Piotr Nowakowski

Preliminary Matters

Service

1. A Notice of Hearing was emailed by the HCPC to the Registrant’s HCPC registered address on 7 August 2023 for today’s hearing on 12 September 2023. This Notice confirmed that the hearing would take place by video conference today.

2. The Panel noted that it was sent in accordance with the requisite notice period of 28 days, in advance of the hearing, as required by the (Conduct and Competence Committee) (Procedure) Rules 2003 as amended (“the Rules”).

3. The Panel also noted that the last communication from the Registrant to the HCPC was in June 2020, prior to the substantive hearing when the Registrant indicated that he had ‘lost confidence’ in the regulatory process and had returned to Poland.

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

5. The Panel was satisfied that service had been effected in accordance with the Rules.

Proceeding in Absence

6. Ms Snookes (the HCPC) submitted that all reasonable steps have been taken to serve the notice of hearing on the Registrant. Therefore, the Panel should exercise its discretion to proceed with the substantive review hearing in the absence of the Registrant. The HCPC referred the Panel to the HCPTS Practice Note: Proceeding in the absence of the Registrant. The HCPC submitted that the Registrant did not attend the substantive hearing of this matter or the first review hearing. She submitted that there has been no response from the Registrant to the notice of hearing and that there has been no engagement by the Registrant with the HCPC since the imposition of the Suspension Order.

7. The HCPC submitted that it was clear from the Registrant’s actions that he had voluntarily absented himself from this hearing. The HCPC further submitted that this was a mandatory statutory review of a Suspension Order and that it was in the public interest for the review hearing to proceed today. The HCPC reminded the Panel that the overriding purpose of fitness to practise proceedings is to ensure public protection.

8. The Panel accepted the advice of the Legal Assessor who referred the Panel to Rule 11 of the Rules, the HCPTS Practice Note: Proceeding in the absence of the Registrant, and the relevant guidance from the cases of R v Jones (Anthony) [2004] 1 AC 1HL and General Medical Council v Adeogba [2016] EWCA Civ 162.

9. The Panel noted that the Registrant was given the required notice of today’s hearing date. He was informed of the powers available to the Panel at this hearing. He was also informed of his right to attend the hearing and/or be represented. In the circumstances, the Panel was satisfied that all reasonable efforts have been made by the HCPC to inform the Registrant of this hearing.

10. The Panel noted that the Registrant has not responded to the notice of hearing and has not sought an adjournment. The Panel was satisfied that the Registrant has waived his right to attend and/or be represented and has voluntarily absented himself from the hearing. Given the Registrant’s lack of engagement with these proceedings, the Panel was further satisfied that an adjournment was unlikely to result in the Registrant’s attendance on a future occasion.

11. The Panel was mindful that there would be some disadvantage to the Registrant if the review hearing proceeds in his absence, however, this must be balanced against the public interest in proceeding with this mandatory, statutory review of an existing Suspension Order.

12. The Panel therefore decided that it was fair and in the public interest to proceed with this substantive review hearing in the absence of the Registrant.

Background

13. The Registrant, a registered Paramedic, is a Polish national. He joined the East Midlands Ambulance Service (EMAS) as part of an international recruitment scheme. He commenced employment on 16 January 2017 and was subject to a nine-month probationary period. Within his first few months at EMAS concerns were raised about the Registrant’s practice, specifically in relation to his knowledge of the English language, and his knowledge and skills as a Paramedic. In October 2017, a formal review was undertaken of his probation and it was determined that this would be extended for a period of two months.

14. On or around December 2017 the Registrant took part in a capability development programme and a SMART Action Plan for 12 weeks. The Registrant was assessed on 11 March 2018 during a “ride out” with SW a Clinical Support Manager. Further assessments followed on 14 March 2018 and 15 March 2018, these raised further concerns about the Registrant’s Paramedic skills and knowledge.

Decision of the substantive hearing panel

15. The Registrant did not attend the substantive hearing and did not submit any written submissions or documents. The evidence of three witnesses and a copy of the Registrant’s terms and conditions established the Registrant was registered as a Paramedic with the HCPC when he was employed by EMAS.

16. The Panel stated that a number of the facts found proved were of such minor consequence that they constituted neither misconduct nor lack of competence.

17. The Panel decided the following factual particulars arose from the Registrant’s lack of competence: 1(a)(i), 1(a)(ii), 1(a)(iii), 1(a)(v), 1(a)(vi), 1(a)(viii), 1(a)(ix), 1(b)(i) (in part), 1(b)(iii), 1(b)(iv), 1(d)(iv) (in part), 1(e)(ii) (in part), 1(f)(i), 1(f)(iii), 1(f)(iv), 2(a), 2(b) and 2(c). The panel did not consider any of the matters found proved constituted misconduct but found the Registrant failed to reach the standards required of a Newly Qualified Paramedic.

18. The matters found proved related to a wide range of issues. A number of which were repeated in respect of each patient. They related, for example, to documentation, assessment, medication administration, handover, and not meeting the required standards in assessments. The HCPC witnesses referred to the Registrant’s lack of knowledge, which did not reach the standard expected of a registered Paramedic. SL, the Registrant’s mentor for a 12-week period, estimated that 50% of the Registrant’s issues stemmed from poor command of the English language and 50% from lack of clinical knowledge. The witnesses agreed that the Registrant was, as a result, not capable of safe, autonomous practice.

19. The Registrant failed a capability review due to insufficient knowledge, skills, competence and ability and, as a consequence, poor judgement. There was sufficient evidence to constitute a fair sample of the Registrant’s work and the acts and omissions found proved constituted an overall lack of competence on the part of the Registrant.

20. The Registrant had not submitted any material to the panel for its consideration. There was thus no evidence of insight, no reflection into what occurred, and no evidence to address the lack of competence or steps taken to resolve or remedy the lack of competence. The Registrant had put patients at unwarranted risk of harm. Due to the lack of any evidence of insight or remediation, the risk of repetition of the lack of competence is high.

21. The Decision of the substantive Hearing Panel was that it considered that the Registrant did not meet the following HCPC Standards of Proficiency for Paramedics (2014):

1: be able to practice safely and effectively within their scope of practice.

3: be able to maintain fitness to practise.

3.1: understand the need to maintain high standards of personal and professional conduct.

4: be able to practise as an autonomous professional, exercising their own professional judgment.

8: be able to communicate effectively.

10: be able to maintain records appropriately.

13: understand the key concepts of the knowledge base relevant to their profession.

14: be able to draw on appropriate knowledge and skills to inform practice.

22. The Substantive Panel in March 2021 identified the following aggravating factors:

• Lack of evidence of current insight and remediation;
• Limited engagement with the regulatory process, and
• An active decision to disengage with the substantive hearing.

23. The mitigating factors:

• No previous fitness to practice history relating to the Registrant;
• He demonstrated some limited insight.

24. The substantive panel concluded that, the Registrant’s lack of competence was not minor in nature, it was wide-ranging and sustained and there is a high risk of repetition. Furthermore, there was no evidence to demonstrate that the Registrant has taken any of the steps required to address that lack of competence; such as training or Continuing Professional Development since 2018. The substantive Panel decided that the Registrant’s lack of competence found proved is in principle, remediable. However, the Registrant’s lack of engagement and the lack of evidence to demonstrate any insight, means there is no indication that he would be willing to comply with conditions. The Registrant currently resides in Poland and there is no information about his current work arrangements.

25. A Suspension Order for 12 months was the only appropriate and proportionate sanction. The panel stated that the Registrant has been given the opportunity to reflect, to obtain and demonstrate insight and remediation, and provide evidence of his current practice, including testimonials, in order to engage with the regulatory process.

16 March 2022 First Review Decision

26. On 16 March 2022 a reviewing panel imposed a further Suspension Order for a further 12 months until 16 April 2023.

6 April 2023 Second Review Decision

27. At the review hearing on 6 April 2023, the background of the case as recorded in the decision of the previous panel was summarised by the Presenter. It was submitted on behalf of the HCPC that the current Suspension Order should be extended for 6 months as the Registrant has not engaged with the HCPC process since June 2020.
28. The Registrant did not appear to have taken the necessary steps to allow a Panel to decide that his fitness to practise is no longer impaired on both the personal and the public components of fitness to practise. The reviewing Panel noted that the substantive Hearing concluded on 19 March 2021, and the Registrant has continued to fail to engage with the HCPC. The Panel decided that extending the period of the Suspension Order for six months would allow the Registrant another chance to engage with the HCPC, bearing in mind that once the Registrant has been suspended substantively for two years, a panel can make a striking off order.

Submissions

29. The HCPC referred the Panel to the substantive review hearing bundle and set out the background and chronology of this matter.

30. The HCPC also referred the Panel to the HCPTS Practice Note: Review of Article 30 Sanction Orders. She submitted that the guidance makes clear that in practical terms, there is a persuasive burden on the Registrant to demonstrate that he has addressed the concerns identified by the previous panels.

31. The HCPC submitted that there has been no engagement by the Registrant since his email of June 2020. Accordingly, nothing has changed since the last reviewing panel had issued its decision. The HCPC submitted that there is no new information available to this Panel. In particular, the Registrant has failed to demonstrate insight into his failings and has not provided any evidence of steps taken to remediate the deficiencies in his practice. The HCPC submitted that the Registrant’s fitness to practise remains currently impaired in relation to the personal component of impairment.

32. The HCPC further submitted that a finding of current impairment was also required in relation to the public component of impairment in order to maintain public confidence in the Paramedic profession. The public would be troubled to learn that a finding of current impairment had not been made in circumstances where the Registrant has not participated in the review process and has not demonstrated any commitment to addressing his lack of competence.

33. The HCPC submitted that the appropriate and proportionate order was a Striking Off Order which was now available to the Panel under Article 29.(5) of the Health Professions Order 2001(the 2001 Order). The Registrant had now been subject to a substantive Suspension Order for a period in excess of two years and accordingly the limitation set out in Article 29.(6) of the 2001 Order no longer applied.

34. The HCPC invited the Panel to consider a Striking Off Order as the most appropriate and proportionate order at this time. She submitted that the Registrant had not addressed the decisions made by the panels which imposed the subsequent suspension orders. The orders were accompanied by clear indications by the panels of the kind of engagement and remediation that would be likely to meet their concerns and provide the Registrant with a route to safe and effective practice.

35. The HCPC invited the Panel to conclude that no lesser sanction than that of a Striking Off Order would meet the risks to the public inherent in the Registrant’s continuing impairment. Further, a lesser sanction would not satisfy the public that it could remain confident in the profession or that standards for the profession would be declared and upheld.

Decision of Today’s Reviewing Panel

36. The Panel received and accepted the advice of the Legal Assessor.

37. The Panel was mindful of its powers upon a review of a Suspension Order under Article 30(1) of the 2001 Order2001 and had regard to the guidance contained in the HCPTS Practice Note: Review of Article 30 Sanctions Orders, the HCPTS Practice Note: Impairment and the HCPC Sanctions Policy.

38. The Panel noted that its task is to conduct a comprehensive review of the current order on the basis of the information available today. It must not seek to go behind the findings of the previous panels. The Panel must first decide whether it finds the Registrant’s fitness to practise to be currently impaired by reason of lack of competence.

39. The Panel noted that in accordance with the guidance in the case of Abrahaem v General Medical Council [2008] EWHC 183 (Admin), the persuasive burden to satisfy the Panel of fitness to practise at a review hearing is upon the Registrant.

40. The Panel further noted that if it found the Registrant’s fitness to practise to be currently impaired, then it should consider what steps to take in respect of the current order in accordance with its powers under Article 30(1) of the Health Professions Order.

41. The Panel was reminded that this is a lack of competence case, but the power in Article 29.(5) to make a Striking Off Order is available to the Panel at this review hearing. The Registrant has been continuously suspended under a substantive for a period greater than two years.

42. In reaching its decision, the Panel carefully considered all of the documents provided to it in the substantive review hearing bundle and the submissions made on behalf of the HCPC. The Panel noted that no submissions or evidence had been provided by, or on behalf of, the Registrant. The Panel further noted that the last contact from the Registrant appears to be his email of June 2020.

43. The Panel first considered whether the Registrant’s fitness to practise remains currently impaired.

44. The Panel carefully considered the reasoning set out in the written determinations of the substantive hearing panel and the first and second reviewing panels respectively. The Panel noted that the Registrant did not participate in either of those hearings. The Registrant’s non-engagement with these proceedings has continued today.

45. The Panel noted that the Registrant is thought to be currently living in Poland and has not engaged with the HCPC for over 3 years. He has failed to demonstrate insight, remorse, undertake CPD or offer an apology for his failings.

46. The Panel noted that there has been no change since the substantive hearing. The Registrant had not submitted any material to this Panel. There was thus no evidence of insight, no reflection into what occurred, and no evidence to address the lack of competence across different areas, or steps taken to resolve or remedy the lack of competence. The Registrant had put patients at unwarranted risk of harm. Due to the lack of any evidence of insight or remediation, including any training or testimonials, the risk of repetition of the lack of competence remains high. The Registrant brought the profession into disrepute, had breached fundamental tenets and there is a real risk of bringing the profession into disrepute in the future. The Registrant’s wide-ranging lack of competence struck at the heart of the trust placed in Paramedics to carry out their role, often in difficult and testing circumstances, while being able to safeguard the safety and wellbeing of their patients at all times and being able to work autonomously with the requisite skill and competence.

47. Further, the Panel considered that a member of the public, in possession of all the facts and information about this case, would be concerned if there were no restrictions on the Registrant’s practice, in light of the wide-ranging and sustained lack of competence despite the support and supervision provided to the Registrant. The need to uphold proper professional standards and maintain public confidence in the profession would be undermined if a finding of impairment was not made.

48. The Panel therefore concluded that the Registrant’s fitness to practise remains impaired on the personal component.

49. Insofar as the public component is concerned, the Panel considered that members of the public would not have confidence in the profession, or in the regulator, if the Registrant is permitted to return to unrestricted practice. Accordingly, this component is also engaged.

50. The Panel has considered the available sanctions in ascending order of severity. The Registrant has not demonstrated any remediation or insight. In reviewing sanction, the Panel found that nothing had changed since the last Order. The Panel decided that to take no action or to impose a caution would not be appropriate because the lack of competence is too serious.

51. The Panel decided that imposing a Conditions of Practice Order would also not be suitable. It took account of the findings and the consequent risks and decided that there are no workable Conditions of Practice that are capable of being formulated in this case due to the lack of engagement. The Panel was not satisfied that it could have confidence that the Registrant would comply with any conditions formulated.

52. The Panel then went on to consider whether a further Suspension Order should be imposed today. It noted that this is the third review of the Suspension Order and that the Registrant has not engaged since June 2020 some 3 years ago. The Panel was not satisfied that there was any likelihood that the registrant was going to engage and demonstrate remediation of his practice.

53. The Panel therefore considered whether a further period of suspension would be appropriate. The Panel recognised that a further period of suspension would allow the Registrant an opportunity to engage in this process and begin to demonstrate that he has addressed the issues relating to his lack of competence. However, the Registrant has not shown any willingness to respond to the earlier suspension orders by using the time constructively to address his failings by training and reflection. A Paramedic must be open to learning and continuous improvement, contrary to the attitude demonstrated by the Registrant.

54. The Panel therefore concluded that a period of suspension was now inadequate to fully protect the public and to maintain the public’s trust and confidence in the Paramedic profession.

55. The Panel decided that in all of the circumstances, the proportionate and appropriate sanction was to make a Striking Off Order under Article 29(5) of the 2001 Order.

56. The Panel therefore decided to impose a Striking Off Order to take effect from the expiry of the current Suspension Order on 16 October 2023.

ORDER: The Registrar is directed to strike off the name of the Registrant from the Register upon the expiry of the Suspension Order on 16 October 2023.

No notes available

History of Hearings for Piotr Nowakowski