Patrick F Ricketts

Preliminary Matters:

Application by the Registrant

1. The Registrant wanted the Panel to confirm that it recognised Sports Therapy as a legitimate degree and professional discipline. The Panel was not persuaded that this was a relevant preliminary matter.

Jurisdiction

2. The Registrant advanced the preliminary submission that the Panel had no jurisdiction since the substance of the complaints related to his professional work as a sports therapist and not as a Podiatrist / Chiropodist. However, the Registrant had attended, and counsel had been instructed. No issues of jurisdiction arose as preliminary points. The Registrant did not expand on the matter. The hearing continued.

Admissions

3. The allegations were read. The Registrant admitted allegation 3 a) in relation to Matter A subject to the qualification that he acted as a sports therapist at the time. In relation to Matter B the Registrant admitted allegations 1 c) and 2 on the understanding that he was acting as a sports therapist at the material time. In both cases, the Registrant denied that his conduct amounted to misconduct and that his fitness to practise is currently impaired, as a sports therapist.

Bundles

4. The Panel noted the following documents as the bundles in this case:

1) HCPC Case summary of 8 pages.
2) HCPC Main bundle of 96 pages.
3) Service bundle of 7 pages.
4) A consent form of 5 pages (containing Service User A’s signed consent form and screen shots).
5) Registrant’s bundle R1 of 667 pages.
6) Registrant’s bundle R2 of 206 pages.
7) Registrant’s bundle R3 of 81 pages.
8) Registrant’s bundle R4 of 4 pages (screenshots from Teesside University's website and an email to the HCPC)
9) Registrant’s document R5 of 1 page (a Training Certificate)
10) Registrant’s document R6 of 2 pages (containing an email from the Registrant dated 06 October 2023 which attached a letter from a student)
11) The Registrant also invited the Panel to receive a video that he had made of his premises.

Background:

5. The Registrant is a registered Chiropodist/Podiatrist who was self-employed as the Director of Therapyroom1 Ltd.

6. On 17 November 2020, Service User A contacted Therapyroom1 (“the Clinic”) looking for a local osteopath. It is alleged that the Registrant responded, indicating that he was an Osteopath, which it is alleged he was not.

7. On 1 December 2020, Service User A contacted the General Osteopathic Council (GOsC) raising concerns about the Registrant practising osteopathy while not registered with them to do so.

8. On 11 March 2021, Service User A contacted the HCPC raising concerns both as to the Registrant practising osteopathy while not registered with the GOsC, and as to the conditions and conduct of the treatment session on 17 November 2020. The Registrant is alleged to have provided unsanitary conditions, inappropriate treatment and conduct of a sexual nature.

9. On 4 April 2022, Service User B contacted the Clinic seeking a Physiotherapist to perform the ‘Epley manoeuvre’ to treat their benign paroxysmal positional vertigo (BPPV). It is alleged that the Registrant confirmed to Service User B by telephone that he could perform this manoeuvre and had done so before, and an appointment was booked for 6 April 2022.

10. Service User B alleges that at the appointment on 6 April 2022, the Registrant made several inappropriate comments and, having explained to him the diagnosis of BPPV given previously by an Ear, Nose and Throat (ENT) Consultant, he purportedly performed the Epley Manoeuvre as treatment for this.

11. On 7 April 2022, Service User B contacted Person C, a Vestibular Physiotherapist. Person C knows the Registrant to some extent, albeit alleges they were not aware of him in 2022. Service User B had an appointment with Person C on 12 April 2022 during which they discussed the conduct of the Registrant on 6 April 2022. Following this, Service User B contacted the HCPC on 29 April 2022 raising concerns about the Registrant.

12. Following this report to the HCPC, Service User B received a letter from the Registrant dated 24 August 2022, which challenged various aspects of the complaint that had been made to the HCPC.

13. An expert, Mr Howard, was instructed to comment on concerns in relation to the Registrant’s conduct. He opined in his report, inter alia, that the Registrant was dishonestly informing patients of being a registered Physiotherapist/Osteopath and was providing inappropriate patient management and communicating poorly.

14. At a Preliminary Hearing on 30 – 31 May 2024 the following relevant directions were made:

• Matter A and Matter B shall be joined and heard together.

• The HCPC has permission to rely on the expert evidence of Mr Jason Howard in attendance at the final hearing.

• There shall be Special Measures in relation to the evidence of the following witnesses at the final hearing of the case:

Evidence

Service User A

15. Service User A affirmed and adopted her statement, dated 10 January 2023, as her evidence in chief. Her evidence was that she searched online for local osteopathy services on 17 November 2020. Later that day she agreed to be seen by the Registrant who had answered in the affirmative when she asked if she would be seen by an osteopath (‘me’).

16. Service User A stated that the Registrant’s treatment had been very painful for her. She declined an offer made to her by the Registrant to ‘crack her back’ (an osteopathic treatment). The treatment provided was not in accordance with osteopathic treatments that Service User A had received from osteopaths previously. It was longer in duration and much more painful, involving her removing her bra and being massaged more widely than in other sessions. She told the Panel that the treatment room was dingy with soiled towels and an unhygienic treatment couch cover.

17. In cross examination, Service User A accepted that she felt claustrophobic in the Registrant’s treatment room.

18. In response to Panel questions, Service User A said that she had assumed the Registrant was an osteopath after a Google search for osteopathic services. However, when she asked the Registrant, he said that he was an osteopath. There were others in the gym area of the premises when she arrived. The Registrant had not been caring in his treatment. She had been hurt a lot in the treatment. She said that it was weird to be asked to take off her bra for the treatment. She refused an offer to have her back ‘cracked’ after the massage treatment because she was in pain and wanted to leave. The Registrant had suddenly and without warning hauled her upright off the treatment couch as she was getting up.

19. Service User A could not remember signing a consent form.

Service User B

20. Service User B affirmed and adopted her signed statement as her evidence in chief, which was that she was treated by the Registrant on 04 April 2022 when she was under the misunderstanding that he was a physiotherapist. Service User B suffered from dizziness which was the result of BPPV as diagnosed by an ENT Consultant, which could be treated by the Epley manoeuvre. Rather than wait for NHS treatment for more than a year she searched for suitable physiotherapy services and the Registrant’s name was drawn to her attention.

21. The Registrant assured Service User B that he could perform the treatment. The Registrant’s website boasted being one of the most advanced treatment centres of its kind locally and specialised in physiotherapy. Service User B knew that she had to be treated by someone trained, skilled, and experienced. She took the Registrant at face value.

22. On 06 April 2022, she received treatment from the Registrant. Inappropriately, he asked her bra size without any context or reason being given. When challenged, the Registrant had told her that “it was a real thing,” and that she should Google it.

23. The Registrant incorrectly told her that she could not be suffering from fibromyalgia since pain in that condition is located in the ribs and not the lower limbs. He asserted that Service User B’s symptoms of pain were either physical in nature or the psychological effect of ‘beaten wife syndrome’ where instinctive guarding against attack results in a pain response.

24. Service User B had no relief from her symptoms as a result of the Registrant’s treatment. She then located and was successfully treated by NH, a vestibular physiotherapist. As a result of discussing the Registrant with NH, Service User B complained about him to the HCPC.

25. The Registrant sent a letter to Service User B, dated 24 August 2024, which she found threatening and unprofessional in its terms. The contents and the unwanted contact frightened her. She sought the assistance of her police authority employer.

26. In cross examination, Service User B did not agree that the letter sent to her by the Registrant was merely a warning of potential adverse outcomes from making an unsubstantiated complaint. She took the tone and content to be a threat. She had felt threatened and had reported the matter to her employer.

27. In response to Panel questions, Service User B said that she had felt very vulnerable when being treated by the Registrant.

NH

28. NH affirmed and adopted her statement as her evidence in chief.

29. NH explained that she had qualifications and experience as a physiotherapist that permitted her to offer treatment for the condition BPPV which is a benign and position triggered rotational dizziness condition.

30. There are three semicircular canals in the structure of the ear. When the canals are intruded into by structures which belong elsewhere, this can cause dizziness which can be treated by the Epley manoeuvre. The head is manipulated in a way to attempt to return the intruding elements to their true position in the ear. This condition can be diagnosed using observations of eye movements under head manipulation. The success rate is around 80% with 50% of cases satisfactorily resolving themselves spontaneously within a year.

31. The condition must be accurately diagnosed to allow for an appropriate treatment. There are other conditions which result in dizziness and are treated differently, not with the Epley Manoeuvre.

32. NH confirmed that other skilled and trained practitioners can perform the Epley Manoeuvre successfully, but not any practitioner may do so without appropriate training.

Mr Howard

33. Mr Howard is a physiotherapist with 30 years professional experience. He is trained and skilled in providing treatments for dizziness including the Epley manoeuvre for BPPV. Mr Howard told the Panel that he manages a large multidisciplinary team which includes sports therapists.

34. Mr Howard opined that it was open for other professionals other than a physiotherapist to perform the Epley manoeuvre. However, he expected that this was provided by physiotherapists of ten years professional standing with post-graduate training after the first four years of practice. He expected that other professions who trained members to provide this treatment would have similarly rigorous training pathways and requirements. The manoeuvre was not a simple task and should be performed only where clinically indicated. There were possible adverse reactions even when performed correctly and by an appropriately skilled person.

35. Mr Howard opined that it would never be appropriate for a physiotherapist to ask a service user to remove their bra for treatment. He could see no valid reason for making this demand of a service user in any context.

36. Mr Howard opined that it was wholly inappropriate and unprofessional to remain in the room with a disrobed service user. Further, to lift them up without warning was potentially dangerous for the service user and was unwarranted professionally.

37. The letter written by the Registrant to Service User B was unprofessional and unwarranted. A complaint should always be treated courteously and seriously.

The Registrant

38. The Registrant affirmed and gave evidence on his own behalf.

39. The Registrant submitted two further documents as follows:

• R5 - Training Certificate from City and Guilds dated 2014

• R6 - 2 emails including a letter from a student from one of the Registrant’s students attached to an email to Blake Morgan Solicitors, dated 06 October 2023, and copied to various people at HCPC.

Mr Irving on behalf of the HCPC did not object to the documents being received, although they were late.

40. The Registrant explained the difficulties he had faced in tracking the numerous changes to allegations and statements as the investigation at HCPC had developed in tandem with an investigation at GOsC which had closed, vindicating him. The GOsC had decided to take no action in their case, however, the HCPC persisted in a contrived and determined pursuit designed to ‘…get Patrick.’

41. The Registrant did not understand the basis of the case against him. He was not working in his capacity as a Podiatrist or Chiropodist when treating Service Users A or B. He was unhappy that the HCPC had failed to contact anyone in Sports Therapy to confirm the basis for his treatments and his expertise. In his view, this underlined the unfairness of the proceedings against him. The Registrant regarded the Panel as part of the same ‘…lot’ that were pursuing a case based on a fundamental misconception about his expertise and treatments. The HCPC had rejected an application in 2010 by the sports therapy profession to be regulated by the HCPC. It was prejudiced and did not value or recognise sports therapy as a legitimate treatment for service users.

42. The Registrant emphasised that as a graduate sports therapist, he was qualified to treat BPPV using the diagnostic tools and treatments for it including the Epley manoeuvre. It had not been shown to him that he had breached a duty of care towards Service Users A and B. The Registrant went on to set out his knowledge of human anatomy and physiology relevant to physiotherapy and sports therapy, which shared many common parts of professional training and development.

43. In respect of the allegations, Service User A was handed a business card by the Registrant at the beginning of her treatment session with him. The Registrant asserted that it was her fault if she failed to appreciate the scope of his treatment. He denied having told Service User A that he was an osteopath. He did not need to show remorse because nothing had happened that was wrong. It was important that the service user removed her bra for the ‘barbeque’ massage as the oils used would have spoiled her clothes. In any event, had she been wearing a bra her breasts would have ‘…popped out’ during the repositioning necessary for the treatment.

44. There was no evidence to show that he had not used a clean cover on the treatment couch and supplied clean towels. The Registrant did not accept Mr Howard’s report as he considered that Mr Howard was unaware of what is involved in sports therapy and not in a position to comment.

45. The Registrant insisted that he had worn a mask during Service User A’s treatment. He did not understand the meaning of ‘heavy handed’ as an allegation because this was subjective to service users. He acted ordinarily in the course of his treatment and was not informed by Service User A that she was in excessive pain. The Registrant stated that it was not possible to snatch up Service User A from the treatment couch. She was a small and heavily built woman and prone, was a ‘…dead weight.’ It was physically impossible to pull her to her feet.

46. The Registrant stated that the expert witness Mr Howard had lost all credibility when it became obvious that he did not know that the corkscrew was a position and not a treatment.

47. There was no sexual element or intention in his treatment of Service User A. It was necessary to have her remove her bra. There was no sexual ogling of her breasts when she became accidentally uncovered, and no sexual comments.

48. The Registrant stated that it was necessary to discuss Service User B’s bra size, as this was relevant to her vertigo as a possible mechanical cause. He did discuss and explain battered wife syndrome but always by fully explaining both that condition and bra strap syndrome to Service User B.

49. The Registrant accepted that when he wrote to Service User B, he had been extremely angry. His letter could have been ‘…better’ but was not intended to frighten her. The Registrant was explaining that when she is proved to have been wrong, she would have ‘…egg on her face.’ He insisted that he never told Service User B that he was a physiotherapist and if she was misled it was not because of anything he had said or done.

50. The Registrant told the Panel that he worked with Lincoln NHS Trust helping to train their physiotherapy students. He had a vast knowledge of the subject area and was widely respected and consulted as a professional and an educator. He had obtained a City and Guilds Level 3 teaching certificate.

51. The Registrant explained that it was pointless for him to have obtained a sports therapy expert. The HCPC was not interested. The Registrant was unable to identify the section in his bundles which established his undergraduate or post-graduate training and certification in the treatment of BPPV.

Submissions on Facts:

52. Mr Irving on behalf of the HCPC submitted that:

53. The Panel should accept the evidence of Service Users A and B, which was direct testimony. There was no hearsay evidence contrary to the position of the Registrant.

54. The Registrant had not challenged either witness in cross examination in any substantial way.

55. In relation to dishonesty, Mr Irving invited the Panel to find that this was proved. The Registrant had claimed to have a professional status which he did not have. He knowingly misled Service User A by claiming to be an osteopath.

56. In relation to the allegation that the Registrant was heavy handed in his treatment, Mr Irving accepted that this was subjective in nature. It was open to the Panel to find this proved if they accept the evidence of the service user.

57. Mr Irving invited the Panel to accept the evidence of the expert witness, Mr Howard. The Panel could therefore find proved that it was not necessary for treatment for Service User A’s bra to be removed.

58. Mr Irving invited the Panel to find proved that the Registrant had snatched up Service User A from the treatment couch based on Service User A’s evidence.

59. Mr Irving also invited the Panel to find that separately and taken together, there was evidence of conduct by the Registrant towards Service User A that was sexual in nature.

60. In regard to Service User B, Mr Irving invited the Panel to prefer the evidence of Mr Howard to that of the Registrant. Accordingly, the Panel should find proved that asking Service User B about her bra size was not professional communication. Further, the Registrant’s discussions relating to battered wife syndrome and his letter to Service User B was also not professional communication.

61. The Registrant did not invite the Panel to consider that any of the allegations should be found proved despite concessions made by him.

62. The Registrant said that Service User A was not a credible or reliable witness. Her statement did not add up. In particular, she referred to the treatment room not having a window. The Registrant said he had proved that it did have a window. Further, the HCPC had refused invitations to visit the Registrant’s premises and be satisfied that the towels were clean, and the premises were sanitary.

63. The Registrant invited the Panel to find that Service User A’s claim to have been seized by him and pulled up from a prone position on the treatment table was improbable and should be dismissed. The service user was overweight and was in a position where it was physically impossible to lift her up as she was dead weight.

64. The Registrant explained that there had been a series of developing statements obtained by both service users since these allegations began to be investigated. Further, the allegations had changed in nature and character. He was confused and was disadvantaged. The Panel had been provided with only a small portion of the relevant material by the HCPC, and as such, the case against him was biased and should be dismissed. The Panel had been directed by the HCPC case towards Podiatry and Chiropody practise, and not towards sports therapy. The Panel was accordingly biased.

65. Service User A had never complained of any sexual misconduct towards her by the Registrant. Accordingly, the allegation of behaving towards Service User A in a sexual way should be found not proved.

66. In respect of Service User B, the Registrant explained that he had undertaken professional training which allowed him to carry out a differential diagnosis in relation to the many types of Vertigo suffered by service users. His question in relation to bra size related to bra strap syndrome which could be a cause of Vertigo.

67. The witnesses Mr Howard and NH were not suitably qualified and equipped to discuss sports therapy treatments and training. That evidence should be discounted to the extent that it contradicted or was at odds with the Registrant’s evidence.

Decision on Facts:

68. The Panel accepted the Legal Assessor’s advice. It recognised that the Council had the burden of proving disputed facts to the civil law standard of balance of probabilities. The Registrant had no burden of proof.

69. The Panel recognised that in general terms, it was an error to begin their assessment of the witnesses with an analysis of their credibility and reliability. However, in this case, there were few helpful contemporary documents. The case turned on the recollections of the factual witnesses and an assessment of their respective merits as witnesses.

70. The Panel noted that Service User A was not challenged directly in cross examination. The Panel considered that she was moderate in her approach to evidence. She provided her evidence in a considered and careful way. There was no hint of any adverse motivation towards the Registrant or inflation of her evidence.

71. The Panel was satisfied that Service User A was a satisfactory witness who had given truthful evidence reliably and it could be accepted by the Panel.

72. The Panel observed that Service User A did not attribute any sexual motivation to the Registrant’s actions or suggest that anything had been sexual in nature.

73. The Panel did not accept the suggestion from the Registrant that Service User A had, in effect, misled herself regarding his status. The Panel considered that taking all the evidence together, it was satisfied that Service User A had been induced to believe that the Registrant was a registered osteopath because of words used by the Registrant. She could not be faulted for failing to take sufficient steps to establish the true position when the Registrant had responded inaccurately to her question.

74. Service User A had expected to be provided with an osteopathic treatment. Instead, she was provided with a massage. She had consented to this treatment while induced to believe that the Registrant was an osteopath.

75. The Panel accepted that Service User A was wrong in saying that the treatment room did not have a window. However, she had visited the treatment room during hours of darkness when the room shutter was most likely closed. Further, she was in pain and keen to be treated. The Panel was not persuaded that this error undermined the quality of her evidence in any material way.

76. Service User A entered the treatment in pain and found the massage uncomfortable. She felt that the Registrant's hands were wandering under her breasts although she was covered by a towel. This was at variance with the treatment she was accustomed to by an osteopath. She felt vulnerable, but did not draw the conclusion that the Registrant’s actions were sexual in nature. This supported her credibility and reliability.

77. The Panel recognised that a number of statements had been produced which had been made by Service User A. In particular, Service User A’s statement to GOsC and the later statements that were provided to the HCPC. None of these statements demonstrated a material divergence or development in the service user’s account of events. Further, the Registrant had not assisted the Panel by pointing out any alleged material differences which undermined the witness’s credibility or reliability.

78. In relation to Service User B, the Panel found her to be a credible and reliable witness.

79. Service User B was only asked in cross examination whether she understood the difference between a threat and a warning. This line of cross examination was not developed in any way and was not expanded upon in submissions by the Registrant. There was no other challenge to her testimony, which gave her any opportunity to comment on or to explain.

80. The Panel found that Service User B was an articulate and intelligent witness. She was clear and concise. She had sought out treatment having been told what to look for in a therapist. It was regrettable that she had been misdirected in her search by a person who appeared not to know, or internalise, that she wished to be treated by a physiotherapist. She attended the Registrant in good faith because she believed that he was a physiotherapist.

81. Service User B’s response to the letter sent to her by the Registrant was a natural and understandable reaction, in the Panel’s view. The Registrant himself had characterised part of it as one that could have been better expressed. There was nothing in her response to suggest that she was intent on damaging the Registrant rather than providing an honest and accurate account of her dealings with him. The Panel considered that there was nothing excessive or inflated in the Service User’s account to reduce her value as a truthful historian.

82. The Panel considered that NH was a careful and precise witness who gave knowledgeable and professionally informed, detached evidence. She explained the treatment for BPPV and the potential side effects of the treatment including the risks. She was clear in her views and was credible and reliable. She agreed with the Registrant that it was not essential that the treatment be provided by a physiotherapist. Another suitably trained and qualified person could also do this procedure. She was familiar with the treatment and had provided it herself on a number of occasions. Her testimony was consistent with that of the expert witness, Mr Howard.

83. The Panel accepted Mr Howard as an expert witness. His testimony was detailed and helpful, explaining for the Panel, the necessary degree of skill and training required by a physiotherapist to successfully offer BPPV treatment to the public. He was an experienced clinician and had acted as an expert witness in a range of cases over several years. The Panel found that his report did not stray beyond his scope of expertise. He was prepared to concede that a suitably qualified person who was not a physiotherapist could provide this treatment.

84. The Panel did not accept that the Registrant was a reliable witness. The Registrant gave his evidence in a forceful and unmeasured way. He challenged, without any objective basis, the truthfulness and reliability of the witnesses including the expert witness; the objectivity of the HCPC in its investigation and presentation of the case; and even the independence of the Panel. He made repeated assertions relating to his skills and expertise which were unsupported in any of the evidence. When he was asked to vouch his training and expertise based on the materials supplied by him for that purpose, it was clear that the materials failed to do so. His evidence was inflated, defensive, self-regarding without restraint and ill-considered. His presentation suggested that he was at times outraged at being subjected to scrutiny by his regulator and angry that the witnesses could take a contrary view of the skills and treatment offered by him. The Registrant was, in the Panel’s view, an unsatisfactory witness.

The Panel’s findings of fact

[Matter A]

Particular 1):

1) On or around 17 November 2020, when Service User A asked you if you were an Osteopath, as they were looking to receive treatment from an osteopath, or words to that effect, you answered ‘yes’, or words to that effect.

85. The Panel found this particular proved.

86. The Panel accepted the testimony of Service User A. She said in her statement:

‘I asked if I would be seeing an osteopath, and he replied with "yes". I asked, "who is that then?" to which he responded "me".’

87. The Registrant said that he told her only that he provided osteopathic treatments. His recollection however was influenced by his defensive approach and was unsupported by any contemporary record. The Panel considered that Service User A would not have understood that the Registrant offered services as an osteopath other than though his direct response to her questions. That information was not found on the Registrant’s website or advertising. The Registrant had not challenged Service User A in cross examination. Service User A was consistent in her reports. The Registrant insisted that there were material variations in the succeeded statements provided by Service User A to the GOsC, and to the HCPC which undermined her reliability as a witness. These were not obvious to the Panel. The Registrant did not use his opportunity to bring any such inconsistencies of an alleged developing narrative in cross examination. Neither did he elaborate in his submissions. On the contrary, in Service User A’s earliest report to the GOsC it was clear that the Registrant had said that he was an osteopath. The Panel was satisfied that the Registrant’s responses to Service User A’s questions induced her to believe, wrongly, that he was an osteopath and for that reason travelled to his premises for treatment.

Particular 2) a) i and ii:

2) On 17 November 2020, while providing treatment to Service User A, you placed them at risk of harm, in that you:

a) did not provide the treatment in sanitary conditions in that you:

i. did not use a fresh covering for the treatment bed; and/or
ii. did not provide a clean towel for Service User A.

88. The Panel found this particular not proved under both limbs a) i and a) ii.

89. The Panel accepted the testimony of Service User A but was not satisfied that there was sufficient evidence to find this particular of the allegation proved on the balance of probability. The towel may have appeared grubby to the service user and the cover of the treatment table may have appeared not to be fresh. However, the Panel was unable to identify sufficient evidence to support the finding that either of these observations created a risk of harm to Service User A. The premises were visited by her during Covid lockdown conditions. There was no objective evidence to support a risk to Service User A. The Panel considered that her perception and observations was insufficient to find the allegation proved.

Particular 2) b):

b) did not wear an appropriate face mask or covering during the consultation; and/or

90. The Panel found this particular proved.

91. Service User A was clear that she wore a face mask where the Registrant had not. The Registrant said that he had. The Panel preferred the evidence of Service User A. Her statement is clear and is reliable. The Registrant’s inflated and aggressively stated evidence was not. The Panel was satisfied that in Covid lockdown, the risks of harm to Service User A were clear and established on the balance of probabilities. The Registrant sought to persuade the Panel, based solely on his testimony (not put to the Service User A in cross examination) that he had instituted a Covid airlock entry system with handwashing on arrival. Service User A did not reference this, and the Panel was satisfied that she would have done, had it been true. Service User A did not make a major point of this face mask issue. It was expressed moderately and in a matter-of-fact way. The Registrant’s extravagant and untested challenge on the point was elaborate and in the Panel’s view, fanciful. There was not an attempt to reconstruct the airlock in the Registrant’s self-guided defence video of his premises, which had been provided in order to persuade the Panel of the sanitary conditions at the premises.

Particular 2) c):

c) were ‘heavy handed’ while providing treatment to Service User A.

92. The Panel found this particular not proved.

93. The Panel accepted that Service User A’s perception was that she had been treated in an excessively inept and painful way. She had however been given a massage and not (as she expected) an osteopathic treatment which was the basis of her perception. Her expectations of treatment had not been met. It was not clear to the Panel that Service User A had explained how very painful she had found the massage and had asked the Registrant to stop. The Panel accepted that her telling the Registrant that the massage treatment was painful might fall within the range of common responses made by service users to the Registrant. In the absence of other evidence, the Panel was not satisfied that the treatment as provided was ‘heavy handed’ in that the Service User A was placed at risk of harm. The service user was already in pain as a result of her condition. The Panel was not able to say that this limb of allegation was proved on balance of probabilities.

Particular 3) a):

3) On 17 November 2020, during your consultation with Service User A, you:

a) requested Service User A remove their bra when this was not required to provide their treatment.

94. The Panel found this particular not proved.

95. The Registrant admits that he asked Service User A to remove her bra as Service User A has said in her evidence. Mr Howard, the HCPC expert and a physiotherapist, had said that in his opinion and in 30 years of professional practice, it had never been necessary to ask a service user to remove their bra. However, the Registrant had satisfied the Panel that he was providing a ‘barbeque’ four-sided massage treatment with oils. This necessitated moving Service User A repeatedly and ran the clear risk of spoiling her clothes with oil contaminant even though her breasts were not touched in the massage. Service User A had complied with the request, which was new to her as an osteopathic, rather than a sports therapy patient. She was offered and made use of a towel cover. The Panel considered that the particular of allegation was not proved on the balance of probabilities in that the removal of the bra was most likely required for the particular treatment provided.

Particular 3) b):

b) did not communicate appropriately and/or maintain professional boundaries with Service User A, in that you stated, “look how strong I am,” or words to that effect, while picking Service User A up by or around her ribcage while she was not wearing a top and/or bra.

96. The Panel found this particular proved.

97. The Registrant, acting in any professional capacity, was required to communicate appropriately and to maintain proper professional boundaries with service users in his care. Service User A said that the Registrant had suddenly and without warning lifted her from the treatment couch by picking her up around the ribcage as she was getting up. Service User A said that at this time, she was sitting on the edge of the treatment couch. She concluded that he was assisting her to get off the treatment couch. However, he did so without explaining what he was doing and in a way that resulted in her being caused pain and embarrassment.

98. The towel covering Service User A fell off exposing her breasts. She came almost face to face with the Registrant who inappropriately and outside of his professional boundaries said, ‘look how strong I am!’. Service User A felt as though she had broken a rib as a consequence of being snatched up like this. The Panel was satisfied that the Registrant had acted as Service User A said he had, and that he had not asked permission to assist her or had acted to preserve her dignity and modesty. Service User A was disrobed at this time, having been asked to remove her bra for treatment. The Registrant had not communicated appropriately and had not maintained professional boundaries in doing this. The service user said in her statement:

‘Pain shot through me and since I did not have a top on, the towel went flying off and exposed me as I could no longer hold it in place between my arms. The lifting came as a complete surprise.’

99. The Registrant advanced a different account in his evidence but had not permitted Service User A an opportunity to comment on that position. Extravagantly, the Registrant asserted that it would have been impossible to lift up Service User A in this way because of her weight and on the assumption that she was lying prone at the time (which was not what Service User A had said nor what she demonstrated to the Panel). He then said that if he had lifted up Service User A, he would have raised her all the way up to the ceiling, seemingly because he regards himself as being sufficiently strong to do so despite the service user’s weight. The Registrant’s evidence was not persuasive.

Particular 4)

4) Your conduct in relation to particular 1 was dishonest.

100. The Panel found this particular proved.

101. The Panel was satisfied that this particular of allegation was proved. The Panel believed and accepted the evidence of Service User A. She had said, I asked if I would be seeing an osteopath, and he replied with "yes". I asked, "who is that then?" to which he responded "me". The Panel was satisfied that the Registrant knew at that time that he was not an osteopath and was not permitted to provide osteopathic treatments. The Panel was satisfied that the Registrant knew at that time that Service User A would be misled by his replies. The service user had explained that she was seeking urgent osteopathic treatment. The Registrant induced a false belief in the mind of the service user and accordingly secured her attendance at his premises under that deliberately induced false belief. The Panel considered that any honest and decent person would consider this to be a dishonest thing to do.

102. The Panel observed that Service User A was still under the misapprehension created by the Registrant when she complained to the GOsC following her treatment by the Registrant.

103. Service User A said in her statement that the Registrant had repeated the deception afterwards when challenged on the phone that he was not an osteopath – he said that he provided osteopathic treatments. The service user challenged him on this as set out in her statement where she remembered, ‘I told him that "you can't do osteopathic treatments if you aren't an osteopath" and he said "sorry”’.

104. The Registrant sought to persuade the Panel that the service user was at fault for her misperception. He said that he had not misrepresented himself as Service User A had said. He had provided her with a business card setting out his true status at the beginning of the service user’s attendance at his premises. This was not a position that was put to the service user, who had said in her statement, ‘At the end of the appointment, the Registrant gave me his business card as I had booked in for another appointment, which I had agreed to as I had just wanted to get out of there’..

Particular 5):

5) Your conduct in relation to particular 3 was sexual in nature.

105. The Panel found this particular was not proved.

106. The Panel observed that Service User A had not considered the incident to be one linked to or motivated by any sexual purpose or intention. The Registrant’s actions were improper professionally but the Panel was not satisfied that there was evidence which made it more probable than not that the actions were sexual in nature or character. The Registrant was rude and discourteous but not more than that.

[Matter B]

Particular 1) a):

1) You did not communicate professionally to Service User B, in that:

a) On 6 April 2022, you asked Service User B: “What size bra are you?” or words to that effect.

107. The Panel found this particular proved.

108. The Registrant admitted using the words alleged. Service User B told the Panel that the words had been said as she was lying on her back while the Registrant held her head and she could not see him. The question was not accompanied by any explanation or advance notice of the purpose of the question which made her feel vulnerable and uncomfortable. Service User B said in her statement:

‘I did not know why he asked me that, so l said, "I don't think that has anything to do with vertigo/BPPV". Mr Ricketts said that it was a real thing, and I should google it. I said OK as at this point, I was really uncomfortable, and I just wanted to go. A younger naiver me probably would have answered him, but I have never had a medical professional ever ask me what bra size I was, so I thought it was highly inappropriate’.

109. Mr Howard, the expert witness, told the Panel that bra size is irrelevant to the understanding of and treatment for vertigo. The Panel accepted this evidence.

110. The Registrant asserted that bra size is a relevant question associated with the treatment of vertigo, if it is related to the mechanical forces exerted on the body by a badly fitting bra causing induced vertigo. There are many types of vertigo, he said, and it is legitimate to ask questions which assist in a differential diagnosis. The issue can be linked to a condition that he identified as ‘bra strap syndrome.’ The Registrant however went on to say that he had explained all of this to Service User B and set out the context for his question. This was not put to Service User B in cross examination.

111. The Registrant’s evidence was delivered in a forceful and apparent false-authoritative manner. There was a stream of detail from him that seemingly was meant to support his expertise in the subject. However, when subject to challenge, the Registrant was unable to satisfactorily identify the basis for these propositions in any of the extensive educational materials supplied by him.

112. The Panel accepted the evidence of Service User B in preference to the Registrant. It was satisfied that the Registrant had not communicated professionally.

Particular 1) b):

b) On 6 April 2022, when Service User B explained that they had been diagnosed with fibromyalgia, you stated “it is probably psychological and most probably from beaten wife syndrome” or words to that effect.

113. The Panel found this particular proved.

114. The Registrant accepted that he had used words closely aligned to those alleged subject to substituting ‘battered’ for ‘beaten’ which, the Panel concluded, were words to the same effect in the context.

115. The Panel accepted the evidence of Service User B that:

‘Mr Ricketts then asked where the pain was for my fibromyalgia. I said it was in my legs and elbows. He then said that in that case I did not have fibromyalgia as the pain would be in my ribs, which I know is not correct. Mr Ricketts said there were two reasons why women get fibromyalgia and that one was physical and the other was psychological. He said that as I had not got the pain in my ribs that it was not fibromyalgia and so there was obviously a psychological reason why I had gotten it. Mr Ricketts said that it was often from beaten wife syndrome and proceeded to say this is where a woman is afraid of her husband and the woman is constantly tensing up. I was quite shocked that he was saying this to me, and I should have gotten up and left the appointment at this point.’

116. The Panel considered that the Registrant had not communicated professionally with Service User B. The Panel did not accept the Registrant’s evidence that he had set out his reasoning for exploring the issue with Service User B in a way that was consistent with a genuine professional enquiry. This was not put to Service User B in cross examination. Service User B’s evidence was supported by the assertive way that the Registrant had approached his evidence.

117. The Panel was satisfied that the Registrant had not communicated professionally with Service User B in this regard.

Particular 1) c):

c) On or around 24 August 2022, in a letter addressed to Service User B, you stated: “Finally, please do your homework before you make allegations which affects other people’s career. Failure to do so will as the phrase is, bite you in the ass!”

118. The Panel found this particular proved.

119. The Registrant did not challenge that the content of his letter was not accurately reproduced. He had in any event copied the letter to the HCPC. He accepted that his use of the expression ‘bite you in the ass’ might have been better expressed. However, the Registrant maintained that the thrust of his letter was no more than an attempt to persuade Service User B that the criticisms of his practice were misplaced. She would be shown to be wrong and so have ‘…egg on her face.’ His limited cross examination of Service User B extended to her being asked if she understood the difference between a threat and a warning. Whatever difference was in the Registrant’s mind was not explained to the service user in her evidence or to the Panel in his submissions.

120. Service User B, said in her statement:

‘I felt threatened by this letter, and I still do. At the end of the letter is a comment that says, "failure to do so [doing my homework before making allegations] would "bite you in the ass"". I do not know what he meant by that or means by that, and it came across as very rude and very unprofessional and threatening.’

121. The Panel considered that the letter was self-evidently not a communication with Service User B which could be regarded as professional.

Particular 2):

2) In carrying out treatment for BPPV to the head and neck of Service User B you have worked beyond your scope of practice as a Podiatrist/Chiropodist (CH10458).

122. The Panel found this particular proved.

123. The Panel recognised that it was common ground between the Registrant and the HCPC that it was beyond the scope of practice of a registered Podiatrist or Chiropodist to carry out treatment to the head and neck of any service user for BPPV. Service User B had been diagnosed by an ENT Consultant who had recommended treatment, referred to as the Epley Manoeuvre, by an appropriate professional. This manoeuvre can be done by a suitably qualified vestibular physiotherapist such as the witness NH. Mr Howard, the HCPC expert, believed that the manoeuvre should be confined to professionals who are suitably trained in a post-graduate level course, after at least four years in general practice and with at least ten years of professional experience. The manoeuvre can be done by professionals other than physiotherapists if suitably qualified. There are risks of failure and there are potential side effects of the manoeuvre.

124. The Registrant carried out the manoeuvre on Service User B. There was no change or improvement in her symptoms as a result. Service User B had consented to the Registrant’s treatment under the mistaken belief that he was a suitably qualified physiotherapist. Service User B was not told by the Registrant that he was not a physiotherapist. She located his services though searching for suitably qualified persons and being told by one person contacted that he was ‘aware’ that the Registrant carried out the treatment. Service User B called the Registrant, and she said in her statement:

‘I spoke to Mr Ricketts, and he said he could perform the manoeuvre, and he had done it before. He said he had not had anyone that vomited from doing it. This gave me confidence as it is not a nice treatment and can make you feel very sick. I booked to see him for the manoeuvre on 6 April 2022 as it gave me confidence, he knew what he was doing.’

125. She also said:

‘His website said that his clinic has one of the most advance treatment centres in Lincolnshire and specialises in physiotherapy to those who need it, so I took it on face value, and I did not directly ask him. I said what I had been diagnosed with and that the Consultant had recommended the manoeuvre, and I was looking [for] a professional to perform that.’

126. The Registrant did not challenge Service User B’s evidence. Instead, he adopted the stance that he was a graduate sports therapist and had been trained in the Epley Manoeuvre as an undergraduate. He was therefore suitably qualified. He dismissed the evidence of NH and especially of Mr Howard, as irrelevant to sports therapy practice. They knew nothing of his profession and its training. Their testimony revealed, at least, that other professions were not precluded from carrying out the treatment, if suitably qualified to do so. The Registrant was prepared to adopt this limited part of their expertise.

127. The Registrant insisted that he could prove his qualifications in the topic. He had produced a multiplicity of educational material including the undergraduate syllabus for sports therapy. He was asked to show the Panel the section establishing that the Epley manoeuvre was taught and examined at undergraduate level. He was unable to do so. However, the Registrant claimed advanced self-directed training. He had read many books since he had qualified. He was sent students to train professionally by an accrediting body, both sports therapists and physiotherapists. He was unable however to provide the Panel with any proof of his training, skills, and accreditation on the treatment of BPPV.

128. The Registrant appeared to adopt the stance that his skills and expertise were established by his bare assertions. He produced a number of substantial looking textbooks from a bag as the Registrant developed his evidence. There was, the Registrant assured the Panel, a wealth of knowledge assimilated by him over his years of practice from such textbooks. The Panel was not satisfied that this was an adequate basis on which it could find that the Registrant was suitably qualified as a sports therapist so that his treatment of Service User B could be regarded as falling under a different and unregulated but permissible title.

129. The Panel was satisfied that even if a sports therapist could obtain suitable training and accreditation to permit them to treat BPPV, the Registrant had not established that he was one of them. His claim to be qualified and able to practise in this field under a different professional accreditation was not made out. It followed that in carrying out this treatment, he was acting outside of the scope of his practice as a registered Podiatrist and a registered Chiropodist. The Registrant did not assert that he was not registered with the HCPC under those titles on the Register. As a registered HCPC professional, he was required to always work within the scope of his professional registration both as a matter of ethical practice and also as a matter of professional competence. Since he had not established a basis for his competence and skill and further had not explained that to Service User B at the relevant time, it followed that he had acted beyond the scope of his practice.

Decision on Grounds:

130. Having made a decision on the facts, the Panel went onto consider whether the Registrant’s conduct in respect of the particulars found proved in [Matter A] 1, 2b), 3b) and 4 [Matter B] 1a), 1b), 1c) and 2 amount to the statutory ground of misconduct.

Submissions by the HCPC

131. Mr Irving had provided the Panel with written submissions on grounds, and he expanded on those submissions orally, inviting the Panel to find that the statutory ground of misconduct had been established. He submitted that the facts found proved by the Panel were serious breaches of the relevant standards in force at the time, which were:

• The HCPC Standards of conduct performance and ethics from 2016-2024 (‘the 2016 Standards’), which were relevant at the time, and

• The HCPC Standards of proficiency for Chiropodists/Podiatrists 2013-2024 (‘the 2013-2024 Standards’).

132. Mr Irving invited the Panel to find that the Registrant’s proved conduct taken together established that the Registrant has acted in a way that:

• breached fundamental principles of registered professionals, and

• fell far below the standard to be expected of a registered Chiropodist/Podiatrist, and

• the public would not expect of a HCPC registered Chiropodist/Podiatrist.

Mr Irving said that the Registrant had breached Standards 1, 2, 3, 6, 8 and 9 of the 2016 Standards. Further, that the Registrant breached Standards 2, 4, 5, 8, 9, 14, and 15 of the 2013-2024 Standards.

Submissions by the Registrant

133. The Registrant, on his own behalf said that the decisions made on the facts by the Panel were contradictory and incoherent. Further, the Panel’s decisions were the result of an unfair and improper use of the evidence.

134. The Registrant said that the Panel’s decision should not have been handed down in his absence on Friday 15 November 2024. He had not been available after 5 pm and so was unable to respond to emails and calls after that time. He stated that the goal posts had continually been moved to his disadvantage. He had been misled by earlier communications that the decision would be available before 5 pm. This was an example of the Panel acting in an arbitrary and unfair way towards him in violation of his rights to a fair hearing.

135. The Registrant was dissatisfied with the explanations offered to him that no prejudice arose as he would not have been asked to make submissions after having received the document in any event, to allow him time to read the decision. Further, the Registrant had not responded to earlier emails on 15 November 2024 updating him on timings.

136. When invited to make submissions on the grounds of misconduct, the Registrant said:

• The HCPC had no grounds to assert misconduct as he was not treating Service Users A and B in his capacity as a Chiropodist/Podiatrist

• There was no misconduct as he had at all times acted as a sports therapist, and

• His letter to Service User B could have been better expressed but he had been provoked by the HCPC letter to him setting out the complaint and the investigation.

Panel’s decision on grounds.

137. The Panel accepted the advice of the Legal Assessor. He referred the Panel to the cases of Roylance v GMC [2000] 1 AC 311, Nandi v GMC [2004] EWHC 2317 (Admin) and Calheam v GMC [2007 EWHC 2606 and GMC v Meadow [2007] 1 QB 462, CA.

138. In considering grounds, the Panel took into account the written and oral submissions of Mr Irving and the Registrant’s oral submissions, all of the relevant evidence including the evidence of the expert Mr Howard, and its findings on facts as set out above.

139. The Panel was aware that in respect of misconduct there was no standard or burden of proof and that it was a matter for the Panel’s own professional judgement. It bore in mind that breaches of the Standards did not automatically result in a finding of impairment.

140. The Panel considered that the Registrant’s conduct fell significantly below the standards to be expected of a registered Chiropodist/Podiatrist. The Panel recognised that, as was said by Auld LJ in the Court of Appeal court in the case of Meadow - Doctor Meadow had acted as an expert witness in a criminal trial and his conduct in so acting was the subject of disciplinary proceedings against him by his regulator. The objection to the regulator’s jurisdiction was that it had no power to discipline a member in such circumstances. Auld LJ said that The Court said:

‘As Lord Clyde noted in Roylance v. General Medical Council [2000] 1 AC 311 (PC), at 330F–332E, [1999] 3 WLR 541, 47 BMLR 63, “serious professional misconduct” is not statutorily defined and is not capable of precise description or delimitation. It may include not only misconduct by a doctor in his clinical practice, but misconduct in the exercise, or professed exercise, of his medical calling in other contexts, such as that here in the giving of medical evidence before a court. As Lord Clyde might have encapsulated his discussion of the matter in Roylance, it must be linked to the practice of medicine or conduct that otherwise brings the profession into disrepute, and it must be serious.’

141. The Panel understood that the Registrant had not formally taken objection to the validity of these proceedings other than in his opening observations. He had returned, however, on numerous occasions throughout the hearing including at the point of submissions on the grounds to assert that he was at all times acting as a sports therapist. The cases against him by the HCPC were, in his view, accordingly misconceived. The Panel considered that the answer to this point had already been drawn to his attention in the Panel’s determination on facts.

142. As the matter was still in doubt in the Registrant’s mind, the Panel reminded itself that had the Registrant established in his evidence that he was at all times acting within the scope of an accredited sister body that, for example, trained and accredited its members in the treatment of vertigo and of the Epley manoeuvre, there was scope for the view that he was acting within the scope of his practice as a Chiropodist/Podiatrist. The Registrant would have required to provide evidence of his training and accreditation as an essential step in making out this defence. There was no burden or standard of proof imposed on him.

143. The Registrant was, however, unable to take the Panel to anything in the evidence other than his unsupported assertions that could begin to make out the defence that he insisted on. Accordingly, not being able to point to any appropriate training or accreditation to support that he was acting within the scope of his practice as a member of a sister or other appropriate body, he was unable to satisfy the Panel that he was acting within the scope of practice of that other body. Accordingly, as in the Meadow case, he was acting beyond the scope of his practice as a Chiropodist/Podiatrist, in that he is required to always act within the scope of his practice in whatever field or activity he was undertaking.

144. In any event, the Panel preferred the evidence of Service User A who said that the Registrant had told her that he was an osteopath, when she had already explained to him that she was in pain and was urgently seeking the services of an osteopath because of that. The Registrant has accepted in these proceedings that he is not an osteopath. He denied making the false assertion. The Panel rejected his evidence on this point. The Panel therefore was satisfied that it is relevant to its consideration of misconduct to take into account that the Registrant has acted outside of the scope of his practice as a Chiropodist/Podiatrist by:

• falsely asserting a professional title that he does not hold and

• by undertaking treatment for a condition that he has not shown accreditation for, despite the expert evidence of Mr Howard that such treatment demands rigorous post-graduate level training and experience no matter which profession allows that treatment to be given.

145. Acting in such a way engages the professional responsibility of a registered Chiropodist/Podiatrist to act always within the scope of his or her practice, irrespective of what capacity a Registrant is practising.

146. The Panel went on to consider the 2016 Standards and 2013-2024 Standards.

147. The 2016 Standards set out the duties of the Registrant which include that a Registrant must (among other duties):

• promote and protect the interests of service users and carers;
• communicate appropriately and effectively;
• work within the limits of their knowledge and skills;
• manage risk;
• be open when things go wrong;
• be honest and trustworthy;

The Panel was satisfied that Registrants are not free to disregard the duties imposed on them in the 2016 Standards. The 2016 Standards inform Registrants that:

‘If you are registered with us, you must make sure that you are familiar with the standards and that you continue to meet them. As a Registrant, you are personally responsible for the way you behave. You will need to use your judgement so that you make informed and reasonable decisions and meet the standards.’

148. Even if not acting as a Chiropodist/Podiatrist, the Registrant was under a duty to act in accordance with the 2016 Standards in any capacity or in any other aspect of his life. The Panel was satisfied that the Registrant’s conduct fell far short of the standards in relation to his letter to Service User B. The Registrant said that his use of certain offensive words which caused real worry and alarm to Service User B ‘could have been better put.’ The Registrant had not explained how he would have re-phrased the letter and, in any event, his words were, (as he invited the Panel to find today), the result of the HCPC writing to him to inform him of Service User B’s complaint and its investigation. He regarded this action as being inflammatory. He wrote to Service User B because of that.

149. The Panel was satisfied that this was a clear breach of Standard 1.

1) Promote and protect the interests of service users and carers

Treat service users and carers with respect

• 1.1 - You must treat service users and carers as individuals, respecting their privacy and dignity.

Maintain appropriate boundaries.

• 1.7 - You must keep your relationships with service users and carers professional.

150. Standard 2 was also breached in a serious way.

2) Communicate appropriately and effectively

Communicate with service users and carers

• 2.1 - You must be polite and considerate.

151. The Panel considered that there were serious breaches of these Standards in relation to the Registrant’s conduct towards Service User B when he discussed ‘bra strap syndrome’ and ‘beaten wife syndrome.’

152. Standard 3 was breached by the Registrant in a serious way. He implied to Service User A that he was an osteopath. He provided treatment for vertigo to Service User B that, the evidence supported, required special training. The Registrant provided no evidence of any training in respect of the Epley manoeuvre for the treatment of BPPV.

3) Work within the limits of your knowledge and skills

Keep within your scope of practice

• 3.1 - You must keep within your scope of practice by only practising in the areas you have appropriate knowledge, skills, and experience for.

• 3.2 - You must refer a service user to another practitioner if the care, treatment, or other services they need are beyond your scope of practice.

153. Standard 6 had been seriously breached by the Registrant in his ineffective and unjustified treatment of Service User B. Further, the standard was seriously breached in relation to Service User A by not wearing a protective face mask when required and by picking up Service User A from the treatment couch in an inappropriate and unanticipated way, causing her pain.

6) Manage risk

Identify and minimise risk

• 6.1 - You must take all reasonable steps to reduce the risk of harm to service users, carers, and colleagues as far as possible.

• 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.

154. The Registrant’s letter to Service User B, which he had still not apologised for in a meaningful way, breached Standard 8.

8) Be open when things go wrong

Openness with service users and carers

• 8.1 You must be open and honest when something has gone wrong with the care, treatment, or other services that you provide by:

o informing service users or, where appropriate, their carers, that something has gone wrong;
o apologising;
o taking action to put matters right if possible; and
o making sure that service users or, where appropriate, their carers, receive a full and prompt explanation of what has happened and any likely effects.

Deal with concerns and complaints

• 8.2 - You must support service users and carers who want to raise concerns about the care, treatment, or other services they have received.

• 8.3 - You must give a helpful and honest response to anyone who complains.

155. The Registrant had been dishonest towards Service User A in implying that he was an osteopath when he was not. This was a serious breach of Standard 9.

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.

• 9.2 - You must be honest about your experience, qualifications, and skills.

156. The Panel was satisfied that the Registrant’s conduct amounted to serious breaches of the 2013-2024 Standards. The 2013-2024 Standards state for Registrants that they must remain within the scope of their practice.

‘Your scope of practice

Your scope of practice is the area or areas of your profession in which you have the knowledge, skills, and experience to practise lawfully, safely, and effectively, in a way that meets our standards and does not pose any danger to the public or to yourself.

We recognise that a Registrant’s scope of practice will change over time and that the practice of experienced registrants often becomes more focused and specialised than that of newly registered colleagues. This might be because of specialisation in a certain area or with a particular client group, or a movement into roles in management, education, or research.

Your particular scope of practice may mean that you are unable to continue to demonstrate that you meet all of the standards that apply for the whole of your profession.

As long as you make sure that you are practising safely and effectively within your given scope of practice and do not practise in the areas where you are not proficient to do so, this will not be a problem. If you want to move outside of your scope of practice, you should be certain that you are capable of working lawfully, safely, and effectively. This means that you need to exercise personal judgement by undertaking any necessary training or gaining experience, before moving into a new area of practice.’

157. The Registrant had not shown that he had undertaken the necessary training and obtained the necessary experience in order to treat Service User B for vertigo. This was a serious breach of the 2013-2024 Standards.

158. Specifically, having regard to the matters already outlined above and not repeated here, the Panel considered that the Registrant had breached the following 2013-2024 Standards.

Registrant chiropodists / Podiatrists must:

1) be able to practise safely and effectively within their scope of practice

• 1.1 - know the limits of their practice and when to seek advice or refer to another professional

• 1.2 - recognise the need to manage their own workload and resources effectively and be able to practise accordingly

2) be able to practise within the legal and ethical boundaries of their profession

• 2.1 - understand the need to act in the best interests of service users at all times

• 2.2 - understand what is required of them by the Health and Care Professions Council

• 2.7 - be able to exercise a professional duty of care

3) be able to maintain their fitness to practise

• 3.1 - understand the need to maintain high standards of personal and professional conduct

4) be able to practise as an autonomous professional, exercising their own professional judgement

• 4.1 - be able to assess a professional situation, determine the nature and severity of the problem and call upon the required knowledge and experience to deal with the problem

• 4.2 - be able to make reasoned decisions to initiate, continue, modify, or cease treatment or the use of techniques or procedures, and record the decisions and reasoning appropriately

• 4.3 - be able to initiate resolution of problems and be able to exercise personal initiative

• 4.4 - recognise that they are personally responsible for and must be able to justify their decisions

• 4.5 - be able to make and receive appropriate referrals

• 4.6 - understand the importance of participation in training, supervision, and mentoring

8) be able to communicate effectively

• 8.1 - be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues, and others

• 8.6 - understand the need to provide service users or people acting on their behalf with the information necessary to enable them to make informed decisions

9) be able to work appropriately with others

• 9.1 - be able to work, where appropriate, in partnership with service users, other professionals, support staff and others

15) understand the need to establish and maintain a safe practice environment

• 15.1 - understand the need to maintain the safety of both service users and those involved in their care

• 15.4 - be able to select appropriate personal protective equipment and use it correctly

159. The Panel determined that both individually and cumulatively, the Registrant’s acts and omissions found proved in Particulars [Matter A] 1, 2b), 3b) and 4 [Matter B] 1a), 1b), 1c) and 2 fell seriously short of the standards to be expected of a registered Chiropodist/Podiatrist and amounted to misconduct.

Decision on Impairment:

160. The Panel was invited to consider whether, in its judgement, the Registrant’s fitness to practise is impaired today. The Panel recognised that its findings in relation to misconduct did not necessarily mean that current impairment of fitness to practise followed. The Panel’s task was to determine whether the Registrant’s current fitness to practise is impaired, based upon:

• the nature, circumstances and gravity of the conduct concerned;
• the risks created for the health and safety of the public, especially those service users who may be treated by the Registrant;
• the risks to the reputation of the professions;
• the need to declare and uphold standards for the professions.

There is no element of punishment for that conduct. The Panel’s sole focus is on protecting the public from Registrants whose fitness to practise is impaired. Any measure of insight shown by the Registrant would become an important factor in assessing and evaluating the likelihood of the Registrant repeating his misconduct and so the level of risk that the public would become exposed to.

161. In its deliberations, the Panel must adopt a forward looking approach to impairment. The Registrant’s past misconduct and any practical and insightful steps taken by him to remedy that misconduct and so remove continuing risk to the public, requires the Panel to consider the history of the misconduct and any remediation by the Registrant.

162. In reaching its decision, the Panel paid regard to the HCPTS Practice Note Fitness to Practice Impairment last updated in November 2023. The Panel paid full regard to the respective submissions made by Mr Irving on behalf of the HCPC and by the Registrant on his own behalf. The Panel accepted the Legal Assessor’s advice.

163. The Panel based its conclusions on Impairment on the ground of misconduct which has been found proved.

Submissions made by the HCPC

164. Mr Irving submitted that the Registrant’s fitness to practise is impaired on both the personal and public components. He reminded the Panel that the Registrant had not apologised for his conduct including to Service User B for the offensive letter sent by him to her.

165. In respect of the personal component of impairment, Mr Irving said that the Registrant had not expressed regret for his past failings. Instead, he had asked the question of whether he needed to show any remorse or regret and had answered his own question with an emphatic ‘No.’ Mr Irving also reminded the Panel that dishonesty can be difficult to remediate. He submitted that based on the absence of any meaningful acceptance and reflections, the Registrant had not shown any insight. In these circumstances, there is a real risk of repetition of his past misconduct. Accordingly, Mr Irving submitted that the Registrant is impaired on the personal element of impairment.

166. Mr Irving invited the Panel to find that the Registrant was also impaired on the public component of impairment. The findings against the Registrant, including dishonesty, were all so serious that public trust and confidence would be seriously undermined if a finding of impairment was not made.

Submissions made by the Registrant

167. The Registrant, on his own behalf, submitted that the Panel could not find impairment on either the personal or the public component unless it recognised his dual qualification as a sports therapist. Unless the Panel is able to assert control of sports therapy as a profession then it had no right to judge his fitness to practise.

168. The Registrant outlined his objections to the Panel’s fact finding including its finding that it preferred the evidence of Service User A. Service User A had said that the Registrant’s treatment room was dingy and windowless. He stated that this was contradicted by the video that he had shown to the Panel establishing that there was a window. The Panel had ‘invented’ an explanation to support Service User A’s evidence that the visit took place during hours of darkness. The room had lighting, activated by a switch, which would make the window obvious. He submitted that the Panel might be expected to be familiar with electric lighting and its illuminating effects. The Panel’s determination to improve on Service User A’s evidence (‘…putting words in the service user’s mouth’) was itself a demonstration of the implausible footing on which the fact finding rested.

169. The Panel had enlarged on its quest to support Service User A’s testimony by observing that the Registrant’s video had not shown the air lock system that was in place during the visit to his premises by Service User A. However, he had explained the air lock to the Panel. The Panel had, characteristic of its approach to the Registrant’s entire testimony, disregarded that evidence without any substantial evidence to discount it.

170. The Registrant emphasised that the expert witness, Mr Howard, was not equipped to comment on sports therapy treatments. By his own admission he knew nothing about the sports therapy degree or the practice of sports therapy. The purported advanced nature of training necessary for physiotherapists was irrelevant to sports therapy. The Registrant said that he could do a one-day training course as a sports therapist and would be fully accredited and trained to offer the Epley manoeuvre for the treatment of vertigo.

171. The Epley manoeuvre can be carried out by patients themselves without specialist training or accreditation. The supposed specialist nature of training was not made out.

172. The Registrant said that the Panel had not produced any evidence relevant to his profession as a sports therapist. An offer of assistance in the investigation by his professional body had been rejected without cause. That produced an injustice in that the Registrant’s fitness to practise was therefore being judged on a partial and inaccurate basis. This case had never been about Podiatry and the Registrant’s title as a Podiatrist.

173. The Registrant submitted that the public need have no concern in regard to his practice either as a Chiropodist or as a sports therapist. He was working as a sports therapist in the Treatment Sessions relating to Service Users A and B. He was doing his best for those patients when practising in that field.

174. The Registrant conceded that part of his letter to Service User B was open to criticism and could have been better expressed. The letter was overzealous but was not a threat as Service User B had misperceived. To that extent only, the Panel was entitled to consider impairment of fitness to practise.

175. The Registrant said that the case against him was faulty. The allegations of sexual misconduct had been pursued in a number of earlier hearings and even in the course of this hearing. Yet, sexual impropriety had now been not found to have taken place. This demonstrated the incoherent nature of the proceedings.
176. Finally, the Registrant said that unless the Panel was able to prove that the Registrant broke the rules of sports therapy in providing treatment, then the Panel is disabled from making findings of impairment of his fitness to practise.

Panel’s decision on impairment

Personal component of impairment

177. The Panel considered the personal component of impairment. It observed that the Registrant had not, even as late as today, shown any recognition of the harm caused to Service Users A and B by his actions. Service User A had been induced to accept a massage treatment under the false impression created by the Registrant that he was an osteopath. She had been hurt by the treatment provided which was not what she had anticipated. She had been hurt by being lifted by the ribs as she was raising herself up from the treatment couch. Her dignity had been violated by her breasts being exposed. Service User B had been frightened by the unpleasant and threatening terms in which the Registrant’s letter had been framed.

178. The Registrant had been afforded an opportunity to consider the Panel’s findings on facts and misconduct in order to reflect objectively on the harm set out and the impact on the Service Users concerned. The Registrant had declined to use that opportunity to step back and assess, in a detached and professional manner, the reality of the Panel’s decisions and the impact that could have on his fitness to practise going forward.

179. The Registrant is entitled to defend himself fully and completely. The Panel takes no issue with his right to do so. He had however, not shown any insight or reflection on the harm caused by his actions to the service users and to the trust and confidence of the public. The Panel concluded that the Registrant appears to be fixed on the unfairness, as he sees it, of these proceedings and the impact on him. He seemed only to make a limited and highly qualified acceptance that his letter to Service User B might have been better expressed. The Registrant submitted that although the impact on her was a subjective misapprehension caused by her inadequate ability to distinguish between a threat and a simple warning that she might end up with ‘egg on her face.’

180. The Panel concluded that the Registrant had not shown any meaningful insight into the impact, harm, and effects of his misconduct.

181. The Panel found it striking that the Registrant had failed to address at all the Panel’s findings in relation to his dishonesty. He had shown no appreciation of the eroding impact of such a finding on his fitness to practise and on the trust and confidence vested by the public in the profession. Misconduct engaging dishonesty is particularly hard, but far from impossible, to remediate depending on the circumstances and the measure of insightful action taken, if any.

182. The Panel found that the Registrant’s misconduct is, in theory and with careful thought, reflection and targeted action remediable. However, none of the misconduct had been remedied. There was, the Panel found, a real and clear risk that the Registrant would repeat his misconduct. If he did so, there was the potential for harm to service users and to a further adverse diminution of the public’s trust and confidence as a consequence.

183. The Panel considered that the Registrant is at real risk of repeating some form of dishonest conduct. In coming to this conclusion, it has taken into account that the Registrant has not demonstrated any insight into the effects of his deception to Service User A in misleading her that he was an osteopath.

184. In these circumstances, the Panel has concluded that the Registrant’s fitness to practise is impaired on the personal component.
Public component of impairment

185. In relation to the public component, the Panel has considered very carefully whether given the nature, circumstances, and gravity of the Registrant’s misconduct in this case, public confidence in the Chiropody /Podiatry 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.

186. 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.

• 9.2 - You must be honest about your experience, qualifications, and skills.

187. The Panel is satisfied that in all the circumstances of this case, the Registrant has breached Standard 9.1 in multiple ways including dishonest conduct. He did not make sure that his conduct justified the public’s trust and confidence in him or in his profession.

188. 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. 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 Chiropody/Podiatry profession if it did not find that the Registrant’s fitness to practise is currently impaired.

189. The Panel had no doubt that the Registrant’s conduct had brought the profession of Chiropodist/Podiatrist 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.

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

Decision on Sanction:

Submissions on behalf of the HCPC

191. Mr Irving, on behalf of the HCPC, said that the HCPC invited the Panel to impose a sanction in the light of the Panel’s earlier findings and the need to protect the public in the widest sense. He did not suggest any particular sanction but reminded the Panel that any sanction should take account of the Panel’s findings regarding the Registrant’s lack of insight and his lack of expressions of remorse for the harm caused to Service Users A and B. Mr Irving also reminded the Panel that the Sanctions Policy was an important though not a binding statement of the relevant factors for the Panel to consider.

The Registrant

192. The Registrant, on his own behalf, asked for and was granted more time to consult with his lawyers before making submissions in respect of sanction. On his return, the Registrant was granted a further application for more time to obtain a response from his lawyers. He said that the advice he sought was connected both with the submissions he intended to make in regard to sanction and in relation to any further steps that he may take following the conclusion of the case.

193. The case resumed at 3:30 pm when the Registrant interrupted the hearing by taking a call from his solicitors while the hearing was in session. The Panel waited until the Registrant had completed his call. The Registrant asked the Panel for a further adjournment until Monday 25 November 2024, the final day of the hearing. He said that he would then be in a position to make his submissions on Sanction.

Monday 25 November 2024

Registrant’s submissions

194. The Registrant, on his own behalf, submitted that he has been able to prove in respect of every Particular of the Allegations that he has done nothing wrong. At all relevant times, he was acting as a sports therapist and anything that he did in that capacity can have no impact on the public’s impression of the HCPC or of the professions of Chiropody/Podiatry.

195. The Registrant said that over a period of seven years to date, culminating in an application for sanctions, the HCPC has undertaken a ‘high-handed’ investigation and fitness to practise process which appears to show that the ‘HCPC hates’ the profession of sports therapy. The HCPC seems to regard itself as ‘close to God’ in matters of professional regulation with the ability to choose to disregard the Registrant’s secondary professional status as a sports therapist. This, he said, was the action of a totalitarian and judgemental organisation. The HCPC has no right to hear this case.

196. The Registrant said that the HCPC had broken the rules in purporting to regulate actions which, on its own case, [Matter A] relates to the profession of osteopathy which lies outside of the HCPC’s reach of governance. The HCPC is too powerful and is ‘drunk with power’. The HCPC shows a lack of insight.

197. The Registrant submitted that Service Users A and B had been shown to be false witnesses and the HCPC was wrong to have insisted that they were reliable. Service User A could not recall a window in the treatment room, but as shown in the video, relied on by the Registrant, it was clearly there. The Panel had distorted the fair use of the evidence in order to support the witnesses’ testimony and disregard the Registrant’s. Service Users A and B were liars.

198. The expert Mr Howard had no place in the case since he had no knowledge or expertise in relation to sports therapy. Sports therapists were permitted to join classes which taught and accredited vestibular therapy.

199. The Registrant said that there was no proof, and the HCPC could not prove, that the Registrant had not worn a mask when treating Service User A. The Panel had demonstrated its lack of impartiality and its bias against the Registrant by dismissing his evidence regarding the air lock in place at the premises when treating Service User A. Nothing sexual had occurred in relation to either Service User A or B.

200. The Registrant said that no sanctions can be applied as the Panel has no power to impose a sanction in relation to purported osteopathy treatment.

201. The Registrant took the Panel to each Particular in turn and repeated the criticisms of its fact finding as set out already above.

202. The Registrant conceded that a sanction of a Warning may be appropriate in his use of the expression ‘…bite you in the ass,’ in his letter to Service User B. It should however be understood to be an expression reflecting his reaction to the case notified to him by the HCPC.

203. If, however, any sanction was imposed, then ‘…this was gonna go nuclear.’ The HCPC and the tribunal was dishonest and impaired. The imposing of a sanction was no more than a means to hide its corruption.

The Panel’s approach to Sanction

204. In considering the appropriate and proportionate sanction, the Panel took account of the HCPC’s Sanctions Policy. The Panel accepted the Legal Assessor’s advice. The Panel recognised that the purpose of any sanction it imposes is not to punish the Registrant, although it may be perceived as having that effect by the Registrant. Sanctions are imposed only for the purpose of protecting the public, maintaining the trust and confidence in which the public hold the professions of Chiropody/Podiatry, and to declare and uphold its standards of conduct and behaviour. The Panel has also had in mind that any sanction it imposes must be appropriate and proportionate bearing in mind the nature and circumstances of the case.

Mitigating factors

205. The Panel considered the mitigating and aggravating factors.

206. The Panel first looked at the mitigating factors and has concluded that the only mitigating factor is that there is an undated supportive testimonial in favour of the Registrant provided by one of his students. The Registrant had attended the hearing and engaged, as is his professional obligation. There are, in common with the great majority of fellow Chiropodists/Podiatrists, no previous regulatory findings against the Registrant, who has been a Chiropodist/Podiatrist for a number of years.

Aggravating factors

The Registrant’s lack of insight, remorse, or apology.

207. The Registrant has the right to not reverse the stance taken by him in relation to the facts of this case. He is not however impeded by that stance from accepting the Panel’s findings as a determination of the facts, of misconduct and of his current impairment which is binding on him. It is open, in these circumstances, for the Registrant to reflect on those findings and to systematically respond in a reflective statement or written piece of work which recognises the Panel’s decisions and concerns for public and service user safety, for the adverse impact on the trust and confidence in which the public holds the professions of Chiropody/Podiatry, and the need to declare and uphold professional standards. There is no retreat from principle in this approach.

208. The Registrant has deliberately and expressly rejected that opportunity. He has maintained that the unfairness (in his eyes) of the proceedings has resulted in a decision which is wrong. He maintains that he has done nothing wrong and has nothing to apologise for, except in a very limited and conditional sense in regard to a specific part of his letter to Service User B. His submissions in relation to the HCPC and the Panel are ill-considered. They reflect the stance taken and maintained by him throughout these proceedings.

Lack of remediation.

209. The Registrant’s approach extends to a complete absence of any practical and targeted remediation which addressed the Panel’s concerns including in respect of his dishonesty.

Service user harm

210. The Registrant’s actions caused harm to Service Users A and B although he declines to acknowledge that.

211. Service User A sought relief from her painful condition, under the false impression created by the Registrant that he could offer the services that she wished to have. Service User A was physically hurt in the process. She was embarrassed and frightened by the Registrant.

212. Service User B was distressed and alarmed by the Registrant’s threatening letter to her. She was also disturbed by the inappropriate questions that the Registrant had asked her during her treatment.

Dishonesty

213. The Sanctions Policy records that dishonesty is to be regarded as a serious case. The Policy reminds panels that the Standard 9 (as set out already above) of the 2016 Standards requires that registrants be honest and trustworthy. Dishonesty undermines public confidence in the profession and can, in some cases, impact the public’s safety. Given the seriousness of dishonesty, such cases are likely to result in more serious sanctions.

214. The Panel recognised that dishonesty is a nuanced and not monolithic concept. The nature, forms, and degree of dishonesty found in relation to the Registrant must be considered by the Panel in an appropriately nuanced way. The factors that the Panel took into account in this regard included:

• The Registrant’s dishonest behaviour took the form of a single act of deception, which was not explicitly corrected by him although he gave Service User A his business card revealing his true registration status at the conclusion of his treatment.

• The Registrant’s dishonesty subsisted throughout the entirety of his treatment of Service User A.

• The Registrant took a personal and active role in his dishonesty.

215. The Registrant has never admitted his dishonesty, nor has he apologised for it. The extent of the Registrant’s dishonesty in this case was not at the highest level of dishonesty. It was however far from trivial and without any recognition of wrongdoing, apology or remediation, there is a clear risk of a repetition, which would expose service users to the risk of harm, as shown in this case. The confidence placed in the professions of Chiropody/Podiatry would be seriously undermined if there was any repetition.

No action

216. The Panel considered the option of taking no action. This is an exceptional outcome, and the Panel was of the view that the circumstances of this case were not exceptional. The Panel decided that the option of taking no action was not sufficient to protect the public or uphold the public interest in this case.

Caution Order

217. The Panel next considered the option of a Caution Order. The Panel considered the guidance in the Sanctions Policy that “A Caution Order is an appropriate sanction for cases, where the lapse is isolated, limited, or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate remedial action.”

218. The Panel was of the view that such a sanction would, in isolation, and if limited in the way insisted upon by the Registrant, be an appropriate sanction to consider in relation to one passage in the Registrant’s letter to Service User B.

219. However, the Panel concluded that the totality of the Registrant’s misconduct made a Caution Order inappropriate and inadequate.

220. Further, a Caution Order would not reflect the seriousness of the findings in this case. It was therefore not an appropriate sanction. The Panel was also of the view that public confidence in the profession, and the HCPC as its Regulator, would be undermined if the Registrant’s behaviour were dealt with by way of a caution.

Conditions of Practice Order

221. The Panel next considered whether to place conditions of practice on the Registrant’s registration. The Panel was of the view that the Registrant’s dishonesty, which is fundamentally attitudinal in nature, was conduct that is difficult to remediate by conditions of practice. Further, the Registrant had repeated in the hearing that the HCPC had no power to regulate his professional conduct. Accordingly, the Panel had no confidence that the Registrant would cooperate with and respect any conditions of practice that might be devised in relation to his non-dishonest conduct. The Panel was also of the view that it would be difficult to find conditions of practice that address the Registrant’s other non-dishonest conduct such as:

• lifting a service user from the treatment couch by the ribs,

• causing them pain and causing them distress by their breasts becoming exposed

• inappropriate communication with service users regarding their bra size, ‘bra-strap syndrome’ and ‘beaten wife syndrome’.

The Panel decided that, accordingly, a conditions of practice order was not workable, proportionate, or appropriate in the Registrant’s case.

Suspension Order

222. The Panel next considered a Suspension Order. The Panel had regard to paragraph 121 of the Sanctions Policy which provides:

“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.”

223. Having taken account of those factors, the Panel considered that a Suspension Order was not the appropriate order in this case.

224. One of the factors in support of a suspension order is the Registrant’s insight. In this case, the Registrant has demonstrated no insight of any meaningful kind except an entirely limited degree relating to his letter to Service User B. The Registrant has not demonstrated any insight into his conduct including his dishonesty, nor has he provided an apology or any expression of remorse.

225. The Panel had already determined that the Registrant’s conduct may be repeated with potential risks for service users and for the reputation of the professions of Chiropody/Podiatry.

226. Given the seriousness of the Registrant’s conduct and his lack of insight and commitment to remediation demonstrated repeatedly by him in these proceedings, the Panel was of the view that public confidence in the profession and regulatory process would be undermined if a suspension order was imposed.

227. The Panel also considered that in the light of the Registrant’s approach to sanctions, which he regarded as an illegitimate exercise in professional regulatory over-reach, unjustified, unlawful, and biased against him, he had demonstrated an attitude of mind that was fundamentally incompatible with continued registration. Casting himself as the victim of a calculated and targeted injustice, he had entirely failed to engage with his regulator in a constructive and meaningful way consistent with any commitment to the protection of the public and the maintaining and upholding of the public’s trust and confidence in the professions of Chiropody/Podiatry.

Striking Off Order

228. The Panel next considered a Striking Off Order.

229. The Panel was aware that this was a sanction of last resort, as set out in paragraph 130 of the Sanctions Policy for serious, persistent, deliberate, or reckless acts involving, among other things, dishonesty.

230. Paragraph 131 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. In particular where the Registrant:

• lacks insight.
• …
• is unwilling to resolve matters.’

231. The Panel is satisfied, based on the Registrant’s lack of insight and the nature and gravity of the proved misconduct, coupled with his entrenched disregard for his regulator, public safety and for the reputation of the professions of Chiropody/Podiatry, a striking off order was necessary.

232. The Panel had in mind what was said by the High Court in the case of Bolton v Law Society [1994] 2 All ER 486 in relation to the factors which are relevant to sanctions. The Court identified that the deterrent effect of a sanction was important to deter others who might be tempted to behave in the same way. There were, the Court said, two other purposes of sanctions orders.

233. The first purpose was to be sure that the offender did not have the opportunity to repeat the offence. That purpose was achieved for a limited period by an order of suspension or for a longer, or indefinite, period by striking off.

234. The second purpose was the most fundamental: to maintain the reputation of the [relevant profession] profession as one in which every member could be trusted. To maintain the profession's reputation and sustain public confidence it was often necessary that those guilty of serious lapses were not only expelled but denied re-admission.

235. ‘A profession's most valuable asset was its collective reputation and the confidence which that inspired. Since orders were not primarily punitive, mitigation had less effect than in criminal cases. … The reputation of the profession was more important than the fortunes of any individual member. Membership of a profession brought many benefits, but that was part of the price.’

236. The Panel concluded that in this case, a Striking Off Order was necessary in order to ensure public confidence in the professions of Chiropody/Podiatry and in the HCPC, as its regulatory body, is maintained, and in order to uphold proper standards of conduct in the profession. It is therefore appropriate and proportionate to order that the Registrant’s name be struck off the Register.

The Registrar is directed to strike the name of Mr Patrick F Ricketts from the Register on the date that 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:

Interim Order Application:

Application by the HCPC

237. Mr Irving made an application for the imposition of an Interim Order. Mr Irving pointed out that the primary order would not take effect for at least 28 days and the public would not be protected by any order until then. If an appeal were to be made by the Registrant, the primary order would not come into effect until that appeal had been withdrawn or otherwise disposed of.

238. Mr Irving said that the factors in favour of an interim order being imposed were:

• Notice of the Panel’s powers to impose an interim order had been given to the Registrant at page 4 of the service documents, served on him on 19 September 2024;

• There is a necessity for an order in circumstances where a striking off order had been imposed for reasons of public protection;

• There was cogent evidence that service users and the public were at continuing risk of harm in the absence of an interim order being imposed, pending the primary order coming into effect.

• An interim order was also necessary for reasons of maintaining the public’s trust and confidence in the professions of Chiropody/Podiatry.

• It was proportionate to impose an interim order as it related only to the period prior to the primary order coming into effect.

Submissions of the Registrant

239. The Registrant did not oppose an interim order being imposed today. He said that ‘…it’s up to you, mate’, and if the Panel thought an interim order was necessary, the Panel should ‘…go for it’.

Decision on an Interim Order:

240. The Panel accepted the advice of the Legal Assessor and took into account the guidance as set out in the HCPTS Practice Note ‘Interim Orders’ last updated in September 2024. In particular, the Panel had regard to the section relating to interim orders imposed at final hearings after a sanction has been imposed.

241. The Panel was satisfied that the Registrant had been advised in the Notice of Hearing, dated 19 September 2024, that there was a real prospect that an Interim Order application would be made by HCPC, should a substantive finding be made by the Panel.

242. The Panel has decided to impose an Interim Suspension Order, for a period of 18 months, under Article 31(2) of the Health Professions Order 2001. The Panel concluded that an interim order was necessary for the protection of the public and was also necessary in the public interest. Substantive findings in relation to the Registrant’s dishonesty, among other things, had been made. A primary order had been made that it was necessary to remove the Registrant from the Register in order to protect the public. The public would be placed at an unacceptable risk in these circumstances if no order were to be in place pending the determination of any appeal.

243. For the same reasons given in its determination on sanction, the Panel concluded that an Interim Conditions of Practice Order would not be appropriate. The Panel therefore determined that an eighteen-month Interim Suspension Order is appropriate and proportionate pending the expiration of an appeal period.

Interim Suspension Order:

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.

This order will expire:

i. (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;

ii. (if an appeal is made against the Panel’s decision and Order) upon the final determination of that appeal.
The maximum length of this order is 18 months.

History of Hearings for Patrick F Ricketts

Date	Panel	Hearing type	Outcomes / Status
21/10/2024	Conduct and Competence Committee	Final Hearing	Struck off