Imran Khan

 

 

1. The Panel was satisfied that notice of this review hearing was sent to the Registrant by an email dated 11 July 2023. The HCPC Certificate of Registration confirmed the Registrant’s email address registered with the HCPC to which the notice was sent. The Panel also had sight of the proof of posting document dated 11 July 2023 confirming the sending of the notice by email on 11 July 2023. 

 

2. The notice of hearing specified the hearing date and gave the required 28 days’ notice of the hearing. The notice advised that the hearing would be held remotely and offered assistance in arranging a remote connection. 

 

3. The Panel was satisfied that there had been proper service in compliance with Rule 13 of the (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”) and the (Coronavirus) (Amendment) Rules 2021. 

 

 

4. Ms Welsh applied for the hearing to take place in the Registrant’s absence.  She informed the Panel of recent contact with the Registrant.  On 27 July 2023, an email was sent by Ms Welsh to the Registrant in relation to arrangements for the hearing and enquiring about his intentions.  The Registrant responded by email on 31 July 2023 stating that he would be attending virtually, would not be represented and would provide documents.  On 2 August 2023, a response was sent to the Registrant in relation to the date for providing his documents.  Ms Welsh stated that since 31 July 2023 there has been no further communication from the Registrant.  

 

5. Ms Welsh informed the Panel of two further matters.  She explained that on 2 August 2023, an email was sent to the Registrant informing him that another open fitness to practise matter concerning him (reference 86858) would be brought to the attention of the Panel at this review hearing.  

 

6. Secondly, Ms Welsh stated that on 21 August 2023, the day before this hearing, the HCPC received an email from PM, an HCPC Registrant, concerning a reference provided by him (PM) which had been referred to in the Panel’s determination arising from the substantive hearing in April 2023.  PM was concerned because he said the reference had not been provided to the Registrant for the purpose of the HCPC proceedings and he had not agreed to its use in the HCPC proceedings.  Ms Welsh said that this communication from PM had been sent to the Registrant on 21 August 2023 to give the Registrant an opportunity to provide any comments in advance of the hearing today.  

 

7. Ms Welsh confirmed there has been no response from the Registrant to either of these recent communications, and no further contact from him since his email of 31 July 2023

 

8. The service documents also included an email from the Royal College of Podiatry dated 11 July 2023 to the HCPC, in response to the notice of hearing.  This advised that they and Thompsons solicitors were no longer supporting the Registrant as his membership had lapsed.  It was stated that the Registrant had been advised of this in several letters and emails, but he had not responded.  This email was copied to the Registrant’s HCPC registered email address.   

 

9. Ms Welsh submitted that it was clear that the Registrant was aware of this review hearing taking place today.  She submitted that he appeared to have voluntarily absented himself.  She submitted that it was therefore in the public interest and the interests of the Registrant for this mandatory review of the current order to proceed today.  

  

10. The Panel considered the submissions on behalf of the HCPC and accepted the advice of the Legal Assessor.  The Panel was referred to the HCPTS Practice Note, Proceeding in Absence, which sets out relevant guidance from the cases of R v Jones (Anthony) [2004] 1 AC 1HL and GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ 162. 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. 

 

11. The Panel noted that the Registrant was given the required notice of today’s hearing date. He was informed of the powers available to the Panel at this hearing.  He was informed of his right to attend the hearing and be represented. He was given information and offered assistance to join the virtual hearing. In the circumstances, the Panel was satisfied that all reasonable efforts have been made by the HCPC to inform the Registrant of this hearing. 

 

12. The Panel noted that, given his response to the Presenting Officer’s email of 31 July 2023, the Registrant appears to be aware that the hearing is taking place today.  He has not indicated any reason why he is unable to attend today, nor has he sought an adjournment. He has not submitted any documents for the review.

 

13. The Panel concluded that there would be some disadvantage to the Registrant if the matter proceeds in his absence, but was satisfied this could be mitigated within the process and would ensure that the hearing is as fair as possible in his absence.  

 

14. The Panel concluded that the Registrant has voluntarily absented himself from this hearing and has waived his right to attend or be represented. He has not sought an adjournment for any reason.  There is no indication that the Registrant would attend on a future date if today’s hearing were adjourned. The current Suspension Order must be reviewed before it expires in September 2023. The Panel was satisfied that it was in the public interest and in the interests of the Registrant that the review hearing should proceed today.

 

 

15. The Panel had received electronic versions of a service bundle (8 pages) and a hearing bundle (66 pages) which included the determination of the Conduct and Competence Committee following the hearing of April 2023.The Panel also received two emails relating to PM’s correspondence. 

 

 

16. Ms Welsh made an application under Rule 10(1)(a) of the Rules for any references to the Registrant’s health to be dealt with in private as this would relate to the Registrant’s private life.  Ms Welsh also applied for any reference to the additional fitness to practise matter (reference 86858) to be considered in private, on the ground that this would be in the interests of justice.  The additional matter related to an ongoing criminal investigation and any risk of prejudice to that investigation should be avoided.  

 

17. The Panel sought and accepted legal advice.  The Panel was mindful of the importance of the requirement that HCPC proceedings usually take place in public.  However, the Panel was satisfied it was appropriate to accede to the HCPC’s application for the reasons set out by Ms Welsh.  The remainder of the hearing, those parts not concerning the Registrant’s private life and the additional fitness to practise matter, would be deal with in public.   

 

 

 

18. A final hearing to consider the above allegation took place before a panel of the Conduct and Competence Committee on 17 – 21 and 24 April 2023. The Panel found that the Registrant’s fitness to practise was impaired. In respect of sanction, the Panel imposed a Suspension Order for a period of four months and also imposed an immediate Interim Suspension Order.

 

19. In relation to the background to the case, in its written determination the hearing Panel it was stated that the Registrant is a Chiropodist who was employed by Walsall Health Care NHS Trust (the Trust) between 12 August 2019 and October 2020.

 

20. Concerns regarding the Registrant’s conduct first arose following which he was not permitted to drive for six months. In the following months, however, the Registrant was seen on multiple occasions by his colleagues driving to and from work. He was spoken to about this matter on multiple occasions by his Team Leader, CH, and his manager, MK, the Clinical Lead Podiatrist.

 

21. During the course of the Registrant’s employment, concerns were also identified relating to inadequate record-keeping by the Registrant in respect of fourteen patients.  

 

22. Following a period of sick leave in March 2020, the Registrant was taken off clinical duties due to the concerns raised regarding his patient care and instead he was to be placed on the wards at the hospital as a Clinical Support Worker (CSW) to assist with the COVID-19 pandemic. During his two-day health and safety training day at the hospital to prepare him for this role, the Registrant was witnessed introducing himself as a doctor. Following this, the Registrant was placed in an office environment to work until the end of his contract with the Trust.

 

23. On 17 March 2023, the Trust referred the concerns relating to the Registrant to the HCPC.

 

24. At the Conduct and Competence Committee hearing, the Panel heard live evidence of fact from five witnesses:

• CH, Team Leader Podiatrist at the Trust;

• MK, Clinical Lead Podiatrist / Manager;

• AM, Interim Clinical Lead Podiatrist;

• MP, lay witness and Practice Education facilitator; and

• SM, e-Learning Developer at the Trust.

 

 

25. In summary, the Panel’s findings of fact were as follows:

 

 

Between September and November 2019 you were seen driving to and from work, on multiple occasions, despite having informed your employer that you were not driving and/or suspended from driving.

 

26. CH stated that she met with the Registrant on 21 October 2019. She had been told by colleagues that he had been seen driving to and from work. She addressed the driving concerns in the meeting. She stated that the Registrant assured her that his wife was picking him up and dropping him off at work. When CH asked if his wife was dropping him off and picking him up when it had been observed that his car was then left in the Trust car park all day, she stated that the Registrant made no comment or eye contact.

 

27. After the meeting, CH stated that from her office, she clearly saw the Registrant leave the building, get into his car (which had a personalised number plate), and drive off. She subsequently wrote to the Registrant informing him of what she saw.

 

28. MK stated that, she spoke to the Registrant and sent him home, following which he was off work for a period of time.

 

29. MK stated that TH, an Occupational Health Advisor who saw the Registrant on 11 October 2019, told her that the Registrant had informed her that he had informed the DVLA and that he was unable to drive for six months.

 

30. MK stated that she spoke to the Registrant about this. She said that the Registrant informed her that he was not driving to and from work, but rather his wife was dropping him off and picking him up. To explain why the car was then left on the premises all day, he informed MK that his wife would sometimes leave the car in the car park whilst she went shopping. However, following this conversation, MK stated that she was still receiving reports that the Registrant was seen driving.

 

31. AM, who gave evidence that on 30 October 2019, she saw the Registrant driving off from the Trust premises.

 

32. In admitting the factual particular, the Registrant stated that he only drove his car on three or four occasions. This happened when his wife assured him that she would drive him to work but then let him down at the last minute. He stated that he did not take public transport because of the time and cost involved, and that his motivation was to ensure that he could get to work in time to ensure that he could complete his clinical list without disruption to colleagues or patients. He stated that he recognised the risk his actions had posed both to himself and others.

 

 

Between 09 September 019 and 24 February 2020 you did not make any and/or adequate notes for:

 

a. Patient A

b. Patient B

c. Patient C

d. Patient D

e. Patient E

f. Patient F

g. Patient G

h. Patient H

i. Patient I

j. Patient J

k. Patient K

l. Patient L

m. Patient M

n. Patient N

 

33. The Registrant was found by the hearing Panel to have failed to keep adequate patient records in respect of the patient identified in the allegation.  Witness CH stated that she randomly selected some of the Registrant’s files for one week and, having conducted a visual audit, concluded that the Registrant was not filling out the written notes, which would not be picked up until the next patient appointment. CH exhibited the relevant patient notes and identified the specific concerns in relation to each patient.

 

34. CH stated that the potential consequences of a clinician taking inadequate notes or not recording notes at all is that there is a risk of liability to the Trust. If a patient decided to sue the Trust, accusing it of negligence, the Trust would have either no notes or inadequate notes to prove otherwise. It is a high risk, not only for the Trust but also for the Registrant. There is also the risk that the next Podiatrist a patient is seen by will not have a full overview of the patient history and would not be aware of any treatment plan being followed. This is not only inconvenient for the Podiatrist but also puts the patient at risk. It also looks unprofessional if the Podiatrist has to ask the patient questions which they have already previously answered.

 

35. The Registrant admitted the facts alleged. The Registrant recognised that his record-keeping was inadequate but explained that he had difficulty adjusting to the practice at the Trust in keeping handwritten notes when the practice at his former post in Oxford was to maintain records electronically. This, coupled with time constraints, meant that he was unable to maintain adequate patient notes, although he stated that he had made some separate handwritten notes but these were not kept with the patients’ records. However, he emphasised that he understood the importance of accurate record- keeping. He stated that he has since undertaken a Continuing Professional Development (CPD) course in record-keeping to “better myself”.

 

 

On or around 5 May 2020 you told colleagues that you were a doctor when this was not the case.

 

36. It was not disputed that the Registrant was not a qualified medical doctor and was not registered with the General Medical Council (GMC).

 

37. AM stated that, following concerns being raised about the Registrant, a decision was taken for the Registrant to be taken away from a clinical role pending the outcome of an internal investigation. A decision was taken that the Registrant should work as a CSW, where he would not have one-to-one contact with patients but would assist nursing staff. It was agreed that the Registrant would take part in the week of CSW training.

 

38. MP stated that on 5 May 2020, colleagues from the Learning and Development team, SM and JE, informed her that the Registrant had attended the training session but he had caused some confusion by informing the group that he was a doctor who specialised in foot and ankle surgery.

 

39. MP stated that she then spoke to the Registrant with SM. She stated that she asked the Registrant to tell her which department he worked in within the Trust. He informed her that he worked in Podiatric Medicine and his line manager was MK, whom MP knew was on secondment at the time. The Registrant went on to say that he had been asked to go on the wards as there were no elective surgeries occurring at the moment, so he was to be redeployed. MP stated that she asked the Registrant what he meant by elective surgeries, and he responded to say foot and ankle surgeries. MP asked him to confirm his role at the Trust prior to the COVID-19 pandemic and he informed her it was carrying out foot and ankle surgeries. She did not ask any further questions about his current role as she recalled being shocked by what he was saying. He then named a particular member of staff at the Trust with whom he worked in surgery. Being a podiatrist herself and previously working at the Trust, MP was aware that this member of staff did not conduct foot and ankle surgery, so she challenged the Registrant on this information. He insisted that this member of staff did conduct foot and ankle surgery and he then proceeded to name another member of staff at the Trust whom MP knew did work in Podiatric Surgery.

 

40. MP then asked the Registrant to confirm whether he was a podiatrist or a doctor, to which he responded that he was both, that he had completed his medical degree and his podiatry degree, and that he was registered with the HCPC and GMC.

 

41. SM, in his evidence, also stated that the Registrant, whom he spoke to as the Registrant was not on his list of training attendees, had also stated to SM that he was a doctor.

 

42. The Panel also considered the hearsay statements of JE, a Clinical Academic Link Tutor, and TH, a Principal Audiologist, who both made a contemporaneous statement of their dealings with the Registrant on 6 and 7 May 2020 respectively.

 

43. In her statement, JE stated that:

 

“I met [the Registrant] in reception and asked what his job was and he told me he was a Paediatric Surgeon who due to elective surgery being cancelled and that he had returned from being off sick, he was due a refresher as requested by HR. I called [ML] as I believed he was due for a doctor’s induction but [ML] didn’t know who he was. A few minutes later [EB] from Recruitment came down and addressed him as the Podiatrist she knew about … I was bit confused as he told me he was a Doctor and not a Podiatrist … I accompanied both [MP] and [the Registrant] into Room 2 within the MLCC. At this point [MP] asked [the Registrant] if he held dual registrations with GMC and Allied Health Profession Register (unable to remember the anacronym). [The Registrant] confirmed that he held both registrations and that he had studied Paediatric Medicine and Podiatry and that he currently did surgery on foot and ankle.”

 

44. In her statement, TH stated that:

 

“I performed Fit Masking Testing on this person on Tuesday May 2020.

As part of the test procedure, I asked [the Registrant] to talk to me for one minute, and he chose to talk about his work.

He said that he worked in Podiatric Medicine, and that he had been brushing up on his Respiratory Medicine in case he was redeployed on ICU with ventilated patients. I am certain that he said that it had been a while since he had covered this in medical school.

I cannot recall any more of his conversation, but the impression he gave was that he was a doctor rather than a Podiatrist.”

45. AM stated that she was informed by MP that the Registrant was referring to himself as a doctor. AM subsequently met with the Registrant, who denied that he had referred to himself as a doctor.

 

46. The Registrant denied that he had said he was a doctor and said that he had no motive for doing so.

 

47. In finding Particular 5 proved, the Panel stated in its written determination that it had weighed up all the evidence and balanced the Registrant’s denial with the HCPC witnesses’ evidence, noting that some of it was hearsay evidence. The Panel also took into account the undoubted confusion given the similarity between the words ‘paediatric’ and ‘podiatric’. However, given the consistency between the accounts of the HCPC witnesses, the Panel concluded that it was more likely than not that the Registrant said he was a doctor, necessitating questions to be asked about possible GMC registration. The Panel did not consider it credible that questions would have been asked about his GMC registration in the absence of the Registrant stating that he was a doctor.

 

 

Your conduct in relation to particulars 1 and 5 was dishonest.

 

48. The Panel found that the Registrant had acted dishonestly in relation to the matter found proved in Particulars 1 and 5. 

 

 

49. The Panel was provided with the Registrant’s written reflective statement, together with evidence of a CPD course in record-keeping undertaken in February 2022.

50. In its written determination the Panel set out the passages from the reflective statement. The Registrant stated in relation to Particular 1:

 

“I realise on reflection that there were other options such as public transport which I should have taken regardless of the cost that it incurred to me. I also feel that the stress, took an extreme toll on me I do not feel I was in the correct mental space and I made poor choices. In this regards this is not an excuse I just want the panel to know I am extremely regretful and remorseful about this entire situation which could have been avoided entirely.

 

I understand just because I am fortunate to have an aura this does not give me the liberty to drive as I was not only putting my life at risk but the lives of other road users, I am so very sorry about this and I am grateful to God that nothing ever happened.

 

I am also deeply ashamed about not telling those whom asked me about the driving situation when asked at the time, I realise now on reflection that honesty with colleagues is the core foundation of team work as there needs to be a level of trust and integrity between colleagues so we are able to support one another and work effectively in a team. I believe it was my internal faulty thinking which led me to conceal this from them at the time, I felt attacked at the time and I just hid, for this I’m sorry.

 

Reflecting on this I would do everything differently I would make choices that do not risk me or others I would have sought help from work and colleagues and spoken up about my issues I was facing at the time, in so that I could have been offered the support that I needed.”

 

51. In relation to Particular 2, the Registrant stated:

 

“Record-keeping is of paramount importance, not only are the notes and records you make legal documents, they are necessary in knowing what exactly occurred or happened in any given contact between a practitioner and patient.

 

The impact of poor record-keeping affects patients, and their safety is put at risk if the records are not thoroughly taken and kept, this leads to problems and potentially catastrophic consequences, especially when it comes to consequential errors from the poor record-keeping in the first instance. The local intervention helped significantly I.e. the use of templates for structuring notes that are complete and coherent, after this my record-keeping improved as I was helped and made aware of my shortcomings and how I could rectify them, I only wish that I had asked for this help and intervention sooner as to avoid this problem in the first place. Also if I had to do handwritten notes again, I would utilise the structural templates I have to my disposal and also ask colleagues and others to review and audit notes to ensure they are lucid, coherent and accurate.

I have since completed CPD courses from the college of Podiatry specifically in relation to record-keeping.”

 

52. In relation to Particular 5, the Registrant stated:

 

“In the future I will make sure that I only use the names podiatry or chiropody as to make sure that no one is confused, as Podiatric Medicine can lead to confusion.

 

I understand that it is problematic to claim you're a doctor when you’re not. On reflection the impact this would have on patients and colleagues would be serious as they would not fully understand your job role or your remit and this could lead to a number of problems and issues for both patients and colleagues, for example if a patient thought their podiatrist was a doctor they may think that the podiatrist should and could prescribe medication for them and if denied by the podiatrist this could escalate into an extremely dangerous situation for both patient and practitioner, similarly with colleagues they may think you are able to for example request imaging or take IV bloods this would all end badly for all parties concerned.

I also understand the impact on my profession, this would have; as members of the public would lose faith in podiatry and put the profession into disrepute as they may generalise all podiatrists in this way, this is not something I wish to do, therefore I have made sure this will not happen again, by only referring to the profession as podiatry or chiropody as to avoid confusion in the future.”

 

53. The Panel found that the Registrant’s conduct in respect of Particulars 1, 5 and 6 amounted to misconduct.  The Panel found that Particular 2 constituted a lack of competence. 

 

54. In its written determination the Panel stated:

 

“Given the Panel’s findings in relation to the facts found proved, it concluded that the Registrant breached standards 1, 6, 9, and 10 of the HCPC “Standards of Conduct, Performance and Ethics”, and, in relation to Particular 2, standards 1 and 10 of the HCPC “Standards of Proficiency for Chiropodists/Podiatrists”.

 

However, the Panel was mindful that a finding of misconduct / lack of competence did not necessarily follow as a result.

 

The Panel carefully considered the seriousness of the Registrant’s failings. In doing so, it identified that:

 

• the Registrant repeatedly knowingly made false statements, as found proved in relation to Particular 6, in relation to his driving and in relation to stating that he was a doctor. Honesty is a fundamental core quality of what it means to be a professional and the public should rightly be entitled to assume that registered HCPC professionals are honest and trustworthy;

 

• by driving when he should not have done so, the Registrant put himself and others at risk of serious harm;

 

• in relation to the Registrant’s record-keeping, CH took a random sample of 14 files and identified that 75% had missing notes. The Panel concluded that this did represent a fair sample of the Registrant’s work;

 

• the Registrant appreciated the importance of accurate record- keeping to ensure effective patient care;

 

55. The Panel concluded that the matters found proved in relation to Particulars 1, 5, and 6 were sufficiently serious departures from the standards expected of a Chiropodist / Podiatrist as to amount to misconduct.

 

56. In relation to Particular 2, the Panel concluded that the inadequate notes did represent a fair sample of the Registrant’s work and amounted to a lack of competence.

 

 

57. In its determination in relation to current impairment, the Panel stated:

 

“In relation to the Registrant’s record-keeping, in assessing future risk the Panel noted that whilst the Registrant had reflected on the importance of accurate record-keeping and had attended a relevant course in February 2022, he had not meaningfully demonstrated what he had learned from that course. In addition, because the Registrant has not been working in a clinical post in the interim since he left the Trust, the Panel was not satisfied that the Registrant had demonstrated there were no longer any ongoing concerns and that he now fully complied with his professional obligations within a clinical setting. As such, the Panel concluded that it was not satisfied that the Registrant had, in practice, remediated his failing in this regard. In the circumstances, it concluded that there remained an ongoing risk of repetition of his lack of competence.

 

As such, in relation to the Registrant’s lack of competence, the Panel determined that the Registrant’s fitness to practise is impaired on the personal component.

 

In relation to dishonesty, the Panel recognised that dishonesty is difficult to remediate. The Panel carefully considered the Registrant’s reflective statement and was satisfied that the Registrant had demonstrated some insight into his dishonesty. Whilst recognising that he would not now lie about driving or state that he was a doctor, the Panel concluded that his insight was limited because it was not satisfied that he had meaningfully reflected and demonstrated insight into the impact of dishonesty on the reputation of the profession generally. The Panel also took into account that the matters found proved reflected repeated acts of dishonesty over a six-month period in relation to separate and distinct events. Given the Panel’s finding that the Registrant’s insight was limited, it concluded that there remained an ongoing risk of dishonest behaviour, albeit that it may not be in relation to the exact same circumstances as arose in this case.

 

As such, in relation to the Registrant’s misconduct, the Panel determined that the Registrant’s fitness to practise is also impaired on the personal component.

The Panel also took into account the overarching objectives of the HCPC to protect, promote, and maintain the health, safety, and wellbeing of the public and patients, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Chiropodist / Podiatrist profession and upholding proper professional standards for members of the profession. The Panel therefore considered that, given the serious nature of the dishonesty found proved and the Registrant’s lack of competence that had yet to be fully remediated, public confidence in the profession would be undermined if a finding of impairment were not made in all the circumstances.

Having regard to all of the above the Panel found that, by reason of his misconduct and lack of competence, the Registrant’s fitness to practise is also currently impaired on the public component of impairment.”

Decision on Sanction 

58. In considering sanction, the Panel stated that it had identified the following aggravating factors:

 

• That the Registrant behaved dishonestly in relation to two separate issues over a six-month period;

 

• That the Registrant drove on at least three or four occasions when he should not have done so, thereby repeatedly putting himself and others at risk.

 

59. The Panel identified the following mitigating factors:

 

• The Registrant engaged in the regulatory process and made early admissions to a number of particulars, including one allegation of dishonesty, at the outset of the hearing;

• The Registrant had difficult health and personal circumstances at the time which impacted on his performance.

• The Registrant provided a positive testimonial attesting to his character and professionalism. However, the Panel attached less weight to that reference than might otherwise have been the case, given that the author had not worked with the Registrant since 2017 and had only done so for approximately five months. The Panel also noted that the referee made no comment on the current allegations or that he was aware of them.

 

60. The Panel stated:

 

“In identifying mitigating factors, the Panel considered that it was incumbent on the Registrant to familiarise himself with the Trust’s procedures, particularly handwriting patient notes, and therefore attached little weight to Mr James’ submission in this regard.

 

Similarly, whilst the Panel noted that the Registrant has undertaken a record-keeping course, the Panel considered that the Registrant has not meaningfully demonstrated what he took from the course nor demonstrated how he has effectively put his learning into practice.

 

Considering all of the circumstances in the round, the Panel considered the Registrant’s dishonesty to be towards the centre of the spectrum of dishonesty.”

 

61. The Panel considered the available sanctions taking account of proportionality and decided that the appropriate sanction was a period of 4 months’ suspension. 

 

62. In its written determination the Panel explained that it considered that this was the appropriate sanction to impose because:

 

• The matters found proved, as set out in the Panel’s determination on misconduct, represented serious breaches of the HCPC “Standards of Conduct Performance and Ethics”;

 

• The Registrant demonstrated some insight into his failings, particularly in relation to Particular 1;

 

• The Panel was mindful that a Striking Off Order was appropriate for the most serious cases of dishonesty. It considered that the Registrant's failings were not so serious that they were fundamentally incompatible with remaining on the Register. In reaching that conclusion, it had regard to paragraph 121 of the HCPC Sanctions Policy, which states that a Suspension Order may be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. The Panel noted, as set out in the Panel’s determination on impairment, that the Registrant had developed some insight into his dishonest behaviour even though that process was not as yet complete.

 

63. The Panel stated that it considered that 4 months was an appropriate and proportionate period of time to enable the Registrant to reflect on the nature and gravity of the misconduct found proved and to allow him an adequate period of time to reflect on and address his failings.

 

64. The Panel stated that a future reviewing panel would be assisted by:

 

a. Further evidence of remediation in relation to record-keeping;

 

b. Evidence of reflection by the Registrant on his conduct, demonstrating meaningful insight into the impact of his dishonest behaviour on the wider profession and the public;

 

c. Up-to-date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;

 

d. Evidence that the Registrant has kept his skills and knowledge up to date;

 

e. Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.

 

 

 

65. Ms Welsh submitted that, in the absence of any attendance by the Registrant at this hearing, or of any documents or submissions from him, there was no information before the Panel as to the Registrant’s current circumstances.  There was no evidence of any steps taken by him to address the issues found proved at the April 2023 hearing by way of remediation.

 

66. Ms Welsh submitted that there were, however, two “new” matters which the HCPC submitted now added to the concerns in relation to the Registrant.

 

67. Ms Welsh referred to a second “new” issue.  An email had been received by the HCPC on 21 August 2023 from PM, an HCPC registered Podiatrist.  PM had become aware that a reference he provided to the Registrant dated 17 May 2021 had been referred to in the HCPC fitness to practise hearing in April 2023 and was referred to in the Panel’s written determination.  PM stated that he had not provided the reference for this use and asked that the reference should not be used for the purposes of any future decision-making in respect of the Registrant.   

 

68. Ms Welsh acknowledged this matter had come to the HCPC’s attention very recently and how or whether it would be taken forward remained to be decided.  

 

69. Ms Welsh submitted, however, that both the “new” matters related to further concerns of dishonesty and the Panel may consider it appropriate to take account of them in reviewing the current order. 

 

70. Ms Welsh submitted that there was an absence of any new information or engagement from the Registrant.  There was now information regarding two further concerns relevant to dishonesty.  

 

71. Ms Welsh said that the HCPC’s position was that the Registrant continued to present a real risk to patients and to public confidence in the Podiatrist profession. She submitted that the Panel should conclude that the Registrant’s fitness to practise remains impaired in respect of both the personal and public components and the HCPC’s position was that the appropriate order is a further period of suspension of 12 months.  

 

 

72. The Panel received and accepted the advice of the Legal Assessor. The Panel was mindful of its powers upon a review of a Suspension Order under Article 30(1) of the Health Professions Order 2001 and referred to the HCPTS Practice Note, Review of Article 30 Sanctions Orders. 

 

73. The Panel was mindful that it’s task at a review hearing is to conduct a comprehensive review of the current order. The Panel must not seek to go behind the findings of the Panel at the original hearing.  This Panel must first decide whether it finds the Registrant’s fitness to practise to be currently impaired by reason of misconduct or lack of competence. In accordance with the guidance in the case of Abrahaem v GMC [2008] EWHC 183 (Admin), the persuasive burden to satisfy the Panel of fitness to practise at a review hearing is upon the Registrant. 

 

74. The Panel was further referred to the HCPTS Practice Note, Fitness to Practise Impairment, and to the HCPC Sanctions Policy. The Panel was advised that if it found the Registrant’s fitness to practise to be currently impaired, then it should consider what steps to take in respect of the current order in accordance with its powers under Article 30(1) of the Health Professions Order. 

 

75. In relation to the power to make a Striking Off Order under Article 29, the Panel was reminded that this matter includes a lack of competence finding and at the date of this hearing the Registrant will not yet have been continuously suspended for a period of two years.  Therefore, the power in Article 29(6) to make a striking off order at this review hearing is only available to the Panel in respect of the misconduct allegations and not in respect of the lack of competence allegation.   

 

76. The Panel considered all the documents presented and the submissions on behalf of the HCPC. No submissions or evidence had been provided on behalf of the Registrant.

 

77. The Panel first considered whether the Registrant’s fitness to practise is currently impaired.  The Panel carefully considered the reasoning set out in the determination of the original Panel following the hearing in April 2023. 

 

78. The Panel was concerned that, despite his indication on 31 July 2023 that he would attend this hearing, the Registrant has not attended today or provided any up to date information to this Panel.  He has not engaged substantively with the HCPC in the period since the substantive hearing. This Panel has no new or up to date information from the Registrant, for example about his current circumstances or any action he may have taken towards remedying his misconduct and lack of competence, or further developing his insight. 

 

79. The Panel considered that the information which the original Panel recommended the Registrant should provide to assist this Panel was comprehensive and detailed.  However, the Registrant has not provided any of the suggested information.

 

 

80. The Panel noted the two additional matters brought to its attention by Ms Welsh.  

 

81. In relation to the use of PM’s reference, this was so recently notified to the HCPC that the Panel felt able to give little weight to it in terms of its decision today.  However, the Panel took into account that both “new” matters potentially indicate a wider range of concerns about the Registrant’s honesty and integrity, issues which formed part of the findings at the original hearing.  

 

82. The Panel concluded that the Registrant had not discharged the persuasive burden upon him to satisfy it that he is fit to practise and the concerns of the original hearing Panel remain unaddressed. In addition, the two “new” matters further raise the level of concern. 

 

 

83. Given these circumstances, this Panel agreed with the findings of the original Panel in concluding that there remains a risk to service users and that the Registrant’s fitness to practise is currently impaired in respect of the personal component of impairment.  

 

84. The Panel was further satisfied that to permit a Podiatrist with the deficiencies identified in the findings of the original Panel would undermine public confidence in the profession and its regulation by the HCPC.  The Panel therefore also found impairment of fitness to practise in respect of the public component of impairment. 

 

85. Having concluded that the Registrant’s fitness to practise is impaired, the Panel next considered its powers at this review hearing.  The Panel considered the available sanctions in ascending order of seriousness.   

 

86. The Panel was satisfied that, given the Registrant’s lack of engagement in this review process, that to take no action, to mediate or to issue a caution to the Registrant would not provide the necessary public protection or address the public interest.  The Panel concluded that a conditions of practice order would not be appropriate in circumstances where there has been no contact from the Registrant and where there is no evidence before this Panel that the Registrant’s misconduct and lack of competence have been addressed.  Further, given the lack of engagement from the Registrant, the Panel could not have confidence that the Registrant would engage or comply with conditions of practice.

 

87. The Panel considered carefully whether a further period of suspension would be appropriate.  This would allow the Registrant a further period of time in which to address the issues relating to his misconduct and professional competence and to re-engage with the HCPC process. 

 

88. Before confirming that conclusion, the Panel proceeded to consider whether a striking off order was now appropriate in relation to the misconduct matters.  The Panel concurred with the view of the original hearing Panel, that a Striking Off Order was appropriate for the most serious cases of dishonesty. The Registrant's proven failings were not at the level of seriousness to mean that they were fundamentally incompatible with remaining on the Register. The Panel had regard to paragraph 121 of the HCPC Sanctions Policy, which states that a Suspension Order may be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. The Panel noted from the original Panel’s determination on impairment that it considered that the Registrant had developed some insight into his dishonest behaviour even though that process was not complete.

 

89. The Panel determined that the appropriate order is that a further period of suspension be imposed from the date when the current order expires.  The Panel concluded that 12 months is the appropriate period to allow time for the Registrant to address the issues of concern and provide evidence for a future review.   The Panel was mindful that it is possible for the Registrant to request an early review under Article 30 of the Health Professions Order should his circumstances change. 

 

90. This Panel considered the information which is likely to assist a future review Panel remains the same as recommended by the original Panel, but wishes to emphasise to the Registrant that the information or evidence that he provides may relate to paid, unpaid or voluntary work. 

 

91. The information which may assist a future review Panel is as follows:

 

a. Further evidence of remediation in relation to record-keeping;

 

b. Evidence of reflection by the Registrant on his conduct, demonstrating meaningful insight into the impact of his dishonest behaviour on the wider profession and the public;

 

c. Up-to-date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;

 

d. Evidence that the Registrant has kept his skills and knowledge up to date;

 

e. Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.