Parul Shah

Preliminary Matters

The notice of hearing

1. The Panel was shown an unredacted copy of an email sent to the Registrant on 25 June 2025, informing her of the date and time of this hearing, and of the fact that the hearing would be conducted by Microsoft Teams. The email was addressed to two email addresses. One of them was the email address held by the HCPC on the Register. The other was an email address which had been used by the Registrant in communications with the HCPC’s Solicitors. The Panel was satisfied that the email sent on 25 June 2025, satisfied the requirement that the Registrant should be provided with notice of this hearing.

The HCPC’s application to proceed in the absence of the Registrant

2. The Presenting Officer applied for a direction that the hearing should proceed in the absence of the Registrant. In support of this application the Panel was provided with a separate bundle of documents extending to 23 pages. This bundle of documents included her reply to a “Response Proforma: Notice of Allegation” completed on 28 January 2023, where the Registrant stated that she did not intend to appear at the hearing. Thereafter, the Registrant had repeatedly and consistently stated that she is not practising as a Dietitian and has no intention of doing so within the NHS and that she has no interest in the outcome of these fitness to practise proceedings. She has also repeatedly requested that she should not be communicated with concerning these proceedings.

3. The Panel acknowledged that to proceed with a hearing in the absence of the registrant it concerns, it must be satisfied that it would be fair to do so. In the present case there are no grounds upon which the Panel could find that there would be any likelihood of the Registrant engaging in a hearing on a future occasion were the present hearing to be adjourned. The allegation, having been referred for hearing by the Investigating Committee, must be decided at some stage. The issues already date back more than five years, and further delay would be contrary to the public interest. In all the circumstances the Panel was satisfied that the factors requiring the hearing to proceed outweighed any disadvantage arising from the Registrant’s absence. The Panel was also satisfied that in the circumstances described it would be fair to the Registrant for the hearing to continue. Accordingly, the Panel acceded to the HCPC’s application.

The applications to amend the allegation

4. At the commencement of the hearing, the Presenting Officer applied to amend the allegation by deleting items, xxi, xxii and xxiii from Schedule 1, those being contentions that were expressed in terms similar to the criticisms advanced with regard to other patients, but which were stated to relate to two patients, namely Patient K and Patient L. The basis for the application to remove the three items was that in preparing the case for the hearing it had been appreciated that those two patients were already included in Schedule 1 as Patient B and Patient D. That being so, it was submitted, it would clearly not be appropriate for the complaints to be duplicated.

5. The Panel agreed to the deletions sought by the HCPC.

6. At the commencement of the hearing, particular 2(d) alleged that the Registrant, “did not complete an incident report in respect of the failure of the hoist.” After the HCPC’s evidence had been called and produced, the Presenting Officer made an application to add the words, “and/or did not do so in a timely manner”. It was submitted that the HCPC would not lead further evidence to deal with the proposed addition to the allegation; it could, it was submitted, be decided on the evidence that had already been produced by the HCPC. Furthermore, it was submitted that the addition of the words proposed would not result in the Registrant being prejudiced.

7. The Panel decided that if the proposed amendment could be made without prejudice to the Registrant, it would be desirable for the allegation to reflect the case that would be advanced by the HCPC. In view of the facts that no further evidence would be produced by the HCPC on this issue, and that the Registrant had not participated in the hearing, and was, therefore, not advancing a case in relation to this element of the allegation, the Panel concluded that there would be no prejudice to her in permitting the allegation. Accordingly, the Panel acceded to amend particular 2(d) by the addition of the words sought by the HCPC.

8. The allegation as it is set out at the head of this document is as amended in the two respects just described.

Background

9. The Registrant is registered with the HCPC as a Dietitian.

10. The matters relevant to this case are alleged to have occurred during the Registrant’s employment as a Dietitian by Croydon Health Services NHS Trust (“the Trust”). The Registrant was employed as a Dietitian by the Trust from 5 June 1992, and by the time of the allegations (June 2020 to June 2021) she was employed as a Band 7 practitioner as a Dietitian for the Community Learning Disability Team. She was the only Dietitian working in an integrated learning disability multidisciplinary team. The majority of her work was in the community, but one day a week she held a general dietetic clinic with the Dietetic Department

11. It is the HCPC’s case that from June 2020 complaints were made by members of the acute dietetic team about the quality of the Registrant’s dietetic assessments.

12. In November 2020, an informal capability process was commenced as it was considered by the Trust that significant and consistent improvements were required in the quality of the Registrant’s work. An action plan based on the Registrant’s job description was drafted and a Band 7 Community Dietitian was appointed as a mentor.

13. In March 2021, stage 1 of a formal capability process was commenced, and this continued until May 2021. At a reconvened meeting held on 21 May 2021, it was decided that the capability process would move to stage 2.

14. Both the informal process commenced in November 2020, and stage 1 of the formal process were overseen by Ms AT, who was the Professional Lead for Dietetics and a joint line manager of the Registrant. Ms AT left the employment of the Trust to take up another post with another organisation at the end of May 2021, and, therefore, from that time, ceased to be involved in the management of the Registrant. Dr NS, the Trust’s Operational Clinical Lead Dietitian and Professional Lead for Dietetics assumed responsibility for the continuation of the formal capability process.

15. On 27 July 2021, the Registrant resigned from her employment.

16. On 27 May 2021, after the decision was made that the formal capability process would move from stage 1 to stage 2, a referral to the HCPC concerning the Registrant was made by Ms AT on behalf of the Trust.

Decision on Facts

17. In reaching its decision on the facts the Panel has remembered throughout its deliberations that the HCPC carries the burden of proving the factual elements of the case, the standard of proof being the balance of probabilities.

18. The HCPC called three witnesses to give evidence before the Panel. They were Ms AT, Dr NS and Ms AM. The roles of Ms AT and Dr NS have already been described in the summary given of the Trust’s capability procedures. Ms AM was the Trust’s General Manager for the Integrated Community, Older People, Rehabilitation and Specialist Services Directorate. Her involvement in the matters relevant to the Panel’s enquiry is that she conducted the Trust’s investigation into the incident on 29 April 2021 that underpins particular 2.

19. The HCPC also provided to the Panel a substantial body of documentary exhibits.

20. Although the Registrant has not provided any evidence or information specifically for the purposes of this hearing, the Panel was nevertheless able to consider accounts she had previously given. In addition to her statements made in relation to her wish not to engage in these fitness to practise proceedings to which reference has already been made, the Panel was provided with additional information. The evidence relating to the Trust’s capability procedures included contemporaneous accounts given by the Registrant. Additionally, the Registrant’s explanations given with regard to the hoist incident on 29 April 2021 were included in the evidence considered by the Panel, as was her response sent to the HCPC on 7 January 2023, in the context of the Investigating Committee “case to answer” decision that was then to be made. The Panel has considered all of this information as it was clearly relevant to decisions that the Panel was required to make as to whether the HCPC had discharged the burden of proving the factual elements of the case.

21. In assessing the evidence presented to it, the Panel accepted the advice it received from the Legal Assessor, and, in particular, acknowledged that special care was needed in the assessment of hearsay evidence. As will be explained below, when the Panel reached its decision on particular 2, it had available to it only hearsay evidence. In accepting the hearsay evidence that is referred to in the explanation for the findings made, and particularly with regard to the incident that occurred on 29 April 2021, the Panel was satisfied that the hearsay evidence was sufficiently cogent to be relied upon.

Particular 1

22. The stem of particular 1 alleges that between 1 June 2020, and 24 June 2021, the Registrant, “failed adequately or at all to conduct and/or record dietetic assessments in respect of one or more Patients in Schedule 1”. With regard to each of the ten patients identified in Schedule 1, the complaint is advanced that there was, “Inadequate and/or incorrect calculation”. With regard to seven of those same patients, the complaint is made that there was, “Incomplete and/or inadequate information or justification”. With regard to Patient G and Patient J it is alleged that “Inappropriate advice” was given, and with regard to Patient F the complaint is made that there was “Incomplete follow up action”.

23. In view of the multiple permutations that the wording of particular 1 would permit, the only sensible way the Panel can decide the case is by first considering the individual Patients and only having done that addressing the stem allegation. In making its decisions with regard to the individual patients, the Panel has been careful to only make findings that can properly and fairly be said to fall within the specific allegations articulated with regard to them. By way of example, the evidence the Panel received with regard to Patient B was that the Registrant had recorded an incorrect date of birth and incorrect NHS number. As the sole complaint made with regard to Patient B related to the issue of calculation, the Panel did not consider it appropriate to include in its findings these alleged errors.

24. Patient A. The Panel was satisfied that the Registrant had not correctly calculated the patient’s nutritional requirements, but continued with a regime that had been prescribed when the patient had been a child despite the fact that by the time of the Registrant’s intervention, he had become an adult.

25. Patient B. With regard to this patient, there was no updated calculation justifying the current feeding regimen recorded by the Registrant on 22 April 2021. The oral diet and enteral feeding recorded exceeded the nutritional requirements for the patient, who had gained approximately 4kg in weight in the period of approximately a year.

26. Patient C. The calculation undertaken by the Registrant was incorrect. In calculating that the contribution to the patient’s feed of Prosource would be 336kcal, whereas in fact it would contribute 88kcal. Alongside incorrect core feed calculations, the Registrant recorded a feed total energy content of 1274kcal, whereas the actual figure is 853kcal. The patient was therefore being underfed. The patient had lost weight of approximately 11 kgs in approximately 2 years.

27. Patient D. The Registrant’s Home Enteral Feeding Regime document prepared on 5 March 2021, included both an incorrect calculation of the patient’s nutritional requirements, and a prescription of feeding that exceeded the requirements that the incorrect calculation suggested and was not justified.

28. Patient E. The prescription included Prosource. For that to be prescribed long term within a community enteral feed prescription, a justification would be required, but none was given by the Registrant with regard to this patient. In addition she had not calculated protein requirements.

29. Patient F. With regard to this patient the Registrant recorded a Malnutrition Universal Screening Tool (MUST) score of “0-2”. It could not properly be a range as 0 means low risk of malnutrition and 2 means high risk of malnutrition. In fact, the score for this patient should have been 0. Further, the referral of this patient is recorded as having been, “Unintentional and rapid weight loss”, whereas the recorded weights disclosed no weight loss in the year preceding the appointment, indeed, the patient’s weight is recorded as having increased in the period leading to the Registrant’s assessment. There was a failure to follow-up appropriately because the Registrant did not communicate with the referrer the erroneous assumption that had led to the referral. Given the discrepancy between the referral and the represented position about the patient’s weight there was inadequate information in the letter.

30. Patient G. This patient was one who was at risk of malnutrition, but there was no MUST score calculated by the Registrant. The patient suffered from Parkinson’s disease and the referral was an urgent one made by a Speech and Language Therapist who stated that an International Dysphagia Diet Standard Initiative (IDDSI) “idds 2 thickened diet” had been recommended. Yet the Registrant did not mention dysphagia in the record of her assessment or include prescribed texture modification in her advice.

31. Patient H. In an appointment on 7 August 2020, the Registrant recorded the patient’s feeding regimen dated November 2019 as fine, but had not undertaken a re-calculation of the nutritional requirements. Further, at this time the patient was still using the specialist supplement, Prosource, yet there was no justification for its continued inclusion.

32. Patient I. When the Registrant saw this patient on 21 February 2021, they had gained weight, and their feeding regime remained as prescribed in November 2019. She should have, but did not calculate nutritional requirements, nor did she refer to the patient’s weight gain.
33. Patient J. With regard to this patient, the percentage calculation of weight loss undertaken by the Registrant was incorrect. The Registrant did not give the justification that would have been required to change the supplement that had been prescribed on discharge from hospital and advice to change her prescription was inappropriate.

34. Particular 1 – stem. In the light of the specific findings in relation to Patients A to J inclusive, the Panel finds that the HCPC has discharged the burden of proving that the Registrant failed adequately to conduct and record dietetic assessments.

Particular 2

35. Particular 2 concerns an incident that occurred on 29 April 2021. Service User A was due to attend a clinic appointment at approximately 2:30pm that day. It was intended by the Registrant that he should be weighed during the appointment, and that a hoist would be used for that purpose. At approximately midday there was a telephone conversation between the Registrant and Service User A’s mother, the terms of which will be further described below. To set the scene it is contended that during this conversation, the Registrant was informed that Service User A would be attending the appointment in a wheelchair that had been provided to him on a temporary basis as his usual wheelchair was being repaired. It is also contended that Service User A’s mother was informed by the Registrant that she (the Registrant) did not know how to use the hoist at the clinic premises. When the hoist was used, it malfunctioned and Service User A became stuck in it for 10-15 minutes off the ground.

36. It is the HCPC’s case that Service User A’s mother was instructed by the Registrant to operate the hoist, the latter being unfamiliar with the use of it. It is also the HCPC’s case that the Registrant neither sought the assistance of a member of the Trust’s staff suitably trained in the use of the hoist, nor did she consider an alternative means of confirming the weight of Service User A. Finally, the HCPC alleges that, the hoist having failed, the Registrant did not complete an incident report either at all or in a timely manner.

37. The only oral evidence the Panel received about this incident was that given by Ms AM. She conducted an investigation into the incident and could not give direct evidence about what had or had not occurred on the day. It follows that to reach its decision the Panel has had to have regard to hearsay evidence. That evidence came from three sources:
• An account given by Service User A’s mother in an email dated 8 May 2021.
• An account given by the Registrant in an email dated 13 May 2021.
• A written account given by Ms JW, Operational Clinical Lead – Learning Disabilities.

38. In her email dated 8 May 2021, Service User A’s mother wrote that in the telephone call that preceded her attendance with her son at the clinic, the Registrant said, “I don’t know how to do this hoist so you will have to do it yourself.”

39. In the email she sent on 13 May 2021, the Registrant wrote, “…. when [Service User A’s mother] came into the physiotherapy room I reminded her that I did not know how to use the hoist.” Included in her learnings that the Registrant described as a result of the incident, the Registrant wrote, “Not informing [Ms JW] on the day or the next day. I was not able to complete a Datix on the 29th as I was not able to find the appropriate codes, however it was my intention to do so as soon as possible…….. However going forward I will ensure that regardless of the circumstances that I inform my line manager promptly.”

40. In the document she prepared, Ms JW described that at approximately 2:30pm on the day following the incident, she overheard the Registrant discussing the incident with a Physiotherapy Technician in a non-confidential area. She requested that they accompany her to a private room where she requested further information. She wrote this: “Once in the room I requested further information from [the Registrant] about the incident. [The Registrant] advised me that she had a planned visit with [Service User A] who was accompanied by his mother and the carer. [The Registrant] advised me that [Service User A] was using a temporary wheelchair and because it was a temporary wheel chair she didn’t know the weight of the chair prior to the appointment and had been informed of this by the client’s mother when booking the appointment. [The Registrant] stated that [Service User A] would need to be hoisted out of the wheelchair before being weighed. I had to prompt for information because I needed to understand why the client needed to be removed from the wheelchair and the rationale for using wheelchair scales. PS stated that as she did not know how to use the hoist and that she had requested that the Mother of the client would have to use the hoist for lifting client [Service User A]. …….. I asked why this had not been reported to me and [the Registrant] could not answer. ……… I advised [the Registrant] to complete a Datix which she agreed to do.”

41. On the basis of the evidence described, the Panel found the following facts to be proven on the balance of probabilities:
• That the Registrant was unfamiliar with the operation of the hoist, and that, for that reason, she instructed Service User A’s mother to use it.
• That the operation of the hoist by Service User A’s mother placed Service User A at the risk of harm.
• Before instructing Service User A’s mother to operate the hoist, the Registrant did not seek the assistance of a suitably trained member of staff, there being such people employed by the Trust.
• From the facts that she acted as she did in instructing Service User A’s mother to operate the hoist and has at no stage suggested that she did consider doing so, the Panel was satisfied that the Registrant did not consider an alternative means of obtaining the weight of Service User A.
• It is clear from the documents provided to the Panel that Datix report number 8908 in respect of the incident was in fact created. The Panel has not been shown a copy of it, nor has it received any evidence as to who made it or when it was made. It is, however, clear from the account provided by Ms JW referred to above, that 24 hours after the incident, no incident report (whether by Datix or otherwise) had been made by the Registrant at that stage. In the judgement of the Panel a report of an incident of this nature was required to be made very promptly, and certainly well before the time when Ms JW advised the Registrant to complete a Datix report. It follows that the Panel finds that the Registrant failed to complete an incident report in a timely manner.

42. The consequence of the findings set out in the preceding paragraph is that each element of particular 2 is proven.

Decision on statutory grounds

43. After the Presenting Officer had an opportunity to read the Panel’s written determination explaining its findings on the factual elements of the case, she made her submissions on the statutory grounds.

44. The Presenting Officer acknowledged that the decision to be made was one for the Panel’s discretion, there being no burden or standard of proof to be applied in relation to the decision. Acknowledging that it is alleged that the factual elements amounted to “misconduct and/or lack of competence”, it was submitted that the HCPC’s case is that the proven facts, when viewed individually and collectively, should give rise to a finding of misconduct. However, it was submitted that if the Panel did not find misconduct, then the HCPC would seek a finding of lack of competence.

45. The Presenting Officer submitted that the Registrant’s actions fell far below the standards of what would be proper in the circumstances. She submitted that they constituted breaches of the HCPC’s Standards of conduct, performance and ethics, and she referred the Panel to specific standards that are included in the standards identified when the Panel explains its decision below. She submitted that not only were service users put at risk of harm, but that actual harm was caused. When asked by the Panel to elaborate on the submission that actual harm was caused, the Presenting Officer submitted that the Panel’s factual findings involved examples of service users experiencing either loss of, or gain in, weight. In all the circumstances, it was submitted, the threshold had been reached in the present case for a finding of misconduct properly to be made.

46. The Panel accepted the advice of the Legal Assessor. The advice was that misconduct could include complaints of a clinical nature if incompetence or negligence of a high degree was established. For misconduct to be established it would be necessary for the Panel to conclude that any falling short on the part of the Registrant represented serious failings. The Panel should start by addressing the issue of misconduct and only consider lack of competence in the event that it concluded that some or all of the proven particulars should not be included in a finding of misconduct.

47. The Panel began its deliberations by assessing whether the Registrant’s actions as reflected by the findings of fact meant that she breached standards to which she was required to adhere. The Panel concluded that she had breached the following elements of the HCPC’s Standards of conduct, performance and ethics in force between January 2016 and September 2024:

• Standard 3. The clinic intervention with Service User A on 29 April 2021, and, in particular, instructing the service user’s mother to operate the hoist, involved the Registrant working outside the limits of her knowledge and skills.
• Standard 6. The Registrant did not manage risk. Specifically, standard 6.1, which required her to take all reasonable steps to reduce the risk of harm to service users, so far as possible, was breached with regard to all of the patients identified in Schedule 1 and with regard to Service User A. Standard 6.2, which required the Registrant not to allow someone else to do anything that could put the health or safety of a service user at unacceptable risk, was breached by instructing Service User A’s mother to operate the hoist.
• Standard 7. In failing to complete a timely Datix report, the Registrant breached standard 7.1, which required her to report concerns about the safety or well-being of a service user promptly and appropriately.
• Standard 8. The Registrant’s inactions following the hoist incident breached standard 8.1.
• Standard 10. The findings made in relation to Schedule 1 necessarily involve a finding that the Registrant’s records were not full, clear or accurate, and for that reason standard 10.1 was breached. The failure to compete the Datix report promptly constituted a breach of standard 10.2.

48. Acknowledging that a finding of breaches of standards should not automatically result in a finding that a statutory ground is made out, the Panel then went on to reach a decision about the seriousness of the failings it had identified.

49. The Registrant was a Dietitian of long-standing and, being in a Band 7 post, was working at a senior level. The Panel is satisfied that the seriousness of the shortcomings it has identified are to be assessed by reference to the standard to which she should have been working as a Band 7 practitioner. There is a sense in which all service users are vulnerable simply by virtue of the fact that they are under the care of a health professional, but it should also be noted that many of the service users under the care of the Registrant, being people with learning disabilities, often requiring enteral feeding, were especially vulnerable.

50. In the judgement of the Panel, the patients and service user referred to in the allegations were placed at risk of harm. The risks were of different types. A direct risk to the patients arose from the absence of, or incorrect, calculations of nutritional requirements, or ignoring other important recommendations. Incorrect feeding prescriptions will result in sub-optimal nutrition, and that in turn will increase the risk of health problems. Two examples of this will suffice. Patient A had a Body Mass Index of less than 18, and for that reason was acutely vulnerable. Yet the Registrant’s prescription for Patient A was incorrect. Patient G was the subject of an urgent referral by a Speech and Language Therapist who referred to the texture modification already described by the Panel. The Registrant’s prescription for Patient G did not reflect the prescription made by the Speech and Language Therapist. Another, less direct but nevertheless important respect in which harm can be caused is demonstrated by the reaction of Service User A’s mother to the hoist incident, who expressed an unwillingness to return to that clinic. If service users do not receive the standard of care they are entitled to expect from all practitioners, it will reduce their confidence that they can expect to be treated competently by any member of the relevant profession, and that is something that can obviously adversely impact on their long-term well-being.

51. It has already been stated that the Presenting Officer submitted that the Registrant’s actions not only gave rise to the risk of harm, but also actually caused harm as a result of patients either gaining or losing weight. Although the Panel does not make a positive finding that harm was not caused to patients, on the evidence that was presented to it, it does not feel able to conclude that harm was actually caused. This is because of the evidence it received represented “snapshots” of the Registrant’s interventions with patients. She did not prescribe appropriately for patients who presented having either gained or lost weight previously, and that failure obviously gives rise to a very real risk that the unintended weight gain or loss experienced to the date of the appointment will not be addressed. However, to make a positive finding that harm was caused, it would be necessary to receive evidence representing interactions involving the Registrant extending over a period of time, rather than the more limited “snapshot” evidence presented to the Panel.

52. In the judgement of the Panel, the Registrant’s performance would represent an unacceptable level of performance for a Dietitian working at any level, let alone for one working at Band 7. It was, quite simply, unacceptable performance over a significant period of time. In the judgement of the Panel the findings of fact made by the Panel are properly to be described as misconduct.

53. In view of the fact that the Panel finds that all of the proven facts should be included in the finding of misconduct, it has been neither appropriate nor necessary for the Panel to consider the issue of lack of competence.
Decision on impairment of fitness to practise

54. After the Presenting Officer considered the Panel’s written determination explaining why it had decided that the proven facts amounted to misconduct, she made submissions on current impairment of fitness to practise.

55. The Presenting Officer reminded the Panel that a burden and standard of proof was not to be applied to the decision to be made. She submitted that in reaching its decision the Panel should have regard to the three overarching objectives of the HCPC, namely, the protection, promotion and maintenance of the health, safety and well-being of the public, the promotion and maintenance of public confidence in the regulated professions and the maintenance of proper professional standards and conduct observed by the members of those professions. The Presenting Officer drew the Panel’s attention to the three questions set out in paragraph 13 of the HCPTS Practice Note entitled, “Fitness to Practise Impairment” dated August 2025 which had been derived from the Fifth Shipman Inquiry Report, and submitted that if the Panel answered those questions, it should decide that the Registrant has acted in the past and is liable to act in the future so as to put service users at an unwarranted risk of harm, that the Registrant has in the past breached a fundamental tenet of her profession, and is liable to do so in the future, and that it is likely that the Registrant’s conduct will be repeated.

56. The Presenting Officer submitted that when the Registrant resigned from her post with the Trust in 2021, the evidence received by the Panel clearly demonstrated that she was not competent to practise, and the passage of four years since that resignation with no evidence of remedial steps having been taken by the Registrant would mean that her knowledge and skills are likely to have deteriorated further. She submitted that the Panel’s findings represented significant departures from acceptable standards for a practitioner working at any level of qualification, let alone for one working at Band 7. The Presenting Officer also submitted that the absence of insight, and the fact that there was no evidence that the Registrant had sought to remediate her shortcomings, meant that there is a high risk of repetition. That being so, the HCPC invited the Panel to conclude that in respect of the personal component, the Registrant’s fitness to practise is still impaired. The Presenting Officer also submitted that when the three factors relevant to the public component were considered, the Panel should conclude that a finding of current impairment of fitness to practise should be made to satisfy that element; service users required protection, and both the declaration of proper professional standards and the need to ensure continued public confidence in the profession of Dietitian necessitated such a finding.

57. The Panel sought and accepted the advice of the Legal Assessor, and accordingly in reaching its decision closely followed the guidance contained in the HCPTS Fitness to Practise, Practice Note.

58. The Panel began, as suggested by the Practice Note, by assessing the seriousness of the findings it had made, and also seeking to identify any mitigating factors.

59. The Panel did not identify any mitigating factors. There was no meaningful insight made by the Registrant; the evidence considered by the Panel was that her reaction to the feedback during the Trust’s capability process had not been positive, she had been defensive, failed to make an apology and, in the representations made to the Investigating Committee, sought to deflect responsibility for shortcomings which were her personal responsibilities. The Registrant has denied the allegations made against her, as she was entitled to, but given her denial it is unsurprising that she has neither expressed remorse for her actions, nor has she suggested that she has even attempted to take steps to address the identified shortcomings, let alone succeeded in remedying them.

60. In relation to the seriousness of the findings made, the Panel does not intend to repeat at this stage what has already been stated in this determination, particularly in relation to the finding of misconduct. It is sufficient to record that:
• The findings demonstrate very significant departures from the standard of professional conduct and standards for a dietetic practitioner at any level. The fact that the Registrant was working at Band 7 means that they were all the more serious.

• The departures continued and were repeated over a significant period of time. Furthermore, they were repeated at a time when the Registrant was subject to a capability process and receiving significant support.

• The service users involved included those who were acutely vulnerable.

• The Registrant’s actions created the risk of harm, and, in the case of Service User A, actual harm.

• No meaningful insight has been shown.

• There has been no remediation and there would be a high risk of repetition were the Registrant to be permitted to return to practise as a Dietitian.

61. When the Panel answered the questions posed in paragraph 13 of the Practice Note, its answers were that the Registrant:
• has acted in the past, and is liable to act in the future, so as to put service users at an unwarranted risk of harm;
• has in the past breached a fundamental tenet of her profession, and is liable to do so in the future: and,
• is likely to repeat the conduct found proved by the Panel.

62. In the light of these findings the Panel has concluded that it is necessary to find that the Registrant’s fitness to practise is impaired in respect of the personal component. So serious are the findings of past misconduct, a finding of current impairment of fitness to practise would be required to declare proper professional standards and to maintain public confidence even were there not the additional factor that the risk of repetition means that there is a need to protect the public from the risk of future harm. The fact that there is that risk makes the finding of current impairment of fitness to practise in respect of the public component all the more necessary.

63. The finding that the Registrant’s fitness to practise is currently impaired means that the Panel must go on to consider the issue of sanction.

Decision on sanction

64. In her submissions on sanction, the Presenting Officer submitted that it would be for the Panel to say what, if any, sanction is required. Her submissions would be intended to highlight what the HCPC would submit are relevant considerations to be applied to that decision. The Presenting Officer submitted that with regard to mitigating factors, the Panel might wish to consider two factors, one being that the events occurred during the period of the COVID-19 pandemic, the other being that during her involvement in the Trust capability process, although there was some pushback by the Registrant, there was some acknowledgement on her part that she needed extra support. With regard to aggravating factors, the Presenting Officer mentioned the factors already identified by the Panel in its decision on impairment of fitness to practise, and in addition to those previously identified matters, referred to the absence of apology. The Presenting Officer submitted that the Panel should follow the guidance provided by the HCPC’s Sanctions Policy, and she took the Panel to various elements of that document. She submitted that to take no action and the option of a caution order would not be appropriate. The Presenting Officer also submitted that it would be unlikely that the Panel would consider a conditions of practice order would be appropriate. In drawing the Panel’s attention to the terms of paragraph 121 of the Sanctions Policy, and the suggested circumstances that would justify the imposition of a suspension order, the Presenting Officer submitted that if the Panel concluded that a suspension should not be imposed, then a striking off order would be both appropriate and proportionate.

65. The Panel accepted the advice it received from the Legal Assessor. Accordingly, it acknowledged that a sanction should not be imposed to punish the Registrant for the findings made. A sanction should only be imposed to the extent that it is required to meet the proper aims of a sanction, namely, to protect the public, to maintain a proper degree of public confidence in the Dietetic profession as well as the declaration of proper professional standards. To ensure that this principle is applied, the Panel is required initially to decide if the decision it has made on the allegation requires the imposition of any sanction. If a sanction is required, then the available sanctions are to be considered in an ascending order of seriousness until one is reached that sufficiently addresses the proper sanction aims just described. As the finding in the present case is one of misconduct, the entire sanction range up to, and including, striking off is available to be considered. In reaching its decision the Panel should follow the guidance provided by the HCPC’s Sanctions Policy, acknowledging that if it is considered necessary to depart from the guidance provided by that document, clear reasons should be provided for doing so. The Panel confirms that in reaching its decision on sanction it has applied the principles just described.

66. When it began its deliberations, the Panel addressed the issue of the mitigating and aggravating factors. It is not necessary for the Panel to repeat here what has already been stated at paragraphs 59 and 60 above. In relation to the Presenting Officer’s submissions on mitigating factors, the Panel acknowledges that the relevant events occurred during the COVID-19 pandemic, but it does not consider that any difficulties arising from altered working during that period explains, still less excuses, the seriousness of the basic failings identified in the Registrant’s practice. With regard to the Registrant’s engagement in the Trust’s capability process, the Panel acknowledges that there was some engagement, but, on the evidence received by the Panel, her engagement was less than whole-hearted, and it is necessary to state that it was not successful in bringing about a significant improvement in the Registrant’s performance.

67. So far as aggravating factors are concerned, the Presenting Officer was correct in identifying a lack of apology as a relevant factor. Furthermore, it is necessary for the Panel to state that its finding in relation to particular 2(d), engaging standard 7.1 of the HCPC’s Standards of conduct, performance and ethics as it does, is identified as an example of a “serious case” by paragraph 59 of the Sanctions Policy.

68. The Panel identified the particularly important factors that would determine the sanction that should be imposed. These factors were:

• The failings were serious. Every one of the service users involved, many of whom were particularly vulnerable, were exposed to a real risk of harm.
• The failings continued over a period of time, and, so far as those relating to particular 1 were concerned, were repeated.
• The repeated particular 1 failings occurred, and the single event reflected in particular 2 also occurred, during the Trust’s capability process.
• The repeated nature of the serious failings gives rise to a very significant risk of repetition.
• If the matters were to be repeated, there would be the same risk of harm to future service users that service users referred to in the allegation were exposed to.
• There was no significant improvement in the Registrant’s performance despite the Trust’s capability process.
• It is now more than four years since the Registrant resigned from her post with the Trust, and there is no suggestion that she has any intention of addressing the shortcomings that were apparent during the period of her employment.

69. In view of the factors just described, the Panel is of the view that to conclude the case without imposing any sanction, or to impose a caution order, would not provide any protection for the public against the risks presented by the Registrant repeating behaviour of the sort established. They were therefore rejected.

70. Similarly, the Panel rejected a conditions of practice order. The Registrant’s lack of insight into her shortcomings means that it would not be an appropriate disposal. The fact that the Trust’s capability process did not result in a significant improvement in performance does not encourage the Panel in thinking that any conditions could be formulated that would provide a sufficient degree of protection, and even if such conditions could be formulated, the lack of engagement in this process means that there could be no confidence that the Registrant would comply with them.

71. The Panel next considered a suspension order, and in doing so had regard to paragraph 121 of the Sanctions Policy, which is in these terms:
‘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; and
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.’

72. The findings in this case do indeed represent a serious breach of the Standards of conduct, performance and ethics, but that apart, the features of the present case do not meet the factors suggested in paragraph 121. The Registrant does not have insight, the issues are likely to be repeated and there is no evidence that the Registrant would be likely to be able to resolve or remedy her failings. This meant that the Panel had to go on to consider whether a striking off order should be made.

73. In considering a striking off order, the Panel paid close attention to the guidance contained in the Sanctions Policy, and it fully recognised the seriousness of the imposition of such an order. Nevertheless, in the present case the Panel has concluded that no lesser sanction would be appropriate. It is important that the Panel should make clear that it is not of the view that findings of the type made in the present case could only result in a striking off order. What makes a striking off order necessary in the present case is the combination of the real risk of repetition and harm resulting from repetition, and the complete absence of any grounds for believing that the Registrant would take any action to reduce those risks in the future. For those reasons, the Panel is satisfied that a striking off order represents the necessary and proportionate response.

The Registrar is directed to strike the name of Parul Shah from the Register on the date 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 Application

1. After the Panel announced its decision that the substantive sanction would be that of a striking off order, the Presenting Officer applied for an interim suspension order to cover the appeal period. She submitted that the Panel’s decision made in relation to the substantive issues resulted in an interim order being necessary for protection of members of the public and being otherwise in the public interest.

2. There were no submissions by or on behalf of the Registrant on this issue.

Decision

3. The Panel accepted the advice it received in relation to the application. It also had regard to the section entitled, “Interim orders” between paragraphs 133 and 135 of the Sanctions Policy and the HCPTS Practice Note entitled, “Interim Orders”. Accordingly, it was first required to decide whether it had jurisdiction to consider the application. If satisfied that it had jurisdiction, it must then decide whether the application should be decided in the absence of the Registrant. If the issue should be decided in the absence of the Registrant, the Panel must then consider whether there are risks that satisfied one or more of the three grounds that could justify the making of an interim order. Those grounds are, (i) that it is necessary for protection of members of the public, (ii) that it is otherwise in the public interest, and (iii) that it is in the interests of the registrant concerned. Furthermore, it is necessary to remember that the default position established by the legislation governing this process is that when a substantive sanction is imposed, there will be no restriction on a registrant’s ability to practise while their appeal rights remain extant. Accordingly, something more than the fact that a substantive sanction has been imposed is required to justify the making of an interim order. The Panel confirms that it has followed this approach.

4. Included in the notice of hearing email sent to the Registrant on 25 June 2025, was the following paragraph statement: “Please note that if the Panel finds that it is necessary to do so, it may also impose an interim order (under Article 31 of the Health Professions Order 2001) at any stage during the hearing. An interim order suspends or restricts a registrant’s right to practise with immediate effect.” The Panel concluded that this afforded the Registrant the opportunity of making representations on the issue of whether an interim order should be made, and for that reason provided jurisdiction for the application to be considered by the Panel.

5. The Panel was satisfied that it was appropriate to decide the application in the absence of the Registrant; when such an application is made there is necessarily a degree of urgency in deciding the matter, the Registrant was informed in the notice of hearing that such an application might be made and there is no reason to believe that the Registrant would wish to be heard on the matter if the Panel did not deal with it at the present time.

6. Whilst acknowledging the default position that there is no restriction on a registrant’s ability to practise while their appeal rights remain outstanding, the Panel concluded that in the present case, an interim order is required. It is necessary for protection of members of the public and it is otherwise in the public interest for the same reasons explained by the Panel in its substantive sanction decision.

7. The Panel considered whether interim conditions of practice would be a sufficient restriction during the appeal period, but concluded that, for the same reasons a substantive conditions of practice order was not appropriate, interim conditions of practice would not provide sufficient protection.

8. The Panel therefore concluded that an interim suspension order should be made.

9. The Panel decided that the interim suspension order should be for the maximum period of 18 months. An order of that length is necessary because the final resolution of an appeal could well take 18 months if the Registrant appeals the Panel’s decision and Order. In the event that the Registrant does not appeal the decision and Order, the interim order will simply fall away when the time within which she could have commenced an appeal passes.

Interim 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) upon the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Parul Shah