Sarah McCamley

Preliminary Matters
Application to adjourn
1. Mr Marsland sought an adjournment as he stated that the current five days allocated to the hearing would be insufficient. He submitted that he did not want the case to go part heard given the Registrant was not ready to proceed at this stage. He explained that this case appeared straightforward regarding an allegedly forged training certificate submitted by the Registrant. She had later accepted that this had been forged when confronted and she had made submissions to the HCPC on 2 July 2020 admitting that allegation at the Investigating Committee Panel (ICP) stage.

2. However, Mr Marsland told the Panel that when Blackfords solicitors had been instructed by the Registrant on 27 October 2022 it emerged that the Registrant’s position had altered. On 18 November 2022 the HCPC were advised by email that the Registrant now denied any involvement in the submission of the forged certificate which had been emailed by her ex-partner, TC, without her knowledge and consent. He submitted that TC had controlled her application and he had emailed the training certificate to Your World Recruitment Agency, a matter that was not disputed.

3. Mr Marsland submitted that this was most unfortunate but the issues had only become clear last week (18 November 2022) when he had a conference with his client and her instructing solicitor. He submitted that the defence lawyers had not yet been able to make the necessary inquiries to support the Registrant’s case. Mr Marsland advised that there were ongoing inquiries regarding possibly calling another witness from Your World Agency, JM. He is not an HCPC witness and the solicitors for the Registrant had yet to contact him. Mr Marsland said that it appeared the Registrant’s ex-partner, TC, had also been referred to the HCPC and was subject to disciplinary action at the Salisbury Hospital where he works and this was, apparently, regarding him authorising training without authority to do so.

4. Mr Marsland said that the Registrant wanted to put before the Panel evidence about TC’s conduct, that he was in control of her application to Your World agency at the time, and he had submitted a forged certificate.

5. Mr Marsland said it would be unfair to start the hearing in these circumstances and the Registrant was not able to begin the hearing now given the ongoing inquiries. He said that the five days for the hearing was, in any event, insufficient and the case would inevitably go part heard. Mr Marsland submitted that a part heard hearing would not be appropriate as it would cause delay to the case. He submitted that it was clear TC had submitted the forged certificate and a delay would not be prejudicial as this was a case based on the documentation, and that it was undesirable to proceed knowing the matter would go part heard. He submitted that this would be prejudicial to the Registrant. The Registrant clarified that her relationship with TC had ended in December 2021.

6. Mr Bridges for the HCPC submitted that the application to adjourn was opposed. He said that the Registrant had been advised of the Allegation on 20 July 2020 and the Council’s Final bundle was disclosed to her on 23 August 2021. He said that the HCPC had three witnesses ready for this hearing. He referred the Panel to the HCPTS Practice Note on Postponement and Adjournment of Proceedings.

Decision on adjournment
7. The Legal Assessor referred the Panel to the HCPTS Practice Note on Postponement and Adjournment of Proceedings and the central entitlement of the Registrant to a fair hearing. He referred to the guidance in CPS v Picton (2006) EWHC 1108 and the need to balance the public interest with the need for expedition and fairness.

8. The Panel considered the submissions from Mr Marsland and Mr Bridges. It accepted the legal advice and was mindful of the need for fairness to the Registrant. The Registrant has instructed solicitors and Counsel. She has altered her position, as she is entitled to do, and her current position in relation to the Allegation was explained to the Panel by Mr Marsland. The Panel noted that her solicitors were instructed over three weeks ago and the hearing bundle was disclosed to the Registrant in August 2021. The events in question took place over three years ago.

9. The HCPC has three witnesses ready to give evidence at this hearing and they speak to the alleged forged training certificate.

10. It appears to the Panel from the witness statements that the evidence of three HCPC witnesses is such that they could not meaningfully be questioned about the Registrant’s defence, and there is no submission that any of them are able to assist to any material extent. Given the nature of the Registrant’s defence, and the narrow, documentary focus of the evidence of the HCPC witnesses, it is not apparent to the Panel on what fair and proper basis their evidence should not be heard at this hearing and ought to be delayed.

11. The Panel was satisfied that the Registrant's defence can, at this stage, be properly and fairly put to the HCPC witnesses by Mr Marsland. It will be for the Registrant in due course to set out her defence in her own evidence, along with any other evidence she chooses to rely upon. It is not clear to the Panel that the inquiries that are apparently still to be made by her solicitors materially contribute to the Registrant’s ability to fairly present her case at this stage. Some of those inquiries could, in any event, be made now during the hearing before the Registrant’s case is presented.

12. The Panel was mindful of balancing fairness, the public interest, the need for expediency and the avoidance of undue delay, which is not in the interest of any party. Given the nature of the Registrant’s defence as presently understood, the Panel did not find that she is currently unable to fairly and properly present her case, or that her ability to present her case and defend her position is compromised to a degree that justifies an adjournment. The Panel concluded that in all the circumstances, it was fair to proceed with the hearing. The Registrant is competently represented by Counsel, and it is in the public interest to proceed and not to delay the hearing.

13. The Panel did not agree that five days allocated to the hearing will necessarily be insufficient and, in any event, that alone is not sufficient to justify adjournment at this stage and the consequent delay in conducting the hearing. There is often a risk of a part-heard hearing, but that does not in this case justify adjournment and the creation of delay. The application to adjourn is refused.

Application to amend the Allegation
14. During the hearing, Mr Bridges advised that a minor amendment to the Allegation was sought to insert “and/or” between the numbers 1 and 2 in Particular 4 of the Allegation so that it reads:- “Your conduct set out in paragraphs 1 and/or 2, and/or 3 was dishonest.” Notice was given to the Registrant on 9 November 2021. This application was not opposed by Mr Marsland and the Panel accepted the legal advice of the Legal Assessor as to fairness and the interests of justice. The Panel decided to allow the amendment. It is a minor amendment that does not alter the nature or gravity of the Allegation as a whole, and it causes no prejudice to the Registrant.

Directions
15. During the hearing, directions were discussed regarding the referral made to the HCPC in respect of TC, also an Operating Department Practitioner (ODP) and an HCPC registrant, and about a defence statement from the Registrant who had not lodged a witness statement. Having heard from the parties, and having taken legal advice, the Panel directed that a formal defence statement be lodged by the Registrant by 9.30 am on Thursday 24 November 2022 (day three of the hearing). The Panel decided that it was not appropriate to order any disclosure in respect of the referral of TC as that was a matter for the HCPC to make such disclosure as it can at this stage. Mr Bridges advised that the public decision in respect of TC on 27 July 2022 was now available. Mr Marsland advised that, rather than a defence statement, he was intending to lodge a formal witness statement from the Registrant. This was received by the Panel on 24 November 2022.

Background
16. The Panel heard from the Registrant as well as three witnesses:-
• SD, Your World Agency
• JV, Theatre Services Manager
• LB, Matron for the Trust

17. The Registrant is a registered (ODP) who was employed by Yeovil District Hospital NHS Foundation Trust (‘the Trust’) between April 2010 and November 2016. She re-joined as an agency ODP in January 2018.

18. During July 2019, the Registrant was employed to work at Yeovil District Hospital via the agency Total Assist. She submitted a mandatory training record to Your World which was passed on to Yeovil District Hospital Academy (the Academy) to verify. The Academy did not recognise the signature, which was queried with the Registrant by witness, LB, a Matron for the Trust.

19. At a meeting on 9 August 2019, the Registrant allegedly told LB, that she had not attended the training in the Academy or attended any other recent training to reflect the training certificate. She allegedly admitted that she had made up the training record, forged the signature and used the Trust’s logo to make the document appear official. Witness, JV, Theatre Services Manager at Yeovil District Hospital, raised a Fitness to Practise Concern with the HCPC on 20 August 2019.

20. The allegation was denied by the Registrant.

Summary of Evidence
Witness 1 - JV
21. The Panel heard from JV. She is a senior nurse, General Manager and the Lead Nurse for Theatre Services, Anaesthetics and Critical Care at the Trust and was in that role at the time of the allegation. She adopted her witness statement as her evidence in chief. She told the Panel about the email she had received from the Academy on 30 July 2019 in respect of the Registrant. She said that the signature on the training certificate was not recognised by her and she queried it and asked a colleague, LB, to contact the Registrant to clarify.

22. JV told the Panel that LB contacted the Registrant and showed her the certificate and JV then received a meeting note from Human Resources at the Trust on 9 August 2019 reporting that the Registrant had admitted to JV that she had forged the certificate and had not attended any recent training at the Academy. JV also said that she had reviewed the Registrant’s training record and that it seemed that they were a “random list of modules.”

Witness 2 – SD
23. The Panel heard from SD. She is a registered Nurse who was employed at the time of the allegation by Your World. She left in March 2021. At the Agency she worked as a registered nurse and dealt with any clinical incidents, concerns or matters. This could include complaints handling, disciplinary action, and governing body investigations. She also conducted clinical interviews and appraisals.

24. SD told the Panel that on 6 April 2018, the Registrant was in the process of applying to register as an agency ODP with Your World. She was applying for an ODP role within Anaesthetic and Recovery (Operating Theatres) roles. SD produced a copy of the Registrant’s application. In her witness statement SD stated that as part of Your World’s on-boarding, they required information about candidates’ training and requested certificates to demonstrate this. She stated that the Registrant’s partner, TC, had sent a training certificate/record dated 7 April 2019 to her colleague at Your World, JM, on 14 June 2019. She told the Panel that she understood he still worked at the Agency.

25. SD stated that, as a matter of course, the training certificates that are sent in by candidates are verified by the hospitals. As far as she was aware, her colleague JM emailed the hospital to verify the Registrant’s certificate. JM then received an email from JV on 22 August 2019 confirming that the training record the Registrant had submitted had been falsified by her, and so Your World had terminated her application process to be placed into ODP roles.

26. SD told the Panel that JV had attached a letter to the email addressed to the Registrant dated 19 August 2019 confirming the outcome and that she was not going to be used by the Trust as an agency ODP anymore. SD produced copies of the correspondence between JM and the Registrant requesting various documents and information, and scheduling tests. She stated these emails were between 13 June 2019 and 20 August 2019, and that emails would likely have been kept by Your World. SD did not recall whether Your World had been advised by the Registrant not to deal with emails from any third parties such as TC. SD said that she recalled being advised that the Registrant had been referred to the HCPC.

Witness 3 – LB
27. LB is employed by the Trust and is a registered nurse. She knew the Registrant in her capacity as Matron for the Trust, but did not work directly with her. She adopted her witness statement as her evidence in chief. She told the Panel that she was presently seconded to NHS England.

28. In her witness statement, she told the Panel that on 5 August 2019, she had received an email from their Education Department Academy asking her about a training certificate that the Registrant had provided. She produced a copy of the email and the certificate dated 7 April 2019. Your World Agency, whom the Registrant was in the process of registering with, had contacted the Academy to verify the Registrant’s mandatory training certificate and the Academy had then raised this with LB. LB said she was not familiar with the signatures for the Academy, and said that the amount and names of the modules on the certificate raised a few alarm bells as they did not reflect the sort of training done at the Academy. It was put to LB that on 5 August 2019 she had met the Registrant and provided her with a copy of the certificate, but LB said that she did not recall when she first met with the Registrant or discussed the matter. She did not recall meeting the Registrant on 7 August 2019.

29. LB said that she had tried to be open and transparent with the Registrant. LB stated that she had asked the Registrant who the trainer had been and whose signature it was. The Registrant did not initially provide an answer, but a day or two after the initial conversation, the Registrant had told LB that the certificate was forged and she had made it herself. LB could not recall whether she had said to the Registrant that the matter would be escalated or referred to the HCPC.

30. On 9 August 2019, LB had a more formal conversation with the Registrant about this at which the Operational Manager also attended. After the meeting, LB emailed to Human Resources a summary of what had been discussed during the meeting. During the meeting, the Registrant had confirmed to LB that she had not attended the training in the Academy or attended any recent training reflected in the training certificate. The Registrant had said to LB that she had forged the certificate and had admitted that she had made up the training record, forged a signature, and used the Trust's logo to make the document appear official.

31. LB said that the Registrant had clearly and openly acknowledged that her actions were unacceptable but LB had not asked the Registrant why she had done what she had. LB said the Registrant had done a “fantastic” clinical role as an ODP. She told the Panel that the Registrant had not disclosed any personal issues or difficulties to her.

32. On 19 August 2018, JV, the General Manager and Lead Nurse for Theatre Services, wrote to the Registrant confirming that the Trust would no longer employ her as an agency ODP.

The Registrant’s evidence
33. The Registrant adopted her witness statement as her evidence in chief. She told the Panel about her relationship with TC.

34. The Registrant told the Panel in her live evidence about her involvement with Your World. She stated that JM at Your World had emailed her stating that there were a number of documents that needed to be provided and had noted that the mandatory training record she had provided was out of date. She said she was with TC when she sent the reply on 13 June 2019 at 16:43 as he had helped attach the documents. The email stated, ‘I believe Tony sent my Mandatory training cert’. She stated she had scanned some certificates using her telephone and then sent them to TC to save. She understood that TC had sent her mandatory training certificate with Total Assist for the year 2019-2020, which included her mandatory training that she completed every year. She said that Total Assist was her primary agency, but TC was with Your World. She stated that she had no knowledge of the email TC sent on 14 June 2019 to JM which read ‘cert signed!!!!! Is this all she needs now????’ and she had no knowledge of the forged certificate before it was shown to her by LB on 5 August 2019. She said she did not prepare that document, did not send it to Your World and did not ask TC to send it on her behalf.

35. The Registrant told the Panel about her ODP training which had to be done annually. She referred to her training record with Total Assist dated 6 February 2019 which was true and correct and said she had completed all of it online that day, as stated on the record. At the stage she applied to Your World she said that her training was up to date and that she had no need to forge a training certificate.

36. In cross-examination, the Registrant said that she first tried to speak to LB on 5 August 2019 but LB had gone home. She said she had tried several times to speak to her the following day. The Registrant largely agreed with LB’s account of the discussions she had with her on 9 August 2019, but she had not “spontaneously” cleared out her locker, as stated by LB.

37. The Registrant denied that she had completed the application to Your World on 6 April 2018, and said she had no recollection of signing it. TC had told her that he had started the application for her and that he had wanted her to join Your World. She was looking to change agencies as there had been problems with being paid on time by Total Assist. TC suggested that she join Your World and she agreed. She reiterated that she had been compliant with the training requirements when the forged certificate was sent to Your World. She agreed that she had emailed JM at Your World attaching her CV on 13 June 2019, and said that TC has assisted her. The Registrant said she responded to JM on 13 June 2019 and had referred to TC sending the training certificate and her need to submit the drug calculation test. She said she thought TC had sent in her Total Assist training certificate (the correct one with her 2019/20 training record) and that she did not know TC had sent in a forged one.

38. On 18 and 20 June 2019 she had also sent JM details of her two referees and a copy of her passport. She emailed him again on 15 July 2019, regarding her Disclosure and Barring Service (DBS) certificate and a health questionnaire; and again on 7 and 20 August 2019. She reiterated that she was not aware that TC had sent the email of 14 June 2019 to JM submitting the forged certificate and that it must be coincidental that it was sent the day after JM had asked her for it as she had no recollection of discussing the issue with TC.

39. Mr Bridges referred the Registrant to her statement and documents produced and submitted by her to the ICP of the HCPC in July 2020. At that stage she had fully admitted to having forged the certificate as alleged. In her written representation to the ICP, she stated that although she had undertaken the training in 2019 Total Assist would not release the certificate confirming this without her paying £45 so she decided to forge a document confirming she was up to date with the mandatory training. In her oral evidence, the Registrant said she had not realised at that time that she did have the up to date training certificate required and said she did not remember writing some of the document produced to the ICP. When confronted by LB the Registrant said that she was in theatre and could not discuss the certificate. The Registrant said it was only after the end of the relationship with TC in January 2022 that she could tell the truth, but she did not know what to do and did not want to change her story. She could not explain how it was that TC had sent the training certificate on 14 June 2019, the day after JM had asked her for it. She said she was “scared and confused” and did not know what to do.

40. In response to Panel questions, the Registrant said that TC had suggested that she join Your World and she did not know if the signature on the application form was hers. She said that she did not think she had written some of the submissions to the ICP but three paragraphs on the first page including the part about paying £45 for the certificate were not written by her, nor was the last paragraph. She said she had not complained to Your World about them accepting the certificate from TC. She was unable to explain why she had told Your World that her manual handling training had been practical when the certificate she thought they had from Total Assist was for online training. She could not recall discussions with TC at the time about the certificate.

41. Before closing his case, Mr Marsland explained to the Panel that the Registrant had decided, having made some inquiries, that she would not seek to call JM to give evidence. The Panel agreed that it was neither proportionate nor necessary to delay the hearing in order to seek evidence from JM.

Submissions of Facts, Grounds and Impairment
42. Mr Bridges summarised the case for the HCPC. He submitted that the Registrant completed the application to Your World and her ex-partner lodged with her knowledge a forged training certificate the day after she was asked for it by Your World. The Registrant, when confronted by LB, admitted the forgery and maintained that position in her 16-page submission to the HCPC ICP on 2 July 2020 where she explained she had created a false certificate as she would not pay a charge from the existing agency for a copy of the training certificate. She was in fact up to date in her training. The Registrant now states that TC forged and sent the certificate without her knowledge or consent. The Registrant now says that her admission was false and that her statement to the ICP was not wholly her work and had not been written by her.

43. Mr Bridges submitted that the only evidence about TC’s actions is the email he sent to Your World on 14 June 2019. He submitted that it is the HCPC position that TC merely emailed the document but was not otherwise involved. He reminded the Panel that the ICP decision made available to the Panel contained merely allegations about TC. He submitted that the Registrant acted as alleged and he referred the Panel to the guidance regarding dishonesty as set out in the Ivey case (see below).

44. On the issue of misconduct, Mr Bridges submitted that a finding on any one of the particulars would amount to misconduct. On impairment, Mr Bridges referred to the guidance and relevant case law including the Grant case. He submitted that there was a clear lack of insight on the part of the Registrant and that the Panel should find that her fitness to practise is currently impaired.

45. Mr Marsland set out the case for the Registrant. He made a point that the evidence could support various factual scenarios, including that the Registrant knew about, but was not involved in the forging of the certificate. Her position is that she knew nothing of the forgery or TC submitting the forged certificate. He submitted that it is agreed that the Registrant was an excellent ODP and well regarded by her peers as confirmed by LB. The Registrant’s training was up to date, and the forged certificate was not necessary. It is her case that the certificate was submitted by her ex-partner TC.

46. Mr Marsland submitted that there was no direct evidence that the Registrant forged the certificate. She said she was not “tech-savvy”. He submitted that the common sense inference was that TC was dealing with the certificate, not the Registrant, and so it was more likely that TC created the certificate.

47. On the issue of submitting the certificate, the Registrant said that she thought TC was submitting her training certificate that was the correct and up to date certificate (the Total Assist certificate). In her email of 13 June 2019 she was under the impression that the certificate had been submitted, when in fact TC sent it the next day. Mr Marsland said that the Registrant was of good character and had no disciplinary history. She told the Panel that the application to Your World was not her priority at the time, as she was applying for another job at the Trust. Mr Marsland submitted that the wider context was persuasive that the Registrant was not involved in the creation or submission of the certificate. Mr Marsland submitted that the Registrant had chosen a difficult route by changing her position and he submitted that this is indicative that she was now telling the truth.

48. Mr Marsland submitted that it would be a remarkable position to choose this path were it not true. Mr Marsland submitted that if it is found proved that the Registrant knew that the certificate was a forgery or had forged it herself, that would amount to misconduct. Even if dishonest, Mr Marsland submitted it was clear that the Registrant, in fact, had the relevant training throughout and that diminishes the seriousness of any dishonesty.

49. On the question of impairment, Mr Marsland referred to the HCPC Practice Note. He submitted that the Registrant’s actions were isolated and had not been repeated. She has remained in practice as an ODP since the incident. As regards insight, there was evidence of a recognition of wrongdoing by the Registrant. He submitted that there was no risk of repetition. He submitted that this case did not give rise to a need to protect service users. He submitted that insight was ultimately a question of the risk of repetition, the facts indicate this would not be repeated. It may be that the Registrant’s earlier admissions at the time were a form of insight, and her only explanation was that she was in the grip of fear for her profession and sought to protect TC.

50. In respect of the public component, Mr Marsland submitted that the Panel is required to consider what a well-informed member of the public would make of the conduct found proved. In terms of maintaining confidence in the profession the Panel should take account that the Registrant, an excellent ODP, has continued to work without further incident.

Decision on Facts
51. The Legal Assessor reminded the Panel that the burden of proof was on the HCPC and that the standard of proof was the balance of probabilities. He referred the Panel to the guidance on dishonesty in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67 and he gave a good character direction in respect of the Registrant.

52. The Legal Assessor referred the Panel to the guidance on misconduct in Roylance v GMC (no 2) [2000] 1 AC 311 where misconduct was defined as “a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances.” The Panel also heard and accepted the advice of the Legal Assessor on impairment. He referred it to the guidance issued by the HCPC in the Practice Note on impairment, and in CHRE v NMC and Grant [2011] EWHC 927 (Admin) and he reminded the Panel to consider the crucial issues of insight, remorse, remediation and the risk of repetition. Further, the Panel should not lose sight of the important public interest issues stressed in Cohen v GMC [2008] EWHC 581 and described as:- “…critically important public policy issues… the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect.” A finding on grounds and on impairment is a matter for the Panel’s own professional judgement and there was no onus or burden of proof in that regard.

53. The Panel found the decision of the HCPC Investigating Committee regarding the allegation against TC of limited value. The allegations are yet to be heard at a final hearing and that Panel can attach very little weight indeed to what are merely allegations at this stage. The Panel noted the allegations do not contain allegations of dishonesty.
The Registrant’s previous position

54. This is a rather unusual case, in that until several weeks before this final hearing, the Registrant had admitted the allegations in full and she had submitted a 16 page written submission to an ICP hearing at the HCPC in July 2020 setting out, in detail, her position and explaining why she had done what was alleged. The Registrant in that submission explained her motivation was to avoid paying a £45 fee requested by another agency for a copy of her training certificate. She explained her position as follows:-
“The following words are my own (Sarah McCamley) and relate to the incident which occurred in August 2019
I was currently engaged as a Locum ODP at Yeovil Hospital when I decided to change agencies as my current one was causing a lot of problems for me. During the course of registering for a new agency, I had to produce a certificate of mandatory training which we must complete each year. I had completed one with the troublesome agency, who decided that they would not release a copy of a course I had completed unless I paid them £45. As I may use it to register with another agency. This is illegal underemployment law as certificates for professional qualifications belong to you not he (SIC) employer; even if they had paid for the course. This was so frustrating. Added to this was the new agency ringing me at least 5 times per day asking if I had got a certificate to complete my file so as to be allowed to work for them. Coupled to this, my stress over my relationship with my ex-husband at the time was causing me to think irrationally.
There seemed to be an impasse With regards to this situation. But then I had a thought, a stupid thought none the less. I will just make one up now and when the real one comes, I can forward that to the new agency who can then scrap the one I have made for a legitimate one. What could go wrong I thought? I am covered legally as I completed the study day, I just can’t show it as of yet, so this certificate will be ok. What I didn't realise is the new agency have a policy of verification of certificates to trusts. This is the reason why I was caught. I understand this process and I am fully behind it as it does help to stop truly dangerous registrants who shouldn't be on the register. I don't believe this is the case for me. I have worked for over 20 years in a profession in which I am so proud to be a member of. I take pride in my work at all times. My patients are the most important people in the theatre at any given time.”

55. The Panel considered that the Registrant in this original submission, set out a clear, plausible and credible account of her actions, explaining her motives and demonstrating remorse and some insight into her actions and why they were wrong. She explained her disclosure to her colleague LB, from whom the Panel has heard. To the extent of her involvement, LB’s account is consistent with that of the Registrant in this submission and in her live evidence regarding admission of the forged certificate.

56. For the sake of completeness that Panel would want to make clear its position in relation to the Registrant’s denial in live evidence of her having written some of the paragraphs in her written submission to the ICP in July 2020, that is in relation to her previous account and admission of the allegation. She accepted in her live evidence that she had read her written submissions at the time and she had submitted them to the HCPC, her professional regulator. She states in those submissions:- “The following words are my own…” The Registrant could not explain how it was that certain paragraphs were, in fact, not her own work, including the one explaining her motive to forge the certificate to avoid the £45 charge. She did not say how it was these paragraphs appeared in her submissions, or who had written them.

57. Although this submission does not bear directly on the allegation, the Panel found this issue was one upon which the Registrant placed some reliance, and it is of some importance in the assessment of her credibility. The Panel found that her position on this matter was not credible or plausible and the Panel did not believe the Registrant when she said the submission was not her own work.

58. The Registrant now asserts a positive defence, namely that her relationship with TC was such that she made false admissions to the conduct and dishonesty alleged at the time, and she supported that with her written submissions to the ICP in July 2020. Further, the Panel is asked by the Registrant to conclude that TC forged and submitted the certificate without her knowledge or consent. To make such findings, the Panel requires a proper evidential basis, and it requires sufficient, cogent evidence to make such findings on the balance of probabilities.

59. The Panel noted that the entirety of the evidence about her relationship with TC is in the Registrant’s formal witness statement, as set out above. The Panel did not hear live evidence from the Registrant about her relationship with TC. The Panel did not receive any documentary or independent evidence about the speeding tickets, the court cases regarding those offences, or about the dispute over the car for TC that the Registrant had paid for, and which had required police involvement. Given the position described by the Registrant, the Panel considered that there is likely to have been some documentary evidence of such matters. The Panel was not provided with any. It was not provided with a copy of the police questionnaire the Registrant referred to. The Panel heard no evidence from any friends, family or associates that may have been able, to some extent, to support the Registrant’s account of her relationship with TC.

60. The nature of the relationship is a question of fact for the Panel, and the Registrant seeks to prove that, and she asks the Panel to make a positive factual finding in that regard. The Registrant relies on a positive finding of fact as to the nature of the relationship to explain her conduct and her false admissions, including her previous version of events. The Panel was mindful that facts must be proved on the balance of probabilities.

61. The Registrant told the Panel that she had been unable until now, to tell anyone that TC had forged and submitted the training certificate in the email dated 14 June 2019 to JM at Your World, and that he had done so without her knowledge or consent. The Registrant told the Panel that she had ended her relationship with TC in January 2022. The Registrant’s position altered some three weeks before this hearing and a witness statement was lodged on day three.

62. The Panel concluded that there was a lack of sufficient evidence about the relationship between the Registrant and TC. The Registrant gave no live evidence in respect of what was a central plank of her case and, indeed, largely her defence to this Allegation and dishonesty. This was a relationship which the Registrant sought to prove explained both her earlier, false admissions and the forged certificate. The Panel noted that the Registrant stated that she ended the relationship some 10 months ago, in January 2022. That was expressed by her as being her decision. She was not able to plausibly explain why she had taken no steps whatsoever since January 2022 to contact the HCPC to advise it of her change in circumstances and tell the HCPC about her materially altered position in relation to the Allegation.

63. The only evidence about the relationship with TC that the Panel had before it was a short written account from the Registrant about that relationship (as quoted in full above). The Registrant gave no live evidence about it, and the Panel had no other evidence before it to support that position. There was no independent evidence, despite reference to some circumstances which had apparently involved third parties, such as the police and the courts. In these circumstances, the Panel concluded on the balance of probabilities, that the Registrant had failed to prove the relationship with TC in relation to and at the time of the allegation.

Particular 1 – Found Proved
In or around June 2019, you compiled a list of training courses on Yeovil District Hospital headed paper and/or arranged for this to be submitted to support an application to register and/or work as an agency Operating Department Practitioner.
64. The Panel considered all the evidence before it. The Registrant now states that she knew nothing of the 14 June 2019 email sent by TC.

65. The Panel considered the emails. On 12 June 2019 JM emailed the Registrant asking her for further details. He asked her to update some details, such as her passport details which had “expired” on the Your World system. The Registrant replied on 13 June 2019 at 4.43pm attaching some of the requested documentation. She sent another email later that day attaching her CV at 16.57; and she completed and attached the required drug calculation test in a further email to JM at 17.39 that day.

66. The Panel noted that the Registrant states in her witness statement that TC was with her when she sent these emails and states:- “I would have needed his help to attach the documents.” When questioned by the Panel, the Registrant also said that she had no recollection of discussing the emails and the training certificate with TC at the time. The Panel noted that the three emails that were sent by the Registrant on 13 June 2019 all had attachments on them.

67. The Panel considered the crucial email sent by TC to JM the next day, 14 June 2019 at 08.19. It does not, in fact, show or refer to any attachment, as do the three emails sent by the Registrant the previous day. This email simply states:- “Cert signed!!!!! Is this all she needs now????” It says nothing else. The Panel noted that it was the evidence of SD that the falsified certificate was attached to this email from TC. Although it is not evident on the face of the email, the Panel accepted the evidence of SD and that she was correct when she told the Panel that this email attached the false certificate. There is no contention by either party that this email from TC did not attach the allegedly forged certificate.

68. The three emails sent by the Registrant on 13 June 2019 had attachments. That day she had successfully attached a number of documents to three emails to JM responding to his request promptly. She accepted that she had done so. The next day TC sent the false certificate. It is the Registrant’s evidence that she was not “tech savvy”. The Panel does not accept that. It flies in the face of the evidence in the 13 June 2019 emails sent by her. The Panel found that she knew how to send emails with attachments, and indeed she had demonstrated that.

69. The Registrant says that the email from TC to Your World on 14 June 2019 was sent without her knowledge or consent. She was unable to explain how it was that TC knew a certificate was outstanding, and she stated in her evidence that it must have been a coincidence that TC sent the certificate the day after she had been asked for it by Your World. She said that TC had assisted her, but she also said that she did not recall any discussions with TC about the certificate at the time. She said that she had realised at some point in time, but could not recall when, that she knew the certificate had been sent but that she had thought it was another training certificate from Total Assist (which was an authentic training certificate). She could not explain to the Panel when and how she realised TC had sent the forged certificate or indeed why he would forge one when she had an authentic one. LB said the Registrant did not express surprise when confronted with the forged certificate and simply admitted forging it.

70. The Panel had no evidence as to what possible motive TC would have had to do as the Registrant asserts, that is to forge and submit a training certificate. The Registrant said in her witness statement that she did not know why TC had sent the certificate. She did not suggest any motive for TC’s actions and she claimed that his sending of the email the day after her, on 13 June 2019, was coincidental. Even if there had been a relationship, a scenario which the Panel has rejected, that does not explain why TC would do as he did. The Registrant herself said she wanted to apply to Your World and her actions the day before, on 12 June 2019 in sending the three emails to JM, were consistent with that.

71. The Panel found that these varying accounts from the Registrant made little sense, they were not consistent and it found that they were inherently contradictory and improbable. The Panel did not accept the Registrant’s account that she had no knowledge of the 14 June 2019 email, which it found was neither credible nor plausible.

72. The Panel found the Registrant’s evidence that she had already done the required training confused and somewhat incoherent. If the Registrant had done the required annual training, why had she not simply told JM that was the case, and that she would send the genuine certificate once she had it? She also said that she was concentrating on applying for another permanent role, but that was not to the point and did not explain the emails she sent to Your World on 13 June 2019. The Panel found this explanation served to further undermine the plausibility and credibility of the Registrant's account as a whole.

73. The Panel found that the Registrant’s account that she did not compile the training certificate, and had no knowledge and did not consent to the 14 June 2019 email from TC was not plausible or credible. Given the surrounding circumstances where the Registrant herself sent emails and attachments the previous day, the Panel found that it was inherently improbable that TC forged and then sent the certificate. Why would TC want to or need to send the email for her with the certificate given it was clear she was capable of sending emails and attachments, as she had done several times the previous day?

74. The Panel was mindful of the wording of the particular, that is that the Registrant “compiled" the list and then “arranged” for this to be submitted. The issue is not binary, it need not be the case that it was either the Registrant or TC who arranged for the list to be submitted. TC did send the email and it may be that TC was involved to some extent, but that does not mean the Registrant did not “compile” or “arrange”. The Panel has rejected the Registrant’s accounts as incredible. Indeed, the Panel considered that her original version of events in her written submissions and admissions in July 2020 were more plausible and credible.

75. The Panel concluded in all the circumstances that it was more likely than not that the Registrant compiled and then arranged for the list to be submitted and it found this particular proved.

Particular 2 – Found Proved
In or around June 2019, you falsified the training record dated 7 April 2019 submitted in support of your application to make it appear that it had been signed off by a trainer.
76. The Panel did not accept the Registrant’s version of events for the reasons set out above. It follows from that reasoning that the Panel concluded that it was the Registrant who falsified her training record dated 7 April 2019 and submitted it when she arranged for it to be emailed by TC to JM on 14 June 2019 as part of the application process to Your World, about which there is no contention that she had earlier commenced and corresponded with JM.

77. The Panel found no plausible evidence that TC falsified the training records. There was, in any event, no motive for TC to falsify the training records as the Registrant was already in the process of applying to Your World and had sent an application and several emails. That TC may also have been involved is not to the point.

78. As set out in the reasoning above, the Panel found that it did not believe the Registrant’s account that TC forged, and then submitted the training certificate to JM on 14 June 2019 without her knowledge or her consent. This particular is proved.

Particular 3 – Found Proved
You did not attend the training listed on the training record which you compiled dated 7 April 2019.
79. The Panel has not accepted the Registrant’s account of events and has found Particulars 1 and 2 proved. It accordingly finds that the Registrant did not attend the training listed on the training records compiled by her and dated 7 April 2019. The Registrant accepted in her evidence that she did not attend all of the courses detailed on the forged certificate. This particular is proved.

Particular 4 – Found Proved
Your conduct set out in paragraphs 1 and/or 2, and/or 3 was dishonest.
80. The Panel considered the Ivey test. It concluded that the Registrant knew at the time she had not done the training claimed in the certificate, and that the training record or certificate that she compiled and arranged to submit to Your World was false. That was dishonest, and the Registrant knew that to be the case. Considered objectively, the Panel decided that any ordinary and decent member of the public would consider that what the Registrant did in respect of Particular 1, 2 and 3 to be dishonest. She lied, sought to deceive and was dishonest. This particular is proved.

Decision on Grounds
81. The Panel has found the Allegation proved, and this includes dishonesty. It was mindful of the guidance in Roylance. The Panel decided that to falsify and arrange to submit a false training certificate was conduct that fell well below what would have been proper in the circumstances and whether separately or together was serious and amounted to misconduct. It breached the most fundamental professional standards of trust, integrity and honesty.

Decision on Impairment
82. The Panel was mindful of the guidance on impairment in the HCPC Practice Note and in Grant and accepted the legal advice. It considered the central issues of remorse, remediation, insight and the risk of repetition. It was mindful of the public interest element of impairment and the need to maintain public confidence in the profession and uphold proper professional standards.

83. The Panel has found that the Registrant has been dishonest. The Panel found that the Registrant expressed remorse and apologised in her original submissions where she admitted the conduct, and showed some developing insight. However, in this somewhat unusual case, there has been a material change in the Registrant’s position away from her earlier admissions. The original expressions of remorse and insight are accordingly, no longer the Registrant’s position. The misconduct is serious, but it is remediable, although the Panel accepted that dishonesty can be difficult to remedy.

84. The Registrant’s explanation and defence have not been accepted by the Panel. She had sought and failed to explain and defend her position with an account of events that the Panel has rejected as incredible, implausible and improbable.

85. Accordingly, in the current circumstances the Panel found that there was limited insight and no remediation demonstrated by the Registrant. The Panel was prepared to accept, to a limited extent, the earlier expressed remorse and understanding of the dishonest conduct, which at that time was admitted by the Registrant. However, the Registrant has not shown that she currently understands her actions and her dishonesty, or the impact of her actions on service users, colleagues and the wider public. The Panel concluded that given the limited insight and any remediation there is a real risk of repetition of the misconduct.

86. The Panel was mindful of the guidance on the proper approach to assessing impairment and the risk of repetition which is expressed in Grant as follows:-
“Do the findings show that fitness to practise is impaired in the sense that:
a) Has the Registrant in the past acted and/or is liable in the future to act in a way so as to put service users at unwarranted risk of harm;
b) Has the Registrant in the past brought and/or is liable in the future to bring the profession into disrepute;
c) Has the Registrant in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession?
d) has in the past acted dishonestly and/or is liable to act dishonestly in the future.”

87. The Panel was mindful that the Registrant had, in fact, done the mandatory annual training with Total Assist and is currently working as an ODP. Her competency is not in issue. As such it did not find there was a current risk of harm to the public and it found that the first limb of the test in Grant is not engaged.

88. However, the Panel concluded that the other three limbs of the test were engaged. In the circumstances of this case, the Panel concluded that :-
• The Registrant has in the past brought and is liable in the future to bring the profession into disrepute
• The Registrant has in the past breached and is liable in the future to breach one of the fundamental tenets of the profession, namely trust and honesty
• The Registrant has in the past acted dishonestly and is liable to act dishonestly in the future.

89. The Panel was also mindful of the wider public interest and the guidance in Cohen v GMC [2008] EWHC 581 on the central importance of the need to safeguard public confidence in the profession and uphold proper standards. It considered what a member of the public might make of the Registrant’s conduct and the effect that may have on the reputation of the profession. The Panel concluded that a member of the public would be most concerned were the fitness to practise of an ODP who had been dishonest in the circumstances alleged, not found to be currently impaired.

90. With the personal and public interest components in mind the Panel found that the Registrant’s fitness to practise is currently impaired.

Continued Hearing reconvened 12 June 2023
91. The Panel reconvened on 12 June 2023 and handed down the decision on facts, grounds and impairment. Having considered the decision, Mr Marsland made a submission that the Panel’s finding on the relationship was not necessary. He stated that it had not been an issue in the case, was not relevant and was not challenged by the HCPC. He further submitted that it was not correct for the Panel to say that the Registrant had not given “live” evidence about the relationship as she had formally adopted her witness statement under oath. Mr Marsland stated that the Panel had been fully entitled to make its findings on facts, grounds and impairment, but that he wished to have it noted that the Panel’s finding in respect of the relationship was not relevant or necessary. The Panel noted the position.

Submissions on Sanction
92. Mr Bridges submitted that the HCPC made no specific bid for sanction and referred the Panel to the Sanctions Policy and to the specific guidance on dishonesty. He submitted that this was not a case for no action to be taken. There was no previous regulatory history and the Registrant had received a good character direction.

93. Mr Marsland, for the Registrant submitted that this was a difficult case. He submitted that the Panel must start at the lowest level of sanction and consider each sanction in turn and impose the proportionate sanction. He submitted that there are no competency issues in relation to the Registrant and that she was an excellent practitioner who had done something very foolish. This was an unusual case given the different positions taken by the Registrant at the ICP and final hearing stages. He submitted that two issues arose, first that the Registrant had, in fact, done the training, and the false document ultimately was not incorrect in the sense that no one was misled about the ultimate issue. He submitted that ought to reduce the seriousness of the case to some extent and that a member of the public would see that as a mitigating factor. Secondly, he submitted that the evolution of the Registrant’s position should be considered. He asked the Panel to consider what weight it can give to the earlier position adopted by her to the ICP about the remorse and insight expressed at that time and whether that had been diminished by the different position taken by her at the hearing.

94. Mr Marsland referred to the HCPC Sanction Policy on dishonesty and submitted that this finding was in a less serious category of dishonesty. He submitted that the agency had not been misled about the Registrant’s skills as she had done the training. He further submitted that this was a single act of dishonesty, despite involving a number of steps and it was not sustained. The Registrant otherwise had an excellent record and was held in high regard and he submitted that was relevant to the consideration of the public interest.

95. Mr Marsland submitted that a Caution Order should be considered as the incident was isolated, limited and relatively minor. He submitted that the Registrant presented a low risk of repetition. Given the nature of this case, Mr Marsland suggested that conditions of practice were not likely to be appropriate, and so the next sanction would be suspension. He submitted that in this case a Caution Order was proportionate given the less serious nature of the dishonesty, where ultimately no one was misled. He submitted that suspension was not proportionate in this case.

Decision on Sanction
96. The Legal Assessor referred the Panel to the HCPC Sanction Policy and reminded it to act proportionately. He advised the Panel to consider sanction in ascending order and to apply the least restrictive sanction necessary to protect the public. It should also consider any aggravating and mitigating factors and bear in mind the public interest and that the primary purpose of sanction was protection of the public.

97. The Panel considered whether there were any aggravating and mitigating features. It found the following were aggravating factors:-
a. Although isolated, the Panel has found a real risk of repetition
b. There is a lack of insight, reflection, remorse and apology
c. The dishonesty was active, planned and premeditated

98. The Panel found the following mitigating factors:-
a. The incident was, to an extent, isolated although it persisted
b. No harm was caused to any service user, and there was no risk of harm
c. The Panel accepted that the Registrant had actually done the mandatory training
d. No evidence of any previous regulatory history

99. Given the nature and gravity of the findings, the Panel concluded that to take no action would not reflect the seriousness of the findings. The Panel has found dishonesty, that there is a real risk of repetition and a lack of insight. Accordingly, to take no action would not be proportionate and would fail to sufficiently mark the seriousness of the findings.

100. The Panel next considered a Caution Order and considered paragraph 101 of the Sanctions Policy. None of the factors listed in the guidance apply in this case. The Registrant falsified a document about her training and held that out knowing it was false. That was dishonest and the Panel has found that there is a real risk of repetition as well as a lack of insight and remediation. The dishonesty was deliberate, planned and premeditated. The Panel found that the dishonesty was not at the lower level of seriousness, it was not relatively minor in nature. It decided that a Caution Order was not proportionate as it would fail to reflect the seriousness of the findings. A Caution Order would also fail to maintain public confidence in the profession and fail to uphold proper professional standards.

101. The Panel decided that a Conditions of Practice Order would not engage with the nature or the gravity of findings in this particular case, particularly as there is no issue about the Registrant’s competency. There is a finding of a real risk of repetition of the dishonest conduct and the Panel decided that conditions of practice could not appropriately or sufficiently manage or deal with the deliberate dishonesty found. In these circumstances, the Panel concluded that conditions of practice were not appropriate, sufficient or proportionate to reflect the nature and seriousness of the case. Further, such an order would fail to properly address the public interest and would fail to maintain confidence in the profession.

102. The Panel next considered a Suspension Order. The Panel was mindful of paragraph 121 of the HCPC Sanctions Policy. Whilst it has found a lack of insight and remediation, the Panel considered that remediation is possible, albeit difficult. Whilst these are serious findings, it considered that the dishonesty found is not at the most serious end of the spectrum of dishonesty. The dishonesty caused no harm and no risk of harm, and it was not done for financial or personal gain. It was not a criminal act, and was an isolated act, in the sense that it related to forging one training document, training that the Registrant had, in fact, completed. The Registrant has fully engaged with these proceedings and the Panel considered that its findings can reasonably be addressed by her. She is otherwise a competent practitioner with no previous regulatory concerns.

103. The Panel considered paragraphs 130 and 131 of the Sanctions Policy on Striking Off Orders. It decided that its findings are not of such gravity that nothing other than a Striking Off Order would be proportionate or appropriate. The Panel concluded that a Suspension Order was the appropriate and proportionate sanction to impose. It will serve to sufficiently mark the seriousness of the misconduct and make clear that it was totally unacceptable and must never be repeated.

104. The Panel next considered the appropriate period of suspension. Given the lack of insight at this stage, and the seriousness of the findings, the Panel concluded that a significant suspension for a period of ten months was necessary to mark the conduct as totally unacceptable. That will also allow the Registrant the opportunity to reflect and develop insight. The Panel found that there was nothing to suggest that she is unwilling or unable to resolve matters.

105. The Panel decided that a ten month suspension order will also serve to uphold and declare proper professional standards and was proportionate and appropriate in order to maintain public confidence in the profession and the regulator.

106. This order will be reviewed by a panel before it expires. The future reviewing panel may be assisted by the Registrant providing the following:-
a. A reflective piece on the Panel’s decision
b. Evidence of insight and remediation
c. Any character references

The Registrar is directed to suspend the registration of Ms Sarah McCamley for a period of 10 months from the date this Order comes into effect.

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

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

Interim Order
Interim Order Application
1. In light of its findings on Sanction, the Panel next considered an application by Mr Bridges for an Interim Suspension Order to cover the appeal period before the Suspension Order becomes operative.

Decision
2. The Panel accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Interim Orders. He reminded the Panel that an Interim Order must be necessary to protect the public, or be otherwise in the public interest. The Panel must act proportionately and balance the interests of the Registrant with the need to protect the public.

3. The Panel was mindful of its earlier findings and concluded that an Interim Order is necessary to protect the public during the appeal period. The Panel decided that it would be wholly incompatible with its earlier findings and with the Suspension Order imposed to conclude that an Interim Suspension Order was not necessary for the protection of the public or otherwise in the public interest. Accordingly, the Panel concluded that an Interim Suspension Order should be imposed on both public protection and public interest grounds. It determined that it is appropriate for that Interim Order to be imposed for a period of 18 months to cover the appeal period. When the appeal period expires this Interim Order will come to an end unless there has been an application to appeal. If there is no appeal the Suspension Order shall apply when the appeal period expires.

4. The Panel makes an Interim Suspension 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.

5. 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 Sarah McCamley