Mr Paul M Sutton

Background:

1. Between July 2014 and July 2015, the Registrant was the Chief Executive Officer (CEO) of South East Coast Ambulance Service NHS Foundation Trust (‘SECamb’ or ‘The Trust’). The Trust answers NHS 111 calls across the region (this includes Kent, Surrey and Sussex) and also responds to emergency 999 calls.

2. During this period, when a call was made to the 999 or 111 service the call was triaged using a system called NHS Pathways in order to decide how to deal with the call. 111 was a non- emergency service, but triaged calls would sometimes require an ambulance. Ambulances are dispatched according to acuity and at the time were categorised as Red1, Red2 and Green.

3. The most serious category was Red1 indicating the patient had a life-threatening emergency, resulting in an ambulance dispatch to reach the patient within 8 minutes. The next category was Red 2, where a patient was extremely unwell but not life-threatening, also an 8- minute dispatch time. The final category was Green, where a patient required an ambulance but not urgent. The National Guidance at the time required that the ambulance should be dispatched after 111 identified the Red/Green disposition. The ‘clock’ started at that point. All ambulance services received guidance, the Ambulance Quality Indicators regarding how they should dispatch ambulances and record performance, including clock start and stop times.

4. During 2014 there was concern, at both front-line and management level, that ambulances were being dispatched when they were not required. The concern was that the 111 system was allocating calls at ‘Red 2’ called when they were in fact ‘Green’ calls.

5. As CEO of the Trust, the Registrant was responsible for a pilot (the Pilot). Under the Pilot, each call 111 had categorised as Red 2 would be categorised as Red 3 and re-triaged by a clinician in the 999 Emergency Operations Centre. This required calls to be put in a queue for up to ten minutes whilst a clinician probed as to whether and ambulance was required. This meant that an ambulance that should have arrived in 8 minutes could be delayed for an additional 10 minutes.

6. The Pilot also changed how the ‘clock’ worked. The IT department were tasked to alter the start/stop times of the calls on the system, effectively stopping the clock in order to triage the calls. This was not compliant with the national standards.

7. The Pilot started on 20 December 2014 and was stopped on 24 February 2015 by the Commissioners. At no point was the Pilot formally approved by either the Trust Board nor the Clinical Commissioner Group.

8. Once the Pilot had been stopped, a number of Board level meetings were held to establish how the Pilot had been initiated and governed. An internal review was conducted and a report submitted to the Governors in June 2015. NHS England undertook a review, concluding in September 2015.

9. After the two reviews, the chain of events was still unclear. Following intervention from Monitor (the health services sector regulator at the time) a third-party, external review was commissioned. It was agreed that Deloitte (a professional services firm) would be commissioned to undertake a forensic review.

10. On 20 November 2015, Deloitte were appointed. IW, Partner in Deloitte’s Forensics department, and two colleagues undertook the investigation. Over the course of the investigation, they interviewed 54 individuals and were given access to the Trust’s email server. Drafts of the report were handed to executive and non-executive directors to point out factual inaccuracies. Reported inaccuracies were identified and corroborated. The report was delivered 22 February 2016.

11. The matter was listed for a Final Hearing on 26 September 2022. Parties engaged in discussions leading up to the Final Hearing. On 26 September 2022, parties agreed to enter into VRA. The HCPC submit that, in the circumstances of this case, disposal by way of VRA is suitable. The Registrant accepts the substance of allegations one and two and that his fitness to practise is impaired.

12. The Registrant has not practised as a Paramedic for approximately eight years and does not intend to do so again.

Application for Voluntary Removal:

Submissions

13. Mr Smart told the Panel that a VRA is an agreement to the effect that the HCPC will not take any further action against the Registrant in relation to this matter on the understanding that he will be removed from the Register, cease from practising as a Paramedic and not attempt to re-join the Register for at least a period of five years.

14. He further explained that The Health Care Professions Order 2001 (the Order) does not provide for consent arrangements. However, the relevant Practice Note in relation to Disposal of Cases by Consent, states that the “disposing of cases by consent is an effective case management tool”. Mr Smart outlined that the effective test is rooted in the HCPC’s overarching statutory objective, protection of the public, namely that a Panel should not agree to resolve a case by consent unless they are satisfied that:

a. The appropriate level of public protection is being secured; and
b. Doing so would not be detrimental to the wider public interest.

15. Mr Smart referred the Panel to the case of Cohen v GMC [2008] EWHC 581 (Admin) where it was stated that there are “critically important public policy issues” which must be taken into account by Panels in fitness to practise proceedings, including the ‘public’ component of impairment. This ‘public’ component requires consideration of the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

16. Mr Smart submitted that the Panel could conclude the case on an expedited basis upon the terms of the draft Notice of Withdrawal put before it or reject that proposal and set the case down for a full, contested Final Hearing.

17. He explained that the Registrant has submitted the signed consensual disposal request and referred the Panel to a copy of the signed Voluntary Removal Agreement from the Registrant and the draft Notice of Withdrawal both contained in the bundle before the Registrant.

18. In relation to the HCPC’s investigation, Mr Smart explained to the Panel that following the outcome of the Investigating Committee Panel on 16 August 2019, Kingsley Napley LLP were instructed by the HCPC to conduct an investigation into the allegations referred to by the Conduct and Competence Committee. He referred the Panel to the documents obtained by Kingsley Napley LLP and used as part of the investigation.

19. Mr Smart submitted that, in all the circumstances, voluntary removal from the Register would be an appropriate means of resolving the current matter and compared to a Final Hearing, a VRA was a fairer and less stressful method of concluding the matter for both the Registrant and also the prospective HCPC witnesses.

20. Mr Smart further submitted that the appropriate level of public protection was afforded by this measure. He said that voluntary removal had the same effect as striking off as there was no higher sanction that a Panel could impose at a hearing. Mr Smart also submitted that a VRA in this case was not otherwise detrimental to the wider public interest. He suggested that the Panel could take the view that common-sense decisions like this enhance the public’s perception of the profession and its regulation.

21. Mr Smart explained to the Panel that there were no live issues that required ventilation at a public hearing and no further concerns about the Registrant, who is not practising as a Paramedic but who has continued to have a successful career in other public health sectors.

22. Mr Smart submitted that there was no evidence that the Registrant has consented to VRA to avoid sanction or otherwise circumvent the fitness to practise process. Rather, his intention to cease working as a Paramedic was genuine and evidenced by the fact that he has not been working as a Paramedic for the approximately 8 years. Mr Smart submitted that it was clear from his career since then that the Registrant had no intention of returning to work as a Paramedic in the future which removes any risk to patients such that public protection would be secured if the VRA is granted.

23. Mr Smart further submitted that permitting the Registrant to be removed from the Register under the terms of the Voluntary Removal Agreement is an appropriate and expeditious way of dealing with this matter.

24. In reply to an issue raised by the Panel after Mr Smarts submissions, Ms Herbert confirmed that the Registrant had chosen not to practice as a Paramedic for the preceding 8 years and had not been required to restrict his practise.

25. Ms Herbert referred the Panel to the Registrant’s documentation contained in the principal bundle provided by the HCPC to the Panel and in particular to the positive references provided on behalf of the Registrant. She told the Panel that since the date of the Allegation the Registrant had continued to work in important positions in other public health sectors and that there had been no concerns raised regarding him. Ms Herbert also told the Panel that there had been no regulatory concerns raised in relation to the Registrant prior to the date of the Allegation. She further submitted that the appropriate level of public protection was secured by the VRA and disposal by way of a VRA would not be detrimental to the wider public interest.

26. Ms Herbert also told the Panel that allegations arose out of concerns about the response time to 999 and 111 calls being met and issues with system categorisations. She said the purpose of the trial was to ensure no risk of harm and that the system piloted in the trial was now used throughout England.

27. Ms Herbert finally submitted that the proposed VRA was appropriate and proportionate.

28. The Panel accepted the advice of the Legal Assessor. He referred it to the HCPTS Practice Note on Disposal of Cases by consent and advised the Panel to adopt the approach set out therein. He advised that the Panel to be satisfied that the appropriate level of public protection was secured by the VRA and that disposal by a VRA would not be detrimental to the wider public interest.

Panel’s Decision:

29. The purpose of today’s hearing is for the Panel to consider a joint application from the HCPC and the Registrant to dispose of this matter by consent. Should the Panel agree to a consent order, in line with the VRA, it would allow the Registrant to be removed from the Register and the HCPC would take no further action in respect of the current fitness to practise matters.

30. In coming to its decision, the Panel considered all of the material before it. It considered the main evidence bundle of 1214 pages, including the Registrant’s bundle containing the Patient Impact Review and the various positive references provided on behalf of the Registrant. The Panel also took into account the HCPC’s supplementary bundle of 33 pages including the HCPC Skeleton Argument, the signed consensual disposal request pro-forma and the signed copy of the VRA in support of the application provided to the Panel in advance of the hearing.

31. The Panel took account of the written and oral submissions of Mr Smart, Ms Herbert’s oral submissions, the HCPTS Practice Note on Disposal of Cases by Consent and the advice of the Legal Assessor.

32. The Panel determined that this was an appropriate case for voluntary removal from the register. The Panel noted that the Registrant had engaged constructively with the regulatory process and that he had admitted to all of the allegations including the statutory ground of misconduct and impairment.

33. The Panel took into account that the Registrant has not practised as a Paramedic for approximately 8 years and has stated that he does not intend to return to the profession at any time in the future. The Panel also considered Ms Herbert’s submission that a VRA was the most appropriate and proportionate disposal for the Registrant.

34. The Registrant has signed the VRA which states that he will not practise as a Paramedic or use any protected title associated with the profession.

35. The Panel concluded that the public would be protected by the Registrant’s agreement to his removal from the register. In signing the agreement, he also understood that any application for restoration to register would be treated as if he had been struck off the register as a result of the allegation. The practical effect of the agreement was that he could not re-apply for restoration to the register for at least five years and were he to reapply for restoration he would have to satisfy the registrar that the concerns before the panel had been addressed.

36. The Panel was satisfied that a voluntary removal from the register was in the wider public interest for all the reasons that have been stated above. The view of the Panel was that a reasonable member of the public with knowledge of the facts of the case would agree that the public interest was served by resolving the matter by agreement. The Panel was therefore satisfied that proceeding in this way would not undermine public confidence in the profession or the regulator.

37. The Panel therefore approved the agreement as an appropriate and practical means of disposal of the case, and that it is consistent with public safety and the public interest.

38. On that basis, the Panel approved the signed VRA and the Panel Chair signed the Notice of Withdrawal.

The Panel grants the application for voluntary removal and directs the Registrar to remove the name of Mr Paul M Sutton from the Register.

No notes available

History of Hearings for Mr Paul M Sutton