Mr Raymond Byron

Background

20. The Registrant was a Band 6 Paramedic who was employed by the West Midlands Ambulance Service University NHS Foundation Trust (the ‘Trust’) from 13 April 1992 until his retirement on grounds of ill health at some stage in 2018.

21. On 4 January 2018, the Registrant was working the night shift and working on his own. He responded to an emergency call from Patient Z. Patient Z had a fall during the night and had sustained a minor head injury. The Registrant lifted Patient Z up off the floor, put him into bed, and then left the scene. The Registrant was recorded as arriving at 03:17 and leaving at 03:26. It is alleged the attendance was not documented, which was usually done using the Electronic Patient Record (“ERP”).

22. Patient Z was later attended to by a further crew of paramedics, Colleague A and Colleague X. They assessed Patient Z and decided to take him to hospital as they were concerned that he was unable to bear his own weight. Patient Z’s condition deteriorated during the journey to the hospital and, as such, the ambulance pulled over. Back up was requested from another Paramedic, Colleague Y, who arrived in a rapid response vehicle and assisted with the care of Patient Z.

23. Patient Z was admitted to hospital and it was later discovered that he had sustained a displaced fracture of his cervical spine. Patient Z sustained permanent paralysis and remained in hospital for some months.

24. At its meeting on the 17 December 2020, the Investigating Committee (‘IC’) of the HCPC determined that there was a case to answer in relation to an allegation of impairment of the Registrant’s fitness to practise and that the matter should be referred to the Conduct and Competence Committee.

The Hearing

25. The Panel heard live evidence from the following witnesses called on behalf of the HCPC:

• Witness 1: Colleague X, who at the material time was a newly-qualified Band 5 Paramedic at the Trust (TB);
• Witness 2: Colleague A, who at the material time was a Student Paramedic at the Trust (AA);
• Witness 3: Colleague Z, who at the material time was a Clinical Standards Manager in the Clinical and Corporate Directorate at the Trust (ST);
• Witness 4: Colleague Y, who at the material time was a newly-qualified Band 5 Paramedic at the Trust (KT).

26. The Panel did not hear evidence from the Registrant but noted the information he had provided in a report he wrote after the incident and in the Trust’s investigatory interview into the incident, both of which were within the HCPC bundle.

27. At the outset of the hearing, Ms O’Connor confirmed that there is no suggestion that the Registrant’s alleged failures caused the outcome in Patient Z and the HCPC do not say that the Registrant should have identified the fracture. She stated that the Allegation relates to not maintaining adequate records and not acting in Patient Z’s best interest by failing to transport him to the hospital.

Decision on Facts:

28. Before making any findings on the facts, the Panel heard and accepted the advice of the Legal Assessor. The Panel has read the bundle from the HCPC.

29. In reaching its decision on the facts, the Panel has borne in mind that the burden of proof rests on the HCPC and it is for the HCPC to prove the Allegation. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities. The Panel has carefully considered the evidence in the round, giving appropriate weight to the documentary evidence.

30. The Panel noted there was some opinion evidence from Colleague Z, despite him attending as a factual witness. The Panel did consider he had specialist expertise and an opinion reasonably related to facts within his knowledge and relevant comments based on his experience can be allowed (Multiples Construction (UK) Ltd v Cleveland Bridge Ltd (2008) EWHC 22220 (TCC)). The Panel was able to attach weight to his evidence as he had undertaken the investigation, was Clinical Standards Manager at the time and was currently the Head of Patient Safety at the Trust.

31. The Panel acknowledged that the Registrant has no previous fitness to practise history.

Particular 1 (a-b) - Proved

1) You did not maintain adequate records for Patient Z, in that you did not:

a) complete an Electronic Patient Record or Patient Report Form for Patient Z either contemporaneously or after leaving the scene;
b) ask Patient Z and/or his family to sign a Patient Report Form for Patient Z in relation to being discharged from care;

HCPC submissions

32. Ms O’Connor submitted there was a duty to produce an electronic record and to get this signed by Patient Z or his relatives. She submitted that as no record was produced, it meant there was nothing provided to Patient Z or his relatives. She reminded the Tribunal that the Registrant had received relevant training in October 2017 which included the relevant policies and the Registrant had confirmed in his interview that he was aware of these policies. She also submitted that the second attending paramedic crew were deprived of the opportunity to compare observations as a result of the Registrant not producing any record of his visit.

33. Ms O’Connor invited the Panel to consider Colleague Z’s oral evidence that the Registrant had just left Patient Z’s house so he should have gone back to get this signed by simply knocking on the door.

Registrant’s evidence

34. The Panel considered the Registrant’s report on the incident and accepted Colleague Z’s evidence that he had spoken to the Registrant who said the reason the form was not completed or signed was because he had not taken any equipment into the house with him. In the Registrant’s account of the incident in a General Report Form, he stated; “I said I needed to do some further check, he said I'm fine and don't need anything more”. The Registrant also stated; “With hind sight I should have done paperwork to this effect but as I had already left patient did not do so, my mistake”.

35. The Panel also had sight of the Trust’s notes of the interview with the Registrant dated 24 January 2018, which had been signed by him. Within this he confirmed he was aware of the UK Clinical Practice Guidelines 2016 for spinal injury, the UK Clinical Practice Guideline 2016 for falls in older adults, the UK Clinical Practice Guidelines for trauma emergencies overview (adults) and the Trust Patient Clinical Record Policy and Procedure. When asked why he didn’t complete an EPR, he stated; “Because I had forgotten about it until I got back out in the car, I turned around, the door was shut and the porch light was off, so I took it as a lift only, I didn’t know why I didn’t go back…they had gone back to bed, it was too late and I left it, I shouldn’t have done”. He also stated; “I shouldn’t have let myself of falling into the trap of going in without equipment, had I of taken everything in with me and the EPR, I would have done a full set of obs…I would have been able to evidence what had been done and what was said…I let myself down by not concentrating or remembering”.

Panel decision

36. The Panel had sight of the policies and had heard from Trust employees on the requirement to produce a record of the attendance even when the patient required no intervention. The subsequent attending crew did complete an ERP as confirmed by both Colleague A and Colleague Y. The Trust investigation had concluded no EPR was taken to the scene by the Registrant, nor was it completed and nor were family members asked to sign it. The Panel accepted the evidence from Patient Z’s daughter that no observations were taken and she herself took observations as she is a trained nurse. Despite this being hearsay, the lack of observations was accepted as it was corroborated by other evidence.

37. The Registrant did not dispute his failure to produce the record, either on paper or electronically, but simply provided reasons as to why this was not done. There was no record produced and there was an opportunity to produce some form of record even after the Registrant had left. Even if he could not get this signed, he still had an opportunity to produce some form of record but he failed to do this.

38. The Panel was satisfied that the Registrant did not complete an EPR or Patient Report Form for Patient Z and that guidance and policies made it clear that such records needed to kept for every incident. This was not completed at the scene or after leaving the scene. This did mean there was no adequate record maintained for Patient Z. As no record was produced, there was nothing available for Patient Z or his relatives to sign.

39. On the balance of probability, the Panel did find Particular 1(a) and 1(b) were found proved.

Particular 2 - Proved

2) You did not act in Patient Z’s best interests in that you did not transport Patient Z to the hospital.

HCPC submissions

40. Ms O’Connor submitted that the Registrant had attended an emergency call where Patient Z, who was 89 years of age, had fallen and was found to be on the floor. She relied on Colleague Z’s opinion that the Registrant should have noticed the cut to the back of Patient Z’s head as this was noticed by the subsequent crew that attended and Patient Z’s daughter also confirmed blood in his hair.

41. Ms O’Connor relied upon the daughter’s statement in the Trust investigation where she stated that the Registrant attended without any bag. She reminded the Panel that Colleague Z had described the equipment that should have been taken and how the history should be taken. Ms O’Connor submitted that the Registrant was only at the scene for 9 minutes in total and the HCPC relied on Colleague Z’s opinion that the Registrant would only have been attending upon Patient Z for 6 minutes, which he believed would be insufficient time to obtain the relevant history or carry out any adequate checks.

42. Ms O’Connor also submitted that in his interview, the Registrant had confirmed he was aware of the relevant guidelines. She relied upon the guidelines and Colleague Z’s evidence that older people are more likely to suffer an injury if they fall. She submitted that a careful physical examination was required and the failure to do this led to the decision to not transport Patient Z to hospital.

43. In relation to the Registrant’s evidence that he wanted to undertake further checks but Patient Z had said he was fine, Ms O’Connor relied on Colleague Z’s evidence that informed consent was not possible as the Registrant failed to undertake the assessments and then relay that information to Patient Z. She also reminded the Panel that Colleague Z’s opinion was that it was not possible to discharge Patient Z on the scene in such a short amount of time and that his view was that Patient Z should have been transferred to a hospital because of his age and the circumstances of the call out.

Registrant’s evidence

44. Within the Registrant’s report of the incident, he stated; “I admit I should have got all equipment first, but thought I would check to see if a crew and other equipment may have been needed first”. Within his interview the Registrant accepted that he failed to undertake an ECG or BP. He explained the cut to the back of Patient Z’s head as “more of a carpet burn”. He also accepted he had remedial training on 13 October 2017 which covered Trusts Non-Transportation and Referral Policy and Procedure.

Panel decision

45. The Panel noted Colleague X stated a detailed list of “minimum observations that I would expect to be undertaken”. He also stated, “I was shocked at the remarks that the previous paramedic spent so little time on scene”. Colleague Z confirmed the various training that the Registrant will have received including undertaking an adequate assessment, adequate patient history, completing observations and taking appropriate equipment to the scene. He also stated, “Discharging the patient home or transporting him to the hospital formed part of his basic training and his remedial training”. The Registrant had confirmed receiving relevant training in October 2017 and being aware of the relevant policies.

46. The Panel noted the evidence of Patient Z’s daughter to the Trust investigation that no observations were undertaken. Patient Z’s wife and daughter also provided a joint signed statement to the Trust investigation dated 22 January 2018 stating, “there was a little bit of blood in the back of his head”. In relation to the Registrant’s attendance, they stated “he didn’t bring anything in at all”. They stated the Registrant was there “10 minutes, maybe less”. The Panel were able to place weight on this evidence despite this being hearsay evidence as the presence of the blood was corroborated by the description of a cut to the back of Patient Z’s head, verified by Colleague A and Colleague X. Additionally, the Registrant had accepted he didn’t take any equipment into the house and the logs confirmed the duration that the Registrant was at the scene.

47. The Panel considered the Non-Transport and Referral Policy dated 18 May 2016, and specifically the checklist at section 15. This stated, “Consider transporting/referral to an appropriate health care facility if you are unable to answer yes to all of the following”. Colleague Z was asked about the various items within this list and answered these in the negative. He stated the risk was not low due to Patient Z’s age, he was unable to answer if any examinations were within normal limits as these were not undertaken, other tests mentioned such GCS were not done, the options were not discussed with Patient Z (in any case his view was that there was no informed consent as the observations were not done nor relayed to the family), no advice was recorded or explained to the patient, no safety netting had been done and no advice was sought from the Clinical Support Desk.

48. The Panel accepted this evidence. The Panel noted that the patient was elderly, there was no record of any examination by the Registrant, the Registrant gave no advice was given to Patient Z or his family and that if Patient Z had simply requested to be put back into bed, it could not have been an informed decision given the Registrant had failed to undertake examinations/observations or explain these to Patient Z. Therefore, none of the items in the checklist could be answered positively, thus meaning that the patient should have been transported to hospital. However, the Registrant had failed to recognise the need to transport Patient Z to the hospital.

49. The Panel thus concluded that the Registrant had not acted in Patient Z’s best interest and concluded that, on balance, the Registrant should have arranged for Patient Z to be transported to the hospital. The Registrant had breached the policy and in doing so had failed to act in Patient Z’s best interests.

50. On the balance of probability, the Panel did find Particular 2 was found proved.

Particular 3 – no evidence offered

3) You did not inform the HCPC in a timely manner that you were under investigation by your employer in relation to your actions outlined in particulars 1 - 2.

51. The Panel had granted the HCPC’s application at the outset of the hearing to offer no evidence on Particular 3, 4 and 6. Accordingly the Panel did not have to consider if Particular 3 was proved.

Particular 4 – no evidence offered

4) Your conduct in relation to particular 3 above was dishonest.

52. The Panel had granted the HCPC’s application at the outset of the hearing to offer no evidence on Particular 3, 4 and 6. Accordingly the Panel did not have to consider if Particular 4 was proved.

Decision on Grounds:

HCPC’s submissions

53. Ms O’Connor submitted the Registrant had breached the HCPC Standards of Conduct, Performance and Ethics. She relied upon the following standards:

• 6 – Manage risk – Identify and minimise risk
• 9.1 – You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
• 10 – Keep records of your work.

54. The rest of the submissions are covered below.

Registrant’s submissions

55. The Registrant provided no submissions. The Panel considered his report and interview notes, but found nothing to assist. The Panel did take into account Colleague Y’s evidence that she had known him for 20 years and always found him to be a conscientious and caring paramedic.

Misconduct and lack of competence

56. The Panel approached its decision on misconduct and lack of competence by considering the proven particulars in the Allegation.

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

58. In relation to a lack of competence, the Panel were assisted by Dame Janet Smith’s explanation in the Fifth Shipman report that ‘competence’ describes knowledge and skills. The Panel noted that a registrant should be judged by the standards applicable to the post to which they are appointed and the work that they are carrying out, rather than a general allegation that they lack competency.

59. Ms O’Connor submitted that competence was a matter for the Panel. She submitted that the Registrant was an experienced Paramedic and the Panel may find that the Registrant knew what he should have done and conclude he did not do this, as opposed to concluding he lacked competency.

60. The Panel did note the Registrant’s previous good character in relation to his fitness to practise. The Panel also noted Colleague Y’s positive comments in relation to the Registrant. It also took into account this was a single event. The Registrant had accepted his failings. The Panel did not consider that there was any evidence that the Registrant lacked appropriate knowledge or skills, particularly given the relevant training he had undertaken prior to the incident. On balance, the Panel concluded there was no lack of competency.

61. In relation to misconduct, the Panel considered whether the Registrant had fallen short in his conduct, by way of “omission or commission of the standards of conduct expected” and that this must be “serious” by reference to conduct that fellow practitioners would find deplorable. It considered any conduct against the relevant objective professional standards.

62. The Panel found misconduct and a breach of the relevant Standards in relation to Particulars 1(a), 1(b) and 2. The Registrant had failed to follow the relevant policies and had breached the Standards. He had failed to follow the training provided. Upon arriving at the address, he had the option to return to his vehicle and obtain the equipment but he failed to do this meaning he was unable to appropriately assess Patient Z and make an informed decision on transferring him to the hospital. No patient record was completed and this remained the case after he realised this upon returning to his vehicle. Patient Z was vulnerable on account of his age and his fall. The Panel was of the view that this conduct would certainly be considered deplorable by other fellow practitioners and this was clear misconduct.

63. The Panel concluded that there had been a breach of the following Standards:

• 6 – Manage risk – Identify and minimise risk

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

o 6.2 – You must not do anything, or allow someone else to do anything, which could put the health or safety of a service, user, carer or colleague at unacceptable risk.

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

• 10 – Keep records of your work.

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

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

Decision on Impairment:

64. The Panel took into account the submissions of Ms O’Connor. The Panel accepted the advice of the Legal Assessor.

65. The Panel has approached its decision on impairment by looking at the situation as it is today. It has had regard to the HCPTS Practice Note “Fitness to Practise Impairment”.

66. The Panel’s primary objective is the protection of the public, the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.

67. In reaching a decision on impairment, the Panel has considered all of the evidence and the submissions and has exercised its’ own judgment on impairment.

68. Whilst there is no statutory definition of impairment, the Panel was assisted by the guidance provided by Dame Janet Smith in the Fifth Shipman Report, as adopted by the High Court in CHRE v NMC & Grant [2011]. In particular, the Panel considered whether its findings of fact showed that the Registrant’s fitness to practise is impaired in that he:

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

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

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

69. The Panel noted there was limited character evidence or submission of references on behalf of the Registrant. The Panel did accept the Registrant was of previous good character with no previous regulatory findings against him. Colleague Y did give a positive testimonial in relation to the Registrant.

70. In determining whether the Registrant’s fitness to practise is currently impaired, the Panel took into account both the “personal” and “public” components of impairment referred to in the case of Grant. The “personal” component relates to the Registrant’s own practice as a Paramedic, including any evidence of insight and remorse and efforts towards remediation (whether it is remediable, whether the Registrant has taken remedial action and if there is a risk of repetition). The “public” component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.

71. With regard to the “personal” component of impairment, the panel took account Ms O’Connor’s submissions. She stated that patient safety issues had been raised, the Registrant is presently retired but if he was to return to practise then the risk of repetition is high. She submitted there was no evidence of remediation and his responses in the Trust report and interview demonstrated little insight. She also stated there was no apology or remorse.

72. The Panel considered that the misconduct was remediable but no remedial action had been taken. Whilst acknowledging the positive reference from Colleague Y in relation to his past performance, the Panel noted that there was no evidence of the Registrant working since he retired in 2018 and thus no evidence as to whether he had changed his practice or reflected on the incident in any meaningful way. This meant that a risk of repetition remained. There was a lack of insight shown and his reaction at the time, as evidenced in his report and interview, seemed to accept little responsibility or understanding of the seriousness of the concerns.

73. The Panel therefore found the Registrant’s fitness to practise to be impaired having regard to the “personal” component.

74. With regard to the “public” component of impairment, the Panel took account of the submissions by Ms O’Connor who submitted that the public would be shocked if no impairment was to be found.

75. The Panel considered that a finding of current impairment is necessary to uphold professional standards. Patient Z’s relatives had made a call in the middle of the night for medical assistance and would expect the attending paramedic to improve the situation, but this did not happen. Whilst the consequences for Patient Z were severe, it was noted that it is not alleged this was attributed to the Registrant. However, an informed member of the public would be shocked that a paramedic had failed to act in a patient’s best interests by not maintaining adequate records or following relevant policies, and not arranging for a patient to be transferred to the hospital. Public confidence in the profession and in the HCPC as its regulator would be seriously undermined if there were no finding of impairment.

76. Accordingly, the Panel found that the Registrant’s fitness to practise is impaired having regard to both the “personal” and “public” components of impairment.

Decision on Sanction:

77. The Panel heard submissions from Ms O’Connor on behalf of the HCPC. She did not seek any particular sanction and left it as a matter for the Panel’s discretion. She reminded the Panel on its finding on the risk of repetition and of breaches of Standard 6.1 and 6.2, which was related to identifying and minimising risk.

78. In relation to mitigating factors, she submitted there were no previous fitness to practise findings, it was a single event, which had occurred over five years ago, against a backdrop of health issues as explained by Colleague Y, and positive comments were provide in favour of the Registrant by Colleague Y.

79. In relation to aggravating factors, Ms O’Connor submitted that there was no remedial action taken and there was no evidence of reflection. She also submitted that there was a lack of insight and reminded the Panel that it had found little responsibility had been taken by the Registrant. She also reminded the Panel of its finding on Patient Z being vulnerable due to his age. Whilst acknowledging that the Registrant’s actions had not caused the adverse impact on Patient Z’s health, Ms O’Connor submitted that there was a potential for it to have caused such an impact and that this in itself would amount to an aggravating feature. She submitted that this was not within the ‘serious cases’ category within the sanction guidance.

80. The Panel accepted the advice of the Legal Assessor and has reached its decision on sanction by following the guidance in the HCPC Sanctions Policy.

81. The Panel has had regard to all the evidence presented. It reminded itself that a sanction is not intended to be punitive although it may have a punitive effect. The Panel bore in mind the principles of fairness and proportionality and that a sanction must be reasonable and the least restrictive possible.

82. The primary function of any sanction is to address public safety from the perspective of the risk which the Registrant may pose to patients and to the wider public interest; namely the deterrent effect on other Registrants, the reputation of the profession and public confidence in the regulatory process.

83. The Panel applied the principle of proportionality, balancing the interests of the Registrant with those of the public, and considered the available sanctions in ascending order.

84. The Panel began its deliberations on sanction by considering the mitigating factors. The Panel did note that the misconduct occurred in January 2018, which was over five years ago, and the Allegation related to a single incident as opposed to a series of failings. The Panel acknowledged that the Registrant had practised for over 20 years and had a previously unblemished career in his professional practice. He had not been subject to any previous fitness to practise proceedings. The Panel did take into account Colleague Y’s evidence that she had known the Registrant for 20 years and always found him to be a conscientious and caring paramedic.

85. The Panel next considered aggravating factors and reminded itself of its finding at the impairment stage; the misconduct was considered remediable but no remedial action had been taken, there was no evidence of the Registrant working since he retired in 2018 and thus no evidence as to whether he had changed his practice or reflected on the incident in any meaningful way. This meant that a risk of repetition remained. There was a lack of insight shown and his reaction at the time, as evidenced in his report and interview, seemed to accept little responsibility or understanding of the seriousness of the concerns. Additionally, there had been very limited apology or remorse shown. There was an ongoing risk to the safety of service users as there was potential for harm to be caused by the Registrant.

86. The Panel next considered the sanctions in ascending order of gravity.

87. It has found that it is not appropriate to make no order because of the serious nature of the Allegation found as well as the impairment found by the Panel.

88. A Caution Order is not appropriate because the conduct found proved was serious and thus not minor in nature. There also remained a risk of repetition as there was lack of insight. There was no evidence of what the Registrant had done in the past five years and thus no evidence of any remediation.

89. The Panel next considered a Conditions of Practice Order. Whilst the misconduct was capable of being remediated, the Registrant had not engaged and thus the Panel had no evidence of remediation and could not be confident that the Registrant would comply with any conditions formulated. The position may well have been different had the Registrant attended and provided details to the Panel, but this was not the case in this hearing.

90. The Panel had also found a lack of insight. The Registrant’s misconduct was serious and there was a risk of repetition. The Panel did not consider there were any conditions that could be formulated that would be proportionate, appropriate and workable. The Panel were concerned that the supervision required would also mean that the Registrant would always need to be paired with another paramedic, which may be unworkable and there was no evidence to assist the Panel that any such support was on offer. In the circumstances, the Panel had determined that the Registrant’s circumstances and the seriousness of the misconduct made a Conditions of Practice Order inappropriate.

91. The Panel next considered a Suspension Order. The Panel noted the serious breaches of standards, the lack of insight and thus the risk of repetition. Whilst the breaches could have potentially been addressed by conditions, the lack of engagement by the Registrant meant that conditions could not be explored further.

92. When looking at the circumstances of the case, the Panel noted that the Registrant did not seek to deny his failings and accepted he failed to take the equipment into the house and failed to maintain any record of the attendance. The lack of evidence on insight was explained by the Registrant having retired at some point in 2018. Therefore, the Panel did consider that there was a possibility of the Registrant being able to remediate the misconduct at some point in the future should he wish to engage.

93. The Panel considered a Striking Off Order and considered paragraph 131 of the HCPC’s Sanction Guidance, which stated as follows;

“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.”

94. The Panel were fully aware that a Striking Off Order “is a sanction of last resort for serious, persistent, deliberate, or reckless acts” (paragraph 129 of the HCPC’s Sanction Guidance). The Panel was satisfied that a lesser sanction would suffice, namely a Suspension Order. The Panel considered it would be disproportionate to issue a Striking Off Order for a single event on a single attendance, in an otherwise unblemished career of over 20 years.

95. The Suspension Order was the more appropriate and proportionate outcome. It would protect the public and the reputation of the profession sufficiently until such point that the misconduct was remedied. It would also serve to allow the Registrant an opportunity to attend a future review hearing and engage.

96. The Panel determined that the Suspension Order should last for a 12-month duration given the seriousness of the matter and the need to protect the public. This would give the Registrant time, should he wish, to reengage and start to undertake any necessary remediation.

97. A review would take place shortly before the expiry of the Suspension Order. The Panel considered a future reviewing panel may be assisted, but are not bound, by the following:

• A reflective piece from the Registrant, which includes reflections on the incident, on the potential impact on service users and their families and on the Panel’s findings at this hearing;
• Evidence of continuous professional development; and
• Any other information that the Registrant considers would assist the reviewing panel, particularly around the care of elderly patients, specifically around trauma.

Order:
The Registrar is directed to suspend the registration of Mr Raymond Byron for 12 months from the date this order comes into effect.

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Application for an Interim Order

1. Ms O’Connor made an application to proceed in the absence of the Registrant. She stated that the Registrant was clearly on notice by virtue of the Notice of Hearing email dated 20 June 2023 that an application for an Interim Order may be made in the event of the Panel determining a sanction of Conditions of Practice, Suspension Order or Strike Off. The Panel were directed to the relevant paragraph on the Notice of Hearing within the Service Bundle.

2. The Panel heard and accepted the advice of the Legal Assessor. The Panel determined that the Registrant was on notice that such an application may be made. The Panel also determined that it should proceed in the absence of the Registrant. For the reasons set out earlier, the Panel determined it would be fair, proportionate and in the interest of justice to consider this application in the Registrant’s absence.

3. Ms O’Connor submitted that an interim order was necessary to protect members of the public and was otherwise in the public interest because the Panel had found the Registrant’s fitness to practise to be impaired and imposed a 12 month Suspension Order.

4. Ms O’Connor also submitted that the basis had been established and the ground of public protection had already been found by the Panel in its substantive determination. She invited the Panel to make an Interim Suspension Order in the same terms. She submitted the duration should only be as long as is necessary and invited the Panel to make the Interim Order for 18 months.

5. The Panel had careful regard to Paragraphs 133-135 of the Sanction Policy and to Paragraph 3.4 of the HCPTS Practice Note on Interim Orders, which offer guidance on interim orders imposed at final hearings after a sanction has been imposed.

6. The Panel recognised that its powers to impose an Interim Order are discretionary and that imposition of such an order is not an automatic outcome of fitness to practise proceedings in which a Suspension Order has been imposed. The Panel took into consideration the impact of such an order on the Registrant.

7. The Panel decided to impose an Interim Order under Article 31(2) of the Health Professions Order 2001. The Panel was satisfied on the basis and requirement of an Interim Order given the facts found proved. In the judgment of the Panel, the risk of repetition identified in the substantive decision and the associated risk of harm that could result from repetition mean that an Interim Order is necessary to protect members of the public. It is also required in the wider public interest as public confidence in the profession and the regulatory process would be seriously undermined if the Registrant was allowed to continue unrestricted practice, after the substantive determination, during the appeal period.

8. The Panel first considered whether an Interim Conditions of Practice Order should be imposed. For the same reasons as the sanctions stage, the Panel did not consider these were appropriate or workable. The Panel considered an Interim Suspension Order would be appropriate and agreed this should be for the 18-month period.

9. If no appeal is made, then the Interim Suspension Order will be replaced by the 12 month Suspension Order, 28 days after the Registrant is sent the decision of this hearing in writing.

Order:

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Mr Raymond Byron