Robert Northwood

Preliminary Matters

Service

1. The Panel was provided with confirmation that a Notice of Hearing had been sent by the HCPC on 12 January 2023, to the email address shown for the Registrant on the HCPC register. The Notice of Hearing confirmed the date, time, and venue of the hearing. Due to the withdrawal of the original registrant panel member and the limited availability of their replacement an amended Notice of Hearing was sent to the Registrant on 17 May 2023. The amended Notice of Hearing confirmed that the hearing had been reduced to 3 days commencing on 24 May 2023, which was Day 2 of the original listing. Prior to sending the amended Notice of Hearing the Registrant was informed, in an email dated 16 May 2023, that the reduced hearing time meant that the case would be adjourned part-heard and that the additional dates required to conclude the case would be sourced at a later stage.

2. The Panel noted that email delivery receipts were provided for both Notices of Hearing. The Panel also noted that it had been provided with confirmation of the Registrant’s registered email address.

3. The Panel was satisfied that notice of the hearing had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time, and venue) of the Conduct and Competence Committee Rules.

Proceeding in Absence

4. Ms Jones, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant under Rule 11 of the Conduct and Competence Committee Rules.

5. The Panel was advised by the Legal Assessor and accepted that advice. The Panel also took into account the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant.”

6. The Panel determined that it was fair and reasonable to proceed with the hearing in the absence of the Registrant for the following interrelated reasons:

i. The Panel noted that in an email, dated 17 May 2023, the Registrant stated:

“…this case has gone on for 4 years I retired from practice last December 2022 my 69th birthday is on the redacted this year after completing 50 years and 2 months service I will be spending my birthday touring redacted with the money I was spending on Solicitors fees which I was quoted 20 thousand pounds there are a lot of irregularities in witness statements but I do not wish to waste any more time and money on this process as I feel 4 years of mental torture is enough I just want to enjoy life…(sic)”

In these circumstances, the Panel was satisfied that the Registrant was aware of the hearing date and had made an informed decision not to attend the hearing and not to instruct lawyers to attend on his behalf. The Panel was satisfied that the Registrant’s decision to absent himself from these proceedings represented a deliberate and voluntary waiver of his right to attend.

ii. The Registrant has not made an application to adjourn and there is no indication that even if the case were to be adjourned that he would be willing to attend on any future date. Therefore, an adjournment would serve no useful purpose.

iii. The Panel noted that there may be some disadvantage to the Registrant in not being able to orally challenge the HCPC’s case or give evidence at the hearing. However, the Panel concluded that any potential disadvantage to the Registrant was significantly outweighed by the strong public interest in ensuring that the witnesses scheduled to give evidence are not unnecessarily inconvenienced and that the hearing commences and proceeds as expeditiously as possible.

Background

7. The Registrant is a registered Operating Department Practitioner (ODP). At the time of the relevant events, he was employed by Wolverhampton Hospital Nuffield Health (“the Hospital”) as an ODP.

8. On 10 September 2019 a referral was made to the HCPC by a Matron from the Hospital.

9. The referral confirmed that concerns had been raised by colleagues that the Registrant had displayed unprofessional behaviour in that he had thrown a privacy arm across the theatre floor in frustration. Further concerns were raised about the Registrant completing clinical observations prematurely by filling out a post-operative checklist while the patient was still in surgery. Premature and false clinical observations are said to have been recorded in respect of two service users. The Registrant was suspended from his duties on 9 July 2019.

10. The Hospital appointed Witness LW, the Superintendent of Magnetic Resonance Imaging (MRI) and Nuclear Imaging within the MRI and Nuclear Imaging department to investigate the concerns further. The investigation report, witness statements, capability records, and the related policies and procedures were attached to the referral.

11. Following the internal Hospital investigation, the Registrant’s case was referred for a disciplinary hearing. However, the Registrant resigned with immediate effect.

12. The HCPC conducted its own investigation and on 15 August 2022, at a preliminary hearing, the allegation referred to above was confirmed.
Hearsay Application

13. Prior to closing her case on the facts, Ms Jones made an application for the witness statement of Witness ES to be admitted as hearsay evidence. Witness ES had provided a signed witness statement to the HCPC on 4 December 2021 and was notified that she had been scheduled to give evidence on 24 May 2023, in an email dated 12 January 2023. The hearings officer confirmed that attempts had been made to contact Witness ES in the week leading up to the hearing and during the hearing itself including a telephone call to the university where she had been studying at the time she signed her witness statement. However, the university stated that it would not be able to provide any information for data protection reasons and the hearing officer did not receive any response to the emails and telephone calls that she made.

14. Ms Jones submitted that all reasonable efforts had been made to secure the attendance of Witness ES. She further submitted that the HCPC had no reason to suspect that Witness ES would not attend the hearing as she stated in her witness statement that she was willing to attend. Ms Jones invited the Panel to conclude that no injustice would be caused by admitting the hearsay evidence of Witness ES as it is a first-hand account and provides reliable evidence based on events that occurred during the course of her employment at the Hospital.

Hearsay Decision

15. The Panel accepted and applied the advice of the Legal Adviser.

16. The Panel noted that Witness ES was a full-time student completing a diploma in operating department practice when she provided her witness statement. However, at the time of the relevant events she was a Theatre Support Assistant at the Hospital and had been in that role for approximately five years.

18. Nonetheless, the Panel noted that the evidence of Witness ES was relevant to the allegation that the Registrant threw a privacy arm across the theatre floor. Witness ES was said to have been present at the time and her evidence corroborates the account of the incident provided by Witness NC. Therefore, the evidence of Witness ES was not the sole and decisive evidence. The Panel also noted that both of these witnesses were interviewed during the internal Hospital investigation and therefore the Registrant had been given the opportunity to challenge their evidence. Although there would be no opportunity for the Panel to ask questions of Witness ES, the Panel concluded that no injustice would be caused by admitting the evidence of Witness ES as hearsay evidence.

19. In these circumstances, the Panel granted the application made by Ms Jones, on behalf of the HCPC, and admitted the witness statement of Witness ES as hearsay evidence.

Decision on Facts

Particular 1 – Found Proved

“On 2 July 2019 you displayed unprofessional and/or inappropriate behaviour in that you aggressively threw a privacy arm across the theatre floor.”

20. Witness NC, who was a theatre practitioner at the hospital on 2 July 2019, provided the HCPC with a witness statement and gave oral evidence at the hearing.

21. Witness NC stated that while the Registrant was in the anaesthetic room with a patient, the consultant ophthalmic surgeon and the team were in the operating room setting up the theatre and preparing for the case. The consultant surgeon stated that he was going to sit on the patient's left-hand side to do the procedure. In order for him to do this, the privacy arm needed to be removed from the side of the operating table and affixed to the other side of the table. Witness NC explained in her witness statement that a privacy arm is a black bendable arm which has oxygen tubing coming through it. The eye drape material is draped over the privacy arm so that the patient does not feel claustrophobic, and the material is not directly in contact with the entirety of the face. The oxygen tube is connected and pushes through the metal bar. Witness NC removed the privacy arm and placed it next to the operating table. She stated that she did not affix the privacy arm to the other side of the table as the patient need
ed to be transferred onto that table when they were brought in from the anaesthetic room and it would have been in the way.

22. Witness NC stated, during her oral evidence, that the theatre team was “a bit rushed” as they could not finish lunch because the surgeon wanted to finish his list. She stated that once the patient was brought into the operating room the Registrant said, "why has the privacy arm been removed?". She stated the Registrant raised his voice as he asked this question but was not shouting. Witness ES, the Theatre Support Assistant, informed the Registrant that the privacy arm had been moved because the consultant surgeon was sitting on that side, and that once he had sat down and the patient had been transferred the intention was to reattach it to the opposite side. The Registrant then repeated the question and so Witness NC thought he had not heard the answer the first time. After the Registrant asked the question, Witness NC recalled that either she or Witness ES replied.

23. The patient was transferred onto the operating table and the Registrant then reached over to get the oxygen tube, which was attached to the bottom of the privacy arm, and held it up. The Registrant then said "when I ask for something I mean get it now" which was confusing to Witness NC as he had not asked for anything. The Registrant was very abrupt in his tone. During her oral evidence, Witness NC described the Registrant as being “loud and slightly aggressive in his manner”. The Registrant then picked up the privacy arm and threw it. The privacy arm was thrown in the direction of Witness ES. Witness NC was unsure if the Registrant meant to throw it in that direction but believed that he threw it in frustration. She stated during her oral evidence that she was “shocked”. Witness NS then observed the Registrant looking around as if searching for something. She thought it was the oxygen mask as at that point he left to go to the anaesthetic room and came back with an oxygen mask in his hand.

24. During the internal Hospital investigation the Panel noted that the Registrant denied that he had thrown the privacy arm. He stated during his interview that he had “bolted” the privacy arm to the table but then found it lying on the floor. He stated that he was annoyed and had to compose himself by taking deep breaths but was not aggressive in his demeanour. He suggested that Witness NC and ES did not like the way he had spoken to them and were trying to get him into trouble.

25. The Panel found the evidence of Witness NC to be clear, compelling, and consistent with the evidence she gave during the internal Hospital investigation. The Panel had no reason to doubt that Witness NS gave an honest account of the events which occurred in the operating room on 2 July 2019. The Panel accepted her evidence as truthful and accurate. In reaching this conclusion the Panel noted that the evidence of Witness NS was corroborated by the witness statement of Witness ES. Witness ES stated that the privacy arm did not hit her, and she did not think that the Registrant threw it at her on purpose. Although the evidence of Witness ES had not been tested by cross-examination and the Panel had been unable to ask her any questions the Panel concluded that her evidence could be given considerable weight. It was consistent with Witness NC’s account and consistent with the account that both witnesses had given during the internal Hospital investigation.

26. The Panel had no hesitation in concluding that throwing equipment in an operating room was wholly unprofessional and inappropriate. The Panel noted that the Registrant had raised his voice shortly before throwing the privacy arm and concluded that it had been thrown aggressively because he was annoyed.

27. For these reasons, the Panel found particular 1 proved.

Particular 2 – Found Proved

“On 9 July 2019 you did not accurately record clinical observations, in that you prematurely and falsely recorded observations in relation to NEWS2 scores of: a. Service User X [and/or] b. Service User Y”.

28. Witness HM is the Matron and Head of Clinical Services within the Hospital. She stated in her witness statement, dated 8 November 2021, that on 9 July 2019, she was the team leader and scrub practitioner for theatre 4. She noticed that on the anaesthetic machine, the observation chart, also known as a NEWS2 chart, for Service User X had been left in the theatre. Witness HM informed the Panel, in her witness statement, that an observation chart contains sections to record information such as the patient's heart rate, blood pressure, oxygen saturation, pain score, and sickness score. Observations are usually taken in theatre before the surgery and always taken in recovery before the patient returns to the ward. The different sections on the chart are completed at different times so that the patient's various scores can be recorded during their journey from pre-surgery to post-surgery.

29. Witness HM recalled that Service User X was having a cataract extraction. In her witness statement, she stated that she asked Witness NC to take the observation chart to the recovery area for the Registrant as he was recovering the patient. Witness HM stated that Witness NC subsequently returned and said that the patient had already left the recovery area and they were returning to the ward. Witness HM was scrubbed at this point and did not want to touch the observation sheet and so Witness NC opened it. Witness HM noted that Service User X’s observations such as heart rate, blood pressure, and pulse had been recorded. During her oral evidence, Witness HM stated that this was significant because the observation chart had remained in the theatre and had not gone to recovery with the patient.

30. Witness HM stated in her witness statement that Service User Y was the last patient on the list. The Registrant’s line manager, Witness CT, requested that Witness HM show her the observation chart for Service User Y when the observation chart came into the theatre. When Service User Y arrived in the theatre the patient notes were there. However, the observation chart was not. Witness HM left theatre 4 whilst the patient was still being operated on to inform Witness CT and noticed that the observation sheet was in the recovery bay. Witness HM took the observation chart to Witness CT. When it was opened Witness HM noted that the recovery observations had already been documented despite Service User Y still being in the operating theatre. Details such as the patient's heart rate, blood pressure, and pulse had already been recorded.

31. The evidence of Witness HM was corroborated by the evidence of Witness CT. Witness CT stated in her witness statement that she checked the observation chart for Service User Y. She noticed that the observations stated 'recovery' and a full set of recovery observations were recorded including respiratory rate, pulse, blood pressure, and oxygen saturations. She immediately took the chart and went into the theatre with Witness HM and they both confirmed that Service User Y was still on the operating table mid-procedure.

32. The Panel noted that the Registrant indicated during his interview (which formed part of the internal Hospital investigation) that the allegations relating to the patient notes were a form of victimisation. He suggested that he was being victimised because “he made them looked stupid” which was a reference to Witness ES and Witness NC. He stated (in relation to Service User X) that he did not know how the patient notes with a blood pressure reading were left in the theatre whilst the patient was taken back to the ward. He also did not know how (in relation to Service User Y) the patient notes were in recovery with observations recorded including blood pressure whilst the patient was still in surgery.

33. The Panel accepted the evidence of Witness HM and CT. The witness statements and oral evidence of both witnesses were clear, compelling, and consistent with the evidence they provided during the Hospital investigation. The Panel was satisfied that their evidence clearly demonstrated that the Registrant had documented recovery observations prior to Service Users X and Y entering recovery or at the end of the surgical procedure. In both instances, as the patients were not in recovery at the time the observations were recorded and therefore these readings did not accurately reflect the post-operative conditions of those patients.

34. For these reasons, the Panel found particular 1 proved.

Particular 3 – Found Proved

“Your conduct in relation to particular 2 was dishonest.”

35. The Panel, having found particular 2 proved, went on to consider the issue of dishonesty.

36. An ODP is required to complete the observation form after surgery when the patient is in recovery. The Panel was satisfied that the Registrant knew that completing the observation chart whilst observing the patient in recovery is an important part of ensuring patient safety. Postoperative patients must be monitored and assessed closely for any deterioration in condition so that the relevant postoperative care plan or pathway can be implemented. Completing the observation chart at the incorrect time will not reflect the true state of the patient's health and well-being and this has the potential to affect how the patient is monitored when they return to the ward. Furthermore, completing an observation chart with post-operative readings whilst the patient is still in on the operating table cannot be based on accurate and reliable observations.

37. The Panel concluded that at the time the Registrant completed the observation charts he knew that the readings were inaccurate. The Panel noted that during his Hospital interview, the Registrant expressed concern that he could have up to 20 patients a day and sometimes he would not have time to complete the care plans. He stated that he would write the observations “towards the end” and take the patient’s blood pressure in recovery. He also stated that the amount of work that he did was “phenomenal”.

38. In the absence of direct evidence from the Registrant the Panel was unable to assess whether the observations were completed prior to recovery to save time. Whether this was the Registrant’s motivation or whether he recorded observations prior to the patient’s transfer to recovery for other reasons the Panel concluded that the recording was false. The Registrant knew they were false as they did not accurately reflect the patient’s condition at the time they were purported to have been made.

39. The Panel was satisfied that the Registrant had a duty to ensure that his clinical notes were accurate. The Panel concluded that the inaccuracy of the observation charts was not a mistake or the result of a misunderstanding. It was a conscious and deliberate act, and the Panel was satisfied that the Registrant’s actions were dishonest by the standards of reasonable and honest people.

40. Accordingly, particular 3 in relation to particular 2 was found proved.

Decision on Grounds

41. The Panel, having found particulars 1, 2, and 3 of the Allegation proved, went on to consider whether these findings amount to misconduct.

The Panel’s Approach

42. The Panel was aware that determining the issue of misconduct is a matter of judgement; there is no standard of proof.

43. The Panel took into account the submissions made by Ms Jones on behalf of the HCPC and accepted the Legal Assessor’s advice.

44. The Panel was aware that a breach of the HCPC’s Standards of Conduct, Performance and Ethics (‘the Standards’) alone does not necessarily constitute misconduct. A departure from the Standards is a starting point and is relevant, but it is not determinative of misconduct and does not create a presumption of misconduct.

45. The Panel also bore in mind the explanation of the term ‘misconduct’ given by the Privy Council in the case of Roylance v GMC (No.2) [2000] 1 AC 311 where it was stated that:

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

46. In Nandi v GMC [2004] EWHC 2317 (Admin) Collins J observed:
“The adjective ‘serious’ must be given its proper weight and in other contexts there has been reference to conduct which would be regarded as deplorable by fellow practitioners.”

Decision

47. The Panel considered the HCPC Standards of Conduct, Performance and Ethics (January 2016) and was satisfied that the Registrant’s conduct breached the following standards:

• 9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
• 10 - You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
48. The Panel also considered the Standards of Proficiency and took the view that the Registrants actions breached the following standards:
• 3.1 - understand the need to maintain high standards of personal and professional conduct.

• 8.1 - be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues, and others.

• 9.1 - be able to work, where appropriate, in partnership with…other professionals, support staff and others

• 10.1 - be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines.

Unprofessional and Inappropriate Behaviour

49. The Panel acknowledged that working as an ODP within a busy theatre can be a pressurised environment and noted that Witness NC stated during her oral evidence that the theatre team was “a bit rushed”. However, even allowing for the stressful circumstances, the Panel was satisfied that the Registrant’s unprofessional and inappropriate behaviour fell far below the standards expected of a registered ODP.

50. It was wholly unacceptable for the Registrant to throw equipment across a theatre room in frustration. Throwing equipment in a confined space with others present would be inappropriate in any setting but was aggravated by the fact it took place in a professional working environment. The Registrant was in a position of trust and his actions had the potential to cause harm to others. His colleagues and employers were entitled to expect that he would manage his emotions and conduct himself in a professional manner at all times. By aggressively throwing the privacy arm across the theatre floor the Registrant failed to uphold the high standards of professional conduct and behaviour expected of a registered ODP.

51. Although the Registrant’s behaviour may have been a momentary failure or a temporary lapse of judgment, the Panel was satisfied that it was sufficiently serious to amount to misconduct.

Dishonestly Recording Inaccurate Clinical Observations

52. The Registrant falsely recorded observations for Service Users X and Y. He knew what he was doing was wrong, but he chose to do it anyway. Such dishonesty is inherently serious as it demonstrates a complete disregard for the policies and protocols in place which are designed to promote patient safety. It is essential that colleagues and patients and other professionals can rely on the honesty and integrity of registered ODPs as their clinical records form the basis for the current and future care of patients. In making false entries on the observation forms the Registrant chose to put his own interests above the interests of service users, his obligations as an ODP and breached his employer’s trust and confidence.

53. Furthermore, the willingness and ability to adhere to high standards of behaviour at all times are fundamental to safe and effective practice as an ODP. The Registrant’s failure to adhere to these high standards, albeit in relation to two patients on a single day, had the potential to expose patients to harm.

54. In these circumstances, the Panel concluded that the Registrant’s conscious and deliberate dishonesty amounts to misconduct.

Resumed hearing 14 July 2023

Service and Proceeding in Absence

55. At the outset of the reconvened hearing the Panel confirmed that it was aware that the Registrant had been put on notice of today’s date (14 July 2023) and the additional date of 16 August 2023, if required. The Panel noted that in an email response dated 12 June 2023, the Registrant stated:

“…I retired December 2022 after 50 year’s practice I no longer intend to work in the appalling circumstances of heath care I am enjoying retirement touring redacted final word goodbye (sic)”

56. The Panel concluded that for the same reasons it set out on Day 1 of the hearing, the resumed hearing should proceed in the Registrant’s absence.

Decision on Impairment
Panel’s Approach

57. Having found misconduct the Panel went on to consider whether the Registrant’s fitness to practise is currently impaired. The Panel took into account the HCPTS Practice Note: “Finding that Fitness to Practise is Impaired” and accepted the advice of the Legal Assessor.

58. In determining current impairment, the Panel had regard to the following aspects of the public interest:
• The ‘personal’ component: the current behaviour etc. of the individual registrant; and
• The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

Panel Decision

59. The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective.

60. The Registrant, in acting dishonestly, inappropriately, and unprofessionally, demonstrated a lack of judgment, abused his position of trust, and completely disregarded the impact of his behaviour on others including his colleagues and patients. The Registrant chose to put his own interests first and when challenged during the internal Hospital investigation accused his colleagues of telling lies.

61. There has been no engagement from the Registrant during the hearing. As a consequence, there was no evidence before the Panel that he fully appreciates the gravity of his conduct and behaviour and had reflected on the impact of his behaviour on his colleagues and former employer. The Panel was mindful that the Registrant’s colleagues and his employer were entitled to expect him to be open and honest with regard to his clinical observations and to act professionally whilst working in a clinical setting. There was also no explanation as to how he would behave differently in the future and no assurance that the deficiencies in his professional conduct have been remedied.

62. The Panel was particularly concerned that the Registrant’s dishonesty was repeated which indicates a fundamental failure to understand and take seriously his professional obligation to be trustworthy at all times.

63. The Panel recognised that demonstrating remediation in a case involving dishonesty is particularly difficult, as probity issues are reliant on attitude, which can often only be inferred from conduct. The Panel noted that the Registrant’s dishonest conduct relates to a discrete set of circumstances, which may have the potential to be remediated, provided that there is evidence of sincere and meaningful reflection that demonstrates that the dishonesty is firmly in the past and is not a deep-seated attitudinal trait. However, the Registrant has provided no information that would assist the Panel in this regard. His dishonest conduct demonstrates a conscious and deliberate decision to record false observations and the Panel took the view that in the absence of any insight and any steps he has taken towards remediation the risk of repetition is high.

64. The Panel concluded that for these reasons the Registrant’s fitness to practise is currently impaired based on the personal component.

65. In considering the public component the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.

66. Members of the public would be extremely concerned to learn that a registered ODP had made false entries in the clinical records of two patients and had aggressively thrown equipment in a theatre room. The Panel took the view that members of the public recognise that it is critically important that clinical records are accurate given that reliance is placed on these records by colleagues and other professionals in order to protect the health and well-being of patients. It is equally important that colleagues are treated with respect and dignity in the workplace.

67. The Registrant’s conduct not only placed colleagues and patients at risk of harm, but also brought the profession into disrepute, undermined a fundamental tenet of the profession and demonstrated that his integrity could not be relied upon. As a consequence, the Panel concluded that public confidence would be significantly undermined if a finding of fitness to practise was not made, given the nature and seriousness of the Registrant’s conduct.
68. The Panel concluded that the Registrant’s current fitness to practise is impaired on the basis of both the personal component and the public component and therefore the HCPC’s case is well-founded.

Decision on Sanction
Panel’s Approach

69. The Panel accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of any sanction is not to punish the Registrant but to protect the public and the wider public interest. The public interest includes maintaining public confidence in the profession and the HCPC as its regulator and upholding proper standards of conduct and behaviour. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity.
70. The Panel had regard to the Sanctions Policy (SP) and took into account the submissions made by Ms Jones, on behalf of the HCPC. The Panel received no submissions from the Registrant.

Decision

71. In determining what sanction, if any, to impose the Panel identified the following aggravating factors:

• The absence of insight, remorse, and apology;
• The absence of any evidence that the Registrant has taken steps towards remediation;
• The risk of harm to colleagues and patients as a consequence of the Registrant’s dishonesty and failure to work in partnership with colleagues;
• The dishonesty was repeated and together with the act of aggression demonstrates a pattern of unacceptable behaviour in the workplace.
• The Registrant did not simply deny the allegations during the internal Hospital investigation; he cast aspersions on the motivations of his colleagues and accused them of lying.

72. The Panel was unable to identify any mitigating factors, other than the Registrant’s previous unblemished record within the context of a long career. The Panel noted that the Registrant was well-regarded as an experienced and competent ODP. However, the Panel concluded that this did not amount to a mitigating factor as there was no criticism of his clinical skills and, in any event, clinical competence cannot mitigate dishonesty and unprofessional behaviour.

No Action

73. The Panel first considered taking no action. The Panel concluded that, given the nature and seriousness of the Registrant’s unprofessional behaviour and repeated dishonesty, to take no action on his registration would be wholly inappropriate.

74. Furthermore, in the absence of exceptional circumstances, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

Caution Order

75. The Panel went on to consider a Caution Order. The Panel noted paragraph 101 of the ISP 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.”

76. As the Registrant has demonstrated no insight into his misconduct, provided no evidence of remediation and whilst the risk of repetition remains, the Panel concluded that a Caution Order would be inappropriate. In any event, the Panel concluded that a Caution Order would be insufficient to protect the public and meet the wider public interest given the nature and gravity of the Registrant’s conduct and behaviour.

Conditions of Practice Order

77. The Panel went on to consider a Conditions of Practice Order. The Panel noted that in paragraphs 107 and 108 the SP states:

78. “107. Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings.
108. Conditions are also less likely to be appropriate in more serious cases, for example those involving:
• dishonesty…
• failure to work in partnership…”

79. The Panel noted that it would be unusual to address findings of dishonesty and unprofessional behaviour by imposing a Conditions of Practice Order as such conduct is based on an attitudinal failing. The Registrant’s dishonesty was repeated and together with the act of aggression demonstrated a pattern of inappropriate behaviour within a short period of time; the two events having taken place within 7 days of each other.

80. Although in theory the Registrant’s dishonesty and unprofessional behaviour are capable of being remedied, such remediation requires an ability to be self-critical, demonstrate an understanding of what went wrong and an appreciation that he should have acted differently to ensure that similar incidents will not occur in the future. However, there was no evidence before the Panel that the Registrant is willing to take active steps to remedy his misconduct. On the contrary, he has made it clear in correspondence with the HCPC that he has retired from practice and has completely disengaged from the regulatory process. As a consequence, there is no incentive for him to remediate the impairment of his fitness to practise. In these circumstances, the Panel could have no confidence that he would comply with conditions even if appropriate conditions could be formulated.

81. Therefore, the Panel concluded that it would not be possible to formulate appropriate conditions that would be workable, measurable, or proportionate. In these circumstances, the Panel determined that conditional registration would undermine rather than uphold public confidence in the profession and high standards of conduct and behaviour.

Suspension Order

82. The Panel next considered a Suspension Order. A Suspension Order would re-affirm to the Registrant, the profession, and the public the standards expected of a registered health professional. The Panel noted that a Suspension Order would prevent the Registrant from practising as an ODP during the suspension period, which would therefore provide a degree of protection to patients and the public. However, the Panel took the view that given the nature and seriousness of the Registrant’s repeated dishonesty and his unprofessionalism in the workplace, a Suspension Order would not be sufficient to maintain public confidence in the profession and the regulatory process. It would also not have a deterrent effect on other registrants. In reaching this conclusion the Panel took into account the Registrant’s non-engagement during the hearing and noted the observation of Mitting J, in NMC v Parkinson [2010] EWHC 1898 where he stated:

“A [practitioner] found to have acted dishonestly is always going to be at severe risk of having his or her name erased from the register. A [practitioner] who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than to direct [A Striking Off Order].”

83. The Panel noted that there was no evidence of insight, remorse, or apology. There was no evidence to support a finding that the issues were unlikely to be repeated and no evidence that the Registrant is willing to resolve or remedy his failings. The Panel concluded that as a consequence of the Registrant’s non-engagement with the regulatory process, there was no information available that offered the Panel the opportunity to exercise leniency.

84. Having determined that a Suspension Order does not meet the wider public interest the Panel determined that the Registrant’s name should be removed from the Register.

Striking Off Order

85. The Panel acknowledged that a Striking Off Order is a sanction of last resort and should be reserved for those categories of cases where there is no other means of protecting the public or the wider public interest. The Panel decided that the Registrant’s case falls into this category because of the nature and gravity of his dishonest conduct, unprofessional behaviour, his lack of insight, and the high risk of repetition. The Registrant’s dishonest conduct was repeated, and the Panel concluded that any lesser sanction would undermine public trust and confidence, as members of the public are entitled to expect honesty from registered practitioners at all times.

86. The Panel had regard to the impact a Striking Off Order would have on the Registrant but concluded that his interests were significantly outweighed by the Panel’s duty to give priority to the significant public interest concerns raised by this case.

87. In these circumstances the Panel decided that the only appropriate and proportionate order is a Striking Off Order.

The Registrar is directed to strike the name of Mr Robert Northwood from the Register on the date this order comes into effect.

Interim Order

88. Ms Jones made an application on behalf of the HCPC, for an 18-month Interim Suspension Order to cover the 28-day appeal period and, if necessary, any appeal on the grounds that is in the interests of the public protection and the wider public interest.

89. The Panel accepted the advice of the Legal Assessor that an interim order will only be justified, if it is necessary for the protection of members of the public, is otherwise in the public interest or the interests of the Registrant himself.

90. The Panel determined that an Interim Suspension Order is necessary for the same reasons that the substantive Striking Off Order was imposed. The Registrant, as it stands, is on the Register and will be able to practise as an ODP even though he has indicated that he has retired and has no intention of returning to practise. If the Registrant were to change his mind, he would be able to practise until the substantive order comes into effect. In these circumstances, the Registrant would present an unwarranted risk to the public and unrestricted registration would undermine the public’s trust and confidence in the integrity of the Register and the regulatory process.

91. Accordingly, the Panel determined that the Registrant’s registration should be suspended on an interim basis. The Interim Suspension Order is necessary to protect the public and to maintain and uphold trust and confidence in the profession.

92. The Panel has concluded that the appropriate length of this Interim Suspension Order should be 18 months, as the interim order would continue to be required pending the resolution of an appeal in the event that the Registrant submits a Notice of Appeal within the 28-day period.

History of Hearings for Robert Northwood