Miss Sophie Close

Preliminary Matters:

Service

1. The Panel was informed by the Hearings Officer that notice of this hearing was sent to the Registrant’s registered email address on 29 November 2024. That email set out that the hearing was due to begin on 17 March 2025 and that the hearing would be a virtual hearing. The Registrant confirmed in an email dated 6 March 2025 that she was aware of the hearing and would not be attending.

2. The Panel accepted the advice of the Legal Assessor who reminded it of Rule 3(1)b and 6(2) of the Conduct and Competence Committee rules. The Panel was satisfied that notice had been properly served and that the notice period was longer than required by the rules.

Proceeding in the absence of the Registrant

3. Ms Bernard-Stevenson applied to proceed in the Registrant’s absence. She submitted that the Registrant has not engaged with the proceedings and has indicated that she will not be attending. Ms Bernard-Stevenson submitted that the Registrant is aware of the proceedings and has not asked for an adjournment. She submitted that the Registrant has chosen to voluntarily absent herself from this hearing and there is no indication that she would attend any future hearing.

4. The Panel heard and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in the Registrant’s absence should only be exercised with the utmost care and caution. She referred the Panel to the cases of R v Hayward, Jones & Purvis in the Court of Appeal ([2001] EWCA Crim 168), and GMC v Adeogba and Visvardis [2016] EWCA Civ 162. She advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and the public interest. That case further stated that, “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”.

5. The Panel has also taken into account the HCPTS’s Practice Note on Proceeding in the Absence of the Registrant.

6. The Panel was satisfied that notice of this hearing was sent to the Registrant’s registered email address and that the Registrant is aware of the hearing.

7. The Panel noted that the Registrant had not sought an adjournment or suggested that she would attend at a later date. The Panel therefore concluded that the Registrant had voluntarily decided not to attend this hearing.

8. The Panel was satisfied that any disadvantage to the Registrant was outweighed by the public interest in the expeditious disposal of this matter. The Panel therefore decided to proceed in the Registrant’s absence.

Application to amend the numbering of the Allegation

9. At the outset it was identified that the numbering of the Allegation contained within the Notice of Allegation sent to the Registrant was incorrect. The wording of the Allegation was the same as that before the Panel however the numbers appeared to be duplicated and then out of sequence. For clarity the Panel determined to use the numbering in the Allegation as set out above. The Panel considered that the amendments could be made without injustice.

Proceeding in Private

10. During some of the evidence, matters were raised which touched on the private life of the Registrant. In these circumstances, the Panel exercised its discretion under Rule 10(1) of the HCPC (Conduct and Competence) (Procedure) Rules 2003 (“the Rules”).

11. The Panel received advice from the Legal Assessor and had regard to the Practice Note entitled “Conducting Hearings in Private”. The Panel noted its powers under Rule 10(1) of the Rules.

12. The Panel concluded that those parts of this hearing relating to the Registrant’s health should be conducted in private.

Background:

13. The Registrant was a newly qualified paramedic (NQP) who was employed by Central Medical Services (‘CMS’). The Registrant started working for CMS on 1 April 2021. In August 2021 CMS launched a pathway for NQP’s and the Registrant was required to complete a portfolio detailing her learning and experience.

14. In her role, the Registrant was responsible for undertaking frontline duties, providing medical cover for events and transporting patients. She was also deployed as a first responder in a Rapid Response Vehicle.

15. In September 2022, multiple concerns were reported by other paramedic colleagues and external organisations regarding the Registrant's practice. CMS carried out an investigation in relation to incidents that had occurred involving the Registrant on 12 May 2022, 8 June 2022, 6 September 2022 and November 2022.

16. On 14 September 2022, RB at CMS held a meeting with the Registrant to discuss and investigate complaints that had been received. He considered that the Registrant did not appreciate the gravity and seriousness of the concerns that had been raised and he considered that her reflections were inadequate to demonstrate that she had the knowledge and skills required. Following that meeting it was decided that a restriction should be imposed on the Registrant's practice which meant that she could only work whilst under the supervision of a Paramedic who had completed their NQP period.

17. It was considered that this restriction would assist the Registrant by providing mentoring and supporting her to improve. However, further concerns were raised by two colleagues who worked shifts with the Registrant about the Registrant’s knowledge and skills when dealing with a male patient who was unresponsive, a female patient with low oxygen saturation levels, a patient who had severe abdominal and chest pain and a patient with mental health issues.

18. Between November 2022 and December 2022, the Registrant had some absences due to issues with her health. Following the restriction on her practice, a review meeting was planned but the Registrant went on sick leave and did not return to work. On 1 December 2022, the Registrant self-referred to the HCPC.

19. On 14 December 2022, the Registrant resigned from CMS and her employer referred the Registrant to the HCPC the following day.

Summary of evidence

20. The Panel read and considered a 460-page HCPC bundle. The Panel also received a written opening note, case summary and closing submissions prepared by Ms Bernard-Stevenson.

21. The Panel heard oral evidence from 5 witnesses.

• CH – Paramedic who worked with the Registrant as a mentor.
• DP – Paramedic who worked with the Registrant and attended incidents as a “back-up” responder.
• LL – Paramedic who worked with the Registrant and attended incidents as a “back-up” responder.
• EM – Registered Nurse and Safeguarding Lead at CMS who dealt with incidents and complaints involving the Registrant.
• RB – Paramedic and Clinical Lead at CMS who was responsible for the training and development of the Registrant and conducted investigations into the concerns.

22. At the conclusion of the case the Panel identified that exhibit RB05 exhibited to the witness statement of RB was not as described and was almost identical to RB04. Further enquiries with the Case Presenter, Ms Bernard-Stevenson, established that this was incorrect, and the correct exhibit was in the possession of the HCPC but had not been served on the Registrant, as the error had occurred at the Investigating Committee stage of proceedings.

23. The Panel asked for the correct version to be served by the HCPC on the Registrant via email with a request for any objections. The Registrant responded promptly to the email confirming she had no objections to the document being provided to the Panel.

Decision on Facts:

Particular 1:

On a date between September 2021 to March 2022, did not provide adequate treatment to a patient in that you:
a) did not check the patient's C-Spine – (proved)
b) did not provide adequate care for a patient's pain - (proved)
c) did not ask the patient and / or did not check the patient's notes to find out what medication they were on – (proved)

24. CH told the Panel that she had worked some initial shifts with the Registrant when the Registrant commenced her role at CMS. All NQP’s were required to complete a minimum of 150 hours with another paramedic before they were allowed to work alone.

25. CH explained that her approach was to allow the Registrant to take the lead to develop her skills. During one of these initial shifts CH told the Panel that she had concerns about the Registrant’s treatment of an elderly patient who had suffered a fall in a care home.

26. CH explained that when she and the Registrant attended at the incident involving the lady who had fallen, the Registrant did not check the patient’s C-Spine or ask about neck pain. In addition, the Registrant did not ask the Patient about any medication they were taking or check the patient’s notes which were available on a table near the bathroom.

27. CH told the Panel that when she placed the blood pressure cuff on the patient’s arm she complained of pain. CH explained that she asked loudly if the pain was new, and the Registrant did not react. CH then told the Registrant about the pain but there was no reaction. As a result, CH assessed the patient’s arm and discovered that the patient had a dislocated shoulder. The Panel accepted CH’s evidence that the Registrant did not offer pain relief or a sling to manage the patient’s pain.

28. The Registrant took the patient to the toilet. CH stated that she asked the Registrant if the patient was on blood thinners and the Registrant responded that she did not think so. CH then checked the patients notes and discovered that the patient was on two different blood thinners. Whilst in the toilet, the patient became less responsive, and CH made the decision to take the patient to hospital.

29. CH told the Panel that she discussed the Registrant’s decision making and asked why she had not checked the C-Spine. The Registrant responded that it was because the care home staff had already got the patient up off the floor.

30. The Panel accepted the evidence of CH, which was clear, consistent and unchallenged. The Panel was satisfied that the Registrant had not checked the patients C-Spine, had not responded to a prompt that the patient was in pain and had not checked the notes or asked the patient about any medications they were taking.

Particular 2:

On 3 May 2022, did not complete a safeguarding referral after seeing Patient A – (proved)

31. The Panel accepted the evidence of EM who told the Panel that, following a complaint from Patient A, it was identified that the Registrant ought to have made a safeguarding referral in relation to this Patient.

32. EM explained that whilst investigating the complaint it was discovered that Patient A had taken an overdose, there were young children in the house and the patient had refused treatment. EM’s evidence to the Panel was that a safeguarding referral should have been made in these circumstances.

33. The Panel noted the documentation completed by the Registrant at the time of seeing the patient on 3 May 2022. This did not make any reference to a safeguarding concern. In a statement produced by the Registrant dated 26 May 2022 in response to the complaint the Registrant stated, “We considered a safeguarding for the patient but due to another responsible adult living in the house and the patient being in hospital the previous day the crew didn’t think it was needed.”

34. It was clear to the Panel that a safeguarding referral was not completed in relation to this Patient.

35. The Panel accepted the evidence of EM that a safeguarding referral was required due to the presence of young children, the mental health issues of the Patient and the refusal of care by the Patient. The Panel considered that the Safeguarding Policy together with a common-sense assessment of the circumstances should have led the Registrant to make a safeguarding referral.

Particular 3:

On 31 August 2022, did not adequately complete a safeguarding referral in relation to a patient in that you did not include:
a) the name of the care supplier – (Not Proved)
b) the name of the patient's daughter – (Not Proved)

36. The Panel noted that the Registrant did complete a safeguarding referral following her visit to an elderly patient with a level 2 pressure sore. The Panel noted EM’s evidence that there was no detail of the care supplier, and this information was requested by the Care Quality Commission in order to progress the matter. EM told the Panel that she sent a query over to the crew about the name of the care agency. The Panel also noted that EM said in her statement, “Often mistakes are made on safeguarding referrals. Approximately, two to three times a week.”

37. The Panel concluded that it would have been clearer if the Registrant had included more detail on the form and this would have been helpful to those who were responsible for investigating. However, the Panel noted that the Registrant had properly made a referral and given a narrative explanation. The Panel also noted that there were the Patient details and an address, and a telephone number.

38. In all the circumstances the Panel considered that the referral was adequate to raise the concern and ensure that steps could be taken to identify the care supplier. The Panel accepted that it would have been more helpful if this information was included but the failure to include these details did not make the safeguarding referral inadequate.

Particular 4 a)

On 5 September 2022, in relation to Patient B:
a) did not provide adequate treatment to Patient B in that you:
i. left Patient B at home when they should have been taken to hospital and/or - (Proved)
ii. did not safeguard Patient B by referring them to their GP and/or – (Not Proved)
iii. did not make a safeguarding referral – (Proved)

39. The Panel heard evidence from LL in relation to this incident who explained that she attended Patient B on the 5 September 2022. LL explained that she was the third ambulance crew to be called to Patient B and the Registrant had been the lead clinician on the second crew and had left the Patient at home.

40. LL told the Panel that in her assessment the Patient lacked capacity to refuse treatment and was unable to retain information or repeat information. LL obtained information from the Patient’s father that his Glasgow Coma Scale (GCS) score was normally 15 and he is normally independent.

41. The Panel noted that the Registrant in her assessment recognised that the Patient’s condition required taking him to hospital, but she had left him at home on the basis that he had capacity to refuse treatment. In her assessment of capacity on the documentation completed at the time, she recorded that the Patients GCS was 13 and this was “normal for him”. The Registrant did not record that a two-stage capacity assessment was undertaken.

42. After the event, when completing a reflection dated 13 September 2022 the Registrant stated that the Patient had recently had a “DOLS” assessment and was deemed to have capacity and he was able to retain and repeat information. The Registrant stated she was satisfied that the patient had capacity.

43. The Panel noted LL’s evidence that upon arrival at hospital a nurse who was familiar with the patient confirmed that she was aware that the patient did not have capacity. LL told the Panel that she attempted to discuss this issue with the Registrant, but the Registrant shrugged her shoulders and laughed.

44. The Panel accepted the evidence of LL that the patient did not have capacity to refuse treatment and should have been taken to hospital. The Panel considered that LL’s assessment of Patient B’s capacity was more likely to be accurate as she had taken a thorough history, and she had considered information from the Patient’s father. This appeared to be supported by a nurse at the hospital who was familiar with the patient. The Panel also noted the documentation completed by LL at the time which clearly set out her observations with regard to capacity and her rationale for the GCS score and this was consistent with the oral evidence she gave to the Panel.

45. The Panel considered that the details later recalled by the Registrant in her reflection about the Patient’s capacity were unlikely to be accurate given the contemporaneous evidence about the presentation of the patient at the time. The Panel also noted that the Registrant had documented that the Patient had short term memory loss which would be inconsistent with full capacity. The Panel therefore concluded that Patient B did not have capacity to refuse treatment and should have been taken to hospital.

46. The Panel was unable to identify any evidence which suggested that a referral to the Patient’s GP was required in these circumstances. LL did not make a referral to the GP. The Panel also noted that there was no requirement in the pathway for a GP referral to be made. In any event, the Panel noted that in her reflection dated 13 September 2022 the Registrant stated that she contacted the Clinical Assessment team (CAT) to make them aware of the situations and “CAT then made a referral and passed an email onto the patient’s GP…” In these circumstances the Panel considered there was insufficient evidence to find this particular proved.

47. The Panel noted the evidence of LL regarding the condition of the Patient’s home and surroundings when she attended. LL also noted that there were difficulties between Patient B and his father and that the father was suggesting he did not want to care for his son any longer. As a result of these concerns LL completed a safeguarding referral.

48. The Panel noted that these concerns were supported by the Registrant’s reflection dated 13 September 2022 in which she noted that the father had stated he would not call an ambulance in future. The Registrant recorded, “At this point, I did wish to complete a safeguard referral but did not complete on due to the patients father refusing to give his contact details to me.” (sic). The Panel also noted an entry on the form completed at the time which states “ps dad refused referral from crew.”

49. The Panel considered that the lack of contact details for the patient’s father was not a reason not to complete a safeguarding referral in these circumstances. The Panel considered that the concerns were obvious and known to the Registrant and the refusal to provide details from the father did not absolve her of the responsibility to make the referral in respect of this patient.

Particular 4 b)

b) did not maintain accurate and complete records for Patient B in that you did not record the following:
i) the time the patient was discharged - (Proved)
ii) a two stage capacity assessment - (Proved)
iii) Patient B's recent medical history including:
1) Patient B's recent brain bleed - (Proved)
2) Patient B's recent cardiac arrest due by hypoglycaemia - (Proved)
3) that Patient B had dialysis three times a week - (Proved)

50. The Panel noted the Patient Report Form (PRF) completed by the Registrant in relation to Patient B. The Panel noted that the box relating to the time the patient was discharged at home is blank. Similarly, in the capacity section the two stage test boxes are also blank. The Registrant stated in her reflection dated 13 September 2022 that a two stage test was undertaken but the Panel could not see any record of it. The Panel considered that the records were therefore incomplete.

51. The Panel noted from LL’s evidence, together with the PRF that she completed, that Patient B had a significant medical history which included a recent brain bleed, a recent cardiac arrest and that he had dialysis three times per week. The Panel considered that these were important factors that should have been recorded as part of Patient B’s past medical history and it accepted the evidence of LL that these were basic questions for a paramedic. The Panel noted that the Registrant’s PRF is lacking in significant detail regarding Patient B’s medical history. The Panel accepted the evidence of LL that this paperwork was poor and did not contain the required detail.

Particular 5 a)

In or around September 2022,
a) did not provide adequate treatment to a patient in that you:
i. did not provide an accurate and/or complete handover – (Proved)
ii. did not do an airway assessment and/or a chest auscultation – (Proved)
iii. applied a blood pressure cuff before assessing the patient's breathing – (Proved)
iv. did not obtain intravenous access – (Proved)
v. did not do cardiac monitoring – (Proved)
vi. did not accurately assess the patient's Glasgow Coma Scale – (Not Proved)

52. The Panel noted the evidence of DP who explained that she had attended this incident in response to a call for priority assistance made by the Registrant. The Registrant had initially attended the patient in the Rapid Response Vehicle accompanied by a student and then requested an ambulance. DP stated that when she arrived 15 minutes later the Registrant was not doing anything and appeared to be “waiting for someone to come and do the work for her.” DP noted that the patient had a blood pressure cuff, and an oxygen saturation probe applied.

53. DP told the Panel that she asked the Registrant for a handover and the Registrant’s responses were vague and she did not provide any information about what had happened. DP stated that the Registrant had not done an airway assessment or breathing assessment and had not done a chest auscultation. The Registrant had not undertaken cardiac monitoring or arranged IV access. DP explained to the Panel that the Registrant had been on the scene for at least 15 minutes, and she would have expected these basic tasks to have been undertaken.

54. DP told the Panel in her oral evidence that the Registrant appeared “overwhelmed” and had admitted to her that she had been “panicking”.

55. The Panel accepted the evidence of DP that the Registrant had not carried out an adequate assessment and had not undertaken basic tasks or gathered relevant history. The Panel considered that in the 15 minutes that she had been on scene there had been plenty of time to do so before the arrival of the ambulance. The Panel accepted the evidence of DP and was satisfied that particulars 5a (i-iv) were proved.

56. The Panel noted that the Registrant had assessed the patient’s Glasgow Coma Scale score as 3. DP assessed the patient’s GCS score as 5 following speaking to the patient as the patient became tearful and had eye movement. In her oral evidence, DP accepted that this was something that could have changed since the patient had been seen by the Registrant. In these circumstances the Panel was not satisfied that the Registrant’s initial assessment was inaccurate. It therefore found this particular not proved.

Particular 5 b)

b) did not provide adequate treatment to a patient in that you:
i. stated that the patient had a panic attack when there were clinical indications that the patient was suffering from heart failure (Proved)
ii. placed the patient on a salbutamol nebuliser when this was not clinically appropriate (Proved)
iii. did not perform an ECG(Proved)

57. The Panel noted the evidence of DP who explained that this incident was another occasion when she had attended as a back-up following a request by the Registrant. DP explained that the Registrant had requested a priority 3 back-up which is the lowest priority. DP told the Panel that the Registrant handed over to her that the patient was suffering from a panic attack which had exacerbated the patient’s existing Chronic Obstructive Pulmonary Disease (COPD). This was the information recorded by the Registrant on the Patient Report Form.

58. DP stated that upon arrival the patient was “tri-poding” which is a red flag for patients with difficulty breathing. In addition, the patient had excessive accessory muscle use, and her oxygen saturation levels were 78 percent which is very low. Further observations taken by DP recorded that the patient had a high heart rate and low blood pressure. DP told the panel that all of these observations made it clear that the patient was suffering from heart failure and not a panic attack.

59. DP told the Panel that the Registrant had placed the patient on a salbutamol nebuliser for 6 minutes prior to her arrival but this had been stopped, and the Registrant had not continued with any oxygen therapy. DP explained that salbutamol can increase the heart rate and should not have been given to this patient with these symptoms. In addition, DP explained that the Registrant had not undertaken an ECG to look for any cardiac issues.

60. DP told the Panel that this was a seriously unwell patient who was deteriorating. The patient was immediately conveyed to hospital on blue lights and provided with oxygen therapy en-route. DP told the Panel that the Registrant challenged her about why the patient was transferred on blue lights and did not seem to understand why this had been done. DP contacted the Registrant after this and offered advice and assistance as part of her development. DP told the Panel that the Registrant did not want to engage with this offer and stated, “I hate being on the car”. DP told the Panel that there was no acknowledgement or reflection from the Registrant about these concerns.

61. The Panel accepted the evidence of DP and concluded that the Registrant’s failure to accurately diagnose the patient and the subsequent failure to carry out an ECG and giving salbutamol instead of oxygen therapy was not adequate treatment.

Particular 6

On 9 November 2022, did not provide adequate treatment to a patient who had a head injury in that you:
a) did not carry out a full assessment of the patient – (Proved)
b) did not complete the minor injuries form – (Proved)

62. The Panel heard evidence from EM that on 16 November 2022 a complaint was received from Oundle School Medical Team regarding treatment provided to a student during a rugby game. It was alleged that a student had suffered a head injury and was given a bandage and allowed to return to the game. As a result, the student did not attend at the medical centre until much later and was subsequently referred to minor injuries and advised not to play rugby for 2 weeks.

63. EM told the Panel that the Registrant, together with an Emergency Medical Technician (“EMT”) were providing medical cover on the 9 November 2022 at the school. EM explained that as part of this role the Registrant would attend at the school medical centre for a briefing and then attend at the sports event and provide any medical assistance as required. EM told the Panel that it was expected that if any treatment was provided that a “minor injuries form” was completed which detailed the assessment and outlined the treatment and advice given.

64. EM told the Panel that the usual response in the case of a head injury would have been for the student to have been referred to the medical centre immediately, particularly if the student was bleeding and had a head injury. She explained that she would have expected a minor injuries form to have been completed but one was not completed for this student. EM told the Panel that when she discussed this incident with the Registrant, the Registrant stated that she had no involvement in the incident and the EMT provided the bandage.

65. The Panel considered that the evidence demonstrated that the Registrant had not undertaken any form of assessment in relation to this student’s head injury and had not completed any paperwork in relation to it. The Panel accepted the evidence of EM that it would be appropriate to assess and document the injury and transport to the health centre for review.

66. The Panel also accepted the evidence of RB as a senior and experienced paramedic that the head injury should have been properly assessed and documented and advice given and documented about what to do if symptoms worsen.

67. The Panel was satisfied that the Registrant’s failure to undertake an assessment and complete the documentation amounted to inadequate treatment of the patient. There was no assessment of the initial severity of the injury which resulted in the student returning to play when he may not have been fit to do so, in addition the failure to document the assessment and treatment affected the subsequent follow-up care of the student as it was not known by the school medical staff that he had been injured until he presented at the medical centre much later.

Particular 7 a)

On 17 November 2022,
a. did not provide adequate treatment to a patient in that you:
i. did not do a full abdominal assessment - (Proved)
ii. required prompting to undertake an ECG - (Proved)
iii. required prompting to administer pain relief - (Proved)

68. The Panel noted the evidence of LL that on 17 November 2022 she was undertaking a shift with the Registrant following the restriction on the Registrant’s practice to provide support and mentoring. LL told the Panel that on arrival, the patient was in severe abdominal pain and also complaining of chest pain. LL set out in her witness statement the process for an abdominal assessment which consists of looking at the abdomen, auscultate every quadrant, percussion of the abdomen and palpating the abdomen. LL told the Panel that the Registrant “had a quick feel” of the patient’s abdomen and had to be told to undertake a full assessment. The Panel accepted this evidence and was satisfied that the Registrant had not undertaken a full abdominal assessment, and this amounted to inadequate treatment.

69. The Panel accepted the evidence of LL that the Registrant required prompting to undertake an ECG and to consider pain relief. The Panel considered that the evidence of LL was clear and consistent, and she explained to the Panel why pain relief and an ECG were required in these circumstances and that this should have been appreciated by the Registrant.

Particular 7 b)

b) did not provide adequate treatment to a patient with mental health concerns, in that you:
i. did not interact with the patient - (Proved)
ii. did not assist Colleague A in managing the patient - (Proved)

70. The Panel noted the evidence of LL relating to the second patient that was seen on the 17 November 2022. LL told the Panel that she was the attending paramedic for this patient, which she explained meant that she was taking the lead. However, she told the Panel that crews work as a team and that it was her expectation that the Registrant would support her, for example by taking observations or undertaking other tasks. This evidence was supported by RB who confirmed that Paramedics work as a team.

71. LL told the Panel that during her assessment of the patient the Registrant did not engage with the patient at all. The Registrant did not greet the patient, introduce herself or say anything at all to the patient and sat in a chair to the side. The patient had mental health conditions and became aggressive towards LL. The patient threw a bottle of coke at LL and then ran away from the supported housing. LL told the Panel that during this incident and subsequently when she was trying to find the patient, the Registrant sat with a cup of tea and provided no assistance. Whilst LL explained that she ensured that the patient was adequately treated in spite of the Registrant’s actions the Panel nevertheless considered that the failure of the Registrant to interact or assist with the managing of the patient deprived the patient of the best care. The Panel noted the evidence of RB who confirmed that sitting with a cup of tea in another room is not acceptable in these circumstances.

Particular 8)

Between August 2021 and November 2022, did not complete your NQP portfolio adequately or at all. – (Proved)

72. The Panel accepted the evidence of RB who explained that as part of her development the Registrant was required to complete a NQP portfolio. RB told the Panel that this portfolio should include reflections on work undertaken, mentoring discussions, self-directed learning and study and details of external courses attended. RB told the Panel that following the concerns being raised against the Registrant he requested details of the work that the Registrant had carried out as part of her NQP pathway.

73. RB told the Panel that at a meeting on 14 November 2022 he met the Registrant for an NQP catch up. He explained that there was minimal evidence within the portfolio that the Registrant had carried out any learning as required. Following the meeting four reflective pieces were emailed to him by the Registrant. RB told the Panel that these reflections lacked depth and did not follow an appropriate model.

74. The Panel noted the content of the NQP portfolio and accepted the evidence of RB that this was not adequately completed and did not demonstrate sufficient development as required by the pathway.

Decision on Grounds:

75. When considering whether the facts found proved amounted to the statutory ground of lack of competence the Panel had regard to the submissions of Ms Bernard-Stevenson and the advice of the Legal Assessor.

76. The Panel considered that the evidence given by the witnesses suggested the Registrant had the required knowledge and skills at the outset and there were initially no concerns with her performance. The Panel noted that the Registrant had been undertaking the role for over 12 months before any serious concerns were raised about her skills. RB told the Panel that it was possible that the lack of knowledge was always present, but it was also possible that the Registrant had become lazy with experience.

77. The Panel noted that the facts found proved related to a range of different scenarios and there did not appear to be a consistent or obvious pattern. The witnesses suggested that the failings were in relation to very basic paramedic skills which seemed to the Panel to be inconsistent with a lack of competence given that there were no concerns raised at the outset and that the Registrant had seen a significant number of patients.

78. The Panel noted that LL, DP, CH and RB told the Panel that the Registrant was reluctant to engage with assistance that was offered, or take on board any feedback. The Panel considered that there was evidence that suggested that some of the facts found proved may be more properly characterised as misconduct as it appeared that there was evidence that the Registrant did have the skills and knowledge required.

79. In these circumstances, the Panel determined to adjourn this aspect of their deliberations to allow the parties to provide submissions on whether the Allegation should be amended to include the statutory ground of misconduct at the resumed hearing.

Resuming hearing on 21 – 23 July 2025:

Service

80. The Panel was informed by the Hearings Officer that notice of this resuming hearing was sent to the Registrant’s registered email address on 10 April 2025. That email set out that the hearing was due to begin on 21 July 2025 and that the hearing would be a virtual hearing. The Registrant confirmed in an email dated 16 June 2025 that she was aware of the hearing and would not be attending.

81. The Panel accepted the advice of the Legal Assessor who reminded it of Rule 3(1)b and 6(2) of the Conduct and Competence Committee rules. The Panel was satisfied that notice had been properly served and that the notice period was longer than required by the rules.

Proceeding in the absence of the Registrant

82. Ms Bernard-Stevenson applied to proceed in the Registrant’s absence. She submitted that the Registrant did not attend the previous hearing and has indicated that she will not be attending this resuming hearing. Ms Bernard-Stevenson submitted that the Registrant is aware of the proceedings and has not asked for an adjournment. She submitted that the Registrant has chosen to voluntarily absent herself from this hearing and there is no indication that she would attend any future hearing.

83. The Panel heard and accepted the advice of the Legal Assessor who advised that the Panel’s discretion to proceed in the Registrant’s absence should only be exercised with the utmost care and caution. She referred the Panel to the cases of R v Hayward, Jones & Purvis in the Court of Appeal ([2001] EWCA Crim 168), and GMC v Adeogba and Visvardis [2016] EWCA Civ 162. She advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and the public interest. That case further stated that, “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”.

84. The Panel has also taken into account the HCPTS’s Practice Note on Proceeding in the Absence of the Registrant.

85. The Panel was satisfied that notice of this hearing was sent to the Registrant’s registered email address and that the Registrant is aware of the hearing.

86. The Panel noted that the Registrant had not sought an adjournment or suggested that she would attend at a later date. The Panel therefore concluded that the Registrant had voluntarily decided not to attend this hearing.

87. The Panel was satisfied that any disadvantage to the Registrant was outweighed by the public interest in the expeditious disposal of this matter. The Panel therefore decided to proceed in the Registrant’s absence.

Decision to amend the Allegation:

88. Given that the particulars were pleaded as lack of competence and given the Panel’s reasoning as set out at paragraphs 75-79 above, the Panel considered whether it should of its own motion amend the statutory ground to include misconduct.

89. The Panel noted the submissions of Ms Bernard-Stevenson which were that the HCPC did not consider that it was appropriate to amend the statutory grounds on the basis that the Investigating Committee had specifically considered this aspect and could not identify anything in the evidence which amounted to “malign intent”. Therefore, the ground of misconduct was not referred to the Conduct and Competence Committee. Ms Bernard-Stevenson submitted it would be unusual for a Panel to amend the grounds at this late stage of proceedings and she maintained that the HCPC’s position was that the facts found proved amounted to a lack of competence for the reasons set out in her previous submissions. Ms Bernard-Stevenson confirmed that she had no further submissions to make should the Panel decide to consider the statutory ground of misconduct.

90. The Registrant had been sent the decision of the Panel in which this aspect was set out in paras 75-79. On the 16 June 2025 she was sent an email from the case manager which explained that the HCPC’s position was that it would not be applying for any amendment to the statutory ground and incorrectly asserted that on this basis the Panel’s powers at the resumed hearing “will be limited” to a finding of a lack of competence and a striking off order would not be open to it. The Registrant responded to this email on the same day that she had no further submissions to make.

91. On the morning of the resumed hearing Ms Bernard-Stevenson sent an email to the Registrant which explained that the Panel was considering amending the statutory grounds to include the ground of misconduct of its own motion. This email set out that if the Panel did make such an amendment, then a striking off order would be available. The Registrant responded to say that she understood this position, that she did not intend to attend the hearing as she had recently given birth, she did not request an adjournment, and she would not be attending any hearing going forward.

92. The Panel considered that it would be appropriate to amend the statutory grounds to include misconduct. The Panel considered that the evidence before it, which was not before the Investigating Committee, suggested that the Registrant did have the skills required but had not used them because she had potentially become complacent with experience. The Panel noted that the witnesses, when asked about the Registrant’s skills, did not raise any significant concerns about her abilities whilst she had been undertaking the role, until the first complaint was received in May 2022. The Panel considered that the facts it had found proved related to very basic paramedic tasks that the Registrant would have been required to undertake with every patient such as history taking, undertaking assessments and recording basic information. The Panel did not consider it was credible that the Registrant had initially been able to undertake these basic tasks and then was no longer able to do so.

93. The Panel had at the forefront of its mind the HCPC’s overarching objective to protect the public and its obligation to ensure that the Allegation before it accurately reflected the seriousness of the conduct. The Panel was mindful that this amendment did widen the scope of the case against the Registrant and opened up the possible sanction of a striking off order. However, the Panel considered that the Registrant was made aware of this possibility in the Panel’s decision which was sent to her in March 2025. Notwithstanding the letter sent by the HCPC confirming it was not intending to apply for an amendment, the Panel considered that it had been made clear to the Registrant that this was an amendment contemplated by the Panel. The Registrant had confirmed in writing that she understood the consequences of this amendment and confirmed that she did not wish to provide any representations nor did she request an adjournment to enable her to attend. In these circumstances the Panel considered that the amendment could be made without injustice and it determined to add the statutory ground of misconduct to the Allegation. Therefore, Particulars 9 and 10 of the Allegation were amended to include the wording “and/or misconduct”.

Decision on Statutory Grounds:

94. In reaching its decision on the statutory grounds of lack of competence and/or misconduct, the Panel took account of the submissions and accepted legal advice.

95. The statutory grounds are contained within the Health Professions Order 2001 at article 22(1). The Panel was conscious that the establishment of a statutory ground was not something that the HCPC was required to prove, but rather a matter for its own judgement having heard all of the evidence. The Panel recognised that it was required to provide a decision in sufficient detail for readers to understand why the facts do or do not amount to the ground alleged.

96. The Legal Assessor referred the Panel to the leading case of R (Calhaem) v GMC [2007] EWHC 2606 (Admin) in respect of the test to be applied to determine whether a registrant lacks competence, and that of Holton v GMC [2006] EWHC 2960 (Admin), which established that a registrant should be judged against the standard reasonably expected of any professional undertaking a role.

97. In relation to misconduct the Legal Assessor advised that the Panel should consider whether the Registrant had acted in a way which fell far short of what would be proper in the circumstances and what the public would expect of a registered Paramedic. The Legal Assessor referred the Panel to the definition of “misconduct” as set out in the case of Roylance v GMC [2001] 1 AC 311 which states,

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a [medical] practitioner in the particular circumstances”.

Lack of competence

98. The Panel reviewed the facts found proved, noting that these spanned a discrete period of the Registrant’s employment and there were no significant concerns raised between April 2021 and May 2022. The Panel had evidence that the Registrant was able to complete documentation to a satisfactory standard and had demonstrated that she was able to undertake assessments and had the knowledge and skills required of a newly qualified paramedic between April 2021 and May 2022. The Panel noted that the facts found proved related to very different failures and there was no obvious pattern of incompetence. The Panel noted that the Registrant would have seen a significant number of patients during her employment and it was not satisfied that it had been provided with a fair sample of her work on which to conclude her professional performance was as a result of lack of competence.

99. The Panel noted the evidence from RB that it was possible that the Registrant had become “lazy” with experience.

100. The Panel considered that the facts found proved were more accurately characterised as misconduct for the following reasons.

Misconduct

101. With regard to the facts found proved at Particular 1, 4a) i, 5a, 5b, 6a and 7a the Panel noted that these findings demonstrated a failure to undertake very basic tasks and assessments, provide basic care and demonstrate empathy to patients in pain. The Panel noted that the Registrant did not respond to prompting to undertake some of these tasks and did not take on board any feedback about her failings or ask for further learning. The Panel noted the evidence of LL that the Registrant “laughed” when LL attempted to explain the seriousness of Patient B’s situation. The Panel considered that this was demonstrative of a cavalier attitude and a lack of professionalism. It was the view of the Panel that the Registrant was aware of her responsibilities to undertake these basic tasks but did not do so. The Panel considered that as a result of the Registrant’s actions, Patients were not conveyed to hospital when they should have been, were not given timely and appropriate care and were placed at risk of serious harm.

102. In relation to the facts found proved at Particular 2 and 4a) iii the Panel considered that this further amounted to misconduct rather than a lack of competence. The Registrant had previously completed safeguarding referrals satisfactorily and there was no evidence before the Panel that an inability to recognise safeguarding issues was a general trend in the Registrant’s practice. On both occasions the Registrant stated in her reflections that she was aware that there were safeguarding issues, but she failed to make a referral. The Panel considered that the reasons given by the Registrant for failing to make a referral in both cases amounted to excuses rather than a legitimate, albeit incorrect, clinical judgement. The Panel considered that the Registrant neglected her responsibilities towards children and vulnerable patients and left them in situations where they could have come to harm. The Panel considered that this would be considered deplorable by fellow practitioners and amounted to misconduct.

103. With regard to the facts found proved at Particulars 4b and 6b, the Panel noted that this related to basic record keeping. The Panel considered that there was evidence that the Registrant was able to keep accurate records and there was no evidence that this was a general issue with the Registrant’s practice. The Panel considered that the failures in the Registrant’s record keeping on these occasions was as a result of taking “short-cuts” with her assessments and failing to carry out the tasks required of her. The Panel noted that the Registrant had included significant details in the PRF for Patient B but had failed to include the capacity assessment she later stated she had undertaken which the Panel has found was unlikely to have been the case. Further, the Registrant stated she had not completed a minor injuries form for the patient with a head injury because she explained she had not seen him in circumstances where the Panel considered she ought to have ensured that any assessment and treatment given was recorded on the minor injuries form. The Panel considered that these failings were attitudinal in nature and representative of complacency and a disregard for the Registrant’s responsibilities to keep full and accurate records. These failings meant that future practitioners were unable to see the full picture. In relation to Patient B, the PRF did not include the seriousness of his condition nor a clear explanation of her capacity assessment that explained her reasoning for leaving a seriously ill patient at home. In relation to the child with a head injury the Panel considered this could have had serious consequences. The Panel considered this amounted to serious professional misconduct.

104. With regard to the facts found proved at Particular 7b) the Panel considered that the Registrant had failed to assist her colleague in providing basic care to a patient and had taken a “back seat” and was having a cup of tea instead of assisting. The Panel considered that this conduct was reflective of an unprofessional attitude towards the Registrant’s responsibilities rather than an inability to understand what was required of her and could properly be characterised as misconduct.

105. In relation to the facts found proved at Particular 8 the Panel considered that the Registrant’s portfolio was a key aspect of her role and she would have been well aware of her responsibility to ensure it was adequately completed to demonstrate her continuing professional development, especially as a newly qualified paramedic. The Panel had no evidence that the Registrant ever raised with anyone that she was in difficulties completing her portfolio. The Panel had no evidence that the Registrant did not know what was required of her with regard to the completion of her portfolio and there was evidence that the Registrant had worked on her portfolio earlier in her employment. In these circumstances the Panel considered that the Registrant was aware of what was required of her and had chosen not to complete or prioritise this work. In these circumstances the Panel considered that this amounted to serious misconduct.

106. The Panel gave careful consideration to the HCPC Standards of Conduct, Performance and Ethics (Jan 2016) and concluded that the Registrant’s conduct had breached the following standards:

• 2.5 - You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
• 3.4 - You must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development.
• 6.1 - You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
• 7.1 - You must report any concerns about the safety or well-being of service users promptly and appropriately.
• 7.3 - You must take appropriate action if you have concerns about the safety or well-being of children or vulnerable adults.
• 9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
• 10.1 - You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

107. In relation to the Particulars found proved the Panel considered that the Registrant’s conduct amounted to a serious departure from the standards such as to constitute serious misconduct. The Panel took the view that the concerns in this case were in relation to a failure to adhere to core professional responsibilities required of paramedics in order to practise safely and effectively. The Panel noted that the Registrant’s failings had placed vulnerable patients at risk of harm. The Panel considered that these failings both individually and collectively were serious and amounted to misconduct.

Decision on Impairment:

108. The Panel went on to consider the issue of impairment by reason of the Registrant's misconduct. It had careful regard to all the evidence before it and to the submissions of Ms Bernard-Stevenson for the HCPC. It accepted the advice of the Legal Assessor and had particular regard to the HCPTS Practice Note on “Fitness to Practise Impairment”.

109. Ms Bernard-Stevenson submitted that the Registrant’s fitness to practice was impaired both on public protection and public interest grounds. In summary in her written submission to the Panel she set out that in considering whether the misconduct had been remedied and was unlikely to be repeated, the Panel should consider the degree of insight and remediation shown by the Registrant. Ms Bernard-Stevenson submitted that the Registrant had provided no evidence of remediation and as such there was a risk of repetition. Further, she submitted that the need to uphold proper professional standards would be undermined if a finding of impairment were not made in this case.

110. The Panel first considered past impairment. It noted its findings that the Registrant had on a number of occasions failed to carry out basic tasks required of her which placed patients at unwarranted risk of harm. The Panel had found that that the Registrant had failed to safeguard vulnerable children and adults, failed to undertake full and appropriate assessments and failed to properly complete important records relating to patients and her own professional skills. The Panel had also found that the Registrant’s misconduct had breached key standards of the HCPC’s “Standards of conduct, performance and ethics” as set out above, and it considered this undermined public confidence in the profession.

111. The Panel went on to consider whether the Registrant’s fitness to practise is currently impaired by reason of that misconduct. In addressing the personal component of impairment, the Panel asked itself whether the Registrant is liable, now and in the future, to repeat misconduct of the kind found proved. In reaching its decision, the Panel had particular regard to the issues of insight and remediation.

112. The Panel noted that in the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin) Mrs Justice Cox stated:
“When considering whether or not fitness to practise is currently impaired, the level of insight shown by the practitioner is central to a proper determination of that issue.”

113. The Registrant has not submitted any material for this Panel to consider. The Panel noted the limited reflection that was prepared by the Registrant at the time of the events. The Registrant has not expressed any remorse for her conduct and has provided no information to explain any steps she has taken since these events to remedy her failings.

114. The Panel had careful regard to Silber J’s guidance in Cohen v GMC [2008] EWHC 581 (Admin) that Panels should take account of:
• Whether the conduct which led to the charge is easily remediable;
• Whether it has been remedied; and
• Whether it is highly unlikely to be repeated.

115. The Panel accepted that the Registrant was at the beginning of her career and her training was likely to have been affected during the Covid Pandemic. However, the Panel reminded itself that these were significant failings to undertake basic tasks and this could have had very serious consequences for service users. The Panel considered that it was fortunate that the Registrant’s failings were addressed by others and no lasting harm was caused. The Panel was mindful that it had determined that there was an attitudinal aspect to the misconduct which is difficult to remediate. However, the Panel considered that with the development of meaningful insight and application to the relevant training and development the Registrant’s misconduct is remediable.

116. The Panel considered that the Registrant had not provided evidence of any meaningful insight into the nature and gravity of her conduct. The Panel took into account the reflection provided by the Registrant in September 2022. However, it was not re-assured that the Registrant had an understanding of the impact her misconduct had on service users, colleagues and the wider profession. The Panel noted that the Registrant did not work for very long after these matters were brought to her attention and has not worked as a paramedic since. The Panel noted that it had no information about the Registrant’s current situation or any learning she has undertaken.

117. The Panel noted there was no evidence of any training or any other professional development undertaken by the Registrant. The Panel had no references or testimonials and no information that would enable it to conclude that the Registrant has learned from these events.

118. The Panel concluded that the Registrant had not developed meaningful insight and had not provided evidence of any remediation.

119. In light of its findings in relation to insight and remediation, the Panel considered that there remained a risk that the Registrant would repeat matters of the kind found proved. For these reasons, the Panel determined that a finding of impairment is required on public protection grounds.

120. The Panel then went on to consider whether a finding of impairment is necessary on public interest grounds. In addressing this component of impairment, the Panel had careful regard to the critically important public issues identified by Silber J in the case of Cohen when he said:

“Any approach to the issue of whether .... fitness to practise should be regarded as ‘impaired’ must take account of…the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour.”

121. The Panel considered that there had been a number of serious failings by the Registrant which had compromised the safety of patients. The Panel considered that the public would be very concerned to learn of the Registrant’s conduct in this matter. The Panel was of the view that public confidence in the profession and the regulatory process would be undermined if the Registrant were permitted to continue to hold unrestricted registration in circumstances where there was an appreciable risk of continuing patient harm. Therefore, the Panel concluded that it was otherwise in the public interest to make a finding of impaired fitness to practise.

122. For all the reasons set out above, the Panel determined that the Registrant’s fitness to practise is currently impaired on both public protection and public interest grounds.

Decision on Sanction:

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

124. The Panel had regard to all of the evidence in the case and the submissions made by Ms Bernard-Stevenson. The Panel also revisited all of the material it had seen and heard.

125. Ms Bernard-Stevenson submitted that the HCPC did not contend for a particular sanction and drew the Panel’s attention to the aggravating features she considered were applicable. These included that there was a repetition of the misconduct which covered a wide range of the Registrant’s practice. Ms Bernard Stevenson submitted that there was a lack of insight, remediation and remorse although she pointed out that there was some limited reflection at a local level. Ms Bernard -Stevenson submitted that there had been a failure to work in partnership with colleagues and service users had been exposed to a risk of harm which suggested a more serious sanction was appropriate. Ms Bernard-Stevenson addressed the Panel in relation to the principles as set out in the Sanctions Policy and reminded the Panel that any sanction imposed should be necessary and proportionate.

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

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

128. The Panel identified the following aggravating factors:

• The Registrant failed to safeguard vulnerable service users leading to a risk of serious harm;
• Wide ranging instances of misconduct over a significant period of time relating to the Registrant’s practice;
• Failure to respond to feedback and guidance offered to the Registrant;
• No evidence of remorse, insight or remediation throughout the period since her misconduct and a failure to engage constructively in these proceedings;
• Significant risk of repetition.

129. The Panel identified no mitigating factors.

130. The Panel determined that the nature of the misconduct in this case was too serious to make no Order.

131. The Panel considered whether to impose a Caution Order but decided that it was inappropriate as this was not an isolated instance of misconduct and there remains a significant risk of repetition. The Panel concluded that a Caution Order would not provide sufficient public protection.

132. The Panel considered that a Conditions of Practice Order was not appropriate because the Registrant had not engaged or shown any willingness to comply with any conditions. There are serious failings which placed service users at risk of harm and the Registrant has not shown any insight. In addition, some of the concerns arose whilst the Registrant was under supervision. The Panel did not consider it would be able to formulate conditions to address the attitudinal concerns found in this case. Further, the Panel considered that the concerns were too serious, and this sanction would not protect the public interest.

133. The Panel went on to consider whether a Suspension Order would be a proportionate and appropriate measure and concluded that this would protect the public during the period that it was in force. The Panel considered whether the Registrant should be afforded an opportunity to demonstrate insight or remediation, but concluded, on the basis of her lack of engagement, remorse and insight that she was very unlikely to respond and that a Suspension Order would serve no purpose other than to prolong these proceedings unnecessarily. The Panel considered that the Registrant has demonstrated a persistent lack of insight over a significant period since these events occurred which suggested that she was either unwilling or unable to remedy her failings.

134. The Panel noted paragraph 52 of the Sanctions Policy states, “Registrants who lack a genuine recognition of the concerns raised about their fitness to practise, and fail to understand or take responsibility for the impact or potential impact of their actions, are unlikely to take the steps necessary to safeguard service user safety to address the concerns raised. For this reason, in these cases panels are likely to take more serious action in order to protect the public.”

135. In considering the sanction of Striking Off, the Panel had in mind that it was the sanction of last resort and that there was a public interest in retaining qualified practitioners.

136. The Panel had regard to paragraph 131 of the Sanctions Policy which states,

“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:
• lacks insight;
• ….; or
• is unwilling to resolve matters.”

137. There was no evidence of remorse, insight, engagement or remediation presented to this Panel aside from limited reflective pieces completed by the Registrant at the time of the misconduct in 2022. In these circumstances the Panel considered this sanction was appropriate on the basis that there was no evidence that the Registrant had addressed her failings and no evidence that she was willing to do so in the future. In addition, the Panel considered that the nature and gravity of the misconduct found proved, in particular the failure to work in partnership with colleagues to safeguard vulnerable service users, was incompatible with continued registration.

138. A Striking Off Order was therefore the necessary and proportionate measure, both to protect the public and to uphold the wider public interest.

The Registrar is directed to strike the name of Ms Sophie Close 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 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: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Miss Sophie Close