the HCPC.
12. You must continue on the NQP Programme until you have successfully transitioned to a Band 6 Paramedic.
Conditions applicable to Settings A and B:
13. You must allow your employer to exchange information with the HCPC about your progress.
14. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
15. You must promptly inform the HCPC of any disciplinary or capability proceedings taken against you by your employer.
16. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and 55
C. any prospective employer (at the time of your application).

9. The panel said that a reviewing panel might be assisted by the Registrant providing the following before the review hearing;
• Any further reflective pieces.
• Records of any further relevant CPD
• Testimonials.

The Decision of this Panel
10. Ms Navarro summarised the relevant facts and the conclusions of the previous panel. In brief summary, she submitted, having regard to all the material before it and the submissions made by Mr Cridland, that the Panel should find that the Registrant’s fitness to practise remains impaired. She submitted that in all the circumstances the Panel should make a further Conditions of Practice Order and she would not oppose an extension for a period of 9 months.

11. The Panel has received from the Registrant a witness statement which produces a number of documents. Those documents are as follows;
• A list of his supervisors.
• Letters from JR, his Practice Placement Educator.
• His action plan, namely a Supportive Development Plan and a Training and Competency Portfolio.
• Correspondence with Yeovil District Hospital.
• Correspondence with the HCPC.
• CPD undertaken between 2018 and 2020.
• Feedback from a patient and from a colleague.
• A reflective piece.

12. In his witness statement, the Registrant stated that in January 2020 he moved department within the Yeovil Hospital and he is now working in the Ambulatory Emergency Care (AEC) department. JR remains his Practice Placement Educator. The Registrant did not give oral evidence. Mr Cridland informed the Panel that the Registrant started work within the A&E department of Yeovil Hospital in January 2019 and that it was at the suggestion of his line mangers that he moved to the AEC department in January 2020. Mr Cridland further informed the Panel that the Registrant’s present contract with the AEC was for a period of 6 months but that he hoped that it would be extended. 

13. Mr Cridland made submissions; in brief summary he said as follows;
• That whilst the Registrant has made considerable progress in addressing and remedying the deficiencies found at the substantive hearing, he accepts that his fitness to practise remains impaired.

• The Registrant had been fully compliant with the conditions previously imposed and has developed insight into his failings and has worked hard to remediate them. However, on the material that was before the Panel, it was clear that progress was not as fast or as full as both the Registrant and his employers desired. In particular, the Registrant had problems with handling time critical situations and case prioritisation.

• The Registrant’s move to the AEC department was at the suggestion of his line managers. It was hoped that the somewhat slower tempo of the AEC department would suit the Registrant better than the busier environment of A&E and that in that environment, he would be able to demonstrate that he could practise both safely and effectively.

• Accordingly the Registrant accepts the need for a continuing restriction on his ability to practise.

• The existing Conditions of Practice are workable and are assisting the Registrant to address the deficiencies found at the substantive hearing. Accordingly the Registrant submits that subject to a minor variation to reflect progress already made (the deletion of condition 3), the present conditions should continue.

• The Conditions of Practice Order should be extended for a further period of 9 months. This will enable a review of the order to take place after the conclusion of the Registrant’s 6 months assignment to the AEC department, when an assessment of his performance should be available.

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

15. The Panel is aware that it has all the powers that are set out in Article 30 (1) of the Health Professions Order 2001 (The Order) and which are summarised in the letter dated 17 December 2019 sent to the Registrant and giving notice of this hearing.

16. This Panel is aware that the process under Article 30 (1) of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise is still impaired and if so whether the Conditions of Practice Order under review remains the appropriate and proportionate means of public protection or should be varied or replaced by some other order.

Decision on Impairment
17. Having taking account of the submissions made by Ms Navarro on behalf of the HCPC and those made by Mr Cridland on behalf of Registrant, the Panel has concluded that the Registrant’s fitness to practise remains impaired. In coming to this conclusion the Panel noted that the Registrant had made some progress in addressing and remedying the deficiencies previously found proved, in particular in his communication with colleagues and patients. He has been compliant with the conditions and has engaged fully with his supervisors and has worked hard to address his failings and to improve his practice. However the Panel felt that there were still concerns in the areas of practice identified by the substantive panel. The Panel concluded that in all the circumstances a restriction on the Registrant’s ability to practise is still necessary in order to protect service users and also to sustain public confidence in the profession of a Paramedic and in the HCPC as its regulator.

Decision on Sanction
18. In considering the appropriate sanction the Panel had regard to the Sanctions Policy (SP) published in March 2019 and the advice of the Legal Assessor.

19. The Panel has applied the principle of proportionality. The Panel is aware that the purpose of sanction is not to be punitive and that it must consider the risk the Registrant may pose to services users in the future and determine what degree of public protection is required. The Panel has considered the sanctions available in ascending order of restriction, the least restrictive before the more restrictive. The Panel considered that to take no action or to impose a Caution Order would not be sufficient or appropriate as neither outcome, would afford the necessary public protection or satisfy the public interest.

20. The Panel next considered whether a Conditions of Practice Order would adequately address the concerns identified. It concluded that a Conditions of Practice Order remains proportionate and sufficient to protect the public and address the public interest. In coming to this conclusion the Panel noted and welcomed the Registrant’s willingness to comply with the existing conditions. It was impressed by the way that the Registrant had engaged with his supervisors to address his failings. The Panel hoped that the Registrant’s deployment within the AEC department would provide the environment which would enable the Registrant to prove that he could practise safely and effectively. Subject to the deletion of Condition 3, which was no longer required, the Panel decided to extend the existing Conditions of Practice Order for a period of 9 months. This would enable the order to be reviewed in the context of the Registrant’s performance within the AEC department. The Panel did not think that a Suspension Order was in any way necessary. 

21. The order will be reviewed before it expires. A reviewing panel may be assisted by the Registrant providing the following before the review hearing;
• A further reflective piece.
• Records of any further relevant CPD.
• Testimonials.
• An assessment by the Registrant’s Practice Placement Educator or supervisor or line manager (if more appropriate) as to the Registrant’s overall performance within the AEC department.

The Registrar is directed to vary the Conditions of Practice Order against the registration of Mr Mark Higgins for a further period of 9 months on the expiry of the existing order. The Conditions are: 

1. You must confine your professional practice to working in either a hospital, or other definitive care setting (Setting A); or for an NHS Ambulance Trust (Setting B).
Setting A:
2. In relation to any work that you undertake as a Paramedic in a hospital or other definitive care setting, you must place yourself under the general supervision of a Paramedic registered by the HCPC or a doctor registered by the GMC or a nurse registered by the NMC. This means that on any shift you have a named supervisor who must be based at the site where you are undertaking that particular shift. The supervisor can be a different person on different shifts.
3. You must have a practice placement educator (or equivalent person) who is suitably qualified to provide further support and guidance. They must be available on a regular basis to speak to you (which can be by telephone), and meet with you to discuss your progress and development.
4. You must devise and develop an individual development plan with your practice placement educator to address the deficiencies in the following areas of your practice:
• Communication skills
• Time critical interventions
• Clinical decision making
You must provide evidence of your progress on this programme to the HCPC prior to any review hearing.
5. You must not work as an autonomous clinician in this setting unless and until after a minimum of 6 months of general supervision, your practice placement educator has assessed you as competent to do so.
You must provide a report from your practice placement educator of this assessment to the HCPC prior to any review hearing.
Setting B:
6. In relation to any work you undertake with any NHS Ambulance Trust, you must undertake and complete the Newly Qualified Paramedic Consolidation of Learning Programme (NQP Programme).
7. You must comply with all the principles of this NQP Programme as set out at www.nhsemployers.org (the Principles).
8. As part of your NQP Programme, you must initially undertake a 6 month period of supervised support working alongside an experienced Paramedic, as defined in the Principles.
9. You must ensure that your employer undertakes a formal review of your progress set against the NQP Programme’s themes and expectations following the 6 months of supervised support.
10. You must promptly forward a copy of the report mentioned in Condition 9 to the HCPC.
11. You must continue on the NQP Programme until you have successfully transitioned to a Band 6 Paramedic.
Conditions applicable to Settings A and B:
12. You must allow your employer to exchange information with the HCPC about your progress.
13. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
14. You must promptly inform the HCPC of any disciplinary or capability proceedings taken against you by your employer.
15. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and 55
C. any prospective employer (at the time of your application).

The order imposed today will apply from 29 February 2020. This order will be reviewed again before its expiry.

History of Hearings for Mr Mark Higgins