Mr John W Williams

Profession: Paramedic

Registration Number: PA39245

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 08/01/2021 End: 17:00 08/01/2021

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Paramedic with South Central Ambulance Service between March 2016 and July 2016 you;

1)       On or around 26 March 2016, attended patient 1 and;

a.    did not complete a primary survey;

b.    did not immediately provide them with oxygen following a below normal oxygen saturation reading.

2)       On or around 31 May 2016, attended patient 2 and;

a.    did not assess the patient’s injury at all, or until prompted to do so, in that you did not:

i.     expose their foot and ankle;

ii.    assess the colour of their foot;

iii.   assess the temperature of their foot;

iv.  assess their pedal pulse;

b.    did not recognise it was a potentially ‘time critical’ incident.

3)       On or around 31 May 2016, attended patient 3 and;

a.    discharged the patient on scene without understanding the nature of their condition;

b.    did not request any assistance in regards to understanding the patient’s condition.

4)       On or around 31 May 2016, attended patient 4 and were unaware of the possible consequences of an Amitriptyline overdose.

5)       On or around 31 May 2016, when questioned by a clinical mentor, were unable to confirm the signs and/or symptoms of a Diazepam overdose.

6)       On or around 30 May 2016, attended patient 5 and did not question the patient regarding sporadic incontinence at all, or until prompted to do so.

7)       On or around 30 May 2016, attended patient 6 and;

a.    did not feel for a radial pulse;

b.    did not understand the patient’s ECG readings, in that you were unable to confirm if the patient was in normal sinus rhythm or not.

8)       On or around 1 July 2016, attended patient 8 and;

a.    did not carry out a visual inspection of their airway;

b.    did not position the patient correctly in order to undertake an abdominal assessment;

c.    did not offer the patient pain relief until prompted to do so;

d.    were unable to identify a potential differential diagnosis.

e.    did not assess Patient 8’s respiratory rate.

9)       On or around 1 July 2016 attended patient 9 and;

a.    did not undertake an ECG during the secondary survey;

b.    did not offer the patient pain relief until prompted to do so;

c.    did not identify an appropriate disposition plan.

10)   On or around 2 July 2016, attended patient 10 and;

a.    Did not carry out a visual inspection of their airway;

b.    did not obtain a respiratory rate;

c.    did not question the patient in order to identify red flags relating to back pain, until prompted to do so;

d.    did   not    communicate   the    side    effects    of    Morphine    before administration to the patient;

e.    before administering a second dose of Morphine failed to check the following until prompted to do so:

a)     Pulse;

b)     Respiratory rate;

c)      Blood pressure;

f.     did not identify air in the syringe which you were about to use to administer Morphine.

11)   On or around 2 July 2016, attended patient 11 and;

a.    did not complete a primary survey;

b.    proposed a plan which would have delayed conveying the patient to hospital had a colleague not intervened;

c.    did not provide them with oxygen therapy.

12)   On or around 4 July 2016, attended patient 12 and did not take the lead in completing the primary survey.

13)   Did not consistently demonstrated effective communication skills when:

a.    Communicating your decisions to patients;

b.    Delegating tasks to other crew members.

14)   The matters as set out in paragraphs 1-13 constitute a lack of competence.

15)   By reason of this lack of competence your fitness to practise as a Paramedic is impaired.

Finding

Background

1. The Registrant was employed as a Band 5 Paramedic, initially by South Coast Ambulance Service (‘SCAS’). As a newly qualified paramedic he was required to participate in the ‘Newly Qualified (NQ) / Preceptorship Programme’, which required a number of shifts to be worked with a clinical mentor. In March 2016, the Registrant’s mentor attended a number of incidents with the Registrant, following which concerns were raised regarding the Registrant’s performance, which led to a formal capability process. The concerns primarily related to clinical assessment skills, as set out in the Allegation above.

2. On 05 February 2019, a panel of the Conduct and Competence Committee agreed to dispose of the case by means of a Consent Order, having found that the Registrant’s fitness to practise was impaired by reason of his lack of competence. The Registrant admitted the Allegation in full and accepted that he had not been practicing at the level of a newly qualified paramedic when initially employed by SCAS. The Registrant also confirmed that he had stepped down from his role as a Paramedic to work as an Emergency Care Assistant (‘ECA’). The panel imposed a twelve month Conditions of Practice Order.

3. The panel, at that hearing, determined that the appropriate order to be imposed was a Conditions of Practice Order for a period of 12 months. The conditions imposed were as follows:

1. You must place yourself and remain under the supervision of a workplace supervisor, registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within one month of recommencing work as a Paramedic. You must attend upon that supervisor as required and follow their advice and recommendations.

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

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

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

  • A. any organisation or person employing or contracting with you to undertake professional work;
  • B. any agency you are registered with or apply to be registered with (at the time of application); and
  • C. any prospective employer (at the time of your application).

5. You must work with your supervisor to formulate a Personal Development Plan designed to monitor and address any deficiencies in the following areas of your practice:

  • A. Undertaking assessments
  • B. Communicating effectively with colleagues and patients

6. Within three months of starting work as a Paramedic you must forward a copy of your Personal Development Plan to the HCPC.

7. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

8. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

4. At the first review hearing, on the 07 January 2020, the Registrant attended and was represented. The panel, on that occasion, determined that the Registrant’s fitness to practise remained impaired, on both the personal and public components, and extended the Conditions of Practice Order, without variation, by a period of 12 months.

5. The first review panel also made suggestions as to how a future review panel might be assisted. The first review panel’s suggestions were as follows:

i. Attendance at the review hearing;

ii. References from any employment in a health care setting; and

iii. Evidence of any steps to maintain his skills, including evidence of any training and Continuing Professional Development (‘CPD’).

Registrant's evidence

6. The Registrant gave evidence before the Panel and he drew the Panel’s attention to his bundle of documents, which contained the following:

i. His C.V;

ii. Feedback/testimonials and references;

iii. Email from Brabners Solicitors, to the HCPC, dated 09 October 2020, notifying the HCPC regarding his engagement with the Order;

iv. His PDP;

v. Monthly development reviews;

vi. Reflections;

vii. CPD; and

viii. Confirmation of acceptance to BSc Top-Up Course at the University of Cumbria.

7. In response to questions, he told the Panel that he had, on 21 September 2020, been successful in gaining employment as a Paramedic with the SCAS.

8. He also informed the Panel that he had complied with all of the conditions of practice, including providing the name and details of his supervisor at SCAS, KH. The Registrant also told the Panel that he had formulated a Personal Development Plan (‘PDP’), with KH, and was working under her supervision. He drew the Panel’s attention to the PDP, contained within his bundle of documents.

9. In response to questions regarding what had changed in his practice since the concerns were first raised, he gave evidence to the Panel that having been employed as an ECA he had been able to review his own practice in terms of clinical assessment and communication with patients and colleagues and that he was receiving positive feedback from his colleagues regarding his improved performance. He further stated that previously, he had wanted to “do everything” and that he wouldn’t “discuss pathways with colleagues”. However, this has changed and he now discusses his decision making with colleagues and the patient and he provided examples, to the Panel, of where he had done so.

10. In response to questions from Ms Knight, on behalf of the HCPC, the Registrant told the Panel that he had been in employment for 3 months and that he felt “a lot happier” and more “comfortable” in his role as a Paramedic. He also told the Panel that he had not engaged in any other work because he had wanted to focus on his work for SCAS.

11. Ms Knight drew the Registrant’s attention to a letter dated 21 December 2020, from JH a Team leader at SCAS, which stated ‘In line with your Personal Development Plan, KH [redacted] has reviewed 6 of your clinical records and these appeared to be well documented with a good use of language and medical terminology. It does appear that your performance has dropped slightly and you are omitting some important details (please refer to your ePRF review documents sent by KH). You acknowledged these omissions and have assured me you can rectify this by our next review.’ In response, the Registrant told the Panel that he had started to fill in the boxes now on the ePRF and that he had omitted, on some occasions, to include his ‘skill level’ within the template documents, as he was required to do.

12. In response to a question regarding his confidence in returning to practice as a Paramedic, the Registrant informed the Panel that he felt that his confidence has improved, he has a “systemic way of assessing patients” now, which he didn’t before, and no longer requires prompting to do so. The Registrant informed the Panel that he felt confident to return to unrestricted practice.

13. The Registrant told the Panel, in response to Panel questions, that his NQP/ Preceptorship period of training was due to complete in September 2022, as it would be in place for two years from his appointment, and that he was required to complete his portfolio by this point also. However, he also told the Panel that by March, it was expected that he had completed approximately 25% of the work required for his portfolio.

14. The Registrant also told the Panel, in respect of his expectation of his next monthly review meeting which was due to be conducted on 14 January 2021, that he would expect that he would meet all of the expectations required of him and that he was confident that his performance would have increased again.

Submissions

15. Miss Knight submitted, on behalf of the HCPC, that the Registrant remained currently impaired. She submitted that whilst it was noted that the Registrant had now successfully gained employment with SCAS, it was as a newly qualified Paramedic and was only obtained some 3 months before the hearing. She stated that whilst the HCPC accepted that it was encouraging that his colleagues had provided testimonials to confirm that his practice was improving, there remained concerns regarding his autonomous practice. She drew the Panel’s attention to the concerns raised in the letter dated 21 December 2020, where the Registrant had omitted important details from patient records. She highlighted to the Panel that there was no evidence before the Panel that the Registrant had rectified these omissions, as the review meeting, with his supervisor, was not scheduled to take place until 14 January 2021.

16. Ms Knight also drew the Panel’s attention to the areas of concern outlined on the Registrant’s PDP. Again, stating that there was a lack of evidence to support any improvement in this regard.

17. Miss Knight submitted that the original panel’s finding was in respect of a lack of competence and as a consequence the Panel should adopt a cautious approach as the Registrant had failed to demonstrate that he had remedied his failings and consequently, there remained a risk to the public.

18. Ms Hewitt, on the Registrant’s behalf, submitted the following:

i. the concerns were of some age; dating back to 2016;

ii. the Registrant had demonstrated great levels of insight, having self-referred originally, and recognising that he was not practicing at the required level. He took a diminishment in status and pay to work as an ECA to improve his practice;

iii. he was committed to the profession and the original concerns were not regarding his integrity, character or attitudinal issues;

iv. the Registrant had worked under conditions and had complied with them and the evidence before the Panel was that he was a vastly different practitioner now, compared to when he self-referred;

19. Ms Hewitt submitted that the Registrant was not currently impaired on either the personal or public component. She told the Panel that the support framework was in place within SCAS, as the Registrant would be subject to supervision during the course of his training, which was due to be completed in September 2022 and consequently a further Order was neither necessary or proportionate.

Panel approach

20. The Panel took into account the documents furnished to it by the HCPC and the Registrant and had regard to the parties’ evidence and submissions.

21. The Panel considered the relevant Practice Note issued by the HCPTS, ‘Finding that Fitness to Practise is ‘Impaired’’, together with the HCPC’s Standards of Conduct, Performance and Ethics and the HCPC’s Standards of Proficiency for Paramedics in England.

22. The Panel accepted the advice of the Legal Assessor.

Decision

23. In making its decision, the Panel had regard to both the personal and public elements of impairment.

24. The Panel found the Registrant to be candid and genuine when giving his evidence and found the Registrant’s responses to questions were honest. The Panel noted that the Registrant had complied with the conditions imposed on his registration and was also of the view that the Registrant demonstrated further insight into his failings. The Panel was encouraged that the Registrant had successfully gained employment as a Paramedic with SCAS in September 2020, and commended the Registrant for engaging with the regulatory proceedings, attending the hearing and providing the documents contained with his bundle, to it.

25. However, whilst the Panel recognised that the regulatory process had been a salutary one for the Registrant and he had demonstrated some improvements, the Panel remained concerned by the evidence before it, which clearly demonstrated that the Registrant was unable to show a sustained and continued improvement in his practice, notwithstanding the supervision in place to support him. In particular, the Panel noted that the Registrant accepted a drop in his performance in December 2020, only two months into his new role. Further, the Panel had regard to the testimonial letter provided by his colleague Ms C, in which she noted a significant improvement in the Registrant’s practice further to concerns raised in 2016. However, she qualified this by stating ‘I feel that if John is supported well and continues to develop his knowledge and assessment skills that he will be a safe clinician’.

26. The Panel noted that whilst the Registrant had complied with the conditions of practice and had provided a PDP, which he had formulated with his supervisor, the PDP provided contained no evidence relating to outcomes or his progress. Consequently, the Panel remained concerned regarding the lack of evidence relating to the Registrant undertaking assessments and communicating effectively with colleagues and patients, areas of concern raised in respect of the Registrant’s competence to practice as a Paramedic. Further, whilst the Panel noted the Registrant’s evidence regarding his omissions on the ePRF, the documents were not before the Panel for it to consider.

27. The Panel also considered the wider public interest considerations in the case and had regard to the need to protect patients and maintain public trust and confidence in the profession. In the absence of evidence of sufficient remediation, public trust and confidence in the profession would be undermined if a finding of impairment were not made in the circumstances of this case.

28. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.

29. The Panel bore in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, that any sanction must be proportionate, so that any order must be the least restrictive order that would protect the public interest, including public protection. The Panel considered the sanctions available to it in ascending order of severity.

30. The Panel considered the option of a Caution Order however, decided that it would not provide adequate protection for the public.

31. The Panel next considered a Conditions of Practice Order. The Panel noted the Registrant’s engagement throughout the regulatory proceedings and that he had taken steps to remedy his failings. The Panel also noted that the Registrant had only recently been able to secure employment, as a Paramedic with SCAS, and comply with the conditions of practice imposed. The Panel was of the view that the Registrant should be afforded a further opportunity to demonstrate that he is capable of safe, effective and independent practice and an opportunity to satisfy a future panel that his fitness to practise is no longer impaired.

32. The Panel considered a suspension order but decided that this would be disproportionate at this time.

33. The Panel considered that a 9-month Conditions of Practice Order was appropriate, as it would provide the Registrant with sufficient time to demonstrate that his fitness to practise was no longer impaired.

34. The Panel also considered that a review panel may be assisted by the following:

i. his attendance at any future review hearing;

ii. references from his supervisors addressing his progress against his PDP;

iii. references from colleagues regarding his communication; and

iv. evidence of any further steps to maintain his skills, including evidence of training and Continuing Professional Development (PDP).

Order

ORDER: The Panel directs the Registrar to vary and extend the current Conditions of Practice Order against the registration of Mr John W Williams for a further period of 9 months from the date of expiry of the current order. The Conditions are as follows:

1. You must place yourself and remain under the supervision of a workplace supervisor, registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within one month of recommencing work as a Paramedic. You must attend upon that supervisor as required and follow their advice and recommendations.

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

3. You must promptly inform the HCPC of any capability or

disciplinary proceedings taken against you by your employer.

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

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

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

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

5. You must work with your supervisor, meet with them on a monthly basis, and document, record and complete your progress in your Personal Development Plan to monitor and address any deficiencies in the following areas of your practice:

A. Undertaking assessments

B. Communicating effectively with colleagues and patients

6. You must forward a copy of your completed, updated and signed Personal Development Plan to the HCPC at least 14 working days before the next review hearing.

7. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

Notes

Right to Apply to the Court

Under Article 31(12) of the Health and Social Work Professions Order 2001, you may apply to the appropriate court to terminate the order.

 

 

Hearing History

History of Hearings for Mr John W Williams

Date Panel Hearing type Outcomes / Status
08/01/2021 Conduct and Competence Committee Review Hearing Conditions of Practice
07/01/2020 Conduct and Competence Committee Review Hearing Conditions of Practice
05/02/2019 Conduct and Competence Committee Consent Order Hearing Conditions of Practice
21/12/2018 Conduct and Competence Committee Final Hearing Adjourned
16/07/2018 Conduct and Competence Committee Final Hearing Adjourned