Miss Tracylee Armit
Profession: Paramedic
Registration Number: PA13190
Hearing Type: Final Hearing
Date and Time of hearing: 10:00 19/02/2024
End:
17:00 28/02/2024
Location:
Virtual Hearing via Video Conference
Panel: Conduct and Competence Committee
Outcome: Struck off
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Allegation
Amended Allegation
1. While working as a Clinical Advisor with Scottish Ambulance Service, you entered into IT system ‘C3’ triage/ welfare calls for patients which you did not make and / or which were inaccurate on:
a) 17 January 2017;
b) 7 July 2017;
c) 24 April 2018;
d) 29 April 2018;
e) 2 May 2018.
f) 4 May 2018
2. You prevented your work activities from being accurately logged in that you did not log into the telephone system for the entire shift worked on the dates set out in Schedule A.
3. Your conduct in relation to particulars 1 and 2 above was dishonest.
4. The matters set out in particulars 1, 2 and 3 above constitute misconduct
5. By reason of your misconduct your fitness to practise is impaired.
Schedule A
1 February 2018;
2 February 2018;
3 February 2018;
4 February 2018;
5 February 2018
6 February 2018
7 February 2018
10 February 2018
11 February 2018
12 February 2018;
13 February 2018;
14 February 2018;
15 February 2018;
16 February 2018;
18 February 2018;
19 February 2018;
20 February 2018;
21 February 2018;
22 February 2018;
23 February 2018;
24 February 2018;
1 March 2018
3 March 2018
4 March 2018
5 March 2018;
8 March 2018.
16 March 2018
17 March 2018
18 March 2018
23 April 2018
25 April 2018
26 April 2018
30 April 2018
29 April 2018
1 May 2018
5 May 2018
9 May 2018
Finding
Preliminary Matters
Service
1. The Panel first considered the issue of service as the Registrant was not in attendance.
2. The Panel had been provided with the Registrant’s e-mail within the Certificate signed by the Registrar dated 11 July 2023. This confirmed the registered email address for the Registrant. The Panel had sight of the notice of hearing email dated 11 July 2023 sent to the Registrant at her registered email address. This confirmed the dates (23-29 August 2023) and times of the hearing as well as informing her that this would be a virtual hearing. It also offered the Registrant an opportunity to attend the hearing and/or make written submissions.
3. The Hearings Officer drew the Panel’s attention to the email from the Registrant’s solicitor dated 22 August 2023, in which she stated that the Registrant would not be attending the hearing and would not be represented but is happy for the hearing to proceed in her absence. The Hearings Officer submitted that good service had been effected.
4. The Panel accepted the advice of the Legal Assessor who referred to the Health Professions Order 2001 and the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules), namely rule 6. The Legal Assessor advised that good service was effected by notifying the Registrant of the time and date of the hearing at her registered email address, with 28 days’ notice.
5. The Panel was satisfied that fair, proper and reasonable notice of the hearing had been served on the Registrant, in accordance with the Rules, having been sent to the Registrant at her registered email address on 11 July 2023.
Proceeding in the Registrant’s absence
6. Ms Jones invited the Panel to proceed in the Registrant's absence. Ms Jones referred the Panel to the Rules which allow the Panel a discretion to proceed in absence, the relevant factors to consider as outlined in the case of R v Jones, and the HCPTS Practice Note relating to proceeding in absence.
7. Ms Jones submitted that the Registrant is aware of the hearing and has provided a witness statement to be considered in her absence. Ms Jones submitted that adjourning the proceedings to provide the Registrant with a further opportunity to attend is likely to be a fruitless exercise. In any event, the witness statement that the Registrant has provided states that she wishes for the matter to be dealt with as soon as possible so that she can get on with her life.
8. Ms Jones invited the Panel to find, in all the circumstances, that it was satisfied that it is in the public interest for the hearing to proceed as scheduled, and for the HCPC’s application to be granted.
9. The Panel heard and accepted the advice of the Legal Assessor in relation to the factors it should take into account when considering proceeding in the Registrant’s absence. This included reference to rule 11 of the Rules and to the cases of GMC v Adeogba [2016] EWCA Civ 162, R v Jones (Anthony) [2003] 1AC1 and Sanusi v GMC [2019] EWCA Civ 1172. The Panel also had regard to the HCPTS guidance ‘Proceeding in the Absence of the Registrant’ dated June 2022.
10. The Panel considered all the information before it, together with the submissions made by Ms Jones on behalf of the HCPC. The Panel was satisfied that the notice of hearing letter had been sent to the Registrant on 11 July 2023 informing her of the hearing.
11. The Panel concluded that it was reasonable and in the public interest to proceed with the hearing in the absence of the Registrant for the following reasons:
• The Registrant has confirmed, through her legal representative, that she will not be attending at the hearing. The email from her legal representative to the HCPC is dated 22 August 2023 and states:
‘I have taken instructions from my client. She will not be in attendance at the hearing. She will be providing a written witness statement, certificates and character references for the panel to consider. I will also not be in attendance, as without my client’s instructions I am not authorised to act.
Ms Armit is aware that the hearing will proceed in her absence and is content for it to do so.
The statement and certificates will follow shortly, and character references will be submitted if the impairment stage is reached.’
• In light of the contents of the email, the Panel concluded that the Registrant had voluntarily and deliberately absented herself. The Registrant had not sought an adjournment of the hearing and there was no indication from her that she would be willing or able to attend on an alternative date. Therefore, re-listing this hearing would be unlikely to secure her attendance.
• This case is an old case with the particulars dating back to 2017, and the witnesses are lined up to give evidence this week. Any delay would cause inconvenience to the witnesses, and the further passage of time if the case was adjourned is likely to have a negative impact on memory.
• The Panel recognised that there may be some disadvantage to the Registrant in not being able to give evidence or make oral submissions. However, she had provided a written statement which the Panel will take into account when reaching its decision at each stage.
Amendment of Allegation
12. Ms Jones made an application to amend the Allegation contained in the Notice of Allegation letter sent to the Registrant on 16 July 2022. The amendments Ms Jones sought are set out above under the heading ‘Allegation’. Proposed additions are included in bold type and proposed deletions contain strike-through.
13. Ms Jones submitted that the HCPC had notified the Registrant of the proposed amendments by letter dated 30 May 2022 (contained within the hearing bundle). Ms Jones submitted that the proposed changes do not alter the stem of the Particulars, they simply better reflect the evidence in the case. Ms Jones submitted that there is no prejudice to the Registrant and invited the Panel to grant the application.
14. The Panel heard and accepted the advice of the Legal Assessor who advised that the Panel has an inherent power to amend an Allegation subject to the requirements to ensure a fair hearing. The Legal Assessor referred the Panel to the case of Professional Standards Authority v Health and Care Professions Council and Doree [2017].
15. The Panel sought clarification as to whether all the dates listed in each of the Particulars have to be found to prove the Particular, or whether it was an ‘and/or’ situation.
16. The Legal Assessor advised that the Panel should apply a fair and reasonable reading of the Allegation. The Legal Assessor referred to the case of Connolly v Law Society [2007] EWHC 1175 (Admin), within that, the Divisional Court had observed that the Law Society should avoid, where possible, formulating charges that include ‘and/or’ allegations. The Legal Assessor advised that the Panel could find none of the dates in each Particular proved, some of them proved in any combination, or all of them proved, and that the stem of each Particular would not fall away if any one of the dates was not found proved.
17. The Panel kept in mind the overarching objectives of HCPC, and the importance of a fair balance being struck between the aims of public interest and fairness to the Registrant.
18. Having regard to fairness to the Registrant the Panel was satisfied that the amendments do not heighten the seriousness of the Allegation and seek to better reflect the evidence in the case.
19. The Panel considered that any prejudice to the Registrant was mitigated in that the proposed amendments had been sent to her and her solicitor over twelve months ago, thus giving ample opportunity for her to understand the case against her and be able to respond.
20. The Panel therefore accepted the submissions of Ms Jones and agreed that the Allegation should be amended as is set out at the start of this decision.
Background (as set out in the HCPC case summary)
21. The Registrant is a registered Paramedic who worked as a Clinical Advisor within the East Ambulance Control Centre within the Scottish Ambulance Service (“SAS”). As part of this role, the Registrant undertook welfare calls for patients who have extended response times to ensure there is no deterioration in their health.
22. On 3 May 2018 the East Ambulance Control Centre received a request from Police Scotland for tapes for an attempted murder incident relating to an incident log 4603738. In the incident, it recorded the Registrant as having dealt with the incident. The Sequence of Events of the call stated that there were three attempts to call the patient back whereby the phone rang out, however, there was no call recording on the relevant systems to evidence this. On the shift in question the Registrant was not logged into her telephone.
23. An audit was then conducted of further shifts that the Registrant had worked, and similar issues were found over a number of dates. As a result of this, SAS commenced an internal investigation, and a referral was sent to the HCPC on 14 June 2018.
Evidence
24. The HCPC relied on the following witness evidence:
JM – Employed by Scottish Ambulance Service (SAS) as Head of Operational Delivery, and who undertook the internal investigation for SAS into the Registrant’s practice. JM was called to give live evidence.
SJ – Employed by SAS as Head of Clinical Services for the Ambulance Control Centre, and who at the relevant time was the Registrant’s line manager. SJ was called to give live evidence.
JMO - Employed by Greater Glasgow & Clyde NHS Board as a General Manager for E-Health Telecommunications, and who at the relevant time was approached by JM and asked to answer some questions as part of the investigation. JMO was called to give live evidence.
AL - Employed by SAS as a Clinical Hub Supervisor, and who at the relevant time was the Registrant’s Clinical Hub Supervisor. (AL’s statement was admitted as hearsay).
HL - Legal Assistant at Kingsley Napley LLP. Prepared a production statement of the documents obtained by the HCPC as part of its initial investigation.
25. The witnesses who were called to give live evidence each gave evidence on affirmation and relied on their witness statements and exhibits.
26. The Panel was mindful of the fact that the Registrant was not present or represented at the hearing and therefore it was incumbent on the Panel and Legal Assessor to ensure that they explored any weaknesses arising in the evidence, particularly in relation to the points raised by the Registrant in her written statement. The Panel therefore asked questions of clarification in respect of each witness.
27. In summary the evidence of JM was as follows:
• The Registrant had been in post as a Clinical Advisor for a number of years. She was responsible for safety-netting patients where an ambulance response was not immediately available or not needed due to the patient’s condition. Her role involved calling patients back where required, taking the patients through the triage system, and using her clinical knowledge to decide what the best course of action was to attend to the patient’s need.
• In around May 2018 he was asked to undertake an internal investigation into the Registrant’s practice by Ambulance Control Centres (ACC) Head of Professional Standards. Prior to conducting the investigation, he would estimate that he had conducted between 15 and 20 investigations.
• He provided an explanation of the three recording systems used by the SAS in the ACC. The three recording systems act independently of the others, though there is some integration between them. These are:
- C3 - The C3 system is the computer-based system used by Call Handlers, Dispatchers, Clinical Advisors and Managers. Live system where information is recorded including priority code, dispatch recommendations and decisions, freelance notes and Clinical Advisor decision making. It is also a historic reporting system that cannot be edited.
- NICE Recording System - The NICE call recording system records all inward and outbound calls from phones within the ACC’s. These calls are stored, and information can be gathered by person, extension number, number dialled or date/time amongst other ways.
- AVAYA - The Avaya system is linked to telephone usage and is a data recording system. Avaya shows staff login/logout times, inbound and outbound call durations, and active talk time. Information is compiled into 15 minute or day intervals dependant on the report requested.
• He explained that it is important that staff log in and out of their phones whilst at their desks because it ensures that SAS have the right governance structure to help it use patient data to inform its improved responses to the public. It also allows SAS to investigate any incidents where there is an alleged risk or patient harm. Furthermore, logging into phones means that data is collected for the staff member’s performance management, with a view that correct processes are put in place and fed back to staff as necessary. For Clinical Advisors, a failure to log into their telephone at the beginning of their shift will not stop them from doing their job; it will just mean that data is not collected.
• The allegation of falsification of welfare calls is serious because, using historical data from patients and ambulance response times, SAS works to standards set out by the Scottish Government. As a result of this data, excessive response times have been identified. These are the points after which we believe the patient starts to become at risk of deterioration.
• He interviewed various staff members as part of his investigation including the Registrant.
• He was provided with data from SJ which included data for other staff members in order to cross reference.
• He set out data for each of the dates referred to in the HCPC Allegation.
• During the investigation, he requested that a Consultant Paramedic from SAS Clinical Directorate undertake a clinical review of some of the incidents identified. The Consultant Paramedic provided his review of two incidents which are exhibited to JM’s statement. JM’s statement gave a summary in relation to incident number 4603738 i.e. the incident for which the police were requesting the audio. In relation to that incident, the Consultant Paramedic found that had ‘earlier intervention by a Clinical Advisor been provided, the recognition of the extent of the patient’s injury and identification of hypovolemic shock may have taken place sooner and the patient could have received intervention more quickly as a result of subsequent escalation of the call’.
• Not calling patients back and escalating calls without justification, would present a risk to patients but also to colleagues, and also had a potential impact on resourcing.
• Upon completion of his investigation, he submitted it, along with the evidence collected, to the Commissioning Manager with his recommendations. The matter was progressed internally to a formal disciplinary hearing, where he presented the management case to the disciplinary panel. Following his presentation and interviewing of witnesses, the Registrant’s representative presented her side. JM was not made aware of the disciplinary panel’s decision.
• He thought that the Registrant was incredibly focused on how NICE was showing incorrect information. He covered this issue with advice from JMO and concluded that the Registrant’s suggestion did not hold up. Even if the systems could not be trusted, looking at the number of incidents, a pattern emerges. If the IT issues the Registrant claimed to have suffered from were in fact taking place, these would have affected others as well, but this was not found to be the case.
• He has dealt with a number of cases over the years involving misuse of IT systems. Consequently, during the investigation he did not just take one system at face value. The investigation went in depth to understand what took place and made concerted efforts to get data for cross-referencing. The data collated identified a clear pattern of behaviour on the part of the Registrant that had taken place over a sustained period of time.
• By way of example in relation to his investigation results, he found that out of 41 calls the Registrant made during her 17 January 2017 shift, 22 of the callbacks were logged in C3 as unable to triage, and no available calls or audio were available within the recording system. If SAS was experiencing IT system faults, it’s not normal for it to be isolated to a single user. That is why other people’s data on the same shift were considered as part of the investigation. Whilst there were improvements to be made in the system at the time which might have made the finding of the calls more challenging sometimes, to not be able to find any data at all for 22 calls relating to one individual when there are no identified system issues and no issues affecting anybody else on the same shift, is highly unusual and led SAS to the conclusion that those calls had not been made.
• They found the same pattern of behaviour across all dates they picked, including the dates picked at random.
• Nobody else was experiencing missing data, every staff member looked at as part of the testing done to understand the logic behind what data would appear there, for every other person, the data appeared in the exact way that it was expected to look. It was only for the Registrant in isolation that that data wasn’t there.
• He believes the Registrant abandoned calls before they connected and falsified the detail of incidents in C3.
• In terms of logging into the AVAYA system, there are times when the Registrant has logged in at the start of her shift and logged out of her shift. His view is therefore, that the Registrant’s chose when not to log in, rather than forgot. To log in 15 times in a five-week period, but then just forget to do it another time is in his view more behavioural.
• He did not recall any major change in the system that came into play in 2018.
• Although supervisors and managers may have been sat in the same area as the Registrant, they would not question what she was doing as they are not clinical. They don’t understand the role. They don’t understand how that workload takes place, so he wouldn’t expect people around the Registrant to pick up on what she was or wasn’t doing.
28. In summary the evidence of SJ was as follows:
• In early May 2018, she was approached by a Duty Manager who said that the local police had come to the control room looking for tapes of a call that was received by SAS on 29 April 2018. It is not uncommon for the police to do this to collect evidence as part of a criminal investigation. When tapes are requested C3 is checked to determine who handled the call(s) and then data would be pulled from AVAYA and NICE to provide to the police. The C3 said that the Registrant had unsuccessfully tried to call the patient three times. Normally, SAS would provide evidence of those three attempts to the police, but the Duty Manager said that she could not find that evidence on NICE or AVAYA.
• SJ personally checked NCIE and AVAYA for the calls but was unable to find them. She checked with Telecommunications Department to see if any faults had been logged but was told not. She therefore started to have a deeper look into the calls for 29 April 2018. She compared the data with other Clinical Advisors to see whether there was a widespread issue with the systems. She could only find calls missing for the Registrant. She raised this concern with the Call Director and her own Director.
• The Registrant was suspended on 11 May 2018.
• SJ was responsible for collecting and reviewing data to provide to JM. SJ asked for support from AL to pull the data.
• SJ made the decision to look at other shifts specifically 24 April and 2 May 2018. She produced a table to cross reference the systems and assess when data was missing.
• SJ prepared a presentation for the Registrant’s disciplinary hearing as she was conscious that there was a lot of information, and it can be difficult for someone who is not familiar with the SAS systems to follow. She was called to give evidence at the disciplinary hearing.
• SJ was concerned about the Registrant’s AVAYA log in activity, so she pulled an activity report and compared the data to other Clinical Advisors. This showed a pattern of the Registrant not logging in which was not seen in the data for the other staff members.
• During the disciplinary hearing, the panel chair requested that SJ look further back to determine how long the alleged conduct had been going on. She chose two random dates, those being 17 January and 7 July 2017. She completed the same exercise of pulling and cross referencing the data.
• SJ noticed a theme across her data review which was that all the missing calls were related to calls that were either left at the same colour coding level of upgraded to indicate an ambulance was now required more quickly. None of the missing calls were ever downgraded or closed as no ambulance was required after speaking to the patient; these calls were always there and recordings in AVAYA records could be found. All calls that were missing were for incidents where the patient was told an ambulance would be on its way and due to an extended response, the Registrant has been expected to call back to ensure the patient had not deteriorated. Those patients would not have known to expect a call because it is an internal process and not information that is routinely given.
• SJ was referred to the HCPC in June 2020 by the Registrant. There were 10 allegations stemming from her actions during the SAS investigation conducted by JM. On 9 April 2021 both SJ and her employer received a letter from the HCPC to say that her case was concluding with ‘no case to answer.’
• There was nothing during the course of the investigation into the Registrant’s conduct to suggest that the systems were not working as they should.
• There was evidence throughout the investigation, that the Registrant followed the log in and call procedure correctly on a number of occasions and incorrectly on others. The Registrant never asked for any additional training, and never identified any problem. Her audits were always good at that point. The audit system has been changed from learning from this incident, but there is nothing to suggest that the training was any part of the issue.
• There were no new systems to SJ’s recollection that were brought in that would affect the way that the Registrant operated on a daily basis and had there been any changes to existing systems, all the training records and associated training was then signed for.
• In the beginning, there was no concerns around the Registrant’s clinical capability. The way SAS used to audit was to download all of the recordings from NICE and then, where there was a call of around 10 minutes or so or a number of minutes, a search for that incident within CAD (C3) would be done and that became the audit. Because SAS were looking for the clinical quality of the call recording, they looked to NICE and reflected that back in C3. What that exposed through the investigation into the Registrant is that SAS could always find calls where the recording was there but what that didn’t show was the gaps of things that we would expect to see in C3 that didn’t have a recording. So, on the face of things, there was never a problem with the Registrant’s clinical capability in that space because all of the recordings that were there had an incident within C3.
29. In summary the evidence of JMO was as follows:
• In 2018 she was approached by local investigator, JM and asked to answer some questions as part of a local investigation.
• She had an interview with JM on 13 June 2018. She was asked questions about call reports and call recordings and to comment on the technology.
• There was one IT issue that she is aware of. It involved a clash of extension numbers. It did not impact on the calls still being recorded and the associated audio was still available. This issue was discovered and addressed very quickly and the staff members who were affected had new log in numbers provided. This happened within a couple of days of the clash occurring. The Registrant was not one of the staff members effected.
• It is very odd for there to have been a recording system error affecting only one position. The control rooms are active 24/7, therefore if a staff member was experiencing an issue with their recordings that issue would affect the person who sat at the desk during the previous shift and the subsequent shift until the issue was resolved.
• When asked how confident JMO would be that if there is nothing on AVAYA or the NICE system about the calls, that they did not happen, she said she was 100%. Unless the Registrant had used her mobile phone which was never alleged. Whilst she has not dealt with something like this before, she was frequently asked to provide calls for fatal accident enquiries, things for the police, and the systems have to be robust and her and her team checked all the systems. They were checked during the day but then they were checked every night. There were on call checks carried out on all the key systems to make sure everything was working, and if there were any incidents the team were called out to deal with them promptly, so she can’t see any way that this could have happened.
30. Ms Jones submitted that the HCPC had one more witness to call, that being AL. Ms Jones had explained at the outset of the hearing at AL was currently unwell and it was envisaged she would be able to attend a hearing towards the end of the year. Given that the hearing was due to be heard in two parts in any event, Ms Jones suggested that the Panel provide dates for the second part of the hearing.
31. The Legal Assessor advised the Panel of its overarching responsibility to ensure fairness and remined it of its case management powers.
32. The Panel made a case management order and re-listed the hearing for 19 – 28 February 2024.
33. The hearing reconvened on 19 February 2024.
Preliminary matters (19 February 2024)
34. The Panel had regard to the updated service bundle. The Panel heard and accepted the advice of the Legal Assessor who advised that the Rules did not prescribe any set notice period for a hearing which had already started but was recommencing. The Legal Assessor reminded the Panel of the importance of ensuring a fair hearing and to take that into account.
35. The Panel had sight of a notice of hearing letter that was sent to the Registrant and her representative (by email) on 06 September 2023, confirming that the hearing would be reconvening on Monday 19 February 2024 at 10:00am until Wednesday 28 February 2024 at 17:00pm. The Registrant’s e-mail address was confirmed within the Certificate signed by the Registrar dated 06 September 2023. The Panel also had sight of an email sent to the Registrant and her representative on 13 February 2024 asking for confirmation of whether they would be attending at the reconvened hearing on 19 February 2024.
36. The Panel was satisfied that the Registrant had been provided with sufficient and adequate notice of the hearing.
37. Ms Jones made an application to proceed in the absence of the Registrant. Ms Jones reminded the Panel of the relevant legal cases and the HCPTS Practice Note relating to proceeding in absence. Ms Jones submitted that it was in the interests of the public for the case to continue and that there is no reason to adjourn the caser off. Ms Jones submitted that an adjournment is not likely to secure the Registrant’s attendance as she has provided no reason for her non-attendance. Ms Jones said that in response to the recent email sent by the HCPC on 13 February 2024, an out of office response had been received from the Registrant’s email address to say she would be out of the country and returning on 29 March 2024. An out of office response had also been received from the Registrant’s representative to say that she would be in a hearing until 23 February 2024 but that her emails will be monitored during this time.
38. Ms Jones submitted that there had been no other communication with the Registrant or the representative since the first part of the hearing in August 2023. Ms Jones said that any adjournment which risk further significant delay of multiple months, and this would not be in the public interest.
39. The Panel heard and accepted the advice of the Legal Assessor in relation to the factors it should take into account when considering proceeding in the Registrant’s absence. This included reference to rule 11 of the Rules and to the cases of GMC v Adeogba [2016] EWCA Civ 162, R v Jones (Anthony) [2003] 1AC1 and Sanusi v GMC [2019] EWCA Civ 1172. The Panel also had regard to the HCPTS guidance ‘Proceeding in the Absence of the Registrant’ dated June 2022.
40. The Panel considered all the information before it, together with the submissions made by Ms Jones on behalf of the HCPC. The Panel took into account that the Registrant had been sent notice of today’s hearing and the Panel was satisfied that she was or should be aware of today’s hearing. The Panel took into account that the Registrant did not attend the first part of the hearing in August 2023, and had made it clear that she was happy for it to proceed in her absence. Since then, she has not engaged with the regulatory proceedings. The Panel, therefore, concluded that the Registrant had chosen voluntarily to absent herself from these proceedings. The Panel had no reason to believe that an adjournment would result in the Registrant’s attendance nor that it would secure her future engagement. Having weighed the interests of the Registrant in regard to her attendance at the hearing with those of the HCPC and the public interest in an expeditious disposal of this hearing, the Panel determined to proceed in the Registrant’s absence.
Hearsay Application
41. Ms Jones said that the HCPC were intending to call AL as a witness to give live evidence. However, she had confirmed that she remained unwell and was unable to attend the hearing. Ms Jones submitted that there was good reason for her non-attendance and as a result, the HCPC applies to admit AL’s statement as hearsay evidence.
42. Ms Jones submitted that AL’s statement has probative value to the Particulars of the Allegation and is signed and dated with a statement of truth. Ms Jones submitted that the evidence is reliable and that it was provided within the context of AL’s employment. Ms Jones submitted that there is no reason to doubt AL’s character and that she would have attended if she had been well enough to.
43. Ms Jones said that the Registrant was made aware of AL’s availability issues in August 2023. No response was received in relation to the issues raised.
44. An email was provided in the Panel’s bundle dated 01 August 2023 sent on behalf of the HCPC to the Registrant’s representative. The email states that ‘We are experiencing difficulties securing the attendance of one of our witnesses, [AL]. [AL] is presently unwell and …unfit to give evidence at the upcoming final hearing...[AL] may be well enough to attend the hearing towards the end of the year. We would like if possible, to reserve our position in respect of [AL] until notification of the date that the adjourned hearing is likely to be reconvened. We would like to make further enquiries with [AL]…at that point to determine whether she … attend the adjourned hearing to give evidence.’
45. The Panel heard and accepted the advice of the Legal Assessor in relation to factors it should take into account in considering a hearsay application. The Legal Assessor did not specifically identify all the case names, but the factors referred to arise from the cases of: Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565 (Admin), R (Bonhoeffer) v General Medical Council [2011] EWHC 1585 (Admin), El Karout v Nursing and Midwifery Council [2019] EWHC 19 (Admin), and Mansaray v Nursing and Midwifery Council [2023] EWHC 730.
46. The Panel began its deliberations by asking itself whether the admission of the evidence would undermine the Registrant’s right to a fair hearing. The Panel took into account its duty to protect the public as well as its common law duty to ensure that hearsay evidence should only be admitted if it is relevant, fair and in the interests of justice.
47. The Panel considered the application in accordance with the approach set out in Thorneycroft v Nursing and Midwifery Council [2014] EWHC 1565.
48. The Panel took into account that the statement of AL is not the sole or decisive evidence in support of the charges.
49. The Panel had regard to the fact that AL only had minimal involvement with the SAS investigation, and she was mainly responsible for printing documents to pass to SJ for the purpose of her audit. The Panel was satisfied that it could test the reliability of her evidence by reference to the other witness evidence.
50. The Panel had no information before it to suggest that AL had reasons to fabricate her evidence.
51. The Panel considered that there was a good reason for the non-attendance of AL who was and remains too unwell to attend the hearing. The Panel did not have any information before it to suggest that AL’s non-attendance was an attempt to prevent a proper evaluation of the evidence.
52. The Panel considered that the HCPC had taken reasonable steps to secure AL’s attendance including allowing her to attend at this second part of the hearing rather than in August 2023. The Panel accepted that it was not in the public interest to allow an adjournment to consider whether AL could attend in due course as it has heard live evidence from other witnesses who speak to the same events.
53. The Panel bore in mind that its role today was to addresses the matter of admissibility, and that once hearsay evidence is admitted it must still be assessed by the Panel as to the appropriate weight to attach to it.
54. Based on the evidence and information before the Panel, and for the reasons set out above, the Panel agreed to the admission of the written evidence of AL.
Evidence
55. In summary AL’s written evidence was as follows:
• I first met the Registrant approximately 15 years ago, when she was working as a nursing auxiliary in the Royal Infirmary.
• Upon my promotion to Clinical Hub Supervisor, I became her line manager. I would describe my relationship with the Registrant as professional and I am not aware of there being any issues between the two of us.
• During the period in which the concerns considered in the local investigation took place, the Registrant did not raise any concerns with me about her workload or issues she was having with the IT systems.
• In April 2018 I was approached by SJ who told me that the Scottish Police had requested the audio of a 999 call. SJ said that the call could not be found. I was asked to look at the Registrant’s UAA and NICE reports to explore whether there were any other incidents of missing calls and if there were any issues.
• For the investigation I provided a large amount of data for the investigator, JM, by way of UAA, NICE and AVAYA reports. I also attended an investigatory interview.
• For the investigation I conducted test calls to understand what the NICE and AVAYA reports were telling us.
• My only involvement in this investigation was the provision of data and attending my investigatory meeting. Initially my understanding had been that the concern was around the missing records requested by the police. I was just tasked with collating the data. Whilst doing this I found that calls were missing from the Registrant’s reports and/or information was not where it should have been. It was not until I received a letter to attend the disciplinary hearing that I found out that there was a concern about the Registrant not logging into her telephone.
56. The Registrant was not in attendance but in advance of the hearing commencing in August 2023, she did provide a written statement with a signed statement of truth.
57. In summary the Registrant’s statement says as follows:
• I qualified as a Paramedic in November 2003; I became a Paramedic Advisor in 2010. This role involved undertaking additional training as a Call Handler, this allowed the new role of Paramedic Advisors to be able to utilise the computers and take calls using the systems properly.
• In 2018, the Paramedic Advisor role was changed to a Clinical Advisor role, which brought in new systems, call handling techniques and would require me to undertake additional training.
• There were not enough training slots for all the staff that needed it and so the Registrant did not get her training. She raised issues about needing training with ‘ID’ her manager at the time but was told she was not a priority.
• AL audited her every month and did not raise any concerns.
• I would always try my hardest to exhaust all ways of contacting the caller before escalating the call.
• The figure that has been used for me and colleagues at pages D109, D218, D21 and D274 is an average across the shift. However, this would not be accurate as not everyone is allocated the same number of calls in the team, nor the same category of calls.
• In circumstances where I couldn’t get a hold of the patient or the family, I would have the option to escalate as it could be that the circumstances have worsened and now require urgent attention.
• The hours that have been recorded that I worked are not accurate for this time period. For a significant working period, I was in Japan on annual leave which again would have an impact on my statistics. The presented rota and total hours from March, April and May 2018 was not physically possible for me to work the hours as I was out the country and the total hours shown on the rota do not add up to the total figure of hours presented to you.
• It would be extremely noticeable that you were not working or hanging up calls.
• I do recall at the time logging a concern with my seniors that some phones were not accepting logins, that we were having to use each other’s logins at the time to get work started and this was all exacerbated by the fact the office was undergoing a re-fit at the time, so it was chaotic. There was also a major problem with staff recording as each other resulting in a major loss of calls. I have never, from day one, denied that on occasion I forgot to log in, I held my hands up straight away and admitted that however, they didn’t listen to me.
• In 2017 it was introduced that Paramedic Advisors could make calls without being logged in and I would forget to log in or forget to log out at the end of a shift. It was such a chaotic time it was hard to keep track. Calls were recorded so we were told that logging in and out was not a priority.
• I have been asked if it would be possible to falsify calls. It would be. However, it would be pointless to do so as calls were always waiting. If you falsified one call, you would have 101 others waiting for you to call. I am unclear on what the motivation for falsifying calls would be. Additionally, managers and colleagues would notice if you had a light workload and ask for assistance as everyone was busy.
• I loved my job; I was good at what I did. The ambulance service was my life, it was 60 hours a week and stressful, but I loved it. I would always undertake extra shifts to help my team out. I was always learning on the job, which is the sign of a good job.
• My role was crucial in building and maintaining the relationship between the patient and the ambulance service in order to allow the paramedics who would be attending to be able to care for the patient.
• I also liked to help out the call handlers. I had started where they were, and many were in training to become paramedics. I felt it was a nice way to support those who were just starting out. I would take calls to help out those who were overwhelmed and would give some general guidance.
• I would never behave dishonestly in the job that I loved so much. I really struggled to find any evidence to exonerate myself as The Scottish Ambulance Service denied me the opportunity to show them it was not deliberate but my navigation of the computer systems. They also denied me access to my email account, refused to send documentation when my union representative requested it, refused me access to my locker which contained pertinent information.
Legal Advice
58. The Panel heard and accepted the advice of the Legal Assessor in respect of the approach to take in determining findings of facts and the burden and standard of proof. The burden of proof rests on the HCPC and it is for the HCPC to prove the Allegation irrespective of any admissions made by the Registrant. The Legal Assessor provided advice on the issues of credibility and reliability, as per the guidance in R (Dutta) v GMC [2020] EWHC 1974 (Admin). Advice was given on the test to be applied when considering a charge of dishonesty which is found in the guidance of the Supreme Court in Ivey v Genting Casinos (UK) LTD t/a Crockfords [2017] UKSC 67. Advice was also given in relation to the Registrant being a person of good character. The Panel was referred to the HCPTS Practice Note titled ‘Making decisions on a registrant’s state of mind’ dated November 2022 and the Practice Note on drafting decisions.
Decision on Facts
1. While working as a Clinical Advisor with Scottish Ambulance Service, you entered into IT system ‘C3’ triage/ welfare calls for patients which you did not make and / or which were inaccurate on:
a) 17 January 2017;
59. It is not in dispute that the Registrant was working as a Clinical Advisor with the Scottish Ambulance Service at the relevant time.
60. The HCPC plead that on 17 January 2017, the Registrant entered into IT system ‘C3’ triage/welfare calls for patients which the Registrant did not make and/or which were inaccurate. The HCPC relied on the evidence of JM and SJ, both of whom exhibit multiple documents from the SAS investigation to their statements.
61. JM’s evidence states that he, ‘was asked to investigate whether there was evidence to demonstrate whether [the Registrant] had falsified welfare calls to patients i.e. was entering data in C3 of calls which she did not undertake and failed to log in to the telephone system, resulting in a lack of information relating to her activities at work. Since SAS works on three different systems, for the purpose of the investigation we needed to set up a framework in which the information pulled together for us was understandable, in order to demonstrate what happened during each call. It is only by joining the data from all three systems, i.e. NICE, AVAYA and C3 that one can comprehend what happened.’ His evidence is that based on that framework of investigation, for 17 January 2017, ‘there are 18 incidents for which the C3 and NICE records do not match’. He states that there are no AVAYA records because the Registrant was not logged into her phone.
62. JM’s statement provides a list of the 18 incident numbers relating to 17 January 2017 with details of the documentary evidence relating to each of the incidents which explains in what way the records do not match. By way of example:
‘Incident number 3489264 120…entries into C3 for this incident can be found starting at the bottom of page 20 of Exhibit 4 Appendix 40, continuing onto page 21. On page 21 there is a row for this incident that has the box for column 3 highlighted in yellow, for a call allegedly made at 12.50 hours. Column 7 reads ‘have reviewed all calls out of NICE at this time…’ This is [SJ’s] entry; it shows a call being made via the softkey but not recording any data in NICE and AVAYA. As mentioned previously, the investigation found that the only way this can be replicated is by terminating the call before it connects…According to Exhibit 4 Appendix 39, there are no calls to or from [the Registrant’s] extension between 12.12 hours and 13.58 hours. If the call of 12.50 hours took place, I would expect it to show in the NICE report and for there to be an associated audio recording of the conversation. [SJ] was unable to locate such audio.’
‘Incident number 3489287…[the Registrant’s] entries into C3 for this incident can be found starting bottom third of page 27 of Exhibit 4 Appendix 40, ending a few rows below. The relevant row starts from that with the box for column 3 highlighted in yellow, for a call allegedly made at 14.00 hours. At 14.02 hours, page 28, [the Registrant] upgraded this incident to an emergency call, which would have resulted in a faster ambulance response time being required. It appears that she did undertake a triage because she has recorded information from this supposed call e.g. ‘advised and apologised for delay to husband. Husband advises she has got worse…’ Details of the triage are recorded in the subsequent rows against incident number 3489576…According to Exhibit 4 Appendix 39, there are no external calls from [the Registrant’s] extension between 13.58 hours and 16.35 hours. If she had indeed triaged this patient, I would have expected for the call data to be recorded in NICE and for there to have been an associated audio recording of the conversation. As per [SJ’s] entry in the last column relating to this incident in Exhibit 4 Appendix 14, [SJ] had searched all NICE records for calls made at this time and this patient’s number was not found as having been called from any extension, hence was unable to locate any audio recordings for this incident.’
63. The Registrant’s written statement does not provide a specific response to each particular or date set out within the Allegation. However, she does state that ‘I would never behave dishonestly in the job that I loved so much. I really struggled to find any evidence to exonerate myself as The Scottish Ambulance Service denied me the opportunity to show them it was not deliberate but my navigation of the computer systems. They also denied me access to my email account, refused to send documentation when my union representative requested it, refused me access to my locker which contained pertinent information.’ The Registrant’s statement also provides details of how she understands the computer systems within her job role to work. Her statement notes that she ‘would also be trying to get calls removed from the queue holistically. If I was unable to make contact, I would have the option to escalate the call to get an ambulance there quicker as it could mean a number of things. Perhaps that the caller had lost consciousness which would require a quicker response time. I always did everything to exhaust all other options of contact, prior to escalating contact.’
64. The Registrant’s statement notes that ‘the issue with call backs to patients was that the number would come up as an 0131 number that was not recognised. Unless callers were told to expect a call back, in an emergency situation they likely would not answer an unknown, or any, call. This made getting in contact with family or the patient themselves more difficult. In circumstances where I couldn’t get a hold of the patient or the family, I would have the option to escalate as it could be that the circumstances have worsened and now require urgent attention.’
65. The Registrant states that, ‘in terms of the office set up, it is worth noting that all Clinical Advisors would be sat at the same desk cluster. We did not have assigned desks but you would be sat with your Control Manager and other colleagues at the same area. It would be extremely noticeable that you were not working, or hanging up calls. We would frequently have discussions with each other and your manager would ask how your work load was and assign additional work or redistribute based on the needs. Calls could also be highlighted by your manager as needing attention on your system. I do recall at the time logging a concern with my seniors that some phones were not accepting logins, that we were having to use each other’s logins at the time to get work started and this was all exacerbated by the fact the office was undergoing a re-fit at the time so it was chaotic. There was also a major problem with staff recording as each other resulting in a major loss of calls… I have been asked if it would be possible to falsify calls. It would be. However, it would be pointless to do so as calls were always waiting. If you falsified one call, you would have 101 others waiting for you to call. I am unclear on what the motivation for falsifying calls would be. Additionally, managers and colleagues would notice if you had a light workload and ask for assistance as everyone was busy’.
66. The Panel approached the fact-finding stage by firstly considering the contemporaneous documents which were initially gathered as part of the SAS investigation and later attached as exhibits to the HCPC witness statements. The Panel placed significant weight on the documentary evidence as it was information gathered closer to the time of the alleged facts and was created in the course of business. The Panel cross referenced each relevant exhibit document with the date referred to in each particular of the Allegation, rather than placing sole reliance on the written and oral evidence.
67. In relation to the 17 January 2017, the Panel had careful regard to the C3 Summary document and cross referenced that document with the NICE Inform Log and the UAA Report. The Panel used the documents to cross check each of the incidents referred to in JM’s statement relating to 17 January 2017. The documentary evidence supported JM’s evidence and the Panel found that on 17 January 2017, there were 18 incidents for which the C3 and NICE records did not match. The Panel found that for each of the 18 incidents, the Registrant had entered into the IT system ‘C3’ triage/welfare calls for patients, and details of what she had entered into the system were noted in the documents. The Panel noted that on some occasions the C3 log noted that there was no answer and on some occasions the C3 log noted specific details which the Registrant had written having allegedly spoken to a service user or their relative.
68. The Panel next considered whether the fact that there were incidents for which the C3 and NICE records did not match equated to the Registrant entering into IT system ‘C3’ triage/ welfare calls for patients which she did not make and / or which were inaccurate.
69. The Panel took into account the evidence provided by both JM and SJ about the three recording systems. SJ’s statement states that without logging into the C3 system there is no way that staff ‘can undertake their job as everything is stored within C3; they physically cannot see incidents if this is not done.’ SJ’s evidence states that ‘NICE records any inbound or outbound calls as soon as there is a connection, however we cannot see the calls in AVAYA unless the staff member is logged into their phone.’ SJ’s evidence further states that, by ‘logging into their phones, staff have three points of contact for proof of the call. What they record in C3 should be replicated in NICE, which should be replicated in AVAYA. The systems do not speak to each other, but the information should correlate across all three systems – C3 logs the physical incident, NICE records the voice and AVAYA records the voice data…If staff do not log into their phones, there are no three points of contact to prove what staff have been doing during their shift or how long they spent on their phones. There will still be voice recordings from NICE and the incidents always exist on C3 but there will be nothing in AVAYA.’
70. The Panel considered the evidence of SJ and JM that an entry on the C3 system should replicate what is in NICE and AVAYA and also that if “a conversation had taken place, it would have definitely been recorded in NICE.” The Panel noted that both SJ and JM state that AL, on instruction from SJ, had replicated various call types to see what would be automatically recorded in NICE and AVAYA if (a) a call is made through C3 using a ‘soft-key’ and disconnected prior to the first ring; (b) a call is made via the soft-key, the phone rings once and then the call is disconnected; (c) a call is made via the soft-key and the call goes to the patient’s voicemail; and (d) a call is made via the soft-key and disconnected after four rings. The conclusion of the test calls was that the only way to replicate ‘the way the Registrant’s calls is to use the softkey and then disconnect the call prior to the first ring. All other calls show in NICE and AVAYA as expected.’
71. In oral evidence JM explained that due to the way the systems work, when the request for recordings was received from the Police, it was considered to be “highly unusual” that there were no associated recordings or associated data held. JM said, “for us to come across a call by accident where there are no call recordings available at all, also no data held within the telephone system, really raised some concerns.” JM told the panel that he stood by the allegations and assessments that he had made during the course of his statement and all the paperwork that he’s completed in relation to the Registrant. He said “We made a real effort to make sure the data was representative and told the real story, and that’s why we really made the effort to benchmark against other people, so other people in the same role, in the same seat, on the same shift, to really get the ins and outs and then go to ICT and say, ‘Show me all your records’, because reporting ICT faults in our business is really normal. So ‘ICT, show me all of your records’. So I think we try to be as balanced as possible, and I think on the balance of probability, was really difficult not to come to one conclusion, and that conclusion is that the Registrant has falsified information, falsified callbacks and falsified information relating to patients, which potentially subsequently might have harmed them.” JM told the Panel that in relation to the missing data, “what we do know is nobody else was experiencing missing data, so everybody we looked at through the testing we had done to understand the logic behind what data would appear there, every other person that we looked at, the data appeared in the exact way that we would expect it to look. It was only when you looked at the Registrant in isolation that that data wasn’t there.”
72. In oral evidence SJ said that “so any conversation, what we found throughout the whole investigation was there were often calls missing from – between the sequence of events, NICE and AVAYA, but everything that was missing from NICE was also always missing from AVAYA. So there was never – it never showed on one system and not the other. So the two independent systems always showed the same information, but different to the information in the sequence of events, which is the information that the Registrant is able to influence and type into. What we also found was none of the calls that were ever missing were where a patient was either expecting the telephone call or an ambulance was stopped.” SJ told the Panel that, “all of the times where the patient was expecting the call, the sequence of events matched with the call recording and matched with AVAYA. So there was a voice recording and a data stamp. But where the patient wasn’t expecting the call, that was always the times that the calls were missing.” SJ told that Panel that in relation to the falsification of calls, “from the Registrant’s perspective, it wasn’t something that she ever admitted to doing through the investigation but, again, coming back to the evidence, there was no other explanation given for it.”
73. The Panel placed significant weight on the evidence of SJ and JM. The Panel found their oral evidence to accord with their written evidence and they were both able to demonstrate a comprehensive grasp of the documents they were relying on to support their assertions. The Panel found that on the whole their evidence corroborated with each other. The Panel had confidence that the evidence provided by JM and SJ was reliable, being based on the data which had been collated as part of the SAS investigation. In placing weight on the evidence, the Panel had regard to the fact that the data provided as part of the SAS investigation had been thoroughly considered and triangulated. The data had been cross-referenced, it was benchmarked against other staff, it was spread across a wide range of dates, and it took into account possible anomalies. The Panel was satisfied that the evidence of JM and SJ had withstood the scrutiny of the Panel’s questions, and that both JM and SJ had been able to provide detailed and comprehensive assurances about the validity of their findings, to counter the issues raised in the Registrant’s statement.
74. Relying on the evidence of JM and SJ, the Panel therefore found on the balance of probabilities, that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate on 17 January 2017. FOUND PROVED
b) 7 July 2017;
75. It is not in dispute that the Registrant was working as a Clinical Advisor with the Scottish Ambulance Service at the relevant time.
76. The HCPC plead that on 7 July 2017, the Registrant entered into IT system ‘C3’ triage/welfare calls for patients which the Registrant did not make and/or which were inaccurate. The HCPC relied on the evidence of JM and SJ, both of whom exhibit multiple documents from the SAS investigation to their statements.
77. The Registrant’s written statement does not provide a specific response to each particular or date set out within the Allegation, but she does make general comments about the systems as set out earlier in this decision.
78. In deciding whether this particular of the Allegation was proved, the Panel took the same approach as it did in relation to its finding for 17 January 2017. The Panel cross checked the contemporaneous documentary evidence and considered that against the evidence of SJ and JM.
79. The Panel noted that in relation to 7 July 2017, unlike other dates, JM had not set out each separate incident entry. The Panel therefore approached the cross-checking exercise using the evidence provided by SJ in her written statement. The Panel had also received audio recordings for this date which it had listened to in advance of the hearing.
80. SJ’s statement refers to the documentary evidence which she states shows that for ‘this shift, three are 14 incidents for which the C3 and NICE records do not match. These 14 incidents cover 10 full incidents and therefore also include 4 part incidents for example where a call was made and another call wasn’t made…On my review at the time, I found that out of the 68 calls [the Registrant] had made for this shift, none of the 14 incidents showed within NICE to support her entries.’ SJ’s statement provides a list of the 10 incident numbers relating to 7 July 2017 with details of the documentary evidence relating to each of the incidents which explains in what way the records do not match. By way of example:
‘Incident number 3879960… [the Registrants] entries into C3 for this incident can be found towards the bottom half of page 29 of Exhibit 37, ending a few rows into page 31. The relevant rows have boxes highlighted in pink and red, for a call allegedly made at 15.23 hours. It appears that [the Registrant] managed to reach the patient because she wrote ‘speaking with caller’ and then proceeds to record clinical details as per her supposed triage between 15.26 hours and 15.28 hours, when she escalated the call to say that an ambulance was required. This would have resulted in a faster outcome for the incident.
According to Exhibit 4 Appendix 38, there are no calls made to or from [the Registrants] extension between 15.21 hours and 15.44 hours. I personally searched all the call data to and from the Control Centre for the patient’s number as recorded in NICE and was only able to find the patient's original 999 call records. If [the Registrant] had in fact spoken to the patient, I would have expected to have found the data logged in NICE and an associated recording of her conversation with the patient.’
81. The Panel cross-checked each of the incident numbers listed in SJ’s statement for 7 July 2017 against the documentary records provided. The Panel found that of the 10 incidents, in 8 of the incidents the documentary evidence shows that the C3 and NICE records do not match. In relation to two of the incidents (3880133 and 3880340), the Panel found that whilst those incidents contained issues between C3 and NICE that may have been relevant for the SAS investigation Terms of Reference, the Panel’s role is to consider the evidence against the drafting of the wording in the HCPC’s Allegation. The documentary evidence and the statement of SJ show that for 3880133 and 3880340, the Registrant did make the calls and therefore they would not be capable of being found proven. However, the Panel had careful regard to the wording of the Particular and found that what is required is for the HCPC to prove that that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate. Therefore, although the Panel found that two of the ten incidents would not be within the scope of the Particular as drafted, the other eight are.
82. Based on the evidence in relation to how the data works, as set out in relation to the finding on 17 January 2017, the Panel was satisfied that in relying on the evidence of JM and SJ, on the balance of probabilities, that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate on 7 July 2017. FOUND PROVED
c) 24 April 2018;
83. It is not in dispute that the Registrant was working as a Clinical Advisor with the Scottish Ambulance Service at the relevant time.
84. The HCPC plead that on 24 April 2018, the Registrant entered into IT system ‘C3’ triage/welfare calls for patients which the Registrant did not make and/or which were inaccurate. The HCPC relied on the evidence of JM and SJ, both of whom exhibit multiple documents from the SAS investigation to their statements.
85. The Registrant’s written statement does not provide a specific response to each particular or date set out within the Allegation, but she does make general comments about the systems as set out earlier in this decision.
86. In deciding whether this particular of the allegation was proved, the Panel took the same approach as it did in relation to its finding relating to 17 January 2017. The Panel cross checked the contemporaneous documentary evidence and considered that against the evidence of SJ and JM, both of whom had set out each incident relating to this date and an explanation of the data they found. SJ’s statement refers to the documentary evidence which she states shows that for ‘this shift, there are eight incidents for which the C3, NICE and AVAYA records do not triangulate.’ By way of example, SJ refers in her statement to the following:
‘Incident 4590917 ...[the Registrant] entries into C3 for this incident can be found towards the middle of page 5 of Exhibit 31. The relevant rows have highlighted boxes in pink for calls allegedly made at 09.47 hours, 09.48 hours and 09.56 hours, which [the Registrant] documented as all having rung out. I can tell that these calls were made by soft-key because the system creates a stamp in the records reading ‘Voice Callback…’ The ‘ringing out’ text needed to be typed by [the Registrant] in the free text box in the C3. At 09.56 hours, [the Registrant] updated the records to say that she was unable to triage (UTT) the patient and an ambulance response was required.
A call is UTT when a Clinical Advisor cannot get in touch with the patient. The incidents remain with the Clinical Advisor until they “complete it” and so UTT is a mark to say we have done everything possible to try to contact the patient. This was an emergency response so an ambulance would be sent when available; however [the Registrant] would have had the ability to upgrade this to a higher priority if she had felt this was necessary. The guidance provided in Exhibit 30 should be considered in such instances.
According to Exhibit 4 Appendix 17, there was one call from [the Registrant’s] extension at 09.27 hours that lasted 2 minutes and 21 seconds. This shows in a blank line in NICE which means the call was not answered and just left ringing. The next call made was at 10.40 hours, lasting for 6 minutes and 16 seconds. If this patient's phone had indeed rung out when she called at 09.47 hours, 09.48 hours and 09.56 hours, I would have expected to see the each call logged in NICE separately on the associated ‘Called Party’ and ‘Calling Party’ boxes to be left blank like the calling 09.27 hours did and shows. According to Exhibit 4 Appendix 18, there were no calls recorded in AVAYA between 08.30 hours and 10.15 hours for [the Registrant]. As only connected calls show in AVAYA, the calls which rung out would not show here (including the call at 09.27 hours) but would all have shown in NICE.’
87. The Panel found that for each of the 8 incidents set out by SJ on this date, the Registrant had entered into the IT system ‘C3’ triage/welfare calls for patients, and details of what she had entered into the system were noted in the documents. For the same reasons as set out in the findings in relation to 17 January 2017, the Panel was confident in relying on the evidence of SJ and JM. The Panel was satisfied that on the balance of probabilities, that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate on 24 April 2018. FOUND PROVED
d) 29 April 2018;
88. It is not in dispute that the Registrant was working as a Clinical Advisor with the Scottish Ambulance Service at the relevant time.
89. The HCPC plead that on 29 April 2018, the Registrant entered into IT system ‘C3’ triage/welfare calls for patients which the Registrant did not make and/or which were inaccurate. The HCPC relied on the evidence of JM and SJ, both of whom exhibit multiple documents from the SAS investigation to their statements.
90. The Registrant’s written statement does not provide a specific response to each particular or date set out within the Allegation, but she does make general comments about the systems as set out earlier in this decision.
91. In deciding whether this particular of the allegation was proved, the Panel took the same approach as it did in relation to its finding relating to 17 January 2017. The Panel cross checked the contemporaneous documentary evidence and considered that against the evidence of SJ and JM, both of whom had set out each incident relating to this date and an explanation of the data they found.
92. JM’s statement refers to the documentary evidence which he states ‘shows that for this shift, there are 23 incidents for which the C3 and NICE records do not match, as relevant to the Terms of Reference. There are no AVAYA records for this date because according to Exhibit 4 Appendix 46, [the Registrant] did not log into her phone. Conversely, NICE can still record from the seating position extension number; you do not need to be logged in. Had she logged in to her telephone, the data generated would have been in the form of Exhibit 4 Appendix 18.’ By way of example, JM refers in his statement to the following:
‘Incident number 4603738…[the Registrant’s] entries into C3 for this incident can be found starting approximately a third of the way into page 27 of Exhibit 4 Appendix 20, ending near the bottom of the same page. The relevant rows are highlighted in orange, for three calls allegedly made at 23.18 hours, 23.20 hours and 23.21 hours. At 23.22 hours [the Registrant] made an entry to say ‘ringing out x3; no message service’ and she was UTT. At the same time she upgraded the call to say an ambulance call was required. In the rows below, it is detailed that a message service was received and a message left.
According to Exhibit 4 Appendix 21, there are no calls to or from [the Registrant’s] extension between 22.55 hours and 00.15 hours. If the patient’s phone had indeed rung out thrice then I would have expected to see the calls logged in NICE with ‘Duration’, ‘Called Party’ and ‘Calling Party’ boxes left blank.’
93. The Panel noted that it was this incident number which was actually the trigger for the SAS investigation into the Registrant’s conduct, as in early May 2018, SJ was approached by a Duty Manager to say that the local police had requested tapes of a call that was received by SAS on 29 April 2018, i.e. incident number 4603738. When the systems were checked despite the C3 entries made by the Registrant, nothing could be found on NICE or AVAYA to support the C3 entry as would be expected.
94. In cross-referencing the incident numbers with the documentary evidence, the Panel noted that the SAS investigation had been based on looking at various shift dates for the Registrant, some of which were night shifts and had therefore straddled two dates. The Panel noted that the Particular of this Allegation relates only to the date of 29 April 2018 and therefore any incidents that occurred solely after midnight (as set out in evidence) was excluded. The Panel found that based on the documentary evidence, there was 16 incidents that occurred (or partly occurred) before midnight on 29 April 2018. The Panel found that the documentary evidence matched the witness evidence of JM and SJ. Out of the 16 incidents, the Panel noted that one incident (4603688) the Registrant had made a call which was answered (according to NICE) albeit the Registrant entered into C3 that the call rang out. The Panel were not persuaded that incident would fall within the drafting of the particular because the Registrant did make a call and it maybe that she was ending the call as it was answered as there was no voice recording, hence she cannot be said on balance to have recorded inaccurate information.
95. Given that there were 15 incidents found by the Panel where the data does not match as set out by SJ and JM, the Panel found, relying on that evidence, that it was satisfied that on the balance of probabilities, that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate on 29 April 2018. FOUND PROVED
e) 2 May 2018.
96. It is not in dispute that the Registrant was working as a Clinical Advisor with the Scottish Ambulance Service at the relevant time.
97. The HCPC plead that on 2 May 2018, the Registrant entered into IT system ‘C3’ triage/welfare calls for patients which the Registrant did not make and/or which were inaccurate. The HCPC relied on the evidence of JM and SJ, both of whom exhibit multiple documents from the SAS investigation to their statements.
98. The Registrant’s written statement does not provide a specific response to each particular or date set out within the Allegation, but she does make general comments about the systems as set out earlier in this decision.
99. As with the previous dates relating to this particular of the Allegation, the Panel relied on the evidence of SJ and JM in accepting the HCPC had proved its case. As with the previous dates the Panel undertook the exercise of cross checking the contemporaneous documents against the witness statements.
100. As with the 29 April 2018 incidents, the Panel noted that the evidence relating to 2 May 2018 also covered a night shift and therefore spanned 2 – 3 May. As the particular is drafted just for the 2 May 2018, the Panel ignored any of the incidents after midnight.
101. In relation to the 2 May 2018, JM’s statement notes that, ‘Exhibit 4 Appendix 10 shows that for this shift, there are 7 incidents for which the C3 and NICE records do not match, as relevant to the Terms of Reference.’ As with other dates, JM details the incident numbers that relate to 2 May 2018 and provides some details of the evidence base and analysis. By way of example:
‘Incident number 4610428…[the Registrant’s] entries into C3 for this incident can be found starting towards the middle of page 1 of Exhibit 4 Appendix 22. There are three rows highlighted. The row highlighted in red is for call(s) reportedly made at 18.52 hours. In the third column, i.e. that headed ‘Text’, [the Registrant] recorded that four of her calls to the patient had rang out and she had not left a message. At 18.53 hours, [the Registrant] updated the record to say she was UTT.
According to Exhibit 4 Appendix 23, [the Registrant’s] first call of the shift was made at 19.09 hours and it lasted for 38 seconds. This is supported by the data in AVAYA. In Exhibit 4 Appendix 24, this is seen in the 15 minute interval from 19:00 hours to 19:15 hours where it says “talk time” is 36 seconds and “DN Calls”, which is outgoing calls in that interval, is 1. If the patient’s phone had indeed rung out four times, I would have expected to see the calls logged in NICE but the associated ‘Called Party’ and ‘Calling Party’ boxes to be left blank. Since the calls allegedly went unanswered, I would not expect to see these recorded in AVAYA.’
102. The Panel found that based on the documentary evidence, there was 5 incidents that occurred (or partly occurred) before midnight on 2 May 2018. The Panel found that the documentary evidence matched the witness evidence of JM and SJ.
103. Relying on the evidence of JM and SJ (for the reasons already set out in this decision under the 17 January 2017 date), the Panel therefore found on the balance of probabilities, that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate on 2 May 2018. FOUND PROVED
f) 4 May 2018
104. It is not in dispute that the Registrant was working as a Clinical Advisor with the Scottish Ambulance Service at the relevant time.
105. The HCPC plead that on 4 May 2018, the Registrant entered into IT system ‘C3’ triage/welfare calls for patients which the Registrant did not make and/or which were inaccurate. The HCPC relied on the oral evidence of SJ, who in oral evidence referred to the presentation document she had prepared for the SAS disciplinary hearing and which she had exhibited to her HCPC witness statement.
106. The Registrant’s written statement does not provide a specific response to each particular or date set out within the Allegation, but she does make general comments about the systems as set out earlier in this decision.
107. In her oral evidence SJ explained to the Panel the incident on 4 May 2018. She told that Panel that this “was an incident where, within the sequence of events of our system, there was a triage typed by the Registrant into our live system. At 19.26, we know that the Registrant was in the incident and voice call initiated through the soft key… is shown within the sequence of events, so that button was clicked. Then from then on, the Registrant types as though she is speaking to the patient – the patient’s wife, I believe it was. So wife is with the patient, the patient is conscious and breathing, responding normally, responding okay, and then goes on to detail that the patient has Hodgkins Lymphoma, a recent admission for sepsis and has been vomiting today. That call is then upgraded, so it has come from a timed admission, which a GP can book a one to four hour ambulance, and that’s then upgraded to an emergency response. However, what we can see by the NICE – so the voice recording details was that there were no calls made by the Registrant until 19.44. All of this detail was recorded between 19.25 when the Registrant went into the call and 19.32 when the call was upgraded, but there doesn’t seem to be on NICE or AVAYA, which are our two independent call reporting systems, there doesn’t look to be any outbound calls at that point. There were also no – there was no record of that telephone number within our system from any other extension number, just in case the Registrant had used a different telephone and the call was upgraded at that point.”
108. SJ further said that, “…when we had a look into the telephone number of the patient, whilst we were looking for any outbound calls at that time that corelate with the triage from the Registrant, there was none to be found. What we do see is that nine outbound calls were made by the Registrant, all to different telephone numbers and that would suggest that there was no fault with the telephone and that those nine calls are detailed within D406.”
109. In relation to the 4 May 2018 incident, SJ explained to the Panel that what she would “expect to then hear is on our NICE system, a voice recording of the conversation between the Registrant and the patient’s wife, as is documented in the notes, and I would then expect to see within our AVAYA system a data stamp that said a telephone call was made at this time and lasted this number of minutes…” SJ told the Panel that when “we search the telephone number of the patient where the phone call had allegedly taken place, we found that there had been a previous incident within our system, so we had attended that gentleman before and most of the information, unfortunately, is recorded in the previous incident. So whilst all of that detail would be available to the Registrant, she would be able to have a look into the previous incidents… and all of that information will have been capture there. So actually in conclusion of that, there is no call recordings. The two systems which are independent to each other show no outbound calls have been made, yet the conversation – or within the sequence of events, it is detailed as though the patient was spoken to and was – and required an upgrade but all of the information was actually either in the initial incident from the GP or in a previous incident from us, which led us to believe that no conversation had taken place.”
110. For the reasons already set out in this decision, the Panel were confident in relying on the witness testimony of SJ. In her oral evidence, she referenced the presentation document which was exhibited to her statement. The presentation document included screen shots of the contemporary documents showing the data such as the NICE Inform Reconstruction Results Table.
111. Relying on the evidence of SJ, the Panel found on the balance of probabilities, that while working as a Clinical Advisor with Scottish Ambulance Service, the Registrant entered into IT system ‘C3’ triage/ welfare calls for patients which she did not make and/or which were inaccurate on 4 May 2018. FOUND PROVED
2. You prevented your work activities from being accurately logged in that you did not log into the telephone system for the entire shift worked on the dates set out in Schedule A.
112. In order to prove this particular, the HCPC relied on the statements of JM and SJ and the exhibited documents.
113. JM’s statement states that through the evidence collected as part of the SAS investigation, ‘it became apparent that at the very least, [the Registrant] had been coming on shift and failing to log into her telephone on multiple occasions. The log in activity of her colleagues was looked at as well…for the same timeframe and it was evident that she was the only one having issues in this regard. From her log in activity data … it showed that out of 41 shifts that she had worked up to 18 March 2018, [the Registrant] only logged into her phone for only 15 of those. I recently requested the historic data from our administrators with reference to the shifts that [the Registrant] worked between 1 February 2018 and 31 May 2018. I produce a copy of the data for 1 February 2018 to 18 March 2018 at Exhibit 39.’
114. JM’s statement continues that, ‘According to Exhibit 4 Appendix 46, between 15 March 2018 and 31 May 2018, [the Registrant] worked on 17 days. On four of those days, she did not log in at all. Separately, seven of those days, she logged out of her phone early i.e. a couple of hours after she logged in. I produce as Exhibit 40 a copy of the data that [the Registrant] worked from the dates of 15 March 2018 to 31 May 2018. To confirm, NICE is the voice recording software and UAA is a function in CAD that reports and shows you all of the actions taken by someone when logged into C3.’
115. SJ’s witness statement notes that, ‘with reference to [the Registrant’s] log in activity on her telephone…I found that I was unable to locate AVAYA records for every date. This indicated that she had not logged onto her telephone at the beginning of her shift as she was meant to.’ SJ witness statement sets out the comparisons which were made with other Colleague’s log in’s and exhibits the Activity Log and staff roster. SJ’s statement notes that ‘All staff are expected to log in to both C3 and telephones…Logging into the telephone also plays a part in the member of staffs own protection…AVAYA is particularly helpful where there is no voice recording…By logging into their phones, staff have three points of contact for proof of the call…There is no reason for staff to not log into their phones; everyone is trained in telephone use…Consequently, all staff should be aware of the importance of logging in…The importance of logging into phones is drummed into staff as part of their basic training.’
116. The Registrant’s statement states, ‘The phone systems had changed in this time, so we were now using AVIYA, however they did not inform us of this change or explain what this new system meant to our role. Poor communication regarding the system resulted in multiple mistakes from all grades of staff.’ The Registrant’s statement further states that, ‘For a significant working period, I was in Japan on annual leave which again would have an impact on my statistics. The presented rota and total hours from March, April and May 2018 was not physically possible for me to work the hours as I was out the country and the total hours shown on the rota do not add up to the total figure of hours presented to you.’
117. In relation to failing to log in to AVAYA, the Registrant’s statement states, ‘I have never, from day one, denied that on occasion I forgot to log in, I held my hands up straight away and admitted that however, they didn’t listen to me…At our desk cluster in particular, there used to be a screen above that you would be able to see who had logged in, who was engaged in a call. It would be helpful as halfway through a shift you would be able to see that you might have forgotten to log in, which would remind you to do so. Additionally, the phones at this time were set up that you would not be able to take a call if you were not logged in. This was a good failsafe to make sure everyone was accountable. However, in 2017 it was introduced that Paramedic Advisors could make calls without being logged in and I would forget to log in or forget to log out at the end of a shift. It was such a chaotic time it was hard to keep track. Calls were recorded so we were told that logging in and out was not a priority.’
118. The Panel firstly considered whether the Registrant had logged into the AVAYA telephone system for the entire shift worked on each of the dates set out in Schedule A. The Panel referred to the documentary evidence provided by the witnesses and cross-referenced this with the statement of SJ and JM, taking into account the Registrant’s comments that she was on annual leave at various points.
119. The Panel relied on the Login/Logout document which starts from 01 February 2018 to 18 March 2018 and shows the login times for the Registrant to AVAYA during that period. The Panel also relied on the rota for the Registrant, which runs from 15 March 2018 to 20 May 2018, and which has been populated with the AVAYA login/logout data.
120. The Panel found that the documentary evidence accords with the witness evidence and found proved, that with some date exceptions (which are listed below), the Registrant had not logged into the AVAYA telephone system for the entire shift worked on the dates set out in Schedule A.
121. The Panel did not find 16 March 2018 as proved because the evidence shows that the Registrant did log in from 6.25am until 2.56pm. She had then taken 3.15 hours of annual leave which would have covered the shift.
122. The Panel did not find 23 April 2018, 25 April 2018, 26 April 2018 and 30 April 2018 as proved because it was not satisfied with the quality of the evidence. The evidence relating to those dates appeared as poorly copied and it was not possible for the Panel to see with any clarity what time the Registrant had logged in and out.
123. The Panel next considered whether by not logging in, the Registrant has prevented her work activities from being accurately logged. The Panel relied on the evidence of SJ set out in this decision which shows the importance of logging into the telephone system and how without that information, there is not the three points of contact for proof of the call.
124. The Panel therefore found on the balance of probabilities that the Registrant prevented her work activities from being accurately logged in that she did not log into the telephone system for the entire shift worked on the dates set out in Schedule A (except for 16 March, 23 April 2018, 25 April 2018, 26 April 2018 and 30 April 2018). FOUND PROVED (save for 16 March 2018, 23 April, 25 April, 26 April and 30 April 2018).
3. Your conduct in relation to particulars 1 and 2 above was dishonest.
125. The Panel considered the oral and written evidence and took into account the legal test on dishonesty as set out within case law and the HCPTS Practice Note. The Panel first considered what the actual state of the Registrant’s knowledge or belief was as to the facts in which the alleged dishonesty arose. The Panel then went on to consider the question of whether the conduct was honest or dishonest by applying the objective standards of ordinary decent people with full knowledge of the facts of the case.
126. The dishonesty alleged in particular 1 relates to the Registrant entering into IT system ‘C3’ triage/ welfare calls for patients which she did not make and / or which were inaccurate.
127. The Registrant states in her statement that the ‘new systems were a minefield. There could be 3 or 4 ways of doing the one task on the system. Part of the problem was that I wasn’t trained and so therefore didn’t know if what I was doing was the most efficient or correct way of using the system.’
128. However, based on the evidence of SJ and JM, the Panel did not accept that this was the case nor that it could account for the entering into C3 triage/welfare calls for patients which she did not make and/or which were inaccurate. The evidence from JM and SJ is that there were occasions, during each of the dates examined, where the Registrant had correctly undertaken her role and the data across the systems had matched as expected. SJ’s evidence was that “none of the calls that were ever missing were where a patient was either expecting the telephone call or an ambulance was stopped…all of the times where the patient was expecting the call, the sequence of events matched with the call recording and matched with AVAYA. So there was a voice recording and a data stamp. But where the patient wasn’t expecting the call, that was always the times that the calls were missing.”
129. The Registrant in her statement states that she accepts it is possible to falsify calls. She states that, ‘however, it would be pointless to do so as calls were always waiting. If you falsified one call, you would have 101 others waiting for you to call. I am unclear on what the motivation for falsifying calls would be. Additionally, managers and colleagues would notice if you had a light workload and ask for assistance as everyone was busy.’ The Registrant’s statement also notes that, ‘At no point were concerns about my calls, usage of the system, my triage or decision making or anything else raised to me.’
130. The Panel considered the evidence of JM in terms of the context of a control room environment. He explained that he had worked in a control room centre environment and previously contact centres for 21 years, and that when you work in an environment which is so system-heavy, you’re relying on IT, and that “people who work in those environments, a small percentage of those people will always try and play the system. Because we work with tech, the tech can be manipulated in a way which will reduce their workload overall within their shift…And because of that person’s individual understanding or perception of how our ICT is deployed and how it’s recorded, often thinks that their behaviours will go unnoticed, because it’s not obvious that that work avoidance has taken place. And from experience, I will say that’s very much the case in this case and had we not identified this through the call from the police initially, this might have carried on for quite a long, long time after that until we came across it by accident.”
131. The Panel also considered the evidence of SJ who stated in relation to Unable to Triage calls (UTT) that the ‘Clinical Advisor average for call marked UTT is 16.2%’ and the Registrant’s ‘average UTT rate is 45.5%.’
132. The Panel found that based on the evidence before it, the Registrant had shown herself as able to use the system properly, she was aware by her own admission that calls could be falsified, and she had access to previous notes on the C3 system when triaging a call the substance of which could have enabled her to falsify the detail she subsequently added to C3.
133. The Panel placed significant weight on the fact that the calls that were missing were all ones where the patient was not expecting a call and therefore in the Panel’s view would be much easier to conceal and showed a clear pattern of behaviour. The Panel placed weight on the fact that the behaviour found in relation to Particular 1 was not replicated by any of the other staff members who were used as benchmarks to quality assure the investigation data, and that her UTT was an outlier compared with other staff in the same role.
134. The Panel also placed weight on the fact, that as accepted by JM, this conduct of not returning calls could have gone unnoticed. This is because the data checked in terms of staff clinical performance were the calls recorded in NICE and therefore this behaviour of not making calls was a ‘blind spot’ until the Police had requested the data from the 29 April 2018. The Panel took into account and placed weight on the evidence that there was nothing to suggest that the IT systems were not working correctly and that even with the one IT issue that had occurred (similar digit numbers being assigned to different staff) this had not impacted on the collection of data.
135. The Panel accepted that the Registrant is a person of good character. However, the Panel found that on all the evidence before it, the Registrant must have known that she was not making the calls that she was entering into C3 as if she had made. She must also have known that by writing inaccurate comments in C3 relating to either being UTT or speaking with patients or their family, anyone else reading that information would infer that the call had taken place. The Panel found that of the incidents it considered in relation to the dates set out in Particular 1, there was at least 17 occasions when the Registrant had added extra text in C3 which made it appear that she had spoken to a patient, relative or left a voicemail, none of which took place. The Panel found that motivation for doing such actions did exist in that it amounted to work avoidance.
136. The Panel concluded that taking into account the Registrant’s understanding of the circumstances, as set out above, an ordinary decent person would find the conduct as dishonest. The Panel considered that entering details of calls that you had not made to give the impression that you had, would be held to be dishonest upon an objective test.
137. The dishonesty alleged in Particular 2 relates to the Registrant preventing her work activities from being accurately logged in that she did not log into the telephone system for the entire shift worked on the dates set out in Schedule A (excluding the dates the Panel found not proved).
138. In her statement the Registrant accepts that she ‘on occasion…forgot to log in, and that she ‘held my hands up straight away and admitted that.’ She explains that ‘in 2017 it was introduced that Paramedic Advisors could make calls without being logged in and I would forget to log in or forget to log out at the end of a shift. It was such a chaotic time it was hard to keep track. Calls were recorded so we were told that logging in and out was not a priority.’
139. The evidence from SJ was that the ‘importance of logging into phones is drummed into staff as part of their basic training.’
140. JM provided evidence that the Registrant had failed to log into her telephone on multiple occasions. JM’s statement notes that ‘the log in activity of her colleagues was looked at as well.’ JM’s statement states that ‘out of 41 shifts that [the Registrant] had worked up to 18 March 2018, [the Registrant] only logged into her phone for only 15 of those… between 15 March 2018 and 31 May 2018, [the Registrant] worked on 17 days. On four of those days, she did not log in at all. Separately, seven of those days, she logged out of her phone early i.e. a couple of hours after she logged in.’
141. SJ provided evidence that data relating to other staff members ‘log in’ was considered. SJ’s statement states that during the period 15 March 2018 to 31 May 2018, ‘Colleague K had worked 41 shifts and forgotten to log out of their phone at the end of their shift twice. Colleague F had worked 23 shifts and forgotten to log out of their phone once. Colleague L had worked 29 shifts and there was no anomalies found.’
142. The Panel found that as an experienced staff member, and based on the evidence of SJ that the importance of logging into the phone system was reiterated at training and staff meetings, the Registrant would have been fully aware of the requirement to log into AVAYA.
143. The Panel found that the evidence shows the Registrant was capable of logging in and did so on various occasions within the data set. The Panel did not find the Registrant’s written evidence that she simply forgot to log in as credible. Whilst it is entirely possible for people to forget on occasions, the repeated nature and consistency of the Registrant’s failure to log in combined with the comparable data showing that other colleagues were not experiencing the same issues, suggests to the Panel that the Registrant was deliberately not logging in to avoid her work activities being captured and that she was attempting to manipulate the system. The Panel placed weight on the data collected from the other Colleagues, noting that out of their combined 93 shifts there had been zero occasions where any of them had failed to log in, the only anomalies were in fact failures to log out at the ends of shift on three occasions.
144. The Panel concluded that taking into account the Registrant’s understanding of the circumstances, as set out above, an ordinary decent person would find the conduct as dishonest. The Panel considered that deliberately not logging into a work system to prevent her work activities from being accurately logged, would be held to be dishonest upon an objective test. FOUND PROVED.
Decision on Grounds
145. Prior to Ms Jones addressing the Panel in relation to Misconduct, the Chair asked if the Registrant had been sent a copy of the decision on facts. The Panel had asked for its decision on facts to be sent to the Registrant and her representative to make them aware that the Panel had found facts and that it was moving to the next stage. Whilst the Panel recognised it was not required to send the decision on facts at this point, it had done so in the interests of fairness. On 22 August 2023, the Registrant’s representative had emailed the HCPC to say that the Registrant would be providing a written witness statement, certificates, and character references. In part the email stated, ‘The statement and certificates will follow shortly, and character references will be submitted if the impairment stage is reached.’ Whilst the Panel had received the written witness statement of the Registrant and the certificates prior to the hearing starting on 23 August 2023, it had never received any character references.
146. The Hearings Officer confirmed that the decision (to date) had been sent by email to the Registrant and her representative on 22 February 2024. An out of office reply had been received from the representative to say that she was on leave until 26 February and that her emails would not be checked in her absence. What appeared to be an out of office reply had also been received from the Registrant, stating that she was out of the country and would be returning in March 2024. The Hearings Officer and Ms Jones confirmed that no character references had been received.
147. The Panel was content to continue with the hearing.
148. Ms Jones provided written submissions in relation to misconduct. Ms Jones supplemented her written submissions with oral submissions.
149. Ms Jones submitted that the facts found proved, show that the Registrant acted in such a way which fell far short of what would be proper in the circumstances and what the public would expect of a HCPC registered Paramedic.
150. Ms Jones submitted that the Registrant breached standards 6, 7, 8, 9 and 10 of the HCPC Standards of Conduct, Performance and Ethics and Standards. Ms Jones submitted that the Registrants actions breached standards 1, 3, 10, 11 and 12 of the Standards of Proficiency for Paramedics.
151. Ms Jones submitted that the Registrant’s actions (in relation to the facts found) spanned a large number of service users and put service users at risk, and in consequence her conduct had fallen far below that which was expected of a registered professional.
152. The Registrant was not present to make submissions, but the Panel had regard to her unredacted written statement.
153. The Panel heard and accepted the advice of the Legal Assessor in relation to Misconduct, which it must consider in the event, it finds one or more of the facts found proved. The Legal Assessor referred the Panel to the case of Roylance v GMC (no.2) [2000] AC 311 and to the HCPC Standards. The Legal Assessor advised that there was no settled definition of misconduct, and it was for the Panel to say in the circumstances of the case whether the behaviour, if found proven, crossed the threshold properly to be categorised as misconduct. The Panel could approach the question by deciding whether an act or omission on the part of the Registrant represented a serious falling short of the standards to be expected of a HCPC registrant. However, it is important to note that not every omission or wrongdoing necessarily constitutes misconduct.
Panel Decision
154. The Panel at all times kept in mind the HCPC’s overarching objective of protecting the public which includes protecting services users, protecting public confidence in the profession and the regulatory process, and declaring and upholding proper standards of conduct and behaviour.
155. The Panel took into account the HCPC Standards of Conduct Performance and Ethics. The panel bore in mind that a departure from the Standards alone does not necessarily constitute misconduct.
156. The Panel concluded that the behaviours of the Registrant in relation to facts found proven do individually and collectively amount to serious professional misconduct.
157. The Panel concluded that the Registrant’s conduct and behaviour fell far below the standards expected of a registered Paramedic. The Panel determined that the Registrant’s conduct was in breach of the HCPC Standards of Conduct, Performance and Ethics (2016), in particular standards:
• ‘6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particulars 1 and 2).
• ‘10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
158. The Panel determined that the Registrant’s conduct was in breach of the HCPC Standards of Proficiency for Paramedics (dated 2014), in particular standards:
• ‘1.4 be able to work safely in challenging and unpredictable environments, including being able to take appropriate action to assess and manage risk.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘2.1 understand the need to act in the best interests of service users at all times.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘2.2 understand what is required of them by the Health and Care Professions Council.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘2.8 be able to exercise a professional duty of care.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘3.1 understand the need to maintain high standards of personal and professional conduct’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particulars 1 and 2).
• ‘10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particulars 1 and 2).
• ‘12.2 be able to gather information, including qualitative and quantitative data, that helps to evaluate the responses of service users to their care.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
• ‘12.3 be aware of the role of audit and review in quality management, including quality control, quality assurance and the use of appropriate outcome measures.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particulars 1 and 2).
• ‘12.4 be able to maintain an effective audit trail and work towards continual improvement.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particulars 1 and 2).
• ‘12.7 recognise the need to monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programmes.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 2).
• ‘15.1 understand the need to maintain the safety of both service users and those involved in their care.’ (The Panel found this to be relevant in relation to the dishonest behaviour relating to Particular 1).
159. Based on its findings of fact, the Panel considered that the misconduct falls into two interlinked areas relating to her job role: i) dishonestly entering into the C3 system calls for patients which she did not make and/or which were inaccurate and ii) dishonesty in preventing her work activities from being accurately logged in that she did not log into the telephone system for the entire shift worked on the dates specified.
160. In relation to the dishonesty relating to the C3 system and welfare calls, the Panel took into account that based on the evidence which it had accepted, the Registrant had repeated this conduct on numerous occasions across numerous dates spanning a period of over twelve months. The Panel concluded that falsely claiming to have made welfare calls that you have not made, and on at least 17 occasions entering narrative details which made it appear that a telephone voicemail had been reached or that the patient/relative had been spoken to, when this was not the case, is serious and it had occurred within the Registrant’s Paramedic role. On some of the incident numbers within the dates found proved, the Registrant had written quite detailed narratives about the patients’ health on C3 based on a conversation which did not happen. Anyone reading the C3 notes would have gained the impression that the Registrant had spoken to the patient/relative and that the notes recorded the current circumstances. For example, incident 3879960 on 07 July 2017, whereby the Registrant had noted into C3 ‘speaking with caller’ and then proceeded to record clinical details as per her supposed triage which included, ‘…unwell yesterday, known ca, previous stroke, now feeling worse, head feeling funny…unable to exclude stroke…’
161. The Panel took into account the evidence it had received from JM in relation to the impact of the Registrant’s conduct. JM’s evidence, which the Panel accepted, was that the Registrant’s conduct not only presented a risk to patients but also to colleagues and had a potential impact on SAS resourcing. JM explained that when the Registrant escalated calls, the next step was for ambulances to be sent out. If these ambulances were attending to patients using blue lights when this was not warranted, this would put the ambulance crew at risk of injury should they have an accident as a result. Innocent bystanders could also have been injured in such a situation. JM’s statement stated that ‘upgrading calls without justification would inevitably have an effect on patients within the system as well. Patients who were upgraded would have received a faster response than those who potentially needed it more but had been bypassed. Those bypassed patients would have had to wait longer for a response, which potentially could have been detrimental.’
162. The Panel concluded that the Registrant’s conduct demonstrated not only a disregard for patient/colleague safety but also the trust that is placed in professional employees who are expected to act with honesty and integrity.
163. In relation to the dishonesty in preventing her work activities from being accurately logged, in that she did not log into the telephone system for the entire shift worked on the dates specified, the Panel considered that the dishonest element of this would undermine the public’s trust and confidence in the Registrant and the wider Paramedic profession.
164. The Panel took into account the evidence it had read and heard about the importance of logging into the telephone system. Without the logging on information, there is not the three points of contact for proof of the call, therefore directly impacting on audits. According to the evidence, which the Panel had accepted, the AVAYA call data is an important element of the ACC telephone governance. The Panel took into account its finding that it considered the Registrant had not logged in deliberately to avoid her work activities being captured and that she was attempting to manipulate the system. The Panel considered that the Registrant’s actions were serious and would be regarded as deplorable by a fellow practitioner.
165. Whilst the Panel found that the dishonest behaviour in relation to Particular 2, was of a less serious nature than that relating to Particular 1, it nonetheless considered it amounted to misconduct.
166. The Panel found that the proven facts of the Allegation all amount to the statutory ground of misconduct.
Decision on Impairment
167. Ms Jones provided the Panel with written submissions in relation to impairment which she supplemented with oral submissions.
168. Ms Jones submitted that in relation to impairment, the HCPC invite the Panel to find that the Registrant is currently impaired. She submitted that there is no evidence before the Panel of remediation. She reminded the Panel that the Registrant was entitled to attend the hearing and to challenge the witness evidence, but she has not done so. Ms Jones submitted that the Panel had no evidence before it of what, if any, action the Registrant has taken to demonstrate insight and remediation.
169. Ms Jones submitted that the Registrant has not provided any relevant training certificates and no evidence of any reflection or insight to demonstrate that she has changed the way she approaches tasks or that she would act differently in the future.
170. Ms Jones submitted that there is no evidence to say that this behaviour will not be repeated and therefore the risk of repetition remains. Ms Jones submitted that the Registrant has not taken any responsibility for her conduct.
171. Ms Jones submitted that both the personal and public components of impairment are engaged. She submitted that given the nature of the facts found proved, which include dishonesty, public confidence in the profession and the regulatory process would be undermined if there were no finding of impairment.
172. The Registrant was not present, but she had provided a written statement which the Panel has already referred to multiple times within this decision. In relation to the Registrant’s current circumstances (as at the date of her statement 13 August 2023) the written statement states as follows:
‘Talking about my current practice: I have no confidence. I am scared that if I were to return I would not be the practitioner that I was…
I am currently working two jobs. One is for…a charity for those with learning difficulties and autism. I work for the response team which is a 24 hour support and care service. This is a telephone-based role, where I answer calls dealing with anything from service users who have dropped medication to falls and everything in between, in their own homes. I have been doing this for 3.5 years. This would be a SSSC registered role but as my HCPC registration is frozen pending these proceedings, I am not SSSC registered. I am acting within SSSC codes of conduct. I have had no further complaints about my conduct while answering phones.
Through this role, I am also a Nanny. Two of the service users had a child, and require additional support. I assist them in caring for the child. I love my current jobs and take so much pleasure in still being able to assist the community.
I have not practiced as a Paramedic since I was suspended, and I have no intention of ever doing so again. I need this to be over so I can try and rebuild my life and me as a person.’
173. The Panel heard and accepted the advice of the Legal Assessor in relation to impairment. The Legal Assessor reminded the Panel to take into account that it should have regard to both the personal and public components and keep in mind the wider public interest. The Legal Assessor referred the Panel to the HCPTS Practice Note ‘Fitness to Practise Impairment’ dated November 2023. The Panel was referred to the cases of, CHRE v (1) NMC & (2) Grant [2011] EWHC 927 (Admin), Cohen v GMC [2008] EWHC 581 [Admin], Cheatle v GMC (2009) EWHC 645 (Admin), Bolton v Law Society 1993, PSA v HCPC + Doree [2017] EWCA Civ 319 and The General Medical Council v Armstrong [2021] EWHC 1658 (Admin).
Panel Decision
174. The Panel considered the Registrant’s current fitness to practise firstly from the personal component and then from the wider public component. The Panel also had regard to whether the conduct in this case is easily remediable, whether it has been remedied and whether it was highly unlikely to be repeated.
175. In deciding impairment, the Panel had regard to the factors identified by Dame Janet Smith in her 5th Shipman Report and cited in CHRE v (1) NMC and (2) Grant (“Grant”). The Panel considered whether:
a- The Registrant has in the past and/or is liable in the future to place service users at unwarranted risk of harm.
b- The Registrant has in the past brought and/or is liable in the future to bring the profession into disrepute.
c- The Registrant has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession.
d-The Registrant has in the past acted dishonestly and/or is liable to act dishonestly in the future.
176. In relation to the first component the Panel determined that the Registrant’s conduct has in the past placed service users at unwarranted risk of harm. The Panel took into account and relied on the evidence provided by JM, which included the outcome of the review carried out by the Consultant Paramedic whose task as part of the SAS investigation was to quantify the clinical risk. In relation to one of the reviewed cases the Consultant had reviewed it was found: ‘Earlier Clinical Advisor intervention to provide additional clinical led telephone triage may have identified the patient’s state of illness/injury and appearance of hypovolemic shock, which would have allowed for the response to be upgraded and potentially allowed for a faster response.’ For the other reviewed case it was found that: ‘Earlier CA intervention providing further clinical led telephone triage may have identified this patient’s state of injury, which would have allowed for the response to be upgraded and potentially allowed for a faster response.’
177. The Panel considered that the findings it made in relation to Particular 1 do show that the Registrant acted in a way that did and could put services user at risk of harm. In relation to the degree of harm, the Panel had no evidence to suggest that the Registrant was seeking to intentionally cause harm, but her work avoidant behaviour and manipulation of the IT systems was such that she had a reckless disregard of the risks.
178. In relation to the question of whether the Registrant has in the past brought the profession into disrepute, the Panel determined she had. A significant aspect of public interest is upholding proper standards of behaviour so as not to bring the profession into disrepute. The dishonest behaviour and conduct found against the Registrant does bring the Paramedic profession into disrepute.
179. In finding that the Registrant did not conduct herself in such a way as to adhere to the HCPC professional standards, the Panel determined that she had breached fundamental tenets of the profession. The Panel considered that honesty and integrity are fundamental tenets of Paramedic practice.
180. In relation to the fourth component, the Panel determined that the Registrant had in the past acted dishonestly and had done so on numerous occasions over numerous dates showing a pattern of behaviour.
181. The Panel considered the extent to which the misconduct in this case can be, and has been, remediated by the Registrant and whether it is likely to be repeated.
182. The Panel kept in mind that concerns that raise questions of character such as dishonesty may be harder to remediate. However, the Panel did think that the Registrant’s dishonest conduct could be remediated, albeit it relates to an attitudinal concern which appears to stem from work avoidance. Whilst the Panel considered that all dishonesty is serious, it found the conduct in this case to be particularly serious as the misconduct persisted, was not a single act and was repeated. It occurred over a prolonged period, and resulted in potential harm to services users. Nonetheless, the panel did consider that the misconduct found was capable of being remedied providing that sufficient insight, reflection and remediation could be evidenced.
183. In relation to insight, the Registrant has accepted that she did not log onto her telephone (AVAYA system) on occasions however, she only admitted this when challenged as part of the SAS investigation. The Registrant has continued to deny that she did not make the triage/welfare calls and/or recorded inaccurate information. She has also continued to deny the dishonesty of her actions. Whilst the Panel took into account that dishonesty in this case was pleaded as a secondary allegation, the Panel considered the actions in relation to Particular 1 were inherently dishonest in that the Registrant was not making calls that she should have been making and was recording inaccurate information against them. Although the Registrant blamed her ‘navigation of the computer systems’, she was an experienced Paramedic Clinical Advisor, and the Panel found that the evidence showed that she was able to use the systems and did so correctly many times and therefore it rejected the Registrant’s defence. It was only for the call types where the patients would not have known to expect a callback that the Registrant had not done as was expected of her. The Panel found that the continued denial of the Registrant, despite what the Panel found to be overwhelming evidence to the contrary, showed a lack of insight.
184. The Registrant’s written evidence provided no confidence to the Panel that the Registrant understands what led to the events which are the subject of the Allegation, nor that she recognises what went wrong, nor that she has accepted her role and responsibilities in relation to the events. It is possible, even when denying an Allegation, for a Registrant to evidence what could (and should) have been done differently and to express remorse. However, the Panel did not find that the Registrant had expressed any remorse or provided any evidence of what could have been done differently. The Panel found that the Registrant’s written evidence does not demonstrate any reflection or demonstrate a genuine understanding of the impact of her actions on others, and the profession. The only information about impact is relating to that which the proceedings have had on her personally, which is not in the Panel’s view evidence of insight.
185. In finding a lack of insight, the Panel also factored in the Registrant’s failure to fully engage with the regulatory process, in that she had failed to attend both parts of the hearing (starting in August 2023 and resuming in February 2024). There had been no correspondence from her since the hearing started in August 2023 and no reasons to explain why she has not engaged with the process.
186. The Panel considered whether there was any evidence of remediation. The Registrant states that she is working in a telephone based clinical role (not as a registered professional) for a charity, but she has not provided any evidence of feedback in relation to her practice within in that role. Nor has the Registrant provided any objective evidence of successful completion of any relevant education or training courses. The Registrant’s statement notes that she has ‘no confidence’ and that she is scared that if she ‘were to return’ she ‘would not be the practitioner that [she] was.’ The Panel took into account that the Registrant had not provided any evidence of how she has or would alleviate this concern about her confidence in practice. Overall, the Panel found no evidence of remediation.
187. The Panel considered whether the misconduct was likely to be repeated by the Registrant. The Panel took into account all it had read and heard about the misconduct. The facts found in relation to the dishonesty show that the Registrant had conducted a pattern of behaviour, she knew the system and she knew how to gain from it in terms of work avoidance. Given its finding that the Registrant has shown no insight and has not remediated the Panel concluded that the risk of repetition remains. The Panel found that given the lack of insight, there remains a potential for the Registrant to behave dishonestly again if she found herself in a similar position whereby the IT systems could be manipulated to support work avoidance, which in turn could have a detrimental impact on the safety of service users and colleagues.
188. The Panel decided that on the personal component the Registrant’s fitness to practise is currently impaired.
189. The Panel next considered whether a finding of current impairment was necessary in the public interest. The Panel was mindful that the public interest encompassed not only public protection but also the declaring and upholding of proper standards of conduct and behaviour as well as the maintenance of public confidence in the profession. It took into account the guidance in the ‘Grant’ case:- ‘In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.’
190. The Panel considered its findings in relation to misconduct. The Panel took into account that Paramedics hold privileged positions of trust. It is essential that the public can trust Paramedics. Abuse of trust by way of dishonesty, particularly given that it occurred as part of the Registrant’s Paramedic role, is a serious and unacceptable risk in terms of confidence in the profession.
191. The Panel concluded that members of the public would be concerned if the Regulator were not to mark the seriousness of the Registrant’s misconduct with a finding of current impairment on public interest grounds. The Panel considered that not to make a finding of current impairment of fitness to practise would undermine public trust and confidence in the Paramedic profession and would fail to uphold and declare proper standards.
192. The Panel therefore decided on the public component of impairment that the Registrant’s fitness to practise is currently impaired.
Decision on Sanction
193. Ms Jones submitted that the Panel’s findings show that the Registrant’s actions were in breach of a number of the HCPC standards. Ms Jones submitted that there are no suitable conditions of practice which could be imposed to sufficiently maintain public confidence, due to the serious nature of the breaches which include dishonesty.
194. Ms Jones highlighted part of the Panel’s decision, noting that the Panel had found the Registrant to have demonstrated a disregard for patient and colleague safety, and a disregard for the trust placed in her as a Paramedic.
195. Ms Jones submitted that there is no evidence to demonstrate any remediation or insight and therefore the risk of repetition of similar behaviour remains.
196. Ms Jones submitted that public confidence in the profession and regulatory process would be diminished if the Registrant were allowed to remain in practice.
197. The Panel heard and accepted the advice of the Legal Assessor, who referred the Panel to the HCPC Sanctions Policy, which states that any sanction must be proportionate, is not intended to be punitive and should be no more than is necessary to meet the legitimate purposes of providing adequate protection to the public, to protect the reputation of the profession, maintain confidence in the regulatory system and declare and uphold proper professional standards. The Legal Assessor reminded the Panel that its primary function at this stage is to protect the public, while deciding what, if any, sanction is proportionate, taking into account the wider public interest and the interests of the Registrant.
198. In respect of the Panel’s findings of dishonesty, the Legal Assessor drew the Panel’s attention to paragraphs 56-58 of the Sanctions Policy and reminded the Panel that the case law in relation to dishonesty makes plain that a finding of dishonesty will always be considered to be serious and to risk serious consequences. However, a more nuanced approach should be taken to dishonesty, and dishonest conduct can take various forms; some criminal, some not; some destroying trust instantly, others merely undermining it to a greater or lesser extent. Not all cases of proven dishonesty will lead to strike off.
Panel’s decision
199. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity. The Panel considered the mitigating and aggravating factors in determining what sanction, if any, to impose.
200. The Panel identified the following aggravating factors:
• The dishonesty was not a single act, it was persistent and repeated, and the Registrant was solely responsible for it. The dishonesty occurred over a prolonged period and resulted in potential harm to services users. It was pre-meditated dishonesty rather than impulsive and the Registrant’s guile allowed her to ‘play the IT system’ for her own gain.
• The dishonest actions occurred within the work setting as part of the Registrant conducting her Paramedic Clinical Adviser role.
• The Registrant benefitted from her misconduct by allowing her to avoid aspects of the work. It also allowed her work performance and professional reputation to go unchallenged by management as the way that staff audits were undertaken (at that time) did not capture the mischief.
• The Registrant has taken no steps to address the concerns that have been raised about her conduct. The Panel has found that the Registrant has no insight into the proved facts, has not demonstrated any remorse or offered an apology for her actions.
• The Registrant has failed to fully engage with the HCPC by not attending both parts of the hearing to respond to the serious Allegation that was raised against her.
• The Registrant had a reckless disregard of the risks and consequences associated with her misconduct.
201. The Panel identified the following mitigating factors:
• There have been no previous regulatory matters raised against the Registrant who has been in Paramedic practice since 2003, becoming a Paramedic Adviser in 2010.
202. The HCPC Sanctions Policy states: ‘The Standards of conduct, performance and ethics require registrants to be honest and trustworthy (Standard 9). Dishonesty undermines public confidence in the profession and can, in some cases, impact the public’s safety. Dishonesty, both in and outside the workplace, can have a significant impact on the trust placed in those who have been dishonest, and potentially on public safety. It is likely to lead to more serious sanctions…Given the seriousness of dishonesty, cases are likely to result in more serious sanctions. However, panels should bear in mind that there are different forms, and different degrees, of dishonesty, that need to be considered in an appropriately nuanced way. Factors that panels should take into account in this regard include:
• whether the relevant behaviour took the form of a single act, or occurred on multiple occasions;
• the duration of any dishonesty;
• whether the registrant took a passive or active role in it;
• any early admission of dishonesty on the registrant’s behalf; and
• any other relevant mitigating factors.’
203. The Panel started by considering the least restrictive sanction first, working upwards only where necessary. It took into account that the final sanction should be a proportionate approach and will therefore be the minimum action required to protect the public.
204. Due to the serious nature of the misconduct found in this case (dishonesty), the Panel considered that taking no further action or mediation would not be appropriate in this case.
205. The Panel next considered whether a Caution Order would be appropriate. The Panel considered that a Caution Order would not be in accordance with the HCPC Sanctions Policy which states: ‘A caution order is likely to be an appropriate sanction for cases in which: the issue is isolated, limited, or relatively minor in nature.’ The HCPC Sanctions Policy also states that a caution order is likely to be an appropriate sanction for cases in which there is: a low risk of repetition; the registrant has shown good insight, and the registrant has undertaken appropriate remediation. The Panel considered its earlier decision on impairment and kept in mind it had not found a low risk of repetition, it had not found the Registrant to have good insight, nor did it find that she had remediated. In the circumstances the Panel considered that the Registrant’s misconduct was too serious for a caution and such a disposal would be contrary to the Sanctions Policy.
206. The Panel next considered whether to impose a Conditions of Practice Order. The Panel took into account the Sanctions Guidance which notes that, ‘Conditions will only be effective in cases where the registrant is genuinely committed to resolving the concerns raised and the panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings. Conditions are also less likely to be appropriate in more serious cases, for example those involving: • dishonesty.’
207. The Panel has found that the Registrant has not shown insight and that she has not engaged in the fitness to practice hearing process. Further, she has had serious misconduct findings made against her by the Panel, including repeated and persistent dishonesty. The Panel found that the Registrant’s conduct was not minor, rather that it was particularly serious given the potential impact it had on service users and colleagues. The Panel kept in mind its decision on impairment, in that it concluded the misconduct was attitudinal in nature and at risk of being repeated given that lack of insight and remediation. Taking all these factors into account the Panel found that a Conditions of Practice Order would not be sufficient to address and safeguard members of the public from the risks of the dishonesty aspects of the Registrant’s misconduct.
208. The Panel next considered a Suspension Order. The HCPC Sanctions Policy states: ‘A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register.’
209. The Panel was mindful that it had found a lack of insight from the Registrant and found a risk of repetition. Whilst the Panel had concluded that the misconduct is capable of being remediated, it had no evidence from the Registrant to indicate that she is likely to be able to resolve or remedy her failings. In fact, she states that she has no intention of ever practising as a Paramedic again and needs ‘this to be over so I can try and rebuild my life and me as a person.’
210. The Panel reminded itself that there are different forms, and different degrees, of dishonesty, which need to be considered in an appropriately nuanced way when considering sanction. Taking a nuanced approach, the Panel considered the degree of dishonesty to be at the gravest end. The Panel found the dishonesty in this case occurred on multiple occasions, took place over a prolonged period, involved the Registrant taking an active role, and it was not an uncharacteristic lapse in a front-line challenging clinical situation, rather it was a pre-meditated and persistent action.
211. The Panel took into account that Paramedics hold positions of trust, and the role often requires them to engage with vulnerable people. Dishonesty is therefore likely to threaten public confidence in Paramedics. The public (which includes employers and colleagues) must be able to trust and rely on the honesty and integrity of Paramedics when performing their duties.
212. The Panel considered that the misconduct in this case was such that the requirements of public protection and the wider public interest would not be adequately served by imposing a Suspension Order.
213. The Panel, having decided a Suspension Order did not protect the public nor meet the wider public interest, decided that the proportionate order was a Striking Off Order.
214. The Panel took into account the Sanctions Policy and noted that a Striking Off Order is a sanction of last resort and should be reserved for those categories of cases where there is no other means of protecting the public and the wider public interest. The Panel decided that the Registrant’s case falls into this category because of the persistent and reckless nature of the dishonest conduct which placed service users and colleagues at risk, and the ongoing risk of repetition. These factors combined with the Registrant’s lack of insight and apparent unwillingness to resolve matters led the Panel to conclude that any lesser sanction would undermine public trust and confidence in the profession and would be insufficient to protect the public.
215. The Panel had regard to proportionality and balanced the public interest against the Registrant’s interests. The Panel took into account the consequential personal, financial and professional impact a Striking Off Order may have upon the Registrant but concluded that these considerations are significantly outweighed by the Panel’s duty to give priority to public protection and the wider public interest.
216. The Panel concluded that the appropriate and proportionate order is a Striking Off Order.
Order
The Registrar is directed to strike the name of Miss Tracylee Armit from the Register on the date this order comes into effect.
Notes
Right of Appeal
You may appeal to the Court of Session 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
217. Ms Jones submitted that the Registrant was on notice that an Interim Order could be made following the imposition of a final restrictive sanction. Ms Jones submitted that the Panel should proceed to deal with the Interim Order application in the Registrant’s absence. Ms Jones submitted that an Interim Suspension Order is necessary in line with the findings of the Panel in relation to the Allegation because the Striking Off Order made today does not take effect until the end of the appeal period. Ms Jones submitted that an Interim Order would safeguard the public and the wider public interest. Ms Jones submitted that the Interim Suspension Order should be made for eighteen months to cover the appeal period.
218. The Panel heard and accepted the advice of the Legal Assessor who advised that the Panel should ensure that it is satisfied that the Registrant has been provided with notice of the application in relation to an Interim Order. If the Panel is satisfied that notice has been provided it should then consider whether it is content to proceed in the Registrant’s absence. In relation to the Interim Order application, the Panel needs to decide whether an Interim Order is necessary under Article 31, to protect the public or in the public interest or the Registrant’s own interest, because of the nature of the findings made in this case. The Legal Assessor drew the Panel’s attention to the HCPC Sanctions Policy which states: ‘An interim order is likely to be required in cases where: … the allegation is so serious that public confidence in the profession would be seriously harmed if the registrant was allowed to remain in unrestricted practice.’ The Legal Assessor also advised the Panel to take into account the HCPTS guidance note entitled ‘Interim orders’ dated June 2022.
Panel Decision
219. The Panel was satisfied that the Registrant had been informed by the HCPC that at the end of this hearing the Panel could give consideration to the issue of imposing an Interim Order. Such consideration arose in the event of the Panel having determined that a Conditions of Practice, Suspension, or Strike off Order was the appropriate and proportionate restriction. That information had been included within the letter of Notice of Hearing sent to the Registrant in advance of this substantive final hearing dated 11 July 2023. A follow up Notice of Hearing letter containing the same information in relation to the potential for an Interim Order to be made, was sent to the Registrant on 06 September 2023 after the first part of the final hearing had taken place.
220. The Panel decided to proceed in the Registrant’s absence for the same reasons as set out in its determination above in relation to the substantive application. The Registrant was notified that the HCPC might apply for an Interim Order and the Panel concluded that the Registrant had voluntarily waived her right to attend and that it is in the public interest that such an application is considered.
221. After considering the HCPTS Practice Note on Interim Orders, the Panel decided that an Interim Order was necessary to protect the public. The Panel found that whilst the Registrant is not currently in Paramedic practice, there is a risk that the Registrant may return to practice if an Interim Order is not immediately in place. The Panel decided that an Interim Order was also necessary taking into account in the public interest for the reasons set out in the Panel’s decision above, due to the nature and seriousness of the findings of misconduct made against the Registrant. Taking into account the Panel’s findings, including dishonesty, an Interim Conditions of Practice Order would not be sufficient to protect the public or the wider public interest. The Panel therefore concluded an Interim Suspension Order was the appropriate order. The Panel concluded that the appropriate length of the Interim Suspension Order is 18 months, as an Interim Order would continue to be required pending the resolution of an appeal, in the event of the Registrant giving notice of an appeal within 28 days.
222. The Panel makes an Interim Suspension Order 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. The Panel decided that the appropriate length of the Order is 18 months to cover the 28-day appeal period and the time it may take for any appeal, if made, to be determined. This order will expire: (if there is no appeal 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.
Hearing History
History of Hearings for Miss Tracylee Armit
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 19/02/2024 | Conduct and Competence Committee | Final Hearing | Struck off |
| 23/08/2023 | Conduct and Competence Committee | Final Hearing | Adjourned part heard |