Piotr Debski

 

 

1. In light of the Government’s advice on containing the current COVID-19 pandemic, this hearing was conducted via video-link.

 

 

2. The Registrant was not present or represented at the hearing. The Panel was provided with documentary evidence that the Notice of this hearing was sent to the Registrant on 13 September 2021 by first class post to the Registrant’s registered address in Poland, being the only postal address for the Registrant held on the HCPC Register. The Notice contained the dates and start time of the hearing and the fact that it would be held remotely due to the ongoing COVID-19 pandemic. 

 

3. The Panel accepted the advice of the Legal Assessor in relation to Rules 3(1) and 6 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) and was satisfied that there had been proper service in this case.

 

 

4. The Presenting Officer, on behalf of the HCPC, applied to proceed with the hearing in the Registrant’s absence. She told the Panel that the HCPC and its Solicitors, Kingsley Napley LLP, had made significant efforts to make contact with the Registrant - at his registered postal address, his email address and by telephone - but that there had been no engagement at all from the Registrant or any representative. The Presenting Officer submitted that the Panel should proceed today; that the Registrant had been served with proper notice, had waived his right to attend and that it was in the public interest to proceed in his absence. 

 

5. The Panel accepted the advice of the Legal Assessor. The Panel referred to the HCPTS Practice Note of September 2018 on Proceeding in the Absence of the Registrant and to the guidance that a hearing panel should consider as provided by the cases of R v Jones (Anthony) [2004] 1 AC 1HL and GMC v Adeogba [2016] EWCA Civ 162. Applying that guidance, the Panel was careful to remember that its discretion to proceed in absence under Rule 11 is not unfettered and must be exercised with the utmost care and caution, and with the fairness of the hearing at the forefront of its mind.

 

6. The Notice of Hearing informed the Registrant of the dates and details of the Conduct and Competence Committee hearing, and of his right to attend and be represented. He was also advised of the Panel’s power to proceed with the hearing in his absence if he did not attend and of how he could apply for a postponement of the hearing. The Registrant was informed of the sanction powers available to the Panel, should it find his fitness to practise to be currently impaired. The Registrant had not requested a postponement or adjournment of today’s hearing, indeed there had been no communication from the Registrant or any representative. Taking all the above circumstances into account, the Panel concluded that it was unlikely in all the circumstances that an adjournment would secure the Registrant’s attendance on a future date. The Panel took the view that the Registrant had voluntarily waived his right to attend and that adjourning this hearing would serve no purpose. 

 

7. The Panel was mindful that it must also consider fairness to the HCPC, whose case was ready to proceed today. Both of the HCPC’s witnesses were present and ready to give evidence. The Panel took account of the public interest in the expeditious resolution of regulatory allegations, the fact that the allegations in this case are more than three years old and the impact of cost and delay caused by an adjournment upon other cases. Following the guidance in the case of Adeogba, given that there was no good reason to adjourn the hearing, the Panel decided it was in the public interest to proceed in the Registrant’s absence.

 

8. The Panel considered that there was some disadvantage to the Registrant in proceeding in his absence as he would not be able to challenge the evidence put forward by the HCPC, or give his own evidence. In the Panel’s judgment, however, this could be mitigated. The Panel was mindful that it could explore any inconsistencies in the evidence which it identified and should ask questions and consider points which might be in the Registrant’s interests and were reasonably apparent from the evidence. Furthermore, the limited disadvantage was the consequence of the Registrant’s decision to absent himself from the hearing, waive his rights to attend and be represented.

 

9. In these circumstances, the Panel decided that it was fair to proceed in the absence of the Registrant. 

 

 

10. The Presenting Officer applied to make several amendments to the Allegation. She told the Panel that the proposed amendments in relation to Particulars 2, 3 and 4 were notified to the Registrant in writing on 7 January 2021. In relation to Particular 1, however, the Presenting Officer explained that, when preparing for this hearing over the last few days, she considered that the proposed amendments notified to the Registrant in January 2021 resulted in Particular 1 being over-particularised and duplicitous. As this had only come to her attention very recently, and in light of the Registrant’s non-engagement with the HCPC to date, the Presenting Officer explained that the Registrant had not been made aware of the newly-proposed amendments to Particular 1. In any event, she submitted that the proposed amendments did not affect the nature or substance of the charge, did not cause the Registrant prejudice and that, if he were in attendance, the amendments would not affect the Registrant’s ability to present his case. 

 

11. On the information before the Panel, the Registrant had not objected to the proposed amendments notified to him on 7 January 2020. 

 

12. The Panel accepted the advice of the Legal Assessor. The Legal Assessor advised the Panel that there is no specific Rule governing a power to amend an allegation. The Panel should have regard to the merits of the case, the fairness of proceedings and consider whether the requested amendments can be made without injustice. The Panel should consider the wider public interest in ensuring that allegations accurately reflect the evidence that has been adduced. 

 

13. In relation to Particulars 2, 3 and 4, the Panel considered that the Registrant had been given plenty of notice and ample opportunity to consider those proposed amendments. No issues of prejudice or unfairness had been raised by or on behalf of the Registrant. In the Panel’s judgment, those proposed amendments were made on the basis of the material gathered during the HCPC's investigation and served to clarify it. The Panel was satisfied that the amendments could be made without injustice to the Registrant and were fair. 

 

14. In relation to Particular 1, the Panel was of the view that the amended Allegation as notified to the Registrant on 7 January 2021 was unusually drafted and clumsy, containing a lengthy narrative. It accepted the Presenting Officer’s submission that there was duplication within the charges. After careful consideration, including in relation to the Registrant’s interests, the Panel concluded that the amendments proposed by the Presenting Officer today, although numerous, were amendments of style rather than substance and would not cause the Registrant to be disadvantaged. 

 

15. Accordingly, the Panel acceded to the Presenting Officer’s application to amend the Allegation. The amended Allegation is set out above.

 

 

16. The Panel received a bundle of documents from the HCPC, comprising a case summary, witness statements and a body of documentary exhibits. At the start of the hearing, the Presenting Officer provided an evidence matrix to the Panel. 

 

17. The Registrant had not submitted any documentation for the Panel’s consideration. 

 

 

18. The Registrant is registered with the HCPC as a Paramedic. 

 

19. The Registrant was employed as a Paramedic by the North East Ambulance Service (the Service) from 2 October 2017 to 13 March 2019, when he resigned. The Registrant was invited to two disciplinary hearings, both of which related to his failure to attend his shifts on numerous occasions. The first disciplinary hearing was on 25 January 2019, which the Registrant attended; the second was on 25 April 2019, which the Registrant did not attend. 

 

20. During the Registrant’s employment at the Service, concerns were also raised about his clinical knowledge and ability to practise safely. He was observed on three ‘ride outs’ by senior paramedics, including on two occasions by Person A, the Registrant’s line manager. Those ‘ride outs’ indicated that there were significant and ongoing concerns about the Registrant’s clinical reasoning and/or decision-making.

 

21. On 21 May 2019 the Service referred the Registrant to the HCPC. 

 

 

22. The Panel heard live evidence from two factual witnesses called by the HCPC: Colleague GC (Operations Manager of the Service and Chair of the disciplinary hearing on 25 January 2019); and Person A (Clinical Care Manager at the Service and the Registrant’s line manager). Both witnesses confirmed and adopted their witness statements as their evidence in chief and were asked a number of supplementary questions by the Presenting Officer and questions from the Panel. Their oral evidence was consistent with their witness statements and the associated documentary evidence, and the Panel considered their evidence to be helpful, balanced and credible. It considered that both witnesses did their best to assist the Panel and had no reason to mislead it. The Panel did not perceive any malice towards the Registrant on their part, or any motive to make false allegations against him. Taking all these aspects into account, the Panel was satisfied that it could place significant reliance and weight upon both witnesses’ evidence.

 

 

23. The Panel accepted the advice of the Legal Assessor. The standard of proof in HCPC proceedings is the civil standard, on the balance of probabilities, meaning that before finding a fact proved the Panel must be satisfied it is more likely than not that the alleged event occurred. The burden of proof was upon the HCPC which brought the Allegation, it was not for the Registrant to prove his innocence. 

 

24. The Allegation contains a charge that the Registrant was dishonest. In considering that charge the Panel applied the test for dishonesty set out by the Supreme Court in the case of Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67 that it should first ascertain the actual state of the Registrant’s knowledge or belief as to the facts and then determine whether his conduct was honest or dishonest by applying the objective standards of ordinary decent people. 

 

25. The Panel has considered each particular of the Allegation separately and has evaluated the evidence in order to make its findings on the facts. The Panel made the following findings:

 

 

You deliberately provided inaccurate reasons for non-attendance at work and: 

a) On 10 or 12 April 2018 you retired four hours early from a shift to attend a college course, which you already knew had been cancelled;

 

26. The Panel bore in mind the drafting of the stem of Particular 1, which required the Panel to determine whether, on the evidence before it, it was satisfied that, on each of the five occasions specified at sub-particulars 1(a) to1(e), it was more likely than not that the Registrant deliberately provided inaccurate reasons for his non-attendance at work.

 

27. The Panel took into account the evidence of both Colleague GC and Person A that, on 10 April 2018, the Registrant had left his shift four hours early and that this was to attend an English course at college. Person A’s evidence was that, “On 10 April 2018, [the Registrant] told me he needed to finish his shift early as he had to attend college for his English course. He left 4 hours early. Another paramedic disclosed to me that the English course had already been cancelled, however, [the Registrant] still took the time off.” 

 

28. The Panel had regard to the notes of a fact-finding meeting on 8 June 2018 in which it was recorded that the Registrant agreed that he had said he would be leaving early to attend an English course but that he had been aware for at least two weeks that the course had been cancelled. The notes recorded that the Registrant stated, “I admit this. I felt down. Next day I was going to Poland.” The Panel also had regard to the notes of the disciplinary hearing on 25 January 2019 in which it was recorded that GC asked the Registrant to “present [his] case” around his absences and the Registrant responded, “The first one about college, I lied. I felt homesick. Next day I went home to Poland.” 

 

29. The Panel considered Colleague GC’s and Person A’s accounts of events to be consistent with the documentary evidence before it and that, according to the notes of both the fact-finding meeting and the disciplinary hearing, the Registrant had given a consistent, clear and straightforward explanation about his reason for leaving work early on 10 April 2018.

 

30. The Panel was satisfied, on the evidence of Colleague GC, Person A and the documentary evidence before it, that the HCPC had established that it was more likely than not that the Registrant retired four hours early from his shift on 10 April 2018 to attend a college course, which the Registrant already knew had been cancelled, and that he deliberately provided inaccurate reasons for his non-attendance at work. Accordingly, the Panel found this sub-particular of the Allegation proved.

 

 

You deliberately provided inaccurate reasons for non-attendance at work and: 

b) On 3 July 2018 you failed to:

i. attend your rostered shift; and

ii. follow the correct absence reporting procedure

 

31. On the evidence before the Panel, it was not in dispute that the Registrant did not attend his shift on 3 July 2018. Both Colleague GC and Person A gave clear evidence that he did not attend work and Person A’s evidence was that, “One of the Clinical Care Managers told me that they had seen [the Registrant] in a garage on their way to work”. In clarification, he explained that the Registrant was at the petrol station, buying a sandwich. The Panel had regard to the notes of a fact-finding meeting at the Service on 27 July 2018 in which it is recorded that the Registrant stated at first that he did not have an explanation for missing his shift on 3 July 2018 but then stated, “I had an emergency, sent email to LE. My car was broken. The coil was broken.” The Panel was therefore satisfied, on the evidence before it, that the Registrant did not attend his rostered shift on 3 July 2018. 

 

32. The Panel next determined whether the Registrant failed to follow the correct absence reporting procedure. Colleague GC’s evidence was that the Registrant “would have known that direct contact, either face-to-face or over the telephone, with a line manager is required for reporting non-attendance. [The Registrant] would have known this as it is addressed in induction.” The Panel also had regard to the notes of the disciplinary hearing on 25 January 2019 in which it was recorded that the Registrant stated, “It is true, it is my fault I did not follow the NEAS rules about absence. I don’t know why.” The Panel was therefore satisfied, on the evidence before it, that the Registrant failed to follow the correct absence reporting procedure on 3 July 2018. 

 

33. The Panel next determined whether the Registrant deliberately provided inaccurate reasons for his non-attendance at work on 3 July 2018. Colleague GC’s evidence was that, “It transpired that [the Registrant] had lied about his car being broken and it turned out that he had gone to the garage on the way to work but went home because he did not feel like going to work.” It was further documented that, in the disciplinary hearing on 25 January 2019, the Registrant stated that he accepted the case against him as documented by the Service; further that, when asked about another unauthorised absence on 17 July 2018, the Registrant stated that he had lied again on that occasion “without reason, similar to 3 July.”

 

34. The Panel was satisfied, on the evidence of Colleague GC, Person A and the documentary evidence before it, that the HCPC had established that it was more likely than not that the Registrant failed to attend his shift on 3 July 2018, that he failed to follow the correct absence reporting procedure and that he deliberately provided inaccurate reasons for his non-attendance at work. Accordingly, the Panel found this sub-particular of the Allegation proved.

 

 

You deliberately provided inaccurate reasons for non-attendance at work and: 

c) On 17 July 2018 you failed to:

i. attend your rostered shift; and

ii. follow the correct absence reporting procedure

 

35. On the evidence before the Panel, it was not in dispute that the Registrant did not attend his shift on 17 July 2018. Both Colleague GC and Person A gave clear evidence that he did not attend work and Colleague GC’s evidence was that at the fact-finding hearing on 27 July 2018, the Registrant had stated that “he had not been sick and that he missed his shift because he had been drinking with friends in Poland that day before the shift.” The Panel had regard to the notes of that fact-finding meeting in which it is recorded that the Registrant agreed that he missed his night shift on 17 July 2018. The Panel was therefore satisfied, on the evidence before it, that the Registrant did not attend his rostered shift on 17 July 2018. 

 

36. The Panel next determined whether the Registrant failed to follow the correct absence reporting procedure. The Panel had regard to the notes of the disciplinary hearing on 25 January 2019 in which it was recorded that the Registrant stated, “It is true, it is my fault I did not follow the NEAS rules about absence. I don’t know why.” The Panel was therefore satisfied, on the evidence before it, that the Registrant failed to follow the correct absence reporting procedure on 17 July 2018. 

 

37. The Panel next determined whether the Registrant deliberately provided inaccurate reasons for his non-attendance at work on 17 July 2018. It was documented that, in the fact-finding meeting on 27 July 2018, the Registrant first stated that, due to an issue with his password, he could not access the system or his email to check his shift. When challenged about this, however, and asked, “Why did you not attend work on 17.7.18?” the Registrant responded, “I had a meeting with my friends in Poland with alcohol,” and confirmed, when asked for a third time, that his reason for not attending work was “Alcohol. It is my responsibility.” The Registrant’s reason then changed for a third time in the notes recorded of the disciplinary hearing on 25 January 2019; on that occasion, the Registrant stated that although he had previously said that he did not attend work because he had been drinking alcohol, that had been an excuse and that he had lied again but could not explain why -“without reason, similar to 3 July...maybe felt down again.” 

 

38. The Panel was satisfied, on the evidence of Colleague GC, Person A and the documentary evidence before it, that the HCPC had established that it was more likely than not that the Registrant failed to attend his shift on 17 July 2018, that he failed to follow the correct absence reporting procedure and that he deliberately provided at least two inaccurate reasons for his non-attendance at work. Accordingly, the Panel found this sub-particular of the Allegation proved.

 

 

 

You deliberately provided inaccurate reasons for non-attendance at work and: 

d) On 2 October 2018 you failed to: 

i. attend your rostered shift; and

ii. follow the correct absence reporting procedure

 

39. On the evidence before the Panel, it was not in dispute that the Registrant did not attend his shift on 2 October 2018. Colleague GC and Person A gave clear evidence that he did not attend on that date and, the notes of the fact-finding hearing on 23 October 2018 recorded that the Registrant agreed that he was off on 2, 3 and 4 October, stating “I was sick.” 

 

40. The Panel next determined whether the Registrant failed to follow the correct absence reporting procedure. The Panel had regard to the notes of both the fact-finding hearing on 23 October 2018, which recorded that the Registrant stated, “I failed NEAS policy again”; and the notes of the disciplinary hearing on 25 January 2019 in which it was recorded that the Registrant stated, “It is true, it is my fault I did not follow the NEAS rules about absence. I don’t know why.” The Panel was therefore satisfied, on the evidence before it, that the Registrant failed to follow the correct absence reporting procedure on 2 October 2018.

 

41. The Panel next determined whether the Registrant deliberately provided inaccurate reasons for his non-attendance at work on 2 October 2018. On the evidence before the Panel, it was not in dispute that the Registrant called in sick on 4 October 2018, stating that he was experiencing flu-like symptoms. Although when challenged in the disciplinary hearing about his absences on 2 and 3 October 2018, it was recorded that the Registrant stated that he was “happy to accept the allegation as [it] is”. The Panel noted that the copy of the written allegation, as sent to the Registrant in the Service’s letter inviting him to the disciplinary hearing on 25 January 2019 was simply that he had failed to attend his rostered shifts and follow due process when opening a medical absence, not that he had provided an inaccurate reason for his non-attendance. The Panel was of the view that, although the Registrant made an admission to lying in relation to his non-attendance on 3 and 17 July 2018, there was no reference to the Registrant using the word “lying” in relation to 2 (or 3) October 2018 and this was not put to him in any of the meetings. The Panel was of the view that the HCPC had provided insufficient evidence in relation to the stem of this sub-particular and was not persuaded, on the balance of probabilities, that the Registrant deliberately provided an inaccurate reason for his absence. Accordingly, it found this sub-particular not proved.  

 

 

You deliberately provided inaccurate reasons for non-attendance at work and: 

a) On 3 October 2018 you failed to:

i. attend your rostered shift; and

ii. follow the correct absence reporting procedure

 

42. On the evidence before the Panel, it was not in dispute that the Registrant did not attend his shift on 3 October 2018. Colleague GC and Person A gave clear evidence that he did not attend on that date and, the notes of the fact-finding hearing on 23 October 2018 recorded that the Registrant agreed that he was off on 2, 3 and 4 October, stating “I was sick.” 

 

43. The Panel next determined whether the Registrant failed to follow the correct absence reporting procedure. The Panel had regard to the notes of both the fact-finding hearing on 23 October 2018, which recorded that the Registrant stated, “I failed NEAS policy again”; and the notes of the disciplinary hearing on 25 January 2019 in which it was recorded that the Registrant stated, “It is true, it is my fault I did not follow the NEAS rules about absence. I don’t know why.” The Panel was therefore satisfied, on the evidence before it, that the Registrant failed to follow the correct absence reporting procedure on 3 October 2018.

 

44. The Panel next determined whether the Registrant deliberately provided inaccurate reasons for his non-attendance at work on 3 October 2018. On the evidence before the Panel, it was not in dispute that the Registrant called in sick on 4 October 2018, stating that he was experiencing flu-like symptoms. Although when challenged in the disciplinary hearing about his absences on 2 and 3 October 2018, it was recorded that the Registrant stated that he was “happy to accept the allegation as [it] is”. The Panel noted that the copy of the written allegation, as sent to the Registrant in the Service’s letter inviting him to the disciplinary hearing on 25 January 2019 was simply that he had failed to attend his rostered shifts and follow due process when opening a medical absence, not that he had provided an inaccurate reason for his non-attendance. The Panel was of the view that, although the Registrant made an admission to lying in relation to his non-attendance on 3 and 17 July 2018, there was no reference to the Registrant using the word “lying” in relation to 3 October 2018 and this was not put to him. The Panel was of the view that the HCPC had provided insufficient evidence in relation to the stem of this sub-particular and was not persuaded, on the balance of probabilities, that the Registrant deliberately provided an inaccurate reason for his absence. Accordingly, it found this sub-particular not proved. 

 

 

In relation to the matters alleged at particular 1, you received pay which you were not entitled to, having provided false reasons for your non-attendance at work.

 

45. The Panel has found that the Registrant deliberately provided inaccurate reasons about his absences from work on three occasions - 10 April, 3 July and 17 July 2018. 

 

46. Colleague GC’s evidence was that the Registrant received full pay despite his absences. The Panel had before it copies of the Registrant’s April 2018 and July 2018 payslips which showed that he was paid for his shifts with no deductions made. 

 

47. The Panel was satisfied, on the evidence of Colleague GC and the documentary evidence before it, that the HCPC had established that it was more likely than not that the Registrant received pay for April and July 2018 which he was not entitled to, having provided false reasons for his non-attendance at work. Accordingly, the Panel found this sub-particular of the Allegation proved.

 

 

Between 1 July 2018 and 26 September 2018, during ride outs with

Person A, Person B and Person D, the Patient Care provided by you was not to the required standard, when:

 

a) On 1 July 2018 your assessment of Patient 1 was not adequate, in that:

 

i. You did not take an accurate patient history;

 

ii. You did not provide adequate rationale for your plan to take Patient 1 to hospital;

 

iii. You did not conduct an adequate clinical respiratory assessment and only performed auscultation requiring your colleague, Person A, to take over patient care;

 

48. In relation to these three sub-particulars, the Panel had regard to Person A’s evidence as detailed in his notes of the ‘ride out’ on 1 July 2018:

 

“[The Registrant] only asked 6 questions before saying to the patient ‘I should take you to hospital’. 

 

There was not structure to his questions. His history taking was very poor. After deciding to take the patient to hospital [the Registrant] said I should listen to your chest. Again no structure to the respiratory assessment, with [the Registrant] only performed auscultation.

 

Due to poor history taking, not structure to questions and no rational [sic] for plan. I stepped in and took over patient care. The patient was already under a specialist team and her current condition was no different to how she had been over the past few days. Following a discussion with her GP, patient was about to be left at home.”

 

 

49. Person A stated in oral evidence that the first patient they attended was a patient with Chronic Obstructive Pulmonary Disease, who was clearly very short of breath. Person A’s oral evidence was that the Registrant “took a very limited history from the patient”, asking only six questions of her before stating that he would take her to hospital, whereas he should have taken a structured, “system-based” history and undertaken patient monitoring to get basic observations. Person A’s evidence was that accurate questioning would have established that the patient’s condition had not changed over the past few days, that she was already under a specialist team and that there was medication available to her at home that she had not yet started.

 

50. The Panel accepted Person A’s evidence which was clear, detailed and consistent with his witness statement. It accepted Person A’s evidence that the Registrant’s questioning of the patient was not comprehensive enough and, as a result, he was unable to gain an accurate patient history. The Panel was persuaded that, as the assessment was not comprehensive, it was therefore not accurate and, as such, his patient care was not to the required standard. Accordingly, the Panel found this sub-particular proved.

 

 

51. Person A’s notes recorded that due to the Registrant’s poor history taking and the lack of structure to his questions, the Registrant had no rationale for his plan to take the patient to hospital. Person A further explained in his witness statement and in oral evidence that a paramedic should find out if there is a care plan in place for managing the illness. Having checked if there are any severe clinical signs indicating that a patient should go straight to hospital, and there are no such signs, a paramedic would find out what would normally happen to the patient in the circumstances. Person A stated, “As a result of [the Registrant’s] poor clinical reasoning, I stepped in to take over the patient’s care. I was able to establish that the patient already had a care plan in place and did not need to go to hospital.”

 

52. The Panel accepted Person A’s evidence in this regard and determined that, because the Registrant did not take an accurate or comprehensive patient history, he came to the incorrect conclusion in deciding to take the patient to hospital. The Panel was satisfied, on the evidence of Person A and the documentary evidence before it, that the HCPC had established that it was more likely than not that the Registrant did not provide “adequate rationale” for taking the patient to hospital and that this patient care was not to the required standard. Accordingly, it found this sub-particular proved. 

 

 

53. In oral evidence, Person A outlined to the Panel what an adequate clinical respiratory assessment would entail - an assessment of the patient’s airway, breathing, listening to their chest (auscultation) and patient monitoring to establish basic observations - but the Registrant only asked six questions of the patient and performed auscultation. The Panel noted that Person A’s oral evidence was consistent with his notes of the ‘ride out’ which stated, “Again no structure to the respiratory assessment, with [the Registrant] only performed auscultation.” It was Person A’s evidence that, because of the Registrant’s failure to undertake a proper respiratory assessment, he had to step in and take over.

 

54. The Panel was satisfied, on the evidence of Person A and the documentary evidence before it, that the HCPC had established that it was more likely than not that the Registrant did not conduct an adequate clinical respiratory assessment, only performed auscultation and that, as a result, Person A had to take over patient care. The Panel further determined that the Registrant’s patient care in this regard was not to the required standard. Accordingly, it found this sub-particular proved.

 

 

b) On 1 July 2018 your assessment of Patient 2 was not adequate in that:

i. You were delayed in completing the assessment of Patient 2, and/or Person A had to prompt Cardio Monitoring of the Patient

ii. You did not interpret the Electro Cardio Gram [ ECG] accurately and/or did not recognise that it showed an inferior Myocardial Infarction;

iii. You did not explain to Patient 2 why you had to transport them to hospital using blue lights;

iv. You did not prepare in advance of the ride out to ensure that you were able to use some equipment on board; namely:

I. the pre-alert radio; and

II. the stretcher.

 

55. In relation to these four sub-particulars, the Panel had regard to Person A’s evidence as detailed in his notes of the ‘ride out’ on 1 July 2018, and his oral evidence. The patient had had a previous Myocardial Infarction and had had stents inserted. 

 

 

56. Person A told the Panel that, on attending this patient who had central chest pains, the Registrant asked the patient what was wrong. The Patient explained that he had had a previous Myocardial Infarction and that he was experiencing the same symptoms now. Person A recorded in his notes of the ‘ride out’ that, “[The Registrant] has no sense of urgency when completing the assessment. Due to this and from what the patient has said about his symptoms, I had to step in to ask for cardiac monitoring to be placed onto the patient.” In oral evidence, Person A further explained that the patient “looked like someone having a heart attack - pale and clutching his chest,” but that the Registrant “didn’t pick up the pace at all”; rather he asked the patient questions about what he had eaten that day and did not seem to recognise the presentation of a patient who was experiencing symptoms of a heart attack. Person A told the Panel, “I suggested an ECG…I took over a lot on this job due to patient safety; I believed the patient needed to be in hospital in a time critical manner.”

 

57. The Panel accepted Person’s A’s evidence which was consistent, detailed and specific. It was satisfied, on the evidence of Person A and the documentary evidence before it, that the HCPC had established to the required standard that the Registrant delayed in completing the assessment of the patient and that Person A had to prompt Cardio Monitoring. Carefully considering the wording of the stem of the allegation, the Panel was also satisfied that the Registrant’s assessment of Patient 2 was not adequate. Accordingly, it found this sub-particular proved. 

 

 

58. Person A’s notes recorded that the Electro Cardio Gram (ECG) “showed ST elevation. [The Registrant] struggled with the interpretation of the ECG, all he could say was that there was elevation of the rhythm strip and that the T Waves were inverted but he could not say what causes this and what it could have meant. At this point Person B advised [the Registrant] that the ECG showed an inferior MI.” In oral evidence, Person A explained that ST elevation was a clinical indication that the patient was having a heart attack and that it was the student paramedic, Person B, who confirmed to the Registrant what was seen on the ECG. Person A said that, in fact, the Registrant had thought that the patient’s problems were caused by his medication.

 

59. The Panel accepted Person’s A’s evidence which was consistent, detailed and specific. It was satisfied, on the evidence of Person A and the documentary evidence before it, that the HCPC had established to the required standard that the Registrant did not interpret the ECG accurately and did not recognise that it showed an inferior Myocardial Infarction. Again taking into account the wording of the stem of the Particular, the Panel was also satisfied that the Registrant’s assessment of Patient 2 was not adequate. Accordingly, it found this sub-particular proved.

 

Particular 3(b)(iii) – Found not proved

 

60. The Panel noted Person A’s evidence that the Registrant told Patient 2 that he would now be transported to hospital using the ambulance’s blue lights but that the Registrant did not explain to the patient the reason for this. Noting the specific drafting of the stem of the Particular, however - “that your assessment of Patient 2 was not adequate in that:” - the Panel could not be satisfied that it had been presented with any evidence that not explaining to a patient why he had to be transported to hospital using blue lights formed part of the Registrant’s assessment of the patient. In the Panel’s view, this was a question of patient care, not assessment. As such, this sub-particular falls and was found not proved.

 

 

61. This sub-particular alleges that the Registrant did not prepare in advance of the ‘ride out’ to ensure that he was able to use the pre-alert radio and the stretcher on board the vehicle. Noting again the drafting of the stem of this Particular, for similar reasoning as set out above, the Panel did not consider that an allegation of failing to prepare in advance of the ‘ride out’ formed part of the Registrant’s assessment of Patient 2, as specifically drafted. Accordingly, this sub-particular falls and was found not proved.

 

 

c) On 1July 2018, your clinical reasoning in assessing Patient 4 was not to the required standard in that:

i. you did not, on arrival at scene, plan to take the equipment required in order to be able to carry out an accurate assessment of Patient 4, and/or had to be prompted to do so by Person A;

ii. you did not recognise that you needed to assess Patient 4 prior to lifting the Patient;

iii. you did not take appropriate action while Patient 4 deteriorated on lifting and/or had to be prompted to do so; and

 

iv. you did not promptly bring the correct equipment to treat Patient 4 after the patient had deteriorated, namely;

i. suction; and

ii. oxygen.

 

62. In relation to these sub-particulars, the Panel had regard to Person A’s evidence as detailed in his notes of the ‘ride out’ on 1 July 2018, and his oral evidence. This patient had had a fall.

 

 

63. Person A’s notes recorded that, “On arrival at this incident I asked the Registrant what is he planning on taking into the property. He initially wasn’t going to take anything in as he stated he didn’t need to as the patient had no injuries. Person B prompted him and advised that the patient would still need checking over.” Person A explained in oral evidence that a paramedic would take in, at least, a Basic Life Support (BLS) medical bag and that he would take that medical kit to every patient, “but especially to this type of patient,” to undertake basic checks before moving them. 

 

64. The Panel accepted Person A’s evidence around the need to take in a BLS bag, on arrival, in order to undertake checks on the patient. It determined it was more likely than not that the Registrant, on arriving at the scene, did not plan to take the equipment required in order to carry out an accurate assessment of this patient. Carefully considering the drafting of the stem of this allegation, specifically that the Registrant’s clinical reasoning in assessing the patient was not to the required standard, the Panel was satisfied that a decision around the correct equipment to take to a patient does relate to clinical reasoning and assessment and that this was not to the required standard. It therefore found this sub-particular proved.

 

65. The Panel noted, however, the evidence before it that it was Person B who prompted the Registrant, not Person A as alleged in this sub-particular. As such, the last part of the allegation, “and/or had to be prompted to do so by Person A” could not be proved and fell away. 

 

 

66. Person A’s notes recorded that the patient was on the floor, unable to get up, had no recollection of falling, and that the Registrant “had to be prompted to check him over before he could help the patient up. When asked how he planned to get the patient off the floor he stated that Person B and [the Registrant] would just pick him up.” In oral evidence, Person A said that the patient was asking to be lifted off the floor but that, “by manually lifting a patient, it goes against all moving and handling training,” risking injury to the patient’s shoulder and to the paramedic’s back. He stated that the Service used lifting cushions, that this was “all covered in training” and that, as soon as Person A had mentioned the lifting cushion, the student paramedic had apologised and agreed that they had covered that in training.  

 

67. The Panel accepted Person A’s evidence and determined it was more likely than not that the Registrant did not recognise that he needed to assess the patient prior to lifting him. Carefully considering the drafting of the stem of this allegation, specifically that the Registrant’s clinical reasoning in assessing the patient was not to the required standard, the Panel was satisfied that a decision around moving a patient does relate to clinical reasoning and assessment and that this was not to the required standard. It therefore found this sub-particular proved.

 

 

68. Person A’s notes recorded that during the lifting of the patient off the floor (using the lifting aid), “the patient had a sudden onset of frank haematemesis. [The Registrant] froze, Person B had to instruct the Registrant to release the lifting aid and roll the patient onto his side. At this point I stepped in to clear the patient’s airway.” 

 

69.  The Panel considered Person A’s notes to be clear, detailed and specific; it accepted his evidence. The Panel was satisfied, on the evidence presented to it, that the Registrant did not take appropriate action when the patient deteriorated on lifting and that he had to be prompted to do so by Person B. Carefully considering the drafting of the stem of this allegation, specifically that the Registrant’s clinical reasoning in assessing the patient was not to the required standard, the Panel was satisfied that the Registrant’s was still assessing the patient at this time and that the allegation relates to his clinical reasoning and that this was not to the required standard. It therefore found this sub-particular proved.

 

 

70. Person A’s notes recorded that when the patient was rolled onto his side, he had stepped in to clear the patient’s airway. He recorded, “Due to only having the green bag, I asked [the Registrant] to go to the ambulance to get the para bag and stuff needed due to the change in patient’s condition. [The Registrant] had no sense of urgency getting the equipment, on his return he had only brought the paramedic bag. I asked where the suction and oxygen were, [the Registrant] stated that I hadn’t asked for them so he didn’t know to bring them.” At that point, Person B brought the missing equipment. Person A’s evidence was that that he would have expected any paramedic to realise that the patient was now very unwell, that the patient’s airway was blocked with blood and that suction “was necessary to save the patient’s life.” 

 

71. The Panel accepted Person A’s evidence. The Panel was satisfied, on the evidence presented to it, that the Registrant did not promptly bring suction and oxygen to treat the patient when his condition deteriorated, that he had to be asked to do so by Person A and that, in fact, Person B finally brought the missing equipment. Carefully considering the drafting of the stem of this Particular, specifically that the Registrant’s clinical reasoning in assessing the patient was not to the required standard, the Panel was satisfied that the Registrant’s was still assessing the patient at this time, that the Particular relates to his clinical reasoning and that this was not to the required standard. It therefore found this sub-particular proved, both in relation to the suction and the oxygen.

 

 

On 26 September 2018, your clinical reasoning and/or decision making as recorded on the EPCRs was not to the required standard as observed by Person A on a ride out, relating to

i. Patient 5;

ii. Patient 6; and

iii. Patient 7.

 

72. The Panel had sight of the electronic patient care records (EPCRs) for Patients 5, 6 and 7 which, Person A explained, are the notes completed by paramedics for each call-out and are “a legal document”. In oral evidence to Panel, Person A explained that, in practical terms, the Registrant would complete these electronic forms and that Person A would add to them or correct them, as required, at the time. He said that, as these are ‘live’ documents and shared with hospitals, they need to be accurate, and explained to the Panel, “I amended them at the time, so we can’t see the Registrant’s own records.” Person A gave detailed evidence to the Panel, however, about his concerns around the Registrant’s clinical reasoning and his decision making as recorded on the ECPR forms, for example, in relation to a patient with sepsis, stating, “I genuinely believe he didn’t understand what he was looking at.” 

 

73. The Panel was mindful of what it considered to be evidential difficulties before it, in that the EPCRs provided to the Panel were those that, according to Person A’s sworn evidence, had already been amended and corrected by him. Because of the ‘live’ nature of the documents -evidence that the Panel accepted - it was not possible to provide to the Panel the Registrant’s original completed EPCRs. The Panel noted, however, that it did have sufficient evidence before it that Person A had been on this ‘ride out’ with the Registrant on 26 September 2018 and it considered Person A to be a truthful and credible witness. It had no reason to doubt his evidence in relation to this sub-particular, which the Panel considered to be clear and consistent evidence. 

 

74. The Panel was satisfied, on the balance of probabilities, that the Registrant’s clinical reasoning and decision making, as recorded by him on the ECPRs, were not to the required standard and that this had been observed by Person A. It therefore found this sub-particular proved.

 

You were unable to communicate effectively at work and/or your communication did not meet the required standard in that on:

 

a. 1 July 2018; 

 

it was reported by Person A and/or Person D that you demonstrated poor communication skills;

 

75. In relation to the Registrant’s shift on 1 July 2018, the Panel had regard to the oral evidence of Person A and had sight of his notes from this ‘ride out’. Person A’s evidence was that, “I told [the Registrant] that he was clinically responsible for the equipment and if something was missing then it would be his responsibility, [the Registrant] didn’t seem to understand this and just kept saying that it was ok…[The Registrant] struggled with English to explain how he felt he could do better or what he could do differently, but he did say he needed to do better assessment…I asked if he could have done anything differently to which he answered he didn’t understand.” 

 

76. The Panel considered that Person A’s evidence was clear, detailed and specific, such that the Panel could place significant reliance on it. The Panel also bore in mind the Registrant’s own general view, as recorded in the disciplinary hearing on 25 January 2019 that, “The problem is still with my English, I don’t deserve to be [a] paramedic.” The Panel was satisfied that the HCPC had established that it was more likely than not that the Registrant was unable to communicate effectively at work and that his communication did not meet the required standard on 1 July 2018. Accordingly, the Panel found this sub-particular of the Allegation proved.

 

You were unable to communicate effectively at work and/or your communication did not meet the required standard in that on:

 

b. 4 July 2018, and 

 

it was reported by Person A and/or Person D that you demonstrated poor communication skills;

 

77. In relation to the Registrant’s shift on 4 July 2018, the Panel had sight of Person D’s notes from this ‘ride out’, which the Panel acknowledged was hearsay evidence. In a specific section of his notes titled “Communication”, Person D recorded that, “[The Registrant] struggled on all 3 emergencies with history taking. [The Registrant] has poor communication skills and does not ask sufficient questions to establish a good history. I was patient and tried to allow him to gain history but ultimately I had to step in and take over the communication with family on all 3 emergencies. The epileptic emergency was a particularly challenging communication exercise as the patient had severe learning difficulties… [The Registrant] was not able to do this emergency as the communication involved was too complex… [The Registrant] does not engage well in any kind of communication. He is a poor communicator, lacks the ability to make decisions quickly and shows no empathy or compassion…”

 

78. The Panel considered that Person D’s evidence around the Registrant’s inability to communicate effectively was corroborated by further evidence contained in a note dated 26 November 2018 from another paramedic to Person D. That paramedic set out that her two “biggest concerns” were that the Registrant refused to speak to the stroke ward on the basis that “his communication was not good enough” and that he was unable to deal with mental health patients as “he just has not got the communication skills required to either calm, reassure or elicit sensitive information from patients that are distressed or non-communicative”; and that she detailed these concerns to help put together an action plan for the Registrant. 

 

79. The Panel determined that it had no reason to doubt the evidence provided by Person D, as captured in his notes of the ‘ride out’ on 4 July 2018. It accepted Person D’s account and was satisfied that the HCPC had established that it was more likely than not that the Registrant was unable to communicate effectively at work and that his communication did not meet the required standard on 4 July 2018. Accordingly, the Panel found this sub-particular of the Allegation proved. 

 

You were unable to communicate effectively at work and/or your communication did not meet the required standard in that on:

 

c. 26 September 2018, it was reported by Person A and/or Person D that you demonstrated poor communication skills;

 

80. In relation to the Registrant’s shift on 26 September 2018, the Panel had regard to the oral evidence of Person A and had sight of his notes from this ‘ride out’. Person A’s evidence was that, having handed over the patient at hospital, “We also discussed the Registrant needing to improve his English and that he had already been on an English course which the ambulance service had arranged. The Registrant said he needed more time…”

 

81. The Panel was of the view that it had sufficient evidence before it that there were grave concerns with the Registrant’s communication skills. It again bore in mind the Registrant’s own general view, as recorded in the disciplinary hearing on 25 January 2019 that, “The problem is still with my English, I don’t deserve to be [a] paramedic.” 

 

82. The Panel was satisfied that that the HCPC had established that it was more likely than not that the Registrant was unable to communicate effectively at work and that his communication did not meet the required standard on 26 September 2018. Accordingly, the Panel found this sub-particular of the Allegation proved.

 

Particular 5 – Found proved

Your conduct in relation to Particulars 1 and 2 above was dishonest 

83. The Panel noted and accepted the Legal Assessor’s advice on the correct application and interpretation of the decision in Ivey v Genting Casinos [2017]. It also bore in mind the HCPTS guidance note called ‘Making decisions on a registrant’s state of mind’ of September 2021. 

 

84. The Panel has found that the Registrant deliberately gave inaccurate reasons to his employer about his absences from work on 3 occasions and that he received pay to which he was not entitled. The Panel noted that following his absence on 3 July 2018, the Registrant was placed on an action plan on 4 July 2018 and was in no doubt that the Registrant knew both that he should not give untruthful reasons to his employer for his absences, and that he needed to perform his work for the Service in order to be paid. It noted that, in relation to his absence on 17 July 2018, the Registrant gave three different explanations, and admitted that he had “lied” in relation to his absences on 10 April, 3 July and 17 July 2018. The Panel also bore in mind the Registrant’s request, when challenged in a meeting, that he be afforded “another chance” by the Service.

 

85. In the Panel’s view, it was a reasonable expectation for the Registrant to be open and honest in his own absence reporting. The Panel was satisfied that the Registrant knowingly and deliberately did not disclose the true reasons for his absences. This was dishonest and he knew it at the time. Further, the Panel was satisfied that, having been untruthful around his reasons for absence, the Registrant knowingly received pay that he knew he was not entitled to and that, again, this was dishonest behaviour and the Registrant knew that. 

 

86. Having established the Registrant’s knowledge or belief as to the facts at the time of his giving inaccurate reasons for his absences and then receiving pay to which he was not entitled, the Panel moved on to decide whether his conduct was dishonest by applying the objective standards of ordinary decent people. It was in no doubt that, applying these standards, the Registrant’s conduct was dishonest. 

 

87. The Panel therefore found the allegation of dishonesty proved in relation to Particulars 1(a)(b)(c) and 2. 

 

 

88. The Panel went on to consider, on the basis of the facts found proved, whether the grounds of lack of competence and/or misconduct were established and if so, whether the Registrant’s fitness to practise is currently impaired. In reaching its decision, the Panel adopted a two-stage approach, first in considering whether the facts found proved constituted lack of competence and/or misconduct, then whether those findings led to the conclusion that his fitness to practise is currently impaired. The Panel noted that there is no burden or standard of proof at this stage and exercised its own professional judgement, keeping at the forefront of its consideration the overarching objectives of the HCPC.

 

89. The Presenting Officer made submissions regarding the issue of grounds and addressed the Panel on both lack of competence and misconduct. In relation to Particulars 3 and 4 and the statutory ground of lack of competence, the Presenting Officer submitted that the Registrant’s professional performance over approximately one year was unacceptably low in respect of numerous service users, as described by the evidence of Person A. She submitted that this represented a fair sample of the Registrant’s work and referenced Person A’s evidence about the Registrant’s abilities and the comprehensive training that he received from the Service, with little effect. She referred to the HCPC Standards of Conduct, Performance and Ethics (2016) referencing paragraphs 1, 2, 3 and 9; and submitted that the relevant HCPC Standards of Proficiency for Paramedics (2014) were paragraphs 1, 8, 9, 10 and 12. 

 

90. The Presenting Officer submitted that, taken together or individually, the behaviour outlined in the factual particulars and the consequences of that behaviour, were easily capable of amounting to misconduct in that the behaviour constitutes a serious falling short of what would be proper in the circumstances. She reminded the Panel of the role of the Registrant and that, whilst he was always supernumerary at the Service, he was supposed to be an already-registered HCPC Paramedic at that level, and that his abilities in the field put not only his colleagues at a disadvantage, but also placed his patients at risk of harm. Finally, she submitted that any allegations found to amount to dishonesty clearly cross the threshold for misconduct.

 

91. The Panel heard and accepted the advice of the Legal Assessor who reminded it of the tests for misconduct and lack of competence and referred the Panel to relevant caselaw of Roylance v GMC (No. 2) [2000] 1 AC 311, Calhaem v GMC [2007] EWHC 2606 and Holton v GMC [2006] EWHC 2960 Admin. 

 

92. The Legal Assessor advised the Panel that, in order to find lack of competence, it would need to have considered a fair sample of the Registrant’s work and that it should consider whether the Registrant had the knowledge, skills and judgment to practise safely. Lack of competence could be distinguished from misconduct in that it indicated an inability to work at the required level and connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances), has been demonstrated by reference to a fair sample of a Registrant’s work. 

 

93. Following the guidance on misconduct in Roylance v GMC (No 2) [2001] 1 AC 311, the Legal Assessor reminded the Panel that misconduct “is a word of general effect, involving some act or omission, which falls short of what would be proper in the circumstances.” The Panel accepted the Legal Assessor’s advice that misconduct is qualified by the word “serious”; it is not just any professional misconduct that will qualify. The Legal Assessor reminded the Panel that not every instance of falling short of what would be proper in the circumstances, and not every breach of the HCPC Standards, would be sufficiently serious such as to amount to misconduct in this context. Therefore, the Panel had careful regard to the context and circumstances of the matters found proved.

 

94. In reaching its decision on the statutory grounds, the Panel also had in mind the HCPC Standards of conduct, performance and ethics (2016) and Standards of proficiency - Paramedics (2014) which set out the standards that a Paramedic must continue to meet throughout their professional career. It concluded that the following standards were engaged in this case and were breached:

 

Standards of conduct, performance and ethics (2016)

1 - Promote and protect the interests of service users and carers

2 – Communicate appropriately and effectively

9 - Be honest and trustworthy.

9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

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

Standards of proficiency - Paramedics (2014)

1 - be able to practise safely and effectively within their scope of practice 

1.3 - be able to use a range of integrated skills and self-awareness to manage clinical challenges independently and effectively in unfamiliar and unpredictable circumstances or situations

1.4 - be able to work safely in challenging and unpredictable environments, including being able to take appropriate action to assess and manage risk

3.1 - understand the need to maintain high standards of personal and professional conduct

4 - be able to practise as an autonomous professional, exercising their own professional judgement

8 - be able to communicate effectively

9.1 - be able to work, where appropriate, in partnership with service users, other professionals, support staff and others

10 - be able to maintain records appropriately

13 - understand the key concepts of the knowledge base relevant to their profession

14.3 - be able to conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely and effectively

15.6 - understand and be able to apply appropriate moving and handling techniques

95. The Panel first considered whether any of the facts proved in Particulars 1(a)(b)(c), 2 and/or 5 could amount to misconduct. The Panel was aware that not every act falling short of what would be proper in the circumstances, and not every breach of the HCPC Standards would be sufficiently serious that it could properly be described as misconduct. The Panel considered, however, that it was incumbent upon the Registrant to attend his scheduled shifts, that he knew was what expected of him in terms of absence reporting procedures but deliberately failed to adhere to them; that he was not open and honest with the Service regarding the reasons for his absence, and did not act with integrity. These are key principles set out in the Standards and indeed, in the Panel’s view, fundamental tenets of the Paramedic profession. In the context of a regulated professional, failure to be open and honest is a serious matter - society expects professionals to be held to a high standard. The Panel, exercising its own professional judgement, was in no doubt that the Registrant’s dishonest conduct, which was deliberate, intentional, and repeated, fell far short of what would be proper in the circumstances, would be considered deplorable by fellow practitioners and amounted to the statutory ground of misconduct.

 

96. The Panel next considered whether the facts proved in relation to Particulars 3 and 4 amounted to a lack of competence and/or misconduct. It had regard to the context and circumstances of the matters it had found proved. The Panel took into account that the Registrant was subject to ongoing action plans at the Service and considered, on the evidence presented to it, that the Service was dealing with the concerns about the Registrant’s practice as competency issues. The Panel noted the referral document from the Director of Quality and Safety at the Service to the HCPC which stated, “It should be noted that throughout the Registrant’s period of employment with the Trust, he did not practise as an autonomous Paramedic as a result of concerns which existed with his line management team associated with his understanding and application of clinical skills.” In oral evidence, Person A explained that the Registrant received initial training as an international Paramedic, intended to be a course run over 8 to 12 weeks, but that this training had to be extended when the Registrant did not reach the required standard. It was Person A’s evidence that the Registrant never met the required standard at the Service; that he was always supernumerary with action plans in place; that the Registrant’s level of competence was that of “a general care assistant, not a paramedic”; and that he would not have wanted the Registrant to treat his own family because of the safety risk. In relation to concerns around the Registrant’s communication skills, the Panel bore in mind the Registrant’s view, as recorded in the disciplinary hearing on 25 January 2019 that, “The problem is still with my English, I don’t deserve to be [a] paramedic.”

 

97. The Panel considered that it had been provided with a fair sample of the Registrant’s practice over a period of time. When considering whether the Registrant’s proficiency in practice had been found to be unacceptably low, the Panel judged the Registrant on the basis of his role as a Band 5 Paramedic and found that the evidence indicated that there were key areas in which his practice and performance were unacceptably low – involving wide-ranging poor clinical skills and his inability to communicate effectively with colleagues and service users - and that he had not demonstrated the ability to operate independently at a safe level of practice, despite support and assistance from the Service. In the Panel’s judgement, the Registrant was unable to meet the standards required of him in his role throughout the relevant time and his proficiency in professional practice fell well below the minimum acceptable level of a Band 5 Paramedic, working in the circumstances faced by him at the time. In the circumstances of the case, the Panel therefore concluded that the Registrant was not competent to work as a Band 5 Paramedic to the required standard and that lack of competence was well founded in respect of Particulars 3(a)(i),(ii),(iii), 3(b)(i)(ii), 3(c)(i)(ii)(iii)(iv), 3(d)(i)(ii)(iii) and 4(a)(b)(c). The Panel determined that, in the particular circumstances, where these general and wide-ranging failings directly related to the Registrant’s deficient clinical skills and poor communication skills, the more appropriate statutory ground was lack of competence, not misconduct.

 

98. In these circumstances, the Panel determined that the grounds of misconduct (in relation to Particulars 1(a) (b) and (c), 2 and 5) and lack of competence (in relation to Particulars 3(a)(i),(ii),(iii), 3(b)(i)(ii), 3(c)(i)(ii)(iii)(iv), 3(d)(i)(ii)(iii) and 4) were well founded.

Decision on Impairment 

99. The Panel went on to consider whether, as a result of that misconduct and lack of competence, the Registrant’s fitness to practise is currently impaired. 

 

100. The Presenting Officer submitted that, save for the Registrant’s admissions during the Service’s investigations, there was no evidence of additional insight or remorse, nor of any attempts to remediate either his dishonest conduct or the deficiencies in his practice since this case was referred to the HCPC. She submitted that the Registrant’s fitness to practise was and remains impaired on both the personal and public components. 

 

101. On the issue of impairment of fitness to practise, the Legal Assessor referred the Panel to the HCPTS Practice Note on ‘Finding Fitness to Practise is Impaired’, and to the guidance on the assessment of impairment and consideration of the public interest, in the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin). She reminded the Panel that it should consider the Registrant’s insight, his remorse, any steps to remediate, and the risk of repetition of the behaviour leading to the facts found proved. The Panel should at all times keep in the forefront of its mind the central importance of the need to protect the public and the wider public interest. The Panel accepted the advice of the Legal Assessor.

 

102. The Panel recognised that there is no burden or standard of proof and that this is a matter for the Panel’s independent judgment. Whilst there is no statutory definition of impairment, the Panel was assisted by the guidance provided by Dame Janet Smith in the Fifth Shipman Report, as adopted by the High Court in CHRE v NMC and Paula Grant [2011] EWHC 297 Admin. In particular, the Panel considered whether its findings of fact showed that the Registrant’s fitness to practise is impaired in the sense that he: 

‘a. Has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or 

b. Has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or 

c. Has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or 

d. Has in the past acted dishonestly and/or is liable to act dishonestly in the future.’ 

103. The Panel’s duty is not only to protect patients/service users but to maintain public confidence in the profession and the regulatory process, which includes the declaring and upholding of proper standards of conduct and behaviour. Paramedics occupy a position of privilege and trust in society and are expected at all times to act professionally, with honesty and integrity and to practise safely and effectively. 

 

104. The Panel first considered its findings in light of the factors indicating that a paramedic’s fitness to practise might be impaired as set out by Dame Janet Smith in the Grant case, as set out above. The Panel was satisfied that all four factors set out by Dame Janet Smith are engaged in this case. It was satisfied that the Registrant’s dishonesty and his deficient clinical and communication skills placed service users at unwarranted risk of harm, brought the profession into disrepute, that the Registrant had breached fundamental tenets of the profession (those of practising safely and effectively, and acting with honesty and integrity) and had acted dishonestly.

 

105. The Panel carefully considered the personal component of impairment and considered the Registrant's level of insight, whether his conduct was capable of remediation, whether it had been remedied and the risk of repetition. 

 

106. In respect of the level of insight that the Registrant has shown into his conduct, its seriousness, and its consequences, the Panel was of the view that the Registrant has thus far shown little insight. The Panel noted that the Registrant made some admissions during the disciplinary process at local level in relation to his absences, and appeared to accept some clinical and communication failings, stating that he should not be a Paramedic and was surprised that he had been accepted as such onto the HCPC Register. The Panel, however, has not been provided with any evidence of reflection that demonstrates the Registrant’s understanding of how his dishonest actions and deficient practice could have impacted upon patient safety, upon his colleagues and on the reputation of the Service, and upon public confidence in his profession. 

 

107. The Panel considered that although dishonesty is often said to be difficult to remedy, in theory, such misconduct was capable of remediation through meaningful reflection. However, the Registrant has not engaged at all with these proceedings and the Panel has not been presented with any evidence that the Registrant has remedied his dishonest misconduct or attempted to do so. Given the absence of this evidence, together with the fact the Registrant admitted his dishonesty at local level and then went on to repeat it, the Panel was satisfied that there remains a real risk that his misconduct might be repeated. 

 

108. In relation to the established lack of competence, the Panel bore in mind Person A’s evidence that the Registrant was given extensive support by the Service to bring his work up to a satisfactory standard but that this assistance made little difference to his concerns about the Registrant; importantly, he stated that he would never allow the Registrant to work as a lead Paramedic, as he simply was not willing to take the risk. Again, the Registrant has not provided any evidence that he has addressed the serious and wide-ranging shortcomings in his practice and, as such, the Panel was satisfied that there was a high, ongoing risk of repetition.  

 

109. Turning to the public interest component of impairment, the Panel next reminded itself of the public component in Cohen v General Medical Council [2008] EWHC 581: “the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect…and that the public interest includes, amongst other things, the protection of service users and the maintenance of public confidence in the profession.” The Panel was mindful of its finding of dishonesty and the established lack of competence and was satisfied that those matters would substantially undermine the trust and confidence the public could have in the profession. Given the nature of its findings and their seriousness, the Panel was satisfied that the need to promote and maintain public confidence in the Paramedic profession and the need to promote and maintain proper professional standards and conduct for members of the profession would be undermined if a finding of impairment were not made in this case. 

 

110. The Registrant’s fitness to practise is therefore impaired on both the personal and public components.

 

 

 

111. Having found that the Registrant’s fitness to practise is impaired, the Panel reconvened on 23 November 2021 to consider what, if any, sanction to impose on the Registrant. 

 

112. The Hearings Officer addressed the Panel in relation to service of the Notice of hearing on the Registrant by the HCPTS. The Panel was informed that the Notice of hearing was sent to the Registrant by post on 19 November 2021 to his registered address in Poland. The Hearings Officer confirmed that the Notice was not, additionally, sent to the Registrant by email on this occasion. She also advised the Panel that there had been no response from the Registrant to the Notice of hearing.

 

113. The Panel heard and accepted the advice of the Legal Assessor in relation to Rules 6(1) and 6(2) of The Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003, as amended (the Rules). Rule 6(1) provides that the Council “shall fix a date on which it is to hear the case and send the parties notice of the date, time and venue for the hearing.” Rule 6(2) provides that the HCPC “shall not fix a date for the hearing which is before the end of the period of 28 days beginning with the date on which the HCPTS sent the notice referred to in paragraph (1) to the registrant.” The Legal Assessor noted that Rule 6 is the only Rule that sets out the length of notice requirement in relation to “a hearing” of the Conduct and Competence Committee - namely 28 days’ notice - and that the HCPC’s procedural rules make no specific reference to the service of Notice of a resuming hearing that has adjourned part-heard.

 

114. The Panel considered that Rule 6, and its requirement that a minimum of 28 days’ notice “shall” be given to a Registrant, was clearly drafted, must be strictly construed and rigorously adhered to. It noted that the Registrant has been given no more than 4 days’ notice in this case. There is no information before the Panel that the Registrant has waived his right to 28 days’ notice. In light of all the information before it, the Panel determined that the Notice of hearing has not been served in accordance with the HCPC’s own procedural rules and that service was not, therefore, effective in this case. The Panel determine that it could not proceed with this hearing today and adjourned the hearing.

 

 

 

 

 

115. The hearing resumed on 7 January 2022. The Registrant was not present or represented at the hearing. 

 

116. The notice of today’s resumed hearing (the Notice), dated 26 November 2021, was sent to the Registrant on or around 29 November 2021 by registered post to his registered address in Poland. The Notice contained the date and time of today’s hearing, explained that it would be conducted remotely via videoconference and invited the Registrant to participate. 

 

117. The Presenting Officer submitted that the Registrant had waived his right to attend and that it was in the public interest to proceed in his absence. 

 

118. The Panel accepted the advice of the Legal Assessor and referred to the HCPTS Practice Note of September 2018 on proceeding in absence and to the guidance that a hearing panel should consider as provided by the cases of R v Jones (Anthony) [2004] 1 AC 1HL and GMC v Adeogba [2016] EWCA Civ 162. Applying that guidance, the Panel was careful to remember that its discretion to proceed in absence is not unfettered and must be exercised with the utmost caution and with the fairness of the hearing at the forefront of its mind.

 

119. The Notice of today’s hearing informed the Registrant of the date and details of this resuming hearing, and of his right to attend and be represented. The Registrant was also advised of the Panel’s power to proceed with the hearing in his absence if he did not attend and of how he could apply for a postponement of the hearing. He was informed of the sanction powers available to the Panel, it having found his fitness to practise to be currently impaired.

 

120. The information before the Panel was that attempts to deliver the Notice of this hearing to the Registrant’s registered address in Poland, via FedEx tracked postal delivery service, had been unsuccessful. The Panel was also informed that documentation sent to the Registrant’s registered email address by the HCPC had been returned as undeliverable. Taking all the above circumstances into account and mindful of the duty on any registrant to notify the HCPC of updated contact and address details, the Panel concluded that the Registrant had continued not to engage with the HCPC process in relation to this hearing. It was unlikely in all the circumstances that an adjournment would secure his attendance on a future date. The Panel took the view that the Registrant had voluntarily waived his right to attend and that adjourning this hearing would serve no purpose. The Panel took account of the public interest in the expeditious resolution of regulatory allegations and was mindful of its finding of current impairment in this case and the ongoing public protection and public interest concerns. Following the guidance in the case of Adeogba, given that there was no good reason to adjourn the hearing, the Panel decided it was in the public interest to proceed in the Registrant’s absence.

 

Decision on Sanction

 

121. The Presenting Officer referred the Panel to the HCPC Sanctions Policy, including the section on “Serious cases” involving dishonesty. He reminded the Panel that the purpose of imposing a sanction was not to punish the Registrant but to ensure that the public was protected, to promote public confidence in the profession and to provide a deterrent to other registrants. The Panel should address the sanctions in ascending order and identify the most appropriate and proportionate means of addressing the concerns identified, acknowledging that this was a matter for the Panel’s judgment. 

 

122. The Panel heard and accepted the advice of the Legal Assessor, who advised it to firstly consider whether any sanction was necessary and, if it was, to consider sanctions in ascending order, settling with the least restrictive that met the Panel’s concerns. When determining the appropriate level of sanction, the Panel must be proportionate so that the sanction:

 

a) is appropriate in the circumstances;

b) secures the protection of the public; 

c) takes account of the wider public interest;

d) is the least restrictive means of securing public protection;

e) is proportionate and strikes a proper balance between the rights of the Registrant and the protection of the public.

 

123. The Legal Assessor reminded the Panel that although it was not open to it to strike the Registrant from the HCPC Register on the basis of his lack of competence, all sanctions were available to the Panel in this case in light of its findings on the statutory ground of misconduct. She advised the Panel that it could only make a striking-off order if it decided that the Registrant’s misconduct (not his lack of competence) was sufficiently serious to justify such an order. 

 

124. No submissions in relation to sanction or any references or testimonials had been submitted by the Registrant.

 

125. In considering the appropriate and proportionate sanction in this case the Panel considered the guidance set out in the HCPC Sanctions Policy. The starting point for the Panel was that both the Registrant’s dishonest conduct (the misconduct established in this case) and his deficient clinical and communication skills (the lack of competence established) were serious and repeated. The failings had not, on the information before the Panel, been addressed in any way. As such the Panel concluded that the Registrant continued to pose a current risk to the public and the wider public interest. 

 

126. Crucial to the Panel’s consideration, in light of the numerous serious breaches of the HCPC Standards of conduct, performance and ethics (2016) and the Standards of proficiency for Paramedics (2014) and the wide nature of the failings, was the Registrant’s ongoing lack of insight. The Panel considered very carefully the HCPC’s description of insight as:

“a registrant’s genuine understanding and acceptance of the concerns which have been raised in relation to their conduct or competence. It is likely to be demonstrated by: 

• a genuine recognition of the concerns raised; 

• an understanding of the impact or potential impact of their actions; and demonstrable empathy for the service user(s) involved.” 

127. In the Panel’s view, even at this sanction stage, the Registrant has not demonstrated any appreciable insight into his lack of competence and misconduct, and their possible effects on patients, colleagues, the Service and his profession. The Panel considered that the Registrant continues to demonstrate a lack of genuine recognition of the concerns raised and, in the Panel’s view, he has not addressed them in any meaningful way. As such, the Panel concluded that he continues to pose a current risk of harm to the public and the wider public interest.

 

128. The Panel considered that there were no specific mitigating factors in this case. It considered the HCPC’s submission that a possible mitigating factor was that the Registrant had struggled with the language barrier in the UK and was away from his family. Although the Panel acknowledged that the Registrant had not been working in his country of origin and had clearly struggled with the English language, the Panel did not regard this as a mitigating feature, in relation to either the misconduct or the lack of competence, which might lead it to consider taking more lenient action. In reaching this conclusion, the Panel had regard to the significant support that the Service had provided, including English language lessons, with which the Registrant had not fully engaged. 

 

129. The Panel identified the following aggravating factors:

 

• the repeated dishonest conduct involved an abuse of the Service’s trust in the Registrant;

• the misconduct found proved in this case was deliberate, self-serving and repeated three times over a four month period (April to July 2018) despite the Service having warned the Registrant about his conduct; 

• the Registrant has not evidenced any steps taken by him to address his conduct;

• the Registrant has provided no evidence of any reflection and lacks insight, especially in relation to the impact of his actions on the Service, his colleagues and the wider public.

 

130. The Panel considered what sanction, if any, should be applied, and considered its powers in ascending order of seriousness. The Panel had in mind the HCPC Sanctions Policy and the principle of proportionality when considering sanctions.

 

131. The Panel paid careful attention to the section in the Sanctions Policy called “Serious cases”, specifically the sub-section on cases involving dishonesty. It bore in mind that the Registrant’s dishonest behaviour occurred on three occasions over a four month period and determined that it was the Registrant alone who instigated the dishonest conduct. 

 

132. The Panel concluded that both the misconduct and lack of competence in this case were too serious to refer for mediation or to take no action. There is a risk of repetition and taking no action would fail to meet the public interest in declaring and upholding proper professional standards and maintaining confidence in the profession and the regulatory process.

 

133. The Panel next considered whether to make a Caution Order. A Caution Order is appropriate in cases where the failing is isolated, limited, relatively minor in nature, or where the Registrant has undertaken appropriate remediation. In relation to the dishonesty found proved in the context of the Registrant’s professional career, this was not an isolated lapse, nor minor in nature. Further, the lack of competence established in this case raised serious and ongoing public protection concerns. The Panel considered that, in relation to both matters, there had been no demonstrated insight or any remediation. In light of there being a risk of repetition of the matters found proved, a Caution Order would not be appropriate or sufficient to protect the public in its broadest sense. 

 

134. The Panel next considered a Conditions of Practice Order. The Panel noted the guidance in the Sanctions Policy that Conditions “will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so.” The Sanctions Policy also provides that Conditions are “less likely to be appropriate in more serious cases, for example those involving dishonesty.” In this case there has been no engagement whatsoever from the Registrant and no demonstrated insight. The HCPC has been unable to make contact with the Registrant and the Panel has no information about his current circumstances. The Panel bore in mind that the Registrant was subject to conditional, supervised practice and action plans at the Service over a lengthy period, but was unable to meet the required standard to work autonomously as a registered Paramedic. Moreover, the Panel concluded that, even if appropriate conditions could be formulated to address the lack of competence concerns and the ongoing risk presented by the Registrant, in the absence of any information from him, it could not be satisfied that those conditions would be workable, or that the Registrant would comply with them. Further, the Panel was of the view that a Conditions of Practice Order would not be appropriate in light of the repeated dishonesty in this case. It was clear to the Panel that Conditions of Practice were therefore not an appropriate or sufficient sanction to protect the public or to address the public interest and the need to uphold standards and declare proper standards of conduct and behaviour.

 

135. The Panel next considered a Suspension Order. The Panel has found that the Registrant’s actions were serious and deliberate, involving an abuse of trust and serious breaches of professional standards. In addition, the dishonesty found proved requires a sanction on the upper end of the scale as a matter of principle. It noted the guidance at paragraph 121 of the Sanctions Policy that such an order may be appropriate where “the concerns represent a serious breach of the Standards of conduct, performance and ethics; the registrant has insight; the issues are unlikely to be repeated; and there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.” Dealing with each of those matters identified in the guidance, the Panel has found that the Registrant has shown no insight at all; that he is likely to repeat the failings, both in terms of the dishonesty and the clinical failings; and that there is no evidence before the Panel that the Registrant is willing or able to remedy his failings. The Panel was mindful that although sanction is primarily about public safety, the public interest is important and that suspension is not an appropriate sanction merely to allow a Registrant more time to develop insight. Given its findings as to the misconduct and lack of competence concerns in this case, coupled with the Registrant’s lack of insight and understanding of their seriousness, together with the lack of evidence as to any remediation, the Panel determined that a Suspension Order would not be appropriate or proportionate. Suspension would fail to adequately address the public interest, fail to uphold standards and would not send an appropriate deterrent message to the profession.

 

136. The Panel considered paragraph 130 of the Sanctions Policy in relation to a Striking off Order and noted that this is “a sanction of last resort for serious, persistent, deliberate or reckless acts involving (this list is not exhaustive): dishonesty…”  The Panel was mindful that it could only impose this sanction of last resort in relation to the misconduct it had found, not the lack of competence. In the Panel’s judgment the repeated incidences of dishonest conduct, representing a significant undermining of trust and underscored by a total lack of insight on the Registrant’s part, caused the Panel to conclude that the misconduct was not capable of being remedied by the Registrant and, as such, was fundamentally incompatible with ongoing registration. 

 

137. The Panel was mindful of the significant impact that such an order may have on the Registrant in terms of financial, personal and professional hardship. In any event, the Panel determined that the protection of the public and the wider public interest outweigh the Registrant’s interests in this regard.

 

1. The Panel heard an application from the Presenting Officer to cover the appeal period by imposing an 18-month Interim Suspension Order on the Registrant’s registration. He submitted that such an order is necessary to protect the public and is otherwise in the public interest.

 

2. The Panel heard and accepted the advice of the Legal Assessor. It had careful regard to Paragraphs 133-135 of the Sanctions Policy and to Paragraph 7 of the HCPTS Practice Note on Interim Orders, which offers guidance on interim orders imposed at final hearings after a sanction has been imposed. This makes clear that registrants should be made aware of the potential for an interim order to be imposed on their registration after the panel has made a substantive order and should be given an opportunity to make representations in respect of an interim order.

 

3. The Panel noted that the Registrant had been informed by the Notice of Hearing letter dated 26 November 2021 that if this Panel found proved the allegation against him and imposed a Conditions of Practice Order, a Suspension Order or a Striking-Off Order, the HCPC may make an application to the Panel to impose an interim order to cover any appeal period. For the reasons set out in its earlier decision to commence the hearing in the absence of the Registrant, the Panel determined that it would also be fair, proportionate and in the interests of justice to consider the Presenting Officer’s application. 

 

 

4. The Panel recognised that its power to impose an Interim Order is discretionary and that the imposition of such an order is not an automatic outcome of fitness to practise proceedings in which a Striking-off Order has been imposed, and that the Panel must take into consideration the impact of such an order on the Registrant. The Panel was, however, mindful of its findings in relation to the misconduct and lack of competence in this case and the risk of repetition. 

 

5. The Panel decided to impose an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001. The Panel was satisfied that an Interim Suspension Order is necessary for the protection of the public and is otherwise in the public interest to maintain confidence in this regulatory process. The Panel has had regard to the misconduct and lack of competence found proved and the resulting public protection concerns, and the full reasons set out in its decision for the substantive order in reaching the decision to impose an Interim Order. In the circumstances, it also considered that public confidence in the profession and the regulatory process would be seriously undermined were the Registrant allowed to remain in practice during the appeal period, even if subject to interim conditions.

 

6. The period of this order is for 18 months, which the Panel considered to be the minimum realistic period to allow for the possibility of an appeal to be made and determined.

 

7. If no appeal is made, then the Interim Suspension Order will be replaced by the Striking-off Order 28 days after the Registrant is sent the decision of this hearing in writing.

 

Interim Suspension Order:

 

8. 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. 

 

9. 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.