Ronald Barnes-Brown

Preliminary Matters
Service
1. The Panel is satisfied that the Notice of Hearing was sent to the Registrant at his registered postal address on 19 December 2022. The Service Bundle contained the postal tracking number and confirmation that the letter containing the Notice of Hearing was delivered to the Registrant’s address on 22 December 2022. The Panel is therefore satisfied that good service has been effected.

2. In addition, the Registrant wrote to the HCPC on 1 January 2023, stating that he would not be attending the Final Hearing.

Proceeding in the absence of the Registrant
3. Dr Danti, who appeared on behalf of the HCPC, submitted that the Panel should proceed in the absence of the Registrant. She submitted that all reasonable steps had been taken to secure the Registrant’s attendance.

4. The Registrant had been served with the Notice of Hearing. In his letter of 1 January 2023, he had made it clear he would not be attending the hearing. She submitted that an adjournment would serve no purpose. She invited the Panel to find that the Registrant had voluntarily absented himself.

5. The HCPC was ready to proceed. In addition, the Panel would be able to ensure that the hearing was fair, as the Registrant had set out his version of events in the letter dated 1 January 2023, which had been placed before the Panel.

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

7. In reaching a decision on whether to proceed in the absence of the Registrant, the Panel has read the HCPTS Practice Note on ‘Proceeding in the Absence of the Registrant’ (June 2022) and the Practice Note on ‘Postponement and Adjournment of Proceedings’ (June 2022). It has had regard to Rule 11 of HCPC (Conduct and Competence Committee) Procedure Rules 2003 which provides that a panel of the HCPTS has a discretion to decide to proceed in the absence of the Registrant.

8. The Panel is mindful that public protection through the effective regulation of registrants is an overriding objective. Furthermore, the Panel has a duty to conclude cases expeditiously. It has balanced these factors against the need to ensure fairness to the Registrant.

9. The Registrant was served with the Notice of Hearing and made aware of his right to attend this hearing. In his letter dated 1 January 2023, the Registrant has made it clear that he did not intend to attend the hearing. He wrote:

“I have left the medical industrial complex and have another career so the out-come of this hearing is meaningless to me”.

10. The Panel accepts the submission of Dr Danti that there is no realistic possibility that the Registrant will attend in the future. The Panel has therefore concluded that the Registrant has voluntarily absented himself.

11. There are five witnesses ready to give evidence via video-link. They would all be inconvenienced if this case were adjourned, and their memories of these events might well be less clear if the hearing is delayed. The Panel has a number of documents containing the Registrant’s account which it will consider in assessing the evidence in order to ensure that the proceedings are fair.

12. Having weighed up all of the competing factors, the Panel has determined that it is in the interests of justice to proceed in the Registrant’s absence.

Application to admit hearsay evidence

13. Dr Danti invited the Panel to admit the following statements and documents:-

(i) Registrant Self-referral Form 29 October 2019
(ii) Summary Registrant Trust Interview 11 December 2019
(iii) Trust Disciplinary Hearing Summary 3 March 2020
(iv) Exhibit 3 A5 Welfare Call report between Registrant and AH on 29 October 2019
(v) Exhibit C3 (and associated invites) Trust interview Transcript with AH about (iv) above.
(vi) Exhibit 3 A4 Statement prepared by NWAS MJ, Duty Manager dated 26 October 2019
(vii) Exhibit 3 A Statement prepared by NWAS PL, Operational Commander for NWAS dated 26 October 2019.
(viii) Production Statement AB

14. Dr Danti’s primary submission was that hearsay evidence is admissible in regulatory proceedings and followed the rules on the admissibility of hearsay evidence in civil proceedings. On this basis, she invited the Panel to find that the evidence was prima-facie admissible. The Registrant had been served with the HCPC bundle and had not objected to the evidence contained within it. Any unfairness arising from admitting the evidence could be addressed by the Panel in determining what weight to attach to the documents/statements once they had been admitted.

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

16. The Panel notes that the rules on the admissibility of hearsay evidence stem from Section 1 of the Civil Evidence Act 1995 (‘the Act’) which provides that in civil proceedings, evidence shall not be excluded on the ground that it is hearsay. Rule 10(b) & (c) of the HCPC Conduct and Competence Committee Procedure Rules 2003 replicates the civil evidence provisions:-

“(b) subject to sub-paragraph (c) the rules on the admissibility of evidence that apply in civil proceedings in the appropriate court in that part of the United Kingdom in which the hearing takes place will apply;
(c) the Committee may hear or receive evidence which would not be admissible in such proceedings if it is satisfied that admission of that evidence is necessary in order to protect members of the public.”

17. The Panel has begun its deliberations by asking itself whether the admission of the evidence would undermine the Registrant’s right to a fair hearing under Article 6 of the European Convention on Human Rights. The Panel has taken into account its duty to protect the public as well as its common law duty to ensure that hearsay evidence should only be admitted if it is relevant, fair and in the interests of justice. The Panel has approached this application in line with the guidance in Karout and Nursing and Midwifery Council [2019] EWHC28, where the Court denounced the practice of ushering through hearsay evidence in regulatory proceedings under the premise of scrutinising it later. The Panel has adopted the two-stage approach, set out in Karout:-

(i) whether the evidence should be admitted and
(ii) only if the evidence is admissible should the question of weight be considered.

18. As set out above, the Registrant has decided not to attend the hearing. The Panel finds that this does not obviate the need to ensure a fair hearing and reinforces the need for scrutiny in assessing whether to admit the evidence. The Panel has adopted the approach set out in Thorneycroft v Nursing and Midwifery Council [2014] EWHC1565. It has considered the following in respect of Dr Danti’s application:-

(i) whether the statements are the sole or decisive evidence in support of the charges;
(ii) the nature and extent of the challenge to the contents of the statements;
(iii) whether there was any suggestion that the witnesses had reasons to fabricate their allegations;
(iv) the seriousness of the charge, taking into account the impact which adverse findings might have on the Appellant's career;
(v) whether there was a good reason for the non-attendance of the witnesses;
(vi) whether the Respondent had taken reasonable steps to secure their attendance;
(vii) the fact that the Appellant did not have prior notice that the witness statements were to be read.

The Registrant’s Self-Referral Form; Investigation Interview and at the summaries of the Registrant’s evidence during the Disciplinary Hearing
19. The Panel finds the Self-Referral Form to be admissible. It is a form completed by the Registrant and signed by him. The Registrant does not dispute that he referred himself to the HCPC. The Self- Referral Form is probative and there are no grounds for excluding it. The Panel notes that it contains the Registrant’s first account of the events of 26 October 2019.

20. In relation to the Investigation Interview on 11 December 2019, the Panel finds this evidence to be relevant and admissible. The Registrant’s Union Representative was present at the interview. The Registrant has not asserted that this account does not reflect what he said on 11 December 2019. The Panel therefore finds that it is fair and in the interests of justice to admit the Investigation Interview.

21. In terms of the Registrant’s evidence at the Disciplinary Hearing on 3 March 2020, the Panel adopts the reasoning set out above and finds that the evidence should be admitted.

22. The Panel will be able to take into account the Registrant’s case as set out in his letters of 15 August 2022 and 1 January 2023. His case as set out in his letter of 15 August 2022 is that his colleague EP threw away the keys.

23. The Registrant attended the Disciplinary Meeting and spoke at the meeting. The Panel notes that the Registrant was sent the bundle before the hearing. He has had the opportunity to highlight any errors in what was recorded. The Registrant has not attended this hearing and the Panel finds that the Registrant’s accounts nearer the time of this incident are relevant and admissible. The Panel finds that it is fair and in the interests of justice to admit the evidence.

Welfare Call

This aspect of the application is contained within the private version of the decision

Hearing in Private

24. During his oral evidence, MM referred to his colleague DP’s private life. The Panel formed the view that the evidence should be heard in private. The Panel also noted that there were references to the Registrant’s health and private life within the documents and anticipated that as the hearing progressed there might be other occasions when the Panel would need to consider whether the evidence should be heard in private in accordance with Rule 10(1)(a) of the Consolidated Fitness to Practise Rules 2003:-

“the proceedings shall be held in public unless the Committee is satisfied that, in the interests of justice or for the protection of the private life of the Registrant, the complainant, any person giving evidence or of any patient or client, the public should be excluded from all or part of the hearing.”

25. The Panel has decided that where there are references to the health or private life of either the Registrant, the witnesses or family members, the evidence should be heard in private.

Background

26. The Registrant is a registered Paramedic who was employed by North West Ambulance Service (NWAS) at the relevant time.

27. On 26 October 2019, the Registrant was working with EP, an Emergency Medical Technician (EMT). During the course of their shift, whilst using an ambulance, call sign A108, they conveyed a mother and her baby to Alder Hey Children’s Hospital.

28. There was CCTV footage at the hospital. It shows an ambulance (latterly identified as call sign A108) park alongside another ambulance (latterly identified as call sign A670) at the emergency entrance. On 26 October 2019, A670 was being used by Paramedic DP and his EMT, MM.

29. The Registrant and EP had conveyed a mother and her baby to hospital. Once their vehicle had been parked, the Registrant, EP and the mother and baby began to make their way into the hospital. The HCPC’s case is that as the Registrant tried to enter the hospital, MM told him he shouldn’t be using the entrance, because it was only for high acuity emergencies. The Registrant continued to enter but was told by the nurse who was admitting patients that he would need to use another entrance.

30. As the Registrant, EP and the patient went out it was accepted that MM made a comment to the Registrant along the lines of “I told you so”. It appears that the Registrant did not reply.

31. After taking his patient to the appropriate department and processing her, it is the HCPC’s case that the Registrant opened the door to A670 and took the keys out of the ignition. He is alleged to have placed them in his pocket.

32. When MM and DP returned to their vehicle, they found that the keys were missing. The CCTV footage was reviewed.

33. The HCPC’s case is that the Registrant had no need to enter a vehicle that was not his. Once the CCTV footage had been reviewed, the Registrant and EP now having left the hospital, were asked via radio if they had the keys. They denied that they had it.

34. The spare key could not be found and the ambulance had to be taken to be low loaded onto a vehicle and taken to a garage where new locks and ignition were fitted.

35. At the end of his shift when the Registrant and EP returned to the ambulance station the Registrant was questioned by ML, the Operational Manager and NG. The Registrant denied taking the keys on a number of occasions. The Registrant was suspended.

36. On 29 October 2019 the Registrant admitted taking the keys. On the same day he self-referred to the HCPC.

The Hearing

37. In reaching a decision in this case, the Panel has watched the CCTV footage, listened to the audio recording, read the HCPC bundle containing witness statements and documentary exhibits.

38. The following witnesses gave evidence by video-link from:

• MM: EMT from Ambulance A670
• DP: Paramedic from Ambulance A670
• ML: Operational Manager on duty on 26 October 2019
• JE: NWAS Investigation Officer
• EP: EMT working with the Registrant on 26 October 2019

The Registrant

39. As the Registrant did not attend the hearing and dishonesty has been alleged, the Panel considers that it is important for it to set out the Registrant’s account of the events of 29 October 2019. This will assist in understanding the Panel’s decision in its proper context.

40. The Registrant completed a Self-Referral to the HCPC on 29 October 2019. He wrote:

“On 26th October, whilst at Alder Hey Children’s Hospital. Words were said whilst at the hospital with another ambulance crew. The other crew left their vehicle and whilst they were gone I took their vehicles keys which were left in the ignition and through them away.
This caused the ambulance to have to be recovered and it was off the road unavailable to attend emergencies.
I cannot explain my behaviour; it is totally out of character after 10 years of exemplary service.
I was investigated at station at 1900hrs and initially denied the allegations under a very stressful time and was suspended pending investigations.
The next day I contacted the Union GMB and spoke to the Branch Secretary and admitted everything-again advising I lost it, I cannot explain why I done it.
[Redacted]
I am so ashamed, embarrassed and may lose my job, career in the job I love.
I think there is a culmination of events which I now know I have not deal with and unfortunately these manifested on a simple turn of words with the other crew”.

41. On the 11 December 2019 the Registrant was interviewed by JE as part of the Trust’s internal investigation. During the interview the Registrant admitted that he took the keys from A670 and disposed of them. He said he had thrown them out of the window when he was driving but could not remember where he had thrown them.

“… we got out and went to the door and pressed the buzzer. The man near the door said 'it's changed you don't come in this way anymore'. I blanked them and we went in the usual way as we had just been in that way before. As we walked in the nurse said 'it has all changed you don't come in this way'. We said 'if you're going to change something can you let us know?' The paramedic on the other vehicle said to Liz, 'I'll show you where to go'. The man next to the door said 'I told you so'. I felt myself rising but I had a patient with me. I thought I'd go back and speak to him after. We went in the back way to get more blankets and he was standing there. I said 'I'm not being funny with you' but he blanked me and I was fuming, I couldn't control myself. I think if I could have punched something in the ambulance then I would but it was locked. I went to their ambulance and saw the keys and put them in my pocket, got Liz and then we went off in our ambulance. Whilst we were driving, I threw the keys out of the window. I buried it in my head I knew what was coming. They asked me if I'd done it and I denied it, I was embarrassed, so ashamed. It was shift change over too, I just wanted out; I wanted to be out of there”.

42. The Registrant attended the Trust’s Disciplinary hearing on 3 March 2020.

43. In answer to questions about what was going through his mind when he took the keys, the Registrant said:

“Pure anger, when I opened the door I was just going to tip gloves out or something but then I saw the keys and I took them. We went round a
roundabout and I dumped the keys there. I couldn't believe what I had done”.

44. On 15 August 2022, the Registrant wrote the following to the HCPC in respect of the events of the 26 October 2019:

“I again confirm that even though I removed the keys from the other vehicle, it may have been for vehicle security, I cannot confirm my thoughts at the time. [Redacted]I have remembered the events and deny throwing or stealing the keys. My colleague EP threw the keys away.”

45. In his most recent letter dated 1 January 2023, the Registrant stated:

“On the day an insignificant comment caused my reaction. I looked for somewhere to put the blankets so I could go and speak to the person making the comment. When opening the driver’s door of their vehicle, I noticed the keys (which should never have been left in the vehicle) so I took them for safe keeping. But I wasn’t thinking at the time forgot about them. When being questioned later on, I had no recollection of the events I was being accused of so denied them. I was told I had taken them and must have thrown them away. I began to believe I must have done this. But throughout all the investigations I constantly advised I could not remember where. The reason for this is I didn’t threw them away. I tried to start the ambulance I was in with them when they didn’t work I placed them in the middle console and tried another set of keys. There were two of us in the vehicle I did not throw the keys away.

I have left the medical industrial complex and have another career so the out-come of this hearing is meaningless to me, but it is important to me that you know the truth as I have always been a truthful and I am not the type of person of which I am being accused of”.

The HCPC Submissions
46. Dr Danti invited the Panel to find the Particulars proved. She submitted that CCTV footage, the audio tape and the evidence of the witnesses established that the Registrant had removed the keys and thrown them away. In respect of allegation 4, she invited the Panel to find dishonesty in respect of all of the Particulars found proved, applying the test in Ivey v Genting Casinos [2017] UKSC67 [§74].

47. Dr Danti submitted that the question of whether the Particulars found proved amounted to the statutory ground of misconduct was a matter for the Panel. She reminded the Panel that if it found dishonesty in respect of any of the Particulars the conduct will almost always be so serious as to amount to the statutory ground of misconduct.

48. Dr Danti invited the Panel to find the following breaches of the HCPC Standards of Conduct Performance and Ethics: 2, 6, & 9.

49. In respect of impairment, she submitted that the Registrant was impaired on both the personal and public component.

Decision on Facts
50. The Panel accepted the advice of the Legal Assessor. In reaching its decision on the facts, the Panel has borne in mind that the burden of proof rests on the HCPC and that it is for the HCPC to prove the Allegation irrespective of any admissions made by the Registrant. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities.

51. It has approached the assessment of reliability and credibility carefully and has followed the guidance in R (Dutta) v GMC [2020] EWHC2020 and Khan v GMC [2021] EWHC374. It notes that it is an error to place over-reliance on the demeanour of a witness and that reliance on the confident demeanour of a witness is a discredited method of judicial decision making. The Panel has carefully considered the evidence in the round, giving appropriate weight to the documentary evidence. Throughout its deliberations the Panel has referred itself back to the CCTV footage which was clear, the audio tape, the statements of the witnesses and their oral evidence. It has considered the Registrant’s account of this incident at the time and in his letters before this hearing.

52. In considering the question of dishonesty, the Panel has applied the two stage test in Ivey v Genting Casinos [2017] UKSC67 [§74],

• What was the Registrant’s actual knowledge or genuinely held belief as to the facts? And;
• Given his actual knowledge or genuinely held belief as to the facts, was his conduct dishonest by the standards of ordinary decent people.

Particular 1 (a)-proved
53. The Panel finds Particular 1 proved from the CCTV footage, the written and oral evidence of the witnesses MM, DP, EP and on the admissions of the Registrant.

54. MM stated that he left the keys to ambulance A670 in the ignition when he returned to the ambulance and prior to getting refreshments with DP. MM and DP gave oral evidence that when they then returned to their ambulance the keys were missing.

55. The Panel accepts the evidence of MM’s that when he watched the CCTV footage, he recognised the man who opened the door of ambulance A670 as the Registrant. He stated that he could see him remove something from the ignition.

56. The Panel has watched the CCTV and noted a man open the driver’s door to ambulance A670 and remove something and place it in his pocket. EP was asked by the Panel to watch the CCTV footage during her oral evidence. She identified the person opening the door of ambulance A670 as the Registrant. The Panel has attached weight to this aspect of EP’s evidence. She had worked with the Registrant for over 7 years and knew him well.

57. Moreover, the Registrant has accepted that he removed the keys from A670. He has not changed this aspect of his account.

Particular 1(b)–proved
58. The Panel finds Particular 2 proved on the Registrant’s own admission, the contemporaneous audio tape of the enquiry from the switchboard and on written and oral evidence of ML, the Operations Manager who questioned the Registrant at the end of his shift on 26 October 2019.

59. The Panel has listened to the audio tape of the enquiry about the keys and heard EP’s evidence that the Registrant denied knowledge of the keys.

60. The Panel also accepts the oral evidence of ML, the Operations Manager, who interviewed the Registrant at the end of his shift on 26 October 2019. ML knew the Registrant well and had been his manager before this incident. The Panel accepted his oral evidence that he gave the Registrant a number of opportunities to tell them what had happened to the keys. At first, he asked open questions, explaining that the keys to ambulance A670 had gone missing and asking the Registrant if he could shed any light on the matter. When the Registrant denied knowledge of the keys, he and his colleague left the Registrant alone in the room. The Panel accepts ML’s evidence that when he came back into the room, that he told the Registrant that there was CCTV footage and offered him another opportunity to tell him what had happened. The Registrant continued to deny any knowledge of the keys and said he didn’t need to check his pockets. He also denied that there was anything that might have impacted on his behaviour that day.

61. The Registrant has always accepted that it was not until the 28 October 2019 that he informed the Trust that he had taken the keys (although the Panel notes that he admitted the matter to his union representative on 27 October 2019).

62. Although the Registrant admitted removing the keys from the ignition of ambulance A670, he has never disclosed the whereabout of the keys. He initially stated that he threw them out of the window whilst he was driving. In his most recent accounts of 15 August 2022 and 1 January 2023 he denied throwing the keys away, specifically accusing EP of throwing the keys away in his account dated 15 August 2022.

Particular 2-proved
63. The Panel finds this Particular proved. The CCTV footage shows the Registrant opening the door to ambulance A670. The Registrant has admitted putting the keys in his pocket and driving off in his own ambulance with the keys. The Panel finds that the taking of the key out of the ignition of ambulance A670 was a deliberate act. Driving away from Alder Hey Hospital with the keys had the inevitable consequence of preventing and delaying the use of ambulance A670 on 26 October 2019.

Particular 3-proved
64. The Panel finds this Particular proved on the oral evidence of JE. The Registrant admitted in his Self-Referral Form, his internal Trust Interview and at the Disciplinary Hearing that he did not tell the Trust that he had taken the keys until 28 October 2019.

 65. The Panel has approached the question of dishonesty in relation to each of the Particulars separately applying the two-stage test in Ivey v Genting Casinos [2017] UKSC67 [§74].

66. In relation to Particular 1(a), the Panel has asked itself what the Registrant’s state of mind was when he removed the keys and whether he believed that he was acting dishonestly. Having reviewed all of the evidence, the Panel accepts on the balance of probabilities that the Registrant may have removed the keys from the ignition in anger and may not perceived his act to be dishonest.

67. Notwithstanding this, the Panel finds that an ordinary member of the public would form the view that taking keys from an ambulance that was not in your custody was dishonest. The Panel therefore finds dishonesty proved in respect of Particular 1(a).

68. In respect of Particular 1(b), the Panel finds this Particular proved on both the first and second limb of the test in Ivey v Genting Casinos. The Panel finds that as soon as the radio enquiry came in asking the Registrant and EP if they knew anything about the keys to ambulance A670, the Registrant would have known that he was acting dishonestly in failing to admit that he had taken the keys. The Registrant has accepted that he maintained this lie when questioned by ML at the end of his shift. In relation to the second limb of the test the Panel finds that an ordinary person would consider this behaviour dishonest.

69. The Panel finds Particular 2 proved on both limbs of the test in Ivey and Genting for the reasons set out in Particular 1(a) and I(b). It finds in relation to the question of dishonesty the Particular adds nothing to the Panel’s findings as set out in paragraphs 72-4 above.

70. In respect of Particular 3 there was no dispute that the Registrant did not inform the Trust of his actions until 28 October 2019. In respect of the first limb of the test for dishonesty, the Registrant was given three opportunities by ML to admit that he had taken the keys at the end of his shift on 26 October 2019. Whilst the Panel accepts that the Registrant may have felt shame and embarrassment and may have wanted to get out of the office and go home, this does not detract from the fact that he knew he was lying. In his Trust interview on 11 December 2019, the Registrant described the meeting on the evening of 26 October 2019 stating, “I buried it in my head I knew what was coming. They asked me if I'd done it and I denied it, I was embarrassed, so ashamed. It was shift change over too, I just wanted out; I wanted to be out of there”.

71. In respect of the second limb of dishonesty, the Panel finds that an ordinary person would find lying about taking a key out of the ignition of another ambulance to be dishonest, irrespective of shame and embarrassment.

Decision on Grounds
72. The Panel has approached its decision on misconduct by considering each of the Particulars in the Allegation separately. The Panel has concluded that the facts found proved in relation to each of the Particulars are so serious as to amount to misconduct.

73. In the Panel’s judgement, the Registrant’s behaviour fell seriously below the standards expected of a registered Paramedic. The Registrant was an experienced Paramedic. He would have been fully aware that in taking the keys he was rendering ambulance A670 inoperable. Whilst the Registrant cannot be held responsible for the fact that the second set of keys could not be found, the inevitable consequence of taking a key from an ambulance was that the ambulance could not be driven. The Registrant’s actions had the potential of depriving or delaying a member of the public of an emergency response. The Panel heard that there were 6 category 2 calls while the ambulance was out of action which might have been allocated to A670. The Registrant’s actions had the potential to place Service Users at undue risk.

74. It is a fundamental tenet of the profession of Paramedic, that Paramedics are available to respond to emergencies. The Registrant’s actions and responses on the day in question were dishonest which further exacerbates the situation and renders the misconduct even more serious.

75. The Panel finds that the Registrant has breached fundamental tenets of his profession and in so doing has failed to uphold professional standards. The conduct involved breaches of the following:

“HCPC Standards of Conduct Performance and Ethics
• 6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible
• 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 or 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.”

Impairment
76. The Panel went on to decide whether, as a result of his misconduct, the Registrant’s fitness to practise is currently impaired. In reaching a decision on impairment, it has had regard to all the evidence presented in this case and the submissions of Dr Danti that the Registrant’s fitness to practise is currently impaired on both the personal and public components.

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

78. The Panel has approached its decision on impairment looking at the situation as it is today. It has had regard to the HCPTS Practice Note ‘Fitness to Practise Impairment’.

79. In Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) 74, Cox J summed up the Panel’s task in the following way:

“In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”

80. 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) EWHC 927. 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; and/or

d. Has in the past acted dishonestly and/or is liable to act dishonestly in the future.”

81. In terms of mitigating factors, the Panel accepts that the Registrant is a man of good character and that he has worked as a Paramedic for 10 years. The evidence from EP was that the Registrant’s actions on 26 October 2019 were out of character. He was experienced, knowledgeable and well-liked by patients and colleagues. EP stated in her oral evidence that the Registrant was always willing to share his knowledge with more junior colleagues and was prepared to go out of his way to help those who needed advice.

82. The Panel accepts that working as a frontline Paramedic is stressful and that Paramedics have to deal with traumatic situations on a regular basis. It follows that the Registrant may have been affected by the difficult experiences that he had dealt with over many years. The Panel finds that as an experienced Paramedic, the Registrant had a duty to inform his employer if he was unfit to work and to seek medical help.

83. Paramedics are expected to act in a professional manner at all times. They must make sure that their conduct justifies both service users’ and the public’s trust in the profession. In terms of the aggravating factors, the Panel finds the following:

(i) The Registrant was not open and honest from the outset. He was given the opportunity to admit to his actions within minutes of the incident. If he had come clean early on and returned the keys, ambulance A670 would have been available to respond to emergencies within a short space of time.
(ii) Despite being given the opportunity to admit his actions at the end of his shift and despite being told that there was CCTV footage, the Registrant continued to deny taking the keys.
(iii) Although the Registrant co-operated with the Trust’s investigation from the 28 October 2019 and apologised for his actions, he has shown less and less insight as time has gone on. In the immediate aftermath, the Registrant spoke of shame and acknowledged that he had rendered an ambulance inoperable. By the Trust’s Disciplinary Meeting in March 2020, the Registrant had begun to rely on bullying by senior members of staff.
(iv) The Registrant’s letter dated 15 August 2022 shows a total lack of understanding of the potential impact of his behaviour on vulnerable service users. He appears to accept no responsibility for the consequences of his behaviour. The Panel found the fact that he blamed his junior colleague for throwing the keys away to be malicious and frivolous in the context of an extremely serious lapse of professional judgment on his part. The tenor of the most recent letter of 1 January 2023 further demonstrates a blatant disregard for his profession and for service users and shows a complete lack of insight and appreciation of the seriousness of the incident.

84. In summary, the Panel has formed the view that the Registrant has not accepted responsibility for his actions on the 26 October 2019 and that he has less insight now than he had at the time of the incident. There has been no remediation and there remains a high risk of repetition in respect of the personal component.

85. In terms of the public component of impairment, this was an attitudinal failing that undermined core tenets of the Registrant’s professional duty to put service users first and ensure that an emergency vehicle was available to respond to emergencies. The Panel has an overarching responsibility to promote and maintain professional standards, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Paramedic profession. The Panel has found that the public would be shocked that a registered Paramedic rendered an emergency vehicle inoperable after a minor disagreement with a more junior colleague.

86. This was an extremely serious incident. The Panel finds that a clear message needs to be sent to the profession and to the wider public that Paramedics are expected to behave in a manner consistent with the tenets of their profession. Paramedics work with vulnerable people often in life and death situations. They work under extreme stress and they have a duty to act with honesty and integrity, to regulate their behaviour and place the public before themselves at all times. The Registrant has failed to do this. Accordingly, Panel finds that public confidence in the profession and the regulator would be undermined if a finding of impairment was not made on public interest grounds.

87. The Panel has therefore determined that the Registrant’s fitness to practise is currently impaired on both personal and public interest considerations.

Sanction
88. The Panel heard the submission of Dr Danti with regard to sanction. In reaching a decision on sanction it has taken these submissions into account.

89. 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.

90. 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.

91. The primary function of any sanction is to address public safety from the perspective of the risk which the Registrant may pose to those who use or need his services and also to the wider public interest; namely the deterrent effect on other Registrants, the reputation of the profession and public confidence in the regulatory process.

92. Whilst the Panel has set out the aggravating and mitigating factors above, the most relevant are repeated below for completeness.

93. In terms of the mitigating factors relevant to sanction, the Panel accepts that:

(i) The Registrant was a man of good character. He worked as a Paramedic for over 10 years. He was well regarded and undoubtedly a good and experienced Paramedic.
(ii) This was a single serious incident in an otherwise unblemished career.
(iii) The Registrant had an excellent and long working relationship with EP who spoke highly of him when giving oral evidence to the Panel.

94. The aggravating factors are:

(i) This was a serious attitudinal failing which undermined core tenets of the Registrant’s duties as a Paramedic. It had the potential to impact on the Trust’s ability to respond to emergencies in a timely manner by taking an emergency vehicle off the road. The Registrant’s actions on 26 October 2019 also demonstrated a blatant failure to work in partnership with his Paramedic colleagues.
(ii) The Panel has found that the removal of keys from A670 was dishonest. The dishonesty was aggravated by the Registrant’s failure to admit what had happened at the time of the incident, despite being given ample opportunity to do so by ML, who he knew well.
(iii) The Registrant has failed to engage in these proceedings.
(iv) The Registrant’s insight has diminished rather than developed. The most recent letters dated 15 August 2022 and 1 January 2023 contain a partial retraction of the admissions made during the Trust’s investigation and include an attempt to blame his longstanding crewmate, EP. This was particularly shocking and concerning in the context of EP’s oral evidence. It was clear to this Panel that EP took considerable steps to support the Registrant in the aftermath of this incident.
(v) There was no evidence of remediation. The incident arose from a disproportionate loss of temper. There was no evidence that the Registrant has attended an anger management course or completed counselling work to address his attitudinal failing and loss of temper.
(vi) [Redacted]
(vii) In his letter of 1January 2023, the Registrant has stated very clearly that he does not care about the regulatory process or the outcome of these proceedings. The only inference that the Panel can draw from this is that the Registrant has no interest in addressing his failings. It appears to the Panel that the Registrant has shown a flagrant disregard for the regulatory process in the context of a serious attitudinal failing.

100. In considering the matter of sanction, the Panel has started its deliberations with the least restrictive sanction, moving upwards.

101. The Panel first considered taking no action but concluded that given the seriousness of the Registrant’s misconduct, this would be wholly inappropriate.

102. The Panel then considered whether to make a Caution Order. The Panel was mindful of its finding that the Registrant was likely to repeat his misconduct. These matters are too serious for a Caution Order to be considered appropriate.

103. The Panel next considered the imposition of a Conditions of Practice Order. The Panel has found that the Registrant has not demonstrated insight into his misconduct. This was not a case where the Registrant’s clinical skills are in question. These are matters involving attitudinal issues, which cannot be addressed by the imposition of conditions of practice without insight having been demonstrated first. Taking into account all of the above, the Panel has concluded that conditions could not be formulated which would adequately address the risk posed by the Registrant, and in doing so protect patients, colleagues and the public during the period they are in force.

104. The Panel went on to consider whether a period of suspension would be appropriate in this case. A period of suspension would be appropriate if the Registrant had demonstrated insight into his misconduct such that there was not a significant risk of repetition, and also if there was no evidence of attitudinal problems. Unfortunately, that is not the case here. The Registrant has disengaged from the process, and has not provided any evidence of insight or remorse. The Registrant has breached fundamental tenets of the profession of Paramedic.

105. The Panel has therefore determined that there is a significant risk of repetition of his misconduct. Furthermore, the Registrant has not demonstrated a commitment to remaining in the profession or taken any steps to remediate his failings or shown any inclination to do so.

106. The Registrant was clearly a good Paramedic. It is therefore with regret that the Panel has determined that even the maximum period of suspension would be insufficient to mark the Registrant’s serious misconduct. With regard to the wider public interest, the public must be assured that Paramedics act with integrity, at all times putting service users first. A blasé attitude to public safety and the regulatory process is totally unacceptable, particularly when working in emergencies often in life and death situations. The Panel is satisfied that the only appropriate and proportionate response to protect the public and the wider public interest in these circumstances is to make a Striking-Off Order.

ORDER: The Registrar is directed to strike the name Mr Barnes Brown from the Register on the date this Order comes into effect

Interim 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 Ronald Barnes-Brown