Anthony Morris

Background

1. The Registrant was employed by North West Ambulance Service NHS Trust (“NWAST”) as a Paramedic.

2. On 26 August 2016, he attended to Service User A in response to an emergency 999 call made by Person C. The Registrant subsequently contacted the Ambulance control room and requested an ambulance

crew as backup. Ms Chadwick and Colleague A were dispatched to assist him and arrived in an ambulance. Ms Chadwick was a paramedic also employed by NWAST and Colleague A was an Emergency Medical Technician (“EMT”). Service User A died shortly after her arrival at the hospital.

3. Person B, Service User A’s mother, submitted a written complaint to NWAST on 22 March 2017 with regard to the care that Service User A received from the Registrant and Ms Chadwick. PC, a Patient Experience Manager at NWAST, subsequently completed an investigation. JP, who was an Advanced Paramedic, conducted a clinical review of the incident.

4. A referral was made to the HCPC by NWAST on 25 July 2017 in regard to the Registrant’s fitness to practise.

5. At the Substantive Hearing, the original panel determined that the matters found proved amounted to misconduct and the Registrant’s fitness to practice to be impaired.

6. In regard to sanction, the panel imposed a Conditions of Practice Order for a period of 12 months to enable the Registrant to address the deficiencies that were identified in his practice, thereby, protecting service users and maintaining public confidence in the profession.

7. That panel did consider whether to impose a Suspension Order but concluded that this would be disproportionate to the deficiencies identified and would not enable the Registrant to resume practice and to address the matters of concern.

8. At the first substantive review, the Panel varied Conditions 1 and 2 and extended the period of the Order for a further 12 months.

Submissions

HCPC

9. Ms Sampson HCPC explained the background to the current hearing, which was convened on the basis of the Registrant’s request for an early review. Ms Sampson explained that the HCPC had been informed by the Registrant that he had been offered employment in which his registration as a paramedic was required, and that he was unable to accept the offer due to Condition 2. That condition required the indirect supervision of a supervisor who was a registered paramedic, and the Registrant sought a variation of that condition.

10. The offer of employment was from a registered nurse who had written to the HCPC to explain that she runs an Intravenous micronutrient supplementation business, and that she would be able to supervise the Registrant but clearly this would not meet the requirement of Condition 2 of the Order as she was a nurse, not a paramedic.

11. Ms Sampson submitted that there had been no material change since the last review, and that as a result, the Registrant’s fitness to practice remained currently impaired on the basis of the personal and public components.

12. Ms Sampson also submitted that a Conditions of Practice Order remained necessary. She told the Panel that the HCPC did not object to the Registrant’s application to amend Condition 2 to allow him to accept the offer of employment. Ms Sampson suggested that Condition 2 could be amended to substitute “registered healthcare professional” for the words “registered Paramedic”, This would allow the Registrant to work as a Paramedic and give him the opportunity to demonstrate remediation which the previous reviewing Panel identified as lacking, and which continued to be the case, as the Registrant had not yet found employment as a Paramedic since the original substantive hearing.

13. The Panel had before it the hearing bundle prepared by the HCPC as well as two telephone attendance notes dated 21 January 2022 which set out conversations between the HCPC and the Registrant as well as the registered nurse who had offered him employment.

Registrant

14. The Registrant made submissions to the Panel by telephone. He told the Panel that he considered that his fitness to practice remained impaired because he had not been in clinical practice for the last 4 years, and he would not be happy to work as a Paramedic without supervision. He told the Panel that for the last 18 months he had been trying to obtain employment as a Paramedic but was unable to do so due to the requirement in the Conditions of Practice Order for supervision by another Paramedic. He told the Panel that he “desperately” wanted to adhere to the conditions. He also told the Panel that he has been informed by the registration department of the HCPC that he had until March 2022 to obtain his clinical hours, otherwise he will be de-registered, and it was extremely important to him to avoid that outcome. He asked that Condition 2 be varied so as to refer to a registered healthcare professional rather than a Paramedic. With regard to the offer of employment, his role as a Paramedic would be to assist the registered nurse, while being supervised by her at all times, by inserting IV cannulas, taking medical histories from patients, preparing IVs to administer, and preparing fluids for those IVs, as well as being present to assist as a Paramedic if an unplanned medical emergency arose.

Decision

15. In reaching its decision, the Panel considered all the information before it together with the submissions of Ms Sampson and of the Registrant. It accepted the advice of the Legal Assessor.

16. It had regard to the HCPTS Practice Note on Review of Article 30 Sanction Orders and the HCPC Sanctions Policy.

17. The Panel had regard to the decision of the Substantive panel and the first reviewing Panel, but it has comprehensively reviewed the matter and has exercised its own judgment in reaching its decision and taken into account the principle of proportionality.

Impairment

18. The Panel has determined that the Registrant’s fitness to practice remains impaired.

19. In coming to this decision, the Panel took into account that the Registrant has not practiced as a Paramedic since the substantive hearing, and therefore has not had an opportunity to engage with the conditions, and to demonstrate remediation.

20. Although the previous panel found that the Registrant had developed a degree of insight, this was considered to be still developing and, in this Panel’s view, this remained the position. The Registrant has not yet completed his reflective statement, a task which was suggested by the first reviewing Panel as something which may help a subsequent reviewing Panel. Today’s Panel noted that this was, it appeared from what the Registrant told it, a work in progress. The Panel did not criticize the Registrant for not completing it, it simply noted that it was not before it today.

21. In these circumstances, the Panel decided that there remains a real risk of repetition of the Registrant’s failings and the consequent risk to patients. Moreover, there remained a need to uphold standards and maintain public confidence in the profession.

22. The Panel therefore concluded that the Registrant’s fitness to practice remains impaired on both the personal and public components.

Sanction

23. The Panel approached the question of sanction from the least restrictive upwards. It exercised the principle of proportionality, was aware that the purpose of sanction is to protect the public and uphold the public interest. The Panel has accepted the advice of the Legal Assessor.

24. The Panel first considered whether to revoke the existing order. It concluded that this would be wholly inappropriate and would provide no restriction on the Registrant’s practice which would be needed to protect the public. Nor would it be sufficient to address the public interest concerns in the case. A Caution would be insufficient for the same reasons.

25. With regard to conditions, the Panel took into account that despite being unable, to date, to work pursuant to the Conditions of Practice Order, the Registrant has expressed to the Panel a clear willingness to adhere to them. He has also informed prospective employers of the conditions imposed, and further demonstrated his respect for the conditions, by seeking the HCPC’s advice, as seen in the telephone notes and correspondence, about the incompatibility of his recent offer of employment with regard to Condition 2.

26. In the circumstances, the Panel has concluded that appropriate Conditions of Practice would be sufficient and proportionate to protect the public against the risk posed by the Registrant and would also address the wider public interest. The Panel carefully considered the Registrant’s request to vary Condition 2 to refer to a registered health care professional, and considered that this would be proportionate and appropriate. The Panel came to this decision for the following reasons. It would provide the Registrant with an opportunity to accept the offer of employment and to assist him in demonstrating remediation, but would also provide a sufficient level of protection to the public, as well as address the public interest concerns in ensuring that he remained supervised. It was a relevant factor that Condition 1 provided further safeguards. Taking into account Condition 1, and Condition 2, as varied by this Panel, the Panel also considered that the safeguards were sufficient should the Registrant work in any other healthcare setting as a registered Paramedic.

27. The Panel did consider a Suspension order but decided that this would be disproportionate as it would not provide the Registrant with the opportunity to remedy his failings and return to safe practice.

28. The Panel did remind the Registrant that the first reviewing Panel had suggested steps for the Registrant to take which may help a future reviewing panel, such as writing a reflective statement. In addition, the Panel indicated to the Registrant that it would be wise for him to contact the HCPC registration department to obtain clarity as to whether the employment which he has been offered will allow him to obtain the requisite clinical hours for him to maintain his registration.

29. The Panel therefore determined that the current Conditions of Practice Order is to continue for the remainder of the current term, with a variation to Condition 2 with immediate effect, pursuant to Article 30(2) of the Health Professions Order 2001.

The Registrar is directed to vary the Conditions of Practice Order for a further period of 12 months, you Mr Anthony Morris must comply with the following conditions of practice:

1. You must work as a registered Paramedic only where you are directly working with another registered healthcare professional.

2. You must place yourself and remain under the indirect supervision of a supervisor who is a registered healthcare professional.

3. You must supply details of your supervisor to the HCPC within 14 days of the commencement of your employment under these conditions.

4. You must attend upon that supervisor as required and follow any advice and recommendations.

5. Informing the HCPC and others:

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

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

iii. 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).

6. You must work with your supervisor to formulate a personal development plan designed to address the deficiencies in the following areas:

• Managing challenging and non-compliant service users;

• Treating service users and their families/others with respect and dignity;

• Clinical assessment and examination;

• Baseline observations;

• Communicating with service users and carers;

• Appropriate extrication and conveyance of service users;

• Timeliness of interventions;

7. Within two months of commencing employment as a Registered Paramedic you must forward a copy of your Personal Development Plan to the HCPC.

8. You must meet with your supervisor fortnightly for the first two months, and on a monthly basis thereafter to consider your progress towards achieving the aims set out in your Personal Development Plan.

9. 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 every three months and prior to any review of this order.

10. You must undertake the process and meet the requirement for Return to Practice set out by the HCPC.

11. You will be responsible for meeting any and all costs associated with complying with these conditions. Any condition requiring you to provide information to the HCPC is to be met by you and sent to the offices of the HCPC, marked for the attention of the relevant Case Manager.

The varied Order will apply from 4 February 2022.

History of Hearings for Anthony Morris