James J Hughes

Preliminary Matters:
Service
1. The Panel has sight of the Notice of Hearing dated 10 April 2025, which had been sent by the HCPC to the Registrant at his registered email address. The email gave details of the hearing, including the date and time. The Panel has seen the electronic communications from Microsoft Outlook, dated 10 April 2025, which confirmed delivery of the email to the Registrant’s email address.
2. The Panel heard and accepted the advice of the Legal Assessor. The Panel was satisfied that there had been proper service of notice of the hearing in accordance with the Conduct and Competence Committee Procedure Rules 2003.
3. The Panel was also satisfied that reasonable notice of this review hearing on the papers had been given to the Registrant, him having been notified of it on 10 April 2025 and today being 8 May 2025.

Proceeding in the absence of the Registrant
4. The Registrant was not present and was not represented at this review hearing.
5. Ms Khorassani, on behalf of the HCPC, submitted that that the Panel should proceed with the hearing today in the absence of the Registrant as no response had been received from the Registrant despite multiple efforts made, good service had been found, the Registrant had voluntarily absented himself, this was a mandatory review hearing and adjourning will not secure future attendance.
6. The Panel heard the advice of the Legal Assessor. It took into account the HCPTS Practice Notes “Proceeding in the Absence of the Registrant” (June 2022). It took into account the submissions made by the HCPC. In considering the application, the Panel was mindful that its discretion to proceed in absence should be exercised with the utmost care and caution.
7. The Panel noted the seriousness of the allegations, and the need for public protection and for expeditious disposal of this review hearing. It took into account fairness to the Registrant and the potential prejudice to him in proceeding in his absence.
8. The Panel noted that the notice of the hearing has been properly served and multiple efforts made to engage with the Registrant. The Panel had regard to the telephone note of 30 April 2025 where the HCPC attempted telephone contact, there was no answer and a voicemail was left. The Hearings Officer had also made efforts and attempted to call the Registrant this morning with there being no reply. The Registrant had attended the previous hearings, thus would have the contact details should he wish to engage. The Panel concluded that the Registrant had voluntarily absented himself.
9. The Panel noted that there has been no application for an adjournment. This was a mandatory review of the current Order which is due to expire on 12 May 2025, and it was in the public interest for the review of the Order to take place as scheduled.
10. Accordingly, the Panel agreed to the application to proceed in the Registrant’s absence.

Background
11. The Registrant is a registered Paramedic (PA22651) and was employed by Great Sutton Medical Centre (‘the Employer’) as a Band 7 Paramedic, from December 2019 until April 2021.
12. On 06 February 2018, the Registrant was convicted of driving a motor vehicle whilst being over the exceeded prescribed limit of alcohol at Liverpool Knowsley and St Helens Magistrates’ Court, contrary to section 5(1)(a) of the Road Traffic Act 1988 and Schedule 2 to the Road Traffic Offenders Act 1988. As a result, the following penalties against the Registrant were imposed: fine of £100, £30 victim surcharge. £85 costs, a collection order and disqualification from holding or obtaining a driving licence for 18 months.
13. It was also alleged that the Registrant failed to advise the HCPC of the conviction, or make the appropriate declaration of the conviction on 29 June 2020 when completing the HCPC readmission form after his registration had lapsed.
14. In July 2020, concerns were raised by the HCPC’s Registrations Department regarding the Registrant’s conduct that he continued to work as a Paramedic whilst he was not registered with the HCPC, between 07 February 2020 and 24 July 2020.
15. As a result of the HCPC’s investigations into the above matters, the Employer raised concerns that the Registrant had failed to disclose to the Employer that he was not registered with the HCPC, between the relevant time set out above. The Employer subsequently conducted an internal investigation into these matters.
16. In addition to the above, on 29 June 2020, it is alleged that, when completing his readmission form to the HCPC, the Registrant did not tick the box on the form to indicate that he had been disciplined by a regulatory body or his employer.

Substantive Hearing on 11 December 2023
17. The matter eventually came to hearing before the Substantive Hearing Panel on 11 December 2023. The Registrant was unrepresented. Having heard evidence from the HCPC’s witnesses and from the Registrant, the Substantive Hearing Panel made the factual decisions outlined above. Further, it found that the Registrant was impaired in relation to the personal and public components.
18. In relation to Sanction, the Substantive Hearing Panel stated:

“170. The Panel considered all the information before it. In doing so, the Panel identified the following aggravating factors:
• That the Registrant repeated his dishonesty over a period of several months. This, the Panel concluded, was a particularly aggravating feature;
• The Registrant’s dishonesty was directed to both his employer and his regulator and had the potential to impact on his eligibility and suitability to practise as a paramedic;
• Notwithstanding that the Registrant has demonstrated some insight, the Panel has recognised that it was limited;
• The Registrant has demonstrated limited steps towards remediating his failings and keeping his knowledge and skills up to date;
• His initial lack of candour at the case review meeting in February 2021 in which he denied that his name had been removed from the register; and
• This is the third time that a disciplinary finding has been made against the Registrant. Whilst the Registrant’s two previous regulatory findings date from some years back, and were for unrelated matters, the Registrant should have had a heightened awareness of his duty to comply with his professional obligations, particularly given that the five year caution order imposed in July 2013 did not expire until mid-2018.

171. The Panel identified the following mitigating factors:
• The Registrant has engaged in the regulatory process and made early admissions to the factual particulars with the exception of the dishonesty allegations at the outset of the hearing;
• The Registrant has expressed remorse and apologised for his actions;
• The Registrant had difficult health and personal circumstances at the time. (REDACTED)
• The risk of direct patient harm was low;
• The Registrant’s dishonesty in relation to practising as a Paramedic whilst unregistered, arose from very particular circumstances which were unlikely to be replicated, and that the Registrant believed that his registration problems, which arose following a refused direct debit payment, would be quickly resolved.

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

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

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

175. The Panel then considered whether to impose a Caution Order and had regard to paragraphs 99-102 of the SP. The Panel concluded that this was also not an appropriate outcome because:
• For the reasons set out in its determination on misconduct in relation to dishonesty and impairment, the Panel did not consider the Registrant’s misconduct to be minor in nature;
• The Registrant’s insight was incomplete;
• The Panel considered that there remained an ongoing risk of repetition given the lack of effective remediation of his failings.

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

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

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

179. The Panel considered that a Suspension Order was the appropriate sanction to impose because:
• The matters found proved, as set out in the Panel’s determination on misconduct, represented serious breaches of the Standards of Conduct Performance and Ethics;
• The Registrant has demonstrated some insight into his failings particularly in relation to Particular 1;
• The Panel was mindful that a striking off order was appropriate for the most serious cases of dishonesty. It considered that the Registrant's failings were not so serious that they were fundamentally incompatible with remaining on the register. In reaching that conclusion, it had regard to paragraph 121 of the SP which states that a Suspension Order may be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. The Panel noted, as set out in the Panel’s determination on impairment, that the Registrant has developed some insight into his dishonest behaviour even though that process was not as yet complete.

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

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

182. So far as any future review is concerned, the Panel considered a future reviewing panel would be assisted by:
• His attendance at any review hearing;
• Further evidence of remediation in relation to addressing his dishonest behaviour;
(REDACTED)
• Evidence of reflection on his conduct demonstrating meaningful insight into the impact of his dishonest behaviour on the wider profession and the public;
• Up to date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;
• Evidence that the Registrant had kept his skills and knowledge up to date;
• Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.”

Substantive Review Hearing on 14 June 2024
19. The Suspension Order was subsequently reviewed on 14 June 2024, where it was extended for a further four months. The Registrant was present at the hearing. At that review, the previous review panel (in its private decision) stated the following:
“(REDACTED)’”

Substantive Review Hearing on 15 October 2024
20. The Suspension Order was again reviewed on 15 October 2024, where it was extended for a further six months. The Registrant was present at the hearing. At that review, the previous review panel (in its private decision) stated the following:
“(REDACTED)”

Submissions
21. Ms Khorassani, on behalf of the HCPC, submitted that the Registrant’s fitness to practise remains impaired on both the personal and public components, and that the HCPC was inviting the Panel to Strike Off the Registrant. She submitted that the Registrant had still not provided any evidence that he had complied with the previous panel’s recommendations. She submitted that the Panel had the power to make a Striking-off Order and the Registrant had been put on notice of this in the last review decision.
22. Ms Khorassani stated that after the last review hearing ended, she spent 45 minutes speaking to the Registrant to encourage him to provide the information/documents sought by the panel so that the Registrant may return to practice. She stated that at that stage the Registrant was undertaking voluntary work, so she suggested he obtain testimonials and written letters of support on the work done, but the Registrant described himself as “shy” and finding it difficult to do this. Despite this, she informed the Panel that she had encouraged the Registrant to provide the information so that he could evidence he is no longer impaired.
23. In light of the findings at the Substantive Hearing, Ms Khorassani submitted that the risks had not been addressed as the Registrant had failed to engage and thus had not discharged the persuasive burden upon him.
24. The Registrant did not attend and had provided no submissions or documents for the Panel to take into account.

Decision
25. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Notes; ‘Review of Article 30 Sanction Orders’ and ‘Fitness to Practise Impairment’. The Panel also had regard to the HCPC’s Standards of Conduct, Performance and Ethics, as well as the Sanctions Policy.
26. The Panel is carrying out a comprehensive reconsideration of the Suspension Order in light of the current circumstances. The Panel bore in mind that it must first decide if a finding of current impairment is necessary to protect the public from any risk of harm (assessing the extent of that current or future risk), maintain public confidence in the profession, or to declare and uphold the proper standards of conduct or behaviour. This is a matter for the Panel’s independent judgment and is essentially a risk assessment in light of all the information before the Panel today.
27. The Legal Assessor advised that, in practical terms, there was a persuasive burden on the Registrant to demonstrate that his fitness to practise is no longer impaired and that the concerns that led to the original finding of impairment have now been overcome. The Panel was referred to the case of Abrahaem v GMC [2008] EWHC 183 (Admin) and the principle that it is for a registrant to fully acknowledge why past performance was deficient and demonstrate that they have, “through insight, application, education, supervision and other achievement … sufficiently addressed the past impairments.”
28. It is only if the Panel determines that the Registrant’s fitness to practise remains impaired that the Panel should go on to consider sanction by applying the guidance as set out in the HCPC Sanctions Policy. The Panel must have regard to the principle of proportionality, which requires that the Registrant’s interests be balanced against the interests of the public.
29. The Panel first considered whether the Registrant’s fitness to practise is currently impaired and it exercised its own professional judgement in this regard. In undertaking this review, the Panel took into account all of the documentation before it, including the determination from the previous hearings where the panel identified that there was an ongoing risk to the public because of the Registrant’s lack of insight.
30. The Panel also took into account the HCPC submissions. There was no evidence or documents on behalf of the Registrant.
31. The Panel noted that the Registrant’s misconduct in this case related to a finding that he had been convicted of driving with excess alcohol and a failure to honestly and appropriately disclose this information to the HCPC on more than one occasion. The Registrant had not provided the previous panel with any evidence of testimonials, work undertaken, or evidence that he had kept his skills and knowledge up to date. This information was also not before this Panel despite the previous panel’s written determination clearly setting out what this Panel would be assisted by today. The Registrant had failed to attend or engage.
32. The Panel concluded that that there remained a lack of insight in respect of the impact of the Registrant’s actions and how they have affected the Paramedic profession and the wider public. Any steps taken to demonstrate insight at the previous hearing was found to fall short by the previous panel, such as not providing documentary evidence in support of the claimed reading and research, or a list of the reading undertaken. This had not changed at today’s hearing.
33. The Panel noted there had been nothing further provided since to persuade it that the insight had developed any further, so the same concerns on insight remain at the current time. The Panel were not satisfied that being “shy” was an acceptable reason in not being able to provide supporting insight from people he volunteered with in order to provide the Panel with evidence of the missing insight. The Panel had concerns on the Registrant’s inability to evidence the work he claimed to have undertaken, because this was limited to what he had informed the previous panels, and there was no evidence to verify the claims.
34. The Registrant had still not demonstrated an understanding of the impact of his actions and dishonesty on the public or the profession, or demonstrated how such conduct would not be repeated in the future. He had failed to discharge the persuasive burden on him of steps taken to demonstrate that he was no longer impaired and that he was safe to return to Paramedic practice.
35. The Panel find there is insufficient insight, insufficient evidence of steps taken to remediate the failings and the Panel had concerns on the risk of repetition.
36. In the circumstances, the Registrant still presented a risk to the public and public confidence in the profession, and the regulatory process, would be undermined should the Registrant be permitted to return to unrestricted practice. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired on both the personal and public components.
37. The Panel bore in mind that sanction is a matter for its own independent judgment and that the purpose of a sanction is not to punish the Registrant but to protect the public. Further, that any sanction must be proportionate, so that any order must be the least restrictive order that would protect the public interest, including public protection.
38. The Panel considered the option of taking no action or imposing a Caution Order however, it decided that it would not provide adequate protection for the public in view of its findings.
39. The Panel next considered the option of a Conditions of Practice Order. However, the Panel decided that conditions would not be workable, or appropriate, at the current time. In forming this view, the Panel noted that the Registrant had not engaged and the Panel could not be satisfied that he would comply with a Conditions of Practice Order. Additionally, he had also failed to demonstrate sufficient insight and it was unknown whether he was still working. The Panel also had regard to the findings of dishonesty, which can reasonably be deemed an attitudinal concern, and it was difficult to craft Conditions of Practice Order for such misconduct. For all of these reasons, the Panel determined that a conditions of practice order was not appropriate or workable.
40. The Panel next carefully considered extending the current Suspension Order against imposing a Striking-off Order. The Panel noted the HCPC submissions seeking a Striking-off Order and accept this is a decision that is open to it.
41. The previous panel had found the Registrant had taken some steps to reflect on his behaviour and his insight did appear to be developing. The Panel had regard to the Registrant’s previous engagement. He had attended both the substantive hearing and two further review hearings. The Panel, particularly having regard to the Registrant’s mental health, had concerns that the reason the Registrant did not attend or engage today was due to his ongoing health condition.
42. The Panel considered that a Striking-off Order would be disproportionate at the current time. It would deprive the Registrant an opportunity to engage. Whilst this hearing went ahead in his absence, it would be disproportionate, given his prior engagement, to impose a Striking-off Order. He had previously attended and expressed his desire to return to Paramedic practice and the previous panel had considered that the Registrant could go on to make a valuable contribution to the Paramedic profession.
43. Therefore, the Panel determine that the Registrant should be afforded a further opportunity to satisfy a future panel that his fitness to practise is no longer impaired. If at the future hearing the Registrant had still not engaged, or provided sufficient evidence, then a future reviewing panel may well consider that a Striking-off Order is the only remaining appropriate option available to it.
44. The Panel determined that the appropriate and proportionate Order, at the current time, is to extend the current Suspension Order. The Panel determined that this should be for a period of 10 months to allow the Registrant time to reflect further, to demonstrate insight into his misconduct and to take steps to demonstrate and evidence that his fitness to practice is no longer impaired. If there is anything that prevents him being able to engage, then the Registrant is to keep the HCPC updated.

45. The Panel considered that a review panel may be assisted by the following:

a. The Registrant’s attendance at a future review hearing;
b. evidence of remediation in relation to addressing:
i. how he would ensure that he would prevent any repetition of his failings in the future by utilising support; and
ii. how he would manage a return to practice, given that his absence from working as a paramedic for three years had diminished his skills as such;
c. (REDACTED)
d. Up to date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;
e. Evidence that the Registrant had kept his skills and knowledge up to date, together with an analysis of what he has learned from all CPD activities;
f. Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.

ORDER: The Registrar is directed to suspend the Registration of Mr James Hughes for a further 10 months from the date of the expiry of the current Order.

The Order imposed today will apply from 12 May 2024. This Order will be reviewed again before its expiry on 12 March 2026.

History of Hearings for James J Hughes