Mr Graeme J Crew

Preliminary Matters

Service/ Proceeding in Absence

1. The Panel was provided with evidence that the Notice of Proceedings was emailed to the Registrant on 12 October 2023. This was to the Registrant’s registered email address. The Case Presenter also confirmed that a hard copy of the Notice and the hearing bundle was also posted to the Registrant’s home address on 27 October 2023.

2. The Panel accepted the advice of the Legal Assessor that good service was effected by notifying a registrant of the time and date of the hearing at his registered email address.

3. The Panel then went on to consider whether to proceed in the absence of the Registrant pursuant to Rule 11 of the Conduct and Competence Committee Rules.

4. In doing so, it considered the submissions of Ms Khan on behalf of the HCPC. She submitted that the Panel should proceed to hear the case because the Registrant had not applied for an adjournment. Indeed, he had not communicated with the HCPTS at all. She argued that an adjournment would simply delay the hearing and that there was no indication that the Registrant would attend on a future date. There was, she submitted a public interest in this matter being dealt with in a timely manner.

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

6. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPC Practice Note entitled ‘Proceeding in the Absence of a Registrant’.

7. In reaching its decision the Panel considered the following; there was no application to adjourn the hearing and there is a public interest in the matter proceeding this being a mandatory review of an existing order. There has been no contact from the Registrant at all.

8. Having weighed the public interest in the expeditious disposal of this case the Panel decided to proceed in the Registrant’s absence.

Background

9. The Registrant was employed by East Kent Hospital University Foundation Trust (“The Trust” or EKHUFT), as a Band 7 Operating Department Practitioner (ODP) in the Channel Day Surgery.

10. In 2018 as the Band 7 of the Channel Day Surgery, the Registrant was supervising over 70 members of staff. The Channel Day Surgery initially operated between Monday and Friday. However, due to significant backlogs, surgeries were booked during the weekend to try to reduce waiting lists.

11. The Trust’s policy in terms of overtime was contained within the Trust’s 2016 Roster Policy, which set out the need to ensure inter-alia that rosters were arranged in line with the Working Time Directive and that the system for the allocation and approval of overtime was fair.

12. On 27 April 2020, the Trust made a referral to the HCPC. The referral related to concerns that the Registrant had failed to inform the Trust that he had received an overpayment of £2,196.40 through double payments for 7 overtime shifts that he had worked between May and June 2018.

13. At the relevant time staff working within the Trust could use two systems through which they could claim overtime payments; EKHUFT (Healthroster). There was also a system operated by an outside agency, National Health Services Professionals (NHSP), for those staff working for that organisation on an agency basis. Particular 1 (a) - (g) relates to the individual overpayments, which the HCPC allege were paid through both NHSP and Healthroster. Particular 2 related to an allegation that the Registrant failed to inform the HCPC when restrictions were placed on his duties during the Trust’s investigation of this matter on 2 January 2020.

14. As part of the referral to the HCPC on 27 April 2020, the Trust included information about a previous disciplinary matter, that had been resolved by the Trust without referring it to the HCPC. This incident related to a lapse in the Registrant’s registration between November 2009 and October 2010. The allegation was that during a registration check by the Trust, the Registrant was discovered to have been working as an ODP, during a period when his registration with the HCPC had lapsed (Particulars 4 & 5).

15. In relation to Particular 6, it was the HCPC’s case that the Registrant deliberately misled the Registration Department when he applied to re-register by stating that he had last worked as an ODP in September 2009, when this was not the case.

16. In respect of Particular 3 related to an allegation that the Registrant failed to inform the HCPC when he was suspended by the Trust, in October 2010.

17. The Registrant had not attended the hearing before the original Panel, the matter being heard in his absence. That Panel was satisfied that the conduct found proved was remediable, but the concerns were serious because they centred around dishonesty and breaches of fundamental tenets of the Registrant’s profession. That Panel noted attitudinal failings and that it had no information as to the Registrant’s current circumstances nor of his insight and understanding into the reasons why he failed to renew his registration and acted in the manner that he did.

18. The previous Panel did find that the misconduct found proved dated back to 2010 and it had not been repeated which was an important factor because a significant amount of time had passed. The records obtained from the Registration Department show that the Registrant had kept his registration up to date since then. In addition, the previous Panel accepted that there was no suggestion that the Registrant posed a risk to Service Users.

19. The original Panel noted that although the actual failings appear to have been remedied, there was an attitudinal failing and lack of insight in relation to integrity and honesty. That Panel therefore found the Registrant was still impaired on the personal component, even though the risk of his conduct being repeated was low.

20. In terms of the public component, the original Panel considered its overarching responsibility to promote and maintain professional standards, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the profession of Operating Department Practitioner and in the regulator. It determined that it was misconduct involving a breach of fundamental tenets of the profession and of dishonesty. The Panel went on to state that the regulatory objectives of maintaining confidence in the regulator and declaring and upholding proper standards would be undermined if the Panel failed to make a finding on the public interest ground. The Panel therefore concluded that the Registrant remained impaired on both the personal and public component.

21. The previous Panel determined that a 12-month Suspension Order would be the appropriate and proportionate sanction in this case and such a Suspension Order would mark the seriousness of the misconduct. That Panel noted that it would also provide the Registrant with a period of time to properly reflect on his actions and demonstrate a commitment to returning to practise in a profession that reportedly he is competent and experienced in.

22. The previous Panel noted that a future panel would be likely to be assisted by evidence of reflection, meaningful insight into the conduct and consequences thereof, remedial action and supporting character references. Furthermore, it noted that most importantly, the Registrant should fully engage with the regulatory process to show that he has fully appreciated the seriousness of this behaviour and so that a future panel can be assured that the behaviour will not jeopardise public protection by being repeated in the future.

The Decision

23. The Panel considered all the material in this case and the submissions made by Ms Khan. She reminded the Panel of the background facts and the matters found proved. She reminded the Panel that it must first consider the issue of impairment and then go on to consider the appropriate sanction. It noted the submissions made by Ms Khan that the Registrant had not engaged with the HCPTS, that he remained impaired and that the appropriate sanction would be one of strike off.

24. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Notes ‘Finding that Fitness to Practise is impaired’ and “Review of Article 30 Sanction Orders.”

25. Unfortunately, the Registrant has still not engaged with the HCPTS. There has been no response to the previous panel’s recommendations and indeed there has been no engagement from the Registrant whatsoever. No outside references or evidence of current up to date training has been provided to this Panel. In the absence of any information as to what the Registrant maybe currently doing, or what his plans are and how he has remediated his practice, this review Panel concludes that his fitness to practise remains impaired on the personal component.

26. In relation to the public component, this Panel agrees with what was previously said about the seriousness of the breaches identified in this case. In the absence of any evidence from the Registrant the Panel finds that the Registrant’s fitness to practise remained impaired on public interest grounds as well. The Panel remains satisfied that the regulatory objectives of maintaining confidence in the regulator and declaring and upholding proper standards would be undermined if the Panel failed to make a finding on the public interest ground.

27. The Panel therefore remains satisfied the Registrant remains impaired on both the personal and the public component.

28. The Panel then went on to consider what, if any, sanction to impose and referred to the HCPTS Sanction Policy.

29. The Panel has reminded itself that a sanction is not intended to be punitive although it may have a punitive effect. The Panel bore in mind the principles of fairness and proportionality and that a sanction must be reasonable and the least restrictive possible. The primary function of any sanction is to address public safety from the perspective of the risk which the Registrant may pose to those who use or need his services and to the wider public interest; namely the deterrent effect on other registrants, the reputation of the profession and public confidence in the regulatory process.

30. The taking of no further action, mediation or a caution order were not appropriate due to the serious nature of the findings.

31. In considering whether to impose a Conditions of Practice Order the Panel’s view was that this would not be appropriate, workable or measurable. The Registrant has not engaged with the HCPTS and has not actioned any of the recommendations of the previous Panel and in those circumstances a conditions of practice order would be unworkable.

32. The Panel next considered whether the appropriate and proportionate sanction was to extend the existing order of suspension for a further period allowing the Registrant an opportunity to engage and to show he can develop real insight and remediate his failings. The panel noted a number of practical steps that the Registrant could have taken, notwithstanding he may be out of practice, to show a future Panel that his fitness to practise is no longer impaired and that he can practise safely as an ODP, if that is indeed his intention. However, the Registrant has done none of the above. The Panel determined that a further period of suspension would serve no useful function.

33. The Panel noted that a striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the Registrant:

• lacks insight;
• is unwilling to resolve matters.

34. In those circumstances and in particular in light of the complete non-engagement of the Registrant, the Panel determined that the only appropriate and proportionate sanction would be one of strike off.

ORDER: The Registrar is directed to strike the name of Mr Graeme Crew from the Register on the date this Order comes into effect.

The Order imposed today will apply from 6 December 2023.

History of Hearings for Mr Graeme J Crew