James Hughes

Preliminary Matters

 

Potential conflict regarding Panel composition

 

1. The Chair raised a preliminary point about whether it was appropriate for him to remain as a Panel member for today’s hearing. He confirmed that he was the Chair of the original panel which had made the previous decision in December 2023.  He reported that he had raised this with the HCPC prior to today’s hearing and had been told that there was no objection as far as it was concerned that he also sit as the Chair of this reviewing Panel.  However, the Chair considered that it was appropriate to raise the issue to check whether either of the parties had any objections to him remaining on the Panel for the remainder of the hearing.

 

2. Neither Ms Khorassani nor the Registrant had any objections to the Chair continuing, so the hearing proceeded.

 

Hearing in Private

 

3. Ms Khorassani made an application that parts of this review hearing should be heard in private in order to protect the Registrant’s private life because there might be reference to the Registrant’s health. Mr Hughes supported the application.

 

4. The Panel had regard to the HCPTS Practice Note on “Conducting Hearings in Private” and accepted the advice of the Legal Assessor. Having considered the references to the Registrant’s health in the previous panel’s decision, the Panel determined that the matters under consideration might necessitate references to the Registrant’s health. The Panel therefore determined that those parts of the hearing which dealt with the Registrant’s health should be held in private in order to protect his private life.

 

Background

 

5. The Registrant is a registered Paramedic (PA22651) and was employed by Great Sutton Medical Centre (the Employer) as a Band 7 Paramedic, from December 2019 until April 2021.

 

6. On 6 February 2018, the Registrant was convicted of driving a motor vehicle whilst being over the exceeded prescribed limit of alcohol at Liverpool Knowsley and St Helens Magistrates’ Court, contrary to section 5(1)(a) of the Road Traffic Act 1988 and Schedule 2 to the Road Traffic Offenders Act 1988. As a result, the following penalties against the Registrant were imposed: a) A fine of £100; b) The payment of a surcharge to fund victim services of £30; c) The payment of costs of £85 to the Crown Prosecution Service; d) A Collection Order; and e) Disqualification from holding or obtaining a driving licence for 18 months, subject to a reduction of 137 days if, by 21 January 2019, the Registrant satisfactorily completed a course approved by the Secretary of State.

 

7. In relation to the conviction concerns as set out above, it is also alleged that the Registrant failed to advise the HCPC of the conviction. Further, on 29 June 2020 it is alleged that, when completing a readmission form to the HCPC, his registration having lapsed, the Registrant did not indicate that he had received the above conviction, as he failed to tick the correct box on the form disclosing this information.

 

8. In July 2020, concerns were raised by the HCPC’s Registrations Department regarding the Registrant’s conduct, namely, it was alleged that the Registrant continued to work as a Paramedic whilst he was not registered with the HCPC, between 7 February 2020 and 24 July 2020.

 

9. As a result of the HCPC’s investigations into the above matters, the Employer raised concerns that the Registrant had failed to disclose to the Employer that he was not registered with the HCPC, between the relevant time set out above. The Employer subsequently conducted an internal investigation into these matters.

 

10. In addition to the above, on 29 June 2020, it is alleged that, when completing his readmission form to the HCPC, the Registrant did not tick the box on the form to indicate that he had been disciplined by a regulatory body or his employer.

 

11. The matter eventually came to hearing before the substantive hearing panel on 11 December 2023. The Registrant represented himself.  Having heard evidence from the HCPC’s witnesses and from the Registrant, that panel made the factual decisions outlined above.  Further, it found that the Registrant was impaired in relation to the personal and public components.

 

12. In relation to Sanction, the previous panel stated:

 

“170. The Panel considered all the information before it. In doing so, the Panel identified the following aggravating factors:

 

• That the Registrant repeated his dishonesty over a period of several months. This, the Panel concluded, was a particularly aggravating feature;

 

• The Registrant’s dishonesty was directed to both his employer and his regulator and had the potential to impact on his eligibility and suitability to practise as a Paramedic;

 

• Notwithstanding that the Registrant has demonstrated some insight, the Panel has recognised that it was limited;

 

• The Registrant has demonstrated limited steps towards remediating his failings and keeping his knowledge and skills up to date;

 

• His initial lack of candour at the case review meeting in February 2021 in which he denied that his name had been removed from the register; and

 

• This is the third time that a disciplinary finding has been made against the Registrant. Whilst the Registrant’s two previous regulatory findings date from some years back, and were for unrelated matters, the Registrant should have had a heightened awareness of his duty to comply with his professional obligations, particularly given that the five year caution order imposed in July 2013 did not expire until mid-2018.

 

171. The Panel identified the following mitigating factors:

 

• The Registrant has engaged in the regulatory process and made early admissions to the factual particulars with the exception of the dishonesty allegations at the outset of the hearing;

 

• The Registrant has expressed remorse and apologised for his actions;

 

• The Registrant had difficult [REDACTED] circumstances at the time. The Panel has regard to the principle derived from the case of Sun v GMC [2023] EWHC 1515 (Admin) in recognising the Registrant’s [REDACTED] history as a potential limited mitigating factor, but recognising the absence of evidence that would be sufficient to excuse or exonerate the Registrant’s dishonesty;

 

• The risk of direct patient harm was low;

 

• The Registrant’s dishonesty in relation to practising as a Paramedic whilst unregistered, arose from very particular circumstances which were unlikely to be replicated, and that the Registrant believed that his registration problems, which arose following a refused direct debit payment, would be quickly resolved.

 

172. In the circumstances, and noting that no patient harm resulted from the Registrant’s dishonesty, the Panel concluded that the Registrant’s dishonest behaviour fell towards the lower, but not at the lowest end of the dishonesty spectrum.

 

173. The Panel approached the issue of sanction starting with the least restrictive first, bearing in mind the need for proportionality and to take into account the Registrant’s interests. Having done so, it concluded that taking no further action would not reflect the nature and gravity of the misconduct. The Panel concluded that taking no action would not be adequate to protect the public or the wider public interest of maintaining confidence in both the profession and the regulatory process. Such an outcome was therefore neither appropriate nor proportionate in the circumstances.

 

174. The Panel next considered mediation, but having had due regard to the circumstances of this case, such an outcome was inappropriate to address the issues of dishonesty. It therefore concluded that this was not an appropriate outcome.

 

175. The Panel then considered whether to impose a Caution Order and had regard to paragraphs 99-102 of the SP. The Panel concluded that this was also not an appropriate outcome because:

 

• For the reasons set out in its determination on misconduct in relation to dishonesty and impairment, the Panel did not consider the Registrant’s misconduct to be minor in nature;

 

• The Registrant’s insight was incomplete;

 

• The Panel considered that there remained an ongoing risk of repetition given the lack of effective remediation of his failings.

 

176. The Panel next considered whether a Conditions of Practice Order was appropriate. It had regard to paragraphs 105-109 of the SP. It has concluded that such a sanction would neither be appropriate nor proportionate to address the nature of the misconduct proved or the public interest concerns identified. The Panel concluded that workable and appropriate conditions could not be formulated that would meaningfully address the dishonesty concerns identified.

 

177. In the circumstances, the Panel concluded that imposing a Conditions of Practice Order was not the appropriate sanction to impose.

 

178. The Panel next considered the sanction of suspension. The Panel has borne in mind that this would be an appropriate sanction to impose where, even though the allegation is serious, the conduct was not fundamentally incompatible with the Registrant remaining on the register, and hence, a Striking Off Order would not be justified.

 

179. The Panel considered that a Suspension Order was the appropriate sanction to impose because:

 

• The matters found proved, as set out in the Panel’s determination on misconduct, represented serious breaches of the Standards of Conduct Performance and Ethics;

 

• The Registrant has demonstrated some insight into his failings particularly in relation to Particular 1;

 

• The Panel was mindful that a striking off order was appropriate for the most serious cases of dishonesty. It considered that the Registrant's failings were not so serious that they were fundamentally incompatible with remaining on the register. In reaching that conclusion, it had regard to paragraph 121 of the SP which states that a Suspension Order may be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. The Panel noted, as set out in the Panel’s determination on impairment, that the Registrant has developed some insight into his dishonest behaviour even though that process was not as yet complete.

 

180. To satisfy itself that a Suspension Order was the appropriate and proportionate sanction to impose, the Panel considered whether a Striking-off Order was justified. It had regard to paragraph 130 of the SP which states that: “A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts” whilst setting out a non-exhaustive list of applicable circumstances. The Panel was satisfied, given the identified mitigating factors, that the facts of this case were not of such gravity so as to merit such a restrictive sanction. It concluded that the public protection, and the public interest concerns could be adequately met by the imposition of a Suspension Order which would restrict the Registrant’s ability to practise as a Paramedic until such time as a reviewing panel determined that he was fit to do so.

 

181. The Panel therefore imposes a Suspension Order for a period of 6 months. The Panel concluded that that was an appropriate and proportionate period of time to enable the Registrant to reflect on the nature and gravity of the misconduct found proved and to allow him an adequate period of time to address and remediate his failings.

 

182. So far as any future review is concerned, the Panel considered a future reviewing panel would be assisted by:

 

• His attendance at any review hearing;

 

• Further evidence of remediation in relation to addressing his dishonest behaviour;

 

 

• Evidence of reflection on his conduct demonstrating meaningful insight into the impact of his dishonest behaviour on the wider profession and the public;

 

• Up to date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;

 

• Evidence that the Registrant had kept his skills and knowledge up to date;

 

• Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice..”

 

Further documentary evidence

 

13. Prior to the hearing, the Registrant lodged the following written reflections:

 

“I would like to submit this statement to the review panel prior to the substantive review hearing as directed and following receipt of the review hearing bundle with regards to my suspension from the HCPC register on the 15 December 2023.

 

Firstly, I would like to state that I believe I have had an appropriate and proportionate period of time to thoroughly reflect on the nature and gravity of the findings proved following the substantive hearing in December.

 

I have been constantly reflecting on the findings and failings identified in the hearing. I have repeatedly reviewed and reflected on the hearing bundles provided to me with all the facts, findings and sanctions delivered following the hearing. I have accepted all of these unequivocally.

 

I understand comprehensively how my actions could have negatively affected service users, other professionals and the public and I fully accept that my actions leading to this suspension fell below the professional standards of conduct, performance and ethics required to practice in my role as a registered Paramedic.

 

I have repeatedly and comprehensively reviewed the HCPC Standards of conduct, performance and ethics documentation published that has led me to have a greater knowledge and understanding of the minimum requirements to practice in my role as a Paramedic. I have done this by regularly reviewing the HCPC website, reading hard copies of the standards and listening to webinars provided by the HCPC especially with regards to the forthcoming updates to the standards in September 2024.

 

I believe this has fully increased my insight into my failings and my continued understanding is ongoing and will continue to do so through regular review and reflection. I also believe that there is no risk of repetition because of this. This has been a situation that I would never repeat in the way I did. I now have the knowledge, experience and full insight to never make the same mistakes again.

 

I have fully complied with all aspects of the investigation and hearing process, without support or professional representation and I continue to do so. I think we can all appreciate how difficult this process can be with support and I feel proud and positive that I have managed to do this on my own.

 

I am hoping for a positive outcome in a very challenging situation and I have a focused approach in addressing the dishonesty, integrity and misconduct issues identified during the hearing.

 

I have complied, at all times, to the existing suspension order.

 

No other Fitness to Practice concerns have arisen during my suspension, neither has there been any criminal convictions since the singular one identified during the hearing that occurred over 6 years ago. I continue, I believe to be an upstanding member of society, again something of which I am proud of.

 

I have been regularly reviewing and improving my knowledge with regards to my profession as a Paramedic. I have continued to maintain my Continual Professional Development by renewing my mandatory training, online reading and research through numerous platforms, websites, medical forums and journal reading.

 

This has consisted, as mentioned, through the HCPC website and webinars, the College of Paramedics, Journal of Paramedic Practice, British Medical Journal, Emergency Medical Journal, NICE Guidelines, MIMS learning, healthier business group, LinkedIn and YouTube webinar recordings. This along with maintaining my professional knowledge and skills from my extensive library of books collected over the duration of my career as a Paramedic.

 

I have completed the following courses through the Healthier Business Group:

 

- Complaints Handling

 

- Conflict Resolution

 

- Countering Fraud, bribery and corruption in the NHS

 

- Equality, diversity and Human rights

 

- First aid in the workplace

 

- Fire safety

 

- Food hygiene

 

- General data protection regulations (GDPR)

 

- Health, safety and welfare

 

- Infection prevention and control (level 2)

 

- Information governance and cyber security

 

- Lone worker

 

- Mental Capacity Act 2005 including DoLS

 

- Resuscitation: Adult basic life support including safe use of AEDs

 

- Safeguarding children (SOCA) level 2 and 3

 

- Safeguarding vulnerable adults (SOVA) level 2 and 3

 

I have continued to be unemployed during the suspension period but I have continued to help in a voluntary capacity with the local food bank, the bread-and-butter project through my local church, providing affordable shopping for the most vulnerable of society, litter picking either on my own or with the Litter Clear Volunteer group in Liverpool. I have tried to give my time to the local community and beyond during my period of suspension.

 

I believe all these improvements have helped following the stressful events that have occurred during the prolonged period of investigation and hearing surrounding the particulars of the case against me and the hearing findings.

 

Finally, I would like to reaffirm my sadness, regret and apologies that these incidents and subsequent investigation, hearing and sanction have ever occurred. I am hoping and wishing for a positive outcome from a very stressful and upsetting time.

 

I would like to be able to be re-admitted to the HCPC register and continue in the worthwhile professional career that I have had the honour of doing for so many years. I believe this will help me secure employment, resurrect a stalled career in which I have excelled at and I will be able to redeem myself to my family, my peers, other professionals and the wider general public.

 

I would just like the opportunity to serve people again to the best of my ability and provide positive outcomes to whoever is in need”

 

 

 

Oral evidence and submissions

 

14. Ms Khorassani was advised by the Panel that she did not need to address the Panel about the factual background to the case or the decision of the previous panel, as it had thoroughly read the HCPC’s bundle. She therefore confined her submissions to the Panel’s powers as to extending, continuing, varying or revoking the current Order.  She referred the Panel to the HCPTS Practice Note on “Review of Article 30 Sanction Orders” which explicitly set out relevant factors to take into account, which included: “the steps taken to address specific failings or other issues identified in the previous decisions; the degree of insight shown and whether this has changed; whether any other fitness to practice issues have arisen; and whether the Registrant has complied with the existing Order.”

 

15. Moreover, Ms Khorassani submitted that, as the decision in Abraheam v GMC [2008] EWHC 183 (Admin) indicated, in practical terms there was a “persuasive burden” on the Registrant to demonstrate at a review hearing that he had fully acknowledged the deficiencies which led to the original finding and had addressed that impairment sufficiently “through insight, application, education, supervision or other achievement…”.  

 

16. With regard to whether the Registrant was currently impaired, Ms Khorassani submitted that the Registrant had engaged with the review process “in a manner which would assist the Panel” and that the HCPC’s stance on impairment was “neutral” and a matter for the Panel. Her submissions preceded the Registrant giving evidence and his oral representations, but Ms Khorassani had no further submissions to make thereafter.

 

17. The Registrant gave evidence under affirmation. He adopted his written reflections set out above.  He indicated that he had used the intervening period since December 2023 to deal with the issues raised “appropriately and professionally” and had reflected upon his failings. He considered that he had developed full insight and maintained that he would “never repeat the same mistakes”.  He reminded the Panel that, in the three years since the investigation began, there had been no further concerns raised and especially no incidents of dishonesty or criminality.  He accepted that his actions could have adversely affected public trust and confidence in the profession but pointed out that no harm had come to any service user or patient.  He relished the opportunity to once again serve and to continue what had been a long and fulfilling career in which there had been no complaints about his clinical capabilities.

 

18. In cross-examination from Ms Khorassani, the Registrant confirmed that he first qualified as a paramedic in 2007. He had always been interested in the medical field. He was looking for a responsible, worthwhile and purposeful career.  He considered that being a paramedic was a “fantastic job helping people in the greatest need” which gave him a purpose in life.

 

19. He went on to say that in the last three years or so he had struggled after losing his job, his income. He had tried to do what he could. He had also adopted a good daily routine and tried to make progress every day towards becoming a better person.  He had been unable to find suitable work.

 

20. However, the last six months had given him “time and purpose”. He did not consider that he was currently impaired as he had “fully reflected and made improvements”.  He did not want to ever be impaired again and wanted to look forward and be positive.  He would welcome the Panel concluding that the current suspension order should lapse.  It would make him feel “elated” – it was “what I want and need to move forward”.  He confirmed that he would “love to renew the career I love and restore purpose to help people again”.

 

21. In answer to some Panel questions, the Registrant elaborated about the impact his dishonesty might have on members of the public and fellow professionals. He considered that the public would “feel wary and would doubt professionalism” and would have doubts about trustworthiness.

 

22. He confirmed that he had done the training referred to in his written reflections on line through an agency he had been registered with. Before being able to re-register, he had been required to undertake the mandatory courses on line.  They each took a matter of hours.  He had completed the courses in May 2024 but had not obtained any certificates or confirmation from the agency or trainer concerned (the Healthier Business Group). Similarly, he had not obtained any testimonials or references from those organisations which he worked for as a volunteer, as he did not like asking people for such things.

 

23. He had looked at reviews and articles on the College of Paramedics website but had not undertaken any CPD courses since he was not currently a member. With regard to his future plans, the Registrant had told Ms Khorassani that he felt able to practice again since his clinical abilities had never been in question. In answer to a question from the Panel, the Registrant stated that he had concentrated his energies on this hearing and had not speculated how he would return to practice.  If there was a positive outcome, he would reflect and “find a way forward”.

 

 

24. The Registrant confirmed that he was still doing his voluntary work. He worked in the food bank every Monday and with Bread and Butter on a Wednesday.  He picked up litter sometimes whenever he went for a walk as well as when asked formally.  He agreed that voluntary work gave him a “buzz” – moreover, he saw people worse off than he and it gave him an opportunity to help people a little bit.  

 

Decision

 

Decision on Impairment

 

25. In reaching its decision, the Panel considered the previous panel’s decision and had regard to the principles set out in the HCPTS Practice Notes entitled “Fitness to Practise Impairment” and “Review of Article 30 Sanction Orders”. The Panel accepted the advice of the Legal Assessor, who confirmed that it would be entitled to presume impairment and see whether there have been any changes in the Registrant’s situation since the last hearing. Further, if the Panel found continuing impairment, it was to have regard to the HCPTS’ “Sanctions Policy”.

 

26. The Panel also had regard to the case of Abrahaem v GMC 2008 EWHC 183 (Admin) in which it was held that there is in practical terms a “persuasive burden” on a registrant to address the concerns that were highlighted by previous panels. This required the Registrant to acknowledge the deficiencies which led to the original findings and to address impairment through evidence or material demonstrating insight, application, education, supervision or some other

 

27. The Panel noted that, whilst the Registrant had submitted a reflective piece, he had not supplied the Panel with all of the suggested evidence or material, for instance …Up to date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid” or “ Evidence that the Registrant had kept his skills and knowledge up to date”.

 

28. The Panel was disappointed by this since it considered that the direction from the last panel had been particularly clear about what proof regarding his progress needed to be supplied. Although the Registrant had given evidence about what he had done in the last six months and before, which had not been challenged by Ms Khorassani in cross examination, he had failed to provide the corroborative evidence that had been requested. 

 

29. The Panel appreciated the difficulties the Registrant had experienced over the previous few months and sympathised with him, but considered that he could have made better efforts to comply with the previous panel’s directions, not least, for example, by asking those who gave him voluntary work to supply written testimonials. The lack of such corroborative evidence therefore made it difficult for the Panel to conclude that the Registrant had fully remediated his Misconduct. 

 

30. The Panel was appreciative of the Registrant’s oral evidence and considered that he gave good answers regarding, for instance, the effect of his dishonesty upon members of the public. To that extent, the Panel was satisfied that the Registrant has made progress regarding his insight, which it considers has improved since the last hearing.  However, the Panel considered that he had not attained full insight.

 

31. Furthermore, the Panel considered that the Registrant had not given sufficient thought to how he would facilitate any return to practice, given that he had not worked as a paramedic for some three years and was currently not registered with the HCPC. In particular, the Panel considered that the Registrant had not demonstrated that he had sufficiently kept his skills as a paramedic up to date.  The Panel noted his evidence that he had had a long career as a paramedic and had had no complaints about his clinical skills, but his training to date did not encompass specific paramedic learning, which was concerning to the Panel given his absence from the profession for so long.  Moreover, the Registrant, although he had confirmed taking the mandatory courses specified and completed online reading and research, had not given any evidence about what he had learned from these.

 

32. Accordingly, the Panel concluded that, although the Registrant has made good progress towards remediating his failings, further work and evidence was needed.

 

33. The Panel first considered that the Registrant remained impaired with regard to the personal component. It was of the view that the conduct was remediable, but as it had not yet been fully remedied (for the reasons outlined above) it was likely to be   The Panel therefore found that the Registrant’s fitness to practise remained impaired on personal grounds.

 

34. Further, the Panel determined that a finding of impairment was also necessary in order to maintain public confidence in the profession and uphold standards. A reasonable and informed member of the public would expect such a finding on the basis that the Registrant remained impaired on public grounds.

 

Decision on Sanction

 

35. The Panel considered the Sanctions Policy of the HCPTS and accepted the advice of the Legal Assessor that a sanction should be the least that is necessary to ensure public protection. The Panel reminded itself that the purpose of a sanction is not to punish the Registrant and that a sanction must be reasonable and proportionate.

 

36. The Panel determined that the nature of the concerns in this case were too serious to make no Order.

 

37. The Panel considered whether to impose a Caution Order but decided that it was inappropriate because a Caution Order would not provide sufficient public protection.

 

38. The Panel determined that a Conditions of Practice Order was not appropriate because the Registrant had not shown sufficient insight and such an order was not appropriate to address the current outstanding issues.

 

39. The Panel then considered an extension of the current Suspension Order. It considered that the Registrant, having made some progress with his remediation, required only a relatively short period of further suspension to provide the next reviewing panel with the evidence requested and the further reflections needed The Panel therefore concluded that an extension of the current suspension order would be appropriate and proportionate.

 

40. The Panel considered that a further extension to the current order of four months would be sufficient to enable the Registrant to reflect further and assemble the documentary evidence required to demonstrate that he had fully remediated his failings and would not repeat them.

 

41. On that basis, the Panel concluded that, given that the Registrant had made progress since the last hearing and had the capacity to respond positively to a further suspension in order to allow him to fully remediate his practice, an Order Striking Off the Registrant would be entirely disproportionate.

 

42. The Panel determined that the current Suspension Order be extended by a period of four months so as to expire on 12 November 2024.

 

43. Towards the end of that period there will be a further review hearing. The Panel considered a future reviewing panel would be assisted by:

 

• The Registrant’s attendance at any review hearing;

 

• Further evidence of remediation in relation to addressing (i) how he would ensure that he would prevent any repetition of his failings in the future; and (ii) how he would manage a return to practice, given that his absence from working as a paramedic for three years had diminished his skills as such;

 

• Up to date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;

 

• Evidence that the Registrant had kept his skills and knowledge up to date, together with an analysis of what he has learned from all CPD activities;

 

• Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.

ORDER: The Registrar is directed to extend the current Suspension Order by a period of four months to 12 November 2024.

No notes available

History of Hearings for James Hughes

Date	Panel	Hearing type	Outcomes / Status
15/10/2024	Conduct and Competence Committee	Review Hearing	Suspended
14/06/2024	Conduct and Competence Committee	Review Hearing	Suspended
11/12/2023	Conduct and Competence Committee	Final Hearing	Suspended