Mr Paul Winfield

Profession: Paramedic

Registration Number: PA26753

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 22/06/2022 End: 17:00 22/06/2022

Location: Virtual hearing - Video conference

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Whilst registered as a Paramedic with the Health and Care Professions Council, you:

1. Made inappropriate and/or offensive comments about Colleague 1’s weight and/or body, in that you:

a) On or around 21 February 2019:

i. Said she had a “fat arse”, or words to that effect;

ii. Said she had jowls and/or was “getting the family trait around her neck”, or words to that effect.

iii. Said Colleague 1 was fat and/or starting to look like her grandmother, or words to that effect.

b) On or around 28 February 2019:

i. Said that Colleague 1 had put on weight, or words to that effect.

c) On or around 1 March 2019:

i. Said “Look at the fucking state of you. You need to lose weight”, or words to that effect;

ii. Said she was a “fucking fat porker”, or words to that effect;

iii. Asked if she was on a diet, or words to that effect.

iv. Made inappropriate physical contact with Colleague 1, in that you touched her bottom;

d) On or around 6/7 March 2019:

i. Suggested that she needed bigger trousers, or words/actions to that effect;

ii. Brought and/or attempted to give Colleague 1 bigger trousers;

e) On an unknown date:

i. (Not proven)

ii. (Not proven)

2. The matters set out in paragraph 1 constitute misconduct.

3. By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary matters

Application for part of the hearing to be in private

1. At the outset of the hearing Mr D'Alton made an application for part of the hearing to be heard in private if and when reference was made to the Registrant's health in order to protect his personal life. The Registrant did not oppose the application.

2. The Panel considered the application with care and accepted the advice of the Legal Assessor. The Panel was satisfied that it was appropriate for any mention of the Registrant's health to be dealt with in private in order to protect his private life and therefore if and when any such matters were raised, they would be heard in private.

Background

3. Mr D’Alton, on behalf of the HCPC, outlined the background to the case.

4. The Registrant is a registered Paramedic who, at the material time, had been employed by East Midlands Ambulance Service NHS Trust (EMAS), where he had worked since 2002.

5. He was a full-time Paramedic who, up to March 2019, worked on a rotational shift pattern comprising both day and night shifts.

6. The matters proved related to conduct by the Registrant towards Colleague 1, an Emergency Care Technician, on dates during February 2019 and March 2019 and included inappropriate and offensive comments about Colleague 1’s weight and size, as well as the fit of her uniform trousers.

7. AW, a paramedic and a colleague of both the Registrant and Colleague 1, raised concerns with SH, the Clinical Operations Manager, about the Registrant’s alleged conduct towards Colleague 1. AW was concerned that it was unprofessional and that it appeared to be having an adverse effect on Colleague 1’s wellbeing, as well as other colleagues who were upset by it.

8. These concerns were investigated during an initial ‘fact-find’ by SH, followed by a full EMAS investigation.

9. On 28 March 2019, the Registrant self-referred to the HCPC following his suspension from EMAS in relation to concerns about his conduct.

10. Both Colleague 1 and the Registrant gave evidence at the final hearing. When considering the evidence of Colleague 1, the final hearing panel stated:

“The Panel found Colleague 1 to be a credible witness on whose evidence it could rely. She restricted her evidence to what she knew and declined to comment on evidence against the Registrant from others where she had no recollection or knowledge of it. She accepted that her memory of dates had been affected by the passage of time but her evidence was very largely consistent with that given in the fact-find and the EMAS investigatory interview.”

11. When considering the evidence of the Registrant, the final hearing panel said:

“The Panel found the Registrant to be evasive and inconsistent in his evidence and that he sought to considerably minimise his behaviour towards Colleague 1. He told the Panel that he believed there was a conspiracy against him which had been orchestrated by IC, a senior manager at EMAS. There was nothing in the documentary evidence before the Panel to support this assertion, which had not been put to any of the witnesses. The Panel found that there was no credible reason put forward by the Registrant as to why the witnesses ([redacted] some of whom he had good professional relationships with, and some who had been his good friends and who he considered to be “decent people”) would collectively enter into a conspiracy against him, risking their registration by lying under Affirmation in the course of this hearing.”

12. The original panel preferred the evidence of Colleague 1 over that of the Registrant and found the majority of the facts proved. In deciding the facts found proved amounted to misconduct, the final hearing panel said:

“The Panel concluded that the Registrant’s inappropriate, offensive, and bullying behaviour, as found proved in Particulars 1a) to 1d), amounted to a serious departure from the standards of conduct that could properly be expected of a Paramedic interacting with members of the public, including colleagues such as Colleague 1.

The Panel considered that this had not been a one-off incident; rather, an ongoing course of serious misconduct against Colleague 1. It had no basis and it was entirely “out of the blue”, and followed what appeared to have been previously good communication between the Registrant and Colleague 1. The Panel did not accept that it could be confused with “banter”.

The Panel noted that the Registrant had not stopped his behaviour despite other colleagues, including AW and SMQ, asking the Registrant to stop behaving in that way towards Colleague 1. It should have been very clear to the Registrant, as it was to colleagues, how he was bullying Colleague 1 and how it affected her.

The effect of his behaviour was to cause humiliation and distress to Colleague 1 and her family, as well as upset to colleagues at the station, where the Registrant’s behaviour had become a talking point. RS, the Registrant’s crewmate, ceased to enter the ambulance station as he felt uncomfortable being present with the Registrant and Colleague 1 due to his behaviour towards her. The Panel considered it also had the potential to cause harm to the public in the provision of the service due to this upset in the workplace. The Panel concluded that the Registrant’s behaviour would be regarded as deplorable by fellow practitioners.”

13. In determining that the Registrant’s fitness to practise was impaired, the final hearing panel said:

“The Panel considered the criteria set out in the case of Grant, and concluded that through his misconduct the Registrant had brought the profession into disrepute and had breached a fundamental tenet of his profession.

The Panel noted that the Registrant had engaged with the EMAS investigation and with the HCPC, his regulator. He had, however, only recently provided very limited evidence of remorse, insight, or remediation. The Panel noted that the Registrant’s undated reflective statement did not appear to be up-to-date, referring to [redacted] the Registrant having had a difficult time “over the last year” whereas it is now over two years since the relevant incidents. It did not contain comment or reflection on what the Registrant had now learned from the courses which he had so recently completed, nor from hearing the evidence of the witnesses. The Registrant referred to being willing to “apologise again” to Colleague 1. The Panel was not satisfied that the Registrant has ever apologised to Colleague 1 about the incidents despite accepting that he made comments about Colleague 1’s appearance and brought in larger men’s trousers for her.

The Panel considered that this was behaviour intended to humiliate Colleague 1 and that the Registrant had, within only the last few days, defended this as his right to free speech, telling Colleague 1 his opinion, and being “helpful”. There was no insight into the restrictions on free speech which are required in order to protect other people from harm. The Registrant made repeated positive assertions during his own evidence that his colleagues, in their evidence, had acted dishonestly as part of a conspiracy against him. To the Panel, this seemed to demonstrate a serious lack of insight.

The Panel noted that the Registrant had completed some relevant training over the previous two days which may suggest the commencement of some insight, but it is extremely limited. It noted that in relation to the previous two years before this hearing, the Registrant did not appear to have undertaken any of the numerous courses accessible online free of charge (which he would not have needed to access through EMAS) which might have given the Panel more confidence in the development of the Registrant’s insight.

Although remediable, the Panel found that despite the recent courses he has undertaken, the Registrant’s misconduct has not yet been remedied. He has not reflected on what he has learned and the Panel has no evidence of how his learning has been embedded within his professional behaviour.

In all these circumstances, it was the judgement of the Panel that it could not be said that the Registrant was highly unlikely to repeat his misconduct.

The Panel also concluded that the Registrant’s misconduct, which had taken place in the course of his professional employment, required a finding of impairment to uphold proper professional standards and maintain public confidence in the profession and its regulator.
Accordingly, the Panel concluded that the Registrant’s fitness to practise is currently impaired on both the personal and public components.”

14. When deciding on the appropriate sanction, the final hearing panel said:

“The Panel concluded that the Registrant’s misconduct was serious, in that he had, in the course of his employment and over fourteen days, made offensive, inappropriate, and demeaning comments to a colleague (who was new to the station) about her weight, her family’s appearance, and the tight fit of her uniform trousers. This included touching the bottom area of her trousers to make a point about the tightness of the trousers. There was evidence from professional colleagues as to the adverse effect of the Registrant’s misconduct on: (i) a normally ‘confident’ and ‘bubbly’ colleague; and (ii) the ambulance station staff, who were upset at having to witness the misconduct and see their colleague upset as a result. These colleagues stated that they just wanted to come to the ambulance station and do their jobs.

The Panel concluded that the following were aggravating factors:

  • The misconduct was repeated over the space of two weeks;
  • The Registrant persisted when told to stop by colleagues;
  • The Registrant caused real emotional upset to a colleague;
  • There was the risk of potential harm to service users because of the disruption causes to colleagues.

The Panel concluded that the following were mitigating factors:

  • The Registrant was experiencing personal difficulties which adversely impacted on him;
  • The Registrant had a long and previously unblemished career.

The Panel first considered whether to take no further action and was of the view that this would not be sufficient to mark the seriousness of the Registrant’s conduct.

The Panel next considered a Caution Order. In terms of the HCPC Sanctions Policy, a caution may be appropriate where the lapse is isolated or of a minor nature, there is a low risk of recurrence, and the registrant concerned has shown insight and taken remedial action. The Panel is of the view that a Caution Order would not be an appropriate sanction as the lapse was not of a minor nature and there is not yet full insight. In addition, it would not address fully the need for remediation. The Panel is also of the view that it would not address the seriousness of the conduct found proved or the public interest considerations.

The Panel next considered a Conditions of Practice Order. The HCPC Sanctions Policy states that conditions are likely to be appropriate where: the registrant has insight; the failure or deficiency is capable of being remedied; there are no persistent or general failures which would prevent the registrant from remediating; appropriate, proportionate, realistic, and verifiable conditions can be formulated; the panel is confident the registrant will comply with the conditions; a reviewing panel will be able to determine whether or not those conditions have or are being met; and where the registrant does not pose a risk of harm by being in (albeit restricted) practice.

The Panel concluded that the Registrant’s conduct is capable of remediation and that he now understands the seriousness of his actions and the potential impact of his conduct on his colleagues, the public, and the profession, which will help him to remedy his conduct. The Panel understands that attitudinal difficulties giving rise to offensive and inappropriate behaviour and bullying of a colleague, as well as upsetting other colleagues, are difficult but not impossible to remedy. In addition, there is no clinical failure as the Registrant had previously practised as a Paramedic until February 2019 without incident and appears genuinely committed to his profession. He has also expressed his willingness to comply with conditions and the Panel is of the view that appropriate, proportionate, and realistic conditions can be formulated to address the matters found proved.

The Panel is aware that the HCPC Sanctions Policy states that Conditions of Practice are less likely to be appropriate in more serious cases and should only be considered where a panel is satisfied that a registrant’s conduct was minor and out of character, is capable of remediation, and is unlikely to be repeated. Although the Panel has found proved a course of conduct which represent a period of fourteen days of misconduct and bullying towards a colleague, the Panel has considered the Registrant’s actions in the context of his career of 17 years and the volume of positive commendations prior to that date. In reaching its decision, the Panel accepted that his actions appeared to be out of character and were described as “out of the blue”. The Panel noted that the Registrant is currently awaiting a Return to Work programme.”

15. The final hearing panel considered that an Order for a period of 12 months would be sufficient to mark the seriousness of the Registrant’s conduct.

16. Prior to confirming its decision to impose a Conditions of Practice Order the panel considered whether a Suspension Order should be imposed. However, the panel did not consider such an outcome to be a proportionate sanction and that conditions were sufficient to protect the public and the wider public interest.

17. The Conditions imposed were as follows:

1. Except in life-threatening emergencies, you must restrict your practice so you are not:

(i) working with; and/or
(ii) based at the same station as; and/or
(iii) involved in the provision of services with any of the undernoted colleagues unless accompanied at all times by a Paramedic at the rank of Clinical Team Leader or above:

• Colleague 1
• RS
• AW
• SM
• SMQ

2. You must place yourself and remain under the indirect supervision of a workplace supervisor who must be a Paramedic at the rank of Clinical Team Leader or above and registered with the HCPC. You must supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

3. You must meet with your supervisor monthly to discuss your learning and future development arising from the matters found proved by the Panel.

4. Within 1 month of your supervisor being notified to HCPC, you must prepare a reflective piece for your supervisor explaining how you failed to uphold the values and ethics of the Paramedic profession and how you intend to put them into effect in the future. This should include identifying in-person/interactive training courses on the subjects set out in condition 6.

5. You must keep a dated log of your monthly meetings signed by your supervisor and submit this log to the HCPC 14 days prior to any review of this Order.

6. You must work with your workplace supervisor to formulate a Personal Development Plan (PDP) designed to address the values and ethics of being a Paramedic in professional practice, including:

• equality and diversity awareness;
• professional boundaries;
• sensitivity to, and support of, colleagues;
• appropriate workplace communication, including ‘banter’; and share this with the HCPC, along with evidence of progress, at least 14 days prior to any review of this Order.

7. You must produce a new, detailed written reflective piece setting out your continued learning from these proceedings and any training completed by you. You must ensure this contains all areas of learning, including:

• The impact on those colleagues involved;
• The impact on the wider profession;
• The potential impact on EMAS and the public, including patients;
• The impact on the reputation of the profession;
• The steps you have taken towards full insight and remediation.

This should be accurately dated and submitted to the HCPC at least 14 days prior to any review of this Order.

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

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

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

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


18. In an email dated 31 August 2021 the Registrant informed the HCPC that he was unable to work as he was on long-term sick-leave.

19. The Trust informed the HCPC that on 20 April 2022 the Registrant’s employment was terminated on grounds of ill-health, to take effect on 23 June 2022. [Redacted].

20. The Registrant lodged an appeal against that decision and that appeal had been due to take place on 20 June 2022, however the appeal did not go ahead as scheduled.

21. [Redacted]


Submissions

22. Mr D’Alton, on behalf of the HCPC, submitted that the Registrant had not complied with his conditions of practice because he has not worked as a Paramedic since these conditions were put in place. He pointed out, however, that this should not have prevented the Registrant from providing a reflective piece, as stipulated in Condition 7. In light of his failure to comply with the conditions, Mr D’Alton submitted that the Registrant’s fitness to practise remained impaired for the same reasons as before and that the appropriate sanction now was one of suspension. He said that conditions were no longer appropriate given the Registrant’s inability to comply with them making them unworkable. He suggested a period of 12 months to allow the Registrant an opportunity to reflect on the final hearing panel’s decision, to write a reflective piece if he felt able to do so, to do any training or remediation he considered appropriate and to prepare any submissions in advance of a review.

23. The Registrant addressed the Panel and said that he had not been able to adhere to the conditions because he had been prevented from returning to the workplace. He said he did not believe his health had any direct effect on preventing him from returning to the workplace and that the issue was his employer’s inability to provide him with an agreed route back into the workplace.

24. The Registrant said that although his health was mentioned in the documents provided, his health was not affecting his ability to retrain as a Paramedic and he had good support mechanisms in place to help him with his health.

25. The Registrant said he accepted that his fitness to practice was currently impaired as he had not been allowed to practise as a Paramedic for three years and he does not have any access to training, supervision or resources, although he had recently been given access to his work emails which helped.

26. The Registrant said that a Suspension Order was more than he could have hoped for and he would see it as a life-line giving him the opportunity to get back to being a Paramedic, which he wanted to try.

27. The Registrant added that he knows he needs to show insight but he was struggling with a reflective piece as he finds it really difficult to write in an authentic manner about something which he does not believe happened. He said he would like to show lots of insight but it would not be honest.


Decision

28. The Panel considered with care the documentation provided and the submissions of both parties. The Panel accepted the advice of the Legal Assessor and in reaching its decisions referred to the HCPTS’s Practice Note on ‘Finding Fitness to Practise is Impaired’. The Panel carried out a comprehensive review of the current order in light of the circumstances as they existed today.

29. The Panel first considered the issue of current impairment. The Panel took account of the principle set out in Abrahaem v GMC [2008] EWHC 183 (Admin) that there is, in practical terms, a persuasive burden at a review hearing for the Registrant to demonstrate that he has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”

30. The Registrant provided over 350 pages of documents for the Panel to consider. The Panel read all the material provided, however it did not consider much of it to be relevant to the issues of current impairment and the other issues that had to be decided at a review hearing. Much of the documentation the Registrant sent related to his dismissal from EMAS and complaints he had about the way in which he had been dealt with. This Panel was concerned with the matters found proved at the final hearing and any steps the Registrant had taken since to remedy and show insight into his conduct.

31. On 9 June 2022, the HCPC wrote to the Registrant reminding him that the Conditions of Practice Order would be reviewed shortly and pointing out that although he had not been working as a Paramedic since the conditions were imposed, it would be helpful if he could provide a written reflective piece as set out in Condition 7.

32. The Registrant responded saying it would be dishonest of him to write a reflective piece when he fundamentally disagreed with what occurred at the final hearing and that was why he had not done one.

33. The Panel noted that the Registrant had been unable to comply with the conditions imposed on his practice, largely because he had not been employed as a Paramedic, but also because of his candid stance in relation to the reflective piece.

34. However, it would still be possible for the Registrant to have shown insight by doing work on-line and taking courses to demonstrate that he understands why such bullying in the workplace was offensive and unacceptable even if he did not accept he was responsible for it. He had not done so and consequently had shown no insight into his offending behaviour, nor had he taken any steps to ensure he would not repeat such behaviour. The Registrant was clearly concerned about being de-skilled and considered that was the reason why he was currently impaired. However, whilst being de-skilled is a concern it was insight and remediation into his bullying behaviour that was particularly required.

35. In light of the Registrant’s failure to comply with the conditions, the Panel determined that there continued to be a risk of repetition, particularly given the lack of remediation or insight. Applying the criteria in the case of the Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin), the Panel was of the view that the Registrant was liable in the future to bring the profession into disrepute and he was liable in the future to breach one of the fundamental tenets of the profession.

36. The Panel therefore found the Registrant’s fitness to practise currently impaired on both public protection and public interest grounds. Confidence in the profession would clearly be undermined if a finding of impairment were not made in circumstances where there had been no remediation and no insight.

37. The Panel next considered the appropriate and proportionate sanction. It took into account the fact that the Registrant’s conduct occurred in 2019 and related to one colleague in a practice otherwise without incident. It also took into account the impact of a continued sanction upon the Registrant. However, action was necessary in order to protect the public and the public interest given the continued risk identified and the seriousness of the conduct complained of and found proved.

38. Having identified a risk to the public it would not be appropriate to take no further action or to make a Caution Order.

39. The Panel thus considered whether to extend the current order of conditions. The Panel noted the inability of the Registrant to comply with the current conditions and his candid acceptance that he does not feel like a Paramedic at the moment, having not worked as one for three years. The Panel also noted the Registrant's stance on his inability to provide a reflective piece. In such circumstances the Panel considered conditions were no longer workable or appropriate. The Panel thus agreed with the submissions made by Mr D'Alton and agreed that the appropriate and proportionate sanction at this stage was to make a Suspension Order.

40. The panel did not consider a Striking-Off order was appropriate or proportionate at this time and that the Registrant should be given the opportunity to demonstrate the necessary insight and remediation and hopefully to return to practice as a Paramedic, if that is what he chooses to do.

41. The Panel decided to make the Suspension Order for a period of 12 months to allow the Registrant sufficient time to reflect upon his conduct as found proved by the final hearing panel and to give thought to what he wanted to do going forward. If he decided to pursue his career as a Paramedic this would also allow him time to provide a reflective piece, demonstrate remorse and insight into his bullying behaviour and to take remedial steps to ensure no repetition of the conduct (even if he disagreed with the findings of the final hearing panel). In the event that he decided not to pursue his career as a Paramedic then he could make that clear at the next review hearing and appropriate action could be taken.

42. This Panel considered that a future panel would be assisted by clear evidence demonstrating how the Registrant has addressed the findings of the original panel. This could include testimonials from colleagues in other paid or unpaid work, evidence of learning and development about the impact of inappropriate behaviour towards colleagues in the workplace and the wider profession.

43. The Panel therefore made a Suspension Order for a period of 12 months, for the reasons given above.

Order

ORDER: The Registrar is directed to suspend the registration of Mr Paul Winfield for a period of twelve months upon the expiry of the current Order.

Notes

This order will be reviewed again before its expiry on 27 July 2023.

Hearing History

History of Hearings for Mr Paul Winfield

Date Panel Hearing type Outcomes / Status
22/06/2022 Conduct and Competence Committee Review Hearing Suspended