Ruth Lambert

Preliminary matters

Proceeding in Private
1. Ms Lambert on her own behalf applied to have the hearing in private. The Panel understood that this application under Rule 8(1) of the Health Professions Council (Investigating Committee) Procedure Rules Order of Council 2003 to hold today’s hearing in private. The Panel recognised that part of the evidence to be discussed will engage the Practice Note Conducting Hearings in Private dated March 2017 in respect of the Registrant’s private life. The public interest in an open and transparent hearing had to be balanced against the risks to the right to respect for private and family life of relevant persons.

2. Ms Atkin, on behalf of the HCPC said that the HCPC was neutral on the issue. She reminded the Panel that where possible hearings should be in public in support of the open justice principle referenced in the Practice Note. Accordingly, it was open to the Panel to proceed only partly in private where the subject matter of the hearing related to the private matters concerning Ms Lambert.

3. The Panel accepted the Legal Assessor’s advice and reminded itself of the content of the Practice Note.

4. The Panel considered that the importance of the public interest in open access to hearings was that it demonstrated that matters were being conducted transparently to reassure the public that public protection was at the forefront of the Panel’s decision making. However, there were occasions when other important considerations took priority. In this case, the right to respect for the private and family life of the Registrant would be at risk without at least partly proceeding in private. After consideration of the whole circumstances, the Panel concluded that this hearing should be conducted partly in private to protect the Registrant’s rights to respect for her private and family life. For those reasons, the Panel decided that it was necessary to hold part of the hearing in private.

Background
5. At the time of committing the offences which led to her conviction, the Registrant was employed as a Paramedic by South East Coast Ambulance Service NHS Foundation Trust (“the Trust”).

6. At some point around or prior to February 2018, the Registrant self-administered some morphine which had been left over from a patient. From that point onwards, she continued to use amounts of leftover patient medication, and additionally offered such medication to Person K, who was her partner and a fellow employee of the Trust.

7. From 3 February 2018 onwards, the Registrant and Person K were jointly involved in the theft of medication and medical equipment, which included on one occasion the theft of a portable ultrasound machine (valued at £14,000 when new in 2008).

8. From May 2020, the Registrant and Person K also conspired to burgle domestic premises, which involved the Person K gathering confidential patient information, which would then allow the Registrant to attend and steal from the homes of persons who had, or who were likely to have, medications including opiates. The Registrant and Person K conspired together to burgle a total of 29 homes prior to their arrests on 5 August 2021, including the homes of vulnerable patients who were terminally ill, and in some cases the homes of patients who had recently died.

9. On 29 March 2021, the Registrant was suspended by the Trust pending the investigation of allegations arising out of the events of a shift on 27/28 March 2021. These included an allegation that the Registrant may have misused controlled drugs during her shift. On 12 April 2021, the Registrant self-referred to the HCPC and explained that she would be disputing the allegations which had been made. Her employer subsequently made a referral to the HCPC on 28 April 2021 in respect of the same matters.

10. On 5 August 2021, the Registrant was arrested by Kent Police in connection with their investigation into a number of burglaries where medication had been stolen.

11. On 11 January 2022, the Registrant was convicted of the offences of conspiracy to steal and conspiracy to commit burglary (having pleaded guilty to the same). She was sentenced to 5 years’ imprisonment.

12. The Registrant is still in custody pending the expiry of her sentence on 5 February 2024.

Decision on Facts
13. The Panel were provided with a certified Memorandum of Conviction which supported Particular 1 as amended.

14. Rule 10(d) of the Panel Rules and the HCPTS Practice Note on Cautions and Convictions provide that where the Registrant has been convicted of a criminal offence, a certified copy of the certificate of conviction (or, in Scotland, an extract conviction) shall be admissible as proof of that conviction and of the findings of fact upon which it was based.

15. The Panel recognised that the burden of proof, to the civil standards of the balance of probabilities, always rested on the HCPC. The Panel however was satisfied that the HCPC had proved Particular 1 on the balance of probabilities.

16. Ms Lambert, on her own behalf admitted the facts of her conviction.

17. The Panel also had the benefit of the transcript of the judge’s sentencing remarks.

18. The Panel decided that the facts in this case were proved.

Decision on Grounds
19. The Panel had regard to the Practice Note ‘Conviction and Caution Allegations’ dated March 2017. The Panel recognised that Article 22(1)(a)(iii) of the Health Professions Order 2001 (the Order) provides that one of the grounds upon which an allegation may be made is that a Registrant’s fitness to practise is impaired by reason of:
“a conviction or caution in the United Kingdom for a criminal offence, or a conviction elsewhere for an offence which, if committed in England and Wales, would constitute a criminal offence,.”

Accordingly, “conviction allegations” include allegations that a Registrant’s fitness to practice is impaired as a consequence of being convicted for an offence by a criminal court in any part of the UK;

20. In this case, the Registrant had been convicted, on her own confession of a serious indictable offence, resulting a in a sentence of imprisonment of five years as a first offender. Ms Lambert, on her own behalf, admitted the grounds.

21. The Panel was satisfied that the grounds were established.

Decision on Impairment

22. The Panel’s task is to determine whether the Registrant’s current fitness to practise is impaired, based upon the nature, circumstances and gravity of the offence concerned, and, if so, whether any sanction needs to be imposed.

23. In considering the nature, circumstances and gravity of the offence, the Panel needs to take account of public protection in its broadest sense, including whether the Registrant’s actions bring the profession concerned into disrepute or may undermine public confidence in that profession. In doing so, the Panel is entitled to adopt a 'retrospective' approach and consider the conviction as if the Registrant was applying for registration with the HCPC. The purpose of this hearing is not to punish the Registrant for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise.

24. Ms Atkin, on behalf of the HCPC, submitted that Ms Lambert was impaired on both the private and public components of current impairment referred to in the Practice Note ‘Fitness to Practice Impairment’ last updated in November 2023.

25. Ms Atkin reminded the Panel of the case of CRHP v GDC and Fleischmann [2005] EWHC 87 (Admin) where it was made clear that ‘where a practitioner has been convicted of a serious criminal offence or offences, he should not be permitted to resume his practice unrestricted’ and ‘the rationale for the principle is that good standing in a profession must be earned if the reputation of the profession is to be maintained.’ Ms Atkin reminded the Panel that Ms Lambert had yet to be released from custody.

26. Ms Atkin submitted that Ms Lambert’s actions could be characterised as serous, persistent, and repeated breaches of the tenets of the Paramedic profession. At the very least, significant distress was caused to patients and their carers and in one case a patient who was in the last 24 hours of life was deprived of necessary medication. In another case, Ms Lambert had attended at an address to seek recovery of controlled medication from relatives only ten minutes after the patient had died.

27. Ms Atkin reminded the Panel that the judge in his sentencing remarks had accepted that Ms Lambert had not acted from some other ‘cold blooded’ motive, such as financial gain. Ms Lambert had expressed genuine remorse and the sentencing judge had accepted her mitigation.

28. The underlying cause of Ms Lambert’s actions however suggested that Ms Lambert remained impaired. There remained a serious risk of harm to patients and the public were Ms Lambert free to return to practice without a restriction.

29. Ms Atkin submitted that due to the absence of independent evidence that the Registrant had remedied the circumstances of the conviction, there is a risk of repetition in this case. She submitted that a finding of impairment on the personal component was required in order to protect members of the public.

30. In relation to the public component, Ms Atkin submitted that a finding of impairment was required in order to maintain public confidence in the Paramedic profession and in the HCPC as its regulatory body. She submitted that a reasonable and informed member of the public would be shocked and troubled if there were no finding of impairment in this case.

31. Ms Lambert made submissions on her own behalf.

32. Ms Lambert expressed remorse and regret for the harm that her actions had caused. She accepted that her fitness to practice was impaired.

33. Ms Lambert explained that she did not offer this information as an excuse for her conduct, which she regarded with disgust. It was no more than a context to explain her otherwise impossible to understand departures from the professional standards that she understood bound her. Ms Lambert said that she accepted that the public would expect that she would be excluded from the profession, in part because of the damage caused by her to the trust and confidence placed in paramedics by the public.

Panel decision
34. In reaching its decision, the Panel paid regard to the HCPTS’ Practice Note on “Fitness to Practice Impairment” and it accepted the Legal Assessor’s advice. The Panel took note of Ms Atkin’s and Ms Lambert’s respective submissions.

35. The Panel was impressed by Ms Lambert’s oral and written submissions. Ms Lambert had demonstrated courage in attending the hearing and in addressing the Panel as she had. The Panel considered her expressions of insight and recovery, while unsupported by any professional opinions and any testimonial or other reflective writing, appeared thoughtful, searching and sincere.

36. In reaching its decision, the Panel paid regard to the HCPTS’ Practice Note on “Fitness to Practice Impairment” and it accepted the Legal Assessor’s advice. The Panel based its conclusions on Impairment on the Registrant’s proved convictions and on the ground of misconduct which has been found proved.

37. The Panel reviewed the convictions and the Judge’s remarks on sentencing. It noted that there were aspects of his case that had revealed to the Judge certain positive elements to the Registrant’s attitude and conduct during the investigation and trial process. These included that the Registrant had no previous convictions and had pleaded guilty.

38. The Panel accepted Ms Atkin’s submissions that Ms Lambert’s actions, despite being driven by a serious addition, were
• planned
• had been persisted in over a long time
• targeted a very vulnerable cohort of patients and families
• had resulted in real harm to patients including in one case being deprived of necessary end-of-life medication and
• a loss of trust in the profession by family members as revealed in the victim impact statements referred to by the sentencing judge.

39. As Ms Atkin had said, the case of Fleischmann made clear that ‘where a practitioner has been convicted of a serious criminal offence or offences, he should not be permitted to resume his practice unrestricted’ and ‘the rationale for the principle is that good standing in a profession must be earned if the reputation of the profession is to be maintained.’

40. Ms Lambert had however, in the Panel’s judgement, shown meaningful and impactful insight which recognised that real harm had been caused to:
• patients and their families,
• the wider public interest and
• to the upholding of the standards rightly expected of Paramedics.

41. Ms Atkin submitted that because there was no independent evidence that the Registrant had remedied the circumstances of her conviction, there is a risk of repetition in this case. She submitted that a finding of impairment on the personal component was required in order to protect members of the public.

42. In relation to the public component, Ms Atkin submitted that a finding of impairment was required in order to maintain public confidence in the Paramedic profession and in the HCPC as its regulatory body. She submitted that a reasonable and informed member of the public would be shocked and troubled if there were no finding of impairment in this case.

Personal component of impairment

43. The Panel first considered the personal component of impairment.

44. The Panel is satisfied that that the conviction in this case is, with difficulty, capable in principle of being remedied. Offences involving dishonesty are particularly hard to remediate since their commission has a corrosive effect on the trust and confidence that can be placed in an individual who is responsible for such offences. The circumstances of this case were especially troubling and were wholly at odds with the fundamental tenets of the Paramedic profession.

45. The Panel considered that Ms Lambert had provided real and meaningful oral submissions which went some way towards practical remediation of her failings. She had apologised to the HCPC in this hearing and had expressed regret and remorse for the harm caused by her actions to patients and her professional colleagues. She had expressed her understanding of the harm that she had caused and the degree of departure from everything expected of a Paramedic. The Panel accepted that it had not been practical for her to have provided any evidence of steps to address her failings in a hands-on way while in custody. Her approach to these issues however was creditable.

46. The Panel however had no evidence in support of her recovery or the plans for continued recovery when the custodial part of her sentence had ended. There was no information in regard to her future situation on being released into the community. There was, for good reason, no means of her demonstrating remediation by means of voluntary work or some other concrete means of building on her insight.

47. In these circumstances, the Panel was satisfied that Ms Lambert was impaired in terms of the personal component.

48. The Panel considered that there is a real likelihood that the Registrant is at risk of repeating some form of dishonest conduct as a consequence of not having demonstrated her complete recovery from it. The risk was felt to be further increased if the Registrant was exposed to the stresses of returning to Paramedic practice. The Panel concluded that the risk of repetition is significant in Ms Lambert’s case, despite the progress she states she has made.
49. In these circumstances, the Panel has concluded that the Registrant’s fitness to practise is impaired on the personal component.

Public component of impairment
50. In relation to the public component, the Panel has considered very carefully whether given the nature, circumstances, and gravity of the conviction in this case, public confidence in the Paramedicine profession and its regulatory body would be undermined if there was no finding of impairment in this case. The Panel has also considered whether it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in that profession if it did not find impairment in this case.

51. The Panel considered the HCPC’s Standards of Conduct, Performance and Ethics and in particular Standard 9 which states:
Standard 9: Be honest and trustworthy Personal and professional behaviour
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

52. The Panel was satisfied that, in being convicted of a very serious conspiracy and campaign of burglary of some of the most helpless and vulnerable patients who depend on the services of a Paramedic among other healthcare workers, the Registrant has breached Standard 9.1. She did not make sure that her conduct justified the public’s trust and confidence in her or in her profession.

53. The Panel concluded that a reasonable and informed member of the public would be very concerned if there was no finding of impairment in this case. The Panel is satisfied that public confidence in the profession and in its regulator would be undermined if there was no finding of impairment in this case. The Panel is also satisfied that it would be failing in its duty to uphold and declare proper standards of conduct and behaviour in the Paramedic profession if it did not find that the Registrant’s fitness to practise is impaired.

54. The Panel had no doubt that the Registrant’s conviction and resulting lengthy prison sentence had brought the Paramedic profession into disrepute and that it had also breached the fundamental tenet of that profession, namely that a Registrant’s conduct must be trustworthy at all times. In these circumstances, the Panel finds the Registrant’s fitness to practise is impaired on the public component.

55. Accordingly, the Panel finds the Registrant’s fitness to practise is impaired on both the personal and public component.

Decision on Sanction
56. Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether it was impaired to a degree which required action to be taken on her registration by way of the imposition of a sanction.

57. The Panel had regard to all of the evidence in the case and the submissions made by Ms Atkin on behalf of the HCPC and the submissions made by the Registrant. In summary, Ms Atkin drew the Panel’s attention to the Sanctions Guidance and in particular the paragraphs relating to dishonesty and criminal convictions. Ms Atkin submitted that there were a number of aggravating features of the Registrant’s conduct. These included repeated dishonesty, abuse of her professional positions and significant harm to service users. Ms Atkin reminded the Panel of the principles in the case of Bolton v The Law Society [1994] WLR 512 and Council for the Regulation of Healthcare Professionals v General Dental Council and Fleischmann [2005] EWHC 87 (Admin). Ms Atkin submitted that the Registrant was still serving a custodial sentence for a serious offence of dishonesty and that personal mitigation in these circumstances carried less weight.

58. The Registrant submitted that she was sorry for her actions and recognised that they were shameful and disgraceful. The Registrant submitted that although like a number of other healthcare professionals she had experienced traumatic events, she had chosen to deal with her difficulties. The Registrant told the Panel that she had reflected very carefully on an appropriate outcome and considered that there was “no way back” for her to become a Paramedic. The Registrant submitted that this was because her criminal conviction would prevent such a return, but also because she considered that she was at risk. The Registrant submitted that she did not think it would be healthy for her to return and she asked the Panel to strike her name from the Register.

59. The Panel accepted the advice of the Legal Assessor and exercised its independent judgement. The Panel had regard to the Sanctions Policy (the Policy) and considered the Sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the wider public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

60. The Panel first identified what it considered to be the principal aggravating and mitigating factors in this case which were relevant to its assessment of the appropriate Sanction. In relation to aggravating factors the Panel considered that the Registrant‘s dishonesty persisted over a significant period of time in a range of different circumstances. The Registrant abused her trusted position as a Paramedic to steal controlled drugs for her own use and in so doing prioritised her own needs above service users. The Panel noted that the Registrant had been under the influence of controlled drugs when driving an Emergency Response Vehicle and when potentially providing care to Service Users.

61. The Registrant had used her position as a Senior Paramedic to access confidential information in order to identify and target vulnerable patients to steal medication. The Panel considered that this amounted to predatory behaviour. In addition, the Registrant had given drugs to her partner and involved her in the conduct by sharing the confidential information to enable Person K to attend at the home of the service user and steal medication. The Panel considered that the Registrant had exploited vulnerable service users and abused her position of trust.

62. The Panel noted that as a result of the Registrant’s conduct very vulnerable service users had been deprived of painkilling medication and had been subjected to significant harm at the end of life. The Panel took into account that this was conduct that had ended only after the Registrant had been caught. The Panel took into account the lengthy custodial sentence imposed by the Court and the fact that the Registrant remains in custody.

63. The Panel noted that there were some mitigating factors and it took into account the Registrant’s guilty plea in the criminal proceedings. The Panel noted that the Registrant has engaged fully with this process and has demonstrated remorse and some insight in relation to her actions. The Panel acknowledged the Registrant’s insight that her conduct was ‘shameful’. The Panel was in no doubt that the Registrant was genuine and sincere in her remorse and that she appreciated the gravity of her misconduct.

64. The Panel had no persuasive evidence of remediation, partly because of the Registrant’s imprisonment. However, it considered that it was unable to give much weight to the Registrant’s personal circumstances at the time of the misconduct given the lack of evidence. The Panel had very little evidence, other than the Registrant’s assertions, that this was as a direct result of her work as a Paramedic. There was no evidence that the Registrant had sought help from her employer to deal with her difficulties.

65. The Panel considered that the Registrant had not fully developed her insight for the Panel to be satisfied that there was a low risk of repetition and indeed the Registrant submitted that she was at risk of should she return to work. The Panel reminded itself of its findings in relation to impairment and in particular the conclusion that the Registrant posed a risk of repeating her behaviour and was a risk to the public.

66. The Panel considered the sanctions available, beginning with the least restrictive. The Panel did not consider the options of taking no further action, mediation, or the sanction of a Caution Order to be appropriate or proportionate in the circumstances of this case. In the view of the Panel none of these options would address the consequent risk of repetition which the Panel had previously identified nor would they reflect the seriousness of the case.

67. The Panel next considered the imposition of a Conditions of Practice Order. The Panel was satisfied that this case did not raise any workplace concerns which may be appropriately addressed through conditions. The Panel was of the view that it was not possible to formulate workable or practicable conditions which would address the Registrant’s dishonesty. Further, the Panel considered that the case was too serious for a Conditions of Practice Order.

68. The Panel next considered a Suspension Order and had particular regard to the HCPC’s Sanction Policy at Paragraph 121 which states,
“121 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. These types of cases will typically exhibit the following factors:
• the concerns represent a serious breach of the Standards of conduct, performance, and ethics;
• the Registrant has insight;
• the issues are unlikely to be repeated;
• there is evidence to suggest the Registrant is likely to be able to resolve or remedy their failings.”

69. The Panel considered that although it had found that the concerns in this case could be remedied, albeit with difficulty, there was insufficient evidence that the Registrant had remedied the concerns. It was clear that the Registrant considered she was a continuing risk of offending behaviour. In addition, the Panel was not persuaded that this sanction, even if imposed for the maximum 12 months would be sufficient to protect the public interest given the gravity and seriousness of the Registrant’s misconduct. The Panel considered that a Suspension Order would not send out an appropriate message to the profession about this conduct and the resulting criminal conviction. The Panel considered that a reasonably informed member of the public would expect a more serious sanction.

70. The Panel has therefore concluded that the only appropriate and proportionate sanction is an order striking the Registrant off the Register. The Panel has considered the Sanctions Policy and in particular, paragraph 130 which states:
“A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts involving…
• Dishonesty
• …..
• Abuse of professional position, including vulnerability
• …..
• Criminal convictions for serious offences”

71. The Panel has also had in mind paragraph 131 which states:
“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process.”

72. The Panel is satisfied, notwithstanding the insight and remorse shown by the Registrant, that it is appropriate and proportionate to order that the Registrant’s name be struck off the Register. The nature and gravity of the allegation is such that to ensure public confidence in the Paramedic profession and in the HCPC as its regulatory body is maintained, and in order to uphold proper standards of conduct in the profession a striking off order is the necessary sanction.

73. The Panel acknowledged that such an Order will have an adverse impact upon the Registrant both personally and professionally. However, the Panel determined that the interests of protecting the public and maintaining public confidence in the profession outweigh the interests of the Registrant.

Order: The Registrar is directed to strike the name of Ms Ruth Lambert from the Register on the date this Order comes into effect

Right of Appeal

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

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

Interim Order
Application
74. Ms Atkin submitted that the Panel should make an Interim Suspension Order to cover the appeal period before the substantive Striking-Off Order takes effect. The HCPC’s application is made on the 2 statutory grounds as follows:
• it is necessary for the protection of members of the public
• is otherwise in the public interest.

75. The Registrant made no submissions and raised no issues.

76. The Panel took account of the legal advice provided by the Legal Assessor who reminded the Panel that an Interim Order must be necessary for the protection of the public, protection of the Registrant or in the wider public interest.

Decision

77. 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 considered that to do otherwise would be inconsistent with its earlier determination and would not protect the public from the risk of repetition identified and would not protect the public interest should the Registrant be permitted to practise without restriction during any appeal.

78. The Panel considered that a period of 18 months was the appropriate and proportionate length of the order to allow for any appeal to be heard and determined.

79. This order will expire:
• if no appeal is made against the Panel’s decision and Order upon the expiry of the period during which such an appeal could be made;
• if an appeal is made against the Panel’s decision and Order, the final determination of that appeal, subject to a maximum period of 18 months to cover the length of any appeal.

History of Hearings for Ruth Lambert