Ashley Edward Williamson

Profession: Paramedic

Registration Number: PA43670

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 28/03/2022 End: 17:00 31/03/2022

Location:

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

The allegation against you is as follows:

As a registered Paramedic (PA43670) your fitness to practise is impaired by reason of misconduct. In that:

  1. Between 1 September 2019 and 20 September 2019, you were unregistered with the Health and Care Professions Council and you practised as a Paramedic for Company A at the ‘Ride Across Britain’ event between 7 September 2019 and 15 September 2019.
  2. In a statement provided to your employer South Western Ambulance Service NHS Foundation Trust in January 2020, you said that you had not worked as a Paramedic at the event and had not received remuneration, when this was not the case.
  3. Your conduct in relation to allegations 1 and/or 2 above was dishonest.
  4. The matters set out in allegations 1,2 and 3 above constitute misconduct.
  5. By reason of your misconduct your fitness to practise is impaired

Finding

Background

1. The Registrant is a Paramedic. This case concerns an allegation that, in September 2019, during a time when his registration had lapsed, he practised as a Paramedic for a private company at a cycling event. It is alleged that when asked about this by his employer, South Western Ambulance Service NHS Foundation Trust (the Trust), he told them that he had not worked as a Paramedic at the event and had not been remunerated by the company. It is alleged that this was untrue and in making such a statement the Registrant’s conduct was dishonest. The Registrant self-referred the matter to the HCPC on 12 October 2020.
2. In respect of his lapsed registration, it is said that both HCPC and the Trust had brought the issue of renewal to the Registrant’s notice. The HCPC contacted the Registrant concerning his renewal initially on 1 June 2019. This was followed up by both the HCPC and the Trust thereafter but well before such time as his registration at that time would lapse. As the Registrant did not renew his registration in good time, the Registrant had to work as an Emergency Care Assistant (“ECA”) until he renewed his registration as a Paramedic with the HCPC with effect from 20 September 2019.
3. The Trust subsequently became aware of evidence that the Registrant had worked as a Paramedic for a private company between 7 September 2019 and 15 September 2019. The Registrant had invoiced the company for his services.

Hearing

4. The Panel heard from the following witnesses who had provided statements who gave oral evidence under affirmation and adopted their witness statements, but supplemented this with further detail:

• Oliver Meakin, who investigated this matter for the Trust;
• Howard Gladden, Operations Officer at the Trust and the person who initially interviewed the Registrant about his role at the cycling event;
• Steven Watkinson, Operations Officer at the Trust and the Registrant’s line manager at the relevant time.

The statement of Nicola Bibbey, HCPC Registration Manager, was included as evidence without her being called. The Registrant did not object to this.

5. The Registrant made full admissions to Allegations 1-4.

6. Oliver Meakin indicated that in his role as Operations Manager at the Trust that he investigated the allegation that the Registrant had worked for a private company while not registered as a Paramedic. He confirmed that a letter had been received on 12 August 2019 from the HCPC concerning the Registrant’s renewal. He similarly confirmed that internal communications within the Trust meant that the Registrant had had the issue of his renewal explicitly brought to his attention.

7. By 2 September 2019 a check of the Registrant’s registration showed that his registration as a Paramedic had lapsed. As a result of this his duties were amended, and the Registrant had to work as an ECA until he re-registered on 20 September 2019.

8. The Trust discovered a Facebook message which revealed that the Registrant had in fact been working as a Paramedic between 7-15 September. Photographs show the Registrant at a private company event accompanied by a message. Initially, the Registrant appeared to indicate to Mr Meakin that he was not working as a Paramedic notwithstanding the messaging and photographs on Facebook. However, by January 2020, the Registrant indicated to Mr Meakin that this was not correct and acknowledged that he had not been truthful. He said that he had been naïve in relation to his lapsed registration and that this has been driven by financial pressures.

9. He said his impression was that the Registrant was genuinely remorseful when he interviewed him. He said that he had never line managed the Registrant but his interaction with the Registrant had focused on the investigation. He said he formed a favourable view of the Registrant who fully acknowledged his error in working when he should not have, and the Registrant provided an apology unprompted.

10. The Registrant did not challenge any of the evidence provided by Oliver Meakin.

11. Howard Gladden, an Operations Officer at the Trust, had no personal knowledge of the Registrant, save for the Trust enquiries into matters. He described the Registrant as someone who came across as apologetic, and thoughtless rather than having set out to do something deliberately wrong. He said his impression was that the Registrant appeared to be open and honest in acknowledging the implications of his lapsed registration. He said that the Registrant offered to provide information to show that he was supporting a friend voluntarily and had not been paid as a Paramedic. He said that he had asked the Registrant open questions in his attempt to find out what had happened.

12. He indicated that the enquiries by the Trust were not immediately a formal investigation. He explained that non-registration of a Paramedic could concern disciplinary issues or clerical errors. He confirmed that the case for this Registrant clearly fell into the latter category.

13. The Registrant had no questions for this witness and did not challenge any of his evidence.

14. Steven Watkinson, an Operations Manager at the Trust since 2012, explained that he had been the Registrant’s line manager between 2018-2019 covering the period that this case is concerned with. He was asked about the culture of fear and intimidation which the Registrant described as contributing to him not feeling able to be forthright. He said that he was sorry to hear that but that was not his experience. He described how he became the Registrant’s Welfare Officer to support him through the Trust investigations but that the Registrant had not approached him for help with writing his statement.

15. He characterised his relationship with the Registrant as one in which they “got on really well,” and said there were not any clinical issues with the Registrant’s work at all. He indicated that the two had been in regular contact and no complaints about him were raised meaning that he had no concerns or worries. He said that he believed that they had a “positive relationship”. While, he acknowledged that he had never worked alongside him on an ambulance crew, he described the Registrant’s teamwork and clinical work as “excellent” from what he observed, as they had attended incidents together and watched him in practice. He said that now the Registrant worked mainly at a G.P. surgery and at the Trust only a handful of times a month, he was now his current line manager, and had identified no problems or issues at all with the Registrant’s work.

16. Mr Watkinson indicated that he hoped that he was a supportive line manager and. He said that he hoped that the Registrant could talk to him about anything.
He said he had never had any issues with the Registrant’s conduct, ability or performance. He said that he had monitored the Registrant’s 18 month and 24 month NPQ process, and indicated that the Registrant never missed his meetings, and was keen to progress. He identified no issues at all. He said that the Registrant would have had to be in contact with others during the NPQ process but he knew of no issues raised by other people either. He said that the Registrant was meticulous with his paperwork and that he prioritised patient care.

The Registrant

17. Mr Williamson gave evidence under affirmation. He said that he was “incredibly ashamed” of his behaviour. He said anyone who worked with him, would know how important honesty and integrity are to him. He said he was extremely disappointed in himself.

18. He addressed how the Trust enquiries began. He said that he had asked: “Can I go away and write out a statement?” but had been told that this was not possible. He said that it was an unusual mixture of formal and informal.

19. He explained that he had experienced bullying and intimidation from one manager and had thereafter never felt comfortable and secure in his role. He said that he never felt the workplace culture was one that encouraged openness as far as he was concerned but that this was not an excuse for him not to be open or honest, which he considered to be inexcusable. He only offered this as an explanation of his mindset. It contributed to why he decided to work part time at the Trust and took up other opportunities at the G.P. practice.

20. The Registrant admitted his dishonesty. He said he had been reckless, and his personal circumstances at the time, relating to his health, financial difficulty, relationship and bereavement had impacted him. He said he did not feel stable and rational and did not feel ‘himself’ at that time. He said that he held himself to high standards. His mindset at the time was not good but he had experienced a “massive learning curve” and was now a different person. He said he was disgusted in himself and how he had historically acted. He said that he had a lot of difficulty at the time and had even taken time off work and finances were ‘tough’.

21. He said that while he had succumbed to temptation on one occasion, he would never do so again. He said that he wished that he had been honest and open sooner. He said that he had been advised by UNISON at the time poorly and this led to them parting ways and ultimately him changing jobs. He said that it had been confusing to hear conflicting positions from different people, in terms of how this case should be resolved. He said that this was a difficult period because he was advised not to be open and also advised to bring a grievance against a Trust member. This was merely background to his conduct and the responsibility to be honest remained his, he acknowledged.

22. He said that nobody could be harder on him than he was being on himself. He said that he wants the care he delivers to be of the highest standard. He indicated that he has reflected, and done much self-analysis, looking at how he could make sure that this would never happen again. He described how his colleagues see him as a natural leader and his Contact Practitioner Service course has been successfully completed to date and that he wants to develop and progress his career further. He explained that he had immersed himself in learning and done a lot of Reflective Practise in the last four months. He mentioned that he has even changed the way that he pays for his registration so that there are no lapses administratively because payment is by direct debit to prevent any reoccurrence of a registration lapse.

23. He explained that his previous behaviour is not something that he recognises now. He said that he was a reformed character. He said that the ‘implications, and everything that comes with that’, means he cannot fathom why he acted in that way, save for the fact that he was not himself at that time and having to deal with multiple pressures from every angle.

24. He said that he now works three days a week, for four partners and salaried GPs in a practice which has 11,000 patients on their books. He explained how he worked with two other people to make up a home-visiting team, including patients who were elderly and/or frail. He indicated that formulating care plans for Care and Nursing Home patients was also part of his role. He said that he does additional shifts where possible and works with the Trust part time.

25. In cross-examination, he admitted that on 1 September 2019 he was not registered with HCPC as a Paramedic and that this had been brought to his attention by the Trust. He acknowledged that due to how the Trust dealt with the period of non-registration that it was clear to him that he could not practise as a paramedic. Similarly, he acknowledged that by 7 September when at a private event where he worked as a Paramedic, he was in a position where he could have had to provide paramedic-grade care. While he could only recall having to address first aid injury management, he acknowledged that broken bones and cardiac incidents could have occurred.

26. He readily accepted that there are clear implications for public trust and confidence and that his actions could have caused a reduction in these. He said that people rely on paramedics when they are most in need of care. He said that he recognised that where something goes wrong this has significant implication for patients, those he works for, public treatment, public perception, and trust in the profession as a whole.

27. He was asked if the initial lie was told because he wanted to avoid consequences. He responded that this was not entirely the case, it was because he said that he did not want to go into the details of his health, financial and relationship difficulties at the time, but could say that he was not in a “space” where he felt he could be open, both given the environment in which he was working and his own emotional state. When asked why he hadn’t confided in his line manager, he explained that he did not “function well accessing support in the workplace at the Trust at the time,” but that this was a personal choice given he had a preference for receiving support from his family.

28. He said that he was in difficult circumstances at the time but had different work now and that relationships move on. He said that he had had no need to access support outside this episode, but that even if there was, the Trust support services would not be his first port of call. He said that he had nothing negative to say about his line manager, but he preferred to use his family as his support network.

29. He acknowledged that integrity and trust is paramount for a paramedic. He said that honesty is an integral part of his role and that he knew what was expected of him as part of his contract. He said that he knew before June that he should have resolved his registration issue. He said that at this time his partner had lost two jobs during the pandemic, but that this was irrelevant. He said he knew he should have been truthful, and his career is something he takes very seriously.

30. He said that today he is a lot more resilient. He said that he has grown and become more mature through dealing with professional and personal difficulties during the pandemic which he found difficult. He said that he could deal with difficulty in a much more resilient way. He said that he is working well in a new environment and would be happy to raise any difficulty with doctors and others in his new professional setting who support him well.

31. In response to panel questions, he acknowledged that even though the invoice did not make any mention of the title of “Paramedic”, he knew that he was employed as a Paramedic. While the care he actually provided at the private company event was at sub-paramedic level, he clearly acknowledged that he could have been placed in a situation where care and treatment is such that it was a higher level than an ECA can provide. He said that he had reflected and knew that he had not been candid when asked by the Trust to own up to his wrongdoing. He said that he had no excuse but that there were extenuating circumstances in play at the time.

32. The HCPC submitted that the credible witnesses have confirmed their witness statements and can be relied upon by the Panel. The HCPC has proved its case factually given the burden and standard of proof. It was said that the Registrant’s behaviour met the statutory ground of misconduct given that the Registrant had not acted as he should have done in that he had breached the following standards:

HCPC Standards of conduct, performance and ethics

6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
9.2 You must be honest about your experience, qualifications and skills.

HCPC Standards of Proficiency for Paramedics.
You must:
2 be able to practise within the legal and ethical boundaries of their profession
2.1 understand the need to act in the best interests of service users at all times
3 be able to maintain fitness to practise
3.1 understand the need to maintain high standards of personal and professional conduct

Decision on Facts

33. In considering the facts, the Panel accepted the legal advice provided by the Legal Assessor. It had regard to the evidence of the HCPC witnesses and the Registrant. In assessing the evidence, it took account of what had been said, instances where documentary evidence had been provided to support what had been said, where there was a lack of any corroborating evidence and the chronology of events. It bore in mind that the HCPC bring the case and must prove it on a balance of probabilities.

1. Between 1 September 2019 and 20 September 2019, you were unregistered with the Health and Care Professions Council and you practised as a Paramedic for Company A at the ‘Ride Across Britain’ event between 7 September 2019 and 15 September 2019.

34. Allegation 1 concerns the Registrant’s period of being unregistered while working as a Paramedic. The HCPC had sent a renewal notice to the Registrant at his registered address on 1 June 2019, as addressed by Ms Bibbey and detailed in a communications log. On 12 August 2019, the HCPC also wrote to the Trust to inform them that the Registrant had not renewed his registration as a Paramedic with the HCPC. The letter stated that the Registrant could avoid his name being removed from the Register if he renewed immediately using the online system no later than 31 August 2019. It also explained that the HCPC had written to the Registrant separately about this but was contacting the Trust to help ensure the Registrant renewed his registration, and the HCPC letter dated 12 August 2019 was exhibited.

35. Internal email correspondence from the Trust, dated 30 August 2019, shows that the Trust raised the issue with the Registrant. Despite this the Registrant’s registration as a Paramedic lapsed and he was de-registered on 1 September 2019. As a result, the Trust advised the Registrant, by telephone on 3 September 2019 and by letter dated 4 September 2019, that he would be placed on restricted duties; working as an Emergency Care Assistant until further notice. The letter notes that, during the call, the Registrant had provided assurances that he was progressing his re-registration with the HCPC “as a matter of urgency”.

36. The Registrant worked as an Emergency Care Assistant until he renewed his registration as a Paramedic with the HCPC with effect from 20 September 2019. The Trust became aware of evidence that the Registrant had worked as a Paramedic for a private company event between 7 September 2019 and 15 September 2019. The Trust was provided with a social media message which suggested the Registrant was one of “4 route Paramedics” at the event. The message included photographs of the Registrant in various outdoor locations with three others. In some of the pictures he wears a green tabard, in others he is stood in front of what appears to be an emergency response vehicle. The Panel had sight of the social media messages which were exhibits.

37. The Registrant accepted that he had not renewed his registration in a timely manner. [The Registrant’s registration was due to expire, and 1 September 2019 fell on a Sunday. This meant that 31 August was a non-working day and the Registrant had left it too late to address re-registration payment on 31 August.] While he had moved house and not kept track of all his administrative requirements, he recognised that this was his responsibility and failing. He acknowledged that he nonetheless chose to work as a Paramedic at a private company while not registered in this capacity.

38. Given the burden and standard of proof, the Panel finds Particular 1 of the Allegation proved.

2. In a statement provided to your employer South Western Ambulance Service NHS Foundation Trust in January 2020, you said that you had not worked as a Paramedic at the event and had not received remuneration, when this was not the case.

39. The Registrant, in a statement to his employer, the Trust, in January 2020, stated that he had not worked as a Paramedic at the private company event and had not received remuneration when this was not the case. Following receipt of the social media message, the Registrant was interviewed about the matter on 19 January 2019 by Mr Gladden, Operations Officer at the Trust. There is a record of their conversation which shows that the Registrant was shown the social media images and reflects his response at that time:

“He confirmed that he had attended the event in an unpaid volunteer capacity and was an extra pair of hands as part of the support team and that he had not acted in any medical capacity and certainly not as a Paramedic. He confirmed that he has not covered the event in any capacity before. He had booked leave to attend the event as a volunteer but not in any medical capacity but as support staff. Many of the support team for this event are adhoc [sic]. His voluntary role was with a friend who was contracted to the event company. [The Registrant] will provide contact details for his friend and is happy for the Trust to contact him if required. He told me that he had spoken to his friend who had made the post to explain to him that it was wrong and that he shouldn’t be tagged as a Paramedic.”

40. Following the meeting with Mr Gladden, the Registrant provided a statement, dated 19 January 2019, setting out his position. In this statement he confirmed that he was not registered as a Paramedic between 1 and 20 September 2019. In relation to the ‘Ride Across Britain’ event, the Registrant stated (emphasis added):

“I was completely aware that not being registered as a Paramedic, meant that whilst there, should I be asked to provide any medical assistance in any capacity, it would not be appropriate or wise to do so. I attended this event purely on the basis of supporting people I knew […]. I was not offered to be paid or paid for my time spent with these people. I am acutely of aware of the risk and inability to practice as a Paramedic when not registered, and did not do so whilst there and made it clear prior to attending that would be the case. I am very much aware ‘Paramedic’ is a protected title too and as soon as I had seen that I had been tagged in the pictures in question as a ‘Paramedic’, I asked for this tag to be removed and explained to the person posting them the connotations and why despite my degree and qualifications I could not be called a ‘Paramedic’ on a public forum and that my supporting of them and the event was in no way in that capacity and it would not be fair for it to be portrayed as such.”

41. As part of its investigation, the Trust obtained an invoice, dated 18 September 2019, sent by the Registrant to Company A for his work at the event. This revealed that, contrary to what the Registrant had told the Trust, he had in fact been paid by Company A. The invoice shows that he worked for 9 days, 7 to 15 September 2019, at a daily rate of £220. Together with a payment in respect of travel this amounted to £2,030.

42. Mr Meakin, as part of his investigation, interviewed the Registrant on 19 June 2019. During this interview the Registrant confirmed that, in fact, he had worked for Company A as a Paramedic and that he did so because he “needed the money”. He confirmed that the invoice was prepared to reflect the work he had done.

43. Mr Meakin explained the concerns around a non-registered Paramedic working in that capacity:

“[…] there were serious concerns that he could have provided treatment to an individual outside his scope of practice when not registered as a Paramedic at the time. This meant that [the Registrant] could potentially practice skills and give medications whilst not registered. The Trust expects its staff to perform to their job specification. At this time, because of his lapse in registration, [the Registrant] was effectively employed as an Emergency Care Assistant and not as a Paramedic, and so he could therefore have acted beyond his level of employment. It also meant that the Trust has a member of staff working above and beyond their contracted hours without the support and governance of the Trust. Any human errors, mistakes or near misses may also go unreported through an unknown employer.”

44. The combination of evidence from HCPC witnesses, supported by invoices and documents prepared at the time, taken with the Registrant’s admissions, mean that the Panel consider this Particular of the Allegation found proved.

3. Your conduct in relation to allegations 1 and/or 2 above was dishonest.

45. Allegation 3 concerns the Registrant’s conduct at allegations 1 and 2 being dishonest.

46. The Panel consider that it can be inferred from all the circumstances that the Registrant’s conduct was dishonest. It finds that he must have known at the time he submitted his statement to the Trust on 19 January 2019 – in which he said that he had not worked as a Paramedic at the event and had not been remunerated by Company A – that it was inaccurate. In any event, when subsequently interviewed by Mr Meakin, the Registrant accepted that what he had put in his January 2019 statement “wasn’t entirely truthful” and that he had panicked and this had “led to me not being truthful”.

47. Similarly, in documents accompanying his self-referral, the Registrant, when addressing his statement to the Trust in January 2019, states that he “was not completely honest in my disclosure on first account,” which he sets out in his Reflective Statement which accompanied his self-referral to the HCPC.

48. The Panel considers the evidence before it today and the Registrant’s admissions. Given the burden and standard of proof, it finds that this particular of the Allegation is proved.

Decision on Grounds: Misconduct

49. In considering whether the Particulars 1-3 of the Allegation amount to misconduct, the Panel has considered the evidence before it, the submissions from parties and the advice of the Legal Assessor. It took into account that the Registrant was clear that his conduct was unacceptable and that he admitted that this was misconduct. In assessing whether the Registrants behaviour falls short of what is proper in the circumstances, it applied the standards the Registrant should have met. It found that the Registrant had breached the following standards by his conduct:

HCPC Standards of conduct, performance and ethics
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
9.2 You must be honest about your experience, qualifications and skills.

HCPC Standards of Proficiency for Paramedics.
You must:
2 be able to practise within the legal and ethical boundaries of their profession
2.1 understand the need to act in the best interests of service users at all times
3 be able to maintain fitness to practise
3.1 understand the need to maintain high standards of personal and professional conduct.

50. The Panel determined that the Registrant’s behaviour had been such that it fell far below the standards expected and that the statutory ground of misconduct was made out.

Decision on Impairment

51. The Registrant called a witness to give character evidence on his behalf:

52. Carolyn Hattersley gave oral evidence under affirmation. She said that she knew the Registrant via a professional role from working at the same GP practice. She explained that the Registrant undertook home visits on behalf of GPs and that he was part of a team of three paramedics who held such a post. She said that he triages patients, visits patients in person, speaks to doctors about his findings and can make his own referrals to social care, etc. She said she had known him since October 2020. She said the first six months was a learning curve for the Registrant who was undertaking a new type of role, and rather than providing only emergency care, had ongoing relationships with patients which provided continuity, which he clearly enjoyed. She knew that he was undertaking training and had observed a significant positive change in his development. She said that he was keen to learn and take on greater clinical responsibility in due course.

53. She said that she was confident that he was open and reflective about his practice, particularly in discussing what could have been done differently sometimes. She said that they had had detailed discussion and that the doctors at the practice and she was confident that he would not work outside his professional boundaries. She was confident of his clinical competency, and meticulous record keeping.

54. She said she had no problems at all with the Registrant’s honesty and integrity. She had discussed problems and issues that he had experienced and encouraged an environment where people can learn from each other. She said that the Registrant in raising issues with her that could be resolved had made her confident of his openness and the practice had received very positive feedback from patients about him. She said that she knew that the doctors at the practice considered that the Registrant had shown a high degree of professionalism. She said that where there was a patient with particular vulnerabilities, she had noted that the Registrant took exceptional care and did not hide things from others. She had listened to him speaking to patients and was completely satisfied with his approach.

55. In cross examination, she said that she was aware of the Registrant’s fitness to practise case and the allegations which were admitted by the Registrant and found proved by the Panel. She said that she became aware of the allegation against the Registrant approximately a year ago but could not be sure of the date, when the Registrant spoke to her and indicated that he had self-referred. She said that she was under the impression that when he spoke to her events were current rather than on 12 October 2020 but indicated that this was not because the Registrant had expressly said that this was the case. She said that she was not concerned at any lack of transparency at the time. She said she was fully aware of the events, as were the partners at the practice and all were content for him to work pending any HCPC outcome. She said that the doctors and she considered that this was a “lapse” rather than “who he was” and that her experience of working with him had confirmed his honesty and integrity.

56. She did confirm that this had not been raised in his interview when he was recruited. She said she had only known that this hearing was taking place this week when the Registrant asked for a character reference, at the beginning of this week. She said that she was aware he was continuing to study, and she knew that he was now qualified. The practice had not changed the Registrant’s role to date post these qualifications but would consider doing so in the future.

57. The Registrant produced a number of other documents, including:
a) A further reflective statement dated 29 March 2020;
b) Certificates of the CPD courses he had done in the intervening period; and
c) Testimonial statements from professional colleagues and patient feedback.

58. Mr Mansell on behalf of the HCPC submitted that the Panel must consider current impairment by reason of his misconduct. The Panel was invited to consider the personal and private component. For the personal component, the Panel was asked to address whether in this case matters were remediable, and remediated, and highly unlikely to be repeated. In this regard, with respect to dishonesty, the Panel were reminded how long the dishonest account by the Registrant was allowed to subsist. The Registrant was asked for his account by the Trust regarding his private work in September in an informal enquiry in January 2019. He only provided the Trust with the truth in June 2019.

59. It was submitted that the Panel may decide that the Registrant is “on the road to remediation but is not yet at his destination”. It was said that was the case for the following five reasons:
i) He was not open and honest with his current employer. He said on Monday that he had not informed his current employer about this hearing taking place this week, which Ms Hattersley subsequently confirmed. The Registrant had not told his current employer about this matter in either of his two interviews in 2020, notwithstanding that he had self-referred to the HCPC.
ii) The Registrant had not undertaken targeted CPD in relation to probity until yesterday. His completion of courses into ethics and probity are positive but insight and remediation are not a box ticking exercise but something that need to be reflected upon.
iii) In his original reflective statement and in his oral evidence the Registrant sought to shift blame onto the Trust, which he said did not encourage an open culture of disclosure. The lack of responsibility reflects a lack of insight. There is a marked difference between the original and more recent reflective statement which suggests his insight is recent rather than embedded.
iv) The Registrant has distinguished the environments in his two workplaces, but this is not supported by the Trust witnesses. Mr Watkinson did not recognise this characterisation when he gave evidence.
v) A similar situation could arise again as the Registrant himself acknowledged. The Panel has heard nothing specific about the time when the incident occurred to explain why it was exceptional.

60. In respect of the public component, the Panel was invited to consider proper professional standards and the need to uphold these. Knowingly practising as a paramedic while not registered is not a minor matter. The Registrant was dishonest in providing a written statement and orally told lies. Mr Mansell said that members of the public would be perturbed and shocked if a finding of impairment was not made, given their expectation of honesty and integrity for the profession.

61. The HCPC invited the Panel to consider that the Registrant is currently impaired on both the private and public components.

62. The Registrant, representing himself, indicated that this process has been a salutary one. He said that he did not seek to blame anyone else for his wrongdoing and had simply been trying to explain his mindset. He accepted full responsibility for what he had done. He said that he knew that his practice was safe and that there was no future risk. He said that he recognised that remediation of dishonesty is difficult to evidence and in retrospect, he said that he should have made the decision to be represented, to avoid the impression that the evidence provided has been created at the last minute.

63. He submitted that he had developed personally and professionally, and he recognised the need to evidence that better. He said that a “lot of processing” has been done privately to get to his current position and the fitness to practice hearing process has given him added insight. He acknowledged that how he now conducts himself and external learning should have been demonstrated.

64. He submitted that he is the paramedic who will go the extra mile and is dedicated to his job and profession. He was loyal to his employers and was hugely regretful of what he did. He submitted that he was confident that he has consolidated his position so that a situation such as this would never happen again. He said that he recognised that he had not accessed some of the support available at time to him and clarified that this was not about lack of support from his line manager at the time, who has always been supportive but a personal preference. He said that he still works for the Trust and has a good relationship with his line manager, who he would access support from going forward if necessary.

65. He described his strong family network as part of his coping mechanism and said that he has become re-involved in sport and self-care. He said that he had grown older and matured. He was conscious that he had qualified as a Paramedic at the age of 22, and he indicated that everyone feels invincible when young but said that he had changed over the recent months. He intends to work on his development and reflection further. He said that he thinks that “he is not the finished article” but “I have made a strong start and some insight”. He said he will continue to reflect and did not consider that this was a completed issue. Notwithstanding this on-going learning, he submitted that he does have insight and does not believe that he poses a risk. He said that he is a good paramedic and a good person and is certain that there will be no repetition and submitted that he was hopeful that the evidence he had been able to provide was sufficient to reassure the Panel.

Decision

66. In reaching its decision on impairment, the Panel had regard to the further evidence, the submissions of both parties, and the HCPTS Practice Note “Fitness to Practise Impairment”. It received and accepted legal advice. The Panel bore in mind that the purpose of this hearing was not to punish the Registrant for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise.

Personal component

67. In relation to the personal component, the Panel first considered whether the Registrant’s misconduct had put patients at unwarranted risk of harm and whether, looking forward, the Registrant is liable to put patients at unwarranted risk of harm. While this was not a case relating to concerns as to the Registrant’s clinical competence, and the Panel concluded that there was no evidence of any past harm to patients, the Panel considered that the Registrant could have been placed into a position when he worked for the private company as a Paramedic while unregistered where he might have had to provide paramedic grade care possibly without insurance.

68. The Panel did not regard there being any significant likelihood of harm to patients in the future.

69. The Panel took the view that the Registrant’s misconduct does not relate to a deep seated attitudinal problem, and that it is capable of being remedied. The Registrant has demonstrated that he has reflected on his wrongdoing and the Panel considered that there is a low risk of repetition of his misconduct.

70. The Panel considered with care the steps taken by the Registrant to remedy this misconduct. The Panel did not dismiss the steps taken by the Registrant but did have some residual concerns, which concerned: (i) him not keeping his current employers fully informed of matters in a timely manner; and (ii) and failing to provide evidence of targeted remediation until a very late stage, e.g., completing an ethics course during the course of the hearing, which did not allow for reflection on what had been learnt, and accordingly needs time to embed this learning.

71. The Panel was concerned that the Registrant has not been entirely frank with his new employers, given that a sanction which impacts his continued work could be imposed. This suggests that the Registrant is still not as open and transparent as he claims to be, which causes the Panel to question whether he has developed sufficient insight.

72. The Registrant had not sought to deny what happened, taking full responsibility for it from the outset of this hearing. The Panel took the view that the Registrant understands the impact of his misconduct on the public and the profession and is genuinely remorseful for his actions.

73. However, the Panel concluded that while the Registrant has developing insight into the seriousness of his misconduct, it is not yet at a sufficiently developed stage to reassure the Panel that he has changed and that the risk of repetition has been sufficiently mitigated.

74. In these circumstances, the Panel has concluded that the Registrant’s fitness to practise is impaired on the personal component.

Public component

75. The Panel considered whether the Registrant’s misconduct has brought the Paramedic profession into disrepute. The Panel had no hesitation in concluding that the Registrant’s misconduct does have an adverse impact on the reputation of the profession. For a practitioner to place himself in a position where he is expected to fill a professional role while unregistered and potentially without insurance cover, would have a detrimental impact on the reputation of the profession. A reasonable and well-informed member of the public would consider this sort of behaviour unprofessional.

76. While the Registrant was only unregistered for a matter of days, when directly questioned about working as a paramedic during this period, he lied. While he may have done so in panic, not being given time to seek advice originally, there was a gap of some months before the Registrant told the truth. The Panel took into account that there were a number of factors that coincided in the Registrant’s life to create a perfect storm but in being dishonest, it was also satisfied that the Registrant’s misconduct breached a fundamental tenet of the Paramedic profession. It is never appropriate for a professional to be dishonest.

77. In relation to the public component, the Panel considered whether, given the nature of the misconduct found in this case, public confidence in the paramedic profession and its regulatory body would be undermined if there was no finding of impairment in this case. The Panel also considered whether it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in that profession if it did not find impairment in this case.

78. The Panel considered that a reasonable and well-informed member of the public would find the Registrant’s misconduct in behaving dishonestly to be unacceptable. The Panel considered that such a person would be very concerned if there was no finding of impairment in this case, where the Registrant acted in breach of a fundamental tenet of his profession by being dishonest. The Panel therefore concluded that a finding of impairment is required to maintain public confidence in the paramedic profession and in its regulatory body.

79. The Panel was also satisfied that a finding of impairment is required to send out a message to practitioners that proper standards of conduct and behaviour must be upheld and that dishonest conduct such as this is not acceptable.

80. The Panel therefore found that the Registrant’s fitness to practise is impaired on the public component.

81. Accordingly, the Panel found on both the personal and the public component that the Registrant’s fitness to practise is impaired.

Decision on Sanction

Submissions

82. Mr Mansell, as is the HCPC’s usual approach at the sanction stage, did not advance any particular sanction. He invited the Panel to consider the HCPC Sanctions Policy which is helpful guidance but does not bind the Panel. He reminded the panel of the considerations that it will want to have in mind including the addressing of risk and the deterrent effect of sanctions. He acknowledged that whilst the Panel had found the Registrant had good insight and had apologised that the Panel must include both the mitigating and aggravating features in this case. Mr Mansell submitted that aggravating features of the case included: (i) the pattern of unacceptable behaviour which persisted over a period of months; (ii) lying orally and in written statements compounding his dishonesty; iii) failing to be fully transparent with his current employers. He took the Panel through the sanctions in turn in terms of their appropriateness.

83. The Registrant submitted that he had learnt a great deal through this process and took it very seriously. He relied on written submissions, which covered the impact that the different sanctions would have upon him. He indicated that if he was not able to work, the financial consequences for him would be dire, and impact not simply him but his partner, and have the potential for negative mental health implications. He indicated that he had spoken to his employers who had said that his current job required his registration and submitted that it would not provide him with an opportunity to prove himself, and potentially lead to de-skilling. He said that this felt unduly punitive and would be disproportionate. He reiterated that he had reflected and learnt from what had gone wrong, and in addition to being hugely regretful was confident that he would never place himself in a situation where there could be any repetition of events. He assured the Panel that while he may not have evidenced his insight as well as he might have, that learning had occurred and would continue.

84. In considering the appropriate and proportionate sanction in this case, the Panel had regard to the representations of both parties and to the Registrant’s evidence and reflective pieces. The Panel was referred to, and has taken account of, the HCPC’s Sanctions Policy. The Panel received and accepted legal advice. The Panel was aware that the purpose of any sanction it imposes is not to punish the Registrant, although it may have that effect, but it is to protect the public, to maintain confidence in the Paramedic profession, and to uphold its standards of conduct and behaviour. The Panel also had in mind that any sanction it imposes must be appropriate and proportionate, bearing in mind the nature and circumstances of the misconduct involved.

85. The Panel considered that there were mitigating and aggravating factors in this case.

86. The Panel first looked at the mitigating factors and decided that the following matters applied:
Mitigating

• The Registrant engaged with the process and participated in the hearing;

• There have been no previous professional findings against the Registrant;

• The Registrant admitted the facts and his misconduct at the outset of the hearing;

• The Registrant has developing insight and has expressed genuine remorse;

• The Registrant did self-report to the HCPC;

• The Registrant has taken steps towards remedying his misconduct, albeit that there is still further work to do in this area to embed the learning and more specifically target the concerns; and

• The Registrant explained that he had been through very difficult personal circumstances, involving bereavement, relationship problems and financial difficulties.

87. The Panel considered the following to be aggravating factors:
Aggravating
• A breach of trust to his employer (SWAST), by lying to them in January 2019 and not admitting the truth until June 2019, allowing the dishonesty to continue for months;
• Allowing his registration to lapse despite reminders from his employer and HCPC; and
• A previous lack of transparency towards his current employer by not keeping them up to date with the progress relating to his referral to the HCPC.

88. The Panel considered its response and made the decision that this was not a case where it could take no action. The Registrant’s misconduct was too serious for this, notwithstanding the mitigating circumstances which applied. It did distinguish the different types of dishonesty and did not consider that this had been planned in advance, given that the lapse of registration was solely administrative and could have been prevented. Had the Registrant not allowed his registration to lapse, which thereafter set in train a course of events which involved dishonesty, he would not have found himself before his regulator. However, dishonesty is a fundamental tenet of the paramedic profession and patients have to be able to trust those who may treat them when they are at their most vulnerable.

89. The Panel considered the available sanctions in ascending order of seriousness.

90. While the Registrant’s dishonesty may be considered to be isolated and limited, it spanned a number of months, before it was corrected. Accordingly, the Panel did not consider that it could impose a Caution Order in this case. This would not be appropriate or proportionate given that the misconduct could not be described as relatively minor in nature. The Panel was satisfied that to ensure public confidence in the profession is not undermined, it must consider a more severe sanction.

91. The Panel then considered a Conditions of Practice Order.

92. The Panel had in mind paragraph 108 of the Sanctions Policy, which states that: “Conditions are less likely to be appropriate in more serious cases, for example those involving … dishonesty”.

93. The Panel did not consider that the Registrant’s conduct was “minor. It further took into account that it would be difficult to formulate workable conditions addressing dishonesty, but further, that the misconduct in this case was serious enough to mean that it would undermine public confidence in the profession and in the regulatory process if it were to impose a Conditions of Practice Order.

94. The Panel next considered whether to impose a Suspension Order. It had in mind the following guidance from the HCPC’s Sanctions Policy:
“121 A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
• 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;
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”

95. Although the Panel found that the Registrant’s conduct involved serious breaches of the Standards of Conduct, Performance and Ethics, it was satisfied that the Registrant is capable of remedying his misconduct and that he has made some progress in that regard. The Panel also concluded that the Registrant is making good progress towards further developing his insight into his misconduct. In these circumstances, the Panel concluded that a Suspension Order for a period of three months is the appropriate and proportionate sanction in this case. The period of three months should provide the Registrant with sufficient time in which to continue his progress towards fuller development of his insight and to implement any other measures which he considers are needed to remedy his misconduct.

96. The Panel decided that a Suspension Order for a period of three months would also be appropriate and proportionate in order to maintain public confidence in the paramedic profession and its regulatory body. The Panel was alive to the fact that this sanction deprives the Registrant from being able to practise as a paramedic and that this will have consequences for him. However, it considers that no lesser order would send out an appropriate message to the profession about the unacceptability of this misconduct. The Panel considered that a reasonable and informed member of the public would be satisfied that such a sanction would properly mark the serious nature of the misconduct in this case.

97. Finally, the Panel considered whether the appropriate and proportionate sanction in this case was a Striking Off Order. The Panel had in mind paragraph 130 of the Sanctions Policy, which states that a Striking Off Order is “a sanction of last resort for serious, persistent, deliberate or reckless acts involving … abuse of professional position”. While the Panel took the view that the Registrant’s misconduct in this case was for acts which were serious, and reckless and were allowed to persist for a number of months, it also had in mind paragraph 131 of the Sanctions Policy.

98. Paragraph 131 of the Sanctions Policy states:
“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession and public confidence in the regulatory process. In particular where the registrant:
• Lacks insight;
• Continues to repeat the misconduct …
• Is unwilling to resolve matters.”

99. The Panel found that the Registrant is developing insight, that he had made efforts to remedy his misconduct, and that he has already taken steps towards doing so. The Registrant continues to engage with the process and so there is no evidence that he is unwilling to resolve matters. The Panel noted that there has been no repetition of the misconduct. The Panel decided that a Striking Off Order in this case would be a disproportionate sanction.

100. The Suspension Order will be reviewed before it expires, and the Panel takes the view that a reviewing panel may be assisted by the following:
a) The Registrant’s attendance, in person or remotely, at the review hearing to assist the reviewing panel.
b) Evidence to show that the Registrant has reflected upon any professional ethics/ probity courses undertaken, detailing what he has learnt about dishonesty from this training.
c) A reflective piece addressing the Registrant’s understanding of the impact of his misconduct on his employers, the confidence of the public in the paramedic profession, and the upholding of professional standards.
d) Up to date references and testimonials from those who can speak for the Registrant’s character in full knowledge of this case.

Order

The Registrar is directed to suspend the registration of Mr Ashley Edward Williamson for a period of 3 months from the date this Order comes into effect.

Notes

This order will be reviewed again before its expiry on 28 July 2022.

Hearing History

History of Hearings for Ashley Edward Williamson

Date Panel Hearing type Outcomes / Status
24/06/2022 Conduct and Competence Committee Review Hearing No further action
28/03/2022 Conduct and Competence Committee Final Hearing Suspended