Jessica Silvester

Preliminary matters

Service
1. On 16 November 2023, the HCPC sent by post and email to the Registrant at her last known registered postal and email addresses the Notice of Hearing. In reaching its decision, the Panel accepted the Legal Assessor’s advice. The HCPC does not have to prove receipt of the Notice of Hearing. However, the Panel has seen proof of receipt in the service bundle establishing that the email was received on 16 November 2023. The Panel observed that the email and postal addresses matched the addresses held on the Register.

2. The Panel determined that there had been good service of the hearing notice email in accordance with Rules 3 and 6 (2) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) and Rule 2A of the Health and Care Professions Council (Coronavirus) (Amendment) Rules 2021 (the Amended Rules).

Proceeding in Absence
3. Ms Atkin on behalf of the HCPC invited the Panel to proceed in the absence of the Registrant. Ms Atkin relied on an email exchange in which the Registrant responded on 12 December 2023 to an email to her from the prison Senior Case Administrator – Offender Management Unit asking the Registrant to confirm that she was happy to not attend the hearing and for it to proceed in her absence. The Registrant said:
‘Yeah they sent me a letter asking whether I was goi BBC (sic) to attend and I sent it back saying I wasn’t, it might not have got to them yet. I also spoke to a union rep who said I didn’t have to.’

4. This indicated to the Panel that the Registrant was aware of this hearing, did not wish to attend, and was content for the hearing to proceed in her absence.

5. In these circumstances, the Registrant had consciously and voluntarily absented herself from the proceedings.

6. The Panel accepted the advice of the Legal Assessor, who summarised the cases of GMC v Adeogba (2016) EWCA Civ 162 and R v Jones (Anthony William) 2002 UKHL 5 (20 Feb 2002). The Panel also had regard to the HCPTS Practice Note, ‘Proceeding in the Absence of the Registrant,’ dated June 2022.

7. The Panel was confident that the Registrant had been served with notice of the hearing in accordance with the Rules, was aware of the hearing and had consciously and voluntarily decided not to attend the hearing. The Panel observed that almost two years had passed since the Registrant was convicted. Although no witnesses were warned for this hearing the matter was now ready to be concluded. It was fair to the Registrant and in the public interest to resolve the matter now.

8. The Panel found that there would be no useful purpose in adjourning the proceedings, as there was no real likelihood that the Registrant would engage if there was a delay in the proceedings. The Panel acknowledged that there may be a disadvantage to the Registrant in proceeding in her absence. This was because the Registrant was not present to respond to the Allegation or to provide any input regarding insight in the event that the facts are found proved. However, this was outweighed by the public interest in concluding the proceedings. It was also in the Registrant’s own interest for the proceedings to be concluded now. The Panel found that the Registrant had voluntarily absented herself from the proceedings and decided to proceed in her absence.

Background
9. At the time of committing the offences which led to her conviction on 11 January 2022, the Registrant was employed as a Paramedic by South East Coast Ambulance Service NHS Foundation Trust (the Trust).

10. At an unknown date around or prior to February 2018, the Registrant began using opiates which were given to her by Person L, who was her partner and was a fellow employee of the Trust.

11. From 3 February 2018 onwards, the Registrant and Person L were jointly involved in the theft of medication and medical equipment, which included on one occasion the theft of a portable ultrasound machine (valued at £14,000 when new in 2008).

12. From May 2020, the Registrant and Person L also conspired to burgle domestic premises, where patients and their carers stored quantities of opiate drugs supplied by their medical advisers to assist with serious life limiting conditions. In some cases, the patients were expected to die imminently, and the stolen drugs were intended for their end-of-life care.

13. The Registrant misused her position as a person trusted with sensitive personal data to discover the details of very vulnerable patients who were likely to have access to controlled drugs including opiate medication. The Registrant passed this confidential patient information to Person L. Person L then attended the homes of the patients, dressed in clothes likely to mislead the patients and their carers that Person L was a nurse, gaining admittance to the addresses. Person L would pretend that a medication review was necessary or that the drugs had to be returned to the NHS. Person L would then distract the occupants of the address and then steal the drugs unnoticed.

14. The Registrant and Person L conspired together to burgle a total of 29 homes prior to their arrests on 5 August 2021, including the homes of vulnerable patients who were terminally ill, and in some cases the homes of patients who had recently died.

15. On 5 August 2021, the Registrant was referred to the HCPC by the Trust after the Trust was notified by Kent Police of the Registrant’s arrest.

16. On 11 January 2022, the Registrant was convicted of the offences of conspiracy to steal and conspiracy to commit burglary (having pleaded guilty to the same). She was sentenced to 5 years’ imprisonment.

Decision on Facts
17. The Panel were provided with a certified Memorandum of Conviction which supported Particular 1 as amended.

18. Rule 10(d) of the Panel Rules and the HCPTS Practice Note on Cautions and Convictions provide that where the Registrant has been convicted of a criminal offence, a certified copy of the certificate of conviction (or, in Scotland, an extract conviction) shall be admissible as proof of that conviction and of the findings of fact upon which it was based.

19. The Panel also had the benefit of the transcript of the judge’s sentencing remarks. The Panel noted that the Registrant was presently in prison. She had not suggested that she had been misidentified as the person referred to in the Memorandum of Conviction.

20. The Panel recognised that the burden of proof, to the civil standards of the balance of probabilities, always rested on the HCPC. The Panel however was satisfied that the HCPC had proved Particular 1 on the balance of probabilities.

Decision on Grounds
21. The Panel had regard to the Practice Note ‘Conviction and Caution Allegations’ dated March 2017. The Panel recognised that Article 22(1)(a)(iii) of the Health Professions Order 2001 (the Order) provides that one of the grounds upon which an allegation may be made is that a Registrant’s fitness to practise is impaired by reason of:
“a conviction or caution in the United Kingdom for a criminal offence, or a conviction elsewhere for an offence which, if committed in England and Wales, would constitute a criminal offence.”
Accordingly, “conviction allegations” include allegations that a Registrant’s fitness to practice is impaired as a consequence of being convicted for an offence by a criminal court in any part of the UK;

22. In this case, the Registrant had been convicted, on her own confession of a serious indictable offence, resulting a in a sentence of imprisonment of five years as a first offender.

23. The Panel was satisfied that the grounds were established.

Decision on Impairment
24. The Panel’s task is to determine whether the Registrant’s current fitness to practise is impaired, based upon the nature, circumstances and gravity of the offence concerned, and, if so, whether any sanction needs to be imposed.

25. In considering the nature, circumstances and gravity of the offence, the Panel needs to take account of public protection in its broadest sense, including whether the Registrant’s actions bring the profession concerned into disrepute or may undermine public confidence in that profession. In doing so, the Panel is entitled to adopt a 'retrospective' approach and consider the conviction as if the Registrant was applying for registration with the HCPC. The purpose of this hearing is 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.

26. In reaching its decision, the Panel paid regard to the HCPTS’ Practice Note on “Fitness to Practice Impairment” and it accepted the Legal Assessor’s advice. The Panel took note of Ms Atkin’s submission. The Panel based its conclusions on Impairment on the Registrant’s proved convictions and on the ground of misconduct which has been found proved.

27. The Panel reviewed the convictions and the Judge’s remarks on sentencing. It noted that there were aspects of her case that had revealed to the Judge certain positive elements to the Registrant’s attitude and conduct during the investigation and trial process. These included that the Registrant had no previous convictions and had pleaded guilty. She had herself twice been the victim of serious criminal assaults while at work which had adversely impacted on her. The Registrant had twice moved to work at a different Health Authority but had been unable to resolve the internal conflict that had been created by this. Further, the Registrant had a difficult childhood background and had personal health conditions which persisted into adulthood. The judge accepted that this appears to have led the Registrant into self-medicating with opiate medications leading to a deepening addiction and finally opening the way to her criminal offending.

28. While the Judge’s comments pointed to some insight by the Registrant, the Panel concluded that it was insight directed solely to the criminal investigation and it did not touch upon the consequences to the patients and families involved, the public, especially vulnerable and terminally ill patients, her colleagues, her profession, and her regulatory body.

29. Ms Atkin submitted that the Registrant’s fitness to practise is impaired on both personal and public component grounds. She reminded the Panel that the Registrant’s conviction was for a very serious criminal offence which was:
• Planned;
• Persisted over a long time;
• Targeted a very vulnerable cohort of patients and their families;
• Resulted in real harm to patients being deprived of necessary end-of-life medication and;
• A loss of trust in the profession by family members as revealed in the victim impact statements referred to by the sentencing judge.

30. Ms Atkin reminded the Panel of the case of CRHP v GDC and Fleischmann [2005] EWHC 87 (Admin) where it was made clear that ‘where a practitioner has been convicted of a serious criminal offence or offences, he should not be permitted to resume his practice unrestricted’ and ‘the rationale for the principle is that good standing in a profession must be earned if the reputation of the profession is to be maintained.’

31. Ms Atkin submitted that due to the Registrant’s lack of insight, and because there was no independent evidence that the Registrant had remedied her conviction, there is a risk of repetition in this case. She submitted that a finding of impairment on the personal component was required in order to protect members of the public.

32. In relation to the public component, Ms Atkin submitted that a finding of impairment was required in order to maintain public confidence in the Paramedic profession and in the HCPC as its regulatory body. She submitted that a reasonable and informed member of the public would be shocked and troubled if there were no finding of impairment in this case.

Personal component of impairment

33. The Panel considered the personal component of impairment. It is satisfied that the conviction in this case is, with significant difficulty, capable in principle of being remedied. Offences involving dishonesty are particularly hard to remediate since their commission has a corrosive effect on the trust and confidence that can be placed in an individual who is responsible for such offences.

34. In this case, the Panel considered that there is no evidence that the Registrant has made any attempt to take practical steps to develop any real insight in to the impact that her offending conduct had on patents, the public and the profession. Her plea of guilty, while creditable, was in the context of criminal proceedings. A letter by her to the court was referred to by the judge but not the detail of the contents. The Registrant has not taken the opportunity since being sentenced to prepare any kind of reflective writing focussing on the harm that she may have been responsible for and the damage caused by her to the reputation and trust that the public place in the profession of Paramedic. She had not, despite hearing the victim impact statements read in court, taken the opportunity to recognise her shortcomings and to apologise for them. The Registrant had instead maintained a silence on the subject when corresponding with her regulator through the offender management service at the prison where she is confined.

35. The Panel considered the likelihood that the Registrant is at real risk of repeating some form of dishonest conduct in consequence of not having demonstrated any insight to the Panel of the effects of her addiction on her behaviour and any material steps taken to address her addiction. The Panel concluded that the risk of repetition is high in this case. It has reached this conclusion based on the grave nature of the conviction, the Registrant’s lack of insight and the lack of steps she has taken to remedy her conviction.

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

Public component of impairment
37. In relation to the public component, the Panel has considered very carefully whether given the nature, circumstances, and gravity of the conviction in this case, public confidence in the Paramedic profession and its regulatory body would be undermined if there was no finding of impairment. The Panel has 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.

38. The Panel considered the HCPC’s Standards of Conduct, Performance and Ethics and in particular Standard 9 which states:
Standard 9:
Be honest and trustworthy Personal and professional behaviour
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

39. The Panel is satisfied that, in being convicted of a very serious conspiracy and campaign of burglary of some of the most helpless and vulnerable patients who depend on the services of a Paramedic among other healthcare workers, the Registrant has breached Standard 9.1. She did not make sure that her conduct justified the public’s trust and confidence in her or in her profession.

40. The Panel concluded that a reasonable and informed member of the public would be very concerned if there was no finding of impairment in this case. The Panel is satisfied that public confidence in the profession and in its regulator would be undermined if there was no finding of impairment in this case. The Panel is also satisfied that it would be failing in its duty to uphold and declare proper standards of conduct and behaviour in the Paramedic profession if it did not find that the Registrant’s fitness to practise is impaired.

41. The Panel had no doubt that the Registrant’s conviction and resulting lengthy prison sentence had brought the Paramedic profession into disrepute and that it had also breached the fundamental tenet of that profession, namely that a Registrant’s conduct must be trustworthy at all times. In these circumstances, the Panel finds the Registrant’s fitness to practise is impaired on the public component.

42. Accordingly, the Panel finds the Registrant’s fitness to practise is impaired on both the personal and public component.

Decision on Sanction
43. Although the Panel cannot re-try a criminal case, it may have regard to whether the Registrant pleaded guilty to the offence and, if so, at what stage in the proceedings. A guilty plea entered at the first reasonable opportunity is indicative of a greater insight on the part of the Registrant than one entered at the last moment. A Registrant who is convicted of an offence but maintains that the conviction was wrong may lack insight into their offending behaviour and this may have a significant bearing upon the sanction which the Panel should impose in order to protect the public.

44. In reaching its decision, the Panel recognised that it should also have regard to any punishment or other order imposed by the courts, but it must bear in mind that the sentence imposed is not a definitive guide to the seriousness of an offence.

45. In this case, the Registrant had entered a full guilty plea and thus avoided the need for a trial and for witnesses to attend and give evidence regarding the distressing circumstances of this conspiracy and burglary case. That pointed towards some limited insight by the Registrant but not in respect of insight into the harm caused by her as a registered Paramedic.
46. In considering the appropriate and proportionate sanction the Panel took account of the HCPC’s Sanctions Policy. The Panel has received and accepted legal advice. The Panel is 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 has also had in mind that any sanction it imposes must be appropriate and proportionate bearing in mind the nature and circumstances of the conviction involved.

47. The Panel has considered mitigating and aggravating factors of the Registrant’s conviction. The Panel first looked at the mitigating factors and has concluded that the only mitigating factor is that there are no previous regulatory findings against the Registrant, who has been a Paramedic for a number of years. The Panel has considered whether it should take the Registrant’s plea of guilty to the criminal offence at Durham Crown Court into account as a mitigating factor. It has decided that it cannot but attach significant weight to this as there is no evidence of insight into matters which are relevant to this hearing or any real evidence of her engagement with her regulator.

48. The Panel considered whether the Registrant’s health conditions and circumstances at the relevant time of her offending might provide any mitigation in this case. The Panel notes that there is evidence in the sentencing remarks that suggests that she was suffering at that time from a number of health conditions which had impacted on her thinking and actions. The Panel has concluded, on the information before it, that it cannot find that these factors could have any material weight in mitigation in this hearing process. The Panel considered that any Paramedic would, as part of their obligations to the public, the profession, and their Trust, come forward and seek treatment for addiction. Paramedics are especially well-placed to understand the dangers and impact of drug addiction from their professional lives, as indeed was mentioned on behalf of the Registrant at her sentencing hearing in court.

49. The Panel considered the following to be aggravating factors:
• The Registrant has no insight into her conviction and its potential impact on the patents and families in this case, or its impact on service users, her profession, and the wider public interest;
• the Registrant has failed to express any proper remorse or to apologise for her conviction;
• the Registrant has not provided any corroborative evidence that she has taken any steps) towards remedying her conviction;
• the harm to patients and their family members was evident and serious involving a diminishment in the essential trust and confidence necessary for Paramedics to practice effectively;
• public confidence in the profession has been undermined.

50. The Panel considered the available sanctions in ascending order of seriousness. It decided that mediation or taking no action is inappropriate in this case given the serious nature of the conviction.

51. The Panel has also decided that imposing a Caution Order would not be appropriate or proportionate. The Panel had in mind the HCPC’s Sanctions Policy paragraph 101 which states:
“101. A Caution Order is likely to be an appropriate sanction for cases in
which:
• the issue is isolated, limited or relatively minor in nature;
• there is a low risk of repetition;
• the Registrant has shown good insight; and
• the Registrant has undertaken appropriate remediation.

52. The Panel considers that while the conviction in this case was “isolated” in the sense that it involved one serious offence, it in fact related to at least 25 individual acts of conspiracy and burglary resulting in real harm to several patients.

53. The Panel is not able to conclude that there is a low risk of repetition because the Registrant has shown no insight into the causes of her offending behaviour, and no insight into its impact on service users, her profession and the wider public.

54. The Panel has also had in mind that a Caution Order permits a Registrant to be in unrestricted practice and considers that this would be inappropriate in this case in light of the Registrant’s unaddressed underlying addiction behaviour.

55. The Panel was satisfied that to ensure public confidence in the profession is not undermined, it must consider a more severe sanction.

56. The Panel then considered a Conditions of Practice Order and in particular the matters set out in paragraph 106 and 108 of the Sanctions Policy, which respectively state:
106 “A Conditions of Practice Order is likely to be appropriate in cases where:
• the Registrant has insight;
• the failure or deficiency is capable of being remedied;
• there are no persistent or general failures which would prevent the Registrant from remediating;
• appropriate, proportionate, realistic, and verifiable conditions can be formulated;
• the Panel is confident the Registrant will comply with the conditions;
• a reviewing Panel will be able to determine whether or not those conditions have or are being met;
• the Registrant does not pose a risk of harm by being in restricted practice.”
108 “Conditions are also less likely to be appropriate in more serious cases, for example those involving:
• criminal convictions for serious offence (see paragraphs 80 – 84).

57. While the Panel has found that the conviction in this case is capable of being remedied, it considers that the Registrant has shown no insight into this. There remains therefore, a real risk of repetition of the behaviour that led to that conviction. The Panel has also concluded that it is not possible to devise appropriate, proportionate, realistic, and verifiable conditions which would address the serious concerns regarding the Registrant’s addiction-linked criminal conduct. The Panel also takes the view that given the nature and gravity of the conviction in this case public confidence in the Paramedic profession and in the regulatory process would be undermined if it were to impose a Conditions of Practice Order.

58. The Panel next considered whether to impose a Suspension Order. It has 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.”

59. The Panel has considered very carefully whether the Registrant’s lack of insight into her conviction and the level of the risk of repetition rules this sanction out. The Panel has already expressed its view that the concerns in this case are capable of being remedied. The Panel considered that there is no evidence that this Registrant is capable of remedying the offending behaviour which led to her conviction.

60. The Panel has also concluded that a Suspension Order even for a period of 12 months would not be appropriate or proportionate to maintain public confidence in the Paramedic profession or its regulatory body. Such an Order would not send out an appropriate message to the profession about this type of serious criminal conviction. The Panel considers that a reasonable and informed member of the public would expect a more severe sanction.

61. The Panel has therefore concluded that the only appropriate and proportionate sanction is an order striking the Registrant off the Register.

62. The Panel has considered the Sanctions Policy where, in paragraphs 130, it is stated that such a sanction is one of:
“last resort for serious, persistent, deliberate or reckless acts involving….and criminal convictions for serious offences (paragraphs 80-84).”

The Panel has also had in mind paragraph 131 which 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.

63. The Panel is satisfied, based on the Registrant’s lack of insight and the nature and gravity of the allegation, that to ensure public confidence in the Paramedic profession and in the HCPC as its regulatory body is maintained, and in order to uphold proper standards of conduct in the profession, it is appropriate and proportionate to order that the Registrant’s name be struck off the Register.

Order: The Registrar is directed to strike the name of Ms Jessica Silvester from the Register on the date that 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.

Interim Order

64. Ms Atkin invited the Panel to impose an Interim Suspension Order to cover the period of any appeal or the appeal notice period whichever is the later.

65. The Panel was satisfied that the Notice of Hearing dated 16 November 2023 referred to the possibility of an application for an Interim Order being sought on the completion of the hearing.

66. In reaching its decisions on the Interim Order application, the Panel accepted the Legal Assessor’s advice and paid regard to the HCPTS’ Practice Note on “Interim Orders”.

67. The Panel has reached its decision on all stages in this case and has imposed a sanction of Strike Off. For the reasons set out in the substantive determination, the Panel concluded that an Interim Order should be imposed on the grounds of the protection of the public and being otherwise in the public interest.

68. Furthermore, the Panel determined that, in order to be consistent and proportionate, the Interim Order must be an Interim Suspension Order and, again, the Panel relied on its reasons in its substantive Determination, and especially as to why an Interim Conditions of Practice Order would be inappropriate and insufficient to protect the public.

69. 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.

70. 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 Jessica Silvester