Joanna Cierzniakowska

The Skeleton Argument.

2. For the purposes of this hearing, the HCPC has submitted and the Panel has read, a Skeleton Argument signed by Ms Shannon O’Connor of Capsticks LLP dated 14 February 2024 [the Skeleton Argument]. Mr Barnfield adopted the Skeleton Argument as the basis of his submission to the Panel. 

Service
3. The Panel has seen the Notice of today’s hearing dated 29 January 2024 which the HCPC sent by email to the Registrant at her registered email address. The Notice of Hearing made clear that this hearing would take place today as a virtual hearing. The Notice informed the Registrant of the time and date of this hearing. Delivery of the Notice was confirmed by an electronic message dated 29 January 2024.

4. Having seen the relevant service documents and having heard and accepted the advice of the Legal Assessor, the Panel was satisfied that good service of the Notice of Hearing has taken place.

Proceeding in the absence of the Registrant.

5. The Panel has seen two emails from the Registrant’s legal representative dated 24 January 2024 and 15 February 2024 stating that the Registrant would not be attending this hearing as the purpose of the hearing was to approve a consent order agreed between the parties.

6. Mr Barnfield on behalf of the HCPC, submitted that the Panel should consider the matter in the absence of the Registrant.

7. The Panel heard and accepted the advice of the Legal Assessor.

8. The Panel was aware that a decision to proceed in the absence of the Registrant was one to be taken with great care and caution. However, the Panel has decided to proceed in the absence of the Registrant. The reasons are as follows:

• Service of the appropriate notice of this hearing has been properly effected.
• The 2 emails from the Registrant’s legal representative dated 24 January 2024 and 15 February 2024 state that the Registrant will not be attending this hearing.
• The Panel has kept in mind the guidance contained in the Practice Note issued by the HCPTS.
• There is no reason to suppose that an adjournment would result in the future attendance of the Registrant.
• There is a public interest in proceeding today in order to effect a consensual disposal of this matter, which is the wish of both the Registrant and the HCPC.
• The Panel cannot identify any prejudice to the Registrant from proceeding in her absence.
• In these circumstances it is right to conclude that the Registrant has voluntarily absented herself.

The hearing to proceed in private.

9. Mr Barnfield submitted that those matters that relate to the health of the Registrant should be received in private.

10. Having heard and accepted the advice of the Legal Assessor, the Panel determined that matters relating to the health of the Registrant or were otherwise confidential in character, should be received in private, but that otherwise this was a public hearing.

Background as set out in the Skeleton Argument.

11. On 2 November 2021, a Panel of the Investigating Committee determined that there was a case to answer in respect of the allegation that is set out above in paragraph 1 of this determination.

12. The Registrant qualified as a paramedic in Poland in 2011. She began working in healthcare in the UK in 2012 when she took a role as a healthcare assistant in August 2012 with HMP Thameside. The Registrant worked at Buckinghamshire Healthcare NHS Trust between April and August 2019. She worked in the Emergency Department of Stoke Mandeville Hospital as a paramedic.

13. The Panel has been provided with and has read all of the following documents; the signed statement of Mr Hulland, paramedic, and former Band 6 paramedic in the A and E department at Stoke Mandeville Hospital, the draft statement of Ms Martins, Deputy Sister in the A and E department at the East Buckinghamshire Healthcare Trust, the draft statement of Ms Lazaruk, Matron of the Emergency Department at Buckinghamshire Healthcare Trust, and the draft statement of Ms Robinson, Deputy Sister in the Emergency Department at Stoke Mandeville Hospital.

14. These statements set out the concerns raised about the Registrant’s ability to prioritise the care of patients, her knowledge of the sepsis screening tool and her understanding of the different types of oxygen masks and the difference between air and oxygen.

Submissions by the HCPC as set out in the Skeleton Argument

15. The submissions of the HCPC as set out in the Skeleton Argument appear below. For ease of reference, the paragraph numbers used in the Skeleton Argument have been retained but are shown in brackets.

Disposal by Consent

(15) The Panel are respectfully referred to the HCPTS Practice Note on Disposal of Cases by Consent, dated March 2018.

(16) As the HCPC’s overarching statutory objective is the protection of the public, a Panel should not agree to a case being resolved by consent unless it is satisfied that:

(i) The appropriate level of public protection is being secured, and,

(ii) Doing so would not be detrimental to the wider public interest.

(17) The Panel are invited to impose a conditions of practice order on the Registrant for a duration of 12 months. The proposed terms of the order, as set out in the draft consent order of the bundle, are as follows:

1) Before undertaking work that may involve use a sepsis screening tool, you must:

a) satisfactorily complete refresher training and/or supervised practice in relation to use of sepsis screening tools; and

b) forward evidence of your completion of Condition 1a to the HCPC.

2) Before undertaking work that may involve use of oxygen or air masks, you must:

a) satisfactorily complete refresher training and/or supervised practice in relation to use of oxygen and air masks; and

b) forward evidence of your completion of Condition 2a to the HCPC.

3) You must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

4) You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

a) prioritisation of patient care;

b) use of sepsis screening tools;

c) understanding of the different types of oxygen masks and the difference between using air or oxygen in patient care.

5) Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

6) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

7) You must allow your workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

(18) Before considering a draft Consent Order, a Panel should satisfy itself that the HCPC:

(i) Has provided a clear, appropriately detailed and objectively justified explanation within its supporting skeleton argument of why the matter is suitable for disposal by consent on the terms set out in the draft Consent Order; and

(ii) Has made clear to the Registrant concerned that co-operation and participation in the consent process will not automatically lead to the Consent Order being approved.

(19) With respect to the first point, the Panel are respectfully referred to the below submissions.

(20) With respect to the second point, the Registrant has confirmed within the consensual disposal pro forma that she has read the Practice Note which explicitly explains that the consent order is a matter for the Panel and they can choose not to agree to the order.

The appropriate level of public protection is being secured Admissions and Insight

(21) The bundle contains a signed and dated copy of the consensual disposal request pro-forma dated 5 March 2022. That form confirms that the Registrant admits the substance of the allegation made against her and that her fitness to practise is currently impaired by reason of her health and lack of competence. It should be noted that the statutory grounds relied on in the allegation referred by the Panel of the Investigating Committee were limited to misconduct and/or lack of competence.

(22) Whilst the Registrant does not accept that her fitness to practise is currently impaired by reason of misconduct, it is submitted that she has still admitted the substance of the allegation, as misconduct was pleaded in the allegation as an additional or alternative ground to lack of competence.

(23) That form also confirms that the Registrant has read the relevant HCPTS Practice Note: Disposal of Cases by Consent. In section 4, conditions of practice are listed as an order she would like the HCPC to consider.

(24) In the appendix to the form, the Registrant states that she still works in a healthcare environment as a healthcare assistant and performs ECGs on a daily basis and has been doing online training and reading medical articles to improve her knowledge and skills. She asks that the submissions made to the Investigating Committee are considered, in particular her explanation of the difficulties that she accepts she had at the time of the allegations. She concludes by stating that she does accept the substance of the allegations and that her fitness to practise is impaired.

(25) The Registrant accepted at the outset that the role she held at the relevant time was perhaps not best suited to her. She accepted that her performance was not always to the standard that it should have been and that was to her great regret.

(26) Further information is provided about the working practises in the Emergency Department which the Registrant admits she found difficult, within that letter from her representative. It was also stressed therein that this was her first paramedic role since coming to the UK and she accepts that she did find it difficult to adapt to paramedic practise in the UK coming from Poland, where the systems and responsibilities of a paramedic can be very different.

(27) In a subsequent document from her representative, it was again noted on behalf of the Registrant that she was open to accepting where errors may have been made and reflecting on her practice.

(28) The bundle contains a reference from Dr Alex Bunn, Lead GP at HMP Wandsworth, dated 20 December 2022 This confirms she started working in the prison in February 2020 and that for at least the last year (as of December 2022) she has worked in the capacity of a HCA, performing ECGs and overseeing phlebotomy. He states he has been very impressed with the standard of her work, including attention to patient safety and that her documentation is excellent.

(29) The Registrant has also included evidence of her Continuous Professional Development, including completion of the 12 Lead ECG Recording course, in which she achieved a score of 90%, on 1 November 2022. The bundle also contains an Activity Report, outlining various training sessions that she has completed.

(31) On 21 February 2024 Capsticks contacted the Registrant’s representative and requested information in respect of the Registrant’s current employment status and practice.

(32) On 22 February 2024, the Registrant’s representative responded and confirmed that she last received an update from Kristen Ross, Head of Healthcare at HMP Wandsworth, on 11 October 2023 confirming that the Registrant was working as a Band 3 Health Care Assistant. Ms Ross identified the Registrant as an ‘excellent HCA’.

Order of the same kind as would be imposed at a final hearing

(32) It is submitted that the draft order is of the kind which the Panel would make if the case had proceeded to a full substantive hearing, taking into consideration the seriousness of the concerns and the mitigation advanced on behalf of the Registrant. It is submitted that the necessary and proportionate sanction would be that of conditions of practise.

(33) The concerns referred to a Panel of the Conduct and Competence Committee involve a failure to demonstrate an ability to prioritise the care of patients (allegation 1), not knowing how to use a sepsis screening tool (allegation 2(a)), and being unable to demonstrate an understanding of the different types of oxygen masks and the difference between using air or oxygen in patient care (allegation 2(b)).

(34) It is submitted that the proposed conditions of practise specifically address these concerns.

(35) Condition 1 prevents the Registrant from undertaking work that may involve a sepsis screening tool until she has satisfactorily completed refresher training and/or supervised practice in relation to the use of sepsis screening tools and has forwarded evidence of this completion to the HCPC.

(36) Similarly, Condition 2 prevents the Registrant from undertaking work that may involve use of oxygen or air masks, and she must comply with the same requirement as set out above.

(37) Therefore, the Registrant will be prohibited from undertaking similar work until she has completed further training.

(38) Condition 3 requires the Registrant to place herself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply the details of the supervisor to the HCPC. This will ensure the Registrant is subject to oversight and supervision from a regulated professional, and thus the risk of repetition of her conduct which forms the basis of the allegation would be greatly reduced.

(39) In addition to the above points, the Registrant must work with her workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the areas of prioritisation of patient care, use of sepsis screening tools, and understanding of the different types of oxygen masks and the difference between using air or oxygen in patient care (condition 4).

(40) It is also a requirement that this Personal Development Plan is forwarded to the HCPC within three months (condition 5). This will allow the Registrant sufficient time to formulate the Plan whilst ensuring the HCPC has oversight of the Plan within a relatively short period of time so that any issues can be identified.

(41) Condition 6 ensures that the Personal Development Plan is a meaningful, working document, which the Registrant engages with, as she will be required to meet with her workplace supervisor on a monthly basis to consider her progress towards achieving the aims set out in the Plan.

(42) Not only will her workplace supervisor have oversight of the Registrant’s progress and any outstanding deficiencies, but condition 7 is that the Registrant must allow her workplace supervisor to provide information to the HCPC about her progress towards achieving the aims set out in the Plan.

(43) It is submitted that this package of conditions both ensures the Registrant will improve her knowledge and skills in the areas of identified concern but also be subject to supervision and oversight, the combination of which reduces the risk of the Registrant repeating the conduct which resulted in the allegation.

(44) Article 30(1) of the Health Professions Order 2001 requires all conditions of practice orders to be reviewed before they expire. The reviewing Panel may extend, or further extend the period for which the order has effect or make an order which could have been made when the order being reviewed was made. Therefore, if the Panel does grant the HCPC’s application, there will be further mandatory oversight from a subsequent Panel and they will consider whether the Registrant has complied with the order and whether her fitness to practise remains impaired.

Doing so would not be detrimental to the wider public interest

(45) It is submitted it would be appropriate to conclude the allegations without a full hearing.

(46) In the case of Cohen v GMC [2008] EWHC 581 (Admin), the ‘critically important public policy issues’ which need to be taken into account by Panels in assessing impairment were described as ‘the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect... and that the public interest includes amongst other things the protection of [service users] and maintenance of public confidence in the profession’.

(47) The submissions above address the issue of protecting service users. However, the Panel will wish to consider whether disposing of the case by consent would maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour and maintaining public confidence in the profession.

(48) It is submitted that the imposition of the proposed conditions of practice order for a period of 12 months would reassure the well-informed member of the public, apprised of the facts of the case, that the HCPC has acted in a robust yet proportionate way, and addressed the concerns as referred by the Panel of the Investigating Committee.

(49) The conditions of practise order sends a clear signal that, where deficiencies are identified in a Registrant’s practise, the regulator will ensure they are addressed. In this way, public confidence in both the profession and in the regulatory process will be upheld.

(50) It is submitted that there is no benefit in the matter proceeding to a substantive final hearing, given the final outcome is likely to be the same or a similar order.

(51) On the contrary, it is averred that an important element of upholding public trust and confidence in the profession and the regulatory process is ensuring that cases are concluded in an expeditious manner and that qualified professionals are able to move forwards with their professional practise, in a way which is safe for service users, colleagues and themselves.

(52) Imposing the proposed Conditions of Practice order fro a duration of 12 months achieves the above aims without further delay that would be caused by the case proceeding to a full substantive hearing.

(53) For the above reasons, the Panel is invited to approve the consensual disposal, and confirm the draft consent order.

The Oral submissions made on behalf of the HCPC.

16. Mr Barnfield on behalf of the HCPC made submissions to the Panel. He referred the Panel to the documents identified in paragraph 13 of this determination. He submitted that those documents clearly set out the concerns that have arisen as regards the Registrant’s fitness to practise. He referred the Panel to the pro forma document dated 5 March 2022 in which the Registrant admitted the substance of the allegations; also that her fitness to practise was impaired. He submitted to the Panel that the proposed Conditions of Practise mirrored those that would probably be imposed at a substantive Fitness to Practise hearing. He said that the proposed Conditions of Practise Order would sufficiently protect the public and address the public interest. He further said that there was no public interest in proceedings to a substantive hearing.

The stated position of the Registrant

17. The Panel has seen the pro forma document dated 5 March 2022 signed by the Registrant in which she accepts the substance of the allegations and that her practice is impaired. The Panel has also seen all the other documents that are referred to in the Skeleton Argument.

Decision of the Panel made on 01 March 2024

18. The Panel has considered the submissions of the HCPC as set out in the Skeleton Argument and adopted by Mr Barnfield. The Panel has taken account of the position of the Registrant as stated in the documents identified above. The Panel has further considered all the other documents that have been submitted.

19. The Panel heard and accepted the advice of the Legal Assessor.

20. In deciding whether or not to approve the agreement for Consensual Disposal by the imposition of a Conditions of Practice Order, the Panel has had regard to the Practice Note published by the HCPTS in March 2018 and entitled Disposal of Cases by Consent.

21. The Panel has concluded that the agreement for a Consensual Disposal by the imposition of a Conditions of Practice Order should be approved and that an order should be made in the terms set out below. Its reasons are as follows;

• The Registrant has admitted the substance of the Allegation. She has also admitted that her fitness to practise is thereby impaired.

• The public will be adequately protected by the imposition of a Conditions of Practice Order for a period of 12 months. Such an outcome is also in the interests of the Registrant. Moreover, it addresses and safeguards the public interest. In coming to its conclusions the Panel has accepted the submissions that are set out in paragraphs 34 to 44 of the Skeleton Argument. The Panel concluded that the proposed Conditions directly address the specific concerns that were identified in the documents referred to in paragraph 13 of this determination. The Panel also derived considerable reassurance from Condition 3 of the proposed Conditions which provides for an overarching supervision by a workplace supervisor. Moreover, the Panel has noted that the proposed Order would be subject to review. In the opinion of the Panel, the proposed Conditions are similar in kind to the Order that would probably be imposed at a substantive Fitness to Practise hearing.

• There are no reasons of a public interest kind to require a substantive fitness to practise hearing. Also, the Panel has concluded that a well-informed member of the public would conclude that this matter is properly disposed of by the consensual outcome sought by the both the Registrant and the HCPC. In coming to these conclusions, the Panel has accepted the submissions that are set out in paragraphs 45 to 52 of the Skeleton Argument

22. For all the reasons that are set out above, the Panel has determined to approve, with immediate effect, the outcome sought by both the HCPC and the Registrant in the agreement for consensual disposal, namely the imposition of a Conditions of Practice Order for a period of 12 months.

ORDER: That the Registrar is directed to annotate the register entry of Joanne Cierzniakowska for a period of 12 months, with effect from 1 March 2024, with the following conditions:

1) Before undertaking work that may involve use a sepsis screening tool, you must:

a) satisfactorily complete refresher training and/or supervised practice in relation to use of sepsis screening tools; and
b) forward evidence of your completion of Condition 1a to the HCPC.

2) Before undertaking work that may involve use of oxygen or air masks, you must:

a) satisfactorily complete refresher training and/or supervised practice in relation to use of oxygen and air masks; and
b) forward evidence of your completion of Condition 2a to the HCPC.

3) You must place yourself and remain under the supervision of a workplace supervisor registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

4) You must work with your workplace supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

a) prioritisation of patient care;
b) use of sepsis screening tools;
c) understanding of the different types of oxygen masks and the difference between using air or oxygen in patient care.

5) Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

6) You must meet with your workplace supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

7) You must allow your workplace supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

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.

History of Hearings for Joanna Cierzniakowska