Jayne M Denton

Preliminary Matters

Service of Notice

1. The Notice of Hearing with information including the date and time of the hearing was sent to the Registrant at her registered e-mail address on 23 November 2021. The Panel had regard to the information in the service bundle and was satisfied that there had been good service.

Proceeding with the hearing in the Registrant’s absence

2. Ms Harman submitted that the Panel should proceed with the hearing in the Registrant’s absence. She referred the Panel to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”. She submitted that the Registrant engaged with the HCPC to the extent that she submitted a pro forma response in September 2021 stating that she did not intend to attend the final hearing. The Registrant has consistently stated that she did not wish to attend the hearing and this was confirmed in correspondence with HCPTS representatives on 22 and 24 December 2021. Ms Harman submitted that the Registrant is voluntarily absent, she has not sought an adjournment, there is a general public interest in expedition, and that it would be fair to proceed in the Registrant’s absence.

3. The Legal Assessor referred the Panel to the cases of GMC v Adeogba [2016] EWCA Civ 162, R v Jones [2002] UKHL5, and Rule 11 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003. The Panel accepted the advice of the Legal Assessor in relation to the factors it should take into account when considering whether to proceed with the hearing.

4. The Panel carefully considered the circumstances of the Registrant’s absence. She is aware that the hearing is scheduled to take place today and that the Panel may decide to proceed in her absence. She has consistently and clearly stated that she does not wish to attend the hearing. The Panel decided that her absence is voluntary. The Registrant has not requested an adjournment and the Panel decided that there would be no purpose in adjourning the hearing because there was little prospect that the Registrant would attend a hearing at a later date. The Panel also considered that there was a public interest in the hearing proceeding expeditiously. The HCPC witness was prepared and ready to give her evidence to the Panel.

5. Having considered the circumstances, the Panel decided that any disadvantage to the Registrant in not attending the hearing was outweighed by the public interest. The Panel concluded that it was fair and appropriate to proceed with the hearing in the absence of the Registrant.

Background

6. The Registrant is a registered Paramedic. At the time of the events she was working as a self-employed Emergency Care Practitioner (ECP) for Care UK Ltd (Care UK Ltd now trades as Practice Plus Group). The Registrant’s ECP role involved participation in the out of hours service during periods in the evening, overnight, at weekends and on bank holidays when GP services are not available.

7. In February 2020, the Registrant moved from Gloucestershire out of hours service to the Worcestershire out of hours service. She ceased to work for Care UK in April 2020. As a self-employed ECP the Registrant was not subject to line management, but the quality of her work was overseen and monitored by LB the Lead Nurse at Care UK/Practice Plus Group.

8. On 30 April 2020, the HCPC received a referral from Care UK. LB had undertaken a routine audit of the Registrant’s work for March 2020. This routine audit involved a review of a randomly selected single case, Patient A. There were concerns arising from this single case, and therefore an enhanced audit was undertaken of five further randomly selected cases (Patients B-F). In all five cases, further concerns were highlighted in the audit and none of the cases were assessed as meeting a satisfactory standard. LB invited another manager, CP, the Medical Lead, to conduct an “blind” audit without sight of LB’s comments. In this further review CP had similar concerns to those of LB.

9. The concerns related to a poor standard of history taking and lack of attention to and awareness of “red flag” symptoms. The Registrant’s examination skills or her completion of documentation reflected a lack of ability to confirm or exclude red flag symptoms and then to act upon them. The audit also found consistent and concerning prescribing errors.

Decision on Facts

10. The Panel accepted the advice of the Legal Assessor. In respect of the facts, the Panel understood that the burden of proving each individual particular is on the HCPC and that the standard of proof is the civil standard, that it is more likely than not that the events occurred as alleged.

11. The Panel read the HCPC bundle of exhibits.

12. The Registrant did not submit documents or other information for the Panel’s consideration.

13. The Panel heard oral evidence from LB. The Panel found that her evidence was professional, reliable, and credible. The Panel noted that she was fair, describing the Registrant as a kind and considerate person, but explaining that her focus was required to be on ensuring patient safety.

14. In her submissions, Ms Harman acknowledged that the HCPC’s evidence was limited to LB’s audit and the patient notes. There was no direct evidence that the Registrant did not carry out the investigations referred to in the Allegation.

15. On 28 April 2020 the Registrant attended an interview with LB and CP. The Panel was provided with the notes of this interview. In these notes the Registrant did not suggest that she had carried out the investigations in question, and that her only failure was not to record her investigations.

16. The Panel took into account the requirement for Paramedics to make full and accurate records and decided that it was reasonable to draw the inference that the Registrant had not carried out an investigation where she had not recorded her investigation or the outcome of her investigation.

17. The Panel carefully considered the record of an interview conducted with the Registrant on 28 April 2020. In this meeting the Registrant did not provide a substantive response to the points and concerns raised by LB. She was given the opportunity to respond and she said that she was “embarrassed and feels upset and she has let people down”. In relation to prescribing she said that she “thinks I was heavy handed, not really surprised re comment”.

Particular 1

18. The Panel found particular 1(a) proved by the evidence of LB and the documentary evidence. In her examination of Patient B on 1 February 2020, the Registrant did not obtain and did not record an adequate medication history.

19. Patient B was an elderly patient who reported pain in her spine. The Registrant recorded that the patient had taken over the counter medication but did not record the patient’s medication history. LB explained that obtaining and recording the medication history is important to enable the Registrant to assess what further medication will be safe and likely to be effective. This establishment of the baseline of existing medication is required before any new medication should be prescribed.

20. After completing the audit, Care UK made contact with Patient B’s GP and was informed that the patient had long term renal failure. This history had not been identified in the Registrant’s notes.

21. The Panel found particular 1(b) proved by the evidence of LB and the documentary evidence. The Registrant did not obtain and did not record results of an investigation into spinal tenderness for Patient B.

22. Patient B reported pain in her spine when touched, which is a “red flag”. Red flags are symptoms which can be associated with particular conditions. As explained by LB, the symptom of tenderness in the spine could be associated with a spinal fracture and should therefore have been investigated.

23. The Panel found particular 1(c) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and record sufficient follow up advice in order to minimise risks of deterioration.

24. The advice to minimise risks of deterioration is described as “safety netting”. LB had written updated guidance on safety netting, but the Registrant informed LB in the interview on 28 April 2020 that she had not received a copy of this document. LB explained in her oral evidence that the steps for “safety netting” patients are part of the basic training for Paramedics and that this is a core skill. The creation of a safety net for a patient involves advising the patient what to look for, in what time frame, and what to do.

25. In her notes for Patient B the Registrant recorded that she advised that Patient B should contact her own GP, 999 or 111 “if worsening”. This was not sufficient follow up advice because the Registrant did not explain what symptoms Patient B should look for or what steps to take in the event of the development of those symptoms.

Particular 2

26. The Panel found particular 2(a) proved by the evidence of LB and the documentary evidence. The Registrant did not demonstrate adequate clinical knowledge in that she prescribed strong anti-inflammatory and pain relief medication without having conducted sufficient investigation into the patient’s medication history.

27. The Registrant prescribed Naproxen, a strong anti-inflammatory, and Codeine for Patient B. The Registrant had not conducted a sufficient investigation into Patient B’s medication history.

28. LB explained that as an ECP the Registrant did not have independent prescribing rights. She was required to follow the Patient Group Directives (PGDs) for prescribing. The PGDs are a set of protocols which explain the conditions medication may be prescribed for and provide a dosage range.

29. In the interview on 28 April the Registrant was asked about her prescribing and the PGDs. The Registrant stated that she “needs to refresh self with PGDs”. In the Registrant’s prescribing decisions she did not demonstrate her compliance with the PGDs and adequate clinical knowledge.

30. The Panel found particular 2(b) partially proved (proved in relation to maximum dosage but not frequency of dose) by the evidence of LB and the documentary evidence. When the Registrant prescribed 28 tablets of Diazepam for Patient B she did not provide sufficient advice on maximum dosage.

31. When prescribing Diazepam the Registrant did record that she gave advice to Patient B on the frequency of the dose “every 4-6 hours as required”.

32. The Registrant did not provide sufficient advice on the maximum dose. The Registrant had not taken sufficient medication history to establish the maximum dose. She also prescribed 28 tablets which LB told the Panel is in excess of the PGD limitation that Diazepam should not be issued for more than three days.

Particular 3

33. The Panel found particular 3(a) proved by the evidence of LB and the documentary evidence. In her examination of Patient F on 1 February 2020, the Registrant did not investigate and record results of an investigation into eye pain and headache.

34. LB explained in her witness statement that the Registrant did not investigate “red flags” for eye pain, such as visual changes, red eye, fever, swelling, speed of onset, whether unilateral or bilateral, eye discharge, or whether the patient had suffered an injury, could have a foreign body in the eye or whether the patient was a contact lens wearer. The “red flags” for headache were not investigated including neck stiffness, rashes, vomiting, position of pain, and severity level.

35. The Panel found particular 3(b) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and did not record sufficient follow up advice in order to minimise risks of deterioration.

36. The Registrant advised Patient F to contact NHS 111 or her own GP “if symptoms worsen or persist”, but this was insufficient advice in accordance with the requirements for “safety netting”, advising the patient what to look for, in what time frame, and what to do in the context of the symptoms.

Particular 4

37. The Panel found particular 4 proved by the evidence of LB and the documentary evidence. The Registrant did not demonstrate adequate clinical knowledge when she prescribed antibiotics to Patient F on 20 February 2020.

38. There was nothing in the Registrant’s notes for Patient F which indicated a bacterial infection rather than a viral infection and therefore the prescription of antibiotics was inappropriate.

Particular 5

39. The Panel found particular 5(a) proved by the evidence of LB and the documentary evidence. In her examination of Patient E on 27 February 2020 the Registrant did not adequately investigate and record results of her investigation into the patient’s shortness of breath and chest pain.

40. Patient E was a pregnant patient who was experiencing shortness of breath and chest pain. The symptoms from Pulmonary Embolism can include shortness of breath and chest pain and the risks of developing Pulmonary Embolism increase with pregnancy. LB explained that Pulmonary Embolism can be fatal if it is not treated immediately.

41. In her assessment of Patient E the Registrant did not consider or explore the possibility of Pulmonary Embolism. In her interview with LB on 28 April 2020 the Registrant agreed that Pulmonary Embolism was a concern, given the symptoms the patient was describing.

42. The Panel found particular 5(b) proved by the evidence of LB and the documentary evidence. The Registrant did not identify the risks of Pulmonary Embolism or explain these risks to Patient E.

43. There is no reference to Pulmonary Embolism in the Registrant notes for Patient E and the Panel inferred that she did not identify or explain the risks to the patient.

44. The Panel found particular 5(c) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and record sufficient advice given to Patient E in relation to Pulmonary Embolism.

45. The Registrant did not identify the risk of Pulmonary Embolism and therefore did not provide or record sufficient advice to Patient E.

46. The Panel found particular 5(d) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and record sufficient follow up advice to Patient E to minimise risks of deterioration.

47. The Registrant advised Patient E to attend hospital to conduct tests including an ECG, but this was insufficient advice. Patient E was not specifically advised about the risk of Pulmonary Embolism and was not in a position to make an informed decision about whether to stay at home or attend hospital.

Particular 6

48. The Panel found particular 6(a) proved by the evidence of LB and the documentary evidence. In her examination of Patient D on 20 March 2020, the Registrant did not investigate and record results of an investigation into testicular pain.

49. Patient D was a male patient with urinary problem. The Registrant treated Patient D for a urinary tract infection, but she did not investigate other possible diagnoses. She did not ask about testicular pain.

50. The Panel found particular 6(b) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and record sufficient follow up advice in order to minimise risks of deterioration.

51. The Registrant did not provide sufficient advice to Patient D to provide a “safety net” by explaining what to look for, in what time frame, and explaining what to do in each event.

Particular 7

52. The Panel found particular 7(a) proved by the evidence of LB and the documentary evidence. In her examination of Patient C on 20 March 2020 the Registrant did not obtain and record an adequate medication history.

53. Patient C was a ninety three year old female patient and it would be expected that such a patient would be on some medication. It was important to establish a baseline for the patient’s medication history. A previous clinician had recorded Patient C’s medication history, but the Registrant’s notes did not refer to or incorporate those notes in her record and there was nothing to demonstrate that she had considered the medication history.

54. The Panel found particular 7(b) proved by the evidence of LB and the documentary evidence. The Registrant did not undertake or record the results of basic observations for Patient C.

55. The Registrant made no record that she had checked Patient C’s heart rate, oxygen saturation, respiratory rate or temperature, and the Panel inferred that she had not carried out these checks.

56. The Panel found particular 7(c) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and record sufficient follow up advice in order to minimise risks of deterioration.

57. The Registrant did not provide sufficient advice to Patient C to provide a “safety net” by explaining what to look for, in what time frame, and explaining what to do in each event.

Particular 8

58. The Panel found particular 8(a) proved by the evidence of LB and the documentary evidence. In her examination of Patient A on 21 March 2020, the Registrant did not obtain and record an adequate medication history.

59. In her notes the Registrant recorded that Patient A had previously been prescribed codeine, but there were no notes about what amounts or dosages the patient had been prescribed. The baseline medication for Patient A was therefore not established before the Registrant prescribed further medication.

60. The Panel found particular 8(b) proved by the evidence of LB and the documentary evidence. The Registrant did not investigate or record results of an investigation into the mode of injury.

61. Patient A’s presenting complaint was back pain. The Registrant did not make a record of the mode of injury. There was a record in the notes made by a previous clinician, but the Registrant did not incorporate or confirm these notes into her own record.

62. The Panel found particular 8(c) not proved.

63. In her notes for Patient A the Registrant made a record of her examination noting no tenderness over the spine, tenderness over the left buttock, ability to abduct and adduct, weight bearing is painful.

64. LB’s criticism of the Registrant specific and limited that she did not conduct sufficient checks in relation to “red flags”. She did not make the more general criticism that the Registrant had not physically examined Patient A and recorded her findings.

65. The Panel found particular 8(d) not proved.

66. In her notes for Patient A the Registrant made a record of her examination, which included noting no tenderness over the spine, tenderness over the left buttock, ability to abduct and adduct, weight bearing is painful. LB’s criticism is specific and limited in that the Registrant did not sufficiently investigate “red flags” rather than that the Registrant did not conduct any examination for symptoms associated with spinal injury.

67. The Panel found particular 8(e) proved by the evidence of LB and the documentary evidence. The Registrant did not provide and record sufficient follow up advice to minimise risks of deterioration for Patient A.

68. The Registrant did not provide sufficient advice to Patient A to provide a “safety net” by explaining what to look for, in what time frame, and explaining what to do in each event.

Particular 9

69. The Panel found Particular 9(a) proved by the evidence of LB and the documentary evidence. The Registrant prescribed Naproxen, a strong anti-inflammatory, for Patient A, without having conducted a sufficient investigation into the patient’s medication history.

70. The Registrant made a record that Patient A had been prescribed Noritypitine by her GP and was taking paracetamol, ibuprofen, and codeine. This was not a sufficient medication history because the Registrant did not record doses or establish a baseline for other anti-inflammatory medications.

71. The Panel found particular 9(b) proved by the evidence of LB and the documentary evidence. The Registrant prescribed Morphine when it was not clinically indicated or supported by relevant prescribing guidance.

72. The Panel accepted the evidence of LB that the Registrant was not permitted to prescribe Morphine under the PGDs and that it was not clinically indicated.

Decision on Grounds

73. Ms Harman submitted that the facts found proved amounted to the statutory ground of lack of competence. She submitted that the Registrant breached the HCPC Standards of Conduct, Performance and Ethics and the Standards of Proficiency for Paramedics.

74. The Panel accepted the advice of the Legal Assessor. She advised the Panel that a lack of competence will usually be demonstrated with reference to a fair sample of the Registrant’s work (Calhaem v General Medical Council [2007] EWHC 2606. It is a standard of professional performance which is unacceptably low. The standard applied is that which applied to the Registrant’s position as a self-employed ECP (Holton General Medical Council [2006] EWHC 2960. A breach of the relevant HCPC standards is not determinative but may be taken into account as part of the Panel’s assessment.

75. The Panel was satisfied that the six cases highlighted over a period of no more than two months was a fair sample of the Registrant’s work. LB was unable to estimate how many cases the Registrant would have completed over one month, but she was able to confirm that it would have been less than two hundred cases. The cases in the audit were selected randomly by an administrator. All six of the cases selected in the audit had significant concerns and did not reach a standard that Care UK considered to be satisfactory. The Panel was satisfied that the audit result fairly reflected the standard of the Registrant’s work.

76. The Panel considered that the findings of fact demonstrated a pattern of failings. In particular the following themes were repeated in the facts found proved:

• Failures to obtain and record medication history to establish a baseline. This failure involved the potential for harm to patients if patients were to be prescribed medication which was inappropriate or establish whether the patient was at saturation level for the type of medication. When Care UK contacted Patient B’s GP, the GP reported that Patient B had stopped taking Naproxen due to gastro-intestinal upset.

• Failures to carry out investigation into symptoms, particularly “red flags”. A particularly serious example was the Registrant’s failure to consider and investigate the possibility of Pulmonary Embolism for Patient E.

• Failures to provide patients with sufficient “safety netting” advice.

• Prescribing medication when it was not appropriate to do so, either because of insufficient investigation of medication history, insufficient advice to the patient, or prescribing medication not permitted under the PGDs.

77. These repeated failings all involved the potential for serious harm to vulnerable patients. There was a risk that patients might be prescribed medication which was harmful, and a risk that the Registrant would fail to identify a potentially serious condition such as Pulmonary Embolism, which can be fatal if it is not treated immediately.

78. The Panel considered that the Registrant’s actions and omissions were a breach of the following HCPC Standards.

Standards of Conduct, Performance and Ethics (2016)

Standard 2.3 You must give service users the information they want or need, in a way they can understand

Standard 3.1 You must keep within your scope of practice by only practising in areas you have appropriate knowledge, skills and experience for

Standard 3.3 You must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development

Standard 6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

Standard 10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

Standard 10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services.

Standards of Proficiency for Paramedics

Standard 1.1 Know the limits of their practice and when to see advice or refer to another professional.

Standard 2.1 Understand the need to act in the best interests of service users at all times.

Standard 2.2 Understand what is required of them by the Health and Care Professions Council.

Standard 2.6 Be able to practise in accordance with current legislation governing the use of medicines by paramedics.

Standard 3.3 Understand both the need to keep skills and knowledge up to date and the importance of career-long learning

Standard 4.1 Be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem.

Standard 4.2 Be able to make reasoned decisions to initiate, continue, modify or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately.

10.1 Be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines.

10.2 Recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.

14.9 Be able to gather appropriate information.

14.11 Be able to undertake and record a thorough, sensitive and detailed assessment, using appropriate techniques and equipment.

14.12 Be able to conduct a thorough and detailed physical examination of the patient using appropriate skills to inform clinical reasoning and guide the formulation of a differential diagnosis across all age ranges.

79. The Panel concluded that the facts found proved demonstrated a standard of professional performance by the Registrant which was unacceptably low and amounted to the statutory ground of lack of competence.

Decision on Impairment

80. The Panel then went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of her lack of competence.

81. The Panel heard submissions from Ms Harman on behalf of the HCPC. She submitted that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component. She submitted that the Registrant has not provided evidence of remediation and that there is no information before the Panel on her current level of insight.

82. The Panel accepted the advice of the Legal Assessor and took in to account the guidance in the HCPTS Practice Note “Fitness to Practise Impairment”. She reminded the Panel that when considering the current risk to members of the public, it should consider whether the matters are remediable, any steps taken by the Registrant to remediate, and any risk of repetition. When assessing fitness to practise impairment the Panel should also consider the nature and gravity of the lack of competence and whether a finding of impairment is required to protect the wider public interest.

83. The Registrant has not engaged with the hearing and has not provided any submissions for the Panel to consider. There was therefore no information before the Panel on which to assess her current level of insight.

84. The Panel noted that on 28 April 2020 the Registrant said she was “embarrassed and feels upset and she has let people down”. In the same meeting LB recorded her concern that the Registrant didn’t appear to “understand the seriousness of review”. When the concerns were raised and explained, the Registrant appears to have accepted and expressed some regret, but her understanding at that time was limited.

85. The Registrant has demonstrated to the Panel no understanding of the seriousness of her lack of competence and its potential impact on patients, her colleagues, the public, or the profession. The Panel concluded that the Registrant has not demonstrated a sufficient level of insight.

86. In the Panel’s judgment the Registrant’s lack of competence is remediable, but she has not provided the Panel with any evidence of remedial steps.

87. In the absence of evidence of remediation or a sufficient level of insight the Panel concluded that there is a high risk of repetition of similar concerns. In its decision on the statutory ground of lack of competence the Panel explained that the Registrant’s lack of competence involves the risk of serious harm to patients. There is therefore an ongoing risk of harm to vulnerable service users and a finding of impairment is required to protect the public against the risk of repetition.

88. The Panel next considered the wider public interest including the need to maintain public confidence in the Paramedic profession and uphold the required professional standards for Paramedics. The Panel considered the aspects of this case that might concern an informed member of the public. They would be concerned that the Registrant’s failures involve the basic requirements for Paramedics in conducting appropriate assessments and investigations of patients, giving appropriate advice to patients, and prescribing medication. There would also be a concern about the potential for harm to patients. This concern involves the risks highlighted by LB in her witness statement and oral evidence, including the risk of Pulmonary Embolism for Patient E.

89. The Panel concluded that public confidence in the profession would be undermined if a finding of current impairment were not made.

90. The Panel therefore decided that the Registrant’s fitness to practise is impaired on the basis of the personal component and the public component.

Decision on Sanction

91. The Panel heard submissions from Ms Harman. She referred the Panel to paragraphs in the HCPC Sanctions Policy (SP) but made no submission on the appropriate sanction.

92. The Panel applied the guidance in the SP and the advice of the Legal Assessor. The Legal Assessor reminded the Panel on its powers in respect of sanction. The option of a striking off order is not currently available under the Health Professions Order 2001 paragraph 29(6). The Legal Assessor’s advice included references to the cases of Bolton v Law Society [1994] WLR 512 and PSA v NMC and Judge [2017] EWHC 817.

93. The primary function of any sanction is to address public safety. The Panel should also give appropriate weight to the wider public interest which includes maintaining confidence in the profession and setting the proper professional standards. The Panel applied the principle of proportionality and balanced the Registrant’s interests against the public interest. The sanction should be the least restrictive which is sufficient to provide the necessary degree of public protection.

94. The Panel identified the following aggravating features:

• the number and seriousness of the concerns identified in all six of the cases reviewed in the audit;

• the risk of harm to vulnerable patients;

• the absence of any evidence from the Registrant relating to insight or remediation.

95. The Panel identified the following mitigating features:

• no fitness to practise history.

96. The Panel considered the sanctions in ascending order of severity. The Panel decided that the Registrant’s lack of competence is of a nature and gravity that the option of taking no action would be entirely insufficient to protect the public and to maintain public confidence in the profession.

97. The Panel considered the option of a Caution Order, but decided that it would be insufficient. The Registrant’s lack of competence is not minor, she has not demonstrated insight, and the Panel has found that there is a high risk of repetition. A Caution Order would not restrict the Registrant’s practice and would not provide sufficient protection for the public.

98. The Panel next considered the option of a Conditions of Practice Order. Although the Panel considered that all the competency concerns are remediable, it decided that conditions of practice would not be appropriate where the Registrant has not engaged substantively with the process and has not provided her commitment to comply with conditions of practice. The Panel has no information on the Registrant’s current circumstances or employment. Further, the Panel did not consider that the Registrant has demonstrated a sufficient level of insight for conditions of practice to be an effective means of addressing the risk of repetition. The lack of competence in this case is wide ranging, rather than limited to one area of practice. Given the current absence of any evidence of remedial steps or insight, the Panel decided that any conditions of practice would need to be so restrictive that they would amount to a suspension. The Panel therefore decided that conditions of practice would be insufficient to protect the public and inappropriate.

99. The Panel then considered the guidance in the SP on a Suspension Order. The Panel noted that not all the factors set out in SP paragraph 121 applied. In particular the Registrant has not demonstrated insight, and the Panel has decided that there is a high risk of repetition. Nevertheless, a Suspension Order is the most restrictive order available to the Panel. A Suspension Order provides sufficient protection for the public because the Registrant will not be permitted to practise as a Paramedic. A Suspension Order also maintains public confidence in the profession and upholds the required professional standards for Paramedics. It is the most restrictive order available to the Panel and it sends a clear message to the public and to the profession that a serious sanction will be imposed to address a lack of competence which places members of the public at risk of harm.

100. The Panel considered that a Suspension Order was fair and proportionate. It would give the Registrant an opportunity to reflect on the Panel’s decision and to engage with the process if she wishes to do so. The Suspension Order will prevent the Registrant practicing as a Paramedic and the Panel acknowledged that it may have a detrimental impact on her financial and reputational interests. The Panel decided that the Registrant’s interests were outweighed by the need to protect the public and the wider public interest.

101. The Panel decided that the Suspension Order should be for the maximum period of twelve months. The Panel considered that this was proportionate because of the serious and wide-ranging nature of the Registrant’s lack of competence. Twelve months is a meaningful length of time which gives the Registrant the opportunity to consider the Panel’s decision, reflect on her position, and begin to take remedial steps, if she chooses to do so.

102. The Suspension Order will be reviewed before it expires. A future reviewing panel is likely to be assisted by:

• the attendance of the Registrant to provide an update on her circumstances;

• a written reflective piece from the Registrant including consideration of the impact of her acts and omissions on patients, colleagues, and the profession;

• evidence of remedial action e.g. any Continuing Professional Development and/or relevant training;

• references or testimonials from employment (paid or unpaid).

ORDER: The Registrar is directed to suspend the registration of Jayne Denton for a period of 12 months from the date this order comes into effect.

This order will be reviewed again before its expiry.

Interim Order Application

103. Ms Harman invited the Panel to consider an application for an interim order in the absence of the Registrant. Her application for an interim suspension order for a period of eighteen months was on the ground that it was necessary for the protection of the public and was otherwise in the public interest. She referred to paragraphs from the Panel’s decision and submitted that if the Registrant were to lodge an appeal, there would be no protection for the public while the appeal was ongoing.

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

105. The Panel first considered whether it was appropriate to consider this application in the absence of the Registrant. The Notice of Hearing dated 23 November 2021 informed the Registrant that if the Panel imposed a sanction which suspended or restricted her right to practise, it may also impose an interim order which would have immediate effect. The Panel decided that the Registrant had received appropriate notice of the application and that she has waived her right to attend the hearing. The Panel decided it was fair and appropriate that the Panel should proceed and consider whether an interim order was required.

106. The Panel decided that an interim order is necessary for the protection of the public. The Panel has identified an ongoing risk to the public arising from the risk of repetition. It would be entirely contrary to the Panel’s decision on impairment and sanction for there to be no public protection during the twenty-eight days before the Suspension Order takes effect and for the duration of any appeal. An interim order is also otherwise in the public interest because informed members of the public would be shocked or troubled to learn that the Registrant had continued to practise as a Paramedic without restriction during the appeal period.

107. An Interim Conditions of Practice Order would not be workable or appropriate because the Registrant is not engaging with the HCPC and has not demonstrated a sufficient level of insight. Therefore, an Interim Suspension Oder is the appropriate and proportionate order. The Panel decided to make this order for a period of eighteen months, the maximum duration, to allow sufficient time for the appeal to be disposed of.

108. The Panel therefore made an Interim Suspension Order for a period of eighteen months.

Interim Order

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Jayne M Denton